Couple and : The Evolution of the Profession with Social Work at its Core by (Gurman & Kniskern, 1981; Nichols & Sharon Bond, Ph. D., S.W. Schwartz, 2008). This article will trace the Assistant Professor historical evolution of couple and family School of Social Work therapy, identifying the benchmarks of prac- Department of Psychiatry, Faculty of Medicine tice, knowledge and professional recognition Director, Couple and Family Therapy Program within Canada and the United States. Social Sir Mortimer B. Davis, Jewish General Hospital work's key leadership role in establishing pro- McGill University fessional recognition in Quebec, Canada is an Email : [email protected] important achievement for the profession.

Historical Development of Family Therapy Historique de l’évolution de la thérapie du Long before the early development of family couple et de la famille au Canada et aux therapy, Mary Richmond (1917) in her classic États-Unis. Historique de la formation des text, Social Diagnosis, prescribed treatment for professionnels et de la législation. the ‘whole family’ and warned against isolat- History of marriage and family therapy in ing family members from their natural context. Canada and the United States. History of “She recognized that families are not isolated professional training and regulations. wholes but exist in a particular social context, which interactively influences and is influenced by their functioning.” (Bardill & Saunders, The profession of Couple and Family Therapy 1988: 319). Mary Richmond was an early “sys- has a long and distinctive history with its roots tems thinker and practitioner” who incorpor- deep within the social work profession. The ated concepts of family cohesion and emotional contribution of social work in the pro- bonding almost 50 years before these principles fession is noteworthy, given that its commit- became integrated within mainstream psychia- ment to the importance of “social context" is try. Many of the early family therapy pioneers a key determinant in both understanding and were social workers working alongside psy- treating individual distress. This core paradigm chiatry in shaping the profession from its early dates back to early social work practice with foundational beginnings to the post-modern the charity movements of the late nineteenth period. They are: Virginia Satir, Harry Aponte, century in Great Britain and the United States. Insoo Berg, Steve de Shaver, Jay Haley, Monica Working with socially and emotionally disad- McGoldrick, Peggy Papp, Lynn Hoffman, Olga vantaged families was considered a common Silverstein, Froma Walsh, Steve de Shazer, social work method long before the ecological Insoo Berg, and Michael White. approach was introduced to family theory and practice. Despite social work’s focus Prior to the advent of Family Therapy, the on the treatment of the “family as the primary focus was on the individual rather than his unit of intervention”, the profession has never family. While , the father of been adequately acknowledged for its pivotal personality theory “chose to focus on individ- role in the development of family therapy ual and the intrapsychic, rather than the family dynamics, he was well aware of the interaction- al context within which symptoms evolved” Intervention, la revue de lʼOrdre des travailleurs (Becvar & Becvar, 2009: 41). His theoretical sociaux et des thérapeutes conjugaux development of the family drama of the et familiaux du Québec. Oedipal conflict was central to his understand- Numéro 131, hiver 2009 : 128-138. ing of neurotic development. Freudian metapsychology, with its emphasis on the

128 INTERVENTION No 131 analysis of , dominated the psychi- families become stuck in maladaptive, repeti- atric community until the 1960s. However, it tive behavioural loops. These ideas represented became apparent that individuals are social a paradigm shift, a new approach viewing beings who do not live in isolation and are organization “wholeness” rather than reduc- likely to be affected by the matrix of their inter- tion as a unifying principle. This shift from personal relationships. Attention shifted to regarding the problem in isolation to a focus examining the psychological problems of the on the relevant wider family organization and individual in the context of the family its relationship to the problems presented that transcended the separateness of these char- occurred in the 1950s. acteristics (Nichols & Schwartz, 2008). Major contributors to the field during this decade The Birth of Family Therapy included anthropologists and The 1950s were identified as the founding , mathematicians Norbert decade of the profession, marked by the first Wiener, John Von Neumann and Walter Pitts, consistent use of family therapy in modern as well as others from the fields of anatomy, psychotherapeutic practice. The birth of family engineering, psychology, sociology, neurophys- therapy began with the Palo Alto Project (1952) iology, to name but a few (Becvar & Becvar, where schizophrenia research (1940s-1950s) 2009). Family therapy flourished not only developed in an attempt to establish a link because it was proven to be clinically effective between family life and the development of but also due to the acknowledgement of the schizophrenia. Three prominent theorists interconnectedness of humanity (Nichols & emerged during this period: Gregory Bateson Schwartz, 2008). (scientist: integrated animal research, learning theory, evolution, ecology applied to hospital- The origins of family therapy theory building ized patients), Jay Haley (conducted social and date back to the 1930s and early 1940s, and psychological analysis of fantasy) and John involve a disparate group of theorists and Weakland (chemical engineer interested in researchers who were searching for a universal