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Book Review   |    
William Vogel
Psychiatric Services 2007; doi:
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by Christine E. Ryan, Nathan B. Epstein, Gabor I. Keitner, Ivan W. Miller, and Duane S. Bishop; New York, Routledge, Taylor, and Francis, 352 pages, $39.95 softcover

Dr. Vogel is affiliated with the Department of Psychiatry, University of Massachusetts Medical Memorial Center, Worcester.

The McMaster model of family functioning originated at McGill University in Montreal approximately 50 years ago under the direction of Nathan Epstein. Development of the McMaster model continued at McMaster University in Hamilton, Ontario, and progressed further at Brown University in Providence, Rhode Island, where Epstein had moved and originated the Family Research Program. The research has involved a major team effort.

I have reviewed many books in family therapy that have presented a wide spectrum of theories and practice models, and this book is truly outstanding. It represents a major development in the coming to maturity of the field of family therapy. It is a very important and impressive piece of scholarly work, which embraces and builds upon other earlier models.

So how is this approach different? First, many workers have attempted to design a highly structured, therapeutic approach, without always managing to do so. This book convincingly presents just such an approach. Secondly, many have tried to develop a short-term, six- to 12-week crisis-centered model without quite demonstrating that they have developed a workable, practical, functional approach; these authors demonstrate that they have done so. Third, the model is clearly evidence based.

Half the book presents us with research instruments and research studies that substantiate many of the authors' claims. The group's research is well done and, unlike much of the research in family therapy, meets the basic requirements of scientific quality, using control or comparison groups, suitable numbers of study participants, appropriate statistics, objective assessment techniques, and hard-headed, rigorous evaluation of findings.

The McMaster model originally emanated from psychodynamic models but is not wedded to psychodynamic or psychoanalytic models. It is essentially a systemic, behavioral approach. To quote the authors, "insight is not a necessary or sufficient ingredient for change to occur in the system. Our concern is not what produces pathology in the individual, but with the process occurring within the family that produces the behavior. Therapy is directed at changing the system and thereby changing the behavior of the individual."

The family therapy movement is young and, too often, is a movement that has been defensive and self-consciously self-promoting. For example, one national American Association of Family Therapy convention adopted the theme "Family Therapy Works!"

In contrast to this type of promotion, in the chapter "Research Using the McMaster Model," I found a statement that says much about the scholarly integrity of this research group: "To date, our preliminary analysis in the treatment studies have not shown a direct cause and effect between receiving family therapy and patient outcome." As someone who has reviewed much of the major work on family therapy over the past 20 years and who, since 1960, has earned his living teaching and practicing family therapy, that is a statement that could arguably be made about much work in family therapy.

We, as a movement, are a work in progress, too often proceeding as much on conviction and faith as on indisputable, hard-science demonstration of our effectiveness. That these authors can fearlessly and unashamedly make such a statement demonstrates their commitment to truth, science, and scholarship and represents in part the coming of age of a major portion of the family therapy moment. I urge the purchase of this timely, impressive, and indispensable book.




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