Evidence and outcome studies

We have listed research studies which provide evidence for the effectiveness of systemic and family therapy.  These should be useful for families, and important for family therapists and commissioners. There is a section on family and couple measures and contextual studies and measures. We include some papers which critically engage with the question of evidence. 

A useful, comprehensive document in relation to evidence of effectiveness:  Stratton, P. (2016). The Evidence Base of Family Therapy and Systemic Practice. Association for Family Therapy, UK.

Carr. A., Pinquart, M. & Haun, M.W. (2020) Research-informed practice of systemic therapy. in Ochs, M., Borcsa, M. & Schweitzer, J. (2020) Systemic Research in Individual, Couple and Family Therapy and Counseling. Springer.


About Families. (2012) Evidence Response. Systemic Therapy: What difference does systemic therapy make to the outcomes for children and families? 

Butler, C., Sheils, E., Joscelyne, T., Lask, J., Pote, H., & Crossley, J. (2020). Measuring Competence in Systemic Practice: Development of the ‘Systemic Family Practice – Systemic Competency Scale’ (SPS). Journal of Family Therapy, 42(1), 79-99. https://doi.org/10.1111/1467-6427.12251

Carr, A. (2019) Family therapy and systemic interventions for child-focused problems: the current evidence base. Journal of Family Therapy.

Carr, A. (2019) Couple therapy, family therapy and systemic interventions for adult-focused problems: the current evidence base. Journal of Family Therapy.

Carr, A. (2016) How and Why Do Family and Systemic Therapies Work?. Australia and New Zealand Journal of Family Therapy, 37: 37-55. doi:10.1002/anzf.1135

Carr, A. (2014) The evidence base for couple therapy, family therapy and systemic interventions for adult-focused problems. Journal of Family Therapy, 36, pp. 158–194 doi: 10.1111/1467-6427.12033

Carr, A. (2014) The evidence base for family therapy and systemic interventions for child-focused problems. Journal of Family Therapy, 36, pp. 107–157 doi: 10.1111/1467-6427.12032

Darwiche, J. & De Roten, Y. (2014). Couple and family treatments: Study quality and level of evidence. Family Process, doi: 10.111/famp.12106

Evans, P.,Turner, S. and Trotter, C. (2012), The Effectiveness of Family and Relationship Therapy: A Review of the Literature. Melbourne: PACFA

Evidence for the effectiveness of Narrative Therapy. https://dulwichcentre.com.au/collection-evidence-for-the-effectiveness-of-narrative-therapy/

Ghavibazou, E., Hosseinian, S. and Abdollahi, A. (2020), Effectiveness of Narrative Therapy on Communication Patterns for Women Experiencing Low Marital Satisfaction. Aust N Z J Fam Ther. doi:10.1002/anzf.1405

Goger, P., & Weersing, V. R. (2021). Family based treatment of anxiety disorders: A review of the literature (2010–2019). Journal of Marital and Family Therapy, 00, 1– 22. https://doi.org/10.1111/jmft.12548


Heatherington, L., Friedlander, M. L., Diamond, G. M:, Escudero, V. & Pinsof, W. M. (2015) 25 years of systemic therapies research: Progress and promise. Psychotherapy Research, 25, pp. 348-364.

Hogue, A., Schumm, J. A., MacLean, A., & Bobek, M. (2021). Couple and family therapy for substance use disorders: Evidence-based update 2010–2019. Journal of Marital and Family Therapy, 00, 1– 26. https://doi.org/10.1111/jmft.12546

Kennedy, E. (2015) Developing interventions in child and adolescent mental health services: Do we really know what works for whom? Clinical Child Psychology and Psychiatry 20(4), pp. 529–531

Lebow, J. L. (2016) Editorial: Empirically supported treatments in couple and family therapy. In Special Edition. Empirically Supported Treatments in Couple and Family Therapy. Family Process, 55(3): 385–389.

Liddle, H. A. (2010) Multidimensional family therapy: a science-based treatment system. Australian and New Zealand Journal of Family Therapy, 31, pp. 133–148.

Petitt, B., Cederblad, M & Wirtberg, I. (2015) Reviewing the evidence for the effectiveness of systemic, family and couple interventions (SFCT).

Rohrbaugh, M. J. (2014). Old wine in new bottles: Decanting systemic family process research in the era of evidence-based practice. Family Process, doi: 10.1111/famp.12079

Sexton, T. L., & Datchi, C. C. (2014). The development and evolution of family therapy research: its impact on practice, current status, and future directions. Family Process, 53(3), pp. 415–433.