cultural anthropology) conducted research to theory of . This group of scien- understand and treat family communication tists and scholars developed what came to be processes considered causal in the develop- known as "general " (GST), the ment of schizophrenia (Nichols & Schwartz, first and perhaps most influential model in the 2008). They become known as the Palo Alto field. General systems theory sought to inte- Group and developed the Communications grate the science of , concerned with Model, a theory of communication to under- organization, pattern and information process- stand pathological family communication ing combined with the biological sciences, processes, how destructive relationship pat- which explored the family as a social organism terns are maintained by self-regulating interac- composed of biological systems. During this tions of family members. Important theoretical period, the Austrian biologist Von Bertalanffy, models and ideas developed during this era: was the "first to introduce the principles of Don Jackson, a clinical psychiatrist developed general systems theory, which provides an the concept of family homeostasis and viewed organismic approach to understanding biologi- symptoms as homeostatic regulators; Virginia cal beings" (Becvar & Becvar, 2009; Glick, Satir, a “charismatic healer” and social worker Berman, Clarkin & Rait, 2000: 12; Nichols & “par excellence” was one of the family therapy Schwartz, 2008). He developed general princi- leaders of the first decade, whose clinical ples to explain biological processes that include artistry and ability to connect to emotional considerable complexity and levels of organiza- processes distinguished her from the more tion in response to reductionistic traditions, cerebral approaches to clinical practice. She which focused on cause-and-effect explana- developed a brand of family therapy with a tions for human phenomena. During the 1950s, focus on communication processes and narrow mathematician introduced family role constraints. Her book Conjoint the integration of cybernetics (how feedback Family Therapy (1964) contributed to the popu- controls information-processing systems), larization of family therapy along with which was used by Bateson to describe how Pragmatics of Communication (Watzlawick,

INTERVENTION No 131 129 Beavin & Jackson, 1976), which distinguished (i.e., internal separation of intellectual and the Palo Alto group as the leading model of the emotional functioning) underscoring the 1960s. Concurrent with the developments in importance of the intergenerational context of California, Theodore Lidz at Yale was studying family life. Further, symptom formation is a the link between family conflict, instability and process involving unresolved issues from pre- the development of psychopathology in chil- vious generations that are being lived out in the dren while Lyman Wynne’s research at the present. Several models developed during this National Institute of Mental Health (NIMH), period were derived from individual therapy Bathesda, Maryland attempted to demonstrate such as: experiential, psychoanalytic and how communication “deviance” in the family behavioural family therapy. Experiential thera- can lead to thought disorder in schizophrenic py has its roots in the existential/humanistic patients. The outpouring of theoretical and orientation of and phi- clinical ideas during this era reflected an excit- losophy, on the here-and-now experi- ing period in theory building and clinical prac- ence. The systems orientation is derived more tice. While these concepts were profound and from the Gestalt psychology of . The still serve an important role in understanding practice of experiential family therapy is led by family systems, the focus on establishing the and Virginia Satir, among others. link between schizophrenia and family com- Emphasis lies on personal growth rather than munication led the field astray. This theoretical on altering dysfunctional interactions or leap between family processes and the etiology removing symptoms. Growth may include of schizophrenia produced damaging conse- autonomy and freedom of choice. quences for families who felt blamed by a Cognitive behavioural family therapy differs generation of clinicians. from traditional family therapy in that it is a Alongside the development of family therapy hybrid that draws from both the individual in the United States, in Europe, the Child and the general systems theory/family systems Guidance Movement began to shift its focus tradition (Friedberg, Gorman & Beidel, 2008). on the family as a means of understanding the Cognitive behaviour family therapy balances child. Many of the early pioneers were psychia- the emphasis on cognition and behaviour trists who, influenced by social work, began to combined with a focus on patterns of family see the importance of understanding the family interaction. Family relationships, cognitions, as the root to understanding the child. The emotions and behaviour are viewed as inter- most famous was John Bowlby (1949), the connected (Dattilio, 2001; Nichols & Schwartz, father of Attachment Theory, whose work in 2008). At the conceptual level, the model the Child Guidance Movement in England assumes that family dynamics are shaped by witnessed a shift from blaming parents to situ- what is happening at the intra-psychic level ating pathology within relationship interaction. within individual family members, as well as the rules that govern the family systems The Golden Age of Family Therapy (Schwebel & Fine, 1992). Moreover, it is During the 1970s family therapy came of age, assumed that individuals acquire relationship as the concept of treating the family as a whole schemas in their family of origin that operate unit was followed by an increasing diversifica- outside