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Conversing about Conversation: What is MedFT?

Posted By Dan Marlowe, Tuesday, February 14, 2012
Since this is my first foray into the blog-o-sphere, I would like to start off by issuing a big THANK YOU (see, it’s big!) to Barry Jacobs, Jennifer Hodgson, and Randall Reitz for allowing me to help with and contribute to the Growing MedFT blog. Secondly, I want to give an even bigger THANK YOU to all of you who have posted, are willing to post, are contemplating about posting, and/or contemplating about contemplating about posting- your thoughts and ideas are incredibly important, appreciated, and essential to growing this "thing” that we are all passionate about. With that said, let’s dive right in….What is MedFT?

Now, before the hairs on the back of your neck stand-up and you ready yourself for an intellectual boxing match with the rest of my post, know that this has nothing do to with actually defining anything. It is my attempt to highlight the importance of our commitment to the on-going conversation about MedFT in general, how we have had that conversation so far, and why now more than ever, it is important for us to keep that conversation going.

What is MedFT? I remember being asked that daily in my doctoral program. In fact, my ability to accurately describe what it was that I was doing and my professional place in the world was a rather large part of my education- "doctoral” and "indoctrination” rhyme for a reason. Is it an approach, is it a sub-specialty, is it an orientation, is it an entirely new field, is it the answer to who actually shot JR (yes, I am old enough to remember Dallas)?
Dan Marlowe
What is MedFT?
In the end the most important part of that question (for me anyway) has little to do with the answer itself, but the conversations we have along the way in search of that answer.

These were questions that I struggled with and argued about for the better part of three years- even writing my competency manuscript on the subject. However, only after graduation did I realize that I had completely missed the most important part of those conversations/arguments.

What is MedFT? We have a lot of great descriptions of MedFT as a construct: we have the seminal work of Susan McDaniel, Jeri Hepworth, and Bill Doherty (1992), the work of John Rolland (1994), Linville, Hertlein, and Prouty-Lyness’s (2007) attempt to synthesize a description from the literature at that time, and even a Delphi study whose purpose was to provide a systematic description of MedFT through interviewing experts in the area (Tyndall et al., 2010). Let’s not leave out the other angles we have used to describe MedFT as well: we write about cases where we see it in play, we present models of care that purport to utilize it, we point to effectiveness research (not enough of it as Tai Mendenhall points out in an earlier blog post- check it out!), we even have specific training programs dedicated to MedFT and yet the conversation about exactly ‘what’ it is persists. I know I have left out a lot of examples here, but my point being that we have been trying to define MedFT for the better part of 20 years! So, should we just give up? Is the lack of consensus a tell-tale sign that our search for the ‘truth’ about MedFT, is ultimately as fruitless as counting how many licks it takes to get to the tootsie roll center of a tootsie pop?

What is MedFT? In the end the most important part of that question (for me anyway) has little to do with the answer itself, but the conversations we have along the way in search of that answer. The fact remains that what MedFT is or is not will be shaped by a number of forces beyond research, academics, and training (e.g., state/nation health policy, insurance companies, popular opinion, state laws), and even then what it becomes will always be up for negotiation- just look at how our own professional homes are in a constant state of flux. We attempt to define the nature of things (especially professions) by any all means necessary, we make laws, we research, we debate, we theorize, we practice; however, all of these things are impermanent, they are always changing, moving and evolving with those involved in their pursuit. In the end, what matters most is not that we ‘find’ the answer in that classical EUREKA!! moment, but that we are always ready and open to keep the conversation going about what that answer might look like if we ever came upon it.

In that vein of thought then: research, practice, develop models, post a blog (wink wink), or even have an old fashioned debate. All of these things embody the conversation about what MedFT is, what it is not, and what it can be. In the end, ladies and gentlemen, MedFT lives or dies on our words, thoughts, and actions in our pursuit of its practice and development. If MedFT is something we consider to be a passion, then the responsibility falls to all of us to keep that conversation going- if not us, then whom?

Now, remember at the beginning when I said I was not going to offer a definition of MedFT- I lied. Here is my stab, albeit a short one, at my understanding of what I do:

Before I start, I ask you to remember that the answer to a question is always bound by the way in which the question is asked. So, medical family therapy, for me, is the extension of an existing epistemology (there’s a 60 point Words With Friends word for you), or a way of thinking, into a specific venue or context (Marlowe, 2011). Now, the systemic/relational thinking indicative of MedFT is not isolated to a particular person or group of people, but it is, I argue, found as a rallying point in particular fields- and one of those fields would be family therapy (I know, I know- on the boxing gloves go). Now, I will be the first to tell you that not all family therapists think relationally, and that there are plenty of psychologists/social workers/physicians/nurses who are incredibly relational in their thinking and practice. However, I am not talking about individuals here (this is where I think we get stuck in these conversations); I am talking about fields of study and practice. As a field, family therapy was built on relational/systemic theory originating from biological, mathematical, and anthropological foundations. Even if we look back at Engel’s original 1977 article (admittedly not about family therapy), he quotes Margaret Meade, and utilizes the ideas of recursion, punctuation, context, frame of reference, and double description as foundations for his argument. It is important for me to point out that while I feel MedFT (as a profession) is indeed a sub-specialty of family therapy, it is not the same as its practice, or the patterns of thinking that define/inform that practice.

When we talk about medical family therapy, depending on the context, we are talking about it in three interlocking ways: as thinking, as practice, and as profession. Our practice of something does not mean that we belong to the profession that defines that practice- pulling a tooth does not make me a dentist. However, our allegiance to a profession, and subsequent practice of the techniques associated with it does not mean we align with its underlying way of thinking either- how many times have you said, "Wow, you don’t think/act like a physician.” My point being, that while practitioners might utilize the relational thinking and techniques associated with MedFT, as a profession, it finds its roots in the foundational epistemology of family therapy and the biopsychosocial model- a model that too attributes much of its roots to systems/cybernetic theory.


So, those are my thoughts. Now it’s your turn…..what is MedFT?


The search for the truth is more precious than its possession.

Albert Einstein


References:

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.

Linville, D., Hertlein, K. M., & Lyness, A. M. P. (2007). Medical family therapy: Reflecting on the necessity of collaborative healthcare research. Families, Systems, & Health, 25(1), 85-97.

Marlowe, D. (2011), Bridging Conversations: Discussing the Intra-professional Relationship between Medical Family Therapy and Family Therapy. Journal of Family Therapy. doi:10.1111/j.1467-6427.2011.00553.x

McDaniel, S. H., Hepworth, J., & Doherty, W. J. (1992). Medical family therapy: A biopsychosocial approach to families with health problems. New York, NY: Basic Books.

Rolland, J. S. (1994). Families, illness, and disability: An integrative treatment model. New York, NY: Basic Books.

Tyndall, L., Hodgson, J., Lamson, A., Knight, S., & White, M. (2010). The state of medical family therapy: A modified Delphi analysis. Unpublished doctoral dissertation, East Carolina University, Greenville.


Dan Marlowe is the co-editor of the Growing MedFT Blog, and the Director of Applied Psychosocial Medicine for the Duke/Southern Regional AHEC Family Medicine Residency Program in Fayetteville, NC. He obtained his MS in Marriage and Family Therapy and PhD in Medical Family Therapy from East Carolina University in Greenville, NC.


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