Evaluation and outcome studies

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

A comprehensive review of family, couples and systemic outcome therapy research from 2000-2009 is available here.

This is a useful document in relation to evidence of effectiveness: ‘The Evidence Base of Systemic Family and Couples Therapies’ (2016).

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

Carr, A. (2018) Family therapy and systemic interventions for child-focused problems: the current evidence base. Journal of Family Therapy.

Carr, A. (2018) 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(1), pp. 37-55

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

Christenson, J. D., Crane, D. R., Bell, K. M., Beer, A. R. and Hillin, H. H. (2014). Family intervention and health care costs for Kansas medicaid patients with schizophrenia. Journal of Marital and Family Therapy, 40, pp. 272–286. doi: 10.1111/jmft.12021

Crane, R.D. & Payne, S.H. (2011) Individual Versus Family Psychotherapy in Managed Care: Comparing the Costs of Treatment by the Mental Health Professions. Journal of Marital and Family Therapy 37(3):273-89

Crane, R.D. et al (2013). Costs of Treating Depression with Individual versus Family Therapy. Journal of Marital and Family Therapy.

Crane, R.D. & Christenson, J. (2014) A summary report of cost-effectiveness: Recognising the value of family therapy in health care. In J. Hodgson, A. Lamson, T Medenhall, & D.R. Crane (Eds) Medical Family Therapy: Advanced Applications. Springer. ISBN 978-3-319-03482-9

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 

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.

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.

Moore, A.M & Crane, D.R. (2014) Relational Diagnosis and Psychotherapy Treatment Cost Effectiveness. Contemporary Family Therapy 36(2), pp. 281-299.

Morgan, T. B., Crane, D. R., Moore, A. M. and Eggett, D. L. (2013), The cost of treating substance use disorders: individual versus family therapy. Journal of Family Therapy, 35, pp. 2–23. 

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

Retzlaff, R. et al (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(4), pp. 619-652.

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

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

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.

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.

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.

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


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.

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 factors.  BMJ 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

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

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

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.

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.

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

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.

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. 

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

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.

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.

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.




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.

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 Adolescents.  Journal of Clinical Child & Adolescent Psychology Vol. 44 , Iss. 5, pp. 707-721.  http://dx.doi.org/10.1080/15374416.2014.971458

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

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

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-harm.  Trials 2015, 16: 501.

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

Peter Stratton, Judith Lask, Julia Bland, Ewa Nowotny, Chris Evans, Reenee Singh, Emma Janes and Anneka Peppiatt (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.

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   

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