Intensive Structural Therapy

The question is what happened to Family Therapy, or more aptly, how is it that CBT has taken over the psychotherapy world?

Everywhere I turn, there is CBT or some other individual therapy.

That is not to say there aren’t some programs and there are certainly some breakthroughs in terms of treatments for family therapy such as the MFT program and various other programs for troubled kids.

Nevertheless, when you talk, especially in the medical world, about what is psychotherapy – it is usually CBT. Invariably, in government circles for the most part it is specialised programs like Trauma Based Therapy.

So, what happened to family therapy?

In the seventies, when I was beginning my training we were getting great results. Overnight we would transform problems such as anorexia and other severe problems but nevertheless we still began a process of our field being marginalised.

Let’s look at some of the history of family therapy to perhaps answer the questions of family therapies marginalisation. Even Inber-Black published a paper on family process - Eschewing Certainties: The creation of family therapists in the twenty-first century.

In this excellent paper, she gives the history of family therapy from the halcyon days of the seventies where there were the charismatic leaders such as Minuchin, Haley, Whittaker, Maris Sara-Palazolli, Virginia Satir and others.

Each of them started their own movements, all based on the family therapy paradigm.

As I read the paper and find the literature, as the progression of family therapy proceeded new models were developed such as the cybernetics model or narrative therapy. Most importantly, to my mind, it is not clear on what basis the earlier models were replaced, one can't tell whether it was fashion or novelty.

The one thing that is clear checking the literature and in Imber-Black's paper is that the earlier models were not replaced by newer models on the basis of improved outcomes. Indeed, it looks as though family therapy just rode off into the sunset in all directions more out of loyalty to the teachers than to the data.

In these blogs, I'm going to discuss where I think family therapy needs to go and this is to be more data driven and more scientific.

There is an innovative movement that has transformed government services and that is result based accountability.

Over the last ten years in our program for troubled adolescents, we've modified some of these concepts to have a clear outcome system.

Eschewing Certainties: The Creation of Family Therapists in the 21st Century
EVAN IMBER-BLACK
Fam Proc 53:371–379, 2014