Efficacy of Family / Systemic Constellation Therapy in the General Population. A Randomized Wait-list Controlled Trial
Phase: NA
Conditions: Mild to Moderate Psychopathological Symptoms
Sponsor: Károli Gáspár University of the Reformed Church in Hungary

Efficacy of Family Constellations in the General Population (NCT05051462) 
 
Methodology, Statistical Analysis Plan, & Consent Form 
Approved: Feb 25, 2021 
 
Design and procedure 
The study will be a randomized, waitlist-controlled trial. Considering the non-diagnosis-
specific nature of the intervention, the a priori selected primary outcome will be general 
(non-diagnosis specific) psychopathology. The 80 participants will be randomly 
assigned in a 1:1 ratio to attend a systemic/family constellation seminar either in the 
intervention group or in the waitlist control group, the members of which will be 
offered the same intervention after completing the 2nd follow-up questionnaire 
(approximately 6 months after the baseline assessment). The assessment protocol will 
include a pre-intervention assessment, a follow-up approximately 4 weeks after the 
intervention, and finally six months post-intervention.   
The G-Power software (Faul et al., 2009) was used for a priori power analysis. The 
results for repeated measures mixed-design analysis of variance (ANOVA) suggested 
that a total sample size of 78 participants (39 participants per study arm) will be 
sufficient to detect a medium effect (cf. Hedges’ g of 0.531 reported in a relevant meta-
analysis) for the primary outcome variable, that is, non-diagnosis specific 
psychopathology with a power of 80% at a significance level of .05.   
The random sequence assigned to participants will be generated by a professional 
outside of the study team, using the Research Randomizer web-based application 
(https://randomizer.org). Due to the nature of the intervention, blinding for either 
intervention providers or participants will not be possible. 
Participants 
Participants of the study will be recruited in Hungary via paid social media 
advertisements targeting the capital (considering the location of the participating 
intervention providers). Inclusion criteria will be being at least 18 years old and 
willingness to participate in a family/systemic constellation seminar on a date 
determined by the randomization process but no other date during the study period. 
Exclusion criteria will be current mental disorder diagnosed by a healthcare professional 
and recent (<1 year) prior participation in a family/systemic constellation seminar in 

another setting. Beyond the opportunity to participate in the intervention free of charge, 
participants will be offered a small financial compensation (total of HUF 5,000; 
equivalent to 4.5 hours of work at before-tax minimum hourly wage at the time) for 
their time in relation to completing the three fully online study questionnaires. All 
participants will give their written informed consent upon enrollment.   
Given that family/systemic constellations are hardly ever prescribed in any setting, we 
will focus on the effect of participation in the intervention (per-protocol analysis) 
instead of the effect of assignment to intervention (intention-to-treat paradigm). 
Significant efforts will be made to encourage participants to complete the 
questionnaires at both follow-up assessment points (two follow-up emails, three 
attempted phone calls, and finally a text message to the participant’s cell phone).  
Intervention and providers 
The intervention will be administered in a group setting in which approximately 15-25 
participants, unknown to each other, will meet for a one-time, 2-to-3-day, facilitator-led 
workshop. Each constellation will start with a brief interview between the ‘active’ client 
(‘issue holder’) and the facilitator to clarify the individual’s goal with the intervention. 
This will be followed by a decision about which members/elements of the client’s 
(inter)personal system will play a significant role in the issue presented, and these will 
be represented by other group members during the constellation. The representatives 
(including the client’s representative) will be positioned in the room by the client 
initially, with spatial distances, angles, and body postures meant to correspond to the 
client’s inner image of the system (“problem constellation”). This will allow the 
facilitator to identify the dynamics beneath the client’s presenting concern, while at the 
same time help the client reflect on their internal experience from a more objective, 
partially external point of view (as they will be observers and not participants of their 
constellation at this point). This part of the process will be largely non-verbal, focusing 
on what participants will begin to experience as being part of the structure created by 
the active client.   
Next, the representatives will be asked by the therapist about their physical sensations, 
feelings, and thoughts they have while in their positions. Rearrangements, spatial 
adjustments, and brief, ritualized conversations will be made based on the principles of 
healthy functioning within a system until a constellation is identified that offers a 
resolution or relief for the client who at this point might enter and actively engage in 
the constellation if they feel ready to do so. Ideally, this “solution constellation” will 
provide a new, more adaptive framework for the client to feel, think, and behave in the 
given system.   

