Case Studies in Marriage and Family Therapy (2nd Edition)

For this, the second edition, I have three new contributors. Montserrat Casado tells the story of an immigrant family, and Bibiana Gutierrez introduces us to a lesbian relationship. Albert Valadez's case is noteworthy for its powerful use of metaphor. I have a word about the state of practice, especially my own 25-year practice. In the years since I started in the glory fee-for-service days of the late 1970s, the working environment of counselors has been transformed by harsh economic conditions. The number of outpatient sessions and the length-of-stay of patients in psychiatric hospitals have declined, as have private practice fees. I think that marriage and family therapy is adapting successfully in the marketplace because it is inherently cost-efficient. When you treat the system, you get results. For me efficient therapy doesn't specify a particular counseling approach (although there are certain methods, notably cognitive-behavior therapy, that are supported by efficacy research). Instead, efficient therapy is characterized by a particular bias: the counselor provides the minimum assistance necessary to alleviate the presenting symptoms. I like to use the term "time-efficient" rather than "brief" when discussing contemporary approaches to therapy In short, what I mean is that just because a particular case requires many sessions does not mean that it is inefficient. For example, my own case,The Boy Who Wouldn't Leave Home,is ongoing after 15 years and more than 250 sessions. When readers consider the context, they may agree with me that this was an efficient use of therapeutic time. The very idiosyncrasy that makes case studies interesting can thwart attempts to compare and contrast one case with another, but I've tried to solve this problem the way I try to solve most problems: organization. There's theSummary of Caseson page x, a chart that categorizes the 19 studies in terms of "Identified Patient and Presenting Problem," "Systemic Foci," and "Featured Strategies." For example, Phyllis Erdman's identified patient is a 17-year-old boy with a presenting problem of substance abuse. However, her systemic focus is an extramarital affair. She uses emotionally focused therapy and a reflecting team as therapeutic strategies. Each of the cases follows the same format. I introduce each case and its author. The author's opening paragraphs present background information about the client and therapist. Who are the clients, and why were they referred? What is the presenting problem, and who is the identified patient? What was the practice setting? How were session fees paid? Were there limits on the number of sessions? Each case includes the subsections described next. Conceptualization.Authors discuss their diagnosis, therapeutic goals, and reasons for choosing specific interventions. I don't push my authors for a DSM-IV-TR diagnosis, given the ongoing (and forever) antagonism between the medical model and the narrative perspective that a formal diagnosis may only contribute to a problem-saturated story! Process.Authors describe session-by-session client contacts. Outcome.Therapeutic results may vary from miserable to excellent. In most cases the outcomes are mixed. Such is the case with therapy in the real world. Discussion.With the benefit of hindsight, how would the authors have done it differently? How have their own marital and family issues influenced their work as therapists? Biographical Statement.This establishes the author's credentials and provides an e-mail address. All of the authors have told me that they are happy to respond to reader e-mail. My e-mail address is lgolden@utsa.edu. Get in touch!Larry Golden is the author of 'Case Studies in Marriage and Family Therapy (2nd Edition)', published 2003 under ISBN 9780130982179 and ISBN 0130982172.