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International Journal of Play Therapy
A Golden Intervention: 50 Years of Research on Filial
Therapy
Nick Cornett and Sue C. Bratton
Online First Publication, April 20, 2015. http://dx.doi.org/10.1037/a0039088
CITATION
Cornett, N., & Bratton, S. C. (2015, April 20). A Golden Intervention: 50 Years of Research on
Filial Therapy. International Journal of Play Therapy. Advance online publication.
http://dx.doi.org/10.1037/a0039088
A Golden Intervention: 50 Years of Research on
Filial Therapy
Nick Cornett
John Brown University
Sue C. Bratton
University of North Texas
In this article, the authors present an extensive review of the research conducted to
date on filial therapy. Filial therapy, first described by Bernard Guerney, Jr. (1964)
50 years ago, is an innovative outgrowth of child-centered play therapy in which
parents receive training, supervision, and support as they embark on a process of
learning how to conduct therapeutic play sessions with their own children. The
authors reviewed quantitative, qualitative, and mixed-method research studies in
which researchers investigated the outcomes and experiences of filial therapy with
participating children, parents, and families. Results are synthesized according to the
following areas: general effectiveness and the reported outcomes and experiences
related to participating children, participating parents, parent– child relationships,
and family functioning.
Keywords: child–parent relationship therapy, filial therapy, outcomes, play therapy, research
More than 50 years ago, Bernard Guerney, Jr. (1964) formally introduced filial
therapy in his now landmark article, “Filial therapy: Description and rationale.” In
this article, Guerney provided an overview of this innovative approach that directly
involved parents in the treatment of their children. The objective of filial therapy,
according to Guerney, was to use “parents as therapeutic agents with their own
children” (p. 304), maximizing what he assumed to be the inherent therapeutic
power of the parent–child relationship. Guerney offered the following as a defini-
tion of filial therapy:
Filial therapy involves the training of parents of young children (in groups of six to eight) to
conduct play sessions with their own children in a very specific way. After training, parents continue
to meet weekly with the therapist to discuss results, conclusions, and inferences about their children
and themselves. (p. 305)
The “very specific way” in which Guerney trained parents to conduct play
sessions with their children was analogous to nondirective or child-centered play
Nick Cornett, Graduate Counseling Program, John Brown University; Sue C. Bratton, Department
of Counseling & Higher Education, University of North Texas.
Correspondence concerning this article should be addressed to Nick Cornett, John Brown Uni-
versity, 2000 West University Street, Siloam Springs, AR 72761. E-mail: ncornett@jbu.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
1
International Journal of Play Therapy © 2015 Association for Play Therapy
2015, Vol. 24, No. 3, 000 1555-6824/15/$12.00 http://dx.doi.org/10.1037/a0039088
therapy. Guerney (1964) communicated the child-centered nature of filial therapy
in describing the goals of parent–child play sessions:
(1) The encouragement of complete determination of the activities of the child by the child, within
certain specified, definite limits....(2)Thedevelopment of empathic understanding on the part
of the parent as to the basic needs and feelings the child is trying to communicate and express
through his play. (3) The immediate communication back to the child that these needs and feelings
are understood, and that he as an individual is fully accepted, whatever his feelings or thoughts may
be. (4) The need of the child to learn to see and accept responsibility for his actions. This is
represented in the sessions by an understanding, but completely firm, enforcement of the “limits.”
(pp. 305–306)
Guerney further described filial therapy training as a combination of instruc-
tion, demonstration play sessions, and role-playing, as well as group processing of
the attitudes and feelings of parents. In addition to presenting an initial definition
and outline of filial therapy in this article, Guerney added to it a radical belief that
this approach was not only for the well-adjusted parent and child but also for
parents and children encountering significant emotional and behavioral difficulties.
Research evidence in support of filial therapy did not take long to accrue after
this landmark article appeared. In 1966, Guerney and a team of colleagues, which
included his wife, Louise, as well as Michael Andronico, Lillian Stover, and Jay
Fidler, secured funding from the National Institute of Mental Health (NIMH) to
work on further researching and developing filial therapy (L. Guerney, 2000). Their
initial outcome research on filial therapy yielded promising results, which led to
several early articles advocating for the use and applicability of filial therapy
(Andronico & Guerney, 1967; Andronico, Fidler, Guerney, & Guerney, 1967; B.