Adherence to a previously developed intervention protocol will be evaluated by 
observers from the study team who will be independent of the clinicians providing the 
intervention. The manual will consist of 19 procedures, eight obligatory elements for 
the workshop in its entirety, as well as seven obligatory and four optional items for the 
individual constellations focusing on a given client. Overall treatment integrity will be 
calculated as the percentage of completed treatment components defined by the 
manual. 
Measures 
To assess sociodemographic characteristics, questions will be administered to assess 
participants’ gender, age, relationship/marital and employment status, as well as 
educational attainment. Respondents will also be asked at baseline about their prior 
experience with systemic constellations and at both follow-ups whether they 
participated in constellation seminars outside of the study context (to assess study 
protocol violation). Free-text questions will also be asked to explore – both positive and 
negative – intervention effects from the participants’ perspective.   
The Hungarian version of the Brief Symptom Inventory will be used to measure an 
individual’s overall psychopathology level. This tool consists of 53 items covering 9 
symptom dimensions: Somatization, Obsessive-compulsive symptoms, Interpersonal 
sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, and 
Psychoticism. As a global measure of pathology and distress, the General Severity Index 
(GSI, mean of all items) will be used in the present study. 
The Hungarian version of the SCOFF screening test will be used to measure non-
disorder-specific risk level for eating disorders. This assessment tool consists of five 
yes-or-no type questions assessing eating disorder symptoms or risk factors. At least 
two positive answers (score of 2) indicate a high likelihood of an eating disorder. 
The Generalised version of the Screener for Substance and Behavioral Addictions 
(SSBA-G) will be used to assess addiction severity. The SSBA-G is a 8-item screening 
tool measuring functional impairment resulting from both substance and behavioural 
addictions. It covers four addiction characteristics (excessive involvement, loss of 
control, compensatory function, and associated problems in important life domains) 
and measures addiction severity through a general description for substance-related (4 
items) and behavioural addictions (4 items). 
The Hungarian version of the EXIS.pers will be used to assess the subjective 
experiences of the individual in their personal social system (e.g. family, circle of 
friends). This 12-item scale covers four dimensions in relation to 1) belonging (a sense 

of being part of a given social system; 2) autonomy (ability to demark boundaries based 
on the belief that the renegotiation of roles, rights, and responsibilities is possible); 3) 
accord (acceptance of one’s social system the way as it is); and 4) confidence (trust in 
the individual’s and their social system’s ability to cope with emerging difficulties). 
The Hungarian version of the Meaning in Life Questionnaire will be used to assess 
meaning in a respondent’s life as an eudaimonic wellbeing indicator. The scale consists 
of 10 items; five items measuring Presence of Meaning, while the other five capturing 
Search for Meaning. The Hungarian 5-item version of the WHO Well-being Index will 
be used to measure participants’ overall subjective well-being as a hedonic indicator of 
wellbeing. Finally, the Hungarian version of the 5-item Satisfaction with Life Scale will 
be used to measure global life satisfaction. 
Data analysis 
All analyses will be carried out using SPSS for Windows, Version 28. Baseline 
characteristics of study completers versus drop-outs as well as study arms will be 
compared using independent sample t-test (continuous variables) and the chi squared 
(categorical variables) test. Effect size will be expressed using Cohen’s d (t-test) and 
Cramer’s V (chi squared test). Repeated measures ANOVAs will be conducted to 
investigate the effect of the interaction between time and study group, considering all 
three assessment points. Post hoc analyses from these ANOVAs will be used to 
investigate within-group differences over time. In the omnibus analyses, effect size will 
be expressed by eta squared, while in the post hoc tests, Cohen’s d will be used to 
express effect size. 
 
 

Consent form 
(Translated from Hungarian, official language of the study) 
 
Dear Interested Participant, 
Below you will find a summary of the purpose, methods, and the benefits and risks 
associated with participating in our research on the efficacy of family constellations. We 
are aware that this document is not brief, but we kindly ask that you carefully study the 
entire text to make an informed decision about your participation. 
PURPOSE OF THE STUDY 
The purpose of our research is to better understand the mid-term effects of family 
constellations, including both positive and potential negative outcomes. The study will 
be led by two clinical psychologists who are independent of the professionals facilitating 
the family constellation sessions (also mental health professionals with doctoral 
degrees). The study has been approved by the Research Ethics Committee of the 
Institute of Psychology at Károli Gáspár University (approval number: XXXX). 
WHAT DOES PARTICIPATION IN THE STUDY INVOLVE? 
The study involves the completion of three questionnaires: the first before the family 
constellation, the second 3-4 weeks after the family constellation, and the third six 
months after the family constellation. Participation in the study is voluntary and can be 
discontinued at any point. As compensation for the effort involved in completing all 
three questionnaires, you will be entitled to: 1) participate for free in a family 
constellation weekend with one of the psychotherapists involved in the research; 2) 
receive a payment of 5000 HUF (either in cash or by e-transfer) for completing all three 
questionnaire sets; and 3) receive information about the aggregated data and results 
after the study is completed. 
By completing the questionnaires, you are also consenting to the use of your data in an 
anonymous and aggregated manner (with no individual identification) for statistical 
analysis, and for publication in a scientific format. All data you provide will be handled 
with strict confidentiality and will not be disclosed to any third party, except for the 
administrative assistants in the study (two psychology students under the supervision 
of the investigators). Your contact details (phone number, email) will be destroyed after 
the study is concluded. 
 

