Residency training and the later use of marital and family therapy in psychiatric practice

Marital and family therapy training during psychiatry residency was compared to later use, in practice, for 87 psychiatrists. Respondents reported modest to minimal amounts of training in residency but practiced marital and family therapy with a variety of problems, identified a spread of effect to other treatment modalities, and preferred marital and family therapy second only to individual therapy. These results suggest a trend towards incorporating marital and family therapy into psychiatry and also indicate levels of training which must be exceeded in order to achieve basic competency.     

AGING AND FAMILY THERAPY: PREVALENCE OF AGING ISSUES AND LATER FAMILY LIFE CONCERNS IN MARITAL AND FAMILY THERAPY LITERATURE (1986-1993)

To what extent are gerontological issues addressed in the marital and family literature? In answering this question, the authors conducted a content analysis of 873 articles published in the Journal of Marital Family Therapy, Family Process, Family Systems Medicine, and the Journal of Family Psychology during an 8-year period beginning in 1986. Only 3.2% (n = 28) of these articles contained explicit emphasis on aging issues and later life family concerns. Furthermore, there was no significant trend in the number of gerontologically focused articles published during this period. The paper describes the content of the 28 aging-focused articles, including the types of presenting problems mentioned, the relational contexts of these problems, and the types of family therapy theories represented. Included in the content analysis were the proceedings of the annual national conferences of the American Association of Marital and Family Therapy from 1986 to 1993. Only 2.3% (n = 37) of the regular conference sessions had an explicit aging focus, as did 1 of the 29 plenary sessions and 1 of the 40 Master Series® sessions. Used as a gauge of gerontological interest and awareness of late life issues, the implication of these findings is that the family therapy community is still engaged in “comming of age.”     

Unlocking the family secret in family play therapy

Family play therapy combines play therapy with family systems therapy. When family secrets are revealed in a family setting, with play to cushion the family's anxiety, families have the opportunity to resolve long-standing intrapsychic and interpersonal difficulties that impede the psychological well-being of both children and parents. Family play therapy effectively reduces symptomatic behavior in children in an age-appropriate manner—an advantage over family therapy that may be geared to adult cognitive levels. It also gradually shifts the family to a systems perspective of its problems in a non-threatening way, thereby facilitating the child's connection to his or her primary caretakers.Ms. Eaker is a psychotherapist in private practice in Family Systems Theory, and therapist for the United Federation Teachers' Stress Management Program and various Employee Assistance Programs, and a PhD candidate.     

Individual versus family psychotherapy in managed care: comparing the costs of treatment by the mental health professions

In an effort to understand how psychotherapy is practiced in the "real world," outpatient claims data were examined to determine the cost of individual and family therapy provided by marital and family therapists, master's nurses, master's social workers, medical doctors, psychologists, or professional counselors. Claims for 490,000 unique persons over 4 years were obtained from CIGNA. Family therapy proved to be substantially more cost-effective than individual or "mixed" psychotherapy. Physicians provided care in the fewest sessions, marital and family therapists had the highest success (86.6%) and lowest recidivism rates (13.4%), and professional counselors were the least costly. Outcomes were overwhelmingly successful, with 85% of patients requiring only one episode of care.     

LEARNING TO "THINK SYSTEMS": FIVE WRITING ASSIGNMENTS

This paper describes five highly structured writing assignments for teaching family therapy trainees to think in systems terms: 1) Analysis of a communication task; 2) Family assessment report; 3) Family treatment plan; 4) Analysis of a marital or family therapy interview; and 5) Family autobiography. The overall training context in which the assignments are given and ways to prepare students for the assignments are also discussed.     

Family Matters: Research on Family Ties and Health, 2010 to 2020

Family ties have wide-ranging consequences for health, for better and for worse. This decade review uses a life course perspective to frame significant advances in research on the effects of family structure and transitions (e.g., marital status) and family dynamics and quality (e.g., emotional support from family members) on health across the life course. Significant advances include the linking of childhood family experiences to health at older ages, identification of biosocial processes that explain how family ties influence health throughout life, research on social contagion showing how family members influence one another's health, and attention to diversity in family and health dynamics, including gender, sexuality, socioeconomic, and racial diversity. Significant innovations in methods include dyadic and family-level analysis and causal inference strategies. The review concludes by identifying directions for future research on families and health, advocating for a “family biography” framework to guide future research, and calling for more research specifically designed to assess policies that affect families and their health from childhood into later life.     

BOOK REVIEWS

Book reviewed in this article:
McGoldrick, Monica, Pearce, John K. & Giordano, Joseph (Eds.). Ethnicity and family therapy .
Framo, James L. Explorations in marital and family therapy: Selected papers of James L. Framo .
Walsh, Froma (Ed.). Normal family processes .
Haley, Jay. Reflections on therapy and other essays .
Huygen, F. J. A. Family medicine: The medical life history of families .
Bank, Stephen P. & Kahn, Michael D. The sibling bond .
Glick, Ira D. & Kessler, David R. Marital and family therapy (2nd ed.).     

