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14 Fa m i ly Th e r a py m a g a z i n e

THERAPY • CONTEXTUAL THERAPY • BEHAVIORAL PARENT TRAINING • BEHAVIORAL MARITAL THERAPY • FUNCTIONAL FAMILY THER

he founding family therapists were rebellious iconoclasts, inventing new models as they went along. “I didn’t start with anything like a theory. What I started with was lost in the world and saying, ‘What the hell is going on out there?’” recalls John Weakland (Hoyt, 1994, p. 15). United by a com- mon interest in context and relationship, and a common willingness to flout established traditions, they experimented in different directions.

Soon these early models, formed by trial and error with clients, solidified around the original postgraduate training centers (Broderick & Schrader, 1981; Bloch & Rambo, 1994; Rambo, 1989). Intergenerational and psychoanalytic family therapy had their headquarters on the East coast, at the Ackerman Institute (Nathan Ackerman, Don Bloch, and Kitty LaPerriere) and Georgetown Center for the Study of the Family (Murray Bowen), respectively. Out on the West coast, the most unconventional of the early family therapists, those with no formal mental health training (Jay Haley, John Weakland, and Gregory Bateson) coalesced with others (Don Jackson and Virginia Satir) to form the Mental Research Institute (MRI). Later, Haley would join Salvador Minuchin and Cloe Madanes at Philadelphia Child Guidance Center. Haley and Madanes went on to create strategic family therapy, and Minuchin, with Charles Fishman and Braulio Montalvo, created structural.

These varied centers on two coasts, different as they were, shared a com- mon interest in experimentation. The position of editor of the journal, Family Process, founded in 1968, was traditionally rotated between Ackerman and MRI for the next several decades. The Galveston Family Institute (Harry Goolishian, George Pulliam and Harlene Anderson) was based in Texas and brought brief therapy to the middle of the country. Carl Whitaker is some- times known as the great original, and he not only created a model, but estab- lished a way of training through co-therapy, which continues today.

As interest and excitement about these early models spread, therapists in the trenches looked for ways to meet and talk with others interested in these ideas. Many found that home in the American Association of Marriage and Family Counseling. But it is important to note that the family therapy tradi- tion was not the only one represented within what would soon become the

s e p t e m b e r o c t o b e r 2 0 0 5 15

A N N E H . R A M B O , P H D S H E L L E Y G R E E N , P H D

Some Historical Reflections

MFTS & MODELS:

T

RAPY • INTEGRATIVE BEHAVIORAL FAMILY THERAPY • COGNITIVE BEHAVIORAL THERAPY • RELATIONAL THERAPIES TODAY • BOWEN

American Association for Marriage and Family Therapy (AAMFT). For the pre- ceding two decades, the American Association for Marriage Counseling had represented the marriage counseling tra- dition. Marriage counselors as a group tended to be interested in educational approaches, and in selectively adding to

these psychoeducational approaches test- ed portions of individual approaches, such as cognitive-behavioral individual thera- py. They may perhaps be designated as cautious utilizers. They were not icono- clasts like the early family therapists; they did not want to rebel against established models of psychotherapy. They wanted to serve their clients using a variety of empir- ically tested models (Broderick & Schrader, 1981; Rambo, 1989).

The coming together of the marriage counseling and family therapy traditions into one organization (AAMFT) for lob- bying and accreditation purposes was not without its bumps and controver- sies (Rambo, 1989). Murray Bowen and other founding family therapists formed the American Family Therapy Academy (AFTA) as an alternative organization, and as one of its early members writes, “From AFTA’s point of view, the fields of marriage counseling and family ther- apy were two separate areas, each with their own histories, concepts, and prac- tices” (p. 12, Framo, 1989). The tension between those early family therapists (who saw themselves as inventors of a new field), and those early marriage counselors (who saw themselves as inte- grating existing approaches), is alive and well in our field today.

Since the 1970s, academic marriage and family therapy programs have grown exponentially, and this has added a new dimension to the study of models. Professors of marriage and family thera- py teach models not just for their theo- retical inventiveness or their clinical util- ity, but also for their historical

importance. Graduates of accredited MFT programs, then, have been exposed to a wide and sometimes confusing vari- ety of models, and may not have had much chance to evaluate them in prac- tice. In the words of one longtime MFT educator, they are more like food critics, able to compare, contrast, and evaluate, than they are like chefs, able to create themselves (Monte Bobele, personal communication, September 10, 2005).

New models, of course, continued to be created. Gianfranco Cecchin and his colleagues (Mara Selvini-Palazzoli, Luigi Boscolo and Giuliana Prata), having studied the work of Bateson, Haley, Watzlawick and others at the MRI, founded the Milan Center for the Study of the Family. The team separated in the early 1980s, and Cecchin and Boscolo developed their own institute in which they applied a passionately interactional lens to their conceptualization of family processes. As Cecchin noted, “The indi- vidual alone makes no sense. Everything is a response to a message from someone else” (Waters, 2004).

