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Family systems medicine: The field and the Journal
Abstract
This article will map the territory labeled
family systems medicine. By delineating the boundaries and the contents of the field we will, as well, indicate our intentions as to the contents of this Journal. In attempting to map this new territory, it is as if we were undertaking to describe the borders and terrain features of a continent already discovered and described by many others, but never before conceptualized in quite the same way as a functionally related unit. We hope to show that these important domains of practice, theory, and research, previously viewed as separate entities, are functionally related to each other and that it will be beneficial to take them all together as a conceptual unit. The mapping process changes, indeed becomes an intrinsic part of, the territory being mapped. As clinicians, researchers, and theoreticians come to know of each other's work under the heading
family systems medicine, network building takes place as well, a legitimate reason for undertaking such a venture as this Journal. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... FST may consider a number of elements, including wholeness, interdependence, homeostasis, rules and boundaries, and reciprocal causation (Dore, 2008). In the current study, we focus on two FST elementswholeness and homeostasis (Bloch, 1983). ...
... According to FST, families strive for homeostasis (i.e. balance) and will adjust their dynamics to achieve this (Bloch, 1983). Differential investment in favor of the gifted child may Gifted but Equal? ...
... From the FST perspective, situational equity strengthens the hierarchical relationship between the parental subsystem and the children's subsystem. This assures all the siblings that there is order, and hence stability, within the family (Bloch, 1983). ...
Childhood sibling relationships shape an individual’s interactions throughout life. To date, there have been only a few studies on sibling relationships in families with gifted and non-gifted children, and these have yielded mixed results. Based on the Family Systems Theory (FST) as a conceptual framework, specifically the homeostasis principle, the current study explores how parents in families with gifted and non-gifted children affect sibling relationships. Interviews with 40 parents of gifted children in Israel revealed three higher-order themes: differential equity, artificial equity, and situational equity. From an FST perspective, results suggest a preliminary typology that describes the parental contribution toward rebalanced sibling relationships. Despite good intentions, using artificial and situational strategies could provide unfavorable results for the gifted and the non-gifted children. The proposed typology may contribute toward developing a systemic theory of sibling relationships.
... For example, Dick Auerswald (1968Auerswald ( , 1974Auerswald ( , 1985 long ago argued for an ecosystemic model that took clinicians out of the office and into the community to attend to the broader systemic context. Other issues that were at first contested as outside the domain of family therapy are gaining acceptance and being taught in our programs include: feminism (Hare-Mustin, 1978;Goodrich et al. 1988;Avis 1988); partner violence (Goldner 1985); race (Aponte 1994); incest (Justice and Justice 1979); sexual orientation and gender fluidity (Green 1985); spirituality (Walsh 1999); and the biopsychosocial model (and medical collaborations) (Bloch 1983;McDaniel et al. 1992;Gardner et al. 2006). Topics on social justice, while still challenged, are just recently included in the classroom and voiced in clinical sessions (Combs and Freedman 2012;Hare-Mustin 1994;McGoldrick et al. 1999). ...
... With an increase in financial therapy literature, scholars began writing about considerations for the development of the financial therapy profession (Gale et al. 2012). Through the example of the historical development of the collaborative family healthcare model (Bloch 1983;McDaniel et al.1992), Gale et al. (2012) encouraged and challenged the FTA to consider 10 themes in the development of their financial association. These themes included articulating outcomes of financial therapy, develop a theoretical framework, addressing ethical standards for financial therapy, defining skills and knowledge of this new profession, credentialing, addressing cultural and religious/ spirituals diversity, and being sensitive and responsive to power dynamics between the professional and the client. ...
This paper presents the benefits and potential concerns of integrating financial counseling with systems therapy. Ethical and conceptual issues of cross-disciplinary collaboration are presented. Issues of social inequity and social determinants of health are highlighted to show the need for critical theory and knowledge of economic injustice in order to do cross disciplinary collaboration. Two models: one for cross disciplinary skills implementation and one for professional collaboration are presented. The paper closes with five recommendations for integrating financial therapy and systems theory.
... The journal was founded by Don Bloch in 1983 as Family Systems Medicine. It was heralded as a cutting-edge extension of Western medicine's renaissance in thinking about health as a biopsychosocial and spiritual phenomenon and health care as an interdisciplinary and collaborative enterprise (Bloch, 1983;Cummings, 2002;Ransom, 2002). This collaborationadvanced over the years as collaborative family health care, integrated care, and other versions of these terms-has consistently called for providers to work together and to work with patients, families, and communities to promote and sustain health (Agency for Healthcare Research and Quality [AHRQ], 2013;Peek, 2013). ...