Guerney, 1976; Guerney, Guerney, & Andronico, 1966; Guerney, Guerney, &
Stover, 1972; B. Guerney, Stover, & Andronico, 1967).
In the 50 years that have passed since its inception, initial research, and
development, filial therapy has enjoyed rich growth. The original filial therapy
approach developed by the Guerneys’ and colleagues, which has been referred to
as Group Filial Therapy (GFT), Filial Family Therapy (FFT), and Child Parent
Relationship Enhancement Family Therapy (CREFT), has continued to be refined,
expanded, and disseminated, as a result of the continued efforts of Louise Guerney,
who recently coauthored a resource outlining their approach (L. Guerney & Ryan,
2013). In addition, the popularity and expansion of this approach has been signif-
icantly aided by two individuals who trained under the Guerneys, Risë VanFleet
(2013) and Barry Ginsberg (2002). In addition to the work of the Guerneys and
their colleagues, Garry Landreth developed a more structured and condensed
10-session filial therapy training format. Landreth and Bratton (2006) formalized
the 10-session format in a text, Child Parent Relationship Therapy (CPRT),to
distinguish the model from other filial therapy approaches. The CPRT protocol was
manualized by Bratton, Landreth, Kellam, and Blackard (2006) to provide practi-
tioners and researchers with a tool for ensuring integrity in implementing the
intervention. Collectively, the efforts of these primary figures in filial therapy, along
with those inspired by their works, have done much in advancing this unique and
efficacious modality.
Using these two filial therapy approaches as a foundation, researchers have
conducted numerous studies examining the effectiveness of filial therapy on a
variety of outcome measures, and these studies clearly provide support for the
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2 Cornett and Bratton
profound effects of this intervention. In an age of evidence-based practice, it is
increasingly important that play therapists are aware of the current research
evidence to inform their clinical practices, to advocate for the appropriateness of
their interventions to consumers and key constituents, and to contribute to the
ongoing advancement of play therapy through contributing to and extending the
research evidence beyond its current state. To assist in these endeavors, the following
is a synthesized review of the outcome research in filial therapy according to the
following categories: (a) its general effectiveness, (b) outcomes and experiences
with participating children, (c) outcomes and experiences with participating par-
ents, (d) outcomes and experiences related to parent–child relationships, and (e)
outcomes and experiences related to family functioning. To provide a thorough
analysis, we have included results from studies using both quantitative and quali-
tative methodology representing a variety of sample sizes as well as dissertation
research and research published in peer-reviewed journals. Given that the overall
objective of this article is to provide a synthesis of the data, it is beyond the
intention and scope of this article to comment specifically on the quality and rigor
of the research design, instrumentation, and execution of each of the research
studies reflected in this review. Instead, we will provide a general commentary on
the state of filial therapy research and possible future directions at the end of the
article. Where applicable and for clarity, we have separated the presentation of
results based on the model of filial therapy (FFT or CPRT) and primary research
methodology (quantitative or qualitative) used in the studies.