of awareness (Schwebel & Fine, 1992). tion of schools. From 1970 to 1985, pioneers Early experiences form the foundation of these established training centres across the United schemas; they are amendable to change States, reflecting an outpouring of theory and through self-reflection and meta-cognition practice building in the profession. Major mod- (Schwebel & Fine, 1992). els within the field include the models derived Three important systemic models developed from General Systems Theory, Cognitive during this period were Bowen, Structural and Behaviour Family Therapy, Psychodynamic Strategic family systems therapy. Bowen family Models, Intergenerational Models, Experiential systems therapy developed at the Menninger Models and Post-modern approaches. Clinic in Topeka, Kansas under the leadership Psychodynamic approaches focus on the indi- of psychiatrist Murray Bowen. He hypothesized viduation of members from the family of origin that emotional disturbance is not an individual

130 INTERVENTION No 131 pathology but rather a definable relationship (Italy) who developed a brief method with a pattern, following an evolutionary process with focus on context and the possible function of its origins deep within the history of the family. patients’ symptoms. They used directives to His transgenerational model tracked the trans- instruct patients to act in ways that were mission of emotional processes, specifically the contrary to their maladaptive behaviour. level of fusion or undifferentiation across gen- These pioneers presented a model that shifted erations. Bowen’s clear focus on intergenera- away from insight, understanding and the tional family themes and emotional processes importance of history towards a model that within a systemic framework distinguished his focused on stimulating behavioural change method for the field. Bowen’s interest in unre- through the interruption of maladaptive behav- solved emotional family processes has recently ioural patterns (Nichols & Schwartz, 2008). found resurgence with its link to attachment theory and family therapy (Bowen, 1976). Feminist Critique of Family Therapy Nathan Ackerman (New York), founder of the During the late 1980s, pioneering family sys- well-known Ackerman Institute, integrated tems models were challenged on both clinical psychoanalytic thinking into systemic family and socio-cultural grounds. These models were work. Ackerman trained with Nathan Epstein widely critiqued by feminist theorists for their who introduced family therapy in Montreal, failure to recognize the importance of gender establishing the first training centre in the roles and gender identity, which include Department of Psychiatry at the Jewish General power differentials in their formulation of Hospital. Dr. Epstein continued to pursue his family functioning (Avis, 1988; Hare-Mustin, clinical ideas at McMaster University in 1978; Goldner, 1985; Bograd, 1992; Goldner, Hamilton, Ontario developing a problem- Penn, Sheinberg, & Walker, 1990). Family centered approach (Epstein, Bishop & therapy’s failure to address abuse and violence Baldarin, 1981). within families and diversity of family forms entered the field in 1969. left the field wide open to scrutiny. The devel- While not one of the first group of family thera- opment of post-modern practice with its focus pists, his influence on the profession has been on contextual understanding of gender differ- the strongest and perhaps the most closely entials in families, the role of women, men, linked to the values of social work. Developed and how issues of gender, social and cultural in collaboration with social worker Braulio locations, sexual orientation structure our Montalvo, his structural family theory and family relationships. model of family therapy are the most widely The Post-Modern Era used and practical of all modalities. Together with Rosman, they developed the first eco- The post-modernatization of family therapy systemic model, which explores family struc- has led to the re-examination of therapeutic ture and organization within a community and positioning, how people construct their subjec- social context. This model describes families as tive reality and whether distinct theoretical having underlying organization. It provides clear models serve the same usefulness in the field. guidelines for diagnosis and treatment and The focus on diversity, pluralism, and the made family therapeutic principles accessible search for meaning has pushed some leading to the frontline practitioner. Minuchin’s imple- therapists to reject systems thinking in favour mentation of the use of the one-way mirror and of the narrative metaphor. There has been an live clinical supervision revolutionized the field attempt to redress the field of restricted think- as clinicians were taught to master complex ing and oppressive influences on family theory family processes through direct “live” instruc- and practice. Today, the boundaries between tion. His book Families and Family Therapy models are blurred with fewer therapists iden- (1974) is the most popular ever written in the tifying exclusively with one particular school. field. Strategic family therapy grew out of The 1980s also witnessed a return of psychoan- communication theory and the Bateson schizo- alytic family therapy. This revival “reflected phrenia project. The pioneers were Jay Haley, changes within and a focus John Weakland and Mara Selvini Palazzoli on more relationship-oriented object relations

