A pod of family psychiatrists is sitting around and chatting about the state of family psychiatry. They are preparing for a plenary at the Group for the Advancement of Psychiatry with the goal of showing how far family psychiatry has come since the first psychiatrists embraced the paradigm of systemic thinking. They also debate why family psychiatry is ignored in current practice, especially since the evidence shows that family treatment dramatically improves recovery rates for many illnesses.
When family therapy had its first wave of popularity, the charismatic leaders were out front wowing the crowds. Dr. Sal Minuchin’s sessions were heavily focused on structure and boundary making, and involved much chair rearranging and pulling family members, especially children, out from between the couple dyad and into their own space and chairs in the room. One of his most famous tapes involved putting an ashtray between the chairs of two family members to literally increase the distance between them!
Jay Haley, Ph.D., delivered strategic barbed arrows that pierced the hearts of the family members. Virginia Satir demonstrated the theater of families, sculpting organic shapes that pulsed with the gestalt of the family. There was much smoking of cigarettes during the sessions, by both the family psychiatrists and the family members. Psychiatry was exciting. The possibilities for change were endless. It was the 1960s.
Unfortunately, in those early days, family therapy was oversold as the sole treatment for schizophrenia and other mental illnesses. As a result, families have felt blamed by the negative attention and are still hesitant to engage in traditional family therapy. Nevertheless, quiet pioneers, like Carol M. Anderson, Ph.D., continue to research and practice a measured educational and collaborative approach aimed at involving families in mental health treatment. Indeed, current American Psychiatric Association guidelines for many psychiatric illnesses recommend that families be brought into the treatment process.
Family research has become much more sophisticated, with Dr. Minuchin’s early research on asthma and "psychosomatic families" being refined by teams led by Betsy Wood in New York, and Dr. Fred Wamboldt and Dr. Marianne Z. Wamboldt in Denver. Family research covers a broad territory, from studies on the impact of care giving on the caregiver’s immune function, to the role of expressed emotion in the outcome of illnesses – medical and psychiatric – to the efficacy of family treatments.
However, the Big Question still remains: Which model is the best? Structural? Strategic? Experiential?
While the arguments among devotees continue, studious researchers are quietly extracting the common factors found in the original family therapy models. These common factors are defined as the variables associated with positive clinical outcomes and are shared by several or all approaches. Andrew Christensen, Ph.D., suggests five principles that evidence-based couple interventions share: a systemic rather than an individual orientation of problems; modification of emotion-driven dysfunctional behaviors by teaching partners constructive ways to deal with differences, problems, and emotions; making both partners aware of avoided, emotion-based, private behaviors of each other, and making these internal experiences accessible to each other; enhancement of constructive communication in speaking and listening; and emphasis on strengths and positive behaviors (Enhancing Couples, Cambridge, Mass.: Hogrefe Publishing, 2009).