... This collaborationadvanced over the years as collaborative family health care, integrated care, and other versions of these terms-has consistently called for providers to work together and to work with patients, families, and communities to promote and sustain health (Agency for Healthcare Research and Quality [AHRQ], 2013;Peek, 2013). The impetus for the birth of FSH centered on an early and growing awareness of complex and costly problems in health care, including fractionation of delivery efforts in response to somatization, nonadherence, and under-or overutilization (Bloch, 1983;McDaniel & Campbell, 2002). These challenges still exist and call for continued scholarship, education, and practice-based innovations (Peek, 2015). ...
Introduction:
The purpose of this investigation was to review recent publication content and trends in (). How do the journal's articles reflect current and emerging challenges in health care? We hope that our findings can guide special issues and content foci.
Method:
All work published in between 2005 and 2015 was included (n = 452); each piece was coded for article type, general foci, and specific foci.
Results:
The most common type of article published over the 10-year time frame was research reports (43%; n = 195), followed by other types (e.g., tribute pieces, poems), commentaries, conceptual/theory papers, literature reviews, and case studies. The most common general focus included family health and/or functioning (28%; n = 128). The most common specific foci centered on children (15%; n = 55). Common themes found in 's most frequently cited publications included family relationships in care, chronic physical illnesses, and mental health. Marked trends in journal content included increases in articles targeting family health and/or functioning and primary care and decreased attention to theory.
Discussion:
FSH's emphasis on research reports to inform current and evolving interventions that target contemporary health challenges suggests that the journal is keeping stride with the most pressing issues in health care today. Future special issues can continue to serve and meet these needs. FSH's robust inclusion of other article types sustains the journal's mission to advance multiple ways of understanding health-care phenomena. (PsycINFO Database Record
... Die Anfänge Systemischer Familienmedizin liegen im 1926 angelaufenen Peckham Experiment in Südost London (Ransom, 1983 (Minuchin et al., 1975;Weakland, 1977). 1983 wurde mit Family Systems Medicine (heute: Families, Systems, & Health) die führende wissenschaftliche Fachzeitschrift für den Bereich Familienmedizin ins Leben gerufen (Bloch, 1983). Ausgehend von Engels biopsychosozialem Modell formulierte die Gruppe um Susan McDaniel in den 1990ern umfassendere klinische Konzepte zur Medical Family Therapy, wie die Systemische Familienmedizin mittlerweile im angloamerikanischen Raum heißt (McDaniel et al., 2014). ...
Körperliche Krankheit trifft alle Familien, wenn auch in unterschiedlichen Phasen ihrer Entwicklung und unterschiedlich schwerwiegend. Im Zuge alternder Gesellschaften und des medizinischen Fortschritts steigt die Zahl der Familien, die mit chronischen Krankheiten über längere Zeit leben und deren Bewältigung mit anderen Entwicklungsanforderungen (bspw.
im Beruf) balancieren müssen. In der Systemischen Familienmedizin wird das Zusammenspiel der psychosozialen Anforderungen von Krankheit und der Anpassungsfähigkeit der
Familie als entscheidender Faktor für die Bewältigung von Krankheit fokussiert. Der Beitrag stellt Grundprinzipien der Systemischen Familienmedizin, Befunde zu deren Wirksamkeit
und ihre Ausgestaltung in der klinischen Praxis vor.
... ABDnin bazý bölgelerinde aile terapisi ve aile hekimliði uzun yýllar birbirleriyle yakýn olarak çalýþmýþlardýr. Bunun için dürtü sistemik aile hekimliði hareketinin diðer kurucularý (Bloch 1983(Bloch , 1987Doherty ve Baird 1983;Dym ve Berman 1985; McDaniel ve ark.1992; Seaburn ve ark.1993). ...
... net/not.org) and by various health professionals working in Family Medicine (Bloch 1983;. When one health professional treats the person with disabilities as well as the caregivers, that professional is able to monitor the needs of the patient and caregiver and suggest individual and family-based interventions for prevention, respite, and improved management as needed. ...
Caregiving is at the heart of family life. Parents care for children, spouses care for each other, and, when illness or disability occurs, family members care for each other. At least 80 % of primary caregivers for individuals with severe disabilities are family members. Families affected by a disability experience a host of relational opportunities and challenges. In this chapter, we will discuss factors that shape family dynamics in caregiving for individuals with disabilities related to chronic illness, trauma, or congenital conditions and how clinicians, educators, researchers, and policymakers can promote health family dynamics.
... He did not round off the corners to mollify critics or those who felt it was too ambitious. His many editorials in Family Systems Medicine and its successor, Families, Systems, & Health confirm this (Bloch, 1983(Bloch, , 1988a(Bloch, , 1988b(Bloch, , 1988c(Bloch, , 1995b. ...
