Admitting to having a favourite text or author is almost as unwise as suggesting one has a favourite child. Yet we all know some children and texts are easier to understand and work with than others. Unashamedly I do have a preference and that is Professor Allan Carr, author of Family Therapy: Concepts, Process and Practice first published in 2000 and the text for the Bower Place Family Therapy and Systemic Practice Programme. Professor Carr is founding director of the doctoral programme in clinical psychology, and former head of the School of Psychology at the University College Dublin and has published over 20 books and 200 papers. For many practitioners his most valued publications are the series of reviews which outline the evidence base for family and systemic therapy. These were published in the Journal of Family Therapy of Britain and have provided a succinct and reliable basis for systemic practice with both child and adult presenting problems with reviews appearing in 2000, 2009, 2014, 2019. Now the most recent in the series is the 2024 publication, Family therapy and Systemic Interventions for Child-Focussed Problems: The Evidence Base, published in The Journal of Family Therapy as the 25th anniversary review.
The Nature of the Review
The review summarises the evidence from meta-analyses and systemic reviews ‘for the effectiveness of systemic interventions for families of young people with common mental and physical health problems and other difficulties where children are the primary focus of concern.’ Family therapy and family-based approaches including parent training and parent implemented interventions, multisystemic therapy and treatment foster care, which engage families and wider social networks are included as systemic interventions.
The categories reviewed include infant mental health, child abuse and neglect, sexual abuse, externalising problems, internalising problems, bi-polar disorder, grief, eating disorders, somatic problems, and psychosis.
How is Information Presented?
For each main category, the author divides information into subgroups. For example, under internalising problems the subcategories include disorders where anxiety is a central feature, depression, bi-polar disorder, grief, and self-harm. A detailed analysis of current information is summarised and the implications of these for service delivery presented. A list of key references under each category is available at the end of the paper providing easy access to further detailed reading.
What Can we Conclude?
Carr concludes that ‘the evidence base for systemic therapy for child-focussed problems has grown steadily in most areas since the last version of this review’ with significant growth in some areas including systemic interventions for infant mental health. The evidence supports the assertion that systemic interventions are as effective as other psychosocial interventions and services, and are more effective in some cases, for example, infant mental health and externalising behaviour problems.
The Implications of these Results
Carr notes that there are implications for research, training, and practice. Research needs to focus on adaptations for use in developing countries, ‘interventions for internalising behaviour problems and coping with pain and chronic illness; enhanced protocols to meet the unique needs of non-responders; and interventions based on social-constructionist and narrative practices.’ He asserts that training should incorporate evidence-based practice and practitioners incorporate this knowledge and treatment resources listed in the paper into their clinical work.
Carr, A. Family therapy and systemic interventions for child-focussed problems: The evidence base J Fam Ther. 2025;47:e12476.
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