The Family in Medical Practice: A Family Systems Primer

267 Pages·1987·10.2 MB·English

by  Janet Christie-Seely, Michael A. Crouch (auth.), Michael A. Crouch M.D., M.S.P.H., Leonard Roberts M.D. (eds.)

The Family in Medical Practice
A Family Systems Primer
The Family
in Medical Practice
A Family Systems Primer
Edited by
Michael A. Crouch and Leonard Roberts
With 29 Figures
Springer-Verlag
New York Berlin Heidelberg
London Paris Tokyo
MICHAEL A. CROUCH, M.D., M.S.P.H.
Department of Family Medicine and Comprehensive Care, Louisiana State
University School of Medicine, Shreveport, Louisiana 71130, U.S.A.
LEONARD ROBERTS, M.D.
Department of Psychiatry, University of Rochester, Rochester, New York
14642, U.S.A.
Permission to reprint illustrations has been provided as follows:
p. ii, Roy Doty/Patient Care. © 1974, Patient Care Communications, Inc., Darien, CT. All
rights reserved; p. 2, © 1982, Cowles Syndicate, Inc. All rights reserved; p. 14, © 1983,
George Dole/Medical Economics; p. 23, © Cowles Syndicate, Inc. All rights reserved; p.
176, © 1985, FilchokfHospital Tribune; p. 178, © 1972, Cowles Syndicate, Inc. All rights
reserved.
Library of Congress Cataloging in Publication Data
The family in medical practice.
Includes bibliographies and index.
I. Family medicine. 2. Family-Health and hygiene.
3. Family psychotherapy. 1. Crouch, Michael A.
II. Roberts, Leonard, M.D. III. Title: Family systems
primer. [DNLM: 1. Family. 2. Family Practice.
WB 110 F1937]
R729.5.G4F34 1986 610 86-131 II
Reprint of the original edition 1987
© 1987 by Springer-Verlag New York Inc.
All rights reserved. No part of this book may be translated or reproduced in any form without
written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010,
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even if the former are not especially identified, is not to be taken as a sign that such names,
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While the advice and information in this book are believed to be true and accurate at the
date of going to press, neither the authors nor the editors nor the publishers can accept any
legal responsibility for any errors or omissions that may be made. The publisher makes no
warranty, express or implied, with respect to the material contained herein.
Typeset by David E. Seham Associates Inc., Metuchen, New Jersey.
9 8 7 6 5 4 3 2 I
ISBN -13:978-0-387-96372-3 e-ISBN-13:978-1-4612-4642-8
DOl: 10.1007/978-1-4612-4642-8
To the families from whence we came, and
to the families we have been fortunate enough to join,
personally and professionally
Foreword
My practice life has spanned 36 years and during that time I have been
involved in untangling countless mysterious maladies-or at least trying
to do so. All of these efforts were without the benefit of any formal training
about family systems. I am greatly encouraged by this book because it
first draws attention to the intricate web that mankind has woven for itself.
The family physician has often been caught up in this web, and therefore
rendered impotent. Efforts to understand all of this are to be applauded.
It has been my good fortune to know the editors, Leonard Roberts and
Michael Crouch and, as a family physician, I feel that their "hearts are
in the right place." They have grown up, medically speaking, in an era
when society has become more complex, where life is not easy. Birth and
its medical participants are suspect; childhood is complicated by divorce
and loneliness; adolescence is a time of aimless searching; young adults
are hard pressed to earn a living; the quality of life is being threatened
somewhat by the overgrowth of high technology; dying with dignity is at
a premium. The editors are to be commended for helping us clarify the
role of the family physician in all of this.
To have some system to figure out a way to find the possible pleasure
that can come from getting in the boat with a troubled family, picking up
an oar, and helping them to find peace, is a very special gift. This book
invites us all into such a world. It does not take the place of wounds and
the scars that come from the healing of the wounds of every day practice,
but it offers structure and guidance. The cases presented here came from
real life. This is not fiction. After all, family practice has nothing to do
with that which is fictitious.
I believe that the only ingredient missing from these pages is you. Read
them and create your own special brand of magic.
B. Lewis Barnett, Jr., M.D.
Charlottesville
Preface
Clinicians and scholars in several disciplines have developed theories and
clinical methods for addressing how the family interacts with the health
and illness of the individual. No particular family theory is widely ac-
knowledged as the most useful way to help individuals and families with
their problems. With advocates of various approaches all vigorously pro-
moting their views, it can be difficult for the health care practitioner to
decide which concepts and perspectives to use in developing practical
clinical skills.
Systems theory is a general way of thinking about the world. It departs