Sexton, T. L., et al (2013). The effectiveness of couple and family-based clinical interventions. In: Lambert, M. J. (Ed.) Bergin & Garfield’s Handbook of Psychotherapy and Behavior Change (6th edn.). NY: Wiley.

Sexton, T. L., Coop Gordon, K., Gurman, A., Lebow, J., Holtzworth-Munroe, A. & Johnson, S. (2011). Guidelines for classifying evidence-based treatments in couple and family therapy. Family Process, 50, pp. 377-392.

Slesnick, N. and Prestopnik, J.L. (2009) Comparison of family therapy outcome with alcohol abusing, runaway adolescents. Journal of Marital & Family Therapy, 35(3), pp. 255–277. doi:  10.1111/j.1752-0606.2009.00121.x

Spengler, E. S., DeVore, E. N., Spengler, P. M., Lee, N. A. ( 2019). What Does “Couple” Mean in Couple Therapy Outcome Research? A Systematic Review of the Implicit and Explicit, Inclusion and Exclusion of Gender and Sexual Minority Individuals and Identities. Journal of Marital and Family Therapy, 00, 1– 16. doi: https://doi.org/10.1111/jmft.12415

Stratton, P., Silver, E. & Nascimento, N. (2015) Couple and Family Therapy Outcome Research in the Previous Decade: What Does the Evidence Tell Us? Contemporary Family Therapy, 37, pp. 1-12, doi:10.1007/s10591-014-9314-6

Vitry, G., Pakrosnis, R., Brosseau, O.G. and Duriez, N. (2021), Effectiveness and Efficiency of Strategic and Systemic Therapy in Naturalistic Settings: Preliminary Results from a Systemic Practice Research Network (SYPRENE). Journal of Family Therapy. https://doi.org/10.1111/1467-6427.12343

Von Sydow, K., et al (2013). The efficacy of systemic therapy for childhood and adolescent externalizing disorders: A systematic review of 47 RCTs. Family Process, 52, pp. 576-618.

Von Sydow, K., et al (2010). The efficacy of systemic therapy with adult patients: A meta­content analysis of 38 randomised controlled trials. Family Process, 49, pp. 457­-485.

Wu, Q., Slesnick, N. ( 2020). Substance Abusing Mothers with a History of Childhood Abuse and Their Children's Depressive Symptoms: The Efficacy of Family Therapy. Journal of Marital and Family Therapy, 46, 81– 94. https://doi.org/10.1111/jmft.12364

Systematic review is a review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review.  Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies.

Couturier J, Kimber M,  & Szatmari P. (2013) Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. International Journal of Eating Disorders, 46(1), pp. 3-11. doi: 10.1002/eat.22042.

Eassom, E., Giacco, D., Dirik, A., & Priebe, S. (2014) Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factorsBMJ Open. doi:10.1136/bmjopen-2014-006108

European Monitoring Centre for Drugs and Drug Addiction (2014) Multidimensional family therapy for adolescent drug users: a systematic review, EMCDDA Papers. Publications Office of the European Union: Luxembourg.

Fisher CA, Hetrick SE, Rushford N. (2010) Family therapy for anorexia nervosa. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD004780. DOI: 10.1002/14651858.CD004780.pub2

González Moller, J., Heaphy, G. and Urrutia Ortiz, J. (2021), The Feasibility of Systemic Interventions for the Prevention and Treatment of Children and Adolescents Mental Health Difficulties in Latin American Countries: A Mixed Studies Systematic Review. Journal of Family Therapy. https://doi.org/10.1111/1467-6427.12327

Harris, R. and Crossley, J. (2021), A systematic review and meta-synthesis exploring client experience of reflecting teams in clinical practice. Journal of Family Therapy. https://doi.org/10.1111/1467-6427.12346

Henken, T., Huibers, M. J. Churchill, R., Restifo, K. K. & Roelofs, J. J. (2009). Family therapy for depression. The Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006728. DOI: 10:1002/14651858.CD006728

McWey, L. M. (2021). Systemic interventions for traumatic event exposure: A 2010–2019 decade review. Journal of Marital and Family Therapy, 00, 1– 27. https://doi.org/10.1111/jmft.12547


Meis, L. A., et al. (2013). Couple and family involvement in adult mental health treatment: A systematic review. Clinical Psychology Review, 33, pp. 275-286.

Retzlaff, R., von Sydow, K., Beher, M. W. & Schweitzer, J. (2013). The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: A systematic review of 38 randomized trials. Family Process, 52, pp. 619-652.

