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The Family in Medical Practice: A Family Systems Primer PDF

267 Pages·1987·10.2 MB·English
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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, U.S.A. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. 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

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