INTERVENTION No 131 131 theory and self psychology. It also reflected life education, and the field of marriage coun- dissatisfaction with the mechanistic aspects selling (Sturkie & Bergen, 2001). Up until the of the cybernetic model” (Nichols & Schwartz, 1950s, was practiced primarily 2008: 237). Over the past several decades, by physicians and limited to psychoanalytical renewed interest has been directed towards theory (Piercy, Sprenkle, & Wetchler, 1996). Bowlby’s early attachment model as a useful Over time, the marriage counselling and family construct for understanding the vicissitudes life education fields began to merge conceptu- of human relating. ally and organizationally. Leaders in the family The development of the profession in Europe is systems movement were often psychiatrists beyond the scope of this review. Developments and their collaborators who had become disen- in Italy, France, Belgium and Switzerland coex- chanted with traditional psychiatric theories isted alongside the United States and Canada and treatment methods. Because of their (for a review of development of family therapy medical training, these persons treated more within the European context, refer to significant psychosocial problems and their Prud’Homme, 1999). approaches were clearly regarded as therapy. Return to Research During this era, family therapy was primarily conceived of as a method of treatment that Research in the field of family therapy outcome focused on the “family unit”. The limited defi- has grown enormously since the mid-1970s. nitions that existed at the time were primarily Presently, there are hundreds of randomized clinical studies in both family and couple thera- intended to help distinguish this new approach py. Meta-analytic studies have concluded that from the other methods and treatment orienta- family therapy generally demonstrates superi- tions that dominated the psychotherapy field. or effects in comparison to alternative treat- This era also marked the beginning of the gold- ments (Shadish et al., 1997; Shadish, Ragsdale, en age of guruism in the field and the term Glaser and Montgomery, 1995). Clinical “family therapy” soon came to have myriad research is now moving in the direction of connotations depending on the particular integrated evidence-based practice models nature of the writers’ conceptual allegiances with an accent on the importance of the thera- (Sturkie & Bergen, 2001). The growing presence peutic alliance as a predictor of psychothera- of many “schools” of family therapy, along peutic outcome across theoretical models with their multidisciplinary origins and identi- (Knobloch-Fedders, Pinsof, & Mann, 2007, fications, confounded early efforts for defini- Knobloch-Fedders, Pinsof, & Mann, 2004). tional simplicity and clarity. While the history of Couple and Family In 1963, almost a decade after the family thera- Therapy has been to emphasize the distinctness py movement began, California passed its first of models rather than common ingredients, licensure law for marriage, family and child there is growing evidence supporting the over- counsellors. Over the next two decades, seven lapping commonalities of change mechanisms other states would pass similar legislation across models. Meta-analytic evidence pro- (Sturkie & Bergen, 2001). Currently all fifty (50) vides support for few meaningful differences states and the District of Columbia recognize across models of Couple and Family Therapy (Sprenkle & Blow, 2004; Shadish & Baldwin, and regulate marriage and family therapists 2003). The above provides a summarized as independent mental health care providers. overview of the field development (for a full Today, the marital and family therapy degree review of the historical development of family is widely established in the United States and therapy, refer to Becvar & Becvar, 2009; Nichols has become a separate and licensed profession. & Schwartz, 2008). Psychology, social work and counselling psy- chology are developing active subspecialties Defining the Profession in family therapy as the field of psychiatry has Couple and family therapy is believed to have shifted in the direction of biological treatment emerged from many separate streams and of psychiatric disorders, overshadowing the professional developments, including social development of new effective work, child guidance, social psychiatry, family within the field of psychiatry. Over time, the

132 INTERVENTION No 131 innovative approaches to treatment that had Council of Philadelphia as part of a handful encouraged the emergence of family therapy of early pioneers responsible for the founding and its major schools also helped marginalize of the American of Marriage it in the mental field as a whole. The develop- Counselors. Under her leadership, the ment of diverse, legal definitions for marital Marriage Counselling Centre became and family counselling emerged (Sturkie & accredited through the American Association Bergen, 2001). Early definitions focused on of Marriage Counselors, the precursor to the the primacy of the legal family unit. present AAMFT. With the progression to the twenty-first centu- Alongside the development of marriage coun- ry, we have seen the emergence of more inclu- seling, Nathan B. Epstein introduced family sive definitions of family life that transcend therapy in Montreal in 1960 and developed the strict adherence to legal and biological defini- first training program in Canada through the tions of family structure. The heterogeneity and Department of Psychiatry of the Jewish diversity of the post-modern family include General Hospital. Many of the early pioneers multiple forms and structures; dual career cou- conducted their initial family therapy research ples: cohabitating couples: gay and lesbian through the Department of Psychiatry at the couples that coexist with traditional family Jewish General Hospital: Dr. Nathan Epstein, structures. Today, the term “family” is used Dr. Herta Guttman and Dr. Leo Chagoya devel- generically to refer to all people identified by oped the Family Category Schema, one of the clients as part of their “family system”. This