Academic journal article Journal of Marital and Family Therapy

Integrative Families and Systems Treatment: A Middle Path toward Integrating Common and Specific Factors in Evidence-Based Family Therapy

Academic journal article Journal of Marital and Family Therapy

Integrative Families and Systems Treatment: A Middle Path toward Integrating Common and Specific Factors in Evidence-Based Family Therapy

Article excerpt

A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility in manual development. A preliminary integrative model termed Integrative Family and Systems Treatment is offered as one option in developing and testing a moderate common factors approach. Such a model might then be studied in eventual clinical trials with other well-developed evidence-based protocols to further address the common versus specific factor debate. Implications for further research and practice are offered.

Thesis - antithesis - synthesis; the wisdom of dialectics and Taoism is in integration.

Wisdom is in finding synthesis or in following the middle path.

In 2004, a lively interchange entered the family therapy literature through the pages of this journal (cf. Sexton & Ridley, 2004; Sexton, Ridley, & Kleiner, 2004; Sprenkle & Blow, 2004a, 2004b). The interchange echoed a now decade-old debate found in the broader psychotherapy literature. The questions at stake focused on the factors that explain why treatment works. These are questions such as "How may we best define the effective elements of therapy?" and "Given that treatment is effective, is the effect due to a range of factors common to all effective treatment (or so-called 'common factors') or to the application of a set of procedures defined by a set of protocols (often referred to as 'specific factors')?" Both sides presented convincing arguments and evidence. Unlike the debate in the larger psychotherapy literature, proponents on both sides of the family therapy debate made an effort to move toward a more centrist position. Sexton and Ridley (2004) acknowledged that common factors are obvious and important parts of any effective marital and family therapy (MFT) and that an either/or stance is detrimental to the field. For their part, Sprenkle and Blow (2004a, 2004b) made clear that they do not favor the positions of more radical proponents of the common factors, such as Duncan and Miller (2000) and Wampold (2001). Instead, they view models as vehicles through which common factors operate. With this in mind, they referred to their position as a moderated common factors approach.

Despite the attempt at rapprochement, the differences between these two camps were significant enough that the interchange was left unresolved. Both sides called for further discussion; however, there has been only indirect exchange in the family literature on this important subject since then. A recent work by Sprenkle, Davis, and Lebow (2009), however, promises to reawaken this discussion.

The purpose of this article is to take this discussion to the next level. We will offer an evolving approach that we have developed over the past 7 years. The importance of this evolving protocol to the question of common and specific factors is that it fits the description of what Sprenkle and Blow (2004b), and more recently, Sprenkle et al. (2009), refer to as a moderated common factors approach. Moreover, we refer to our model as a metamodel that uses the common factors and a perspective on the general process of change to organize treatment and train behavioral health specialists. Our approach, namely Integrative Family and Systems Treatment (I-FAST), is being used and tested with high-risk youth and families in a homebased intervention format. This treatment population comes from community mental health settings and shares similarities with populations served by empirically supported treatment models such as functional family therapy (FFT) and multisystemic family therapy (MST).

Our intent is to offer I-FAST as a modest option for how one might build and test a moderate common factors model against a range of alternate efficacious models developed for the same population. …

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