Is Symptom Outcome the Whole Story? – A Multilevel Meta-Analysis of Systemic Therapy for Adults Including Family System Functioning

Objective: Systemic Therapy conceives mental health symptoms in the context of social systems. Previous meta-analyses on Systemic Therapy focused on symptoms. This meta-analysis aims to focus on family system functioning while including all types of outcomes. Method: We conducted a systematic literature research in multiple databases (PsycInfo, PubMed, Embase, Cochrane Central). We included RCT-studies on adults with a psychiatric diagnoses, which compared Systemic Therapy with an active psychosocial control and reported family system functioning as outcome. The literature research resulted in twelve RCTs and 90 effect sizes. We conducted a random-effects three-level meta-analysis. We categorized outcomes into: symptoms of patients, family system functioning, further secondary outcomes of patients and psychopathology of family members. Results: The results show a small significant overall effect size of g =. 22 (CI: .10-.34 , p<.001) for all outcomes. Systemic Therapy revealed small effect sizes with regard to family system functioning (g = .27, p = .0004, k = 26, s = 12), symptoms (g = .19, p =.0097, k = 24, s = 10), and further secondary outcomes (g = .26, z= 3.51, p = .0005, k = 32, s = 8). The effect sizes for psychopathology of family system members were reported rarely (k = 8, s = 5).Conclusion: This meta-analysis shows the potential relevance of investigating system functioning as a primary outcome for systemic therapy.