Keeley Pratt: I met Dr. Shields when I was just a first year doctoral
student in East Carolina University’s Medical Family Therapy program. We meet
over breakfast, a meeting I anxiously initiated, at one of the annual American
Association for Marriage and Family Therapy conferences. I learned of Dr.
Shields work from literature I had read on families and health, but also
because he worked and lived in Indiana- the state I grew up in. I have to admit
looking back I was nervous to meet him; he clearly is an esteemed researcher
and educator. However, quickly after meeting Dr. Shields it became evident that
we shared a kinship for health and families, research, the Midwest (think
cornfields and basketball), and sarcasm. I consider myself extremely fortunate
to have had him as professional mentor, at a distance, for close to five years
now. I was honored to interview him for the Medical Family Therapy blog series
and to have the opportunity to share the pearls of wisdom he has relayed to me over
the past five years with current and future Medical Family Therapists whom I’m
sure will benefit.
1. What experience in
your professional or personal life was most influential in your development as
a medical family therapist?
I grew up in a family where we weren’t shielded from older
folk’s illnesses. I was lucky to grow up right next to my grandparents. I was
involved in taking care of my great-grandmother and an uncle in their last
years. My sister, my cousins, and I were never shielded from aging, illness, or
death. We were told the truth as it was appropriate to our age at the time. My
parents helped us become comfortable the realities of life and death.
I was in the ministry for a few years, so I did a lot of
visiting of older folks and some hospital work with ill people. During my time
in seminary and church ministry, I learned about caring for people, read a lot
of family therapy books, and spent a lot of time with sick people. That piqued
my interest in becoming a marriage and family therapist. When I came to grad
school (at Purdue), I discovered that I also had the skills to be a researcher.
I had not thought about doing health-oriented research work
until I finished my degree at Purdue and started a faculty position at the
University of Rochester Medical Center. I worked primarily in Family Medicine, and
was immediately thrust into doing therapy with patients with complex medical
problems. At the same time, I started conducting research on family
relationships and health problems. I became a medical family therapist because
of my work context, which involved seeing patients in exam rooms with
physicians and having patients come to me who weren’t talking about their
marriage. I was trained as an MFT but my patients wanted to talk about their
diabetes, why they didn’t like their medication, their cancer, or whatever
disease/illness they had. So, I suddenly had to learn about health. I learned by
stopping a physician or a nurse practitioner in the hall and saying "What does
this mean?” I got educated quickly by colleagues and from extensive reading.
I was at Rochester to build a research program, which
because I had not been trained in health, required a huge amount of reading. At
Rochester I wrote some papers with Lyman Wynne 1,2,3, worked on
publications and book chapters on treating medical illness with Susan McDaniel4
published research with
others. It was a great group of people there: Tom Campbell, Susan McDaniel, Barbara Gawinski,
Sally Rousseau, Tziporah Rosenberg, David Seaburn5- and all of the physician
collaborators and primary care doctors who are great people and great human
beings, many who had also been trained as family therapists.
2. What do you consider
your most important contribution to the medical family therapy field or
When describing what it is I do, I say that I am a family
therapist who studies the role of clinical communication in the management of
chronic illness and the role of clinical communication in healthcare
disparities. Clinical communication is a broad term that includes not just
physicians but anyone (such social workers, nurses who give discharge
instruction, and family therapists) who interact with patients and their family
members. My research is between basic and applied, and I am very interested in
turning research into interventions.
Toward the end of my time in Rochester, I started conducting
research with Ron Epstein and Kevin Fiscella on physician-patient communication6-10.
I have continued this research since coming to Purdue in 2006, and it has been
the most fruitful and rewarding collaboration I’ve ever had.
Most of my research has been in relationships and health. I
haven’t published much about therapy so I don’t think I contribute directly to
the medical family therapy clinical literature. I see myself as doing more
basic and applied research on healthcare focused on clinical communication. Now,
working through the Purdue Regenstrief Center for Healthcare Engineering, I
collaborate with hospitals and physicians in the state. Currently, I am doing a
large physician–patient communication study funded by NIH with colleagues at
Purdue, the University of Rochester, and Michigan. I am working with colleagues
at IU and Duke to develop an intervention study to improve communication
between physicians and adolescents about sexuality. I am an MFT, one of us is a
communications PhD, and the other is a pediatrician. This is where the fun is,
interdisciplinary research; reaching across disciplinary boundaries and
expanding knowledge. I’d encourage every MFT to collaborate with people outside
their own departments.
