Deterioration in marital and family therapy: empirical, clinical, and conceptual issues

Recent empirical evidence of deterioration during both nonbehavioral and behavioral marital and family therapy is presented. While the frequency of patient worsening in marital-family therapy does not appear to exceed that previously found for individual psychotherapy, the acceptability of the evidence for negative effects in the treatment of systems may be greater than that which exists for individual treatment. After examining the empirical evidence of negative effects in family therapy and some of the factors that influence their occurrence, the authors discuss some conceptual issues relevant to a definition of worsening in marital and family therapy and present some methodological guidelines for the assessment of deterioration in therapy with family systems. It is concluded that the study of deterioration processes in family therapy may aid the understanding of family change processes more generally.