Family therapy in Romania and lessons for the West

In the United States, family psychiatrists continue to deal with the fallout from the 1950s and 1960s, when the early family therapists located mental illness within the family and then touted family therapy as the cure. Families felt blamed and shied away from "family therapy."

Yet, research shows that family treatment for many psychiatric and medical illnesses, whether it is family inclusion or psychoeducation, is very effective in reducing morbidity. Stigma and fear about family involvement have resulted in family treatment lagging behind other psychotherapies in its acceptance as a valid therapeutic intervention.

As a contrast, it is therefore interesting to look at Romania, a postcommunist country, where all psychotherapies were deemed "unnecessary" under communism. According to Dr. Ileana-Mihaela Botezat-Antonescu, "Psychotherapy and psychoanalysis were known as the studies of the soul during the communist regime and went underground. Secret psychotherapy meetings were held in Sibiu and Timisoara, but after the 1989 revolution, we had access to information from abroad," she said during a presentation this year at the World Psychiatric Association meeting in Bucharest, Romania.

"In 1990, freedom occurs, but nobody tells you what to do. You cannot count on anything. It alienated people seeking help. It was a process that took time," said Dr. Botezat-Antonescu, a psychiatrist and psychoanalyst who was trained in the mid-1990s by trainers from the Dutch Psychoanalytic Association and serves as chair of the National Center for Mental Health.

Psychotherapists in Romania must somehow address the traumatic environment that lasted a generation. Young people strive to gain their sense of identity and belonging and, at the same time, are challenged with reestablishing a connection between the generations. The sense of intergenerational trauma and loss extends back to grandparents who lost their farms, houses, and social position.

An understanding of the intergenerational transmission of trauma can inform psychotherapists across the globe in their care of young people. Family therapy is a type of psychotherapy that is well suited to address this intergenerational trauma.

Psychological trauma is passed down through the generations in subtle and unspoken ways. It is important for therapists to recognize when this is occurring and work with the whole family. Family therapy that specifically addresses the intergenerational transmission of trauma can help move a family from feelings of helplessness toward resilience.

Development of family therapy

Family therapy developed in Romania through training courses in Cluj, Târgu Mures, and Timisoara. As there were no Romanian trainers, these courses were taught by family therapists from countries such as Ireland, France, and Yugoslavia. Families and trainees spoke Romanian or Hungarian, and during live supervision, simultaneous translation occurred. All courses, readings, and assignments were in English. Family therapy developed in Romania through training courses in Cluj, Târgu Mures and Timisoara.

Trainees saw families in their own work contexts, for example, psychotherapy centers; psychiatry hospitals; and community centers, such as family planning clinics and domestic violence shelters. Currently, there are 16 family therapy professional organizations (Contemp. Fam. Ther. 2013;35:275-87), including:

• Systemic Family Therapy Association in Cluj

• Association of Family Therapy in Bucharest

• Romanian Association for Family and Systemic Therapy in Timisoara

• Association Crisdu Areopagus in Timisoara

• Pro Familia – Family Therapy Association in Miercurea-Ciuc

• Association for Couple and Family Psychotherapy in Iasi

• Association for Family Counselling and Therapy in Iasi

Dr. Zoltán Kónya and Dr. Ágnes Kónya run the family therapy center in Cluj and have written about the challenges of practicing family therapy in Romania (Context 2007;92:2-4 and Contemporary Family Therapy 2013;35:1). Since family therapy training courses developed at different times, in different places, with trainers invited from different countries, the sense of what constitutes family therapy varies across Romania.

The meaning of the word "systemic" has proved particularly contentious. For some, systemic is synonymous with the Milan approach – which is based on the notion that "families are self-regulating systems that function based on self-developed rules tested over time through a process of trial and error" (Case Conceptualization in Family Therapy, Boston: Pearson, 2013). However, others consider family therapy as more than a systemic approach. Some promote systemic thinking as an all-encompassing epistemological frame for consultation with individuals, families, and organizations, but others do not attach much importance to the term "systemic."

The challenge of organizing into one Romanian family therapy institution with one outlook is great. This challenge also replicates one of the major problems in our field – the idea that family therapy means different things to different people. In Romania, well-meaning outside attempts ended up in a fractured national family therapy identity.

The Kónyas, trained by Irish family therapists, identify additional challenges of introducing family therapy into a culture unfamiliar with the concept. "The fit between systemic therapy and Romanian culture has been a concern of ours since the beginning of our training," they wrote in 2003. "There had been no tradition of people seeing psychotherapists in times of distress. Also, the vast majority of health care professionals had not even heard about family therapy. Would families come to therapy?"

