Preface Acknowledgments Part I. The Context of Health Care Today What's Already Known Some Basic Notions What's Already Been Tried: Antecedents What's Been Tried: 1945 to the the Present The Organization of Collaborative Health Part II. Collaborative Health Care In Practice Starting Up A Sampler: Clinical Examples of Collaborative Health Care Problems in Collaboration Referral to the Therapist Questions Frequently Asked About CHC Summary Bibliography Index About the Author

The basic outlines of what has come to be called "family systems medicine" have now been laid forth. This contextual approach to medical care emphasizes the interrelationship of psychosocial and biomedical factors in illness and its treatment. It focuses on ways in which the family unit both affects and is affected by sickness in any of its members. The use of systems thinking sharpens a view of illness as an evolving process: illness is seen as a patterned phenomenon rather than an isolated time-bound thing, as a socially defined entity rather than a simple physiological event, as a dynamic process rather than as straightforward cause and effect. The core theories of this approach, its perspective, and its contextual insistence have already been described. The studies that validate these concepts and ideas have been accumulating for the past 30 years; and, while they may still seem new in some circles, their overall coherence and strength is already a fait accompli.

Yet, in all of this, something has gone wrong: The organization of health care which should reflect such a systemic world view has not developed, and in fact lags far behind the advances in theory. A broader view of health and illness suggests that health care should be an interdisciplinary process, uniting the efforts and skills of different health professionals. Responding to social, political, cultural, and economic conditions, however, the organization of health care services is now marked by a paradoxical resurgence of the biomedical model: specialist care, fragmentation of services--a world view that seemed passe 20 years ago, supposedly superceded in medicine by the biopsychosocial model of health and illness.

A long-range view suggests that this is not surprising. The transformation of ideas into practice is a difficult process and it often lingers behind the development of the ideas themselves; deep resistance frequently opposes any kind of change. An integrated health care system may yet develop, although it is not a given by any means. The current trends that oppose such care require careful investigation and analysis. Are they simply part of the dialectical process of inevitable change, or do they instead signal the decline of the biopsychosocial model as a force which affects the actual delivery of health care?