REVIEW OF THE RESEARCH
General Effectiveness of Filial Therapy
Results on the effectiveness of filial therapy have consistently demonstrated the
viability of this treatment approach. Perhaps one of the most impressive conclu-
sions concerning filial therapy came from a meta-analysis conducted by Bratton et
al. (2005) of 93 controlled-outcome research studies investigating play therapy and
filial therapy. Using Cohen’s (1988) dto interpret effect sizes (.20 ⫽small, .50 ⫽
medium, .80 ⫽large), the researchers found that parents trained in filial therapy
demonstrated a large overall treatment effect (d⫽1.15). Interestingly, play therapy
provided by a mental health professional exhibited a moderate treatment effect
(d⫽.72). Further analysis conducted by Bratton et al. revealed that the difference
between these effect sizes was statistically significant (p⬍.01). The researchers
offered the following conclusion in light of these results:
Certainly, this research strongly supports the adoption of filial therapy as an effective therapeutic
modality in working with children . . . a therapy model that not only can be greatly effective in a
relatively short amount of time but also provides the additional benefit of serving to prevent future
problems by impacting the family system. (p. 386)
Examining the data collected in the Bratton et al. (2005) meta-analysis, Brat-
ton, Landreth, and Lin (2010) reported that studies using CPRT methodology
exhibited an even larger treatment effect (d⫽1.30). This result is impressive when
considering that parents conduct only seven play sessions with their children during
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3A Golden Intervention
the course of CPRT. A more recent meta-analysis conducted by Lin and Bratton
(2015) replicated the finding that treatment involving caregivers trained in filial
therapy resulted in statistically greater effect sizes when compared to treatment
that did not involve filial therapy.
Other findings from research studies on filial therapy have supported the ability
of parents to be therapeutic forces in the lives of their children. In a study
comparing the change in observed empathic behaviors of 21 parents who received
training in CPRT with 13 graduate students enrolled in a play therapy course, Elling
(2003) found no significant differences between the skill levels of these groups in
being able to communicate acceptance and allow the children to self-direct the
sessions. Smith and Landreth (2003) found that filial therapy conducted by parents
was as effective in reducing problematic behaviors in children as intensive play
therapy and intensive sibling group therapy conducted by professionals.
In addition, research thus far has supported the effectiveness of filial therapy in
maintaining changes over time. Guerney (1976) reported the results of a longitu-
dinal study of 42 mothers who completed filial therapy and found that 76% of these
participants reported continued improvement in their children 1 to 3 years after
treatment, and 86% reported maintained improvements. Sensué (1981) conducted
a follow-up study of parents trained in filial therapy and found that parents
continued to show positive gains in parental acceptance and perceptions of their
children’s adjustment six months and three years after training when compared to
a normative sample.
Research has also supported the effectiveness of filial therapy with a variety of
populations that represent various cultures, family structures, and presenting con-
cerns. Researchers have successfully used filial therapy with Hispanic parents
(Ceballos & Bratton, 2010; Garza, Kinsworthy, & Watts, 2009; Sangganjanavanich,
Cook, & Rangel-Gomez, 2010; Villarreal, 2008), Korean parents (Jang, 2000; Lee
& Landreth, 2003), German parents (Grskovic & Goetze, 2008), Israeli parents
(Kidron & Landreth, 2010), Chinese parents (Chau & Landreth, 1997; Yuen,
Landreth, & Baggerly, 2002), Native American parents (Boyer, 2011; Glover &
Landreth, 2000, 2009), African American parents (Sheely-Moore & Bratton, 2010;
Solis, Meyers, & Varjas, 2004), Iranian parents (Alizadeh, Talib, Abdullah, &
Mansor, 2011), Sudanese parents (Lim & Ogawa, 2014), and Jamaican parents
(Edwards, Ladner, & White, 2007). Regarding family structure, researchers have
found significant results using filial therapy with parents of adopted or foster
children (Carnes-Holt & Bratton, 2014; Cornett & Bratton, 2014), single parents
(Bratton & Landreth, 1995), adolescent parents (Sparks, 2010), and with married
couples (Bavin-Hoffman, Jennings, & Landreth, 1996). Researchers have also
presented case studies that reinforce the applicability of filial therapy with a parent
and child who had experienced divorce (Glazer & Kottman, 1994), a single parent
(Ray, Bratton, & Brandt, 2000; Vafa & Ismail, 2009), custodial grandparents
(Bratton, Ray, & Moffit, 1998), and a blended family (Johnson-Clark, 1996).