Sousa, H., Ribeiro, O., Afreixo, V., Costa, E., Paúl, C., Ribeiro, F., & Figueiredo, D. (2021). “Should WE Stand Together?”: A systematic review and meta-analysis of the effectiveness of family-based interventions for adults with chronic physical diseases. Family Process, 00, 1– 19. https://doi.org/10.1111/famp.12707

Sprenkle, D. H. (2012). Intervention research in couple and family therapy: A methodological and substantive review and an introduction to the special issue. Journal of Marital and Family Therapy, 38, pp. 3-29.

Thompson, J. (2021), The Effectiveness of Couple Therapy on Psychological and Relational Variables and Pregnancy Rates in Couples with Infertility: A Systematic Review. Aust N Z J Fam Ther. https://doi.org/10.1002/anzf.1446

Tseng, C.‐F., PettyJohn, M.E., Huerta, P., Miller, D.L., Agundez, J.C., Fang, M. and Wittenborn, A.K. (2021), Representation of Diverse Populations in Couple and Family Therapy Intervention Studies: A Systematic Review of Race/Ethnicity, Sexual Orientation, Age, and Income in the United States from 2014 to 2019. Fam. Proc.. https://doi.org/10.1111/famp.12628

Von Sydow, K., Retzlaff, R., Beher, S., Haun, M. W. & Schweitzer, J. (2013). The efficacy of systemic therapy for childhood and adolescent externalizing disorders: A systematic review of 47 RCT. Family Process, 52, pp. 576-618.

Winter, F., Steffan, A., Warth, M., Ditzen, B. and Aguilar-Raab, C. (2021), Mindfulness-Based Couple Interventions: A Systematic Literature Review. Fam. Proc.. https://doi.org/10.1111/famp.12683


Meta-analysis is a statistical technique that combines the results of individual studies to arrive at one overall measure of the effect of a treatment.

Baldwin, S. A., Christian, S. & Berkeljon, A. (2012). The effects of family therapies for adolescent delinquency and substance abuse: A meta-analysis. Journal of Marital and Family Therapy, 38, pp. 281-304.

Barbato, A. and D'Avanzo, B. (2020), The Findings of a Cochrane Meta‐Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice. Family Process 59: 361-375. doi:10.1111/famp.12540

Couturier J, Kimber M,  & Szatmari P. (2013) Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. International Journal of Eating Disorders, 46(1), pp. 3-11. doi: 10.1002/eat.22042.

Hartnett, D., Carr, A., Hamilton, E. and O'Reilly, G. (2017), The Effectiveness of Functional Family Therapy for Adolescent Behavioral and Substance Misuse Problems: A Meta-Analysis. Family Process., 56: 607–619. doi:10.1111/famp.12256

Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G. and Morgan, C. (2002) Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 32(5), pp. 763-782.  

Pinquart, M. Oslejsek, B & Teubert, D (2016) Efficacy of systemic therapy on adults with mental disorders: A meta-analysis. Psychotherapy Research, 26: 2, 241-257. doi: 10.1080/10503307.2014.93583

Riedinger, V.,  Pinquart, M. & Teubert, D. (2017) Effects of Systemic Therapy on Mental Health of Children and Adolescents: A Meta-Analysis, Journal of Clinical Child & Adolescent Psychology, 46:6, 880-894, DOI: 10.1080/15374416.2015.1063427

Stouwe, Van der T., Asscher, J.J., Stams, G.J.J.M., Dekovic, M. & van der Laan, P.H. (2014) The effectiveness of multisystemic therapy (MST): A meta-analysis. Clinical Psychology Review, 34: 468-481

van der Pol, T.M., Hoeve, M., Noom, M.J., Stams, G.J.J., Doreleijers, T.A., van Domburgh, L. and Vermeiren, R.R. (2017), Research Review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems – a meta-analysis. J Child Psychol Psychiatr, 58: 532-545. https://doi.org/10.1111/jcpp.12685

Wampler, Reifman, & Serovich, (2005) Meta-Analysis in Family Therapy Research. In D.H. Sprenkle and F.P. Piercy (eds) Research Methods in Family Therapy. Guildford: Guilford Press.


Qualitative meta-synthesis is an intentional and coherent approach to analyzing data across qualitative studies.