Solution focused therapy came along in the 1980s (de Shazer et al., 1986), and by the late 1980s and early 1990s, an interest in postmodernism and social con- structionism led to the development of

languaging and narrative approaches (Anderson & Goolishian, 1988; White & Epston, 1990). Functional family ther- apy (Alexander & Sexton, 2003), emo- tionally focused couples therapy (Greenberg & Johnson, 1988; Johnson, 2004), and other newer models, typical- ly more process-oriented than the origi- nal family therapy models, have garnered much attention and empirical validation.

As marriage and family therapy has moved into the mainstream, the stakes have grown higher. In the past 15 years of the accredited MFT program in which we both teach, we have seen our gradu- ates move into training child welfare workers, working as family counselors in the public schools, directing agencies, and running statewide preferred provider organizations. In the process, they have changed the mental health system, and also they have had to change to accom- modate the system, becoming better able to communicate and compete with other mental health professionals. That same process has been repeated nationwide, of course. As we move into these leadership positions, we have choices to make about the MFT models that get used.

For some MFTs, the choice has been to identify primarily with a particular model, rather than with the field as a whole. For example, The Solution- Focused Brief Therapy Association was established in 2002 “to foster the exchange of ideas and practices in the field of Solution-Focused Brief Therapy” (www.sfbta.org). The organ- ization provides no credentialing, but offers members a sense of professional and clinical identity. Similarly, members of the Avanta Network identify them- selves with Satir’s model of therapy. While members of both organizations may also identify themselves as MFTs, for many, their identification with the model is primary, and the MFT label sec- ondary, if retained at all.

Others have chosen to examine the factors common to all successful MFT models, to identify what might be unique about MFT as a whole (Sprenkle & Blow, 2004). This has gone along with a renewed interest in empirical validation, essential to those tasks of communica-

16 Fa m i ly Th e r a py m a g a z i n e

THE TENSION BETWEEN THOSE EARLY FAMILY THERAPISTS (who saw themselves as inventors of a new field),

and those early marriage counselors (who saw

themselves as integrating existing approaches),

is alive and well in our field today.

AL VIEW • RELATIONAL THERAPIES TODAY • PROBLEM-CENTERED SYSTEMS • BRIEF STRATEGIC FAMILY THERAPY • SOCIAL CONSTRU

tion and competition with the rest of the mental health field.

Does all this make much difference to the average MFT? One recent study suggests that 31% of MFTs practice primarily cognitive/behavioral therapy (Northey, 2004) and another suggests that over 40% of MFTs are uncomfort- able working with families that include children (Sori & Sprenkle, 2004). Many within the field may find they have more in common with the marriage counsel- ing tradition of cautious utilization than with the rebellious innovation of the early family therapists. Models may inspire, or they may be seen as academ- ic, to the busy clinician.

The pioneering family therapists were not only clinicians and theoreticians; they were also researchers (Sprenkle & Piercy, 2005). As the field has evolved, however, the distinctions between researchers and therapists have grown more pronounced, and the dialogues, in some cases, more contentious. The fascination with post- modern ideas in the 1990s ignited a surge of interest in theoretical foundations and their varied applications to therapy. More recent professional trends have moved the field to a stronger emphasis on empiri- cally based models and techniques that can be replicated and assessed. In our search for shared understandings, it will be useful to consider Sprenkle and Piercy’s notion that “clinical judgment and the sci- entific method are two overlapping ways of knowing, both to be valued and both to be questioned.”

Perhaps the primary grounding idea that the iconoclastic founders of our field brought into play was that problems could be conceptualized more usefully as products of relational contexts than as indicators of individual pathology. This founding idea continues to inform much of the vibrant new work in our field, and to allow us to approach our clients with curiosity rather than judgment. Given that theory and research are always inter- twined, it is likely that the research efforts of the current moment will give rise to innovative theories and models.

Despite the differences between theo- rists and empiricists, the common ground between our early innovators and cur-

rent researchers lies in their willingness to challenge the status quo and their pas- sion for discovery. ❍

ANNE RAMBO, PHD, AND SHELLEY GREEN, PHD,

are associate professors of family therapy

at Nova Southeastern University in Ft.

Lauderdale, FL. Rambo and Green are Clinical

Members of the AAMFT and Approved

Supervisors.

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CTIONIST • CONSTRUCTIVIST • COLLABORATIVE LANGUAGE-BASED MODELS • SYMBOLIC EXPERIENTIAL • INTERNAL FAMILY SYSTE

s e p t e m b e r o c t o b e r 2 0 0 5 17

I N M E M O R I A M STEVEN DE SHAZER passed away on September 11, 2005,

in a Vienna hospital after succumbing to recent health problems. He was

co-founder and senior research associate at the Brief Family Therapy Center in

Milwaukee, Wisconsin. Mr. de Shazer was the co-developer of the Solution-

Focused Brief Therapy Model and author of four ground-breaking books, including Patterns

of Brief Therapy, Keys to Solutions in Brief Therapy, Clues: Investigating Solutions in Brief

Therapy, and Putting Difference to Work (W.W. Norton). We at the AAMFT extend our

deepest sympathy to his family and colleagues.