The Efficacy of Marital and Family Therapy: An Empirical Overview, Conclusions, and Recommendations

Article excerpt

To meet the challenge of providing effective mental health services, health care professionals need valid and reliable scientific data about the costs and the effectiveness of the treatments they offer. The primary purpose of this article is to provide an overview of the state of scientific knowledge about the efficacy of marital and family therapy for a variety of mental disorders and problems. Unfortunately, due to the paucity of available information, a review of the costs and cost effectiveness of marital and family therapies is impossible. Data on costs and cost effectiveness are just beginning to emerge. This article also presents a set of conclusions about the current state of empirical knowledge about the effectiveness of family therapy and a set of recommendations for future research.

A number of writers differentiate psychotherapeutic efficacy and effectiveness (Shadish, Ragsdale, Glaser, & Montgomery, 1995; Starfield, 1977). Efficacy refers to the effects of psychotherapy in controlled clinical trials conducted under specified conditions, usually in a university or hospital laboratory or clinic setting. Weisz, Weiss, and Donenberg (1992) call this "research therapy." Effectiveness applies to the effects of "clinic therapy" conducted "in the field," in the "normal" circumstances in which most therapies are provided. Most of the research cited in this selective overview pertains to efficacy, and this term will be used predominantly throughout the article.

What is marital and family therapy (MFT)? For the purposes of the articles in this Special Issue of the Journal of Marital and Family Therapy, family therapy is pragmatically defined as any psychotherapy that directly involves family members in addition to an index patient and/or explicitly attends to the interaction among family members. Marital therapy, a subclass of family therapy, directly involves both spouses and/or explicitly attends to their interaction.

THE STATE OF KNOWLEDGE ABOUT THE EFFICACY OF MFT

This overview of the state of knowledge about the efficacy of marital and family therapy derives primarily from the review articles that comprise this Special Issue of IMFT. We begin with a quantitative overview from the meta-analysis of Shadish et al. (1995). We then review the efficacy data for marital and family therapy for major mental illnesses, summarizing the findings of Goldstein and Miklowitz (1995) for schizophrenic disorders and Prince and Jacobson (1995) for affective disorders. Next we consider the data for disorders of childhood (Estrada & Pinsof, 1995) and adolescence (Chamberlain & Rosicky, 1995) and then move to the treatment of marital conflict and divorce prevention (Bray & Jouriles, 1995). At that point we turn to the efficacy data for treating alcohol (Edwards & Steinglass, 1995) and drug abuse (Liddle & Dakof, 1995), concluding with an examination of the efficacy data for treating physical illnesses (Campbell & Patterson, 1995).

Although these articles and this overview probably provide the most comprehensive empirical look at the research on family therapy outcome available to date, they are neither definitive nor totally comprehensive. The methodological shortcomings of the available literature are addressed at the conclusion of this article. In addition, substantial areas in which MFT is widely used, such as sex therapy, spousal and child abuse, and nonspecific marital disorders, are not included in this issue or this overview because they lack sufficient research or definition at this time to enable us to draw conclusions about efficacy.

An Overview from Meta-Analysis

There have been three major meta-analyses of marital and family therapy. Hahlweg and Markman (1988) focused exclusively on behavioral marital therapies, and Hazelrigg, Cooper, and Borduin (1987) examined a limited number of family therapy studies over just three dependent variables. The Shadish et al. …