Family Therapy Meets Internal Medicine: Innovations in Medical Family Therapy

Abstract

This article describes a growing area of the field of marriage and family therapy that is termed "medical family therapy" or "collaborative family health care." In short, this area involves collaborative approaches to health care in which health care providers and marriage and family therapists or other family-oriented mental health professionals work together to provide an integrated, biopsychosocial approach to care that actively considers and engages the patient's family or support system in the treatment process.Review of LiteratureMedical family therapy or collaborative family health care has been billed as the "next frontier" of marriage and family therapy (Bloch, 1992). Medical family therapy involves collaboration among family therapists and health care providers who, in more integrated collaborative models, may be practicing in the same facility. This interest in coordinated care has developed in the context of a call for more cost-effective and innovative approaches to health care (McDaniel, Hepworth & Doherty, 1992; Patterson, Peek, Heinrich, Bischoff, & Scherger, 2002). Four factors have contributed to the interest in collaborative approaches:* First, an enormous number of mental health problems are presented in medical settings, particularly in primary care. Up to 40 percent of primary care patients have a diagnosable mental disorder, and one-half to two-thirds of those meeting criteria for a mental disorder go unrecognized (deGruy, 1997).* Second, a small percentage (10%) of patients, termed "high utilizers," accounts for 40 to 60 percent of health care expenditures. Half of these high utilizers have psychiatric diagnoses, such as depression or somatization disorder, and frequently have a history of abuse or neglect (Seaburn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). These high utilizers often are not amenable to a traditional biomedical approach and demand expensive diagnostic procedures that often are unable to detect any observable biomedical cause for their complaints.* Third, shorter hospital stays and increasing use of outpatient surgery have led to family members taking on greater burdens of health care in the home (McDaniel et al., 1992). Thus, family members are providing significant amounts of informal health care but are infrequently actively involved in the treatment process by medical providers.* Fourth, advances in health care and prescription medications have meant more focus on chronic illness and lifestyle issues, which often can be greatly influenced by family dynamics and relationships (Campbell, 2003; Rolland, 1994).Active family involvement can play a significant role in improving treatment adherence over the course of chronic illnesses. In each of these four areas, one can see how the addition of a mental health professional, such as a marriage and family therapist working alongside medical providers, would serve to enhance the overall health care services for patients and their family members.Given these four factors, family therapists have much to offer health care providers in addressing some of the more difficult and frustrating aspects of their work (Bischof, 1996). For example, issues of noncompliance with medical treatment and difficulties altering destructive health behaviors such as cigarette smoking or overeating may be understood more clearly as the family system and patient or family beliefs are investigated by the family therapist. Research in the area of compliance or adherence with medical treatment recommendations reveals that only one-third of patients correctly follow physicians' directives, and approximately half of patients are not taking medications as prescribed (Ekstrand & Chesney, 2002). It has been suggested that noncompliance may be related to the power differential between the physician and patient and that patients may not feel their problems have been adequately listened to or understood or do not fully understand the rationale for the recommended plan of treatment. …