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An Addendum to the 1997Outcome Research ChartRichard B. Miller a , Lee N. Johnson b , JonathanG. Sandberg c , Traci A. Stringer-Seibold d & LorrieGfeller-Strouts ea School of Family Life , Brigham YoungUniversity , Provo, Utah, USAb Friends Universityc Syracuse University , Syracuse, New York, USAd Private Practice, Arlington, Texas, USAe The Crisis Center , Manhattan, Kansas, USAPublished online: 30 Nov 2010.

To cite this article: Richard B. Miller , Lee N. Johnson , Jonathan G. Sandberg ,Traci A. Stringer-Seibold & Lorrie Gfeller-Strouts (2000) An Addendum to the 1997Outcome Research Chart, The American Journal of Family Therapy, 28:4, 347-354,DOI: 10.1080/019261800437900

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The American Journal of Family Therapy, 28:347–354, 2000Copyright ©2000 Brunner/Mazel0192-6187/00 $12.00 + .00

Address correspondence to Richard B. Miller, 360D SWKT, Brigham Young University,Provo, UT 84602. E-mail: rick_miller@byu.edu

347

An Addendum to the 1997Outcom e Research Chart

RICHARD B. MILLERSchool of Family Life, Brigham Young University, Provo, Utah, USA

LEE N. JOHNSONFriends University

JONATHAN G. SANDBERGSyracuse University, Syracuse, New York, USA

TRACI A. STRINGER-SEIBOLDPrivate Practice, Arlington, Texas, USA

LORRIE GFELLER-STROUTSThe Crisis Center, Manhattan, Kansas, USA

The authors would like to thank those researchers, especially Dr. Duncan Stanton, whoprovided helpful feedback about the 1997 review article. Appreciation is also expressed toAimee Bass for her assistance in the preparation of the manuscript.

In 1997, an article in the American Journal of Family Therapy waspublished that summarized the outcome research regarding theefficacy of specific approaches of Marriage and Family Therapy intreating certain disorders (Sandberg et al., 1997). The article up-dated the original matrix of findings reported by Gurman, Kniskern,and Pinsof (1986) by reviewing the relevant research through 1995,and provided a summary of findings in an updated version of theoriginal 1986 chart.

Since the publication of that article (Sandberg et al., 1997),feedback has been received from a number of MFT researchers whopointed out some omissions and oversights in the updated chart.After responding to their feedback, it has been concluded that anumber of changes must be made to the 1997 summary chart topresent a more complete summary of MFT outcome research upthrough 1995.

METHODS

The 1986 and 1997 charts rated the demonstrated efficacy of 17 models oftherapy in treating 13 specific disorders. The scoring system of 0 for “effec-

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R. B. Miller et al.348

tiveness untested,” 1 for “effectiveness uncertain,” 2 for “effectiveness prob-able,” or 3 for “effectiveness established” was operationalized in the 1997review (Sandberg et al., 1997, p. 124) as follows:

0: No quality studies were found indicating effectiveness of the specifictherapy in the treatment of the specific disorder.

1: At least one quality study supporting the effectiveness of the therapyin treating the disorder was found, or a few studies were found of alesser quality.

2: Some quality studies supporting the effectiveness of the therapy intreating the disorder were found, or a number of studies of lesserquality were found.

3: Four or more quality studies supporting the effectiveness of the therapyin treating the disorder were found, or the results of one quality studywere replicated by another researcher.

The 1997 review defined a “quality study” as one that “employed acontrol group, identified a disorder or problem, and employed appropriatestatistical methods. Studies utilizing only comparison groups... were consid-ered of lesser quality.” (Sandberg et al., 1997, p. 124). The present adden-dum to the 1997 review uses the same scoring scheme and the same defini-tion of a quality study, with the exception that studies which utilizedcomparison groups were not discounted. The rest of the methodology fol-lows that used in the 1997 review.

FINDINGS

Behavioral Family Therapy

In addition to the articles presented in 1997, a number of behavioral therapyoutcome studies were discovered that should be added to the chart. Onestudy reported that cognitive-behavioral family therapy resulted in greaterimprovement among children with recurrent abdominal pain than those chil-dren treated with standard pediatric care (Sanders, Shepherd, Cleghorn, &Woolford, 1994). On the basis of this study, the behavioral category for psy-chosomatic disorders was increased from a 0 to a 1 (see Table 1).

Behavioral family therapy has also been found to be successful in thetreatment of childhood obesity (Aragona, Cassady, & Drabman, 1975; Epstein,Wing, Koeske, & Valoski, 1987; Kingsley & Shapiro, 1977; Wheeler & Hess,1976). However, there are no conclusive results regarding the effectivenessof this approach with adult obesity (Patterson & Campbell, 1995). In addi-tion, there are two studies that demonstrate the efficacy of behavioral familytherapy in treating anorexia nervosa (Crisp et al., 1991; Robin, Seigel, Koepke,Moye, & Tice, 1994). Based on this evidence, the score for eating disorders

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An Addendum to the 1997 Outcome Research Chart 349

was upgraded from 1 to 3, indicating that behavioral family therapy is effec-tive with some eating disorders. And finally, a study reported that maritalcommunication training was effective in decreasing hypertension (Ewart,Taylor, Kraemer, & Agras, 1984). Consequently, the score for chronic illnesswas increased from 0 to 1.

