THE EFFICACY OF MARITAL AND FAMILY THERAPY: AN EMPIRICAL OVERVIEW, CONCLUSIONS, AND RECOMMENDATIONS

Based primarily on the contributions to this Special Issue of JMFT, this article provides an overview of the empirical research on the efficacy of marital and family therapy for the following disorders and problems: schizophrenia; affective (mood) disorders; slected externalizing, internalizing, and pervasive developmental disorders of childhood; adolescent conduct disorder; marital distress and the prevention of divorce; alcoholism; adult and adolescent drug abuse; and various chronic adult, adolescent, and childhood physical disorders. Convincing scientific evidence supports the efficacy of broadly defined marital and family therapy for the treatment of many disorders, as well as its superiority to standard and individual treatments for certain disorders and populations. We conclude with recommendations for future research as well as for collaborative initiatives between marital/family therapists and other professionals working in the marriage and family field.     

Empirically supported family-based treatments for conduct disorder and delinquency in adolescents

Several family-based treatments of conduct disorder and delinquency in adolescents have emerged as evidence-based and, in recent years, have been transported to more than 800 community practice settings. These models include multisystemic therapy, functional family therapy, multidimensional treatment foster care, and, to a lesser extent, brief strategic family therapy. In addition to summarizing the theoretical and clinical bases of these treatments, their results in efficacy and effectiveness trials are examined with particular emphasis on any demonstrated capacity to achieve favorable outcomes when implemented by real-world practitioners in community practice settings. Special attention is also devoted to research on purported mechanisms of change as well as the long-term sustainability of outcomes achieved by these treatment models. Importantly, we note that the developers of each of the models have developed quality assurance systems to support treatment fidelity and youth and family outcomes; and the developers have formed purveyor organizations to facilitate the large-scale transport of their respective treatments to community settings nationally and internationally.     

DEVELOPING FAMILY PSYCHOEDUCATIONAL TREATMENTS FOR PATIENTS WITH BIPOLAR AND OTHER SEVERE PSYCHIATRIC DISORDERS

Developing family treatments for patients with severe and persistent psychiatric disorder begins at the basic research level, through identifying psychosocial variables that have prognostic significance. Treatment protocols informed by this basic research can then be designed, manualized, and piloted. Next, the efficacy of a new treatment is examined, first in a randomized trial and then, if successful, in a community effectiveness study. We describe this treatment development pathway in a population for whom family attributes have prognostic importance: patients with bipolar affective ddisorder. The methodological complexities of psychosocial treatment studies are many. Moreover, the results of these studies often reflect interactions between treatment, process, and outcome variables.     

Social Integration,Work‐Family Conflict and Facilitation,and Job and Marital Quality

This paper examines relationships between 2 dimensions of social integration (community participation and affective community resources) and job and marital quality. Data from the 1995 National Survey of Midlife Development in the United States (n= 1,816) indicate that the level of community participation is unrelated or negatively related to job and marital quality, whereas affective community resources show positive associations with job and marital quality. Relationships between community participation and affective community resources and job stress are partially mediated by work‐to‐family conflict and facilitation. Family‐to‐work conflict and facilitation partially mediate relationships between affective community resources and marital satisfaction and risk. The study takes a beginning step in establishing relationships and exploring processes that make up the work‐community‐family interface.     

Meta-analysis of MFT interventions

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 martial 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.     

Conceptualizing and Treating Problem Gambling as a Family Issue

Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians' experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic-based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.     

Common factors and our sacred models

In this article we argue that much of what makes one treatment effective is common to other forms of effective treatment--both in psychotherapy generally and in marital and family therapy (MFT) specifically. Yet MFT has largely ignored the research on common factors. In this article we present a moderate view of common factors that, while repudiating the extreme position that there is no difference among treatment models, stresses that there are common factors and mechanisms of change that undergird most forms of successful treatment. These common mechanisms of change should be given more attention in our field, which has tended to emphasize the uniqueness of our sacred models. We delineate some of the major common factors, review the empirical evidence for them, and discuss implications of adapting a common factors informed approach to family therapy.     

