Defining Who We Are and What We Do: Clinical Practice Patterns of Marriage and Family Therapists in Minnesota

Article excerpt

There is a near total absence of published data on the clinical practice patterns of marriage and family therapists (MFTs). As a result, family therapy leaders who promote the field to insurers, businesses, and governmental bodies must do so without the benefit of empirical data on the actual clinical practice patterns of MFTs. The goal of this study is to describe the clinical practice patterns of a representative sample of marriage and family therapists in one state.

Practitioner demographics and practice-related matters of other mental health disciplines have received attention in recent years. Data collected from practitioner surveys have been used by insurers and lawmakers in the development of services and provider networks for consumers, as well as in public policy determinations. Surveys have been conducted on service providers in psychology (VandenBos & Stapp, 1983); psychologists in independent practice (Beach & Goebel, 1988; Norcross & Prochaska, 1983); master's level counseling psychologists in private practice (Watkins, Campbell, & McGregor, 1991); counseling psychologists in private practice (Watkins, Lopez, Campbell, & Himmell, 1989); counseling and clinical psychologists (Johnson & Brems, 1991); school psychologists (Carlson & Sincavage, 1987); health psychologists (Blancarte, Murphy, & Reilley, 1991); psychiatrists (Dorwart et al., 1992); community mental health center-based psychiatrists (Vaccaro & Clark, 1987); social workers in private practice (Brown, 1990; Hardcastle & Brownstein, 1989); social workers in urban versus rural areas (York, Denton, & Moran, 1989); research-oriented social workers (Cheatham, 1987); career counselors (Spokane & Hawks, 1990); and lay counselors (Seaberg, 1985). Few research projects have compared practices across mental health disciplines.

Only two prior studies have used case data as opposed to therapists' estimates of their own practices. Using the federally funded Mental Health Service Providers Survey, Knesper, Pagnucco, and Wheeler (1985) surveyed over 9,000 psychiatrists, psychologists, social workers, and primary care physicians to address comparability of services across provider groups and practice settings. The study provided descriptive data on length of treatment, severity of client condition, diagnoses, and use of psychotropic medication from closed individual treatment cases. Knesper, Belcher, and Cross (1989) utilized the same data set to compare the practices of psychiatrists and psychologists.

No studies were identified regarding utilization of DSM-III-R diagnoses. A small number of studies have examined other aspects of diagnosis for mental and nervous disorders. Using hypothetical case vignettes, Knesper, Pagnucco, and Kalter (1986) examined diagnostic agreement among psychiatrists, psychologists, and social workers. Diagnosis has also been discussed in relation to ethical considerations (Denton, 1989, 1990), insurance reimbursement (Kutchins & Kirk, 1988), and malpractice (Kutchins & Kirk, 1987), but until the present study, no researchers have gathered DSM-III-R diagnoses on a representative group of clients treated by a professional group.

Despite the lack of practice pattern data, there is increasing interest in marriage and family therapy, its effectiveness as a mode of treatment, and the role of marriage and family therapists in the larger health care system. Interest derives from a number of sources. First, there is growing concern about the impact of troubled and often violent adult relationships on children's mental and physical health, and increasing recognition of the links between family life and the workplace. Increasingly, Employee Assistance Programs (EAPs) have shifted to providing services related to troubled marital and family relationships (Adragna, 1991; Brodzinski & Goyer, 1987; Kabb, 1992; Korr & Ruez, 1986; Krusor & Blaker, 1992; Maiden, 1988; McClellan & Miller, 1988; Rich, 1987). …