TABLE 1. Ratings of effectiveness across therapy modalities and disorders: An addendum tothe 1997 chart

Adult Child/Adolescent MaritalDisorders Disorders Problems

Behavioral 2a 3b 3 3c 1 3d 3d 0 3 1e 1 3 1Bowen FST 0 0 0 0 0 0 0 0 0 0 0 0 0Contextual 0 0 0 0 0 0 0 0 0 0 0 0 0Functional 0 1 0 0 0 3 0 0 0 0 0 0 0Humanistic (f) 0 0 0 0 0 0 0 0 0 0 0 0 0McMaster PCSTF 0 0 0 0 1 1 1 1 0 0 0 0 0Milan Systemic 0 1 1 1 0 1 1 1 1 0 0 1 0MRI Interactional 0 0 0 0 0 0 1 1 1 0 0 0 0Multigenerational:

other (g) 0 0 0 0 0 0 0 0 1 0 0 0 0Psychoeducational 3 0 2 0 0 0 0 0 0 0 0 0 3Psychodynamic/

Eclectic 1 2h 0 0 1 0 1 1 2 1 0 0 0Strategic 1 2i 0 0 1 0 0 0 1 0 0 1 0Structural 0 3i 0 0 2 2 0 0 0 0 0 2 1Symbolic-Experientia l 0 0 2 0 0 0 0 0 3j 0 0 0 0Triadic 0 0 0 0 0 0 0 1 0 0 0 0 0Narrative 0 0 0 0 0 0 1 0 0 0 0 0 0Feminist 0 0 0 0 0 0 0 0 0 0 0 0 0Solution-Focused 0 0 0 0 0 0 0 0 0 0 0 0 0Multisystemic 0 2 0 0 0 3 0 0 0 0 0 0 0

1. Bolded items increased in ratings.2. 3 = effectiveness established; 2 = effectiveness probable; 1 = effectiveness uncertain; 0 = effective-ness untested.3. New categories and problems are denoted by dotted lines.a = Behavioral family management.b = Alcohol abuse.c = Spouse-assisted exposure therapy.d = Parent management training.e = Divorce mediation.f = Satir (1967).g = Based on Framo (1976) and Williamson (1981, 1982a, 1982b).h = Conjoint couples groups for alcoholism.i = Integrative structural/strategic therapy (Stanton et al., 1982).j = Emotional focused couple therapy.

Schiz

ophre

nia

Subst

ance

Abuse

Mood (

Affec

tive

) D

isord

ers

Anxi

ety

Dis

ord

ers

Psy

choso

mat

ic D

isord

ers

Juve

nile

Del

inquen

cy

Conduct

Dis

ord

ers

Mix

ed D

isord

ers

Mar

ital

Dis

cord

Div

orc

e A

dju

stm

ent

Mar

ital

Vio

lence

Eat

ing D

isord

ers

Chro

nic

Illnes

s

Type of Therapy

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R. B. Miller et al.350

Strategic

A study was conducted that integrated structural and strategic therapy in thetreatment of substance abuse (Joanning, Thomas, Quinn, & Mullen, 1992).The model was influenced by the seminal work of Stanton, Todd, and Asso-ciates (1982), and the format for the delivery of the therapy was based on theMilan approach to strategic therapy. The treatment was found to be moreeffective in treating adolescent substance abuse than adolescent group therapyand family drug education. Although this study provides further evidence ofthe effectiveness of strategic therapy in treating drug abuse, at least oneadditional study is needed before the score of 2 can be changed to 3.

Goldman (1988) compared strategic therapy with emotionally-focusedtherapy (EFT) and a control group in treating marital discord. She found thatstrategic therapy was as effective as EFT, with both groups experiencingsignificantly more improvement than the control group. Based on this study,the score for marital discord was raised from 0 to 1.

Structural

Three additional studies were located that provide further evidence of theeffectiveness of structural family therapy in treating substance abuse (Lewis,Piercy, Sprenkle, & Trepper, 1990; Liddle et al., 1993), including the previ-ously mentioned study that integrated strategic and structural therapy(Joanning, Thomas, Quinn, & Mullen, 1992). As a result, the score for sub-stance abuse was raised from 2 to 3.