Relational resources, gender consciousness and possibilities of change in marital relationships

Investigating the possibilities of change in marital relationships, we argue, involves examining the interplay of gender consciousness, relational resources and material circumstances in their concrete, interactional manifestations. The attempt to address this interface is grounded in the idea that understanding gender relations necessarily involves both institutional and interactional dimensions. While much research has been devoted to the influence of material or structural resources on indicators such as the domestic division of labour, relatively little direct attention has been given to the issue of differing ‘relational’ or interpersonal resources. We use a multi-method approach based on interviews with women in different occupations to analyse possibilities of change in marital communication and the domestic division of labour in relation both to women's material and to their relational resources. We conclude that a combination of increased gender consciousness and the development of particular inter-personal skills facilitates negotiation and change in the boundaries regulating both communication and the domestic division of labour within the marital relationship.     

Partnering Across the Life Course: Sex, Relationships, and Mate Selection

Marital delay, relationship dissolution and churning, and high divorce rates have extended the amount of time individuals in search of romantic relationships spend outside of marital unions. The scope of research on intimate partnering now includes studies of "hooking up," Internet dating, visiting relationships, cohabitation, marriage following childbirth, and serial partnering, as well as more traditional research on transitions into marriage. Collectively, we know much more about relationship formation and development, but research often remains balkanized among scholars employing different theoretical approaches, methodologies, or disciplinary perspectives. The study of relationship behavior is also segmented into particular life stages, with little attention given to linkages between stages over the life course. Recommendations for future research are offered.     

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.     

EFFICACY OF FAMILY THERAPY FOR DRUG ABUSE: PROMISING BUT NOT DEFINITIVE

Drug abuse is an enormous public health problem with consequences not only for individuals using drugs but also for families, communities, and society. Moreover, research evidence and clinical experience agree that drug abuse is one of the more difficult problems to treat. Despite considerable research on the connection between family factors and drug use, and the existence of family therapy models for drug abuse, comparatively few controlled efficacy studies have been conducted. This article presents a critical review of controlled treatment outcome research in the area of family therapy for drug abuse in both adults and adolescents. A number of studies from different clinical research groups demonstrate that different versions of family intevention can engage and retain drug users and their families in treatment, significantly reduce drug use and other related problem behaviors, and enhace particular domains of prosocial functioning. Moreover, a smaller number of comparative efficacy studies have shown family therapy to be more effective than nonfamily therapies. Family therapy of adolescent drug abuse is more developed at present than family therapy of adult drug abuse. Although the results of the reviewed studies are promising, a blanket confirmation of family therapy's efficacy for drug abuse cannot be made at this time because of the relatively small number of studies and the noted methodological limitations of the studies published to date. Nonetheless, substantial progress in this clinical research area has occurred, and if research and funding support continue or can expand, significant breakthroughs in the treamtment of drug abuse with family-based treatments are possible.     

Parents' Marital Status, Conflict, and Role Modeling: Links With Adult Romantic Relationship Quality

This study investigated three parental marital statuses and relationship quality among unmarried, but dating adults ages 18 to 35 (N = 1153). Those whose parents never married one another tended to report the lowest relationship quality (in terms of relationship adjustment, negative communication, commitment, and physical aggression) compared to those with divorced or married biological parents. In addition, those with divorced parents reported lower relationship adjustment and more negative communication than those with married parents. Parental conflict and the degree to which participants rated their parents' relationship as a healthy model for their own relationships partially explained the associations between parental marital status and relationship outcomes. We suggest that this particular family type (i.e., having parents who never marry one another) needs greater attention in this field in terms of research and intervention.     

BONDS OR BARGAINS: RELATIONSHIP PARADIGMS AND THEIR SIGNIFICANCE FOR MARITAL THERAPY

Contrasting conceptual paradigms describing the nature of intimate relationships are discussed. In particular, relationships may be viewed in terms of a rational bargain or as an emotional bond. The implications of each paradigm for the process of marital therapy are delineated, and the role of bonding and attachment in adult intimacy is considered. Some general conclusions are then drawn as to future directions for the marital therapy field.     

Out of the Darkness: Three Waves of Family Research and the Emergence of Family Therapy for Lesbian and Gay People

Like family relationships themselves, the history and treatment of lesbian and gay people and their families is complicated. For this paper, three waves of research on the families of gay and lesbian individuals are described. During the first wave, gay and lesbian sexual orientation was seen as a disease and family dynamics were blamed for its genesis. Subsequently in the second wave it was believed that, fearing rejection many gay and lesbian people either distanced or were rejected from their own families and established friendship networks that have been described as families of choice. More recently, in the third wave, the family has been identified as a resource for lesbian and gay youth whereby open relationships with parents can help protect them from mental illness, substance abuse, and HIV risk. Furthermore, an increasing number of same-sex couples are choosing to become parents, overcoming biological and social obstacles. In this article these shifting views of the role of family in the lives of lesbian and gay people will be described along with case material that illustrates the historic influences, current developments and future directions of family treatment for this population. To be maximally effective with gay and lesbian people and their families, clinical social workers and other mental health professionals must understand how family therapy has been influenced by a progression of ideas that continue to evolve. In this paper, research examining the role of the family in the lives of lesbian and gay people will be described in three waves; as a source of blame, to an impediment to gay and lesbian happiness and ultimately a resource that can enhance lesbian and gay well-being. The influences of research on family therapy with this population will be described and case examples will demonstrate how to harness the strengths of family relationships identified in the most recent wave.     