I recently became Director of the Center on Poverty and
Health Inequities (COPHI). COPHI's mandate is to examine in the US and
internationally the effects of socio-economic status, race and ethnicity,
national origin, religion, poverty, education, and geography on health care
inequities. The Center’s faculty includes scholars from public health, counseling
psychology, communication, and consumer sciences. With less than half of our
faculty being born in the U.S., our meetings are like a mini UN, which makes
our meetings a lot of fun.
Dr. Melissa Franks and I are conducting a study on
unnecessary hospital readmissions of patients with Type 2 diabetes. We are
examining whether hospital discharge instructions and involvement of family
members in discharge planning predicts unnecessary readmission to the hospital.
We hope this study could lead to interventions to improve discharge planning,
which fits nicely with the recommendations we made in our recent JMFT paper11.
Not everybody needs family therapy, but many families can
benefit from family interventions delivered within the healthcare system. Family
therapists can devise simple interventions for healthcare providers to involve
family members. Interventions can be as simple as encouraging family members to
ask questions, encouraging their involvement, and giving them information that
will help them provide care adequately.
Clearly there are people who need family therapy, but a lot
of people would benefit from psycho-educational interventions that involve the
family. So, there is plenty of therapy work to do, but there is also plenty
that a healthcare professional with a family-orientation can do to improve
healthcare. Family therapist are needed when there is a full-fledged
relationship problem that needs intervention, but if you are just trying to get
healthcare providers to incorporate the family then we (family therapists) can
design programs to do that, but we don’t need to be the ones doing all of it. That’s
my position and what we argued in the JMFT article11.
3. What does the field
of medical family therapy most need to move into the mainstream of healthcare?
From my perspective, we need a research base, its one thing
to say we need to do this or that, but we should be plowing ahead and doing
research similar to other professions like Health Psychology. I think it is
important to establish when it’s important to involve family members and when
it’s not; not every problem requires a family member to be intimately involved-
lots of individuals can take medication for their bronchitis without a family
member reminding them. Major lifestyle changes probably do involve family
members, so it is particularly important to develop family oriented interventions
to improve the management of chronic diseases. There is a fair amount of basic
research on this, but we need to know how to help family members provide needed
4. What advice do you
have for future medical family therapy students or young professionals who are
interested in getting into research?
If they want to get into research, they should really know
the methodology literature. They should find a mentor, and if they are a
marriage and family therapy student and they have to find a mentor in another
department, don’t hesitate to do that. They need to find a content expert in their
research. They should take advantage of National Institute of Health (NIH)
health-focused research conferences. They need to go to research conferences, for
example the Society of Behavioral Medicine, because most marriage and family
therapy conferences include little research. Find a conference about the health
problem they want to study, and go to it. Learn as much about the medical
issues involved in their chosen topic. Our focus is around the behavioral
issues in managing those diseases, we’re not going to change someone’s
medication- we’re not physicians, but we can help change their behaviors such
as diet, exercise, medication adherence, and improve family interactions to
increase support for changing and maintaining these new behaviors.
We need to be part of interdisciplinary teams. You can’t do
research in this area without collaborating with all kinds of people. We need
to think that we are bringing a family systems perspective to other areas, but
we have just as much to learn from them. We have tons to learn from
epidemiology, public health, nutrition science, engineering, economics, and all
the other professions involved; and we need to learn to collaborate with them. Every
project I am doing is a collaborative project. MFT programs should encourage
their new faculty to develop interdisciplinary relationships at their
5. What about choosing
where to publish: healthcare journals, MFT journals, disease specific journals-
How do you decide?
