The McMaster family therapy outcome study: an overview of methods and results

A multifaceted outcome design was used to investigate the results of brief, system-oriented family therapy. The present report describes the methods used and provides an, overview of clients' status on a variety of outcome measures. Treatment was brief and involved the entire family in most cases. Therapists varied in discipline (psychiatry, social work, psychology or nursing) and experience (students to very senior status). A variety of measures were obtained at the beginning of treatment, at treatment closure, or after a six month follow-up. Independent interviewers conducted the six month follow-up. Measures were obtained regarding the parents' and children's level of intellectual functioning, children's academic achievement, and disruptive school behaviour. Therapists' ratings of the families' change in treatment and prognosis were also obtained at treatment closure. At follow-up, measures of the children's academic achievement and disruptive school behavior were repreated and the interviewers determined the family's satisfaction with the services they received. The results indicate that the majority of families did well on most of the measures considered. No significant change was found in terms of the children's academic performance, but there was a significant decline in their disruptive school behaviour.This project was funded by grants from the Medical Research Council of Canada, and Health and Welfare Ministry, Canada.     

Early interactional change and its relationship to family therapy outcome

In the present study, a tailoring methodology was employed to investigate the detection of early interactional change in the course of family therapy and the possible prognostic value of such change for therapy outcome. The predicted relationship received partial support and suggested a model of change in families, with early interactional change as a mediating factor.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.     

Family therapy and outcome: Relationships between therapist and family styles

This study examined therapeutic outcome for a group of 175 clinic families divided into levels of family competence and style, and, later, into seven clinical groupings. The division into these groups was based on the level of rated Competence and Style determined by using the Beavers Systems Model. Therapists also rated their level of Openness/Sharing Strategy, Power Differential, and Partnership with the family at the third session. Results indicate that more competent families who fared well in therapy had therapists who formed a partnership, disclosed strategy, and employed a minimal power differential with the family. The most disturbed families, and those with a Centrifugal style, did better with therapists employing a high power differential and lower levels of openness and partnership. The study also presented the distribution of individual diagnoses by family groups. Implications for family therapists, including the value of family assessment, are provided.     

Videotaped simulated families as a tool in family therapy outcome research

Twenty-two therapists who had treated 57 families in brief conjoint family therapy under supervision responded to a videotaped simulated family as if they were treating it. Their responses were audiotaped and coded on a system devised for this study. Positive relationships were found between the ratings of expertise based on the coding system, and independent ratings of the treated families' satisfaction with treatment and the status of the presenting symptoms 6 months after termination. Videotaped simulated families are potentially useful as standardizable methods of revealing individual differences in therapists for family therapy outcome research.     

The end-of-session message in systemic family therapy: a descriptive study

A retrospective case note review was conducted with the aim of describing the end-of-session messages conveyed during Milan-style systemic family therapy. Fifty consecutive families treated in an adult family clinic were included. A classification of messages was developed; for each type of message the mean number per therapy session was calculated and the rates compared both within and between four systemic categories of family. 'Supportive/engaging' messages were given more frequently than 'hypothesis-related' messages in each systemic category and this difference was most marked in families with grief as the central issue. More 'acknowledgement' messages were used in the 'grief' group than in the 'separation/individuation' group. 'Hypothesis-related' messages were used more often in the 'separation/individuation' group than in the 'grief' group. We discuss possible reasons for the observed patterns and compare different ways in which the message can be conceived and implemented.     

The practice of community family therapy

This paper presents a summary of the basic theories and methods of Community Family Therapy (CFT), a relatively new therapeutic approach developed in response to the need for effective intervention in treating low-income, urban families. CFT operates outside of the traditional therapeutic box, successfully combining family therapy techniques with developmental and motivational theories, community mental health, social work, economic development, and community mobilization strategies. CFT utilizes a dualistic approach in which both client and therapist become involved with the same three levels of engagement. Specifically, the client strives for: (a) personal and family change and growth-level 1, (b) accessing community resources-level 2, and (c) leadership development and civic action-level 3. Also, CFT calls upon therapists to strive for: (a) personal growth and maturation-level 1, (b) collaboration with community resources for professional support-level 2, and (c) operation as a "citizen therapist," through civic action and volunteer services-level 3.     

