Medical Family Therapy : Conceptual Clarification and Consensus for an Emerging Profession

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Tyndall, Lisa E.

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East Carolina University


The term Medical Family Therapy (MedFT) was coined in the early 1990s (McDaniel, Hepworth, & Doherty, 1992a) by a team of family therapists and a family psychologist. Since then there has been growing interest in MedFT, including the expansion of training programs and an increasing prevalence in the academic literature. While this growth is exciting, if MedFT is going to continue to move forward and gain credibility in the healthcare system, its practitioners, researchers, and scholars must first establish a common lexicon, that can thereby ground the MedFT's professional identity, regulatory oversight, and scientist-practitioner models. The first article presented in this dissertation highlights the available literature on MedFT and identifies ways to further MedFT research initiatives and possibilities. The second article is based upon based on responses from an expert panel of MedFTs and includes an analysis of their perspectives on how MedFT should be defined, practiced, and taught.    The first article is a non-systemic literature review that illustrates the state of MedFT as well as reports on the similarities and differences present in its myriad of available definitions. Additionally, the article presents the theoretical foundation and skill set of MedFTs as found in the applied clinical literature and foundational research. Researchers who have studied MedFT interventions or incorporated MedFTs as interventionists in models of clinical care are also reviewed. Overall, 65 articles were reviewed and three distinct themes emerged from the process: 1) the inception of MedFT, 2) MedFT skills and applications, and 3) MedFT Effectiveness and Efficacy Research. During the review of these articles, variations in the definition of MedFT included or excluded concepts such as: collaboration, family systems, or the biopsychosocial perspective. These variations appeared to reflect the qualifications and educational background of the practitioners, the focus and generalizability of the research. Additionally, these variations will affect the future of MedFT as either an orientation to be practiced by a wide variety of professions or a profession to be licensed independently. Upon reviewing the literature and articulating the existing gaps, it is clear that the most salient need for future research is a cohesive definition of MedFT, quality science that demonstrates its effectiveness, and educational guidelines for those desiring to be MedFT practitioners. Therefore, three recommendations are made: 1) those with expertise in MedFT must reach a consensus on a definition from which practice, training, and research can grow, 2) the MedFT intervention framework must be strengthened through research, and 3) agreement must also be reached on a MedFT curriculum with which to train future practitioners and scholars.   The second article is the results of a research study conducted to address two of the recommendations suggested in the literature review. A modified Delphi (Dalkey, 1972; Linstone & Turoff, 1975) study was conducted bringing together 37 panelists with MedFT expertise to identify the current definition of MedFT, its scope of practice, and educational competencies believed to be essential to those who practice it. After analyzing these data, we discovered that several of the foundational elements of MedFT discussed in McDaniel et al. (1992a) still hold true, including the importance of collaboration, the connection to marriage and family therapy as a parent discipline, and the overarching goals of agency and communion. The biopsychosocial (BPS) model (Engel 1977; 1980) also a foundational element of MedFT (McDaniel et al., 1992a), remained fundamental; however, the expert panel also argued for the inclusion of the spiritual dimension of health to be addressed. Panelists endorsed MedFT as primarily an orientation, a way of thinking; leaving it open to be practiced in a wide array of settings with a variety of conditions. However, some panelists also believed MedFT to be a developing profession. Also discovered was a general consensus for what a core MedFT curriculum would include. MedFT students should have a strong theoretical base and clinical skill set in family systems theory and the BPS framework, as well as comfort and skill working within medical settings and collaborating with medical professionals. MedFTs should be familiar with a variety of diseases, illnesses, disorders, and disabilities, as well as have taken courses in areas such as psychopharmacology, MedFT theory, medical culture and collaboration, and families and illness. Panelists called for MedFTs to be involved in the creation of healthcare policy, but also provide psychosocial support to medical professionals in an effort to help them to avoid caregiver burnout, compassion fatigue, and improve patient care. Recommendations for future research, clinical practice, and education in MedFT are offered.