Supervision Bulletin
News and Information for 
AAMFT Approved Supervisors and Supervisors–in–Training
Winter/Spring 2001
Pages 3-4

The Changing Face of Models of 
Marital and Family Therapy
Jay Lebow

The history of the field of marital and family therapy has been relatively brief, yet filled with radical shifts. First, conjoint therapy was seen as an extension of individual psychotherapy. Then came the upheaval brought by systems theory in which models were presented that dismissed the importance of individual functioning and history. Just as these models were becoming part of the establishment, they too came to be displaced from the center of attention by models that emphasized individual processes and present experience, such as narrative.

These shifts have left those of us who teach marital and family therapy with a dilemma. What therapy models do we teach in a field that has been so ever changing? In order to deal with the widely contrasting ideas at base in our models and the need for some sense of continuity in teaching, our texts and classes have come to follow a fairly standard set of models, presented in a rapid "If it’s Tuesday this must be Belgium" tour of the ways that intervention with families have been envisioned. Every student is familiar with the names and content of these models. Indeed, these models form the core of many of the questions we ask on the marriage and family therapist licensure examination: if you don’t know these models you aren’t qualified to be an MFT.

Tradition tells us that this is the set of models to teach, but does this tradition make sense? This brief commentary has one essential purpose: to call in to question this part of our curriculum and suggest alternatives. But let me first say clearly, this argument is not intended to negate the value of these theories and approaches. Elsewhere, I have written extensively about the important contributions made by these very theories and their landmark value in helping move our field to its present status. We have much to learn from those theories. However, we are a young field; one far too young to regard it as essential to teach all those approaches that emerged in its history. It is far too early to become stuck defining intervention in terms of such a standard set of approaches. Most strikingly, our texts and courses still extend prominence to approaches that almost no one practices any longer. In some cases, even those who developed methods no longer practice those methods, long ago having moved on to other more promising ideas. Some old essential concepts, such as the double bind theory of schizophrenia and its related interventions designed to double bind the double binders, have even come to be understood to do precisely what is not indicated as useful for families, because these methods increase rather than decrease the level of expressed emotion, a vital predictor of difficulty.

I remain a proponent of understanding the range of aspects of human functioning raised by such a diverse base of theories, of maintaining a broad view of the change process, and of insuring that we not forget our history, but we also must consider what we are not teaching when we choose to focus on such a historically driven set of models. Most prominently, when we teach this unchanging set of theories, we do not teach those models that have emerged more recently, and, most especially, the empirically tested treatments that have been specifically designed to deal with prominent specific difficulties encountered by families. As Pinsof and Wynne (1995) pointed out in their seminal issue of the Journal of Marital and Family Therapy reviewing the research on couple and family therapy, recent research has identified a number of very effective models for working with the problems of couples and families, most of which combine modalities of treatment. Because our curricula are filled with teaching the history of approaches in our field, we rarely find room for students to become familiar with these approaches. How many of our students know what Sue Johnson’s and Les Greenberg’s Emotionally-focused therapy is, let alone how to practice it, or Howard Liddle’s Multi-dimensional Family Therapy for adolescent substance abuse? I believe it is time for us to make a radical shift, to move those approaches that both have become infrequently practiced and which lack empirical support into the two to three page afterthought sections of our books and courses, replaced by engaging approaches such as these, for which we have specific evidence for their effectiveness.

Ultimately, as I have written elsewhere (Lebow, 1985,1987, 1996), I hope we can help our students grasp essential principles of family process and of change and develop integrative strategies for intervention that maximize their personal effectiveness. Toward this end, I believe we would do far better to expose them in our core theory courses to the rich integrative approaches that have been developed and validated. Such models draw from first generation theories, including elements from such models as structural family therapy, experiential therapy, and behavioral family therapy, but in the context of constructing the most effective therapy aimed toward specific difficulties, without the invective aimed at other approaches that characterized earlier methods. These models also represent ways of intervening that have been proven to work. Focusing more attention on such approaches also would help our students to see our field as a developing science and art, rather than as a contest of competing ideologies. At one time, all there was in our field was ideology and ideas (albeit sometimes brilliant ones). Today, we have the prospect of offering our students a view of a field that is evolving, in which much is known from research, and in which our approaches become more refined, more specific, and better. My hope is that we can at least begin to reshape our core theory courses to reflect these developments. If we do so, we can spur the co-evolution of better teaching and practice.

Jay Lebow, Ph.D., is a senior therapist and research consultant at the Family Institute at Northwestern and Adjunct Associate Professor at Northwestern University. He is an AAMFT Approved Supervisor and supervises in the Family Institute’s MFT program. He serves on the editorial boards of JMFT and Family Process, is a contributing editor for the Networker, and is the author of numerous articles about the interface of research and practice, research in couple and family therapy, and integrative methods of practice.

References

Lebow, J. L. (1987a). Developing a personal integration in family therapy: Principles for model construction and practice. Journal of Marital and Family Therapy, 13, 1-14.

Lebow, J. L. (1987b). Integrative family therapy: An overview of major issues. Psychotherapy, 40, 584-594.

Lebow, J. L. (1984). On the value of integrating approaches to family therapy. Journal of Marital and Family Therapy, 10, 127-138.

Pinsof, W., & Wynne, L. (1995) The efficacy of marital and family therapy: An empirical overview, conclusions and recommendations. Journal of Marital and Family Therapy, 21, 585-613.



Supervision Bulletin
Winter/Spring Issue
2001
Pages 3-4

© 2002 American Association for Marriage and Family Therapy
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