Don Bloch is the central figure in the origin story for the field of collaborative family health care; the journal Families, Systems, & Health; and for the Collaborative Family Healthcare Association (CFHA). He exerted extraordinary intellectual and practical leadership for all 3. He convened a national working session in 1994 that took stock of the field and set out next steps, one of which was to create the interprofessional organization dedicated to collaborative family health care that is now CFHA.
As part of honoring Don Bloch's contributions to the field and this journal, this article sets out tenets of his original vision and traces next steps toward this vision generated by national groups between 1994 and 2014, showing what is the same or different over these 20 years, and especially what this means for the field going forward.
Precepts of Don Bloch's original vision are drawn from his writings, including the briefing papers he prepared for the national Wingspread group convened in 1994, which also set out next steps for the field. These steps are then compared with next developmental steps for the field generated by CFHA conference attendees in 2004 and again in 2014, after reviewing the history of the organization and the field.
Much of Don Bloch's vision has remained relevant to health care transformation, with a number of areas showing significant accomplishment and acceptance, whereas others remain aspirational, and a few others arguably being more difficult to achieve now than when Don articulated them. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
... Pediatrics probed the family factors that affected the appearance of illness, its course, and its management. Toward the end of the 1960s, family medicine came into being, proudly pledging to appreciate both the role of family factors in health and disease and the complex levels of organization affecting the provision of family medical care-an appreciation that came to be known as the systems approach in medicine (2). ...
The biomedical model of illness, seemingly in its decline 20 years ago, has made a dramatic comeback. Several fields of medicine—among them psychiatry, family medicine, and internal medicine—have edged back toward the biomedical model’s narrower perspective. The increasing use of medication, the profusion of new technological procedures, and a rekindled interest in genetics all signal a move toward basic science and away from social science in medicine. Factors responsible for this include the economic structure of medical practice (both fee for service and HMOs), the biomedically oriented diagnostic and procedural codes by which medical providers are paid, current conservative political trends in the United States, and the public’s conceptions of health and disease. Chances for restructuring American medical care appear small unless the still-prevailing biomedical paradigm is supplanted by a broader biopsychosocial view.
... T wenty-five years ago, a pioneering group of family therapists and primary care practitioners introduced their colleagues to an exciting new field they called "family systems medicine" (FSM). As conceptualized by Donald Bloch, the editor of the journal also called Family Systems Medicine, "FSM" was a term describing a "unified approach to human disease" that placed particular emphasis on an integration of three different components-family therapy, systems theory, and modern medicine (Bloch, 1983). Critical to the approach was the view that modern organ-and disease-based medicine had potentially shortchanged its recipients by its emphasis on technological cures, to the possible corresponding de-emphasis on viewing "the patient-as-person and the patient-in-context" (p. ...
Despite its early promise, family systems medicine (FSM) has struggled to realize its full potential as an exciting conceptual model for the practice of medicine in primary care settings. Instead, since the mid-1990s, it has been relegated to the sidelines despite compelling research and clinical evidence of its effectiveness. In this article, I will argue that in addition to challenges attributable to clinical and training issues, FSM has been seriously undermined by the current system of health care financing in the United States. I will also point to possible trends suggesting that major changes in the organization and funding of health care in the United States may well be on the horizon, bringing with them some exciting new opportunities for the implementation of concepts and practices inherent in the FSM model. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The study manifests how the patient's illness exposed familial themes and undercurrents of its emotional system. In addition, it brought tremendous changes to the family members' emotional processes and to their interactions with the therapeutic teams (2,3,5,8,10,11). ...
Describes the conjoint treatment of a severely depressed 70-yr-old female Israeli Jewish patient and her family by a family physician, a community psychiatrist, and a nursing team. After persistent deterioration, despite 5 mo in a psychiatric hospital, the patient was returned to her kibbutz infirmary. A new therapeutic team assumed responsibility for the patient, with emphasis on considering the family as a system. One year after her return, the S was continuing to live in the infirmary without needing any medication. Her rehabilitative process transformed the kibbutz infirmary into her substitute home. The role of the coordinative practitioner and the sequence of activities taken by the family physician in the rehabilitative process can be seen as a guide in the treatment of such cases. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Notions of mindbody divisions and cause-effect linearity have long played major roles in conceptualizations of psyche-soma relations in general and of conversion symptoms in particular. Only recently have these assumptions begun to be questioned and challenged-especially by advocates of family therapy and family systems medicine (4,29,32). These developments, particularly within psychosomatic medicine, are still in a germinal or preparadigmatic stage (14). ...
