Academic journal article Journal of Marital and Family Therapy

Integrative Module-Based Family Therapy: A Model for Training and Treatment in a Multidisciplinary Mental Health Setting

Academic journal article Journal of Marital and Family Therapy

Integrative Module-Based Family Therapy: A Model for Training and Treatment in a Multidisciplinary Mental Health Setting

Article excerpt

Thirty years ago, leaders in psychiatry expressed hope for more interdisciplinary collaboration with family therapy. Since then marriage and family therapy (MFT) has entered the mainstream of clinical practice in psychiatry and psychology. It is mandated for training in psychiatry and psychology. We propose a model for collaboration, training, and treatment in interdisciplinary mental health settings that strives to integrate empirical bodies of knowledge in MFT, psychiatry, and psychology and to provide a usable and testable clinical approach to treatment. It can be taught to trainees with various or limited training in MFT. This model delineates nine critical domains that guide treatment. Flexibility is central to this model, focusing on techniques and clinical methods based on empirically supported treatments, when available, and best-practice standards.


Current Challenge and Opportunity for Family Therapy

In 1974, McDermott and Char wrote "The Undeclared War between Child and Family Therapy." In this article they decried the lack of mutual respect and cooperation between psychiatry and family therapy and stated that "many child psychiatry training programs have ignored training in family therapy" (p. 423). They noted that there were then "pathetically few" (p. 422) articles in psychiatric journals directly related to family functioning and that psychiatry had "fumbled the ball" (p. 424). At the same time, family therapy had contributed to the polarization by being "anti-medical" (p. 425) and "antidiagnostic" (p. 425). McDermott and Char concluded by calling for child psychiatrists to "catch up with a rapidly changing field from which they have become separated" and encouraging family therapists to overcome "internal disputes between schools of thought" (p. 435) and join the mainstream of clinical practice.

In the 1980s and 1990s, two related trends emerged in marriage and family therapy (MFT). The first dealt with the establishment of family therapy as an independent profession. Marriage and family therapy was no longer only an activity that occurred within the professions of psychiatry, psychology, and social work. Rather, it became a specialized profession with its own body of knowledge and licensing standards. However, as MFT became more established, some viewed it as increasingly isolated from practice in the other mental health professions. In 1994, Shields, Wynne, McDaniel, and Gawinski stated that MFT had become marginalized and family problems had been "trivialized" (p. 126) within the discourse of mental health practice. Shields et al. called for the "promotion of MFT" as an "interdisciplinary field" (p. 135) and for more collaboration in clinical work, training, and research.

Thirty years after the challenge of McDermott and Char (1974), mental health practice has continued to lack fully integrated approaches to family treatment and training in many multidisciplinary mental health settings. In 2004 McDermott described the current era in Child and Adolescent Psychiatry as "atheoretical" (p. 657), yet he reminded us that "you can't practice without some kind of theory." He further noted that the biopsychosocial model of Engel, first proposed in the 1970s, has not advanced or been developed in psychiatry. In the end we are still left with "no integration of the three levels" (p. 657). McDermott stated that psychiatry needs more active theory building that takes the multiple levels of human functioning seriously. Within MFT discourse, Carol Anderson (2003) has described this specialization and isolation as an ever-widening gap between researchers and clinicians.

In addition, the practice of psychotherapy has significantly changed in the last decade. Kazdin (2005) has noted that theory-based models "have been largely abandoned" (pp. 13-14). He identifies four critical developments that require reconceptualizing therapy. First, clinical interventions need to be focal and therapies testable. …

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