Over the last few years the health systems, specially the mental health system, have been pressured to prioritize empirically validated techniques and practices. Systemic family therapy (SFT) in particular has been accused of neglecting research, and has been strongly challenged to prove the effectiveness of its interventions.
Within such framework, it was inevitable that systemic therapists and researchers would work together for that goal, in order to scientifically fundament the rightness of family therapy funding as an integral part of mental health services.
As a result, this alliance has recently allowed systemic therapy to acquire significant visibility in the mental health field, having proven its capacity against various relational problems and difficulties, such as domestic violence, anxiety, alcoholism, depression, and having been considered less expensive when compared to alternative and equally effective treatments or even as cost effective as other mental health groups.
In sum, it can be said that the efforts made to subject this approach to scientific scrutiny have opened paths not only in research (showing areas of future studies and contributing to an evidence-based clinical practice) but also in clinical practice (proving the effectiveness of this type of intervention which relies on practice-based evidence). Kazdin highlight the fact that knowing the influence of certain aspects in therapy can be important at a theoretical as well as a practical level.
The review mainly focused on recent published works (about 80% of the reviewed literature was published after 2000), but it also considered other works (the oldest dates back to 1983), for a deeper approach of the original models. We conducted systematic searches on online databases (e.g., EBSCO Host), from publication date of 1983 to present, including terms as “family therapy” “family therapy research” “family therapy outcomes” “family therapy process” “common factors” and “systemic research methodology”.
Manual searching was also performed to identify references that were not picked up during the computer-based research. Our selection process resulted in a similar number of studies related to therapy outcomes and processes (sagu.edu). Specifically, 3 references about “family therapy” were selected, along with 18 references about “family therapy outcome research“, 14 relating to “family therapy process research” and, finally, 3 about “systemic research methodologies”.
Naturally, some of these references provided important information on more than one subject (for example, references about family therapy outcomes research, very often also clarify some aspects about process research and vice versa); however, for simplification purposes, we categorized them according to the paper’s main theme. The global references selection constitutes an attempt to represent a sample of relevant studies, although we are aware that many other studies may be pertinent to this review.
The concern with the rigor of therapy in general, including family therapy, together with an emphasis in explaining outcomes, led to an accentuation of the importance of the factors associated with the therapy(ie)s’ success. Initially, the paradigm of therapeutic change considered the models and techniques as the only aspects responsible for the process of change. This exclusivity was later challenged by a group of authors who presented the common factors paradigm.
Since the end of the thirties, the concern to identify the key elements that make different interventions (in terms of models and techniques) effective has been increasing, with a view to understanding which therapeutic factors are most common. According to this last paradigm, the success of therapy does not depend mainly on the specific contributions of each model or theoretical approach, it rather depends on a number of factors or mechanisms of change which are common in the different forms of effective therapy, and the models are considered as a background in which the common factors operate.
With this approach in mind, we will present some elements, which are widely identified as relevant for the therapeutic process in general, and, therefore, also for SFT.