An updated systematic review on the effectiveness of family constellation therapy

Background Family constellations as system therapeutic individual interventions in a group setting are frequently part of psychiatric, psychological and psychotherapeutic care. They conduce the spatial enactment of relationship structures, particularly in psychosocial conflicts. So far there have been practically no systematic overviews on the effectiveness of these system therapeutic interventions. Objective The aim of this article is to fill this void. Material and methods The systematic literature search (databases: PsycINFO, Embase, MEDLINE, ISI Web of Science, Psyndex, PsycEXTRA, ProQuest Dissertations & Theses, the Cochrane Library, Google Scholar and the database of the German Society for System Constellations: time period: up to April 2020, 6 languages) identified 4199 potentially relevant records, of which the full texts of 69 publications were reviewed for their suitability for further inclusion. Results A total of 14 studies fulfilled the inclusion criteria (11 independent samples; altogether 590 participants, mostly from the general population). Outcome variables showed a high diversity (e.g. self-image, psychopathology, perceived family functioning). Statistically significant improvements after participation in family constellation therapy were reported in 11 studies. The studies showing no significant treatment benefits were of lower methodological quality. In nine studies, iatrogenic effects were investigated and six studies reported minor or moderate negative effects in a small proportion (5-9%) of participants. Conclusion The results are indicative of the effectiveness of family constellation therapy; however, the quantity and overall quality of the evidence is low. Future randomized controlled studies are necessary to reproduce the effects found so far.