BOOK REVIEWS

Book Reviewed in this article:
Walsh, F. (Ed). (1999). Spiritual resources in family therapy .
Flores, M. T., & Carey, G. (Eds.). (2000). Family therapy with Hispanics: Toward appreciating divesity .
Gerson, M. J. (1996). The embedded self: A psychoanalyitic guide to family therapy .
Madsen, W. C. (1999) Collaborative therapies with multi-stressed clients: From old problems to new futures .
Lerner, H. (1998). The mother dance: How children change your life .
Gottman, J. M. (1999). The marriage clinic: A scientifically based marital therapy .     

BOOK REVIEWS

Book Reviewed in this article:
Fanning, P., & McKay, M. (Eds.). Family guide to emotional wellness: Proven self-help techniques and exercises for dealing with common problems and building crucial life skills.
Leiblum, S., & Rosen, R. (2000) (Eds.). Principles and practice of sex therapy (3rd ed.).
Sturkie, K., & Bergen, L.P. (2001). Professional regulation in marital and family therapy.
Kaslow, F. (Ed.). (2000). Handbook of couple and family forensics: A sourcebook for mental health and legal professionals.     

Family structure,family organization,and quality of family life

This study examines how family organization is associated with the quality of family life for parents in first marriages, remarriages with biological children, and several types of stepfamilies. Data are drawn from the 1987–1988 National Survey of Families and Households; only married couples in which both spouses participated in the survey and who had children under age 19 in the household are considered (N=3,120). Results indicate that respondents in different family structures differ in the perceived quality of parent-child relationships, that differences in family structure are not related to differences in family organization, and that some aspects of family organization are related to marital quality and the quality of parent-chil relationships. Hierarchical multiple regression analyses indicate that family structure and family organization are independently related to the quality of family life. This research was supported by National Institute of Child Health and Human Development Grant R15 HD28198-01. The National Survey of Families and Households was funded by a grant (HD21009) from the Center for Population Research of the National Institute of Child Health and Human Development. The survey was designed and carried out at the Center for Demography and Ecology at the University of Wisconsin-Madison under the direction of Larry Bumpass and James Sweet. The fieldwork was done by the Institute for Survey Research at Temple University. A previous version of this article was presented at the annual meeting of the National Council on Family Relations, Orlando, November 1992. Her research interests include the work/family interface and family policy. She received her Ph.D. from Wayne State University. His research interests include the effects of divorce and remarriage on parents and children. He received his Ph.D. from Ohio State University. Her research interests include adolescents and adoption. She received her Ph.D. from the University of Delaware.     

Qualitative research in family therapy: publication trends from 1980 to 1999

In the early 1990s, scholars from a variety of disciplines encouraged greater inclusion of qualitative research methodology in the mental health field. Moon, Dillon, and Sprenkle (1990) hoped their paper “Family therapy and qualitative research” would serve as a stimulus for further development of qualitative research in the field of family therapy. Ten years later, entering the new millennium, has the field been influenced by recommendations for an increase in use of qualitative methodology in family therapy? A content analysis was conducted on articles published in the marriage and family therapy literature from 1980 to 1999. Of the numerous articles examined in four journals, 131 articles were published using qualitative research methodology. Findings support the contention that qualitative research is increasing, but still accounts for a small number of research articles published in marriage and family therapy journals.     

BOOK REVIEWS

Book reviewed in this article:
Carter, B. and McGoldrick, M. (Eds.). The changing family life cycle: A framework for family therapy
Falicov, C. J. (Ed.). Family transitions: Continuity and change over the life cycle.
Walters, M., Carter, E., Papp, P. and Silverstein, O. The invisible web: Gender patterns in family relationships.
Luepnitz, D. A. The family interpreted: Feminist theory in clinical practice.
Jacob, Theodore. Family interaction and psychopathology: Theories, methods, and findings.
Napier, Augustus Y. The fragile bond: In search of an equal, intimate and enduring marriage.
Solomon, Marion F. Narcissism and intimacy: Love and marriage in an age of confusion.
Fishman, H. Charles & Rosman, Bernice L. (Eds.). Evolving models for family change: A volume in honor of Salvador Minuchin.
Toman, W Family therapy and sibling position.
Hoopes, M. M. & Harper, J. M. Birth order roles and sibling patterns in individual and family therapy.
Kahn, M. D. & Lewis, K. G. (Eds.) Siblings in therapy.
Liddle, H. A., Breunlin, D. C. & Schwartz, R. C. (Eds.). Handbook of family therapy training and supervision.
Weeks, Gerald R., & Hof, Larry (Eds.). Integrating sex and marital therapy.     

MARITAL AND FAMILY THERAPY CERTIFICATION AND LICENSING EXAMINATIONS: ONE MODEL*

The design of the North Carolina Marital and Family Therapy Certification Examination is outlined by its authors to provide a frame of reference for the development of other licensing and certification instruments. The purpose, procedures, resources, guidelines, content, and normative data of the examination are described. The model is offered to stimulate meaningful dialogue on marital and family therapy licensing and certification instrumentation. Guidelines toward the development of a national marital and family therapy examination are also presented.     