They found that not only did clients come to therapy, but they also were ready to work hard when they did.

"We admire our clients’ courage in facing a series of challenges involved in the therapy process: consulting an outsider for a family problem, participating in sessions as a family, being asked unusual questions, being videotaped and, sometimes, being observed by a team and/or supervisors from abroad," they said.

In their work with patients, the Kónyas write, they have encountered difficulties tied to the use of words and phrases used in systemic therapy.

"For example, the Batesonian phrase 'a difference that makes a difference' is very difficult, if not impossible to properly translate into Romanian – of course, this may only be a problem in a training context, not in therapy. In response to the Romanian or Hungarian translation of the question: ‘And how has this been a problem for you?’ clients almost invariably demonstrate a lack of comprehension: ‘Would you please say that again? I didn’t understand.’ The difficulty here is not that the question makes no sense, but that it is culturally unusual – and therefore potentially therapeutic," they write (Context 2007)

"Also, certain words that might sound neutral in the West sometimes trigger strong emotions in our country. For example, monitoring progress on a 1-10 scale might recall painful experiences connected with school, because in Romania, marks are from 1 to 10. Also, talking about ‘systems’ may trigger discomfort, as this is the word people used during communism to describe the oppressive dictatorial regime. People who challenged the dominant ideas used to be called ‘the enemies of the system.’ "

The communist ideal of "systemization" broke families. Women were encouraged to give birth in a pronatal policy that resulted in orphans and unwanted children. After the 1989 revolution, more than 300,000 Romanians were living in psychiatric institutions. Communist factories were closed, and displaced workers had no place. Raising a voice against the regime risked imprisonment as an enemy of the system. The word "system" is associated with oppression in Romania.

Are there lessons for us in the West? I think the answer is yes and that the Romanian experience highlights several imperatives that are useful for Western mental health professionals. Among those imperatives:

• Family psychiatry needs to agree on a definition of family therapy. Is it any approach that includes families? Do we need to be systemic to be considered family therapists? Does family support qualify as family therapy? Does family psychoeducation qualify as family therapy? Can we embrace these two levels, as well as a third, more-skilled level, a systemic family therapy? Can we accept a three-level definition of family treatment?

• Can we incorporate all the family therapy models into one approach that people will recognize as a generic approach to families? Can we use the common factors approach described by Douglas H. Sprenkle, Ph.D., Sean D. Davis, Ph.D., and Jay L. Lebow, Ph.D., in "Common Factors in Couple and Family Therapy" (New York: The Guilford Press, 2009)? For couples and family therapists, common factors over and above the well-recognized individual psychotherapy factors are conceptualizing the problems in relational terms, using therapy that aims to disrupt dysfunctional relational patterns, expanding treatment to include family members of the index patient, and fostering an expanded therapeutic alliance, according to Dr. Sprenkle, Dr. Davis, and Dr. Lebow.

• Can we develop a protocol that beginners can follow? Aaron Beck’s cognitive-behavioral therapy (CBT) provides a basic template that is easy for the novice therapist and the patient to use, yet brings a unique perspective to psychotherapy. CBT has gone on to develop in several diverse directions, but all CBT models have the same basic set of beliefs. Can a family approach or protocol be both simple AND allow for more sophisticated elaboration? Can we develop a set of basic steps that define family treatment?

• Should there be an approach to families that all disciplines can follow? Family therapy is practiced by physicians, nurses, social workers, and marriage and family therapists. Each discipline tends to work with different populations. Physicians tend to see families in which one person is the identified patient. Social workers tend to see families that have been referred for social services, families who are frequently struggling with such problems as housing, financial, and legal difficulties. Marriage and family therapists are often employed by community and hospital agencies as health care extenders and might work alongside other health care professionals. Would a single approach to families be useful?

In summary, if family therapy is to endure, it must be teachable, translatable, and relevant across disciplines and national boundaries. The systemic paradigm is an important perspective from which all practitioners can benefit. We must continue to disseminate evidence-based family treatments and teach family principles that can be incorporated on a daily basis by all mental health professionals.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).

In the United States, family psychiatrists continue to deal with the fallout from the 1950s and 1960s, when the early family therapists located mental illness within the family and then touted family therapy as the cure. Families felt blamed and shied away from "family therapy."

Yet, research shows that family treatment for many psychiatric and medical illnesses, whether it is family inclusion or psychoeducation, is very effective in reducing morbidity. Stigma and fear about family involvement have resulted in family treatment lagging behind other psychotherapies in its acceptance as a valid therapeutic intervention.

