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Addressing systemic challenges in couple and family therapy research: Introduction to the Special Section

We are pleased to introduce the two articles featured in this special section of Psychotherapy Research, placing them in the context of the current status of couple and family therapy (CFT) research. CFT theories and practice have evolved from multiple sources, as described next, yet share a focus on the interpersonal system as well as the person within the system, a perspective that is central to contemporary CFT research endeavors. Following a brief overview of CFT theories, we summarize the state of outcome research on CFT and discuss some of the challenges in both outcome and change process research, followed by comments on the two current contributions. Since its inception in the mid-20th century, the CFT field has witnessed a uniquely rich variety of theoretical perspectives. Constructs from cybernetics (Wiener, 1948), general systems theory (von Brtalanffy, 1950), psychodynamic theory (Ackerman, 1967), anthropology, communication, and psychiatry (Reusch & Bateson, 1968; Watzlawick, Beavin, & Jackson, 1967) were joined in creative new approaches to understand and treat psychological problems within clients’ social contexts. Behavioral theory was, from the beginning, also a major force in early approaches to couples’ (Jacobson & Margolin, 1979) and families’ (e.g., Patterson, 1974) conflicts. Couples therapies have been especially well developed, and the early behavioral focus on couple interaction is now fully integrated with an affective focus (Greenberg & Johnson, 1988) and a cognitive focus on partners’ attributions, interpretations, and evaluations of each other’s behavior (Dattilio & Epstein, 2003; Baucom, Epstein, & LaTaillade, 2002) as well as elements of acceptance (Christensen, Jacobson, & Babcock, 1995; Dimidjian, Martell, & Christensen, 2002). Indeed, cognitive conceptualizations, which were largely implicit in the first generation of family therapies (e.g., structural family therapy) became explicit in secondand third-generation integrative CFT theories (e.g., functional family therapy and attachment-based family therapy; Friedlander & Diamond, in press). Perhaps predictably, given feminist and other critiques of family therapy, the rising interest in cognition, and postmodern theory in philosophy, yet another set of treatment approaches was born, based on the idea that subjective perceptions of interpersonal reality and the language used to communicate about them are paramount. These approaches include social construction, solution-focused, and narrative therapies (cf. Sexton, Weeks, & Robbins, 2003). Out of this rich bed of theory and the widespread practice of conjoint family therapies arise three familiar questions: Does family therapy work? Do some approaches work best for some problems? What are the mechanisms by which they work? The answer to the first question, based on numerous controlled studies, reviews, and meta-analyses, is a resounding ‘‘Yes!’’ The answer to the second question will also not surprise individual therapy researchers: The efficacy of certain approaches, notably cognitive behavioral and emotion-focused couple therapies, as well as approaches for treating troubled adolescents and their families is well established (see Friedlander & Diamond, in press, for a summary of several current evidence-based programs). At the same time, however, other widely used approaches have not yet been adequately tested. Moreover, the study of change process mechanisms, despite notable progress in the last 10 to 15 years, has quite a way to go relative to individual psychotherapy (Heatherington, Friedlander, & Greenberg, 2005). Psychotherapy Research, March 2009; 19(2): 129 132