A study of anorexia nervosa and bulimia found that structural familytherapy was more effective than individual therapy in treating patients underthe age of 18 (Russell, Szmukler, Dare, & Eisler, 1987). However, the twoforms of therapy had similar effects on adults with anorexia and all patientswith bulimia. Although this study provides additional empirical support, it isnot enough to change the score of 2 on eating disorders.

It should be noted that one study was found that showed children suf-fering from severe asthma who were treated by structural family therapyshowed more improvement than those who received only regular medicaltreatment (Gustafsson, Kjellman, & Cederblad, 1986). This is the only studyfound that provided evidence for chronic illness, so the appropriate score is1. The previous score in the 1997 chart was an error.

Symbolic Experiential

There are two studies indicating that emotionally focused therapy (EFT) iseffective in treating depression. In a study of maritally distressed couples,where the female partner was depressed, Dessaulles (1991) found that EFTwas effective in reducing the women’s depression. MacPhee, Johnson, andVan Der Veer (1995) also found that EFT significantly improved depression

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An Addendum to the 1997 Outcome Research Chart 351

among female partners. Based on this evidence, the score for mood disorderwas increased from 0 to 2.

Dessaulles (1991) also found in his study that EFT was effective in im-proving the marital satisfaction of women, but not for their partners. Thisadditional evidence on the effectiveness of EFT in treating marital discord isenough to increase the score from 2 to 3.

Multisystemic

A new modality of family therapy has been added to this review. Multisystemictherapy (MST) is based largely on family systems theory, but it expands thetraditional view of family systems to view “individuals as being nested withina complex of interconnected systems that encompass individual, family, andextrafamilial (peer, school, neighborhood) factors” (Henggeler, Melton, &Smith, 1992, p. 955). Consequently, interventions may occur within multiplesystems. Multisystemic therapy draws heavily on structural family therapy forits theoretical base, but it also utilizes strategies from other family therapyapproaches (Henggeler & Borduin, 1990). Moreover, in a review of the con-duct disorder literature, Kazdin (1997) listed MST as a distinct theoreticalmodality. Consequently, MST is listed as a separate treatment modality.

Multisystemic therapy has demonstrated its effectiveness in treating ju-venile delinquency. Four outcome studies have been conducted that showMST is more effective than standard treatments in reducing arrests, self-re-ported offenses, and jail time (Borduin, Henggeler, Blaske, & Stein, 1990;Henggeler et al., 1992; Henggeler, Rodick, Borduin, Hanson, Watson, & Urey,

TABLE 2. Movement in ratings from 1986 to 1995: An addendum

Behavioral 1 2 1 1 3 1Functional 1 1Milan 1 1 1 1Psychoeducational 1 3Psychodynamic/Eclectic 1Strategic 1Structural 1 2 2 1Symbolic-Experiential 2 3Narrative 1Multisystemic 2 3

Note: Number of levels that the rating moved up since the original chart in 1986.

Schiz

ophre

nia

Subst

ance

Abuse

Mood (

Affec

tive

) D

isord

ers

Anxie

ty D

isord

ers

Psy

choso

mat

ic

Juve

nile

Del

inquen

cy

Conduct

Dis

ord

ers

Mar

ital

Dis

cord

Mar

ital

Vio

lence

Eat

ing

Dis

ord

ers

Chro

nic

Illnes

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1986; Mann, Borduin, Henggeler, & Blaske, 1990). This demonstrated effi-cacy results in a score of 3 for juvenile delinquency.

Two additional studies have found MST to be effective in treating sub-stance abuse. Reported in a single journal article, one of the studies wasconducted in Missouri, while the other was done in South Carolina. Both ofthe studies found that juvenile delinquents that received MST experienced asignificant reduction in substance abuse problems (Henggeler et al., 1991).

SUMMARY OF FINDINGS

Table 2 contains the revised summary of movement in ratings between theoriginal Gurman et al. (1986) chart and 1995. During that 10-year period,additional evidence was found for the effectiveness of 10 family therapyapproaches. These outcome studies also provide further support of the ef-fectiveness of various modalities of family treatment in treating 11 significantmental health problems.

Based on the feedback from MFT researchers on the 1997 review(Sandberg et al., 1997), this addendum to the 1997 charts presents a morecomplete summary of the demonstrated efficacy of specific family therapymodalities in treating specific disorders.

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Borduin, C. M., Henggeler, S. W., Blaske, D. M., & Stein, R. (1990). Multisystemictreatment of adolescent sexual offenders. International Journal of OffenderTherapy and Comparative Criminology, 34, 105–113.

Crisp, A. H., Norton, K., Gowers, S., Halek, C., Bowyer, C., Yeldham, D., Levett, G.,& Bhat, A. (1991). A controlled study of the effects of therapies aimed at adoles-cent and family psychopathology in anorexia nervosa. British Journal of Psy-chiatry, 159, 325–333.

Dessaulles, A. (1991). The treatment of clinical depression in the context of maritaldistress. Dissertation Abstracts International, 53, 1605–B.

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