Couple and Family Therapy Outcome Research in the Previous Decade: What Does the Evidence Tell Us?

Abstract

Meta-analyses of randomized control trials include only a small proportion of the published outcome research of Couple and Family Therapy. This paper surveys the ranges of published research through a systematic review of the outcome studies of family, couple, and systemic therapies published in English language peer reviewed journals in years 2000 through 2009. After application of criteria of relevance to Couple and Family Therapy and systemic practice, 225 studies were identified, summarized, and coded under 14 broad headings giving 125 potential classifications for each article. Analyses of these codings found consistent conclusions of effectiveness; differential availability and quality of research for different conditions; and quite frequent absence of important methodological information. The findings are interpreted as showing that this body of recent research supports claims of effectiveness. Although the journals included many of good quality there are substantial areas of weakness in reporting. It is concluded that there are significant influences on the body of published research that arise both from funding policies and journal practices as well as perhaps author bias. The consequences are to reduce the value of research to practitioners, to favour randomized control trials with positive evidence of the effectiveness of therapy, and to exclude publication of negative findings.

Appendix

Strategy for Literature Searching

This section describes the search strategy adopted for searching the bibliographic databases. The search strategy was informed by the following guidelines: Centre for Reviews and Dissemination (2001). Undertaking Systematic Reviews of Research on Effectiveness. Centre for Reviews and Dissemination’s Guidance for Those Carrying Out or Commissioning Reviews, CRD Report No. 4, 2nd edition. Centre for Reviews and Dissemination, York. Also, attendance of the Cochrane Systematic Review course held in Leeds in May 2006 by one of the researchers in the team (GP) helped to define the research question and develop the search strategy.

Initial “scoping” searches were carried out on the OVID databases, Medline and PsycInfo, using the following keywords: “family therapy”, “couples therapy”, and “marital therapy”. The purpose of carrying out this exercise prior to developing the final search strategy was to compile a list of further keywords associated with CFT that may have been overlooked, and can thus be included in the final search strategy (on the complete reference of a particular article, Medline and PsycInfo provides other keywords and MeSH headings that the article has been indexed under). Doing this ensures a more accurate and comprehensive search strategy, that is less likely to overlook some potentially important references. This referencing had to be repeated for all the databases as they all operate different referencing systems.

In order to ensure that the final search strategy was as comprehensive and inclusive as possible, we employed a range of MeSH headings (category headings) and keywords (additional search terms to refine the search strategy, and ensure that no articles were overlooked), using Boolean Logic (AND/OR) to combine different components of the search strategy. Furthermore, it was known that English spellings in UK-published journals sometimes varied from the spellings in non-UK journals. To overcome this problem, wild cards (denoted by an asterisk, *) were used to capture spellings in both UK and non-UK journals, and truncation of keywords was used to capture text words with a common root. We also utilized adjacency operators in our search strategy.

The following bibliographic databases were searched for relevant papers: AMED; British Nursing Index and Archive; CINAHL; EMBASE; Global Health; MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; PsycINFO. Web of Science (2000 – 2009) and the Cochrane Library (2000–2009) were also searched.

A representative example of the search terms used is: 1—Family Therapy; 2—Relational Therapy; 3—Interpersonal Therapy; 4—Biopsychosystem Therapy; 5—Family Therapy; 6—Marital Therapy; 7—Couples Therapy; 8—Systems Psychotherapy; 9—Narrative Therapy; 10—Family Psychotherapy; 11—Solution focused Therapy; 12—Family intervention; 13—Couples Psychotherapy; 14—Marriage Therapy; 15—(1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14); 16—limit 15 to (english language and year = “2000–2009”).

The initial inclusion criteria were applied to the database search results; if it was not possible to judge from the title and abstract alone whether an article was relevant to our study, the full text was obtained to assess whether an article passed the initial inclusion criteria. The full text of all articles deemed relevant to our review judged by the initial inclusion criteria was obtained.

To increase the rigor of our search, we cross checked the existing search against the reference lists of relevant Cochrane and other reviews and selected included articles, to highlight any studies that we had not previously extracted. Further relevant studies were found from hand-searching relevant academic journals that had repeated citations. Primarily: The Journal of Family Therapy, the Journal of Marital and Family Therapy, the American Journal of Family Therapy, Family Process, and the Journal of Marriage and Family. Furthermore, using Web of Science, we performed Cited Ref searches, and searched for studies done by specific authors identified to be carrying out important research in this field, as well as searched existing studies in the Principal Investigator’s personal reference collection. Finally, an interim version of the list of articles was sent to leading researchers in the field with a request to provide any missing references.