The Role of Family Therapy

As Tipper Gore, mental health advisor to the President and chair of the 1999 White House Conference on Mental Health, has said, "Marriage and family therapy is not just for bickering spouses or children who act out," as often seems to be the public's perception. Ms. Gore explains that marital and family therapy "has been shown to effectively treat ... adult alcoholism and drug abuse, elderly dementia, adolescent drug use, depression and childhood autism." The editors of the Journal of Marital and Family Therapy add to this list of effective, and often superior, treatments: adult hypertension, adult obesity, children's conduct disorders, anorexia in young adult women, chronic physical illness in adults and children, and marital distress and conflict.

MFTs specialize in treating mental disorders in the context of marriage or family relationships, working with the individual, couple or family to change behavioral patterns so that problems can be resolved. In general, the presenting problems of clients seen by MFTs tend to be severe, according to studies. Only six percent of MFT clients have problems that are considered mild. Furthermore, three in ten clients of MFTs are taking psychotropic medication, over ten percent have been hospitalized in the past year, and many are hospitalized while under treatment by a marriage and family therapist.

Despite their focus on family systems, marriage and family therapists do not limit their treatment to couples and family units. Nearly one-half of the cases seen by marriage and family therapists are individuals, with less than one-quarter being couples, and 12 percent being families.

Prognosis for MFT Clients

Clients of MFTs, according to research studies, significantly improve after treatment: in their emotional health, their overall physical health, and their functioning at work. In a recent study of MFT clients, 83 percent reported that their therapy goals had been mostly or completely achieved. Nearly all (98 percent) rated the services as good or excellent, saying that they got the kind of help they wanted, and that they were satisfied with the amount of help they had received. Furthermore, nine out of ten said they would return to the same therapist in the future and that they would recommend their therapist to a friend.

Cost for Family Therapy

Treatment by marriage and family therapists is typically brief and cost-effective, with a focus on bringing about change in behaviors and patterns of interaction that contribute to illnesses and other problems in a family. The average length of treatment for couples' therapy is 11.5 sessions, for family therapy, 9 sessions, and for individual therapy, 13 sessions. The average fee is $80 per hour, and average cost per case, $780.

Extended Roles for Therapists

Marriage and family therapists work in all areas of mental and physical healthcare, often providing interdisciplinary connections for more comprehensive treatment. For example, marriage and family therapists have been central players in the growth of "family systems medicine," now often called "collaborative family healthcare." The premise of collaborative family healthcare is that the treatment of illness and nurture of health require close collaboration among medical and behavioral health practitioners, consumers and healthcare administrators.

While those in private practice are most visible, MFTs can also be found in schools, businesses, government agencies, hospitals and other healthcare facilities (i.e., community mental health centers, residential treatment facilities), legal and correctional systems and county mental health departments. In addition, increasing numbers are employed in Employee Assistance Programs (EAPs). HMOs, PPOs and other managed care companies employ and contract with MFTs for utilization review and provider screening as well as to provide mental health treatments. Insurance companies reimburse for psychotherapy services rendered by MFTs in most indemnity (fee-for-service) plans.

Professional Opportunities for MFTs

Currently, forty-two states recognize and regulate marriage and family therapists as independent mental healthcare providers, with licensure bills pending in other states. In addition, the National Institute of Mental Health recognizes the field of marriage and family therapy as one of the five core mental health disciplines, and the healthcare program for military dependents, CHAMPUS/TRICARE, recognizes and reimburses MFTs as independent health care providers.

Marriage and family therapy is a distinct professional discipline with graduate and postgraduate programs. To become an MFT, an individual must obtain a Master's degree or complete a doctoral program in marriage and family therapy or a related field. Once the formal education of the MFT is completed, the individual must obtain post-graduate clinical experience in marriage and family therapy. The training of MFTs includes direct clinical supervision by experienced clinicians. When the supervision period is completed, the therapist can take a state licensing exam or the national exam for MFTs.

Healthcare providers and managed care programs are becoming increasingly aware that marriage and family therapists are vital to the provision of quality, cost-effective healthcare. Marriage and family therapists are seen as bringing a holistic perspective to health care and are concerned with the overall, long-term well being of individuals and families. By analogy, they have been called the "family docs" of behavioral healthcare.

John P. Ambrose is General Counsel for the American Association for Marriage and Family Therapy in Washington, D.C., where he directs the Association's legal, government affairs, media and division liaison programs. Previously, he served as Vice President for Public Affairs for the National Mental Health Association and Volunteer President of the National Council of Community Mental Health Centers. For more information about AAMFT, visit their website at www.aamft.org, call 202/452-0109; fax 202/223-2329 or e-mail at jambrose@aamft.org.