Medical Family Therapy: The Future

of HealthcareEmily Sullivan MAMFT Candidate, & Heidi McKinney LMFT, North Central University

OVERVIEW

Medical Family Therapy

PRESENTATION OUTLINE

1. Brief Background of Medical Family Therapy

2. Framework3. Collaborative Treatment Model4. Scope5. Focal Points (Perspective in Practice)6. Case Study7. Application

Medical Family Therapy: In a Nutshell

Began in 1980’s & 1990’s

Medical Focus: Doctors treat “Disease”; MedFT’s help alleviate “Illness”

“An approach to integrating mind, body, and family in collaborative, systems-oriented treatment” (Doherty, McDaniel, & Hepworth, 1994).

Physical

Health

Biological

Factors

Behavioral Factors

Social Factors

Familial Factors

Psychological Factors

Factors that Influence Health and Illness

Factors that Influence Health

Biological Factors

Psychological Factors

Social Factors

Familial Factors

Behavioral

Factors

Medical Family Therapists Seek to Integrate Systems

FRAMEWORK

Medical Family Therapy

FOUNDATIONAL PRINCIPLES OF MEDFT

Biopsychosocial approach + systemic family therapy

Collaborative

Focus on problems traditionally considered medical, as well as mental health conditions

BIOPSYCHOSOCIAL FRAMEWORK (BPS)

Biopsychosocial – Spiritual Model (BPSS)

Psychological

Social

Spiritual

Biological

COLLABORATIVE TREATMENT

MODEL

Medical Family Therapy

Collaborative Nature of Medical Family Therapy

Uses Collaborative Teams to achieve its aims of addressing the biopsychosocial-spiritual needs of the patient and family.

Team provides comprehensive and coordinated patient care

Team provides outreach to communities

Team provides self-management support

AGENCY COMMUNION

Increase individual and familial control and participation in treatment

Continuing or substituting life activities

Support healthy coping

Develop support network

Promote sense of being cared for

Assist with setting boundaries

MedFT Collaborative Treatment Goals

Collaborative Treatment Model: Example

Brief Therapy Goals:1. Manage acute problem and crisis situations2. Increase coping skills3. Elevate the patient/family’s voice on

healthcare team4. Affirm and explore what sustains positive

relational connections5. Increase patient & family awareness of

connection between health & relationships6. Validate unique patient & family experience

Emotionally Focused Therapy fMRI Study

THE PATIENT IS THE FOCUS

HOW TO MAKE THE PATIENT, NOT THE DISEASE, THE FOCUS:

1) Recognize patient’s multisystemic experience of the disease.

2) Develop a caring relationship with patient. (AKA, “Joining”)

3) Elevate patient in their role in the health care team.

SCOPE

Medical Family Therapy

THERAPEUTIC QUADRANGLE

Medical Family Therapist’s Various ROLES

MENTAL HEALTH COUNSELOR

(Falke & Patrick-D-Arrigo (2015))

“Mental Health Counselor”

1)Expand patient narratives to embrace motivating beliefs related to their condition

2)Enhance coping skills, including their ability to renegotiate roles and rules

3)Process difficult emotions related to the illness experience

Medical Family Therapist’s Various ROLES

FAMILY THERAPIST

“Family Therapist” Goals

1) Enhance relationship connection through fostering a context of mutual support among family members

2) Process (with each individual family member) the difficult emotions related to the illness or other related stressors

3) All within the biopsychosocial – spiritual framework

Medical Family Therapist’s Various ROLES

LIASON / PATIENT ADVOCATE

“Liason” Objectives

When necessary, the MedFT will:

1) Challenge the dominant treatment plan

2) Challenge the patient – provider interactions that might discourage or disempower patients

3) Act as a “joiner” of patient – provider goals and perspectives

Medical Family Therapist’s Various ROLES

CONSULTANT TO HEALTH PROFESSIONALS

“Consultant” Role

Assess patients to provide a uniquely systemic BPSS-S perspective

Provide One-on-one consultations with physicians

Provide Experiential group debriefingParticipate in patient rounds

Medical Family Therapist’s Various ROLES

TEACHER

“Teacher”

Provide psychoeducation about the diagnosis and emotional impact of the illness for their patients and their families

Competent in basic biomedical facts about basic diseases

Familiar with the problems involved, the major treatments, and their psychosocial implications.

