Clinical Manual of Couples and Family Therapy
I attended medical school at Brown University in the early 1980s, where I became familiar with the McMaster model as it was developed by Nathan B. Epstein, MD, then chair of the psychiatry department. Because the McMaster model is such a comprehensive and functional tool for helping families, this book is long overdue and a real treasure for people who wish to gain better insights into the treatment of families. The McMaster model breaks down family assessment (and, later, setting goals) into 6 stages: orientation, assessment, biopsychosocial formulation, contracting, treatment (including tasks and assignments), and closure.
The book takes us through applying each of these assessment tools, including attention to affective involvement, affective responsiveness, and behavior control. There is a predominant implication that the very task of defining familial roles and behaviors will already begin the course of healing families. But the process also includes negotiating—and renegotiating—changes within the family development.
The book very much represents the model itself: it is organized, clear, systematic, and wide in scope. The authors are highly invested in applying a biopsychosocial model to the formulation of family and relational problems. The book promises to help psychiatrists organize how information is collected and clarify clinical decision making. "Psychiatrists?" you ask. Yes, this book lobbies strongly for the need to integrate psychiatric care and family care. Many of the case histories, and the primary case illustration, are centered on care of families in which at least one member has an identified psychiatric diagnosis. One chapter deals specifically with how to understand and approach specific psychiatric illness.
This book includes some excellent research-based justification for applying family-based work to the care of psychiatrically ill patients, including the deleterious effects of poor family functioning on the course of schizophrenia, and the salutary effects of an intact marriage on general health outcomes in men and women.
Discussion of interpersonal dynamics is quite thorough, but, while this book nicely catalogs different styles of marital therapy, I do not feel it makes a strong argument for lumping together marital therapy with family therapy. In my experience, a "family" is bound by blood or obligation and a sense that it will fight as a unit for survival against outside forces. Unfortunately, many people who are married do not consider their partners to be "family"; they take their marital vows too lightly and begin to see their partner as the enemy. Because, compared to family ties, marital bonds can be easily dissolved, this book may have limited therapeutic utility for healing marriages.
The strength of the book is in its organization and breadth. It includes a DVD of Dr Keitner applying the tools described in the book. The DVD alone is worth the price of the book, as it is wonderful to see the in-depth work of a master family therapist. Dr Keitner’s ability to probe into the lives of vulnerable individuals (he sticks with one family throughout the DVD), while making them feel heard and empowered, is a model for anyone who intends to do this work themselves.
The DVD, however, is a double-edged sword. Frequently the authors refer in the book to specific chapters on the DVD as examples of principles they wish to illustrate. I prefer to read on planes or in bed (or other private places), so I don’ t always have a DVD player at the ready to observe the referenced example. It would have been helpful for the authors to have added a printed excerpt of the referenced DVD clips so that readers like me would not have to put down the book to access the case study.
The psychiatric community should welcome this very useful book and DVD as a practical tool for applying the McMaster model to their practice.
Author affiliation: NRI Community Services, Woonsocket, Rhode Island. Potential conflicts of interest: None reported.
© Copyright 2012 Physicians Postgraduate Press, Inc.