Examined 15 "conversion families"—those with at least 1 child or adolescent member exhibiting a disabling physical disorder for which no corresponding organic problem can be found—referred to a psychiatric clinic for evaluation and treatment. The central features shared by these families are described, including a sense of being "damaged goods," extreme concern with moral issues of right/wrong and propriety/impropriety, engagement in fundamentalist religion, and involvement in organized sports. A conversion family culture, with interrelated material and ideational dimensions, is proposed, and the major links between family history and symptoms are discussed. Within the frame of an anthropological and transgenerational approach to these families, a family therapeutic understanding of conversion disorders and their expression is proposed. (33 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The typology o f illness can facilitate a key goal o f family systems medicine to integrate a number o f sovereign territories into a truly coherent discipline ( 5 ) . When used in an interlocking way with typological models o f the family or an illness oriented family assessment, this categorization scheme provides the researcher and clinician with a clearer path into this rich forest. ...
Describes a conceptual model that distinguishes types of illnesses and key phases in their natural history. A typology of chronic or life-threatening diseases is proposed; the illnesses are grouped according to particular characteristics that dictate significantly different psychosocial demands for the ill individual and his/her family. The model addresses problems of illness variability and time phases on 2 dimensions: (1) Chronic physical illnesses are grouped according to key biological similarities and differences. (2) The prime developmental time phases in the natural evolution of chronic disease are identified. These 2 dimensions together provide a matrix with which existing data can be compared and contrasted and hypotheses about psychosocial factors pertinent to the course of chronic illness can be generated. Possibilities for this model's research applications and its implications for preventive screening or for more comprehensive family assessment and treatment planning in a wide range of medical and mental health settings are discussed. (51 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Notable among these efforts are psychologists working from family-oriented systems perspectives (Doherty & Baird, 1983;McDaniel et al., 1992) and process-oriented behavioral systems perspectives (Ross & Doherty, 1988;Mullins, Gillman, & Harbeck, 1991). These mental health services are described as (a) comprehensive care in which the psychologist takes into account the impact of larger systems (i.e., the family, the health care system) on the patient and subsequent health outcomes (Bloch, 1983;Mash, 1989;Pace et al., 1995) or (b) the incorporation of behavior therapy into primary care settings using primary mental health care providers (Strosahl, 1996). The Med-Plus model differs from these approaches in its behavioral medicine focus, stepped care strategy, and physician training emphasis. ...
Psychologists have an unprecedented opportunity to influence primary medical care systems where chronic conditions, somatic symptoms, and health-threatening behaviors are prevalent. The authors developed a new model to incorporate behavioral medicine expertise into existing primary care practice with the purpose of delivering integrated, comprehensive, and efficient health care through physician training and direct patient care services. This model moves psychologists from isolated referral settings to the front line of medical care, where a broader impact on the outcomes and costs of health care can be achieved. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... As with the Newtonian revolution, the adaptation to and incorporation of the systemic paradigm has been difficult and uneven. Nor is it suitable for all purposes-far from it (5). The persistent and unprecedented interest of family therapy in epistemology is worth a moment of attention. ...
This article originated in an effort to develop a model for relating two classes of events: illness events and family-systems events. The first focus of the article was on the coevolution of disease pattern and family pattern. This led to a reconsideration of the concept of context, as well as what is meant by the term 'family'. Borrowing from others, who will be cited below, this exploration ultimately led to a consideration of a construct: the problem-generated or problem-defined system. This construct subsumes family and all other elements that are involved in maintaining or disequilibrating the patterns under consideration - a disease pattern or family pattern in the present instance. The main concern of this article is to present the coevolutionary perspective: how an entity and its context evolve together, shape and stabilize each other. Throughout, medical and psychiatric conditions are used as case examples; we will consider a wide variety of such conditions: the adominal pain syndrome in children, postpartum depression, cervical caner, nonorganic paralyses in children, among others. The systemic perspective of the article should make clear that in none of these instances are we talking about the cause or etiology of any of these syndromes.
... The practice of " Family Systems Medicine, " as a field, was coined in 1983 with the publication of the journal «Family Systems Medicine». The new field was characterized by an alliance between medicine, family therapy and a systems thinking orientation (Bloch, 1983). The changes in medical and mental health practice, the establishment of family medicine and family therapy, and the epistemological shift from linear to systemic thinking created the conditions that culminated in the end of the schism between the medical and mental health field. ...
Although, recently, the biopsychosocial approach has been emphasized in the practice of family medicine, how psychologists and physicians interact in collaborative family health care practice is still emerging in Portugal. This article describes a qualitative study that focused on the understanding of psychologists and family physicians' perceptions of their role and the collaborative approach in health care.
A questionnaire gathered information regarding collaboration, referral, training and the practice of biopsychosocial medicine. A content analysis on respondents' discourse was performed. Results show that both physicians and psychologists agree on the importance of the biopsychosocial model and interdisciplinary collaboration. However, they also mentioned several difficulties that have to do with the lack of psychologists working full time in health care centers, lack of communication and different expectancies regarding each other roles in health care delivery.