Harris, R. and Crossley, J. (2021), A systematic review and meta-synthesis exploring client experience of reflecting teams in clinical practice. Journal of Family Therapy. https://doi.org/10.1111/1467-6427.12346

Tseliou, E., Burck, C., Forbat, L., Strong, T. and O’Reilly, M. (2020), The Discursive Performance of Change Process in Systemic and Constructionist Therapies: A Systematic Meta‐Synthesis Review of In‐Session Therapy Discourse. Family Process doi:10.1111/famp.12560

Tseliou, E., Burck, C., Forbat, L., Strong, T. and O’Reilly, M. (2020), How is Systemic and Constructionist Therapy Change Process Narrated in Retrospective Accounts of Therapy? A Systematic Meta‐synthesis Review. Family Process. doi:10.1111/famp.12562


Content analysis of family therapy research publications is a method which can provide an overview of what has been researched.


Lambert-Shute, J.J., Nguyen, H.N. & Peterson, P.W. (2018) Reflecting on the past: A content analysis of family therapy research from 2000-2015. Journal of Marital and Family Therapy. 45(2) 256-274.


Von Sydow, K., Beher, S., Schweitzer, J. & Retzlaff, R. (2010). The efficacy of systemic therapy with adult patients: A meta-content analysis of 38 randomised controlled trials. Family Process, 49, pp. 457-485.


Dakof, G.A., Henderson, C.E., Rowe, C.L., Boustani, M., Greenbaum, P.E., Wang, W., Hawes, S., Linares, C., Liddle, H.A. (2015) A randomized clinical trial of family therapy in juvenile drug court. Journal of Family Psychology, 29(2): 232-241. doi: 10.1037/fam0000053.

Diamond, G.S., Wintersteen, M.B., Diamond, G.M., Shelef, K. and Levy, S. (2010) Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial.  Journal of the American Academy of Child & Adolescent Psychiatry, 49(2), pp. 122-131.

Fonagy, P., Butler, S.M., Cottrell, D., Scott, S.B. et al (2020) Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): 5-year follow-up of a pragmatic, randomised, controlled, superiority trial. The Lancet Psychiatry 7(5):420-430

Greenbaum, P.E., Wang, W., Henderson, C.E., Kan, L., Hall, K., Dakof, G.A. & Liddle, H.A. (2015) Gender and ethnicity as moderators: Integrative data analysis of Multidimensional Family Therapy randomized clinical trials. Journal of Family Psychology, 29(6): 919-930. doi:10.1037/fam0000127

Hogue, A., and Liddle, H. A. (2009) Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research. Journal of Family Therapy, 31, pp. 126-154. 

Leff, J., Vearnals, S., Brewin, C. R., Wolff, G., Alexander, B., Asen, E., Dayson, D., Jones, E., Chisholm, D. and Everitt, B. (2000) The London Depression Intervention Trial: randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner; clinical outcome and costs. British Journal of Psychiatry, 177: 95-100.

Liddle, H. A., Dakof, G. A., Turner, R. M., Henderson, C. E. and Greenbaum, P. E. (2008) Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103, pp. 1660-1670.

Lock, J. (2015) An Update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and AdolescentsJournal of Clinical Child & Adolescent Psychology Vol. 44 , Iss. 5, pp. 707-721.  http://dx.doi.org/10.1080/15374416.2014.971458

Mannell, J., Davis, K., Akter, K., Jennings, H., Morrison, J., Kuddus, A., & Fottrell, E. (2020). Visual Participatory Analysis: A Qualitative Method for Engaging Participants in Interpreting the Results of Randomized Controlled Trials of Health Interventions. Journal of Mixed Methods Research. https://doi.org/10.1177/1558689820914806

Prado, G., Pantin, H., Huang, S., Cordova, D., Tapia, M., Velazquez, M.R. et al. (2012) Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: A randomized controlled trial. Archives of Pediatrics and Adolescent Medicine, 166: 127-133. doi: 10.1001/archpediatrics.2011.189

Tilden, T., Wampold, B.E., Ulvenes, P., Zahl‐Olsen, R., Hoffart, A., Barstad, B., Olsen, I.A., Gude, T., Pinsof, W.M., Zinbarg, R.E., Nilssen, H.H. and Håland, Å.T. (2020), Feedback in Couple and Family Therapy: A Randomized Clinical Trial. Family Process., 59: 36-51. doi:10.1111/famp.12485

Addis, M.E. et al (2006) Does Manualization Improve Therapy Outcomes? in Norcross, John C., Beutler, Larry E.  & Levant, Ronald F. (Eds) Evidence-based practices in mental health: Debate and dialogue on the fundamental questions, pp. 131-160. Washington DC, US: American Psychological Association, xv, 435. http://dx.doi.org/10.1037/11265-003

