Читать книгу Theory and Practice of Couples and Family Counseling - James Robert Bitter - Страница 85

With few exceptions, the models of family therapy presented in this book emerged from the efforts of clinicians who wanted to understand family practice through engagement and action. Bowen at the National Institute of Mental Health and Georgetown University; Bateson, Jackson, and associates at the Mental Research Institute in Palo Alto, California; and Minuchin and colleagues at the Philadelphia Child Guidance Clinic studied families in an effort to see what worked. These men were, for the most part, scholar-practitioners determined to discover or create the interventions that would make a difference with some of the most severe problems encountered in physical and mental health. In many ways, they were qualitative and action researchers embedded in and connected with the very systems they sought to know and study.

Even practitioners in private practice such as Dreikurs, Satir, and Whitaker brought an investigative orientation to their clinical work that focused on the development of personal and professional skills as well as family growth and development. In more recent years, Monica McGoldrick and her many associates have focused on developing theory and practice that seeks to articulate the relationship of race, ethnicity, culture, gender, and sexual orientation to families and family therapy (see McGoldrick & Hardy, 2019).

Starting in 1942 with the formation of the American Association for Marriage and Family Therapy there has been a concerted effort to demonstrate the efficacy and effectiveness of family practice through the Journal of Marital and Family Therapy. In 1995, meta-analyses of effectiveness studies concluded the following:

 Marriage and family therapy worked better than no psychotherapy at all;

 Marriage and family therapy did not appear to have negative or harmful effects;

 Marriage and family therapy was more efficacious than individual therapy for adult schizophrenia, marital distress, depressed women in distressed marriages, adult alcoholism and substance abuse, adolescent conduct disorders, anorexia in teenage women, childhood autism, and a variety of physical illnesses in both adults and children;

 No particular model of marital and family therapy was superior to (more effective than) any other approach;

 There was some evidence that marital and family therapy was more cost effective than inpatient or residential treatment for schizophrenia and severe conduct disorders or delinquency in adolescents; and

 Although marriage and family therapy was a critical and necessary component in the treatment of severe problems, the most effective programs also included psychoeducational therapies, individual or group counseling, and/ or medication (Pinsof & Wynne, 1995).

Reviews of outcome research over the past 20-plus years have not produced any noticeable changes or differences in these reported results. Indeed, additional studies have continued to confirm these findings (see Gladding, 2019; I. Goldenberg et al., 2017; Nichols & Davis, 2017). Those parenting and family models related to behaviorist family interventions have produced change in behavioral and conduct disorders (S. A. Baldwin et al., 2012; Henggeler & Sheidow, 2012; Kaslow et al., 2012).

The year 2012 was a huge year for reporting on the effectiveness of couples and family counseling, thanks in large part to a special issue of the Journal of Marital and Family Therapy. Couples and family interventions have reduced relational problems and led to enhanced couple functionality (Lebow et al., 2012; Markham & Rhoades, 2012). O’Farrell and Clements (2012) and Rowe (2012) validated the effectiveness of family interventions in addictions work. Shields et al. (2012) addressed the effectiveness of couples and family work in addressing health problems. Stith et al. (2012) reported on couples and family interventions related to intimate partner violence, and Beach and Whisman (2012) noted the effectiveness of family interventions with affective disorders.

Southern (2005) noted that four marriage and family therapy journals publishing 131 articles between 1980 and 1999 contained the results of mostly quantitative studies. Even though qualitative research was increasing, it accounted for a very small percentage of the articles. For a field that still feels it must validate and justify its methods, such a finding is perhaps not surprising. This same study also noted that articles addressing diversity issues in the Journal of Marital and Family Therapy nearly doubled in 10 years to 31% of the articles in the 5 years leading up to 2000.

Toward the end of the 1980s, the International Association of Marriage and Family Counselors established The Family Journal in an additional effort to provide a forum for “groundbreaking, innovative scholarship for counseling researchers, educators, and practitioners” (Carlson, 1993, p. 3). For almost 30 years, this journal has provided space for both qualitative and quantitative research; the development of theory and practice; the relationship of personal exploration and growth to professional development; considerations of race, culture, and gender in family counseling; and efficacy studies for the training of family practitioners.

In a content analysis of The Family Journal, Southern (2005) listed the main themes addressed as “techniques, training, & supervision, assessment & diagnosis, children at risk, multicultural issues, family issues, ethics, sexual issues, marital & couple issues, addiction, and healthy relationships” (p. 8), with an increase in articles dealing with ethics, addiction, and work and socioeconomic issues. Southern also noted a trend toward increased coverage of sexual issues, training and supervision, marital and couples issues, family issues, and health.

In spite of their openness to qualitative design, such articles still make up a relatively small amount of the total number of articles. Still, I believe that qualitative investigations and action research methods hold the greatest promise for integrating scholarship and clinical practice (see Sprenkle & Piercy, 2005).

Qualitative research embeds the knower (all of us as practitioner-scholars) within the experiences of the known (the family) and asks us to consider what effects our presence and observations have on the people and systems we are investigating. Is this not what all of us have to do in clinical practice anyway? Is it not important to regularly reflect on who we are, what we are experiencing, and what kinds of recursive effects we are having with the families we serve? Qualitative research engages us in a search for patterns and themes, and the more formal processes of continual categorization, sorting and resorting, and coding and recoding have the potential to orient and train the practitioner’s mind for receiving and making meaning out of the stories and experiences in therapy (Echevarria-Doan & Tubbs, 2005). Qualitative research can be phenomenological and supports efforts to study families in natural contexts (Dahl & Boss, 2005). It reminds us that meaning can be different for various members of families and systems, that there are multiple ways of knowing, and that the language and meanings of everyday life are socially constructed and significant. Most important, qualitative research emphasizes that we are not separate from the people and families we study and serve: The knowledge we have is shared and held by practitioners and families alike. These assumptions provide a significant bond between clinical practice and clinical research with the strengths of each informing and enhancing the other.

Action research offers practitioners still another model for assessing and evaluating their effectiveness in therapy (Mendenhall & Doherty, 2005). Again, action research is a methodology that can train and orient the minds of family practitioners in useful ways. It emphasizes democratic partnership (or collaboration); problem-solving in context; cyclical processes of interventions and evaluations; and adjustments, humility, and adaptability. In action research, participants engage in corrective and evaluative processes that guide changes in approach and intervention, the very same guidance that the early masters of family therapy sought in their developmental work.

For too many years, the very word “research” has led to resistance in those who are training for the helping professions. Required courses in statistics, empirical and experimental design, and controlled studies seem to be disconnected from the rest of professional training in family practice. With the emergence of qualitative and action research methods, it is possible for scholarship to be reconnected and indeed fully integrated with clinical practice.