The effectiveness of family therapy and systemic interventions for adult-focused problems

This review updates a similar paper published in this Journal in 2000. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of couples and family therapy for adults with various relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multimodal programmes, for relationship distress, psychosexual problems, domestic violence, anxiety disorders, mood disorders, alcohol abuse, schizophrenia and adjustment to chronic physical illness.     

The evidence base for family therapy and systemic interventions for child‐focused problems

This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multi‐modal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, attention deficit hyperactivity disorder, delinquency and drug misuse); emotional problems (including anxiety, depression, grief, bipolar disorder and self‐harm); eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, medically unexplained symptoms and poorly controlled asthma and diabetes) and first episode psychosis.     

The evidence base for couple therapy,family therapy and systemic interventions for adult‐focused problems

This review updates similar articles published in JFT in 2000 and 2009. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of couple and family therapy for adults with various relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multi‐modal programmes, for relationship distress, psychosexual problems, intimate partner violence, anxiety disorders, mood disorders, alcohol problems, schizophrenia and adjustment to chronic physical illness.     

A structured approach to disengagement in family therapy with child-focused problems

The aim of this paper is to describe a structured approach to managing the disengagement process. Six distinct disengagement scenarios are first outlined. Thereafter, phasing out therapy, dealing with family belief systems concerning the permanence of improvements and relapse management are discussed. Ways in which disengagement from specific episodes of therapy may be construed as part of an ongoing therapeutic relationship and the practicalities of recontracting for further episodes of therapy, handing over cases, and referring cases on to other professionals are considered. An approach to therapeutic failure analysis is presented. Finally, ways in which disengagement may lead to significant loss experiences are discussed.     

Couple therapy,family therapy and systemic interventions for adult‐focused problems: the current evidence base

This paper updates previous similar reviews published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of couple therapy, family therapy, and systemic interventions for adults with a range or relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multimodal programmes, for relationship distress, psychosexual problems, intimate partner violence, anxiety disorders, mood disorders, alcohol problems, psychosis and adjustment to chronic physical illness.     

Evidence-based practice in family therapy and systemic consultationChild-focused problems

Evidence for the effectiveness of family therapy and family-based interventions from critical literature reviews and controlled trials is considered for families with children and adolescents who present with various difficulties. The evidence supports the effectiveness of family therapy as an effective treatment either alone or as part of a multimodal or multisystemic treatment programme for child abuse and neglect, conduct problems, emotional problems and psychosomatic problems. Implications for practice, training and continuing professional development in the field of family therapy are discussed.     

The development of therapeutic consultations in child-focused family work

This paper outlines the theoretical influences that have led to our use of a consultation approach to work with children and families. Winnicott's notion of therapeutic consultation, the narrative approach in family therapy, the use of letters in therapeutic work and the two-plus-one model of therapeutic contact are discussed. A model of the consultation interview and process is presented together with examples of consultation letters responding to typical client expectations of the process.     

Family therapy and systemic interventions for child‐focused problems: the current evidence base

This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis.     

Competences and occupational standards for systemic family and couples therapy

This article reports on the recent government initiative of 2007–2010 to delineate, for the major forms of psychological therapy, expected professional standards of practice and conduct in workplaces (the national occupational standards) and to specify expected levels of competent practice (the competences). The article focuses on the processes and outcomes of this initiative for systemic therapy and its clinical and political relevance. The rationale, research and consultation processes by which these formulations were achieved are described and the outcomes of the work are reported. We also discuss their wider implications, including the various ways in which these achievements might be used and their potential value for the field of systemic family and couples therapy.     

A systemic view of family therapy ethics

A critical review of the literature on family therapy ethics is used to develop the proposition that a more systemic analysis is needed, one that includes the levels of therapist and society as well as patient (family). These ideas are discussed through reexamining the issues of family secrets, therapist deceptiveness, and therapist advocacy of personal (feminist) values.     

Changes of expressed emotion in systemic family therapy

This study measured the levels of expressed emotion throughout the course of systemic family therapy-Videotapes of the first, second and final sessions of therapy were rated for twelve families, by an independent rater who was not involved in the treatment. Six of the therapies were completed before the study began, and six were rated prospectively. Emotional over-involvement and criticism were found to be significantly reduced from the early stages, while warmth was found to increase later. The findings are discussed in relation to the systemic model.     

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.     

Family therapy without the family: a framework for systemic practice

This paper contrasts the basic tenets of systemic thinking with some guiding principles of the psychodynamic approach, and outlines specific techniques which family therapists can use when seeing individuals. It is argued that a useful systemic framework can be maintained if the therapist aims to keep the therapy system 'open' for relevant others to join at any time.     

The cost‐effectiveness of family therapy: a summary and progress report

This paper provides a summary of the cost‐effectiveness research for family therapy. Data were available from four different sources in the United States: (1) a health maintenance organization with 180,000 subscribers; (2) the Medicaid system of the State of Kansas; (3) CIGNA Behavioral Health, a division of a health insurance company with nine million subscribers; and (4) a family therapy training clinic. Results suggest that family therapy reduces the number of healthcare visits, especially for high utilizers. The studies suggest that including family therapy as a treatment option does not significantly increase healthcare costs.