As a contrast, it is therefore interesting to look at Romania, a postcommunist country, where all psychotherapies were deemed "unnecessary" under communism. According to Dr. Ileana-Mihaela Botezat-Antonescu, "Psychotherapy and psychoanalysis were known as the studies of the soul during the communist regime and went underground. Secret psychotherapy meetings were held in Sibiu and Timisoara, but after the 1989 revolution, we had access to information from abroad," she said during a presentation this year at the World Psychiatric Association meeting in Bucharest, Romania.

"In 1990, freedom occurs, but nobody tells you what to do. You cannot count on anything. It alienated people seeking help. It was a process that took time," said Dr. Botezat-Antonescu, a psychiatrist and psychoanalyst who was trained in the mid-1990s by trainers from the Dutch Psychoanalytic Association and serves as chair of the National Center for Mental Health.

Psychotherapists in Romania must somehow address the traumatic environment that lasted a generation. Young people strive to gain their sense of identity and belonging and, at the same time, are challenged with reestablishing a connection between the generations. The sense of intergenerational trauma and loss extends back to grandparents who lost their farms, houses, and social position.

An understanding of the intergenerational transmission of trauma can inform psychotherapists across the globe in their care of young people. Family therapy is a type of psychotherapy that is well suited to address this intergenerational trauma.

Psychological trauma is passed down through the generations in subtle and unspoken ways. It is important for therapists to recognize when this is occurring and work with the whole family. Family therapy that specifically addresses the intergenerational transmission of trauma can help move a family from feelings of helplessness toward resilience.

Development of family therapy

Family therapy developed in Romania through training courses in Cluj, Târgu Mures, and Timisoara. As there were no Romanian trainers, these courses were taught by family therapists from countries such as Ireland, France, and Yugoslavia. Families and trainees spoke Romanian or Hungarian, and during live supervision, simultaneous translation occurred. All courses, readings, and assignments were in English. Family therapy developed in Romania through training courses in Cluj, Târgu Mures and Timisoara.

Trainees saw families in their own work contexts, for example, psychotherapy centers; psychiatry hospitals; and community centers, such as family planning clinics and domestic violence shelters. Currently, there are 16 family therapy professional organizations (Contemp. Fam. Ther. 2013;35:275-87), including:

• Systemic Family Therapy Association in Cluj

• Association of Family Therapy in Bucharest

• Romanian Association for Family and Systemic Therapy in Timisoara

• Association Crisdu Areopagus in Timisoara

• Pro Familia – Family Therapy Association in Miercurea-Ciuc

• Association for Couple and Family Psychotherapy in Iasi

• Association for Family Counselling and Therapy in Iasi

Dr. Zoltán Kónya and Dr. Ágnes Kónya run the family therapy center in Cluj and have written about the challenges of practicing family therapy in Romania (Context 2007;92:2-4 and Contemporary Family Therapy 2013;35:1). Since family therapy training courses developed at different times, in different places, with trainers invited from different countries, the sense of what constitutes family therapy varies across Romania.

The meaning of the word "systemic" has proved particularly contentious. For some, systemic is synonymous with the Milan approach – which is based on the notion that "families are self-regulating systems that function based on self-developed rules tested over time through a process of trial and error" (Case Conceptualization in Family Therapy, Boston: Pearson, 2013). However, others consider family therapy as more than a systemic approach. Some promote systemic thinking as an all-encompassing epistemological frame for consultation with individuals, families, and organizations, but others do not attach much importance to the term "systemic."

The challenge of organizing into one Romanian family therapy institution with one outlook is great. This challenge also replicates one of the major problems in our field – the idea that family therapy means different things to different people. In Romania, well-meaning outside attempts ended up in a fractured national family therapy identity.

The Kónyas, trained by Irish family therapists, identify additional challenges of introducing family therapy into a culture unfamiliar with the concept. "The fit between systemic therapy and Romanian culture has been a concern of ours since the beginning of our training," they wrote in 2003. "There had been no tradition of people seeing psychotherapists in times of distress. Also, the vast majority of health care professionals had not even heard about family therapy. Would families come to therapy?"

They found that not only did clients come to therapy, but they also were ready to work hard when they did.

"We admire our clients’ courage in facing a series of challenges involved in the therapy process: consulting an outsider for a family problem, participating in sessions as a family, being asked unusual questions, being videotaped and, sometimes, being observed by a team and/or supervisors from abroad," they said.

In their work with patients, the Kónyas write, they have encountered difficulties tied to the use of words and phrases used in systemic therapy.

