Evaluating and Treating Families: The McMaster Approach

Evaluating and Treating Families: The McMaster Approach, by Christine E. Ryan and colleagues, is a book that I would have welcomed as a marriage and family therapy trainee. Even though I trained as a family physician in a biopsychosocially oriented family medicine residency, I was still unprepared for the complexity of the material I learned during my introductory course in family systems. Ryan and colleagues’ text provides a comprehensive and systematic description of the historical, theoretical, methodological, and research bases for the McMaster model of family therapy, beginning with the description of their model for normal family functioning. Nathan B. Epstein, one of the early developers of the McMaster model, is the second author, and his experience and history with the model are evident throughout. Part 1 outlines the history and development of the McMaster Model of Family Functioning (MMFF) and the Problem Centered Systems Therapy of the Family (PCSTF) and discusses considerations in training and research using the McMaster model. Part 2 (pp. 225–318) presents 7 assessment and research scales developed by the McMaster program and includes instructions for their use. The authors state in the Introduction that the McMaster model of family therapy has “internal consistency and demonstrated effectiveness” (p. xi). In chapter 1, the authors lay out the historical development of Dr Epstein's approach to working with families, including his experience with psychodynamic, interactional, and systems models. The authors describe how Dr Epstein synthesized these ideas into the McMaster model and provide comparisons and contrasts with other models of family therapy. Of importance, the authors point out that the McMaster model is a family systems approach wherein the therapist maintains open and clear communication with the family during the course of treatment. According to the McMaster model, and in contrast to psychodynamic/psychoanalytic models, insight into the problem is neither necessary nor sufficient for change to occur, but, rather, the therapist directs the family's attention to assist them to change the family dynamics that allow or encourage the undesired behavior. Chapter 2 describes the MMFF, beginning with the 6 dimensions of family functioning that underlie the model: (1) problem solving, (2) communication, (3) roles, (4) affective responses, (5) affective involvement, and (6) behavior control. These 6 dimensions compose the main axes of the Family Assessment Device, which is discussed throughout the book and presented in part 2. Trainees will find these dimensions helpful in understanding family functioning, in both “normal” and “distressed” families. Chapter 3, “The Problem Centered Systems Therapy of the Family,” moves from the description of the MMFF into a description of the process of assessing and treating families using a structured technique. The PCSTF emphasizes what the authors refer to as the “macro stages” of therapy, that is, the major stages of treatment, in contrast to specific interventions or more “micro” strategies or specific techniques that different therapists employ. In this model, the family is responsible for change, and the therapist provides a thorough assessment with the entire family present, with a focus on current problems, family strengths, and a time-limited approach with a behavioral change outcome. Marriage and family therapy program directors and faculty will find helpful material throughout the text, particularly in chapter 4, in which the authors describe their training program and describe assessment tools for evaluating trainee progress. Even faculty who do not use the entire McMaster model will find ideas that may be relevant to their own program. Trainees will find this book enjoyable and helpful, especially in small doses. The pages are packed with information, concepts, and vignettes designed to illustrate the conceptual material. Ample tables provide at- a-glance review of material covered thoroughly in the text. The table of contents is clear, chapter titles accurately reflect the contents of the chapters, and a complete list of tables and figures provides ready reference to tabular material. Much of the material may be used by faculty in a more limited manner with psychiatry residents, family medicine residents, and other family-oriented primary care clinicians. Evaluating and Treating Families contains helpful material for family researchers, including a full description in the text of the family assessment devices, as well as a summary of their applications and strengths and limitations. Part 2 includes complete instruments and scoring guides for several tools helpful in research and training. The Family Assessment Device (version 3), the McMaster Clinical Rating Scale (rating the 6 dimensions of family functioning), and the McMaster Structured Interview of Family Functioning would be useful for researchers looking to understand and compare family functioning across families or for faculty who are teaching assessment and interviewing techniques to trainees. The authors provide their trainee assessment tools introduced in chapters 4 and 5, absent any scoring rubrics. These 4 tools assess the trainee's adherence to and competence in executing steps in the McMaster model during observed therapy sessions (the McMaster PCSFT Adherence Scale and the McMaster PCSFT Competence Scale) as well as the trainee's conceptual and applied knowledge of the model (the McMaster Family Functioning Concept Test and the McMaster Family Functioning Percept Test). In summary, Evaluating and Treating Families: The McMaster Approach provides a comprehensive guide to the historical development of both the MMFF and the PCSTF as well as information about training students in the model, using strcutured assessments for both clinical and research work. The book is densely packed with information and is widely applicable to marriage and family therapy faculty and trainees. Portions of the text, particularly many of the tables, may be useful in teaching basic family concepts to family-oriented primary care and psychiatry trainees, and the rich description of the measurement scales will be useful for family researchers. Colleen T. Fogarty, MD, MSc University of Rochester Medical Center, Rochester, New York