THE MARGINALIZATION OF FAMILY THERAPY: A HISTORICAL AND CONTINUING PROBLEM

Family therapy, and marital and family problems, are mariginalized in the larger fields of mental and physical health care, which is a misfortune both for family therapy and for other mental health professions. The early family therapists, who had multidisciplinary backgrounds, attempted toestablish a new, nondisciplinary paradigm and also tried to expand the perspectives of the more traditional mental health disciplines. More recently, family therapists have exerted greater effortsto establish marriage and family therapy as a differentiated, autonomous profession. These alternatives each involve dilemmas for the family therapy field. The positive side of becoming a distinctive profession is greater internal strength and clear professional identy; the downside is the threat of increased marginalization in rlation to the other professions, a tendency toward intellectual isolation, and hence restricted opportunities for invigorating new challenges. Family therapy now needs to develop new modes of interchange, collaboration, and selective integration with otherhealth care professions. Such interchange will be beneficial both to family therapy and to other professions.     

Zig Zagging All Over Again: An Interview with Moshe Lang

Moshe Lang was one of the pioneers of family therapy in Australia. Before establishing Williams Road Family Therapy Centre — which offers a range of therapeutic, teaching and consulting services — he worked for many years at Bouverie Clinic. Moshe has been President of the Victorian Association of Family Therapists, a founder of our national conferences (he also gave the very first Opening Address) and a founder of this journal, later becoming Foundation Chairperson of the Editorial Board. He has taught in most centres in Australia and New Zealand and has published several papers characterised by thoughtfulness, humour and lucid, direct expression. For many years he has espoused the value of story telling as a medium for learning, and the importance of exposing one's work for critical appraisal. These concerns are reflected directly in two sections of this journal — Story Comer and Audio-Video Review. More recently he has co-authored with his wife Tesse a book of stories about his experiences as a therapist, entitled Corrupting The Young and Other Stories of a Family Therapist.     

The spiritual genogram in family therapy

Spiritual and religious issues often surface during marital and family therapy. In this article, I describe a spiritual genogram that is a multigenerational map of family members' religious and spiritual affiliations, events, and conflicts. Used as a tool in family therapy, the spiritual genogram enables clients to make sense of their families' religious/spiritual heritage and to explore the ways in which their experiences impact present couple or family issues.     

Marital Therapy,EMDR, Herman's Model of Recovery from Trauma The Journey of One Woman and Her Family

Judith Herman (1992, page 183) delineates a three stage model of recovery from trauma: 1) Safety, 2) Remembrance and Mourning, 3) Reconnection. She criticises current treatment methods for their failure to make a difference in the “constrictive symptoms of numbing and social withdrawal … and marital, social and work problems do not necessarily improve”. Family therapy has been criticised often for insufficient focus on emotion and general sensations. This case analysis will illustrate how these shortcomings can be successfully addressed with the use of marital counselling and EMDR. The use of multiple treatment approaches contributed to one client's resolution of recent trauma due to a car accident, of past crises due to marital infidelity and early childhood abuse, with significant changes for her in her current family as well as in her family of origin. Theoretical implications for “family therapy” are raised.     

Love attitude and marital adjustment in the family life cycle

The present study examines husband and wife perceptions of attitude toward love and marital satisfaction through seven family life cycle stages. A significant relationship was determined between husbands’ and wives’ attitude toward love and marital satisfaction for couples in the early years of marriage with no children, and for couples with children in the preschool years. Marital satisfaction and attitude toward love seem to function more independently of one another in the other family life stages. Overall, husbands vary slightly more than wives on marital satisfaction and attitude toward love, but the pattern for both is similar in that each relationship is curvilinear.     

Defining the psychomedical and systemic paradigms in marital and family therapy

A framework for defining paradigms within the field of marital and family therapy is presented. The term "paradigm" is critically analyzed as applied to mental health services. Paradigm crisis in marital and family therapy is described as resulting primarily from practical-theoretical, professional, andpolitical concerns rather than scientific anomaly. Subsequently, two paradigms are defined as related to marital and family therapy: the psychomedical and the social systems (systemic) paradigms. Both paradigms are defined according to basic propositions and methodological tenets. The need for, and the design of, critical paradigmatic experiments of the psychomedical paradigm against the systemic paradigm are addressed. Critical paradigmatic experiments are viewed as an offshoot of a postpositivistic empiricism in keeping with a contextual view of knowledge.     

BOOK REVIEWS

Book reviewed in this article:
Nichols, Michael P. Family therapy: Concepts and methods.
Stahmann, Robert F and Hiebert, William H. (Eds.). Counseling in marital and sexual problems:
Anderson, Carol M. and Stewart, Susan. Mastering resistance:
Doherty, William J and Baird, Macaran A Family therapy and family medicine: Toward the primary care of families.
Bagarozzi, Dennis, Jurich, Anthony and Jackson, Robert. Marital and family therapy: New perspectives in theory, research and practice.