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Research in MedFT Country

Posted By Melissa Lewis, Wednesday, August 22, 2012

Medical Family Therapists (MedFTs) are doing increasingly important and interesting research on a broad spectrum of topics including cost offset of integrated care (IC), healthcare policy, patient-provider relationships, defining MedFT, manualizing IC interventions, and IC effectiveness, for example. Recently, I contributed to this ever growing body of MedFT literature as I published the literature review section of my recently completed dissertation on the biopsychorelational health of couples with the assistance of my dissertation committee.

As I started out on my journey to do MedFT research I asked myself:

1. ‘How is MedFT research different from other fields of research?’ and once I felt I had a handle on the difference I thought,

2. ‘How in the world am I going to carry out this complicated research?’ I offer my experience and thoughts on this process.

Melissa Lewis
One can take measures of health from all of the BPS arenas, but if health is not conceptualized as interrelated, then a reductionist, and therefore, linear perspective is relied upon.

I really wanted to ensure that if I was doing a literature review or an intervention that I did not just skimp over biopsychosocial (BPS) aspects of health but really try to provide a clear picture of each of these three areas and then demonstrate their relationship to one another. This, I believed, was the heart of MedFT and what separates it from other fields. In my research, I separated sections out by BPS domain and then systematically explained the interrelationships between each of these health arenas and my outcome variable: marital health. When gathering data on couples at their family medicine visits, couples completed a research packet that had several assessments in each health arena capturing biomarkers that are commonly provided at primary care visits, a series of psychosocial assessments pertaining to substance use and distress, as well as relational assessments to better understand the couple’s relationship health. 

Of course, the real test was how we conceptualized health. One can take measures of health from all of the BPS arenas, but if health is not conceptualized as interrelated, then a reductionist, and therefore, linear perspective is relied upon. Thus, I had to make certain to provide a fluid argument for why I was using so many measures and why they were related. I used the Stress Hypothesis Model to suggest a way for readers to understand couple’s total BPS health and the interrelatedness of the domains (i.e., stress ---> negative physical and relational outcomes, while poor medical and marital health ---> stress).

In addition, to capitalize on my MFT roots, I wanted to use a dynamic and relational perspective of health. Therefore, I collected data from patient and spouse to gain a systemic understanding of their health. In this way, data can be collected over time (at multiple intervals) and statistical modeling techniques can be used to ascertain what percentage of change in physiological stress response can be attributed to marital health versus life distress for each member of the couple. In other words, is the conflictual marriage or the life distress experience contributing more to the patient’s physiological stress response and is the wife’s or the husband’s marriage experience related more to the patient’s physiological stress response (which we know is related to increased susceptibility to illness, which is related to stress, and so on and so forth).

Obviously, as we use a non-linear, ecological perspective to conceptualize health we do a better job of describing the health event (i.e., infinite contributors to a health event that are multi-directional) than if we used a linear perspective alone. Unfortunately, data collection, data analysis, and even MedFT implications can become more complicated to undertake and require more advanced skills and time to complete the research project. For many of us, we are navigating into unchartered territories by creating and testing our own theories and models, utilizing research techniques from several other disciplines and redefining health and health interventions in hopes of contributing in a relevant and applicable way for our patients and the field of healthcare. I hope that this may spark your interest in MedFT research and am curious about how you define and carryout MedFT research. Please share your MedFT research experience with us by commenting below!


Melissa Lewis is a licensed Marriage and Family Therapist in North Carolina. She received her Master's degree at Arizona State University (MFT) in 2007 and her PhD from East Carolina University (MedFT) in 2012.Her research area broadly encompasses the relationship between stress response and BPSS outcomes. Specifically, she studies the stress transmission model with military couples and is also evaluating integrated care interventions aimed to reduce BPSS health symptoms in both Native American and military populations. Melissa can be contacted at

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Randall Reitz says...
Posted Thursday, August 23, 2012
Melissa, thanks for sharing this great post. Your research reminded me of my dissertation. We used mixed-methods analyses to measure biopsychosocial outcomes of family therapy with families with an adolescent with diabetes. What we found was that the psychological measure (the Diabetes Quality of Life Scale) tended to move in opposite directions as blood sugar control, whereas the family measure (the Family Environment Scale) tended to move in the same direction as blood sugar control.

We had a smallish sample and our methodology didn't allow for causal analysis. So, we can't say which variable drove the other, but it seems that an intervention focusing on individual quality of life might be less effective at improving blood sugar control than an intervention to improve the quality of the family environment.
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