Regarding presenting concerns, filial therapists have achieved positive results with
parents of children with chronic illness (Glazer-Waldman, Zimmerman, Landreth,
& Norton, 1992; Tew, Landreth, Joiner, & Solt, 2002), children with learning
difficulties (Kale & Landreth, 1999), children with developmental disorders (Beck-
loff, 1997; Sullivan, 2011), children with selective mutism (Garwood, 1999), children
with intellectual disabilities (Boll, 1972), incarcerated fathers (Landreth & Lo-
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4 Cornett and Bratton
baugh, 1998), incarcerated mothers (Harris & Landreth, 1997), parents who were
court-referred for child maltreatment (Walker, 2002), victims of family violence
(Kinsworthy & Garza, 2010; Smith & Landreth, 2003), and nonoffending parents of
children who experienced sexual abuse (Costas & Landreth, 1999; West, 2010).
Filial therapists have also demonstrated the effectiveness of filial therapy in a
variety of formats. Although researchers conducting investigations of the effective-
ness of filial therapy often have used CPRT, which is already a time-limited model
comprised of 10 sessions traditionally delivered in a one-session-per-week format,
several of the research studies noted above used a condensed version of CPRT and
achieved positive results (Bornsheuer-Boswell et al., 2013; Harris & Landreth,
1997; Jang, 2000; Kidron & Landreth, 2010; Smith & Landreth, 2003; Walker, 2002).
Ferrell (2003) conducted a more formal investigation of the effect of delivering
CPRT in a condensed form over four days of training. When comparing this format
to traditional CPRT, the researcher found no significant differences in effectiveness
between the groups, thus providing support for the comparable effectiveness of the
traditional and condensed formats.
Outcomes and Experiences of Participating Children
One area well-documented in the research on filial therapy is the outcomes
with participating children. An added benefit is that many of the studies conducted
by the Guerneys and their colleagues, as well as most conducted by those outside
their team, used some of the same instrumentation, thus allowing greater ease in
comparing and replicating findings. The two main instruments used by these
researchers to measure child behavior problems have been the Filial Problem
Checklist (FPC; Horner, 1974) and the Child Behavior Checklist (CBCL), which
comes in two versions depending on the age of the child (Achenbach & Rescorla,
2000, 2001). The FPC is a self-report instrument completed by parents indicating
the presence and severity of 108 problematic child behaviors. Although the FPC is
not a norm-referenced instrument, L. Guerney and Ryan (2013) note support for its
discriminant validity in being able to differentiate families with varying levels of
problem severity. The CBCL is a standardized, self-report measure of child behav-
ior problems completed by caregivers that yields results regarding whether the child
is demonstrating clinically significant behavior problems. The CBCL has adequate
reliability, supported by average test–retest reliability coefficients of .85 and .88 and
average cross-informant agreements of .61 and .59 for the preschool-age and
school-age versions, respectively (Achenbach & Rescorla, 2000, 2001). In addition,
the CBCL possesses strong validity, as indicated by analyses supporting its content,
criterion, and construct validity (Achenbach & Rescorla, 2000, 2001).
Improved child adjustment, as measured by decreased problematic behaviors
on the FPC, was a consistent finding in the earliest filial studies (Dematatis, 1981;
L. Guerney & Stover, 1971; Lebovitz, 1983; Oxman, 1971; Sywulak, 1977), and
Sensué (1981) found that the children maintained these improved behaviors over
time. In addition to the studies investigating child adjustment, researchers conduct-
ing early studies of children in filial therapy also reported improved social adjust-
ment (Boll, 1972), personality adjustment (Payton, 1980), and behavior that more
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5A Golden Intervention
closely approximated what their parents considered as representative of an “ideal
child” (Oxman, 1971).
Other researchers conducting studies using FFT have also found improvements
related to participating children. Johnson-Clark (1996) conducted a rigorous study
of 52 mother–child pairs using a different measure of child behavior problems and
also found statistically significant improvements in child behavior when comparing
the treatment group with a play-only group and a no-treatment control group. In a
study of FFT with two families of children with selective mutism, Garwood (1999)
found that parents experienced their children as more adaptable, more autono-
mous, and less selectively mute. A case study of using FFT with a 4-year-old child
and her parents revealed parental reports of decreased temper tantrums and
greater control of emotions (Packer, 1990).