Both physicians and psychologists acknowledge the lack of academic training and consider the need for multidisciplinary teams in their training and practice to improve collaboration and integrative care. Implications for future research and for the practice of biopsychosocial medicine are addressed.
Current approaches to Systems Medicine are mostly research-focused and concentrate on emergent properties on the cellular level (e.g., cancer) based on descriptions of molecular complexity. Initial steps to integrate tissue, organ and organism levels exist and must extend to environmental and social systems even if not every aspect of humanity can be represented (yet). Systems Medicine provides a paradigm shift from parts-oriented reductionism to process-oriented holism developing a valid causal theory of how ‘bio’, ‘psycho’ and ‘socio’ actually relate. Delivering on this conceptual progress will require similar paradigm shifts in the organisation of healthcare and public health.
Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
The author proposes the system approach as a means of understanding and action for the family doctor. Different clinical situations are considered: the interview with the whole family, the interview with part of the family and the individual encounter. These examples show the utility of the system approach for the family doctor. The tools can also be used in individual consultation-the most common situation for the family doctor. In family medicine, the family is often identified as the 'patient'. Some believe that individual care should be given 'in the context of the family'. The author believes that the missing link between these two viewpoints is the use of the system approach in the individual encounter.
Collaboration between family-oriented primary care physicians and mental health professionals has generated much interest and enthusiasm in recent years, providing new opportunities for improved care for our patients. The development of the biopsychosocial model (1) has provided a theoretical foundation that can be shared by both primary care and mental health. The field of family systems medicine has begun to articulate the implementation of this theory, including issues around collaborative health care (2–4). Several kinds of collaborative relationships are possible between the primary care physician and the mental health specialist, ranging from consultation (for mysterious or stuck cases) to co-therapy sessions (for especially difficult cases like somatic fixation or dysfunctions around chronic illness) to referral (for serious or time-consuming cases) (5,6). (See Fig. 22.1.) This chapter will make practical suggestions for building a collaborative model that increases the ability of primary care providers to work with mental health professionals to maximize outcome for the patient and the provider.
Family dynamic research and family therapy are modern methods of psychotherapy and medicine. Although Richardson already stated the importance of family support for patients in 1948, family therapy as a new institution within psychotherapy was not developed before 1960. This early period is charcterised by an enthusiastic rise in popularity and pioneer-like improvement, whereas, in the 1970s, different schools within family therapy developed different theoretic concepts. Nowadays, we seem to be in a period of consolidation and critical reflexion of the existing concepts aiming at a pragmatic integration into practice (Gurman et al. 1986; Wirsching 1986). In what follows, basic notions of the family-dynamic approaches are outlined. As there exists at present only limited knowledge with respect to the application of the family-dynamic approach to patients with brain injury, our reasoning is of a more general nature and focuses only at the end on problems with patients who have suffered brain injuries.
Es gibt verschiedene Gründe, die den behandelnden Arzt veranlassen können, bei einem chroniseh kranken Kind die psychosoziale Dimension starker zu beriicksichtigen; 3 Aspek-te stehen im Vordergrund (s. auch Minuchin 1982):
1)
Probleme bei der Krankheitsverarbeitung. Dies ist wohl in der Praxis die wichtigste und häufigste Indikation (Anthony 1970). Das bis zur Krankheit unauffällige Kind entwikkelt Schwierigkeiten, die mit der Erkrankung in engem Zusammenhang stehen.
Nachdem die 60er Jahre in der Familientherapie von pionierhaftem Aufschwung bestimmt waren, und in den 70er Jahren die Konzepte und Schulen zur Blüte kamen, sind die 80er Jahre verschiedentlich als Dekade der kritischen Bestandsaufnahme und des integrativen Vergleichs bezeichnet worden.
