For couples and family therapies, common factors are conceptualizing the problems in relational terms, disrupting relational patterns, expanding treatment to include family members of the identified patient and an expanded therapeutic alliance (Common Factors in Couple and Family Therapy: The Overlooked Foundation for Effective Practice, New York: Guilford Press, 2009). Relational patterns have cognitive, behavioral, and affective domains, all of which can be targets of intervention. The therapeutic alliance is with the relationship and the family, rather than with the individual family members.
Patients, families, and psychiatrists all demand treatments that have been shown to work well. Family psychiatry has moved from theatrical showmanship to evidence-based treatments. Within a broad range of family interventions are different levels of family involvement. Family inclusion is the easiest intervention – simply involving the family members as historians, supporters, and allies in treatment.
Second, family psychoeducation has amassed a substantial evidence base showing its efficacy in the treatment of schizophrenia, bipolar disorder, and many medical illnesses, such as diabetes.
Last, but certainly not least, are the family systemic therapies, which in a meta-analysis of family systems therapies, were defined as "any couple, family, group, multifamily group, or individual focused therapeutic intervention that refers to either one of the following systems-oriented authors (Tom Andersen, Dr. Ivan Böszörményi-Nagy, Steve de Shazer, Jay Haley, Ph.D., Dr. Minuchin, Ms. Satir, Dr. Mara Selvini Palazzoli, Dr. Helm Stierlin, Paul Watzlawick, Ph.D., Michael White, Gerald H. Zuk, Ph.D.) or specified the intervention by use of at least one of the following terms: systemic, structural, strategic, triadic, Milan, functional, solution focused, narrative, resource/strength oriented, McMaster model" (Fam. Process 2010;49:457-85).
Family systems therapy has come a long way from the early days. We are very clear that for serious mental illness, family therapy alone is not enough, but neither are medications. Combination treatment produces symptom reduction AND good quality of life.
However, most psychotherapies – of the individual and family variety – are delivered by non-psychiatrists. Psychiatry is in danger of losing itself, as primary care physicians prescribe medications and refer patients to psychotherapists who are often co-located in their offices. Psychiatrists, however, are still the only professionals who have the potential to see the whole person and oversee the entire treatment: medications, individual, and family interventions.
It is to our advantage to be knowledgeable about all psychotherapeutic interventions AND to use them. We must make family therapy more visible and easier to teach in residencies. Psychiatrists have been reluctant to identify themselves as family psychiatrists because our enthusiastic charismatic leaders took the promise of family therapy too far. We hope that the solid family research now available will encourage all psychiatrists to learn and implement family interventions.
Dr. Minuchin and the ashtray, however, remain potent symbols of how creativity and genius created a new paradigm in psychiatry.
Dr. Heru is with the department of psychiatry at the University of Colorado, Denver. She has been a member of the Association of Family Psychiatrists since 2002 and currently serves as the organization’s treasurer. In addition, she is the coauthor of two books on working with families and is the author of numerous articles on this topic.