Outcome research regarding the effects of CPRT on participating children has
also often revealed positive changes. Multiple controlled outcome research studies
have demonstrated that parents trained in CPRT reported statistically significant
decreases in child behavior problems, as measured by either the FPC or CBC
(Bratton & Landreth, 1995; Carnes-Holt & Bratton, 2014; Ceballos & Bratton,
2010; Grskovic & Goetze, 2008; Harris & Landreth, 1997; Jang, 2000; Kidron &
Landreth, 2010; Sheely-Moore & Bratton, 2010; Smith & Landreth, 2003; Tew et
al., 2002; Villarreal, 2008; Yuen et al., 2002). Although notably less in number, some
researchers have not observed statistically significant improvement in behavior
(Beckloff, 1997; Costas & Landreth, 1999; Ferrell, 2003; Kale & Landreth, 1999;
Kellam, 2004; Ray, 2003). However, when taking a holistic view of the research
conducted thus far, the general trend supports the notion that filial therapy tends to
have a positive impact on the behavior of children. Researchers have also examined
the effect of CPRT on the self-concept of children, with findings from two studies
indicating a statistically significant improvement (Landreth & Lobaugh, 1998; Yuen
et al., 2002) and two others indicating no statistically significant improvement
(Costas & Landreth, 1999; Glover & Landreth, 2000).
Several researchers have also reported noteworthy findings using qualitative
examinations regarding the experiences of children in filial therapy. Several qual-
itatively-based research studies, each involving multiple parents, have found that
CPRT-trained parents reported experiencing their child’s behavior as improving
(Bavin-Hoffman et al., 1996; Bornsheuer-Boswell, Garza, & Watts, 2013; Edwards,
Sullivan, Meany-Walen, & Kantor, 2010; Garza et al., 2009; Lim & Ogawa, 2014;
Lindo, Akay, Sullivan, & Meany-Walen, 2012; West, 2010). In an extensive ethno-
graphic study of CPRT using three parents and their children, Lahti (1992) found
that parents reported experiencing that their children exhibited increased respon-
sibility for their behavior, improved communication, decreased aggressive and
withdrawn behaviors, and increased happiness. Two separate qualitative studies of
individual parents who completed CPRT found that they experienced their children
as having greater self-confidence (Edwards et al., 2007; Solis et al., 2004). Steen
(2005), using a collection of case studies of filial therapy with seven parents who had
a child with a life-threatening illness, found that parents reported experiencing their
children as more confident, more cooperative in the hospital, more communicative
with parents and staff regarding medical issues, and more communicative with
parents regarding personal feelings and concerns. In a qualitative study of six
mothers, Foley, Higdon, and White (2006) noted that parents reported experienc-
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6 Cornett and Bratton
ing that their children displayed more empathy and cooperation, used some of the
same play therapy skills and attitudes that parents were using in play sessions, and
were more responsible and self-directed.
Outcomes and Experiences of Participating Parents
Many researchers investigating the effect of filial therapy on participating
children also included outcome measures aimed at measuring potential changes in
participating parents. Researchers conducting investigations on the effect of filial
therapy on parents have frequently included one or both of the following: the
Porter Parental Acceptance Scale (PPAS) (Porter, 1954), a 40-item self-report
measure of a parent’s acceptance of a child, and the Measurement of Empathy in
Adult-Child Interactions (MEACI) (Stover, Guerney, & O’Connell, 1971), an
observation instrument that assesses the degree to which parents demonstrate
empathic behaviors toward their children during play sessions. The PPAS reflects
adequate reliability, as indicated by a split-half reliability correlation of .76, and
content validity was supported by all items reflecting majority agreement by at least
three of five expert evaluators (Porter, 1954). Reliability for the MEACI is sup-
ported by protocol that stipulates that observers obtain a certain degree of inter-
rater agreement before data is considered reliable (Stover, Guerney, & O’Connell,
1971).
Early filial therapy research revealed statistically significant improvements in
parental acceptance (Sywulak, 1977; Dematatis, 1981) that parents maintained over
time (Sensué, 1981). In addition, early researchers repeatedly found statistically
significant improvements in one or more of the empathic behaviors of parents
trained in filial therapy (Dematatis, 1981; Guerney & Stover, 1971; Lebovitz, 1983).