early family process research measures. The would include fictive kin and relationships Jewish General has a long interdisciplinary of choice. tradition with social work clinicians working alongside psychiatrists and psychologists. Key With this broadened understanding of family, social work leaders at the Jewish General: “Family therapy might be thought of as any Bernadette Laroche, Shirley Braverman, Janet type of psychosocial intervention using a Sutherland and Sherrie Poplack to name a few, conceptual framework that gives primary trained generations of clinicians on the applica- emphasis to the family system and aim to tion of systemic methods in collaboration with affect the entire family structure” (Glick, psychiatrist Ronald Feldman and psychologist Berman, Clarkin & Rait, 2000). Couple and Lilianne Spector. Their commitment to develop family therapy is a specialized form of psy- live supervisory methods, the use of the reflect- chotherapy for individual, couple and family ing team, family sculpting and strategic inter- distress that places its focus on family commu- vention distinguish them in the field. The nication, interactional problems, and conflict Couple and Family Therapy Training Program between members. The goal is to develop more at the Jewish General Hospital continues this satisfying ways of living for all members of the tradition, integrating research into family thera- family system and improve functioning of the py practice. Alongside developments at the family as a whole. Jewish General, the McGill School of Social Work has a similar tradition of teaching in the The Development of Couple and Family area of family practice. Over the years, noted Therapy in Quebec faculty such as Myer Katz, Dorothy Freeman, Couple and family therapy has a long tradition Shirley Steele, Shirley Braverman, Diane in Quebec. The field began with the develop- Riechertz, Judy Magill, Annette Werk, Carol ment of couple counselling, introduced in 1956 Cumming-Speirs, Diana Shannon and Sharon by psychiatrist Baruch Silverman through the Bond have served as role models for a genera- establishment of the Marriage Counselling tion of social work practitioners. The School of Centre of Montreal. This centre along with Social Work has been at the forefront of the Family Life Education became integrated into development of innovative programs for the Mental Hygiene Institute under psychiatrist diverse family forms with a commitment to Alistair MacLeod. During the 1960s and early helping those individuals marginalized within 1970s, social worker Dorothy Barrier worked family structures. McGill University has recent- closely with Emily Mudd of the Marriage ly submitted a proposal for the creation of

INTERVENTION No 131 133 a Master’s program in Couple and Family The majority of post-graduate training pro- Therapy (CFT), in the School of Social Work, in grams in Montreal were developed under the partnership with the Department of Psychiatry leadership of social work educators and clini- at the Sir Mortimer B. Davis - Jewish General cians. At present, there are three postgraduate Hospital. The Master’s program in CFT is Couple and Family Therapy training programs designed as a comprehensive two-year clinical in Montreal accredited by the Commission on degree that combines the academic excellence Accreditation for Marriage and Family of McGill University, a major research institu- Therapy Education (COAMFTE) of the tion, with the clinical expertise of the Depart - American Association of Marriage and Family ment of Psychiatry at the Jewish General Therapy (AAMFT), the professional standard Hospital. In keeping with the tradition of a for family therapists in North America. Sharon multidisciplinary approach in Couple and Bond is the Director the Postgraduate Family Therapy, the proposed program will Certificate Program in Couple and Family draw from multiple disciplines in its curricu- Therapy (CFTP) and the Programme de certificat lum, including such fields as Social Work, post-universitaire en thérapie de couple et de Social and Transcultural Psychiatry, Psychology la famille, both offered under the auspices of the and Counselling Psychology. McGill University Department of Psychiatry at the Jewish General is at a unique advantage as it has established Hospital, a teaching hospital affiliated to links with renowned scholars in these fields. McGill University. Joan Keefler is the Director Furthermore, the fact that the program will be of the Post-Master’s Training Program in offered in partnership with the Jewish General Marital and Family Therapy offered in English Hospital’s Department of Psychiatry will allow by the Argyle Institute of Human Relations, a for the possibility of research development and non-profit charitable organization established sharing of academic expertise. This program in 1982 to provide counselling and psychother- will build on the tradition of inter-disciplinary apy services and be a post-degree training training in family therapy with student recruit- facility for mental health professionals. ment from a multi-disciplinary background Several other private centres also provide mar- including social work, counselling psychology, riage and family therapy training in French in clinical psychology, nursing, and medicine. Quebec. While these programs are not accredit- Family-centered practice has traditionally been ed by external bodies, completion of the pro- a cornerstone of professional social work in grams can give access to the couple and family North America. Over the years, several training therapy permit issued by the OPTSQ. The centres in Quebec developed by social work Programme de formation à la psychothérapie analy- practitioners and scholars have secured a solid tique individuelle, conjugale et familiale is a three- foundation