Seeking the Family:
Emergence of Medical Family Therapy
The notion of including the family system and focusing on the interconnectedness of individuals within the system was a radical shift in the world of mental health practice in the 1950s. Around the same time, medicine was searching for a more comprehensive approach. In one sense, medicine was also searching for family around the same time. John Geyman (1977), a pioneer in the field of family medicine, wrote the following:
It is axiomatic that the specialty of family practices is involved in the comprehensive, ongoing care of individual patients and their families, and that the knowledge and skills required by the family physician include a broad range of clinical competencies. It is likewise axiomatic that the family is the basic unit of care in family practice, but involved herein is a profound conceptual shift extending well beyond the care of the “whole patient” to the care of the family, not just the individual as the patient. Although this point is part of everyday language of developing discipline of family medicine, a gap usually exists between this conceptual goal and actual practice, including teaching practices with intended commitment to this goal.
Three years after this statement, the first seed of what we now know as Medical Family Therapy emerged as a conference presentation in the 1980 annual conference of the American Association of Marriage and Family Therapy. The presenters, William J. Doherty (family therapist, clinician, researcher, and educator) and Macaran Baird (family medicine educator, clinician, and researcher) gave their talk on Family therapy and Family medicine. Their continued friendship and collaboration resulted in a book titled “Family Therapy and Family Medicine”, published in 1983. This original collaborative scholarship becomes the source that inspires the future iterations of family therapy in medicine in general.
Although the 1980s witnessed an increased number of clinicians practicing family therapy in medical settings, it was only in 1992 that the term Medical Family Therapy was coined and established as a core concept when Susan McDaniel, Jeri Hepworth, and William Doherty published the book “Medical family therapy: A Biopsychosocial approach to families with health problems.” With a combination of George Engel’s Biopsychosocial framework (1977) and von Bertalanffy’s general system theory, these pioneers sparked a movement toward solidifying MedFT as a field of family therapy (Hodgson, Lamson, Mendenhall, & Crane, 2014). In 1994, John Rolland MD, a psychiatrist trained in family systems work authored his book titled “Families, Illness & Disability: An Integrative Approach”, further enhancing the theme of family in addressing issues of illness, recovery, and health.
Since 1992, there has been increased interest and commitment to developing MedFT as a clinical and academic discipline. With training programs springing up in various parts of the US along with dedicated internship programs that focus on Medical Family Therapy, this systemic extension is exploring the core elements of its identity with the larger clinical, academic, healthcare and research worlds. A step in maturation of this identity was the publication of the 2nd version of the original book on Medical Family Therapy. McDaniel, Hepworth, and Doherty published “Medical Family Therapy and Integrated Care” in 2014. Their revision advances the clinical knowledge about Medical Family Therapy and expands the focus of MedFT to include community, health care teams, and healthcare systems. With a focus on application and MedFT techniques, the second edition also incorporated ideas from the numerous articles and research that had been published about the field (Jacobs, 2012).
In 2010, Tyndall, Hodgson, Lamson, White, and Knight confirmed a definition of MedFT, which was used throughout the newest book on Medical Family Therapy. Medical Family Therapy: Advanced Applications (2014) works to further solidify the field by outlining the training, research, policy, and finance that contribute to the current state of MedFT including how it continues to effect the growth of the field. The chapters within this text help to outline core concepts within the field of MedFT such as context in healthcare settings, collaboration with families and communities, the concept of a practitioner as scientist, and core competencies for the field. This book dives into how to implement and apply the concepts within the field as well as in training future Medical Family Therapists.