relate to what is real). These modes of communication
provide, in a sense, the essence of communication and
feeling. They do not negate the role of cognitions, but
they do place the emphasis where Satir believed it
belongs.
Other Varieties of Family TherapyThere are many other types of family therapy. The
following are a sample of the more commonly
encountered versions.
Concurrent Family Therapy. Inconcurrent family
therapy, one therapist sees all family members, but in
individual sessions. The overall goals are the same as
those in conjoint therapy. In some instances, the
therapist may conduct traditional psychotherapy
with the principal patient but also occasionally see
other members of the family. As a matter of fact, it
is perhaps unfortunate that the last variation is not
used more often as a part of traditional psychother-
apy. Because it is often the case that an individual
patient’s problems can be understood better and
dealt with better in collaboration with significant
others in the patient’s life, the use of such arrange-
ments should facilitate the therapeutic process.
Collaborative Family Therapy. In collaborative
family therapy, each family member sees a different
therapist. The therapists then get together to discuss
their patients and the family as a whole. As we saw
earlier, the use of this approach with child patients
was one of the factors that stimulated the early
growth of family therapy. In a variation of this gen-
eral approach, cotherapists are sometimes assigned
to work with the same family. That is, two or
more therapists meet with the family unit.
Behavioral Approaches to Family Therapy.
Some clinicians (e.g., Liberman, 1970; Patterson,
1971) have viewed family relations in terms of rein-
forcement contingencies and skills training. The role
of the therapist is to generate a behavioral analysis of
family problems. This analysis helps identify the beha-
viors whose frequency should be increased or
decreased as well as the rewards that are maintaining
undesirable behaviors or that will enhance desired
behaviors.Behavioral family therapythen becomes a
process of inducing family members to dispense the
appropriate social reinforcements to one another for
the desired behaviors.
Given the recent developments in cognitive-
behavioral therapy, it is not surprising that this approach
has found its way into the family therapy enterprise.
Similar to cognitive-behavioral therapy for the individ-
ual, the family version involves teaching individual
family members to self-monitor problematic behaviors
and patterns of thinking, to develop new skills (com-
munication, problem resolution, negotiation, conflict
management), and to challenge interpretations of
family events and reframe these interpretations if nec-
essary (Carlson, Sperry, & Lewis, 1997; N. Epstein,
Schlesinger, & Dryden, 1988).Multisystemic Therapy. A more recent mode
of family therapy, multisystemic therapy (MST)
(Henggeler, 2011; Henggeler & Borduin, 1990;
Henggeler, Schoenwald, Borduin, Rowland, &
Cunningham, 2009), was developed as an interven-
tion for juvenile offenders and their families. The
model behind MST assumes that clinical problems
are determined by multiple factors, including the
individual, the family, the school environment,
and the neighborhood. These influences are viewed
as“systems”of influence within which each person
operates. MST sees the family as the most impor-
tant link in changing problematic behavior, and this
approach is characterized by several key compo-
nents: (a) treatment is delivered in the person’s
home, school, or other community locations;
(b) MST therapists are available for consultation
24 hours a day, 7 days a week; (c) the caseloads of
MST therapists are kept intentionally low (4 to
6 families) in order to provide intensive services to
each family; (d) MST therapists serve on a team in
order to provide continuity of services and to
be available for back-up should the need arise
(Henggeler, 2011). MST uses several evidence-
based techniques (e.g., cognitive-behavioral), and
both individual and family outcomes are tracked.
MST has been shown to be both efficacious
(compared to no treatment) as well as effectiveGROUP THERAPY, FAMILY THERAPY, AND COUPLES THERAPY 447