Medical Family Therapy
Medical Family Therapy (MedFT) is a field that uses the biopsychosocial-spiritual (BPS-S) model (Engel 1977, 1980; Wright, Watson, & Bell, 1996) and systems theory (von Bertalanffy, 1968) in various spheres of medicine. Tyndall et al. gave this definition, “An approach to healthcare sourced from a BPSS perspective and marriage and family therapy , but also informed by systems theory. The practice of MedFT spans a variety of clinical settings with a strong focus on the relationship of the patient and the collaboration between and among the healthcare providers and the patient. MedFTs are endorsers of patient and family agency and facilitators of healthy workplace dynamics” (2010). Main areas include clinical work, healthcare research, healthcare policy, and more recently graduate and undergraduate medical education. A basic premise of MedFT is that there are no psychosocial problems without biological features, and there are no biomedical problems without psychosocial features (McDaniel, Hepworth, & Doherty, 1992). According to McDaniel, Hepworth, and Doherty (2014), MedFT is also a response to five eco-systemic splits that lead to “fragmented, ineffective, and less humane care.”
They summarized the five splits as:
Mind body dualism: This split separates physical health from mental health and treats both systems as separate rather than a continuum.
Individual vs. the family: some aspects of healthcare training (medicine and allied health professions) who inherently believe in the unity of mind and body often downplay the role family. The authors see family as a “powerful interpersonal force field within which the patient lives and functions.” Separating the individual from this force field leads to fragmentation of care.
Individual, family vs. institutional settings: Families with long health complications not only have the relationships that define their internal experiences but also a certain dynamic of trust, mistrust, and confidence with the healthcare institution and healthcare team. MedFTs serve as liaisons between the members of the family and the healthcare team, which is an important aspect of treatment.
Clinical, operational, and financial: Too often, these worlds are separated in clinical practice and the operational and financial wings of the healthcare system holds answers to long term sustainability of integrating different providers into the healthcare team.
Separation of community from clinical health care: Most students of healthcare disciplines and social sciences know that neighborhoods, culture, and larger institutions directly impact the quality of our lives. A MedFT not only appreciates these rich frames but also facilitates their involvement in the flow of clinical care.
In short, MedFT punctuates the layers of relationships that are necessary to address issues of health, illness, and recovery. The systemic principles are equally applicable to the family in concern, as well as the members of the healthcare team. The approach comes from a three worldview framework addressing operational, financial, and clinical aspects (Peek, 2008).
MedFTs are grounded in systems theory, but their training and skills go beyond traditional marriage and family therapy training. MedFTs’ knowledge expands past psychosocial stressors to include a basic understanding of biomedical illness, trauma, and health (Doherty, McDaniel, & Hepworth, 1994).
Goals of MedFT
MedFTs help promote and facilitate communication and collaboration among staff in healthcare systems, between staff and patients and families, and between mental health and physical health professionals (Doherty, McDaniel, & Hepworth, 1994; Hodgson, Lamson, Mendenhall & Crane, 2012; Tyndall, Hodgson, Lamson, White, & Knight, 2010). MedFTs value relationships, culture, community, and health as clinicians, researchers, educators, healthcare administrators, and policy makers (Hodgson, Lamson, Mendenhall, & Crane, 2014). As clinicians, researchers, and policy-makers, MedFTs promote health equity and aim to reduce health disparities based on age, race, class, gender, and sexual and gender identity. Two goals of medical family therapy are to promote agency and communion (McDaniel, Hepworth, & Doherty, 1992; Tyndall, Hodgson, Lamson, White & Knight, 2012). Agency refers to empowering patients and families in making decisions regarding their healthcare. Communion refers to the importance of having family and community support. Further, helping patients and families act as a team and feel supported rather than experiencing isolation while coping with illness
Biopsychosocial and Systems Theories
The practice of what is now known as Medical Family Therapy (MedFT) emerged in the late 1970s/early 1980s to address the gap in the healthcare system between biological and psychosocial health. Clinical, academic, and administrative professionals in the healthcare field began to recognize the importance of collaboration between medicine and behavioral health, which resulted in a growing relationship between family medicine and marriage and family therapy (MFT) practitioners. Across the country, different family therapists worked together with family physicians and began publishing on family oriented care and collaboration.
MFT applies Systems Theory to treat individuals, couples, and families struggling with emotional and relational challenges. MedFT is grounded in this practice as well as the biopsychosocial approach, proposed by George Engel in 1977. The biopsychosocial approach was expanded to the biopsychosocial-spiritual after MedFT pioneers recognized the importance of including spirituality in whole-person care. As it is practiced today, MedFT is based in a biopsychosocial-spiritual systems model and encourages active collaboration between members of the healthcare team.
The term Medical Family Therapy first emerged in the literature by McDaniel, Hepworth, and Doherty (1992) in a text titled Medical Family Therapy: A Biopsychosocial Approach to Families with Health Problems. MedFT addressed the need for systemic and family-oriented approaches across all facets of healthcare. Since its initial evolvement in practice in the 1980s and in the literature in the 1990s, it has developed as an independent field, with MedFTs practicing in primary, secondary, and tertiary healthcare settings. In response to this expansion in the mid-1990s and 2000s, prominent scholars called for the inclusion of MedFT training within MFT programs, and the field responded. The first accredited MedFT doctoral program was established in 2005 at East Carolina University. There are currently 2 PhD programs and 17 MedFT professional programs and training opportunities available in the US. Please see section on training for further information.
It is important to note that this growth has not come without controversy. Some initial critics had concerns that the approach was not unique. In the United Kingdom, a biopsychosocial approach to care had been practiced for years. Others agreed, but highlighted MedFTs uniqueness of bringing this perspective to primary care and its foundation in MFT. At present, the underlying biopsychosocial-spiritual lens and emphasis on collaboration with the medical team remain hallmarks of MedFTs (Wright, Watson, & Bell, 1996). How this plays out in practice, professional training to become a MedFT, and trueness to McDaniel and colleagues initial text is varied. Therefore, the field of MedFT is currently focused on setting core competencies and evaluation methods.