The goals of this Phase I project are to (1) develop and pilot test a 20- week Relational Psychotherapy Parenting Group (RPPG) for opioid addicted mothers, and (2) to develop and refine a therapist training manual, and therapist competence/adherence rating scales, for this therapeutic intervention. Opioid addicted mothers of minor children have complex treatment needs related both to their high levels of comorbid psychopathology, and to a range of deficits in parenting skills. Although several treatment programs have recently been developed specifically for addicted women and mothers, relatively few systematically offer psychotherapeutic services and parenting skills training. In cases where such services are offered, the lack of documentation and manualization of interventions limits the feasibility of training/dissemination. Development of the RPPG intervention is based on principles and techniques of interpersonal Therapy (IPT), interactional group therapy, and gender sensitive perspectives on treatment for women. Rather than attempting to 'educate' women about parenting issues via didactic, psychoeducational lectures (the norm in many current programs), parenting skills training will be offered within the context of supportive psychotherapeutic interventions that are sensitive to the patients' needs as women and as mothers. A preliminary attempt to test this approach over four weeks met with a positive response. Participants attended the groups regularly, and strongly endorsed the usefulness and desirability of such an intervention. In the proposed study, the RPPG intervention will be piloted in two sites: a standard methadone maintenance program involving both males and females, and one targeted specifically at women. Following a 'pre-pilot' intervention that will guide initial development of the manual, rating scales, and training materials, two pilot interventions will be conducted in sequence at each of the two sites, with four concurrent pilot comparison groups involving the treatment typically offered at each clinic. These sequentially implemented interventions will guide ongoing refinements of training materials and therapist adherence/competence rating scales. Multi-informant and multi-trait pre- and post-assessments will be made to assess areas potentially modifiable with the RPPG treatment. Based on these efforts, at the end of a three-year period, we anticipate having the methods and pilot data to support a more extensive randomized efficacy trial of the RPPG intervention, that we anticipate will not only directly benefit opioid addicted mothers, but also, will indirectly help their minor children.
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