STUDYING MARRIAGE AND FAMILY THERAPISTS IN THE 21ST CENTURY: METHODLOGICAL AND TECHNOLOGICAL ISSUES

Journal of Marital and Family Therapy, Jan 2005 by Northey, William F Jr

In this article, I present data from two waves of research on demographic characteristics and practice patterns of marriage and family therapists (MFTs) conducted in 2000 and 2002. The research focuses on the methodological and technological issues in studying this population. Specifically, an online survey with MFTs obtained lower response rates and was therefore more expensive relative to phone and mail methods. Questions about evidence-based therapies (EBTs) were asked two different ways with significantly different results based on how the questions were phrased. A discussion of the relative advantages and disadvantages of using different survey methodologies and consideration of issues pertinent to studying EBTs are included.

The internet has significantly changed the way people understand and experience the world. It also has allowed unprecedented access to information and has allowed communication among people in ways never before imagined. The internet has had a significant impact on mental health, the delivery of services, and the way people communicate. For example, Health Insurance Portability and Accountability Act of 1996 (HIPAA) now requires that much of the information exchanged between health care providers and third-party payers be done electronically. Further, the use of e-mail to communicate with clients, colleagues, and others has increased significantly (McDaniel, 2003; Negretti & Wieling, 2001).

Online Surveys

The internet and e-mail have become integral parts of many people's lives. In addition, surveying by telephone has become increasingly more difficult in recent years (Dillman, 2002). Given these realities, in this study, utilization of an online survey was deemed to be an efficient use of the available technology. Online surveys also have the potential to improve dramatically the ways in which research participants are recruited and data are collected. In fact, Murray and Fisher (2002) have argued that the potential costeffectiveness and efficiency of data collection by way of the internet have been overlooked. However, the research to date has been equivocal regarding the effectiveness of internet-based surveys. For example, Schafer and Dillman (1998) achieved identical response rates using an e-mail survey and a traditional mail survey with faculty members, 90% of whom reported using e-mail. Other researchers have obtained lower response rates for web-based surveys when compared to paper-and-pencil surveys (Epstein, Klinkenberg, Wiley, & McKinley, 2002), with some response rates for online surveys as low as 20% (Sills & Song, 2002). However, Epstein and Klinkenberg (2002), relying on participants who regularly use the internet, were able to obtain very good response rates when they used the internet to survey gay and lesbian respondents.

One explanation for the varying response rates in these surveys is how and who were recruited to participate. Dillman, Tortora, and Bowker (1998) point out that the same techniques found to be successful with mail and telephone surveys must be incorporated into online surveys. Schafer and Dillman (1998) suggest that this should include using multiple contacts, personalizing the survey materials, and utilizing mixed modes of contact (mail, phone, and Internet). Further, the relative technological sophistication of respondents and the processing power of their computers must also be considered (Dillman et al., 1998).

Increased Use of Technology

In recent years, use of the internet also has increased substantially among professional organizations and is now an integral part of the communication strategies of most. The American Association for Marriage and Family Therapy (AAMFT) has used e-mail to communicate with its members, created a website that allows members to update their membership information, obtained a plethora of information about the field and services provided by the association, and used the website to receive and evaluate conference abstracts. Such services can be provided at minimal cost.

Given the potential benefit to reach a large number of MFTs, the relatively low cost, and the fact that data had not been systematically collected on the profession to date, assessing the viability of an internet-based data-collection system to study MFTs was a logical choice. As I have pointed out elsewhere (Northey, 2002), there is a dearth of research on mental health service providers in general, and very little on marriage and family therapists (MFTs) in particular (with a few notable exceptions, e.g., Doherty & Simmons, 1996; Nelson & Palmer, 2001; Northey; Simmons, & Doherty, 1995) and nothing on the utility of online surveys among mental health professionals in the literature. It follows, therefore, that if MFTs are using the internet and have been accustomed to providing information electronically, an online survey of MFTs might provide an efficient, cost-effective way to ameliorate the lack of data on this profession.

Evidence-Based Treatments

Evidence-based treatments (EBTs; a.k.a., empirically supported treatments) are models that have been empirically validated, generally in some type of controlled setting. Various groups, including Division 17 of the American Psychological Association (APA) have been working to identify and disseminate these models to improve clinical practice. Although these models have been tested in controlled settings, the dissemination of the models varies considerably. Some have very sophisticated dissemination systems (e.g., multisystemic therapy, Henggeler, Mihalic, Rone, Thomas, & Timmons-Mitchell, 1998; and functional family therapy, Alexander et al., 1998). Others are disseminated in readings, workshops, and other training (e.g., emotionally focused couple therapy, Johnson, 1996; and cognitive-behavioral therapy; Epstein & Baucom, 2002), whereas still others lack any coordinated dissemination. Consequently, how these EBTs are being used and by whom is still very much a mystery.