WHAT HAPPENS DURING A FAMILY CONSTELLATION WORKSHOP? 
Family constellations are a form of group psychological counseling aimed at 
uncovering, understanding, and potentially modifying family patterns and repetitions. 
Participants come to the group with personal or psychological issues they are willing to 
share with the group leader and fellow group members. Using the family constellation 
method, the group leader works with the help of group members to symbolically 
represent and reframe the main participant's personal issue. A typical weekend session 
includes 16-20 participants, and everyone will have the opportunity to be the "main 
focus" of a constellation while also participating as helpers in other people's processes. 
Each session usually runs from 9 AM to 6 PM both days of the weekend, with a one-
hour lunch break. 
POTENTIAL BENEFITS AND RISKS OF FAMILY CONSTELLATIONS 
There has been little empirical research on the effects of family constellations so far. 
The available data suggest that family constellations are safe, and the vast majority of 
participants retrospectively evaluate the experience positively, with favorable changes 
occurring in one or more areas of their lives (e.g., improved family relationships, 
reduced depressive symptoms, increased self-confidence and self-acceptance). 
At the same time, some participants report a subjective worsening of their condition in 
similar areas, though it is still unclear whether this is directly related to their participation 
in family constellations or due to unrelated external events (e.g., losing a job, the death 
of a family member). The primary goal of the study is to learn more about these effects; 
therefore, it is important that participants complete all three questionnaires. If you, as a 
participant, feel that the family constellation leads to negative consequences in your life 
that you have difficulty handling alone, the study leaders are committed to providing 
psychological support to you during this process. 
WHO ARE THE GROUP LEADERS PARTICIPATING IN THE STUDY? 
Dr. Mária Angster: Clinical psychologist, psychotherapist 
She currently leads family constellation groups with more than 20 years of experience. 
She is also involved in the teaching and research of family constellations and has 
published several books, book chapters, and articles on the topic. 
Dr. Edit Jakubovits: Anesthesiologist, hypnotherapist, psychotherapist, family 
constellator 

She is currently an assistant professor at the Institute of Psychology at Károli Gáspár 
University and has been running a private psychology practice for over 15 years, 
working with both individuals and groups. 
WHO ARE THE INVESTIGATORS? 
Dr. Barna Konkolÿ Thege: Clinical and research psychologist at a Canadian psychiatric 
hospital (Waypoint Centre for Mental Health Care) and assistant professor at the 
Department of Psychiatry at the University of Toronto. He is a member of several 
academic journal editorial boards. His main research areas are addiction, psychological 
measurement, psychosomatics, and the effectiveness of family constellations. 
Dr. Gergely Sándor Szabó: Health psychologist, integrative hypnotherapist, 
psychodrama leader. He is currently an assistant professor at the Institute of Psychology 
at Károli Gáspár University and conducts research. His research areas include altered 
states of consciousness, psychological effectiveness studies, and psycho-oncology. He 
has been providing individual and group counseling for 10 years. 
WHO CAN PARTICIPATE IN THE STUDY? 
The study is open to individuals who are over 18 years old, currently do not suffer from 
a mental disorder diagnosed by a doctor or psychologist, and have not participated in a 
family constellation within the last year. Participants also agree to: 
 participate in a 2-day family constellation workshop, which they will be randomly 
assigned to by the study leaders (possible dates: XX, XX, XX, XX); 
 acknowledge that they cannot choose the specific date for the family 
constellation and must attend the assigned session (the study leaders will notify 
them of the chosen weekend at least one month in advance); 
 acknowledge that they cannot choose between the two designated family 
constellation group leaders; 
 complete the study questionnaire package at the start of the study, one month 
later, and another 5 months after (a total of 3 occasions, each completion takes 
about 30 minutes); 
 not to participate in any family constellation outside the study during the six-
month duration of this study. 
I have understood the information about the research and have decided to participate 
based on this. I also declare that: 
 

 I am over 18 years old; 
 I do not currently suffer from any mental illness diagnosed by a mental health 
professional; 
 I have not participated in a family constellation in the past year; 
 I am able and willing to make myself available on the 2 days assigned to me by 
the study leaders for my participation in the family constellation; and 
 I agree not to participate in any family constellation outside the study during the 
study period. 
Yes □ No □ 
Your name: _________________________________________________ 
Email address: ______________________________________________ 
Phone number: _____________________________________________ 
 
After submitting your application, you will be notified by email about further details. If 
you have any further questions or comments about the research, please feel free to 
contact us. 
 
Dr. Gergely Sándor Szabó, affiliation, contact details 
Dr. Barna Konkolÿ Thege, affiliation, contact details