What We Do and Don't Know About the Process of Family Therapy

Despite convincing outcome evidence and the popularity of family therapy, little is known about how interpersonal change actually comes about in this context. To synthesize and integrate what is known and to offer recommendations for future, clinically relevant research, all published process studies on family therapy were reviewed. Included were naturalistic studies of conjoint treatment in which the focus was the in-session verbal behavior of the participants or their self-reported perceptions of actual interactions. Dating from 1963, 36 studies met the inclusion criteria. The review was organized according to 3 hierarchically ordered levels of in-session processes ( L. S. Greenberg, 1986 ): observations of (a) speech acts, followed by studies of (b) important incidents or change episodes and (c) the therapeutic relationship. The implications of what is "known" are followed by a discussion of what is not "known" and suggested directions for future research.