Using another parent outcome measure, Payton (1980) found statistically signifi-
cant improvement in maternal child rearing attitudes. Informal reports collected by
Sywulak (1977) indicated that parents perceived themselves as more self-aware,
patient, self-confident, and better at communicating as a result of training in filial
therapy. Packer (1990) found in her intensive case study that the parents reported
gaining more parenting skills and perceiving themselves as having an enhanced
ability to use these skills to promote positive changes in their child’s behavior.
More recent studies conducted by researchers using FFT have also found
changes related to parents. For instance, Johnson-Clark (1996) found that filial-
trained parents reported statistically significant decreases in parental rejection, a
finding stable at a 2-month follow-up testing. In an intensive case study of two
families, Garwood (1999) found that parents experienced themselves as more
empathic and firmer in limit-setting, as well as experiencing increased parental
competence and nurturance and decreased parenting stress.
Researchers conducting studies of the effects of CPRT on parents have found
similar results, replicating these findings in numerous studies. Multiple controlled
outcome research studies have revealed that parents trained in CPRT reported
statistically significant increases in parental acceptance as measured by the PPAS
(Bratton & Landreth, 1995; Chau & Landreth, 1997; Costas & Landreth, 1999;
Ferrell, 2003; Harris & Landreth, 1997; Kale & Landreth, 1999; Landreth &
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7A Golden Intervention
Lobaugh, 1998; Lee & Landreth, 2003; Ray, 2003; Sparks, 2010; Tew et al., 2002;
Yuen et al., 2002). Only one controlled outcome study on CPRT did not find a
statistically significant improvement in parental acceptance (Beckloff, 1997). In
addition, CPRT researchers have found statistically significant increases in the
empathic responses of parents as measured by the MEACI (Bratton & Landreth,
1995; Carnes-Holt & Bratton, 2014; Chau & Landreth, 1997; Costas & Landreth,
1999; Ferrell, 2003; Glover & Landreth, 2000; Harris & Landreth, 1997; Jang, 2000;
Kidron & Landreth, 2010; Lee & Landreth, 2003; Smith & Landreth, 2003; Sparks,
2010; Yuen et al., 2002). Using other parent outcome measures, Grskovic and
Goetze (2008) found that parents reported statistically significant improvements in
displaying a positive attention parenting style compared with a control group of
parents receiving another intervention.
Researchers conducting qualitative investigations of the experiences of parents
in CPRT have further highlighted the personal changes parents have noted. The
most frequently occurring experience noted in parents’ reports across qualitative
studies was an increased awareness of the feelings or needs of their children
(Edwards et al., 2007; Foley et al., 2006; Kinsworthy & Garza, 2010; Lahti, 1992;
Lindo et al., 2012; Solis et al., 2004; Wickstrom, 2009). Another common experience
was increased parental confidence or competence (Foley et al., 2006; Garza et al.,
2009; Grskovic & Goetze, 2008; Lahti, 1992; West, 2010; Wickstrom, 2009). Several
researchers have reported that parents indicated experiencing improved parenting
knowledge, skills, or styles (Edwards et al., 2010; Lindo et al., 2012; Kinsworthy &
Garza, 2010; Solis et al., 2004; West, 2010). Researchers have also found parents
have reported experiencing increased empathy (Grskovic & Goetze, 2008;
Kinsworthy & Garza, 2010; Wickstrom, 2009) and increased acceptance of their
children (Grskovic & Goetze, 2008; West, 2010; Wickstrom, 2009). Other replicated
findings were feeling less responsible for and controlling of the behavior of their
children (Kinsworthy & Garza, 2010; Lahti, 1992; Wickstrom, 2009), increased
feelings of support (Foley et al., 2006; Kinsworthy & Garza, 2010), and increased
understanding of their children (Foley et al., 2006; Grskovic & Goetze, 2008).
Isolated results included increased self-awareness, patience, and resourcefulness
(Foley et al., 2006); changed expectations of children, decreased reactivity, and
decreased rescuing behaviors (Wickstrom, 2009); increased vulnerability (West,
2010); more realistic expectations of self (Kinsworthy & Garza, 2010); and de-
creased feelings of frustration related to parenting (Garza et al., 2009).
