Meta-Analysis of MFT Interventions

Article excerpt

This article briefly reviews 20 meta-analyses of marital and family interventions. These meta-analyses support the efficacy of both MFT for distressed couples, and marital and family enrichment. Those effects are slightly reduced at follow-up, but still significant. Differences among kinds of marital and family interventions tend to be small. MFT produce clinically significant results in 40-50% of those treated, but the effects of MFT in clinically representative settings have not been much studied. The article also introduces the concept of meta-analytically supported treatments (MASTs), which are treatments that meet certain criteria for efficacy in meta-analysis, and which remedy certain problems in the empirically supported treatment (EST) literature. The article concludes with recommendations for doing better meta-analyses.

Moses Herzog, the fictional academic whose moniker is the title for Saul Bellow's (1964) novel, once said "What this country needs is a good five-cent synthesis" (p. 207). Well, we are pleased to report that we are halfway toward that goal. In meta-analysis, we do indeed have a good methodology for the synthesis of scientific results. Unfortunately, as we will see later in this chapter, doing meta-analysis nowadays costs a lot more than just five cents.

The development and widespread use of meta-analysis is significant to both researcher and clinician in marriage and family interventions. Researchers benefit from a statistical tool that can be used to summarize the increasingly large research literature on such interventions, and which points to gaps in the literature that future research should address. Clinicians benefit in three ways: first in getting evidence they can show to third-party payers that the work they do is effective, second in having a practical way to inform themselves about the effectiveness and efficacy of marriage and family interventions, and third in a host of specific conclusions that may help them in choosing treatments proven to be effective for different problems. These uses resemble the movement in medicine and public health toward evidence-based medicine, a good model from which to view the meta-analytic literature.

This chapter has the following structure. First, we provide a brief history of meta-analysis, and summarize the key statistical feature of meta-analysis-the effect size. The latter material can be skipped by those with little interest in the methodology of meta-analysis. Second, we describe 20 meta-analyses that have already been done on the effects of both therapy and enrichment interventions with couples and families. In this second section, we summarize the overall results of these 20 meta-analyses, and then present more detailed discussions of the effects of different kinds of marriage and family interventions, the effects of marriage and family interventions compared to other kinds of intervention such as individual therapy, the clinical significance of these effects, the clinical representativeness of this research, and some intriguing findings about variables that may influence how effective marriage and family interventions may be. Also in this second section, we present the idea of Meta-Analytically Supported Treatments (MASTs); that is, treatments that have been shown to be effective in meta-analytic work. Third, we review methodological problems in this research, and offer a set of suggestions for improving future meta-analyses in this area. Fourth, we present evidence about the costs of meta-analytic research, and review possible funding sources.

META-ANALYSIS

A Brief History of Meta-Analysis

If you have been around long enough as a researcher, you have seen many innovations occur. Some of those innovations are passing fads, some are interim developments until something better comes along, and some become a minor but permanent feature of the scientific landscape. Occasionally, however, an innovation changes the very landscape of the field. …