for the profession. During the year program offered by the Institut 1970s, Gérard Duceppe and Jacqueline Montréalais de Psychothérapie Analytique Prud’homme developed a training program under the leadership of social worker and psy- inspired by an integration of Virginia Satir’s choanalyst Carole Hamel and psychologist and experiential model and a combination of sys- psychoanalyst Serge Arpin. The Centre d’étude, temic modalities. Generations of clinicians in de recherche et de formation en intervention sys- Quebec were trained under their inspirational témique (CERFIS) under the leadership of social leadership. Social work’s strong presence in workers Madeleine Laferrière and Jean-Luc shaping the profession is evidenced by the Lacroix and couple and family therapist Michel work of Maurice Moreau on the ecosystemic Lemieux provides a three-year systemically model and Claude Brodeur and colleagues’ focused couple and family training program. development of the network approach At present, there exist no university programs (Prud’homme, 1999). Geniève Hone and Julien to meet the training needs of professionals in Mercure from the tradition of pastoral coun- Couple and Family Therapy as defined by the selling provided training through the Pastoral Quebec Government. McGill offers the follow- Institute of Saint-Paul University Ottawa, Canada. ing related programs: Counselling Psychology, Clinical Psychology, Educational Psychology,

134 INTERVENTION No 131 Social Work, to list a few. No Quebec university degree programs that have gained wide recog- currently offers a Master’s in Couple and nition for their contribution to clinical practice Family Therapy. and evidence-based research.

Canada and the United States Historical Development of In Canada, there are two Master’s level Professional Regulations programs providing specialized studies in Alongside the professional developments couple and family therapy accredited by the in the United States, in November 2001, the Commission on Accreditation for Marriage Quebec Government recognized couple and and Family Therapy Education (COAMFTE) of family therapy as a profession with reserved the AAMFT. The M.Sc. in Couple and Family title, regulated under the Professional Code. Therapy offered by Department of Family As of that date, couple and family therapists Relations and Applied Nutrition at the Univer - were integrated into the Ordre professionnel des sity of Guelph is an uninterrupted 24-month travailleurs sociaux du Québec (OPTSQ) and a program combining academic courses, research, series of professional regulations and govern- and clinical training. The Master’s degree in ment legislation has evolved from this profes- Marriage and Family therapy offered by the sional recognition. The integration of the University of Winnipeg is an associate program profession has prompted Social Work program of the Faculty of Theology (which provides administrators at Quebec universities to dis- registration and record-keeping) using the cuss the new decree and the development of Aurora Family Therapy Centre (located on the proposals for new Master’s programs. McGill’s University of Winnipeg campus) as a major School of Social Work has addressed Quebec’s clinical practice centre. It is a clinical degree need for a Master’s program in Couple and with no research component and “is designed Family Therapy seriously and taken up the for social workers, school psychologists, pas- initiative with great interest. Laval University toral workers and others who want a quality recently established a planning committee to education in this area.” explore the development of a doctoral degree An integrated Social Work and Family Studies in Couple and Family Therapy. On May 29, program is offered at the University of British 2009, the McGill School of Social Work submit- Columbia. The School of Social Work and ted a proposal for the creation of a Master of Family Studies at U.B.C. offers two separate Science, Applied, in Couple and Family degrees: the M.S.W. and M.A. (Master of Social Therapy to CREPUQ's Commission d'évaluation Work; Master of Arts in Family Studies). There des projets de programmes (CEP) for evaluation. is an administrative integration of these two This is the first step in the external evaluation/approval process for this complete degrees under the aegis of the School, which is dossier. Once the program has passed CEP's in the Faculty of Arts, but no curriculum inte- scrutiny and received a favourable "Avis", it gration exists at this time (i.e., joint courses). will be submitted to the MELS (Ministre de In Calgary, couple and family therapy has been l’Éducation, du Loisir et du Sport) for approval. guided by the scholarly teachings of psychia- The curriculum developed for the Master’s trist Karl Tomm, whose interpretation of the program in Couple and Family Therapy is Milan systemic approach and development of guided by provincial standards for the practice expanded systemic therapy methods (such as of Couple and Family Therapy in Quebec “interviewing the internalized other”) have developed by the OPTSQ (Référentiel des compé- had a strong influence on the field. Through the tences des thérapeutes conjugaux et familiaux, field of nursing, Lorraine Wright and Maureen 2005; Normes pour l’exercice de la profession de Leahey’s work on illness, belief systems and thérapeute conjugal et familial, 2006 et Référentiel family systems has been a major contribution de la formation des thérapeutes conjugaux et to medical family therapy. familiaux, 2007) and the Commission on In the United States, there are approximately Accreditation for Marriage and Family 60 universities offering Master’s degrees in Therapy Education of America Association Family Therapy. There are several Master’s for Marriage and Family Therapy.