Outcomes and Experiences Related to Parent-Child Relationships
It seems reasonable to assume that the extensive changes reported in parents
and children in filial therapy both reflect and contribute to changes in these
parent–child relationships. Researchers have specifically examined the effect of
filial therapy on the parent–child relationship, primarily through qualitative anal-
yses of information gathered during and after treatment. Although early research
studies did not include formal assessments of the parent–child relationship, Sywu-
lak (1977) reported that parents in her study indicated improved parent–child
relationships as a result of filial therapy, specifying greater closeness, warmth,
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8 Cornett and Bratton
openness, positivity, and less tension. Garwood’s (1999) in-depth case study of two
families also found that parents reported closer parent–child relationships. Based
on their case study with a single mother, Vafa and Ismail (2009) observed improve-
ments in the parent–child relationship, and reports from the mother corroborated
their observations.
Several researchers studying the effect of CPRT on the parent–child relation-
ship have used a quantitative outcome measure, the Parenting Stress Index (PSI;
Abidin, 2012). The PSI is a standardized instrument, with demonstrated support for
its reliability and validity, that evaluates the degree of stress in the parent–child
relationship (Abidin, 2012). Most researchers conducting controlled outcome re-
search studies of CPRT have found statistically significant decreases in parent–
child relationship stress as measured by the PSI (Bratton & Landreth, 1995;
Carnes-Holt & Bratton, 2014; Ceballos & Bratton, 2010; Chau & Landreth, 1997;
Costas & Landreth, 1999; Kale & Landreth, 1999; Kidron & Landreth, 2010;
Landreth & Lobaugh, 1998; Lee & Landreth, 2003; Sheely-Moore & Bratton, 2010;
Tew et al., 2002; Yuen et al., 2002). A smaller number of researchers have not
observed statistically significant reductions (Ferrell, 2003; Glover & Landreth, 2000;
Kellam, 2004; Ray, 2003; Sparks, 2010).
All researchers performing qualitative analyses involving CPRT have noted
that parents reported experiencing improvements in their parent–child relation-
ships (Bavin-Hoffman et al., 1996; Bornsheuer-Boswell et al., 2013; Edwards et al.,
2007; Edwards et al., 2010; Foley et al., 2006; Garza et al., 2009; Kinsworthy &
Garza, 2010; Lahti, 1992; Lim & Ogawa, 2014; Lindo et al., 2012; Sangganjana-
vanich et al., 2010; Solis et al., 2004; West, 2010; Wickstrom, 2009). One of the most
common reports from parents identified in qualitative studies was improved par-
ent–child communication (Bavin-Hoffman et al., 1996; Garza et al., 2009; Lahti,
1992; Solis et al., 2004; West, 2010). In addition, multiple researchers have found
that parents reported experiencing increased closeness with their children (Ed-
wards et al., 2007; Kellam, 2004; West, 2010). Isolated results included experiences
of increased enjoyment (Foley et al., 2006), increased warmth (Garza et al., 2009),
more collaboration between parent and child (Foley et al., 2006), less friction
(Lahti, 1992), and increased respect for the parent–child relationship (Kinsworthy
& Garza, 2010).
Outcomes and Experiences Related to Family Functioning
The substantial amounts of research regarding the effects of filial therapy on
individuals and parent–child relationships make sense given the conceptual impor-
tance of these domains within this treatment approach. Although investigators have
conducted little research to date regarding the effect of filial therapy on family
functioning, the results to date are promising.
Qualitative studies conducted by Bavin-Hoffman et al. (1996), Lahti (1992),
and Wickstrom (2009) have resulted in reported experiences that are suggestive of
potential changes occurring in the family as a whole. In interviews with 20 married
couples who participated in CPRT, Bavin-Hoffman et al. (1996) found that partic-
ipants reported improved family interpersonal communication skills, specifically
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9A Golden Intervention
improved parent–child communication and improved partner communication. In
addition, these couples reported increased marital unity and indicated that their
families valued the filial therapy experience. Lahti’s (1992) ethnographic study of
three CPRT-trained parents also found reports of closer marital relationships.
