Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated health care for patients (McDaniel, Hepworth, & Doherty, 1995). This is the story of one such patient, her son, and those of us who were the three primary participants on her treatment team. To provide an account that comes closest to the experience itself, we have taken quotes from videotaped sessions and electronic mail communications that occurred throughout the course of therapy. Each provider tells part of the story in his or her own voice. The general commentary is provided by Susan McDaniel.
THE DEVELOPMENT OF BIOPSYCHOSOCIAL MEDICINE AND MEDICAL FAMILY THERAPY
Family Psychologist Dr. McDanielEvery theory evolves in a particular context that is a fertile, determining environment for its development. Biopsychosocial medicine, an alternative to the reductionistic biomedical model, was developed at the University of Rochester School of Medicine out of the inspiration of one internist, George Engel (1977), working among a cluster of talented physicians interested in disease and the social aspects of the human condition (Epstein et al., in press). In 1980, I brought my family systems training to the psychosocially sensitive Department of Family Medicine. Family physician Thomas Campbell, having just completed a fellowship with George Engel, joined me to develop a behavioral science curriculum for primary care physicians. This curriculum integrated family systems and biopsychosocial approaches, which evolved from a common root in general systems theory.Once we had developed a curriculum (McDaniel, Campbell, & Seaburn, 1990), we realized that most mental health professionals did not communicate, much less collaborate, with the physicians we were teaching to provide family-oriented, biopsychosocial care. When lesser interventions (such as pleading with community therapists) did not rectify the situation, we decided to experiment with on-site familyoriented mental health services. The experiment succeeded beyond our expectations. Problems with communication decreased sharply and, even more important, the setting provided routine opportunities for innovation and collaboration with other health professionals. Of course, barriers to collaboration occurred daily, but my tolerance for working through them was high because I grew up in a medical family (my father was an obstetrician) and live in one now (my husband is a pediatrician and internist). This is a context that I understand.We had brought family systems theory to the medical context, but what had we ourselves learned about family therapy in the process? With family therapists Jeri Hepworth in Connecticut and William Doherty in Minnesota also working in primary care Some facts about the people involved in this case have been altered to protect the confidentiality of the patients 323