THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

PROLIFIC WRITERS IN MARITAL AND FAMILY THERAPY: A RESEARCH NOTE

Success and promotion within an academic setting depends heavily upon one's ability to publishscholarly work. The "publish or perish" syndrome, and how it relates to marital and family therapy, is of importance to current and aspiring academicians' futures as well as those who wish to impact the field. Research was conducted to identify the most prolific journal writers in the field, and 18 persons were surveyed in order to ascertain how they organized themselves personally and professionally, in order to write productively. The results are analyzed, and recommendations are made regarding the organization of oneself for publishing success.     

AN EXPERIENTIAL APPROACH TO FAMILY-OF-ORIGIN WORK WITH MARITAL AND FAMILY THERAPY TRAINEES

An experiential approach to family-of-origin work with marital and family therapy students is offered as a complement to didactic study. Recommendations are made for structuring courses to include family-of-origin work without blurring the roles of instructor and therapist.     

THE NATIONAL MARITAL AND FAMILY THERAPY EXAMINATION PROGRAM

Examinations constitute one of the principal methods by which professions assess minimal competence in aspiring practitioners. The Examination in Marital and Family Therapy is used by most states which regulate the profession. This article provides the rationale for the examination program, describes its development and maintenance, and presents the knowledge base it samples. Administrative policies and procedures are also discussed as an aid to prospective licensure and certification candidates.     

THE USE OF INTERACTIVE VIDEO TO DEMONSTRATE DIFFERENTIAL APPROACHES TO MARITAL AND FAMILY THERAPY

This article outlines the development of an interactive video system designed to demonstrate differential approaches to family therapy using identical therapy situations. The primary purpose of the project is to resolve some of the confusion many novice family therapists experience while being exposed to the numerous family therapy approaches. Technical aspects of the interactive video system are also outlined.     

AGING AND FAMILY THERAPY: PREVALENCE OF AGING ISSUES AND LATER FAMILY LIFE CONCERNS IN MARITAL AND FAMILY THERAPY LITERATURE (1986-1993)

To what extent are gerontological issues addressed in the marital and family literature? In answering this question, the authors conducted a content analysis of 873 articles published in the Journal of Marital Family Therapy, Family Process, Family Systems Medicine, and the Journal of Family Psychology during an 8-year period beginning in 1986. Only 3.2% (n = 28) of these articles contained explicit emphasis on aging issues and later life family concerns. Furthermore, there was no significant trend in the number of gerontologically focused articles published during this period. The paper describes the content of the 28 aging-focused articles, including the types of presenting problems mentioned, the relational contexts of these problems, and the types of family therapy theories represented. Included in the content analysis were the proceedings of the annual national conferences of the American Association of Marital and Family Therapy from 1986 to 1993. Only 2.3% (n = 37) of the regular conference sessions had an explicit aging focus, as did 1 of the 29 plenary sessions and 1 of the 40 Master Series® sessions. Used as a gauge of gerontological interest and awareness of late life issues, the implication of these findings is that the family therapy community is still engaged in “comming of age.”     

THE MARITAL AND FAMILY THERAPY EXAMINATION PROGRAM: A SURVEY OF PARTICIPANTS

Participants in the Examination in Marital and Family Therapy between November 1994 and May 1996 were surveyed to ascertain who took the examination, how they prepared for it, whether they thought that it was fair, and how these variables related to scores. Two-thirds of the respondents were female. Most were taking the examination for the first time, were relatively young, were Caucasian, and spoke English as their primary language. They primarily practiced marital and family therapy and had completed master's level university programs in marital and family therapy, counseling, and psychology. Most were sitting for the examination relatively soon after completing their training in marital and family therapy. Individual study was the preparation method of choice for half of the sample. Demographic variables had a modest but ambiguous effect on test score. Educational background had none. However, a relatively short latency between graduation and examination was related to a higher score, as was the use of multiple preparation procedures. With regard to fairness, the participants largely agreed that the examination was moderately difficult, but that the problems were realistic and they had enough time to complete the test.     

A NEW TECHNOLOGY FOR TEACHING/LEARNING MARITAL AND FAMILY THERAPY

A computer technology known as Group Support Systems (GSS) was pilot tested in a doctoral marital and family therapy (MFT) course to explore its usefulness in teaching/learning marital and family therapy. GSS allowed participants to combine face-to-face interaction with dialogue structured by GSS on personal computers. Through linked computers, each participant contributed to group discussions both simultaneously and anonymously. GSS was used to discuss a videotape, to conduct two role plays, and to write this paper. GSS was found to improve brain-storming, enhance collaboration, reduce hierarchical status among participants, increase self-reflection, create a trusting environment, and promote group-supported active learning. Recommendations for further MFT teaching, research, and application of GSS are presented.     

MARITAL AND FAMILY THERAPY CERTIFICATION AND LICENSING EXAMINATIONS: ONE MODEL*

The design of the North Carolina Marital and Family Therapy Certification Examination is outlined by its authors to provide a frame of reference for the development of other licensing and certification instruments. The purpose, procedures, resources, guidelines, content, and normative data of the examination are described. The model is offered to stimulate meaningful dialogue on marital and family therapy licensing and certification instrumentation. Guidelines toward the development of a national marital and family therapy examination are also presented.     

