Medical Family Therapy
MedFT Overview
Medical Family Therapy (MedFT) is a field that uses the biopsychosocial-spiritual (BPSS) model (Engel 1977, 1980; Wright et al., 1996) and systems theory (von Bertalanffy, 1968) in various spheres of medicine. Tyndall et al. (2010) gave this definition:
“An approach to healthcare sourced from a BPSS perspective and marriage and family therapy , but also informed by systems theory. The practice of MedFT spans a variety of clinical settings with a strong focus on the relationship of the patient and the collaboration between and among the healthcare providers and the patient. MedFTs are endorsers of patient and family agency and facilitators of healthy workplace dynamics.”
Main areas include clinical work, healthcare research, healthcare policy, and graduate and undergraduate education in medical and mental health fields. A basic premise of MedFT is that there are no psychosocial problems without biological features, and there are no biomedical problems without psychosocial features (McDaniel et al., 1992). According to McDaniel, Hepworth, and Doherty (2014), MedFT is also a response to five eco-systemic splits that lead to “fragmented, ineffective, and less humane care.”
They summarized the five splits as:
Mind body dualism: This split separates physical health from mental health and treats both systems as separate rather than a continuum. MedFTs honor the mind-body connection in the promotion of health and wellness.
Individual vs. the family: Some aspects of healthcare training (medicine and allied health professions) frequently downplay the role family. The family is seen as a “powerful interpersonal force field within which the patient lives and functions.” Separating the individual from this force field leads to fragmentation of care.
Individual, family vs. institutional settings: Families with chronic health complications not only have relationships that define their familial experiences, but also develop relationships with healthcare institutions and teams. These relationships are characterized by dynamics of trust and confidence or mistrust and skepticism. MedFTs serve as liaisons between the members of the family and the healthcare team, which is an important aspect of treatment.
Clinical, operational, and financial: Too often, clinical practice is seen as separate from the operational and financial wings of the healthcare system. However, the operational and financial worlds hold answers to long term sustainability and integrating different providers into the healthcare team.
Separation of community from clinical health care: Most students of healthcare disciplines and social sciences know that neighborhoods, culture, and larger institutions directly impact the quality of our lives. A MedFT not only appreciates these rich frames but also facilitates their involvement in the flow of clinical care.
In short, MedFT punctuates the layers of relationships that are necessary to address issues of health, illness, and recovery. The systemic principles are equally applicable to the family in concern, as well as the members of the healthcare team. The approach comes from a four world view framework addressing operational, financial, clinical, and training aspects (Peek, 2008).
MedFTs are grounded in systems theory, but their training and skills go beyond traditional marriage and family therapy training. MedFTs’ knowledge expands past psychosocial stressors to include a basic understanding of biomedical illness, trauma, and health (Doherty, McDaniel, & Hepworth, 1994).
Goals of MedFT
MedFTs promote and facilitate communication and collaboration among staff in healthcare systems, between staff and patients and families, and between mental health and physical health professionals (Doherty et al., 1994; Hodgson et al., 2012; Tyndall et al., 2010). To this end, two goals of medical family therapy are to promote agency and communion (McDaniel et al., 1992; Tyndall et al., 2012). Agency refers to empowering patients and families in making decisions regarding their healthcare. Communion refers to the importance of having family and community support. Further, promoting communion helps patients and families act as a team and feel supported rather than experiencing isolation while coping with illness.
MedFTs value relationships, culture, community, and health as clinicians, researchers, educators, healthcare administrators, and policy makers (Hodgson et al., 2014). MedFTs also promote health equity and aim to reduce health disparities based on age, race, class, gender, and sexual and gender identity.