Using a sample of eight parents trained in CPRT, Wickstrom (2009) found that
parents identified “four relational shifts” as a result of treatment, which included
“improved parent–child relationships, improved marital relationships, improved
sibling functioning, and improved family of-origin relationships” (p. 199).
Two studies on filial therapy have included a quantitative measure of family
functioning. To measure the impact of CPRT on the family environment, Glass
(1986) used the Madanes Family Hierarchy Test (MFHT; Madanes, Dukes, &
Harbin, 1980), the Family Environment Scale (FES) short form (Moos, 1974), and
the Children’s Version of the Family Environment Scales (CVFES; Pinos, Simons,
& Slawinowski, 1984). Glass found that families who participated in CPRT re-
ported some improvements in their family environment. In a more recent study,
Cornett and Bratton (2014), using self-report and observational measures based on
the Circumplex Model of Family Systems (Olson, 2000, 2011), found seven of eight
families who had a parent and child participating in CPRT reported statistically
significant improvements in their family functioning. In addition, seven of the
families reported improvements in family satisfaction, four families noted increases
in family cohesion and family communication, and one family noted improved
flexibility. Observational measures indicated that five families improved in their
flexibility, and four families improved in their family cohesion and family commu-
nication.
SUMMARY AND FUTURE DIRECTIONS
As summarized in this review of the research literature, researchers investigat-
ing filial therapy have found strong results that support its general effectiveness
when applied to a variety of populations, family structures, and presenting concerns
as well as when applied in condensed formats. In particular, researchers have
discovered strong empirical support for beneficial outcomes and experiences of
filial therapy for participating children and parents, particularly in decreasing child
behavior problems and increasing parental awareness of and sensitivity to chil-
dren’s feelings and needs. In addition, parent–child relationships also appear to
reflect significant improvements, particularly in decreasing relationship stress. The
potential benefit of filial therapy for family functioning has also received initial
support based on the research conducted thus far.
Based on our review of the research to date on filial therapy, it appears evident
that large portions of the research on filial therapy, particularly more recent studies,
have tended to use qualitative methodology and smaller sample sizes. Although
such research offers undeniable benefits in providing more individualized and
in-depth perspectives of the experiences of those receiving filial therapy, more
studies relying on quantitative measures and control or comparison groups are
needed. In addition, as noted throughout the article, many of the research studies
have used similar instrumentation. This has provided benefits in terms of comparing
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10 Cornett and Bratton
and synthesizing studies within the professional literature on filial therapy; how-
ever, added benefits could be realized in using alternative instrumentation that
measures different constructs within the domains that have been explored thus far
(child functioning, parental functioning, and relationship functioning). Continued
integration of data from observational assessments, in addition to self-report in-
struments, would also strengthen the research base on filial therapy. In addition,
exploring and adapting instrumentation used in other therapeutic modalities aimed
at intervening within the parent–child relationship would allow for basic compar-
ative analyses. Controlled outcome research concentrated on specific populations
and presenting concerns, in which researchers compared filial therapy with other
modalities with empirical support (e.g., PCIT), would be highly beneficial.
The current status and possible future directions of filial therapy research
accentuates how far filial therapy has advanced in 50 years. The powerful research
conducted to date provides support for what once existed as bold and largely
theoretical contentions advocated by Guerney (1964) five decades ago: that parents
can serve as therapeutic agents in the lives of their children, that parents and
children can experience significant positive changes in filial therapy, and that
changes in the parent–child relationship can serve as a potent initiator of that
growth. Our hope is that play therapists using filial therapy would be emboldened
and encouraged by this research evidence while also being inspired to continue the
task of solidifying and extending the research on this approach. Such work would
serve as an ongoing as a testament to the impact that filial therapy has had,
continues to have, and will have in the lives of children, caregivers, and their
families.
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Received August 14, 2014
Revision received December 17, 2014
Accepted January 22, 2015 䡲
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