Looking at the field as a whole through metaanalysis, Shadish et al concluded (based on 162 studies) that marital and family therapies were significantly more effective than no treatment and at least as effective as other forms of psychotherapy. Although these reviews and others are positive, individual studies raise many questions. For instance, based on research findings, family treatments increasingly have become standard care for patients with schizophrenia. It remains unclear what degree and type of family involvement is needed for which patients at which stage of their disorder. In the area of anxiety and depression, there are too few studies to make any strong conclusion. Although investigators such as Barrett, Cobham, and Diamond have produced some positive results, the Lewinsohn and Clark studies fail to demonstrate the added benefit of family involvement. Although Brent's study showed CBT to reduce depression faster, family therapy and supportive therapy did just as well in the long run, and family conflict was a strong risk factor for relapse. In the area of anorexia, Russell and Robins produced strong results from family interventions, whereas Geist found no difference between different types of family interventions. Family treatments for obesity have been inconsistent. In a metaanalysis of 41 studies, parental involvement did not contribute significantly to outcomes. In the Epstein study, however, which included 5- and 10-year follow-up, the results of family intervention were impressive. Although many of these studies can be cited for various methodologic flaws, the most consistent problem is that sample sizes are too small to detect difference between two or more active treatments. The most consistent findings (and most well-done, large studies) that support the efficacy of family-based interventions are done with externalizing problems. Work groups led by Patterson, Eisenstadt, Webster-Stratton, Alexander, and Henggeler all have produced impressive reductions of oppositional and antisocial behavior. Clinical programs that treat these populations without using a family-based intervention as at least a component of a treatment package are seriously ignoring the findings of contemporary intervention science. Programs of research by Henggeler, Szapocznik, and Liddle demonstrate similarly impressive results for substance abusing adolescents. Although preliminary results from the Dennis et al study suggest that various treatment approaches may benefit this population. Family interventions have had less success in reducing ADHD symptoms, yet these psychosocial treatments have been essential in reducing much of the family and school behavior problems associated with this disorder. Many investigators would agree that a combined medication and family treatment approach may be the treatment of choice for children with ADHD. In fact, many studies across various disorders suggest that patients respond best to comprehensive treatment packages, of which a family treatment is at least one component. Although the data are promising, many challenges lie ahead. Although collectively many family intervention studies exist, many disorders lack enough rigorous and large-scale investigations to make any strong conclusions. Kazdin argues that sample sizes of 150 are essential to detect significant differences between active treatments, and few of the reviewed studies include these kinds of patient numbers. Furthermore, not enough committed and sophisticated family treatment researchers have carried out some of the major studies. For example, the Brent study on depression and the Barkley study of ADHD, although testing family approaches, lacked well-developed and published treatment manuals, a demonstration of the necessary expertise to supervise these treatments, and data about training and adherence to these models. Although the absence of expertise limits investigator allegiance biases, treatment development and modification are essential for tailoring family treatments to target family processes specific to each disorder. Investigators such as Patterson and Liddle have invested great effort in rigorously dismantling the treatment process, identifying and refining essential ingredients, and repackaging more potent treatment protocols. This process has paid off well. Programmatic treatment development is needed for many disorders to address myriad questions. What are the essential disorder-specific family processes that should be targeted by interventions? Hostility, criticism, communication, attachment and autonomy, attributional sets, and behavior management are important processes of family life, but each may have more relative importance for specific disorders. With a greater understanding of these processes, treatments could be tailored to target these mechanisms more efficiently and effectively. (ABSTRACT TRUNCATED)
This investigation used the Process‐Person‐Context‐Time Model (U. Bronfenbrenner, 1979, 1995) to study adolescent diabetic control. The dependent variable was a blood test measuring diabetic control (i.e., HbA1 C [glycosylated hemoglobin]). Independent variables included adolescent/maternal perceptions of family environment and communication, blood glucose monitoring frequency, age of disease onset, disease duration, race/ethnicity, gender, and mother's education level. Stepwise regression revealed that glucose monitoring and problem communication explained 17% of the variance.
Il contributo descrive i processi relazionali nella famiglia conseguenti all’insorgen-
za, al decorso e all’esito delle malattie neoplastiche. Gli studi di letteratura inerenti
l’ambiente familiare dei pazienti oncologici segnalano due ordini di fenomeni: l’uno
concerne le trasformazioni degli affetti e dei rapporti nella famiglia e nel contesto di
cura, l’altro consiste nei riflessi psicologici e/o psicopatologici della malattia per i
caregiver. I riflessi psicopatologici più frequenti consistono in disturbi dell’adatta-
mento, nonché sindromi post-traumatiche osservabili che si presentano con una
maggiore frequenza nel caregiver e nei figli del paziente. Anche la struttura delle
relazioni familiari viene negativamente influenzata dalla malattia. Si evidenziano
conflitti di ruolo, crescenti difficoltà di comunicazione, isolamento sociale, disorga-
nizzazione o, al contrario, esasperato invischiamento. La conoscenza di questi pro-
cessi consente di programmare idonei interventi di sostegno psicologico per il part-
ner e i familiari del paziente mirati a migliorare la collaborazione consapevole fra
famiglia, paziente ed equipe di cura e a sostenere la famiglia nelle fasi cruciali della
malattia e delle terapie oncologiche.
