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Book Reviews   |    
An Introduction to Marriage and Family Therapy • Family Involvement in Treating Schizophrenia: Models, Essential Skills, and Process • Emotional Cutoff: Bowen Family Systems Theory Perspectives • Thrice-Told Tales: Married Couples Tell Their Stories
Reviewed by William Vogel, Ph.D.
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.5.616
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edited by Lorna L. Hecker and Joseph L. Wetchler; New York, Haworth Clinical Practice Press, 2003, 625 pages, $49.95 softcover • by James A. Marley, Ph.D.; New York, Haworth Clinical Practice Press, 2004, 157 pages, $24.95 softcover • edited by Peter Titelman; New York, Haworth Clinical Practice Press, 2003, 500 pages, $49.95 softcover • by Diane Holmberg, Terri L. Orbuch, and Joseph Veroff; Mahwah, New Jersey, Lawrence Erlbaum Associates, 2003, 256 pages, $24.50 softcover

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Four books relevant to family and couples therapy are reviewed here.

The first is An Introduction to Marriage and Family Therapy, edited by Lorna L. Hecker and Joseph L. Wetchler, two well-known and highly accomplished family therapists. The title of the book is somewhat misleading in describing the book as an "introduction"; this is more a comprehensive encyclopedic handbook, valuable for the experienced practitioner as well as for the student.

The various chapters of the book address each of the major theoretical systems in family therapy, as well as couples therapy, sex therapy, gender issues, ethical and legal issues, and research. All the authors of chapters in this edited work are highly credentialed clinicians or academicians, and all are or have been directors or key players in the development of family therapy programs at their various institutions. If there is some topic in the area of family or marital therapy that the editors have neglected to cover with a thoroughly thought-provoking and professional presentation, I certainly have not discovered it. The book is certainly lengthy, but as in an encyclopedia, each of the chapters can stand on its own as a comprehensive discussion of its topic. The chapters are uniformly well written. The book deserves to be purchased by any student, practitioner, or researcher in the area of family therapy.

The second book, Family Involvement in Treating Schizophrenia: Models, Essential Skills, and Process, is by James A. Marley, Ph.D. Dr. Marley is a family therapist with a major interest in schizophrenia. His book begins with a description of the history of diagnosis and treatment of the disorder and the relationship between the illness and the family. Marley then proceeds to a description of how the disease can be understood and treated within the scope of each one of all the major models of family therapy. Marley notes that family therapy, at the time of its inception, was focused on the treatment of schizophrenia, but "second and third generations of family therapists have moved further and further away from it" for a large variety of reasons. He is on target, in my opinion, in citing the "constraints of managed care contracts" as one major reason.

At the same time, Marley does an excellent job of discussing family therapy and its uses in treating schizophrenia in terms psychodynamic, Bowenian, systemic, cognitive-behavioral, and other family therapy systems. He notes, however, that "no empirical support exists for psychoanalytic, Bowenian, structural, systemic, narrative, experiential, strategic, or solution-focused theories as they apply to schizophrenia. Better support exists for behavioral and psychoeducational models, as well as for multiple family group therapy (MFGT)."

Marley argues that the lack of empirical support for the theories for which little empirically based treatment evidence exists "may have more to do with the interests of clinicians and researchers than with any fundamental flaw in the theory or model." He is a highly convincing advocate for such work.

The third book, Emotional Cutoff: Bowen Family Systems Theory Perspectives, edited by Peter Titelman, is, in effect, intentionally or not, a Festschrift for Murray Bowen—a memorial volume published to honor him. All the contributors, we are informed, "had the opportunity to learn family systems theory through direct contact with Murray Bowen."

The entire volume is a focus on the concept of cutoff. Titelman writes that, of all the eight concepts in Bowen's theory, cutoff was the least fleshed out by Bowen: "the concept of emotional cutoff describes the way people, using physical or internal emotional distancing, handle their unresolved emotional attachment to their parents … the concept deals with the way people separate themselves from the past in order to start their lives in the present generation."

The book is divided into four parts. Part 1 describes the concept of cutoff in Bowen's theory and goes on to discuss it in evolutionary and physiological terms. Part 2, "The Therapist's Own Family," is, to me, the most fascinating part of the book. Here four contributors—three of them therapists—discuss the concept in terms of their attempts to understand and deal with their own families. Part 3 describes clinical applications, including the development of a research instrument to measure cutoff. Part 4, "Social Applications," is riveting, using the concept to describe and understand central aspects of our contemporary world: families in the Soviet Union, with reference to World War II and the political process; the effect of migration on animal and human families; the Holocaust; and relations between Israelis and Palestinian Arabs.

It would seem an injustice to attempt to summarize this material; it has to be read directly. All the writers had, it is apparent, intense, personal, and professional involvement with Bowen, involvement that affected each of them directly, if in different ways, and that imparted direction and meaning to their lives, personally and professionally. The reader can almost hear these individuals conversing with Bowen through the pages of the book. The book is a must for anyone whose professional work has been touched by Bowen, which includes all family therapists.

Finally, Thrice-Told Tales: Married Couples Tell Their Stories is an innovative, groundbreaking work, an account of research in process. The research might best be described as an investigative study into scientific quantification of qualitative data—that is, couples' oral histories of their marriages, with a focus on how the narratives change over time and what that can tell us about the nature of contemporary marriage.

The project is a fascinating one, a long-term clinical psychosocial study of 373 couples, comprising 199 African-American couples and 174 couples living in Wayne County, Michigan—"moderately educated (high school degree or some college being most common, with relatively moderate incomes, more than half less than $30,000 per year)." Intensive interviews were conducted in the first, third, and seventh years of the couples' marriages by professional interviewers, all women, with social background matched for the interviewer and couple.

This work is of great interest. Given the breadth of the issues under investigation, the relatively small number of study participants, and the narrow nature of the sample, the findings are, quite appropriately, modestly presented. The narratives are influenced by factors such as marital well-being, the passage of time, gender, and ethnicity. However, the importance of the work goes well beyond the data that were collected. The work has important and constructive lessons for both researchers and clinicians as an innovative model. For example, it would be fascinating to apply lessons gleaned from this book to scientific studies of family, group, and couples therapy. It is a well-written book, one that should be of interest to any research or clinical worker in the mental health field or in the sociological sciences as broadly defined.

Dr. Vogel is associate professor of psychiatry at UMass Memorial Health Care, Inc., in Worcester, Massachusetts.




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