Couples and Family Therapy in Clinical Practice

This updated classic textbook on couples and family therapy is written through a psychiatric and psychosocial lens. It delineates clinical practice, research, and training issues, in part through case examples. The chapters present family therapy and family–oriented interventions with an emerging evidence base in an easy–to–read and digestible manner.

Organized into six sections, this title covers: 

The history of the field and the general concepts of family function and dysfunction How to do family evaluation, formulate a broad diagnostic plan, delineate goals and plan treatment Provides indications, contraindications and evidence–based results Discusses ethical quandaries, professionalism, and training issues Techniques that can be utilized in the therapeutic encounter to foster change and growth in both patients and their families.

The text addresses the need for the modern day clinician to have a solid foundation in cultural competency and to be able to work with patients who come from a range of cultural, ethnic, sexual, and socioeconomic backgrounds. This classic teaching textbook is well suited for mental health clinicians of all levels who work with families.

Contributors

Forewords
Ellen M. Berman, M.D., and Lloyd I. Sederer, M.D.

Preface

Acknowledgments

A Guide for Using the Text

List of Tables

List of Figures

SECTION I FAMILY THERAPY IN CONTEXT

CHAPTER 1 The Field of Marital and Family Therapy: Development and Definition

Objectives for the Reader

Introduction

Development of the Family Therapy Field

Definition of Couples and Family Therapy

Core Concepts

Differentiation of Family Therapy From Other Psychotherapies

Clinical Practice Implications

Suggested Readings

References

CHAPTER 2 Family Life in Historical and Sociological Perspective

Objectives for the Reader

Introduction

Structure and Function of the American Family

Immigration

Ethnicity

Secular View of Marriage

Structures of Marriage

Divorce

The Functional Single–Parent Family

Stepfamilies

LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer) Couples

Parenting in Post–Modern Relationships

Multiracial Families

African–American Families

Latino Families

Asian Families

Social Class

Aging of the Population

Family Life Cycle

Clinical Practice Implications

Suggested Readings

References

SECTION 2 FUNCTIONAL AND DYSFUNCTIONAL FAMILIES

CHAPTER 3 Understanding the Functional Family

Objectives for the Reader

Introduction

The Family as a System

The Marital and Family Life Cycle

The Family Life Cycle

Family Tasks

Family Belief Systems

Family Resilience

Clinical Practice Implications

References

CHAPTER 4 Understanding the Functional Family in a Variety of Family Forms

Objectives for the Reader

Introduction

Impact of an Extended Individual Life Cycle

Marriage

Divorce

Binuclear Families

The Functional Single–Parent Family

Remarriage and Blended Families

Stepfamilies (Blended Families)