This review describes the family interpersonal dynamics due to the onset, the course and the outcome of cancer as well as a psychological treatment program for the family caregivers. The literature concerning the family environment of cancer patients highlights two issues: the first concerns the change in relation-ship patterns in the family as well as in the context of care, the second refers to the psychological and/or psychopathological consequences for the caregivers. These clinical features consist of adjustment disorders and post-traumatic syndromes often observed in the caregiver and in the patient's children. The structure itself of family relationships is negatively affected by the disease. Role conflicts, increasing communication deviances, social isolation, disorganized or enmeshed relationships are described. The knowledge of these processes suggests to schedule tailored psychological support programs for the patient's partner and the families. These interventions are aimed at improving the active collaboration between family, patient and medical team as well as at supporting the family during the critical phases of the disease and of cancer treatments. A treatment program, including a counselling module, called "Family Psychoncological Counseling" and a psycho-therapeutic module, called "Phasic Family Therapy," is described.
“Medical family therapy” is an approach to psychotherapy with patients and families experiencing a medical illness or disability such as infertility. It assumes that no biomedical event occurs without psychosocial repercussions, and that no psychosocial event occurs without some biological marker. Medical family therapy interweaves the biomedical and the psychosocial by utilizing a biopsychosocial/systems theory, with collaboration between medical providers and family therapists as a centerpiece of the approach. This paper illustrates medical family therapy with couples experiencing infertility and facing the challenges of infertility treatment. Strategies are described that enhance the patient's sense of agency and the family's sense of communion during what tends to be a lengthy medical crisis.
The purpose of this paper is to invite considerations and conversations to continue, and potentially even expedite, the positive evolution of the emerging profession of financial therapy and the newly formed Financial Therapy Association (FTA). Varying perspectives are provided by reviewing another association's challenges when implementing cross-disciplinary collaboration and a unique identity. Ten considerations are provided in the development of financial therapy as a professional practice, which are designed to be starting points for facilitating the strong development of this emerging profession and new association. Exercises are provided to assist professionals in recognizing similarities and differences between their profession and others represented in the membership of FTA. INTRODUCTION The Financial Therapy Association (FTA), a recently formed organization representing the emerging profession of financial therapy, has been rapidly expanding, both in membership and in resources (Archuleta et al., 2011). In 2008, a preliminary meeting of 30 diverse professionals (e.g., academicians, financial planners, psychologists, and family therapists) discussed the merits and logistics of forming this association and made a decision to move forward (Grable, McGill, & Britt, 2010). The organization was federally recognized as an association the following year (2009). The first annual conference was held in Manhattan, Kansas, in September 2010, where over 100 participants from across the country attended. Participants included a dynamic blend of practitioners, educators, researchers, and students, representing at least seven different professions (i.e., financial counseling, financial planning, financial coaching, psychology,
Reviews the nature of rehabilitation medicine and describes how systems thinking may be used as multiple levels to understand the nature of rehabilitation and potentially facilitate health care delivery. It is argued that the systems theory and biopsychosocial approaches to rehabilitation medicine appear to have considerable value and utility in the field, particularly in light of current and proposed health care reform. Recommendations are made for increased involvement by systems-trained professionals from clinical, research, educational, and policy perspectives. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Proposes 5 characteristics of the scientific nature of family medicine. It is maintained that family medicine is a natural science, a multifactorial science, a probabilistic science, a human science, and a multiparadigmatic science. Each issue and its importance to family medicine are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Instructional dramatization via a dinner theater was used to teach rural physician/preceptors about family systems medicine. The training sketch presented in the article provides a unique and instructionally effective program design. Content and process data were collected by having the physician/preceptors rate the three acts of the dramatization. The data indicated that the majority of the rural physicians found the simulation to be both informative and enjoyable. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examines patient–physician–family triangulation and analyzes Balint group process cases that illustrate how physicians get caught in the drama of triangulation and induced into family systems. This is described as happening because a triangle may manifest a dynamic quality of its own that often induces its players into the roles of victim, rescuer and persecutor. Residents learn in the Balint process of evaluating specific troubling doctor–patient relationships that they do not have to defeat illness, restructure families or rescue patients from distressing medical, life threatening situations in order to be therapeutic. This is described as avoiding triangulation and pursuing a more efficient, therapeutic doctor–patient relationship. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Family medicine is struggling to find an identity. The discipline "has been our Atlantis, a legendary continent, the subject of many fables, but thus far hard to realize in actuality." In this article we will argue that our difficulty in making progress in our search for Atlantis is meaningful and can be seen as being political in nature. Our goal is to begin to understand the philosophical, personal, professional, and social issues affecting our search. We hope that by engaging in this discussion, the impediments to our progress will grow clear, and a more creative approach to progress will emerge. