Couple and family treatments: study quality and level of evidence.

This paper examines the application of the guidelines for evidence-based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two-step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, "evidence-based" treatments; one was a level II, "evidence-informed treatment with promising preliminary evidence-based results"; and four were level I, "evidence-informed" treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.

The influence of profession and therapy type on the treatment of sexual dysfunctions.

Sexual dysfunctions are serious mental health issues that affect an estimated 1 in 3 Americans, yet many people with sexual dysfunctions do not seek treatment. Health services research on variables related to access, barriers, costs, and outcomes of treatment may help improve the quality of care. The current research is a retrospective analysis of administrative data from CIGNA that explores whether the type of profession (i.e., psychologist, social worker, marriage and family therapist, or professional counselor) or therapy modality (i.e., individual, conjoint, or mixed-mode, a combination of individual and conjoint therapy) influence the outcomes of mental health treatment. Participants included 230 men and 189 women between the ages of 18 to 101 years from all regions of the United States who received treatment for sexual disorders from 2001 to 2006. Results indicate that outcomes are similar across the different license types. Results also suggest that mixed-mode therapy has lower dropout rates and longer retention than individual or conjoint therapy. These results suggest that using a combination of relational and individual sessions may be beneficial for the treatment of sexual dysfunctions.

Guidelines for classifying evidence-based treatments in couple and family therapy.

Guidelines for Evidence-Based Treatments in Family Therapy are intended to help guide clinicians, researchers, and policy makers in identifying specific clinical interventions and treatment programs for couples and families that have scientifically based evidence to support their efficacy. In contrast to criteria, which simply identify treatments that "work" and have been employed in the evaluation of other psychotherapies, these guidelines propose a three-tiered levels-of-evidence-based model that moves from "evidence-informed," to "evidence-based," to "evidence-based and ready for dissemination and transportation within diverse community settings." Each level reflects an interaction between the specificity of the intervention, the strength and readth of the outcomes, and the quality of the studies that form the evidence. These guidelines uniquely promote a clinically based "matrix" approach in which the empirical support is evaluated according to various dimensions including strength of the outcomes, the applicability across cultural contexts, and demonstration of specific change mechanisms. The guidelines are offered not only as a basis for understanding the evidence for diverse clinical approaches in couple and family therapy within the systemic tradition of the field, but also as an alternative aspirational model for evaluating all psychotherapies.