Grandparent–Headed Families

Lesbian, Gay or Transgendered Families

Parents with a Gender Non–conforming Child

Multiple–partner Fertility Families

Adoption and Families

Interracial Families

Trends in Parenting

Clinical Practice Implications

Suggested Readings

References

CHAPTER 5 Problems and Dysfunction From an Integrated Family Systems Perspective

Objectives for the Reader

Introduction: The Dysfunctional Family System

A Systems Approach to Problems and Dysfunction

Family Beliefs and Myths

The Larger Social System and Dysfunction

Implications for Treatment The Development of Symptoms in a Particular Person

Life Cycle Problems and Dysfunction

Task Performance in the Dysfunctional Family

Clinical Practice Implications

Suggested Readings

References

SECTION 3 FAMILY EVALUATION

CHAPTER 6 The Process of Evaluation

Objectives for the Reader

Introduction

Who to Include in the Family Evaluation

Progression of the Family Evaluation Interview

Dimensions of Couple and Family Assessment

Working with a Systemic Model of Change

Role of Historical Material

Role of Individual and Family Diagnoses

Clinical Practice Implications

References

CHAPTER 7 The Content of Evaluation

Objectives for the Reader

Introduction

Dimensions of Family Function

Family Evaluation Outline

The Family Genogram

Clinical Practice Implications

References

CHAPTER 8 Formulating an Understanding of the Family Problem Areas

Objectives for the Reader

Introduction

Rating Important Dimensions of Family Functioning

Family Classification and Diagnosis

Planning the Therapeutic Approach and Establishing the Treatment Contract

Case Example Illustrating the Outline

Suggested Readings

References

SECTION 4 FAMILY TREATMENT

CHAPTER 9 Major Family Therapy Schools and Their Treatment Strategies

Objectives for the Reader

Introduction

Insight–Awareness Model

Family of Origin Model

Systemic–Strategic Model

Structural Model

Cognitive–Behavioral Model

Experiential Model

Constructivist Model

Psychoeducational Model

Clinical Practice Implications

References

CHAPTER 10 Goals

Objectives for the Reader

Introduction

Mediating and Final Goals As They Relate to Schools

Individualizing Goals With the Family

Goals and Their Relation to Process and Content Issues

Mediating Goals and Their Related Strategies

Goals and Related Strategies Common to All Family Therapy Schools

Clinical Practice Implications

References

CHAPTER 11 Family Treatment: Integrated Strategies and Techniques

Objectives for the Reader

Introduction

General Elements of Psychotherapy and Their Relationship to Family Therapy

Basic Strategies of Family Intervention

Techniques for Supporting Adaptive Mechanisms and Strengths: The Psychoeducational Approach

Techniques for a More Effective Construction of Family Reality

Treatment Packages

Indications for Differential Use of the Basic Strategies

Clinical Practice Implications

References

CHAPTER 12 The Course of Family Treatment

Objectives for the Reader

Introduction

Early Phase

Middle Phase

Termination Phase

Conducting Brief Family Therapy: Treatment as It Is Influenced by Time Constraints

Clinical Practice Implications

Suggested Readings

References

CHAPTER 13 Promoting Change in Family Treatment: Issues of Alliance and Resistance

Objectives for the Reader

Introduction

The Therapeutic Alliance

Models for Dealing With Families That Have Trouble Forming an Alliance

Problems in Creating Change: Resistance and Disconnection

Techniques to Deal With Resistances or Stalled Therapy

Clinical Practice Implications

Suggested Readings

References

CHAPTER 14 Family Therapy: General Considerations

Objectives for the Reader

Introduction

Family Participants

Including Children and Adolescents in Family Therapy

Therapist Combinations

Setting

Time, Scheduling, and Fees

Keeping a Record of Treatment

Family Therapy in Combination With Other Psychosocial Therapies

Clinical Practice Implications

References

SECTION 5 Couples Therapy

CHAPTER 15 Dysfunctional Couples and Couples Therapy

Objectives for the Reader

Introduction

Marriage in Its Historical Context

Couples Difficulties, Problems, and Dysfunction

Couples Therapy

Clinical Practice Implications

References

CHAPTER 16 Sex, Couples and Sex Therapy

Objectives for the Reader

Introduction

Diagnosis Systems Issues

Some Parameters of Sexual Function

Assessment of Sexual Disorder

Treatment

Other Issues Related to Sexuality and Couples

Clinical Practice Implications

Suggested Readings

References

CHAPTER 17 Couples and Families Breaking Apart: Separation and Divorce

Objectives for the Reader

Introduction

Separation

Divorce and Postdivorce Treatment

Single–Parent and Binuclear Families

Blended Families (Stepfamilies)

Cohabiting Couples

Serial Relationships

Clinical Practice Implications

Suggested Readings

References

SECTION 6 Family Treatment When One Member Has a Psychiatric Disorder or Other Special Problem