from simplistic everyday logic and reasoning. Thinking about patients and
their families as interrelated elements in complex systems can usefully
augment the clinician's pragmatic commonsense approaches. The authors
of this book present principles from several family systems theories and
illustrate how they can be applied in medical practice. The approaches
covered in most detail are (in order of decreasing emphasis) multigener-
ational (Bowen and Satir), structural (Minuchin), problem-oriented (Doh-
erty and Baird), and strategic (Haley).
Customized vocabularies are developed by experts to communicate with
each other within specific fields of knowledge. This book explains special
terms by focusing on their meanings and clinical implications, rather than
on the jargon itself. Analagous terms are either used as synonyms or are
differentiated by subtle differences. The Glossary of Terms further clarifies
some closely related terms.
Some of the authors incorporate humor into their discussion of serious
family issues because they believe humor to be an integral part of a healthy
individual's life and an essential ingredient of a vibrant family life. Just
as an individual benefits from taking him/herself seriously, but not overly
so, the health professional can help families by regarding their issues ear-
nestly without losing sight of the irony and levity that pervade even families
with grave problems. Humor can be one of the clinician's most useful
therapeutic tools when used thoughtfully and respectfully.
Reading this book will hopefully help health professionals take better
x Preface
care of their patients by dealing more effectively with the family aspects
of their problems. The intended audience includes: students and teachers
of medicine, nursing, social work, psychology, and allied health fields;
resident physicians in family practice, psychiatry, pediatrics and medicine;
and established health care professionals interested in learning more about
family-oriented approaches to helping people.
Although the chapters are interrelated and arranged in a logical se-
quence, the content of each chapter stands on its own, and chapters may
be easily read in any desired order. Chapters 1-5 present current knowl-
edge about the family and health care. Chapters 6-8 explain practical skills
for working with families clinically. Chapter 9 encourages the reader to
grow personally and professionally by studying hislher own family. Chapter
10 previews future developments in family-oriented medical practice, re-
search, and education.
The editors are grateful to their secretaries, Lillian Irving and Barbara
Tuttle, for their invaluable assistance, to the authors for their diligence
and patience, and to the staff at Springer-Verlag for their unwavering sup-
port and professionalism. We would greatly appreciate feedback from the
readers about the usefulness and limitations of the book, and we welcome
suggestions on how to improve the next edition.
July 30, 1986 Michael A. Crouch
Leonard Roberts
Contents
Foreword ............................................................... vii
Preface.................................................................. IX
Contributors ............................................................ xiii
The History of the Family in Medicine
JANET CHRISTIE-SEELY and MICHAEL A. CROUCH
2 A Systems View of the Clinical Relationship
HOWARD F. STEIN ............................................... 28
3 Family Systems Theory in Medical Practice
LEONARD ROBERTS .............................................. 50
4 The Family Life Cycle in Medical Practice
LEONARD ROBERTS.............................................. 74
5 Families and Illness
LISA BAKER ...................................................... 97
6 Applying a Systems Approach to Common Medical Problems
THOMAS CAMPBELL and SUSAN McDANIEL................... 112
7 Systems-oriented Counseling
KAREN WEIHS and KAREN KINGSOLVER 140
8 Using the Genogram (Family Tree) Clinically
MICHAEL A. CROUCH and TERRY DAVIS ...................... 174
9 Working with One's Own Family Issues: A Path for
Professional Development
MICHAEL A. CROUCH ........................................... 193
xii Contents
10 Future Directions for Family-oriented Medical Care:
Research, Education, and Practice
MICHAEL A. CROUCH and JANET CHRISTIE-SEELY ........... 209
Appendixes
A Some Residency Training Programs Emphasizing Family
Systems ........................................................... 224
B Some Family Therapy Training Programs, Centers, and
Resources ......................................................... 226
C Family Systems Research Programs/Centers .................. 228
D Some Family Systems Journals ................................. 229
E Suggested Further Reading About Family Systems and
Health............................................................. 230
Glossary of Terms ..................................................... 231
Subject Index .......................................................... 239
Index of Names........................................................ 253