The Marginalization of Family Therapy: A Historical and Continuing Problem

Abstract

Family therapy, and marital and family problems, are marginalized in the larger fields of mental andphysical health care, which is a misfortune both forfamily therapy and for other mental health professions. The early family therapists, who had multidisciplinary backgrounds, attempted to establish a new, nondisciplinaryparadigm and also tried to expand the perspectives of the more traditional mental health disciplines. More recently, family therapists have exerted greater efforts to establish marriage andfamily therapy as a differentiated, autonomous profession. These alternatives each involve dilemmas for the family therapy field. The positive side of becoming a distinctive profession is greater internal strength and clear professional identity; the downside is the threat of increased marginalization in relation to other professions, a tendency toward intellectual isolation, and hence restricted opportunities for invigorating new challenges. Family therapy now needs to develop new modes of interchange, collaboration, and selective integration with other health care professions. Such interchange will be beneficial both to family therapy and to other professions.

Couple and Family Interventions in Health Problems

“…Helping patients and their families manage chronic illnesses requires family therapists to become more integrated within the larger healthcare system (Shields et al., 1994). Many family therapists work in primary care settings (Frank, McDaniel, Bray, & Heldring, 2004) or in private offices in close consultation with primary medical providers (Driscoll & McCabe, 2004).…”

Brief Family Therapy Training in India

“…The setting does not use systemic understanding in general but the primary aim of the family therapy training is to introduce trainees to a systemic framework when working with patients and their families. Shields, Wynne, McDaniel, and Gawinski (1994) have touched upon these as important issues in ongoing controversies about marginalization of family therapy from mainstream mental health practice. One group of family therapists believes that training should occur in a setting that provides opportunities for practice, too, and that it must remain integrated with larger practice and services in mental health.…”

Children and Psychotropic Medication: A Cautionary Note

“…The source of power for the medical subspecialty of psychiatry, which now dominates mainstream mental health, is economic, not scientific. This is made obvious in recent efforts to integrate family therapy into mental health (Shields, Wynne, McDaniel, & Gawinski, 1994), where the debate has centered on the usefulness and viability of mental illness diagnoses and psychotropic medications (e.g., Denton, Patterson, & Van Meir, 1997; Sparks, 2002). The educational guidelines promulgated by the Commission on Accreditation for Marriage and Family Therapy Education (2005) include the requirement to cover psychopharmacology, traditional psycho‐diagnostic categories, and diagnosis and treatment of major mental health issues.…”