Think about the articles you want to write and see where similar
articles have been published. So if you find a really good research article
that really speaks to the kind of research you want to do- look at where it was
published and then go look that the reference list and see where those papers
were published. Your goal is to publish at the highest level possible. Most NIH
panels are not going to be familiar with most family therapy journals, so try
to publish in non-MFT as well as MFT journals. Publish in disease specific
journals. If your area is diabetes, then try to publish in Diabetes Care or Diabetes Educator, which are behaviorally oriented diabetes journals.
Finally, new researchers need to learn to write persuasively and
scientifically, which is argumentative writing and quite different than
describing a new clinical approach.
1. CG Shields & LC Wynne. (1997). The strength–vulnerability model of mental health and
illness in the elderly. Brunner/Mazel.
2. CG Shields, LC Wynne, SH McDaniel, BA Gawinski. (1994). Conceptual and structural marginalization: Challenges and
opportunities for the field of family therapy [A rejoinder to Hardy and
Anderson]. Journal of Marital and Family Therapy 20 (3), 297-300.
3. CG Shields & SH McDaniel. (2007). Family Therapy Pioneer, Researcher, and Mentor: Lyman C.
Wynne, MD, PhD 1923–2007. Journal of Marital and Family Therapy 33 (2), 132-133.
4. CG Shields & SH McDaniel. (1992). Process differences between male and female therapists in
a first family interview. Journal of Marital and Family Therapy 18 (2), 143-151.
5. D Seaburn, B Gawinski, J Harp, S McDaniel, D Waxman, C Shields.
(1993). Family systems therapy in a primary care medical setting:
The Rochester experience. Journal of Marital and Family Therapy 19 (2), 177-190.
6. CG Shields,
CJ Coker, SS Poulsen, JM Doyle, K Fiscella, RM Epstein & JJ Griggs. (2009). Patient-centered
communication and prognosis discussions with cancer patients. Patient Education and Counseling, 77, 437–442.
7. CG Shields,
GR Morrow, J Griggs, J Mallinger, J Roscoe, JL Wade, SR Dakhil, S. R., et al.
(2004). Decision-making role preferences of patients receiving adjuvant cancer
treatment: A University of Rochester Cancer Center community clinical oncology
program. Supportive cancer therapy,
8. CG Shields, KW Ziner, SA Bourff, K Schilling, Q Zhao, P
Monahan, G Sledge & V Champion.
(2010). An intervention to improve communication between breast cancer
survivors and their physicians. Journal of Psychosocial Oncology, 28(6),
9. CG Shields, RM Epstein, P Franks,
K Fiscella, P Duberstein, SH McDaniel
& S Meldrum. (2005) Emotion
language in primary care encounters: reliability and validity of an emotion
word count coding system Patient Education and Counseling, 57: 232-238
10. RM Epstein, T Hadee, J Carroll, SC Meldrum, J Lardner, CG Shields. Could this be something serious? (2007) Journal of general
internal medicine 22 (12), 1731-1739.
11. CG Shields, MA Finley & N Chawla & P Meadors. (2012). Couple
and family interventions in health problems. Journal of Marital and Family
Therapy, 38(1), 265-280. doi:10.1111/j.1752-0606.2011.00269.x
12. MM Franks, CG Shields,
L Sands, E Lim, S Mobley & CJ Boushey. (2012). I will if you will:
Similarity in health behavior change of married partners. Health, Education, & Behavior.
39:324-331. DOI: 10.1177/1090198111402824
13. MM Franks, CG Shields, L Sands, E Lim, S Mobley & CJ Boushey.
(2012). I will if you will: Similarity in health behavior change of married
partners. Health, Education, &
Behavior. 39:324-331. DOI: 10.1177/1090198111402824
Cleveland Shields, PhD is an Associate Professor in the
Department of Human Development and Family Studies at Purdue University in West
Layfayette, IN. Dr. Shields’ main research interests include: families and
health, couple and family interventions in health, patient-centered care in
medical settings, and couples and cancer. He has published extensively in the
area of family/patient/physician communication and family/couple intervention
development, and has recently been awarded a grant by the National Cancer
Institute to examine social and behavioral influences on clinical communication
and pain management.