Charting as a Multipurpose Treatment Intervention for Family Therapy

This paper discusses the behavior modification technique of charting as a double-bind communication. Though the procedure was initially employed as a step in demonstrating operant conditioning ( 7 ) and later in diagnosis of the antecedents and consequences maintaining undesired behavior ( 8 ), it also proved one of the more powerful therapeutic interventions. Literature reviews on treatment programs for obesity ( 6 ) and behavioral approaches to marital therapy ( 2 ) support this contention. Its efficacy can be explained by integrating the viewpoints of behaviorist and family therapy approaches espoused by Haley ( 4 ) and Weakland et al . ( 9 ). Following are brief case reports in which charting resulted in quick and sometimes dramatic change.     

Medical Family Therapy in a Primary Care Setting: A Framework for Integration

As the profession of marriage and family therapy (MFT), as well as the emerging sub-specialty of medical family therapy (MedFT), continue to grow and evolve within the current healthcare system, the arena of integrated primary care (IPC) presents an ideal environment for professionals who are relationally and systemically inclined. Although there has been a inundation of literature detailing collaborative systems of healthcare, several gaps still exist: (a) a lack of horizontally integrated models (i.e., models that do not target specific diseases or demographic populations), (b) a lack of model utilization regardless of disease trajectory (i.e., decline, stabilization, improvement), and (c) a lack of IPC models explicitly utilizing MedFT/MFTs as the mental health providers within the system. In lieu of these gaps, the authors present a framework for IPC, utilizing MedFTs/MFTs, that is neither population nor disease specific, as well as a model geared towards implementation regardless of disease trajectory. The framework, which was obtained using ethnography of communication, details MedFTs?? interactions with front line medical providers and patients from initial contact through coordination of a shared treatment plan. Recommendations for future research studies incorporating the use of MedFTs in integrated primary care settings are extended in the context of a three world view framework (Peek in Collaborative medicine case studies: Evidence in practice. Springer, New York, pp 25?C38, 2008; Peek and Heinrich in Family Syst Med 13:327?C342, 1995, Integrated primary care: the future of medical and mental health collaboration. Norton, New York, pp 167?C202, 1998).     

A Didactic Course for Family Therapy Trainees

This paper describes the rationale, procedures, and reading materials used in a didactic course included in a training program for family therapists.     

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.     

Bridging Conversations: Discussing the Intra‐professional Relationship between Medical Family Therapy and Family Therapy

This article examines the conceptual and practice relationship between medical family therapy (MedFT) and its parent field, family therapy, with MedFT viewed as the extension of relational sense‐making and understanding into a specific venue; that of medicine. The extension of this relational meaning system into medicine is typified by the ability of the therapist to negotiate and connect three main areas of conceptual difference that often account for conflictual relationships between mental and biomedical healthcare providers: (i) patient and provider conceptualizations of issues and goals, (ii) linear and circular understanding of issues and goals and (iii) consultative and expert positions on issues and goals. Two case examples are offered to describe how these three areas of tension are reconciled in practice.     

Medical Family Therapy for a Woman with End-stage Crohn's Disease and Her Son

Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients (McDaniel, Hepworth, & Doherty, 1992). This is the story of one such patient, her son, and those of us who were the three primary participants on her treatment team. To provide an account that comes closest to the experience itself, we have taken quotes from videotaped sessions and electronic mail communications that occurred throughout the course of therapy. Each provider tells part of the story in his or her own voice. The commentary is provided by Susan McDaniel.     

Group Processes in Family Therapy: a Psychoanalytic Approach

This paper describes a model of family therapy that draws on experiences and theories of psychoanalysis as applied to individuals and groups. It suggests concepts that help to understand and work with the family as a system. A brief example is given to illustrate the effort to engage with the patients' immediate feelings in the session in relation to each other and the therapist.     

Family Therapy with a Multiparental/Multispousal Family

This article examines therapy with a Bedouin-Arab family from the Negev, Israel, which consisted of 69 members: a husband, 8 wives, and 60 siblings. The husband, who lived with his youngest wife, paid little attention to his other wives and their children. There was considerable competition, hostility, and jealousy among the wives; no communication between the co-wives or the children of different wives; and a variety of behavioral and psychosocial problems among family members. I describe the varied strategies and systems involved in family therapy. The main strategies were to establish good relationships among the co-wives and to build a coalition among them, including the youngest wife, through group therapy in a medical clinic. A secondary strategy was using the children's problems to get the husband involved in the therapy. With improvement of the children's functioning, and with reduced intra-subfamily hostility, the husband's relationships with his children and wives improved.     

Behavior Therapy in a Family Context: Treating Elective Mutism

This paper discusses the necessity of using both behavioral and family approaches in combination, while working with electively mute children. The symptom and its significance within the family system is presented along with a rationale for avoiding the pitfalls of individual approaches with such children. A case history outlining specific behavioral techniques is described in detail with an exploration of the use of reinforcement theory, counter-conditioning, and successive approximations in bringing about change in electively mute children. The need for bringing about changes within the family system so as to maintain the changes that have occurred through use of the behavior techniques is discussed and presented as crucial to the treatment process. The paper takes the position that either approach, by itself, will not be effective in helping electively mute children but that the treatment of choice is a combination of therapeutic techniques.     

Including a Spiritual Dimension in Family Therapy: Ethical Considerations

The inclusion of a spiritual dimension in family therapy theory and clinical practice may well be viewed as an important professional challenge of the nineties. Following a working definition of terms, this paper explores the ethical complexities inherent in operationalizing a spiritual orientation in therapy in light of the following principles adopted from medical ethics: Respect for clients' autonomy, safeguarding clients' welfare, protecting them from harm, and treating them justly and honestly.     

Engaging African Americans in Therapy: Integrating a Public Policy and Family Therapy Perspective

The field of marriage and family therapy faces a growing imperative to reach historically underserved populations. African Americans are a prime example of a minority group in the United States that continues to be underserved by the current mental health system. We integrate Andersen’s (1995, Journal of Health and Social behavior, 36, 1–10) public policy model of health service use with Fox et al. (1995, Journal of Health Care for the Poor and Underserved, 6, 434–468) revision of the rural de facto mental health services model (Regier and Goldberg, 1978, Archives of General Psychiatry, 35, 685–693) to develop a more inclusive and culturally sensitive framework that captures salient factors influencing African Americans’ entry into and engagement in therapy. Recommendations for overcoming barriers and suggestions for future research are presented.     

Family Therapy Training: An Evaluation of a Workshop

This article describes the methodology and results of an evaluation of family therapy training workshops. Cognitive skills were measured by written answers about a case history and intervention skills by the rating of videotaped interviews. Improvement was found on both variables, but cognitive and intervention skill levels and development were not related. These results have implications for training and job selection procedures.     

Family Therapy After the Divorce: Developing a Strategy

Family therapy with the whole family after a divorce has taken place provides a unique opportunity for intervention. Though the spouses have legally terminated their relationship, their parenting function remains. However, this reality is often clouded by the emotional conflicts generated by the divorce. Family therapy can be useful in facilitating life in the post-divorce period. A four-part model for intervention is described. The first task is to redefine the family as existentially including all members. Next, generational boundaries are firmed in order to reduce the parentification process, often intensified by the parent's physical absence. Third, the family needs to have a replay of the history of the marriage to correct developmental distortions and offer a changce to mourn the loss of the intact family. Finally, the therapists attempt to facilitate an emotional divorce. A case study is presented to elucidate the manner in which these steps unfold in treatment.