Illness, Family Theory, and Family Therapy: I.Conceptual Issues

This article examines and clarifies controversies about the concept of illness in the field of family therapy. We contend that illness, as traditionally understood in all cultures, is a relational, transactional concept that is highly congruent with core principles of present-day family theories. Family therapists need not buy into a biotechnical, reductionistic reframing of illness as disease. Rather, it is more appropriate to conceptualize and work with illness as a narrative placed in a biopsychosocial context. Such a narrative includes how shared responsibility for coping and for finding solutions can take place, without becoming involved in disputes about causal models.     

Individual,Marital, and Family Therapy

Two therapists have recently suggested that marital therapy is either a shadow of individual therapy (Robert Harper) or eclipsed by family therapy (Jay Haley). We offer an apologia for marital therapy. We suggest that empirical evidence shows that it works. Further, clients often request it and resist a redefinition of marital concerns as individual or family problems. Finally, people value a focus on the marriage because (a) it blends individual rights and communal responsibilities and (b) it is the only voluntary relationship between dyads with the family. We conclude that marital therapy, when requested and appropriate, is legitimate and effective.     

Training Facilities in Marital and Family Therapy

This survey reports the results of a national survey of training programs in family therapy. Two hundred and forty-five programs responded to the survey questionnaire providing data for the development of a master list of training programs and a general assessment of the nature and magnitude of training efforts in the field. The survey included programs housed in diverse institutional settings. The data indicate the extent of growth and the increasing formalization of professional training in family therapy. A classification system is proposed for distinguishing among the major types of facilities providing family therapy training. Programs are compared in terms of the type, duration, and intensity of the training offered and the number of students enrolled.     

Marriage and Family Therapy with Low-Income Clients: Professional,Ethical, and Clinical Issues

Economic stress greatly increases the likelihood of mental health issues occurring within a family. Although this is widely known within the mental health profession, there is a lack of literature that assists therapists in working effectively with low-income clients. As a result, marriage and family therapists may be ill equipped to meet the needs of those in poverty, and may even be conducting therapy that is ethically unsound. The authors of this article discuss several ethical and professional issues regarding therapy with families in poverty. A number of suggestions are presented for improving the effectiveness of therapy with low-income clients. Michele E. Grimes and Alyssa D. McElwain are masters students in Marriage and Family Therapy at Purdue University Calumet, Hammond, IN. Michele E. Grimes and Alyssa D. McElwain contributed equally to this article.     

The Field of Marital and Family Therapy

This article defines the emergence of marital and family therapy as a distinct clinical discipline and an area of clinical practice. Significant historical developments that shaped the field and the integrative aspects of family systems theory are described. The role of the American Association for Marriage and Family Therapy in professional credentialing and state and federal advocacy is reviewed, along with the contributions of the Commission on Accreditation for Marital and Family Therapy Education. These areas of development set the stage for recommendations for further interdisciplinary collaboration among the mental health disciplines.     

Gender Dilemmas and Myth in the Construction of Marital Bargains: Issues for Marital Therapy

Marital therapists are regularly confronted with issues of equality and fairness when working with couples. This article examines the social-contextual factors that influence couples' negotations about these issues. A common solution for couples, "the myth of equality," is identified, together with the processes that maintain it. The role of the therapist in relation to gender equality is addressed.     

A Developmental, Conceptual Premise for Family Therapy

The article describes an hypothesis about the staging of the development of the family system for use in diagnostic understanding and treatment planning with families.     

Problem Definition in Marital and Family Therapy: A Qualitative Study

This paper describes findings from a grounded theory study on the process of constructing problem definitions by marital and family therapists. Coding of the observations and interviews resulted in two meta-problem definition processes. In the first meta-process clinicians kept their definitions internal to themselves during the therapy session. In contrast, the second meta-definition process involved clinicians bringing forth their internal problem definitions and incorporating them into the therapeutic conversation. Implications for existing conceptualizations and marital and family therapy practice and supervision are discussed, as well as suggestions for further consideration.     

Team Family Therapy Training: Conceptual and Pragmatic Considerations

This paper presents a family therapy training model that can be used to teach conceptual and executive skills to beginning therapists in community and academic settings. The model is based on the organization and philosophy of family therapy teams and the methods of live supervision. The goals, structure, and leadership of traditional family therapy teams are discussed and contrasted with the proposed team training model. Pragmatic details of the training program are described and advantages and disadvantages explored. Team leadership skills are categorized by context and future directions proposed.     

A Conceptual and Empirical Basis for Including Medical Family Therapy Services in Cancer Care Settings

Psychosocial interventions in oncology settings have largely been individually and group-based despite evidence that a family-based approach fills a treatment gap in the cancer care experience. Medical Family Therapists are trained to address the family as the unit of treatment and provide services that consider family dynamics, reorganization of couple and family roles, and broader systemic issues. This article describes the conceptual bases for Medical Family Therapy services provided in cancer care settings, and reviews research on their implementation and effectiveness. Following a review of the literature, recommendations for studying the effectiveness and efficacy of MedFT in cancer care treatment are detailed.     

Understanding Forgiveness as Discovery: Implications for Marital and Family Therapy

This article explores the concept of forgiveness in relationship systems and examines various conceptualizations and definitions found in the literature. Forgiveness is described as a complex psychological and relational process that is more a discovery than an act of will. A rationale for viewing forgiveness in a contextual, historical, and relational attachment paradigm is presented, and the association of forgiveness with empathy and emotional intelligence is discussed. Marital and family therapists are encouraged to attend to contextual family of origin issues and to facilitate an empathic relational environment where ambivalence is expected and tolerated for enhancing the process of forgiveness. Relevant clinical cases are shared to illustrate the process of forgiveness as discovery.     

Tools and Techniques for Diagnosis and Evaluation in Marital and Family Therapy

This is a slightly edited version of a chapter to appear in a forthcoming book. ¹ It is a beginning attempt at codification of existing tools and techniques and is therefore nonexhaustive. The authors welcome feedback from readers concerning omissions and information on new techniques, references, and applicability to therapeutic settings.     

Medical Family Therapy: A Theoretical and Empirical Review

Medical Family Therapy (MedFT) is a relatively young sub-specialty founded initially at the intersection of Family Therapy and Family Medicine. The purpose of this article is to synthesize and review scholarly literature covering almost 30?years of history, growth, and available research on MedFT. Eighty-two articles that met specific inclusion criteria were reviewed and the literature was categorized into four distinct themes: (a) Emergence of MedFT in the literature; (b) Contemporary MedFT skills and applications; (c) Punctuating the ??family therapy?? in MedFT; and (d) MedFT effectiveness and efficacy research. What was learned was that MedFT is growing so rapidly there is now a need for a current definition, identification of core curriculum standards and competencies for training, as well as a commitment to produce rigorous research on its effectiveness and efficacy. Recommendations to advance efforts across the foci are provided.