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The efficacy of marital and family therapy: An empirical overview, conclusions, and recommendations

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To meet the challenge of providing effective mental health services, health care professionals need valid and reliable scientific data about the costs and the effectiveness of the treatments they offer. The primary purpose of this article is to provide an overview of the state of scientific knowledge about the efficacy of marital and family therapy for a variety of mental disorders and problems. Unfortunately, due to the paucity of available information, a review of the costs and cost effectiveness of marital and family therapies is impossible. Data on costs and cost effectiveness are just beginning to emerge. This article also presents a set of conclusions about the current state of empirical knowledge about the effectiveness of family therapy and a set of recommendations for future research.

A number of writers differentiate psychotherapeutic efficacy and effectiveness (Shadish, Ragsdale, Glaser, & Montgomery, 1995; Starfield, 1977). Efficacy refers to the effects of psychotherapy in controlled clinical trials conducted under specified conditions, usually in a university or hospital laboratory or clinic setting. Weisz, Weiss, and Donenberg (1992) call this "research therapy." Effectiveness applies to the effects of "clinic therapy" conducted "in the field," in the "normal" circumstances in which most therapies are provided. Most of the research cited in this selective overview pertains to efficacy, and this term will be used predominantly throughout the article.

What is marital and family therapy (MFT)? For the purposes of the articles in this Special Issue of the Journal of Marital and Family Therapy, family therapy is pragmatically defined as any psychotherapy that directly involves family members in addition to an index patient and/or explicitly attends to the interaction among family members. Marital therapy, a subclass of family therapy, directly involves both spouses and/or explicitly attends to their interaction.