A. Campbell (2002), in an extensive review of the family therapy outcomes literature on physical disorders concluded that there are no randomized control trials for marital or family therapy for adult illnesses. While this is strictly true, interest in research in this area has been on the rise, and there has been a significant increase in the number of studies assessing the outcome of family therapy. This healthy development can be found first in distinct research endeavors, namely, meta-analyses that use quantitative techniques to summarize the results of scientific studies on family therapy outcome (Shadish and Baldwin, 2003), and second, in evidence-based studies that determine primarily through a review of the research literature the efficacy of family therapy in treating a variety of disorders.
Yet, as noted by Campbell, it can be said without any fear of contradiction that studies of family therapy outcome in relation to the medically ill population remain scarce. As was evident in the case of Mrs. Layton, on occasion the medical problem may be secondary to the relationship issues. If we accept the proposition that the focus of intervention in that case was on the family relationships rather than on her headaches, then there is indeed considerable evidence for the efficacy of family therapy. Halford and associates (2002), in their review of the literature on relationship enhancement, concluded, while there is much we do not know [about family relationships], there is a substantial body of evidence that guide us in this enterprise [family therapy]. They express optimism that in another decade or so, much more will be known and understood about the key dynamics that contribute to family happiness.
The literature on the merit of family therapy for health problems include studies on stroke (Clark et al., 2003), cancer (Keller and Jost, 2003; Sellers, 2000), diabetes (Hagglund et al., 1996; Satin et al., 1989), anorexia nervosa (Ball, 1999), and depression (Chase and Holmes, 1990; Clarkin et al., 1990; Lebow and Gurman, 1995; Stevenson, 1993; Waring et al., 1995). A comprehensive literature search failed to produce any controlled outcome study for family therapy and chronic pain disorders. However, there is one study that investigated the efficacy of couple therapy where both partners were victims of chronic pain (Boyd, 2001). The sample included five couples. Treatment outcome was analyzed from the participants' responses. This istudy is useful in understanding the emotional and relational needs when both partners are afflicted with chronic pain disorders. All the couples received eight sessions of therapy, and the outcome was generally positive. In an earlier study I reported on the effectiveness of family therapy for headache with eight couples (Roy, 1989b).
Meta-analyses of family therapy effectiveness, while very technical in nature, are encouraging. Several studies concluded that family therapy for a variety of problems led to short-term and sometimes even long-term improvement. One study that has direct bearing on our case reported that "meta-analyses support the efficacy of both MFT [marital and family therapy] for distressed couples, and marital and family enrichment. The effects are slightly reduced at follow-up, but still significant" (Shadish and Baldwin, 2003); 40% to 50% of those treated achieved clinically significant results. The authors strongly recommended meta-analytically supported treatment for problems in the empirically supported literature.
Another study updated research on the couple communication (CC) through meta-analyses (Butler and Wampler, 1999). The authors reported meaningful effect sizes for CC on all types of measures, confirming the positive outcome for CC training. However, communication gains deteriorated substantially at follow-up. The authors concluded that CC improved couple communication together with moderate couple-perceived changes.
One study that is not directly related to our case in hand reported that on the basis of meta-analyses for the efficacy of family therapy with adolescent drug abuse with the objective of abstinence, family therapy produced medium-sized effects and superior outcome, both for children and adolescents (Sack and Thomasius, 2002).
Improvements were found in family dynamics, symptom severity, and psychosocial integration. A 2-year follow-up revealed stable results. In their meta-analysis of marital and family therapy, Shadish and Baldwin
(2002), made the following observations:
1. Marriage and family interventions, both therapy and enrichment, are more effective than no treatment. Those effects tend to be maintained at follow-up.
3. Different kinds of marriage and family interventions tend to produce similar results.
4. The effects of family interventions are comparable to or larger than those obtained by alternative interventions, ranging from individual interventions to medical treatments.
5. Meta-analytically supported treatments exist that have strong empirical support. However, it makes sense to use meta-analytically supported treatments when empirically supported treatments are not available.
6. Marriage and family therapies produce clinically significant results in 40% to 50% of those treated.
7. The effects of marriage and family interventions in clinically representative conditions have not been studied much.
8. We do not know much about the variables that moderate the effects of marriage or family therapies, although available evidence suggests that how the research is done has as strong an impact on outcome as what kind of treatments are used.
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