Medical Family Therapist’s Various ROLES

HEALTH CARE TEAM TRAINER

“Health Care Team Trainer”

Teach foundational aims and concepts of MedFT

Teach family therapy theory and techniqueDemonstrate therapy through the use of role

play and conjoint patient encountersProvide opportunities for self-of-the

practitioner debriefing

PERSPECTIVE IN PRACTICE

Medical Family Therapy

Negative Systemic Factors that Impact Health

Negative Health Outcom

es

Conflict

Trauma

Stressors

Isolation

Disruption

Rigidity

Being Nasty is Worse Than Not Being Nice

Positive Systemic Factors that Impact Health

Optimal

Health

Connectedness

Mutually Supportive Relationshi

ps

Direct Communicati

onClear Family Organization

Caregiver Coping Skills

“The Stuck Patient”

CASE STUDY

Medical Family Therapy

APPLICATION

Medical Family Therapy

APPLICATION: PERSONAL DEVELOPMENT

What are your personal attitudes, beliefs, & experiences around:

Family history with health and illness?

Family history with uncertainty, loss, death, dying, including useful and not useful coping styles?

Power and status concerns related to physicians?

APPLICATION: PERSONAL SELF-CARE

What are your personal attitudes, beliefs, & experiences around:

Your own health issues?

Your own self-care?

Your own biopsychosocial-spiritual care? (Diet, physical activity, sleep, healthy relationships, spiritual nourishment)

APPLICATION: FAMILY INTERVENTIONS

What are your experiences around:

Physical illness with clients?

Physician referrals?

Biopsychosocial-Spiritual Treatment issues?

FORUM DISCUSSION

Medical Family Therapy

SOCIAL CONSTRUCTION OF ILLNESS

How can our language when working with clients impact their experience of illness?

How does the language we use to describe disease / illness affect how we (in the U.S.A.) view and respond to that disease or illness?

Whose responsibility is it to bring awareness and affect change?

FINAL THOUGHTS

Medical Family Therapy

REFERENCES

Medical Family Therapy

REFERENCES

Bischoff R.J., Springer P.R., Felix D.S., Hollist C.S. (2011). Finding the heart of medical family therapy: A content analysis of medical family therapy casebook articles.

Families, Systems & Health, 29(3), 184-196.

Campbell T.L. (2003). The effectiveness of family interventions for physical disorders. Journal of Marital and Family Therapy, 29(2),

263-281.

Doherty W.J., McDaniel S.H., & Hepworth J. (1994). Medical family therapy: An emerging arena for family therapy. Journal of family therapy, 16,

31-46.

Doherty W.J., McDaniel S.H., Hepworth J. (2014). Contributions of medical family therapy to the changing health care system.

Family Process, 53(3), 529-543.

Engel G.L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136.

REFERENCES

Falke S.I., D’Arrigo-Patrick E. (2015). Medical family therapists in action: Embracing multiple roles. Journal of

Marital and Family Therapy, 41(4), 428-442.

Frankel R.M., Quill T.E., & McDaniel S.H. (2003). The biopsychosocial approach. Rochester N.Y.: University of Rochester Press.

Nichols M.P. (2010). Family therapy: concepts and methods, 9th ed. Boston, Mass: Pearson Education, Inc.

McDaniel S.H., Doherty W.J., Hepworth J. (2014). Medical Family Therapy and Integrated Care, Second

Edition. American Psychological Association.

REFERENCES

Rolland J.S. (1994). Families, illness, & disability: An integrative treatment model. New York: BasicBook.

Seaburn D.B., Lorenz A.D., Gunn W.B., Gawinski B.A., &b Mauksch L.B. (1996). Models of collaboration: A guide for mental health professionals working with health care pratitioners. New York: Basic Books.

Taylor LE.V., Stotts N.A., Humphreys J., Treadwell M.J., Miaskowski C. (2013). A biopsychosocial-spiritual model of chronic pain in adults with sickle cell disease. Pain Management Nursing, 14(4).

Tyndall L, Hodgson J., Lamson A., White M., Knight S. (2014). A review of medical family therapy: 30 years of history, growth, and research. In Hodgson et al. (eds). Medical Family Therapy. Springer

International: Switzerland.