Attending to the Context of Family Treatment: Pitfalls and Prospects

Abstract

This paper argues that family therapy is failing to attend to the contexts in which family mental health services are provided and, therefore, is losing touch with the realities of family services in communities. We present a model for describing the institutional contexts of family mental health treatment in North America, and explore how these contexts influence family treatment. The model proposes that family mental health care can be categorized into three levels, analogous to the levels of the health care delivery system: (a) primary, (b) secondary, and (c) tertiary care. These levels represent systematically different contexts for family treatment; each has unique advantages and limitations. Translating treatment methods across levels can be hazardous because of differences in contexts. We argue that delineating the contextual levels of family mental health care can encourage more fruitful and respectful collaboration among the diverse professional groups working with families.