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Training in primary care medicine in the past decade has included more attention to the psychosocial issues of patients. With this shift, psychologists have new opportunities to collaborate with medical providers to provide comprehensive health care to medical patients and their families. Systems theory and biopsychosocial medicine provide compatible theories to underpin this collaboration. Suggestions are made for overcoming the considerable barriers to implementation of this model, and examples of creative collaboration are described. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To introduce systems concepts to first-year family practice residents, the faculty at the University of California, San Francisco, created a longitudinal curriculum entitled the "2-on-2." In this curriculum, a family physician and a behavioral scientist form a collaborative teaching team that will supervise two first-year residents in their outpatient practice. As its goal, the curriculum aims to help family practice residents learn how to provide systems-oriented care to urban, underserved families. To succeed, residents must understand the multiple influences that affect patients/families (sociocultural variables, inter- and intrapersonal variables, issues of health and illness) and those that affect themselves as clinicians (clinical setting, collegial relationship, professional development). This understanding of multiple influences better allows the formation of a strong, trusting patient/family-clinician/team relationship for the purpose of providing optimal healthcare. Curricular methods include immediate supervision via one-way mirror observation, and delayed supervision via videotape review and discussion. Experience over the 15 years of this curriculum suggests three valued features: 1) the longitudinal relationship between faculty and residents; 2) the emphasis on collaboration with patients and with colleagues; and 3) a process of reflection for residents and faculty. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The development of this paper was supported in part by a National Research Service Fellowship Award, US PHS No. NU-05805-01. The author would like to thank the following for their valuable feedback during the development of this manuscript: Marilyn Savedra, R.N., D.N.S.; Katharyn May, R.N., D.N.S.; Bonnie Holaday, R.N., D.N.S.; and Catherine Gillis, R.N., DNS.
Since the inception of field, theoreticians and teachers of family therapy have advocated for either problem-solving, skill-based training, or transgenerational training that emphasizes the therapist's own family-of-origin work. This article proposes an end to these polarized positions and argues for both-and, that is, a model of training that integrates the trainee's own family-of-origin work with live supervision and skills training. A family-of-origin curriculum designed for this purpose is described.
Although a large body of research demonstrates that the family has a powerful influence on physical health, the evidence for the effectiveness of family interventions in physical illness is less conclusive. Family therapy and other family interventions appear to be most effective in chronic childhood illnesses such as asthma and diabetes. Family interventions have also been shown to be effective in the management of some cardiovascular and neurologic disorders and for the treatment of obesity. Family therapy appears to be more effective than individual therapy for some groups of patients with anorexia nervosa. This research supports the increasingly important role of medical family therapy in the new health care system. Recommendations for future research are discussed.
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.
The establishment of an accurate psychosocial assessment is important in clinical social work with all adolescents. With those who are physically ill the complexities imposed by the illness make it essential to take into account the predictable physical and emotional effects of the illness or disability as well as the developmental tasks, the apparent adequacy and flexibility of the defenses and coping capacities and the availability of personal, cultural and institutional resources. A framework for assessment is proposed which examines these variables and their dynamic relationships.
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.
Family systems theory provides the physician with a comprehensive paradigm to investigate the social and interpersonal context of physical illness. All physical illnesses, particularly life-threatening and chronic ones, profoundly affect the family life of the patient, and the changed family circumstances in turn have impact upon the physically ill patient. This reciprocal interaction between the illness and the family system varies according to the onset, course, outcome, and level of disability. This paper discusses the general application of family systems theory to physical illness as well as the description of the family dimension of acute life-threatening illness, AIDS, chronic illness, chronic neurologic disease, dementia, chronic pain, and cancer in children. We propose that an operational knowledge of theoretical concepts and technical competencies of family systems theory can enhance the therapeutic reach of physicians and other health professionals.
At a time when an increasing number of professionals are calling themselves "family therapists," many teachers and theorists in this field are troubled that the term "family therapy" no longer adequately characterizes the concepts or activities of the field. Recently, clinical, political, and economic circumstances have emerged that suggest the need for alternatives to the role of "family therapist." By adding the roles of family consultant and systems consultant, we can open up new options for ourselves and our clients. During initial contacts with families, agencies, and other professionals, we can heighten our therapeutic potential by proceeding with consultative stocktaking, not starting with therapy. Family consultation also can assist in redirecting therapy when a new problem or an impasse develops, in focusing on competency rather than on pathology, and in engaging constructively with families that have a physically or mentally ill member.
We have established a psychosocial support system that is highly integrated with physician activities and that is tailored to the special needs of our patient population. The core of this system is the close interaction between the physician and the patient counselor, who is a clinical social worker and psychotherapist. Viewed as a permanent member of the breast cancer team, the patient counselor provides psychosocial care in the oncology clinic using normal clinic events as vehicles for interaction. Thus, time spent waiting in the clinic and follow-up phone calls can be converted to sessions for psychological counselling. This approach has been effective in our patient population, where social biases and financial constraints limit the use of out-of-clinic psychiatric services.
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