COMPARING MEDICAL AND GRADUATE SCHOOL TRAINING: A PERSONAL PERSPECTIVE

In this paper the author subjectively compares his experiences in medicla school, psychiatric residency training, and an AAMFT -accredited PhD program in marriage and family therapy. The goal is to stimulate thinking on the nature of training and professional identity. This is done by marking assumptions regarding training overt which usually go unrecognized and unchallenged, Differences and similarities between the two programs of training are high-lighted and discussed. It is proposed that the primary objective of professional traininjg is to learn how to apply knowledge while the primary objective of graduate training is to learn how to question knowledge.     

RELATING PROCESS TO OUTCOME IN MARITAL THERAPY

Although there are a growing number of outcome research studies in marital therapy, there is a complete absence of research on change processes, and how such processes relate to outcome. This study attempts to analyze the process of change in the "best" sessions of Emotionally Focused Marital Therapy (EFT) (Greenberg & Johnson, 1986). Client performance in therapy was rated on depth of experiencing and the quality of interpersonal interactions. The occurrence of particular change events arising from the theoretical principles of EFT was also noted. Results confirmed hypotheses that higher levels of experiencing and more autonomous and affiliative interactions characterized "best" sessions of couples who were successful in therapy. The implications for treatment are discussed.     

MARITAL THERAPY AND GENDER-LINKED FACTORS IN COMMUNICATION

Understanding the process of communication is important because communication is critical to all forms of psychotherapy. A proper understanding of communication is particularly important in marital therapy because communications is often a treatment target. A central question of this paper is whether or not communication training (CT) programs in marital therapy have been sufficiently sensitive to the complexities of gender in communication. A critical review of research on the role of gender in communication is presented. Existing data indicate that individuals tend to hold stereotypes of gender differences in language, but many of these purported differences have not been supported in empirical investigations. However, gender has been found to be linked to variables such as amount of conversation elicited, length of utterance, use of qualifying phrases, swearing, use of back channel cues, breaking of silences, function of tag questions, and compliment style. Numerous limitations of the empirical literature exploring gender differences in communication behavior are described. This paper advocates the development of models of communication in which gender is recognized as having significant implications.     

MARITAL PARADIGMS: COMPATIBILITY, TREATMENT, AND OUTCOME IN MARITAL THERAPY

Marital paradigms comprise the guiding images that serve as reference models for a couple's relationship. Such individualized images can be understood as variations on a small set of basic themes. An understanding of clients' marital paradigms can help foeus treatment on the most appropriategoals usingapproaches and techniques that are most effective for a particular couple. An unselected group of 103 couples seen in systems-oriented marital therapy were reviewed, to identify outcome and treatment issues as a function of marital paradigm. Based on outcome criteria that took marital paradigm into account, 92% of 38 cases where both partners identified with the same basic paradigm were judged to be treatment successes, while only 60% of the cases where the partners identified with different paradigms could be considered successful outcomes. Clinical approaches based on experience with marital therapy conducted within a paradigmatic framework are presented.     

AFFECT IN MARITAL THERAPY

Affect has been conceptualized in various ways. These conceptualizations have influenced the manner in which emotion is dealt with in marital therapy. Using a network theory of emotion, the role of the evocation of emotion in emotionally focused marital therapy to create intimacy and facilitate conflict resolution is discussed. Accessing underlying primary emotional responses in partners makes available adaptive action tendencies which promote problem solving and helps change self- and relationship definitions. The role of emotion in creating change in cognitions, motivation and communication patterns in marital therapy is discussed.     

THE FEMINIST CRITIQUE IN EPISTEMOLOGICAL PERSPECTIVE: QUESTIONS OF CONTEXT IN FAMILY THERAPY

Family therapy's neglect of social context as a factor in its continuing distortion of women's issues has led feminist critics to wonder if systems-based psychotherapy truly serves women. Rather than heralding the demise of family therapy, however, the feminist critique is here taken to open up concerns central to the epistemological discussion underway in the field. At first, these have to do with the functions of "punctuation,""boundary" and "closure" in systemic epistemology. Later, the central question becomes that of the place given to context in systems epistemology generally, as well as family therapy in particular. Several implications of a more lively interest in context for family therapy's work are explored. These are discussed with respect to women's issues, clinical epistemology, and the challenge to raise novel questions in family therapy.     

FAMILY SYSTEMS THERAPY IN A PRIMARY CARE MEDICAL SETTING: THE ROCHESTER EXPERIENCE

Collaboration between family therapists and physicians has attracted increasing attention in the field of family therapy. Family therapists practicing in medical settings encounter many stimulating oppoutunities and challenges. This paper focuses on the experience of the authors providing family therapy in a primary care medical setting which is also a family medicine residency program. The authors discuss the role of physician and patient expectations in treatment as well as the influence of the medical context on the development of family therpists.