INTERVENTION No 131 135 The recent adoption of Bill 21 (Act to amend Looking Forward: Social Work at the Professional Code and other legislative the Forefront provisions in the field of mental health and This article provides an overview of the devel- human relations) provides the delineation of opment of family therapy from its early social professional activities for marriage and family work inceptions at the turn of the century in therapists in the Province of Quebec. Great Britain to the proliferation of the field Section 37 of the Code across Canada, the United States and Europe. ii. if practicing the profession of marriage and The historical evolution of the field is traced family therapist: assess relationship dynamics through the origins of systems theory building of couples and families, determine a treatment across disciplines representing a paradigm shift and intervention plan, and restore and improve from the earlier individualistic approaches to a couple’s or family’s lines of communication human and family distress. The development with a view of fostering better relations among of the profession of Couple and Family spouses or family members in interaction with Therapy is marked by the increasing diversifi- their environment; cation of schools of family therapy across the United States and Canada, and the develop- The current status of marriage and family ther- ment of professional regulations. An overview apy is in the process of being established in is provided of the historical process of profes- Quebec. The Comité de la pratique de la thérapie sional regulation across the United States and conjugale et familiale (OPTSQ), the administra- Canada with specific focus on the evolution of tive body overseeing the profession of couple the profession in Quebec. and family therapy, has been working diligent- ly to establish provincial standards for the prac- As we move forward into the twenty-first tice of Couple and Family Therapy in Quebec. century, couple and family therapy skills On June 18, 2009, with the adoption of Bill 46, will be increasingly required for community, the name of the Professional Order was official- health and mental health practice. Families ly changed to “Ordre des travailleurs sociaux et are presenting with an array of complex social, des thérapeutes conjugaux et familiaux du Québec”. psychological, physical and mental health Quebec maintains two professional associations: problems, such as poverty, single-parent house- Quebec Association for Marriage and Family holds, diverse family structures, health-related Therapy (QAMFT) (a regional division of the concerns such as chronic medical illness, seri- AAMFT) and Association des psychothérapeutes ous mental disorders, depression and anxiety, conjugaux et familiaux du Québec (APCFQ). In the childhood disorders. These necessitate clini- United States, it is recognized both as its own cians with a broad understanding of family life profession (as evidenced by the existing bodies and mental health disorders, and a clinical of knowledge, academic and clinical training ability to offer effective services. Family-based programs, accreditation and credentialing interventions are recognized as some of the processes and governmental recognition at the most effective for several disorders, most state and federal levels) and as one form of notably childhood behavioural problems, ado- speciality treatment used by many different lescent drug abuse and delinquency (Rowe & professionals (Sturkie & Bergen, 2001). Family Liddle, 2003; Liddle, Dakof, Parker, Diamond, Therapy today is not a treatment method in the Barrett & Tejada, 2001; Liddle, Rowe, Dakof, & usual sense; there is no generally agreed upon Lyke, 1998). Well-controlled studies have do- set of procedures followed by practitioners cumented their effectiveness for almost every who consider themselves family therapists. type of disorder and relational problem in chil- While there exists a diversity of treatment dren, adolescents and adults (Pinsoff & Lebow, models, the field of family therapy is gener- 2005). Treatment modalities such as cognitive ating a body of treatment outcome research behavioural family therapy, family psychoedu- demonstrating positive results for certain cation for families with psychotic disorders family problems ranging from schizophrenia (Falloon, Boyd & McGill, 1998) and multimodal to childhood problems. These research projects treatments for serious disorders such as schizo- are growing in number and becoming more phrenia, substance abuse, anorexia and autism sophisticated in design and execution. are considered the best practice methods for

