Clinical Psychology

four steps involve assessment of the couple and
attempts to interrupt the cycle of negative interac-
tions. The next three steps involve helping create
new, more adaptive interactional styles that meet
partners’needs. Finally, the last two steps of EFT
involve the consolidation of changes made.
Through these steps, partners are better able to
recognize their own emotional and bonding needs
and to modify their interactions with each other. In
this way, they can ensure that these needs are more
likely to be met and that destructive interactional
patterns are minimized.

Do Family Therapy and Couples

Therapy Work?

As with other forms of psychotherapy, it is impor-
tant to evaluate the empirical evidence that speaks
to the efficacy of different forms of family and cou-
ples therapy. Before presenting these data, however,
it is important to note that the measurement of
outcome in family and couples therapy is complex
because of the multiple perspectives that must be
considered (different family members, both
spouses). As in individual psychotherapy research,
self-report measures, ratings by others (e.g., the

therapist), and observational ratings are used exten-

sively in family and couples therapy research.

Family Therapy. Despite the popularity of fam-

ily therapy in clinical practice, relatively few well-

controlled empirical studies have been conducted

to evaluate its effectiveness. One meta-analysis of

this literature (Shadish et al., 1993) computed 44

effect sizes from published articles and unpublished

dissertations (years 1963–1988) that evaluated the

efficacy of family therapy. The average effect size

for any form of family therapy was .47, indicating

that the average treated client was functioning bet-

ter than 68% of those individuals not receiving

treatment. Shadish and colleagues also reported

average effect sizes separately for various types of

family therapy. Eclectic (combinations of orienta-

tions) and behavioral/psychoeducational treatments

were most effective, whereas humanistic and sys-

temic approaches were least effective. These data

are shown in Table 15-1.

Although the Shadish et al. (1993) meta-

analysis gives us a sense of the overall efficacy of

family therapy across modalities and target popula-

tions, another meta-analytic study provides data on

the efficacy of family therapy for specific disorders

T A B L E 15-1 Average Effect Size (ES) and Percentile Equivalent for Selected Forms of
Family Therapy and Couples Therapy

Type of Therapy Mean ES Percentile Equivalent

Any Type of Family Therapy 0.47 68%

Behavioral/Psychoeducational 0.44 67%

Systemic 0.25 60%

Humanistic 0.29 61%

Eclectic 0.55 71%

Any Type of Couples Therapy 0.60 73%

Behavioral/Psychoeducational 0.74 77%

Systemic 0.62 73%

Humanistic 0.12 55%

Eclectic 0.63 74%

NOTE:Percentile equivalentindicates the percentage of thosenotreceiving treatment whose outcome isexceededby those receiving the treatment in
question.
SOURCE:“Effects of Family and Marital Therapies: A Meta-Analysis,”by W. R. Shadish, L. M. Montgomery, P. Wilson, I. Bright, and T. Okwumabua,Journal of
Consulting and Clinical Psychology,61, pp. 992–1002. Copyright © 1993 American Psychological Association. Reprinted with permission.

452 CHAPTER 15