Child behavior therapy and family context: Research and clinical practice with maritally distressed families

Clinical experience has led many writers in the field of child behavior therapy to point to marital distress as an important predictor of treatment failure. While further research is needed to clarify the role of marital variables in treatment, there is some evidence that marital distress may be associated with failure to maintain change after treatment, despite a successful immediate posttreatment outcome. It appears that behavioral aprent training can improve parent-child interactions while having no impact on marital conflict and other contextual factors that are associated with parent-child relations. Attempts to assess the role of risk factors such as marital distress, maternal depression and social insularity in treatment have been piecemeal and some recommendations for improving clinical practice and research methodologies are made. Evidence is mounting that providing expanded interventions is associated with improved treatment effects, however all expansions of basic parent training appear to improve teratment ourcome and more specificity of sample selection, measures used and control conditions is needed to make sense of this data. For clinical practice, the integration of marital and child focussed interventions is reviewed. An integrative model is described with specific suggestions for facilitation families' adherence to a broadly focussed family intervention that incorporates marital and child foci.