Clinical Manual of Couples and Family Therapy [With DVD] »

Gabor I. Keitner, M.D., is Professor of Psychiatry at The Warren Alpert School of Medicine and Brown University/Rhode Island Hospital in Providence, Rhode Island.

Alison Margaret Heru, M.D., is Associate Professor of Psychiatry at the University of Colorado in Denver, Colorado.

Ira D. Glick, M.D., is Professor of Psychiatry at Stanford University School of Medicine in Stanford, California.

The Clinical Manual of Couples and Family Therapy presents a conceptual framework for engaging families of psychiatric patients. It outlines practical, evidence-based family therapy skills that make it easier for clinicians to effectively integrate families into the treatment process. Moreover, it reestablishes the role of the psychiatrist as the leader of the team of professionals providing mental health care to patients in need.

The underlying assumption in this concise manual is that most psychiatric symptoms or conditions evolve in a social context, and families can be useful in identifying the history, precipitants, and likely future obstacles to the management of presenting problems. The book clarifies the clinical decision-making process for establishing family involvement in patient care in different clinical settings, and it outlines distinct steps in family assessment and treatment within a biopsychosocial organizing framework that can be applied to all families, regardless of the patient’s presenting problems. The book’s approach is based on a broad model of family functioning, which provides a multidimensional description of families and has validated instruments to assess family functioning from both internal and external perspectives. Unique features and benefits of the manual include:

• A focus on one consistent model of assessment and treatment that can be applied to a wide range of psychiatric conditions and clinical settings
• Numerous case examples, tables, and charts throughout the text to further highlight the material
• A summary of key concepts at the end of each chapter
• A companion DVD, keyed to discussion in the text, that demonstrates how to perform a family assessment and treatment

All psychiatrists should be proficient in assessing the social and familial context in which a patient’s psychiatric illness evolves. The Clinical Manual of Couples and Family Therapy is a practical guide designed to facilitate a clinician’s ability to evaluate and treat couples and families.

Doody Review Services

Reviewer:Aaron Plattner, MD(Rush University Medical Center)
Description:This book illustrates the importance of family therapy in the treatment of psychiatric patients, outlining the therapy skills using the problem-centered systems therapy of the family within an evidence-based biopsychosocial framework.
Purpose:It is intended to equip healthcare providers with family therapy skills that will enable them to engage families effectively in the treatment process. Families are very influential in the treatment process and the potential benefits for patients and their families of using these techniques are significant.
Audience:Psychiatrists are the primary audience, but the information can be helpful for all physicians and allied mental health professionals. Psychiatric residents will find this a very useful supplement to their psychiatric education.
Features:The book begins by setting a standard of how a healthy family should function and reviewing the most current research on relational factors. The next section instructs readers how to collect, organize, and use the data from interactions with family members of a given patient with an emphasis on a biopsychosocial formulation using the problem-centered systems therapy of the family. The remainder of the book reviews other models for family therapy, describes techniques for specific and special family situations, and provides further direction for additional training that is needed to fully implement the techniques. Chapters begin with main objectives and end with a summary of the main points. Several helpful case examples and charts are woven throughout. An accompanying DVD with references is very helpful, enabling readers to view the various concepts presented in real practice.
Assessment:My training in family and couples therapy has mostly been drawn from photocopies of various books and journal articles and I appreciate that this book provides an efficient yet complete framework for basic therapeutic practices with family members. Before reading this book, I often felt overwhelmed by how to organize the information I would get when meeting with families, but now I feel more confident in my ability to work more effectively with them. Listing references at the end of the chapter makes for smoother reading than citing them in the body of the text. However, the title may be misleading because the book does not make a clear distinction between family therapy and couples therapy. Clarification of the similarities and differences would be helpful. Further, the DVD was damaged causing it to skip in several places.

A Guide for Using the Text and DVD ix

Acknowledgments xiii

1 Introduction 1

Current Psychiatric Practice 3

Family-Oriented Patient Care 5

Specific Family Assessment and Intervention Model 7

Conclusion 9

References 10

2 Healthy Family Functioning 11

Family Functions 13

Historical Trends 13

Dimensions of Family Functioning 15

Marital and Family Life Cycle 20

Family Resilience 26

Conclusion 28

References 29

3 Family Research 31

Relational Factors and Biological Systems 32

Relational Factors and Medical Illnesses 37

Relational Factors and Psychiatric Illnesses 43

Conclusion 54

References 55

4 Family Assessment 63

Connecting With the Family 64

The Evaluation Process 69

The Assessment Process 71

Tools for Family Assessment 79

DSM-IV Relational Diagnoses 83

Conclusion 86

References 87

Appendix 4-1. Case Example 88

5 Site-Specific Family Assessment 93

Orientation 94

Assessment 94

Formulation 95

Treatment Planning 96

Case Examples 96

Conclusion 108

Reference 108

6 Biopsychosocial Formulation 109

Evidence for the Interaction of Biological, Psychological, and Social Factors 112

How Is a BPS Assessment and Formulation Done? 114

How Should Psychiatrists Practice BPS Psychiatry? 116

Case Examples 117

Conclusion 128

References 129

7 Diagnostic Reasoning and Clinical Decision-Making Process 131

Putting the Biological Paradigm in Its Place 132

Rationale for Involving Families in the Decision-Making Process 134

Meaning of a Diagnosis 135

Engaging Patient and Family in Decision Making 139

Discussing Treatment Options 142

Best Practice for Clinical Decision Making 145

References 145

8 Family/CouplesTherapy: Models 149

Insight Awareness Model 150

Family-of-Origin Model 151

Systemic Strategic Model 154

Structural Model 155

Cognitive-Behavioral Model 156

Experiential Models 158

Constructivist Model 158

Psychoeducational Model 160

Multifamily Group Therapy 160

Conclusion 161

References 162

Suggested Readings 163

9 Problem-Centered Systems Therapy of the Family 165

Key Principles of PCSTF 167

Stages of Treatment 173

Conclusion 193

References 193

Appendix 9-1 Case Example 194

10 Integrating Family Treatment into Biopsychosocial Care 197

Evidence-Based Studies of Combined Treatment 197

Case Examples 208

Implementing Integrated Treatment 211

Conclusion 211

References 212

11 Family Interventions with Specific Disorders 215

Schizophrenia 216

Bipolar Disorder 223

Major Depression 227

Alcoholism and Substance Abuse Disorders 232

Anxiety Disorders 236

Conclusion 245

References 245

12 Special Situations 249

Therapeutic Alliance: Gender, Race, Culture, and Sexual Orientation 249

Competing Value Systems 253

Affairs 254

Violence 257

Divorce 262

Legal Issues 264

Conclusion 264

References 265

13 Training in Family Skills and Family Therapy 269

Knowledge 270

Skills 271

Family Therapy Training 276

Supervision 278

Assessment of Trainees 285

Conclusion 286

References 287

Appendix 13-1 GAP Proposal for Specific Family Systems Competencies 290

Appendix 13-2 Assessment Forms for Family Therapy Trainees 294

14 Conclusions and Future Directions 297

Index 303