CHAPTER 18 Family Treatment in the Context of Individual Psychiatric Disorders

Objectives for the Reader

Introduction

The Family Model and Individual Diagnosis

Schizophrenia

Mood Disorders: Bipolar Disorder

Mood Disorders: Persistent Depressive Disorder and Major Depressive Disorder

Borderline Personality Disorder

Anxiety Disorders

Obsessive–Compulsive Disorder

Post Traumatic Stress Disorder

Dementia, Amnesia and Other Cognitive Disorders

Eating Disorders

Substance Related Disorders

Psychiatric Disorders of Childhood

Clinical Practice Implications

Suggested Readings

References

CHAPTER 19 Family Treatment in the Context of Other Special Problems Violence to Self and Others

Objectives for the Reader

Introduction

The Family Model and Violence

Intrafamilial Child Sexual Abuse

The Family Model and Child Abuse

The Suicidal Patient and the Family

Clinical Practice Implications

References

CHAPTER 20 The Family and Treatment of Acute and Chronic Psychiatric Illness

Objectives for the Reader

Introduction

Background

Acute Treatment

Families of the Chronically Ill

Community–Based Support Groups

Controversies in the Treatment of Acute and Chronic Psychiatric Illness

Clinical Practice Implications

References

CHAPTER 21 Working with Families in the Medical Setting

Objectives for the Reader

Introduction

How Family Functioning Impacts Illness

How Illness Impacts Family Functioining

Family Coping and Adaptation to Illness

Caregiving

A Family Systems Interview for Families with Medical Illness.

Family Interventions

Suggested Readings

Clinical Practice Implications

References

SECTION 7 Results of and Guidelines for Recommending Family Therapy

CHAPTER 22 Indications for and the Sequence of Family Therapy Evaluation and Treatment

Objectives for the Reader

Introduction

Sequence of Evaluation and Treatment Planning

Step 1: Is Family Evaluation Indicated?

Step 2: Is Family Treatment Indicated?

Step 3: What Shall Be the Duration and Intensity of Family Therapy?

Step 4: What Model of Family Intervention Is Indicated?

Clinical Practice Implications

References

CHAPTER 23 Controversies, Relative Contraindications, and the Use and Misuse of Marital and Family Therapy

Objectives for the Reader

Introduction

Couples Therapy

The Child as the Identified Patient

The Adolescent as the Identified Patient

Family of Origin Issues

Other Intimate Interpersonal Systems

Situations in Which Family Therapy Is Difficult and Perhaps Contraindicated

Skills and Attributes of the Therapist As They Affect Family Work

Clinical Practice Implications

References

CHAPTER 24 Results: The Outcomes of Couples and Family Therapy

Objectives for the Reader

Introduction

Overview of Psychotherapy Outcome Research

What the Studies Show

Couples Treatments for Adult Disorders

Family Treatments for Adult Disorders

Family Treatments for Child and Adolescent Disorders

Family Interventions for Medical Illnesses

The Effectiveness of Combining Medication and Family Therapy

Limitations of Family Therapy

Negative Effects of Family Therapy

Inability to Engage and Premature Termination of Family Therapy

Clinical Implications of Data From Family Therapy Outcome Studies

Clinical Practice Implications

Suggested Readings

References

SECTION 8 Ethical, Professional, and Training Issues

CHAPTER 25 Ethical and Professional Issues in Family Therapy

Objectives for the Reader

Introduction

Ethical Issues Inherent in Family Therapy

Ethics in a Managed Care World

Informed Consent

Financial Issues

Professional Issues

Competencies

Training and Licensure

Clinical Practice Implications

Suggested Readings

References

Subject Index

Author Index

Ira D. Glick is Professor Emeritus of Psychiatry and Behavioral Sciences and formerly Chief of the Schizophrenia Clinic at Stanford University School of Medicine, USA.

Douglas S. Rait is Clinical Professor of Psychiatry and Behavioral Sciences and Chief of the Couples and Family Therapy Clinic at Stanford University School of Medicine, USA.

Alison M. Heru is Associate Professor of Psychiatry at the University of Colorado, USA.

Michael S. Ascher is Clinical Associate in Psychiatry at the Perelman School of Medicine, University of Pennsylvania, USA.