Handbook of Family Therapy: The Science and Practice of Working with Families and Couples

By Thomas L. Sexton; Gerald R. Weeks et al. | Go to book overview

CHAPTER 19

Treatment Through Writing

A Unique New Direction

LUCIANO L'ABATE, PhD
Georgia State University


INTRODUCTION

Historically, the development of psychotherapy can be distinguished according to three stages: (1) a passive-reactive one, as exemplified by psychoanalysis and client-centered therapy in the first half of last century; (2) an active-directive one, as exemplified by cognitive-behavioral, rational-emotive, and family therapies, in the second half of last century; and (3) an interactive stage, which began during the last quarter of the last century. In this third stage, families were encouraged to become involved and take responsibility for the treatment process by completing homework assignments.

Impetus for this approach was given by sex therapists and behavioral marital therapists (Holtzworth-Munroe & Jacobson, 1991). Among the former, Heiman, LoPiccolo, and LoPiccolo (1991), for instance, stated that “therapy structure begins via homework assignments” (p. 610). Weeks and Gambescia (2000) adamantly declared that “One of the hallmarks of sex therapy is homework” (p. 108). Among the latter, Jacobson (1981), for instance, alluded to the same point, by concluding that “Couples tend to be more compliant with homework assignments when the task is explicitly made synonymous with therapy than when the link between these tasks and their in-session use is unclear or unspecified” (p. 573). This third stage was also coupled with the administration of written homework assignments, requiring families to come together at home to complete and discuss assignments interactively, as a condition of being accepted into a therapeutic contract. This requirement assured a much greater degree of cooperation and compliance than obtained otherwise (L'Abate, 1986; L'Abate, Ganahl, & Hansen, 1986).

According to one estimate (T. Patterson, personal communication, March 28, 2002): “90% of couple, family, and parent-child therapy practiced today incorporates either

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