Cognitive therapy outcome: the effects of hopelessness in a naturalistic outcome study

This study prospectively examined the effect of hopelessness on outcome in cognitive therapy. Hopelessness has a central role in cognitive theories of depression, and consistently predicts suicide attempts and suicide completion. Furthermore, there is indirect evidence that hopelessness predicts cognitive therapy outcome, in terms of early termination of therapy, perhaps in part because theories of therapy change suggest that "remoralization" is a critical first phase of change. It was hypothesized that hopelessness non-responsiveness early in therapy would be predictive of eventual outcome, over and above hopelessness severity at intake. In a naturalistic study of 122 patients diagnosed with unipolar depression, it was found that non-responsive hopelessness predicted outcome in cognitive therapy, and this effect is over and above any effect of initial severity of hopelessness or depression. These findings suggest that patients whose level of hope is responsive to early interventions make more rapid and pronounced improvements during "real world" cognitive therapy.     

A factor analytic study of structural family therapy constructs

The lack of empirical work on therapists' use of Structural Family Therapy (SFT) concepts is discussed. The important SFT dimensional models are briefly reviewed. Three groups of therapists were required to make judgements of video-taped interviews using a set of SFT concepts. The data were factor analysed and the results discussed in terms of the relationship between the therapists' produced factors and theoretical models of SFT.     

The integration of individual and family therapy

It is time to put an end to the separation in training programs between individual and family therapy. Competent therapists should be able to think at an intrapsychic and circular level concurrently. Training programs should maintain their current major focus and develop their minor area of expertise sufficiently so that their graduates can practice both individual and family therapy and choose whichever modality is more appropriate to the case at the time. Bridge concepts, essential differences, and some integrative approaches in individual and marriage and family therapy are discussed.     

The marital and family therapy examination program

This report is intended to inform the reader—as fully as is compatible with examination security—about the Examination in Marital and Family Therapy used by most of the states licensing marital and family therapists in the United States. The rationale for the examination is given, its development and validation are described, and the knowledge base that it samples is provided. The examination is presented as a necessary and logical component in the development of marital and family therapy and as an essential part of the implicit contract that exists between professionals and the community.Although a great many people labored on the Examination in Marital and Family Therapy, and continue to do so, the National Exam largely was founded and developed under the leadership of Carl F. Johnson of Atlanta, Georgia.     

The process of enabling change: a study of therapist interventions in family therapy

We describe the application of discursive analysis to the task of researching family therapy process. Through the analysis of a central theme in two family therapy treatments, we found that individual family members move to using a wider range of discourses on the central theme by the end of therapy. Using the example of one family's therapy sessions, we examine how the therapist contributes to the new meanings and views that emerge, and present our analysis of the therapists' interventions in relation to the 'production' of these alternative meanings. It is argued that discourse analysis can fruitfully be applied to family therapy process research and could contribute to theoretical concepts of change and therapeutic competence.     

Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE

There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self‐report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non‐clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.     

participating in a couples therapy outcome study: Participants' views

Discovering that participants who received therapy in a research project and were being debriefed in a therapy outcome study considered those assessment sessions therapeutic, the authors conclude that participants: (a) are aware of the research context, (b) have some idea about how it affected the treatment they got, and (c) see positive outcomes for taking part in the study. Assessment and treatment were not separated in the minds of some participants, as they had been in the mind of the researchers.This study was supported in part by National Institute on Drug Abuse grant #1R 18DA 1069232001.     

Re-editing family mythology during family therapy

Family mythology includes false or edited beliefs about the present which may be coupled with family legends which support those beliefs. Families are particularly likely to use their histories dys-functionally if they either see the present as an exact replication of the past or, in contrast, deny that the past has any relevance whatever. Re-editing myths involves enabling families to alter their relationships and their self perceptions. This allows a fresh exploration of the past; a process which can support and encourage further change. Case material is used to illustrate this.