136 INTERVENTION No 131 these populations. Therapies that target the Descripteurs : emotional life of the family such as emotionally Thérapie familiale - Histoire // Thérapie conjugale - focused therapy (Greenberg, Ford, Alden & Québec (Province) - Histoire // Thérapie de couple - Johnson, 1993) and integrative modalities that Étude et enseignement (Universitaire) - Québec combine elements of multiple approaches have (Province) // Thérapie familiale - Étude et been identified as highly effective for a range of enseignement (Universitaire) - Québec (Province) // social and psychological problems. Structural Thérapie familiale - Étude et enseignement (Universitaire) - Canada // Thérapie familiale - modalities that target non-compliant families Étude et enseignement (Universitaire) - (Stantisben et al. 1996; Szapocznik et al., 1988) États-Unis // Thérapie familiale - Programmes have been identified as effective for multi- d’études // Thérapie de couple - Législation - stressed families. In view of the present mental Québec (Province) health reform in Quebec, with the envisioned Family therapy - History // Marital psychotherapy - transfer of “front-line practitioners” to commu- Quebec (Province) - History // Marital nity practice, clinicians will be required to psychotherapy - Social service - Study and teaching - demonstrate a wide range of practice compe- Quebec (Province) // Family therapy - Study and tence with specialized skills for treating com- teaching - Quebec (Province) // Family therapy - plex couple and family systems. With the Study and teaching - Canada // Family therapy - pressure on today’s health and social service Study and teaching - United States // Family therapy programs // Couple therapy - networks, skilled and autonomous practition- Regulations - Quebec (Province) ers are an essential requirement for front-line practice. The development of a university- based Master’s level program in Couple and References Family Therapy will give its graduates cutting- Avis, J. M. (1988). Deepening awareness: A private edge training in the family-based approaches study guide to feminism and family therapy. In outlined above, thus providing a highly desir- L. Braverman.(ed.). Women, feminism and family able skill set for employers of both present and therapy. New York: Haworth Press. future health and social service care providers. Bardill, D. R., & Saunders, B. E. (1988). Marriage In 2001, when couple and family therapy and Family therapy and graduate social work education. In H. A. Liddle, D. C. Breunlin & received official recognition as a profession R. C. Schwartz (Eds.). Handbook of family therapy with reserved title, the legislation’s intent was training and supervision: 316-330. New York: to develop a master’s level university program Guilford Press. within five years of its implementation. As over Becvar, D. S., & Becvar, R. J. (2009). Family therapy: seven years have passed since that date, the A systemic integration (Seventh Edition). Boston: development of this university degree program Pearson Education, Inc. Allyn & Bacon. is considered the logical next step. Since the Bograd, M. (1992). Values in conflict: Challenges to date of this integration, the profession has feminist thinking, Journal of Marital and Family secured a solid place on the professional land- Therapy, 18, 245-256. scape. With the adoption of Bill 46, the name of Bowen, M. (1976). Theory in the practice of psy- the professional order has been officially chotherapy. In P. J. Guerin, ed. Family therapy: changed to Ordre des travailleurs sociaux et des Theory and practice. New York: Gardner Press. thérapeutes conjugaux et familiaux du Québec. Bowlby, J. (1949). The study and reduction of group This legal recognition identifies Social Work as tensions in the family, Human Relations, 2, 123-138. “The Professional Home of Couple and Family Dattilio, F. M. (2001). Cognitive-behavioral family Therapy”. A retrospective of our long tradition therapy: Contemporary myths and misconcep- identifies social work at the forefront of profes- tions, Contemporary Family Therapy, 23 (1), 3-15. sional development since its early beginnings. Epstein, N. B., Bishop, D. S., & Baldarin, L. M. (1981). The establishment of a professional recognition McMaster model of family functioning. In combined with the development of a strong F. Walsh, ed. Normal family problems. New York: professional presence through the consolidation Guilford Press. of university-based programs in Couple and Falloon, I. R. H., Boyd, J. L., & McGill, C. W. (1998). Family Therapy within Quebec distinguishes Family care of schizophrenia. New York: Guildford. this province as a leader in the field.

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