Barbato, A., D’Avanzo, B., Vadilonga, F., Cortinovis, M., Lombardi, S., Pili, F., Rangone, G. and Visconti, A. (2020), Systemic family therapy integrated with attachment interventions for adoptive families. Development of a treatment manual. Journal of Family Therapy, 42: 536-559. doi:10.1111/1467-6427.12278

Forbat, L., Black, L. and Dulgar, K. (2015), What clinicians think of manualized psychotherapy interventions: findings from a systematic review. Journal of Family Therapy, 37: 409–428. doi: 10.1111/1467-6427.12036

Fruggeri L. (2012), Different levels of psychotherapeutic competence. Journal of Family Therapy., 34: 91–105. doi:10.1111/j.1467-6427.2011.00564.x

Jones, E. and Asen, E. (2000). The therapy manual. In Systemic Couple Therapy and Depression. London: Karnac. 

Krautter T., and Lock, J. (2004) Is manualized family-based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at the end of treatment. Journal of Family Therapy, 26: 66-82. 

Pote, H, Allison, S, Cottrell, D, Perlesz, A & Stratton, P (2002) Manualising Systemic Family Therapy: The Leeds Manual, Australian & New Zealand Journal of Family Therapy, 23(3), pp. 153-158., doi: 0814-723X

Pote H., Stratton, P., Cottrell, D., Shapiro, D. and Boston, P. (2003) Systemic family therapy can be manualized: research process and findings. Journal of Family Therapy, 25, pp. 236-262.

Stratton, P. (2013) Manuals: A secure base for playful therapy? Human Systems: The Journal of Therapy, Consultation and Training, 24: 176-187.

Wright-Hughes, A. et al (2015)  Self-Harm Intervention: Family Therapy (SHIFT), a study protocol for a randomised controlled trial of family therapy versus treatment as usual for young people seen after a second or subsequent episode of self-harmTrials 2015, 16: 501.

Anderson, S. R., Johnson, L. N., Miller, R. B., & Barham, C. C. (2021). The Couple Relationship Scale: A brief measure to facilitate routine outcome
monitoring in couple therapy
. Journal of Marital and Family Therapy, 00, 1– 20. https://doi.org/10.1111/jmft.12541

Onwumere, J. (2009) Family interventions in psychosis: a scale to measure therapist adherence. Journal of Family Therapy, 31(3), pp. 270-284. 

SCORE-15 Index of Family Functioning and Change: SCORE is a self-report outcome measure designed to be sensitive to the kinds of changes in family relationships that systemic family and couples therapists see as indications of useful therapeutic change. It is intended to be serviceable in everyday practice; short, acceptable to clients and usable across the full range of our work - the full range of presenting problems, the clientele, and the formats of work: including individual, couple, family and multi-family groups. It is free to use. For more information visit AFT page on SCORE: http://www.aft.org.uk/view/score.html.

Stratton, P. et al  (2014) Detecting therapeutic improvement early in therapy: validation of the SCORE-15 index of family functioning and change. Journal of Family Therapy, 36(1), pp. 3–19.

Sundet, R. (2014) Patient-focused research supported practices in an intensive family therapy unit. Journal of Family Therapy, 36, pp. 195–216 doi: 10.1111/j.1467-6427.2012.00613.x   

Barber, B.K. et al (2017) Contextualised suffering in the occupied Palestinian territory: a mixed methods study. The Lancet, 390. S29.

Charlson, F. et al (2019) New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. The Lancet,  June 11, 2019.

Runnymede Report. Committe for the Elimination of Racial Discrimination 2021.
https://www.runnymedetrust.org/uploads/CERD/Runnymede%20CERD%20report%20v3.pdf

Ziadni, M. et al (2011) Sources of human insecurity in post-war situations. The case of Gaza. Journal of Human Security, 7(3) pp 23-36.

Process research

These studies research therapeutic change processes, addressing questions of 'how therapy works', and can be considered to produce 'practice-based...

Topics

Research has been categorised under the following topics listed alphabetically

Research methodologies

Here research studies are categorised according to the methodology used. These can be helpful to see what kind of analysis different methodologies...

Type of therapeutic approach

Studies here have been categorised according to the type of therapeutic approach and consultation that is being researched.

Tavistock Systemic Doctoral Research Theses.

Doctoral systemic and family therapy research carried out on the Professional Doctorate in Systemic Psychotherapy at the Tavistock. Many full texts...

Other Systemic Doctorate and PhD Research Theses

Titles and links to Systemic Doctorate and Phd Theses carried out at other Institutes and Universities

Masters research dissertations

Titles and abstracts of systemic masters research dissertations from UK family therapy training institutes that were awarded distinctions and from...