An Introduction to Marriage and Family Therapy

An Introduction to Marriage and Family Therapy Lorna L. Hecker & Joseph L. Wetchler, Editors. New York, London, and Oxford: The Haworth Press, 2003

This is a comprehensive (600-page) family therapy textbook designed and appropriate for beginning students in the field, as well as a good review and reference for practitioners. While it is written from the perspective of marriage and family therapy as a separate profession, it gives credit to social work and other mental health professions for developments in the field. Like other overview texts in the field (i.e., Nichols & Swartz, Becvar & Becvar, Goldenberg & Goldenberg), which the authors frequently cite as sources, this book has a historical overview of the field followed by chapters on different theoretical approaches (Part I) and a special issues section (Part II), with a chapter on relevant research at the end.

Unlike these other texts, this one has a total of 20 authors writing the various chapters, which has its strengths as well as a downside. On one hand, having the different approaches written by proponents of the approaches gives each chapter freshness and some expertise, and ensures that there is a fairer presentation and less bias. In addition, since the authors are allowed their own styles, it is refreshing for the reader to have some variation. For example, some chapters are written in a straight factual lecture style, and others are more chatty and personal. In this regard I liked Volker Thomas's personal style as it fit the approach he described (experiential).

On the other hand, having so many authors (some were coauthors on chapters) creates a less integrated text with unnecessary redundancies and more information than most beginning students can assimilate, but this feature would serve family therapists well as an overview.

A special attribute of this text is the comprehensive glossary at the end of each chapter. This addition enhances its usefulness greatly, as learning these terms would help students master the concepts. The clear and concise definitions can serve as a summary of the main ideas in the chapters. Case examples for each approach strengthened the book also. Other especially useful attributes of this book include an excellent summary of the field in the Preface, descriptions of the graduate programs in marriage and family therapy, and a chapter on legal and ethical issues in marriage and family therapy with appendices including AAMFT's Code of Ethics, and suggested consent forms and disclosure statements. It is important for students to be exposed to these practical matters early, and this chapter walks them through the difficult decisions they will face.

This book is strong on history through the 1980s, but is weaker on subsequent developments and issues. The earlier paradigm shift of the '60s and '70s from psychodynamic to systemic practice is covered very thoroughly, but the later equally revolutionary shift in practice, occurring in the late '80s through today, is not given sufficient attention. For example, medical research since the early family therapy movement has changed the way we think about mental illnesses. A biological basis for mental illness is generally accepted now rather than being seen as a result of or necessarily maintained by family and relationship patterns. Research demonstrating usefulness of family therapy for persons with mental illness (as opposed to relational problems such as marital or parent-child conflict) has been mostly in the psychoeducational and supportive approaches. While psychoeducation is given three pages in Part II, it is only in the research chapter that the entire history of thinking about mental illness and family therapy research and practice is covered well.

The authors do acknowledge at the end of the history chapter that there is a "marked radical shift in family therapy" from the late '80s on, but then cover the whole "revolution" in three paragraphs and trivialize it by saying its historical importance "is yet to be determined." Further it is a weak summary, missing key points. The definition of narrative therapy in the glossary of the history chapter wrongly states that it challenges clients' views of "having problems." In fact, narrative therapy respects clients' views of having problems, but challenges their views of "being" the problem. The social constructionist movement, along with the post structuralist movement and the host of other but related ways of thinking about family therapy (i.e., feminist therapy, empowerment models and strength based therapy, culturally competent and socially conscious therapy, integrated models of family therapy, and family centered practice in health care and school settings) have radically changed the ways we practice and teach family therapy. We now practice in more collaborative ways, seeing the family as the identified client's support system rather than assuming they are part of the problem, and most family therapists rely on more than one method, using more integrated models, fashioning their work to the needs and wants of the client system. Today, it is generally recommend that therapists not refer to their clients as "schizophrenics," "anorexies," or "drug abusers," or their families as "schizophrenic families," as they were in this book. The preferred and more accurate terms are as people "with" or "suffering from" these problems, suggesting they have other attributes besides their affliction. People with mental illness were rarely referred to as "persons" in the early chapters. These changes in therapy reflect the changes in larger society, and are also in response to the critiques of family systems theory and to research in the field.

I recognize that the authors of the early chapters were reporting and describing the work of the early theory developers, but they could have put disclaimers on these earlier terms. I did see one such disclaimer in the history chapter when the author clearly stated, "they were wrong" (referring to causal factors of mental illness). It would have been useful if the authors of the approach chapters would have noted the strengths and potential problems of the approach being described, including for whom would it be more or less useful and why, and critiqued the approach for cultural competence, gender sensitivity, and research findings. There were passing references to the feminist critique and to Haley being "controversial," but in citing other sources and without discussion of the issues. There is one chapter (out of nine in Part I) on the collaborative approaches, in fact it was the only chapter that had a section on constraints and limitation of the approach. There was discussion of some of these topics in Part II, but the coverage was minimal considering their impact and importance. I would have liked more discussion and critique of the approaches. In Part I, also. Students and practitioners need to think critically about each approach and the supporting research. In addition, discussion of distilling common and useful elements across approaches develops skills in analysis and synthesis. Generally, the references in Part I were old and frequently secondary sources.

While it is important for family therapists and students of family therapy to understand the history of the profession, I believe that it is important for them to have exposure to today's practice theories. In Part I there is a full chapter each on system theory, structural therapy and strategic therapy, and a half chapter each on Bowen and Nagy, while there were two paragraphs each on narrative and solution focused therapy in the social constructionist chapter. These latter two therapy approaches are widely used today and solution focused is favored by managed care. The systemic and transgenerational therapies are still used, but are usually modified or incorporated into integrated models. For example, the functionalist idea that a symptom exists because it serves a function for the family is widely discredited today, but helping parents take charge of their children (Minuchin) or interrupting a problem sequence (Haley) are useful interventions. Similarly, many of Bowen's ideas about dependence and independence and family of origin are useful concepts to explore in therapy, but in the current managed care world few can practice the long-term therapy Bowen described.

In summary, there are many useful aspects of An Introduction to Marriage and Family Therapy. It is strong on early history of the field, and there is excellent use of case examples and glossaries to help readers understand the concepts presented. Part II had some especially useful chapters; the ones on contextual issues (13), special topics (14), ethical, legal, and professional issues (15), and research (16), were the chapters I found to be the most original and up to date. I thought the research chapter had excellent content and it was well-placed at the end of the book, as it integrated the content from the rest of the book, covering history, theory, and critiques from early work to the present, through the prism of the relevant research. I hope readers don't skim over this chapter, as "not relating to practice," as it is full of important information that is highly relevant to practice.

Patricia Kelley, PhD

Professor Emerita

School of Social Work

University of Iowa

Iowa City, Iowa

Copyright Families in Society Jul-Sep 2004
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