FAMILY LIFE AND AMERICAN POLITICS: THE "MARRIAGE GAP" RECONSIDERED

In recent years, several writers have identified marital statusas a potentially important line of political cleavage, observingthat singles are more likely to vote Democratic than marriedvoters are. Changes in both the structure of American familiesand in the salience of "family politics" in the policy arenasuggest increased attention to the political consequences ofmarital status and family life-style. This paper contributesto advancing theory concerning the relationship between familylife and politics, and empirically evaluating several competinghypotheses concerning the so-called marriage gap in the 1972through 1988 presidential elections.     

Historical Perspectives on Family Studies

This article explores the relationship of historical research to contemporary family studies. Family history was influenced greatly by fields such as sociology and anthropology, leading it to make several contributions to those fields in turn. The continuing collaboration of these disciplines can significantly enrich current family research, practice, and policy making. History's specific contribution lies in its attention to context. Although historical research confirms sociologic and ethnographic findings on the diversity of family forms, for example, it also reveals that all families are not created equal. The advantage of any particular type of family at any particular time is constructed out of contingent and historically variable social relationships. Historical research allows researchers to deepen their analysis of family diversity and family change by challenging widespread assumptions about what is and what is not truly new in family life. Such research complicates generalizations about the impact of family change and raises several methodological cautions about what can be compared and controlled for in analyzing family variations and outcomes.     

THE CORRELATES OF HEALTHY FAMILY FUNCTIONING: THE ROLE OF CONSENSUS AND CONFLICT IN THE PRACTICE OF FAMILY THERAPY

The present study explores the relative importance of individual, dyadic and triadic measures of intrafamily functioning in predicting family health. Using self-report data from 78 families, it was found that dyadic measures pertaining to marital quality and parent-child relationships were more powerful predictors than either individual measures of emotional maturity, anxiety, self-esteem or locus of control, or triadic measures of the families' hierarchical alignments. The study also found that while mothers' and fathers' assessments of intrafamily functioning were more important than the childrens' (except for the childrens' view of parent-child relationships), the parents differed in that marital quality was more important to the mothers' evaluations of the family unit while parent-child relationships were more important to the fathers'. Compositely, the findings suggest that family health is a complex multidimensional phenomenon, and that change in a particular dimension of family life may not necessarily be greeted with consensual validation or repudiation by all family members.     

Sociobiology misses the mark: An essay on why biology but not sociobiology is very relevant to sociology

This essay takes the position that sociologists need to pay more attention to biology, but that the biological perspective provided by sociobiology is not the perspective that is the most relevant. The reductionist nature of sociobiology is noted and the treatment by sociobiology of altruism, religion, homosexuality, the maximization of inclusive fitness, group versus individual inheritance, and the genetic inheritance process itself is critiqued. Sociobiology’s strong emphasis on ultimate causation and the denigration of proximate causation is treated as particularly problematic. The paper ends with a plea that sociologists pay more attention to the research that shows the interactional effects of biological, psychological and social processes. Best known for his work on mental illness and on gender and marital roles, he also has published extensively in the area of family, crime, and aging. While an undergraduate student in the 1950s, he was trained in biology and has had a strong interest in biological issues since that time.     

ICONOCLASM VERSUS INNOVATION: BUILDING A SCIENCE OF FAMILY THERAPY-COMMENTS ON MOON, DILLON, AND SPRENKLE

We dispute Moon, Dillon, and Sprenkle's (1990) claims regarding the unique advantages of qualitative methods and inherent limitations of traditional quantitative approaches for addressing the needs of family therapy research. We support the role of qualitative research as a generative phase in theory development and concur that exclusive allegiance to a standard set of research methods may limit our attention to important family therapy processes. However, we also assert the need to document generalizability of informal observations through controlled procedures using appropriate quantitative techniques. Both ethical and practical considerations demand that we document treatment efficacy based on a science of family therapy.