(Henggeler, 2011). Finally, MST has been modified
to address other clinical problems as well, including
youth emotional disturbance, youth substance use
disorder, family abuse and neglect, and child/youth
health problems (Henggeler, 2011).
When to Conduct Family Therapy?There are no hard-and-fast rules as to when family
therapyisappropriateandwhenitisnot.Mostoften,
family therapy is begun with an adolescent as the
principal patient. Perhaps the patient’s problems are
so tied up with the family that family therapy is really
the only sensible course. Perhaps the family has
impeded therapeutic progress in the past or has
resisted the therapist’s advice. Alternatively, some
therapists may conceptualize the adolescents’symp-
toms as a signal that there is trouble somewhere else
in the family unit (e.g., a teen’s acting out keeps
attention away from a conflictual marriage; until
the marital relationship is addressed, it will be hard
to get the adolescent to reduce disruptive behavior).
Sometimes, family crises, such as the death of a
family member, propel the entire family unit into
pathology almost as one. In some families, there are
conflicts over values. For example, an adolescent who
begins to take drugs or becomes totally absorbed in a
cult or a different religion may disrupt the entire
family by seeming to undermine its values. In such
instances, family therapy may be a logical recourse.
Finally, significant marital or sexual problems
may be resolved best by a form of family therapy.
It can, of course, be difficult to determine whether
individual, family, or couples therapy should be
undertaken as a way of working out such problems.
However, family therapy or couples counseling
would seem appropriate when the problems do not
seem to stem from deep-seated emotional conflicts
but from matters that can be dealt with education-
ally, including misguided attitudes, poor knowledge
about sexuality, or lack of communication.
However, family therapy is not a cure-all, and it
is not always appropriate. Sometimes a family is so
disrupted that such intervention would clearly be
doomed to fail. It is also possible that one or more
family members will refuse to cooperate. In some
instances, it quickly becomes clear that a given family
member is so disturbed, so uncooperative, or so dis-
ruptive that the entire process of family therapy
would be poisoned by his or her presence.
Since family therapy involves several people,
one must sometimes consider its possible use in
cost–benefit terms. Although family therapy might
benefit the identified patient of the group, the pro-
cess could have malignant consequences for some of
the other members. Like individual patients, some
families do not possess the psychological strength or
resources to cope with the threatening material that
may come out in family therapy sessions. Deciding
when to use family therapy is often a difficult mat-
ter that requires careful assessment and a great deal
of clinical sensitivity.Couples Therapy
Although we use the term couples therapy, this
approach is not limited to married couples and
can be provided to unmarried couples, same-sex
couples, and others. There are many issues that
bring couples in to consult with a clinician. In
one sense, couples therapy can be construed as a
form of family therapy. For example, when a hus-
band and wife are seen together and the focus of
treatment is on the marital relationship rather than
on the problems of the individuals, a form of family
therapy seems to be involved.
Although the couples therapy movement, like
the family therapy movement, owes much to inter-
personal theorists such as Sullivan, Horney, and
Fromm, the development of couples therapy as a
discipline can be attributed to pragmatic concerns
(Fruzzetti & Jacobson, 1991). Essentially, a wide
variety of professionals (including doctors and law-
yers), in the course of carrying out their normal
professional duties, became increasingly involved
in attempting to resolve marital conflicts. Fruzzetti
and Jacobson (1991) note the remarkable growth of
couples therapy since the 1960s. Today, the most
popular forms of couples therapy are behavioral
marital therapy, cognitive couples therapy, emo-
tionally focused couples therapy, sex therapy, and
insight-oriented (psychodynamic) couples therapy.
To give the reader a flavor of what techniques
are used in couples therapy, we briefly describe450 CHAPTER 15