Fam Proc 20:189-197, 1981 Client, Treatment, and Therapist Variables Related To Outcome in Brief, Systems-Oriented Family Therapy CHRISTEL A. WOODWARD, PH.D. JACK SANTA-BARBARA, PH.D. DAVID L. STREINER, PH.D. JOHN T. GOODMAN, PH.D. SOLOMON LEVIN, M.B. NATHAN B. EPSTEIN, M.D. a a At the time of the study, all authors were members of the Department of Psychiatry at McMaster University, 1200 Main Street West, Hamilton, Ontario, L85 4J9 Canada. Client, therapist, and treatment characteristics were examined with respect to how much of the variance they could account for in a variety of outcome measures. Multiple regression analyses were used to examine relationships among each of the client, therapist, and treatment characteristics studied and the various outcome measures. For the 219 families that were treated with brief family therapy, only a relatively low amount of variance in any of the outcome measures could be accounted for. The amount of explained variance, however, varied considerably from one outcome measure to the other. When the more homogeneous groups of clients (single parents or adolescent identified patients) were considered, the amount of explained variance generally showed an increase. Different sets of client, therapist, and treatment variables accounted for the variance in these outcome measures across client groups, demonstrating both the complexities of the relationships and the relative independence of various outcome measures. New variables are suggested for future research. In any evaluative research project assessing therapeutic outcomes, it is important to determine the role client, treatment, and therapist variables play in the outcomes obtained. If a significant proportion of the observed variance in outcome can be explained by client characteristics, this information could be used to develop the most efficacious treatment plan for each client subgroup. In addition, the information would also be useful for designing more controlled research on the effectiveness of treatment outcome for particular client populations. One of the major objectives of the McMaster family therapy outcome study (7, 8, 11, 12) was to delineate easily measureable client, treatment, and therapist characteristics that are predictive of good and poor outcomes, using brief, systems-oriented family therapy (2). As recommended by Garfield (3), client and treatment characteristics were studied in their natural interacting state and then evaluated in relationship to clinical outcomes. The family therapy outcome study was a large, quantitative study using a correlational design (8, 11, 12). The study group consisted of families seeking help at an outpatient regional children's mental health facility in Southwestern Ontario who presented with a child who had behavioral or academic problems and who consented to participate in an evaluation of the effectiveness of the services they received. They are similar to clients seen at child guidance clinics across North America. Most of the children were labeled "adjustment reaction of childhood." The usual clinic procedures for assignment of new cases were followed. Families were assigned to the team on intake duty the day they applied and within that team to the therapist available to take on a new case. The Centre at which these families were treated is a major training centre. Multi-disciplinary teams teach a wide variety of students (psychiatric and family practice residents, psychology interns, social work and nursing students) and treat families. Both regular staff and students were involved in the project, representing a broad range of experience and skills in family therapy. All of the senior therapists and therapy supervisors use a systems-oriented approach. (See Epstein and Bishop (2) for a comprehensive description of the type of family therapy used.) They trained together and thus have acquired a similar way of working with families. The therapist variables coded for research purposes were the therapist's discipline, sex, and years of experience as a clinician. In addition, all therapists were rated by their supervisors on their expertise as a family therapist according to the instructional objectives developed by Cleghorn and Levin (1). The number of treatment sessions and whether individual members of the family were seen alone as well as within the family group were also recorded. Extensive demographic information was gathered when the families entered treatment. Each therapist developed treatment goals for the family, using Kiresuk and Sherman's Goal Attainment Scaling technique (4, 11). The therapists also _____________________________________________________________________________________________________________ 1