"For example, the Batesonian phrase 'a difference that makes a difference' is very difficult, if not impossible to properly translate into Romanian – of course, this may only be a problem in a training context, not in therapy. In response to the Romanian or Hungarian translation of the question: ‘And how has this been a problem for you?’ clients almost invariably demonstrate a lack of comprehension: ‘Would you please say that again? I didn’t understand.’ The difficulty here is not that the question makes no sense, but that it is culturally unusual – and therefore potentially therapeutic," they write (Context 2007)

"Also, certain words that might sound neutral in the West sometimes trigger strong emotions in our country. For example, monitoring progress on a 1-10 scale might recall painful experiences connected with school, because in Romania, marks are from 1 to 10. Also, talking about ‘systems’ may trigger discomfort, as this is the word people used during communism to describe the oppressive dictatorial regime. People who challenged the dominant ideas used to be called ‘the enemies of the system.’ "

The communist ideal of "systemization" broke families. Women were encouraged to give birth in a pronatal policy that resulted in orphans and unwanted children. After the 1989 revolution, more than 300,000 Romanians were living in psychiatric institutions. Communist factories were closed, and displaced workers had no place. Raising a voice against the regime risked imprisonment as an enemy of the system. The word "system" is associated with oppression in Romania.

Are there lessons for us in the West? I think the answer is yes and that the Romanian experience highlights several imperatives that are useful for Western mental health professionals. Among those imperatives:

• Family psychiatry needs to agree on a definition of family therapy. Is it any approach that includes families? Do we need to be systemic to be considered family therapists? Does family support qualify as family therapy? Does family psychoeducation qualify as family therapy? Can we embrace these two levels, as well as a third, more-skilled level, a systemic family therapy? Can we accept a three-level definition of family treatment?

• Can we incorporate all the family therapy models into one approach that people will recognize as a generic approach to families? Can we use the common factors approach described by Douglas H. Sprenkle, Ph.D., Sean D. Davis, Ph.D., and Jay L. Lebow, Ph.D., in "Common Factors in Couple and Family Therapy" (New York: The Guilford Press, 2009)? For couples and family therapists, common factors over and above the well-recognized individual psychotherapy factors are conceptualizing the problems in relational terms, using therapy that aims to disrupt dysfunctional relational patterns, expanding treatment to include family members of the index patient, and fostering an expanded therapeutic alliance, according to Dr. Sprenkle, Dr. Davis, and Dr. Lebow.

• Can we develop a protocol that beginners can follow? Aaron Beck’s cognitive-behavioral therapy (CBT) provides a basic template that is easy for the novice therapist and the patient to use, yet brings a unique perspective to psychotherapy. CBT has gone on to develop in several diverse directions, but all CBT models have the same basic set of beliefs. Can a family approach or protocol be both simple AND allow for more sophisticated elaboration? Can we develop a set of basic steps that define family treatment?

• Should there be an approach to families that all disciplines can follow? Family therapy is practiced by physicians, nurses, social workers, and marriage and family therapists. Each discipline tends to work with different populations. Physicians tend to see families in which one person is the identified patient. Social workers tend to see families that have been referred for social services, families who are frequently struggling with such problems as housing, financial, and legal difficulties. Marriage and family therapists are often employed by community and hospital agencies as health care extenders and might work alongside other health care professionals. Would a single approach to families be useful?

In summary, if family therapy is to endure, it must be teachable, translatable, and relevant across disciplines and national boundaries. The systemic paradigm is an important perspective from which all practitioners can benefit. We must continue to disseminate evidence-based family treatments and teach family principles that can be incorporated on a daily basis by all mental health professionals.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).

In the United States, family psychiatrists continue to deal with the fallout from the 1950s and 1960s, when the early family therapists located mental illness within the family and then touted family therapy as the cure. Families felt blamed and shied away from "family therapy."

Yet, research shows that family treatment for many psychiatric and medical illnesses, whether it is family inclusion or psychoeducation, is very effective in reducing morbidity. Stigma and fear about family involvement have resulted in family treatment lagging behind other psychotherapies in its acceptance as a valid therapeutic intervention.

As a contrast, it is therefore interesting to look at Romania, a postcommunist country, where all psychotherapies were deemed "unnecessary" under communism. According to Dr. Ileana-Mihaela Botezat-Antonescu, "Psychotherapy and psychoanalysis were known as the studies of the soul during the communist regime and went underground. Secret psychotherapy meetings were held in Sibiu and Timisoara, but after the 1989 revolution, we had access to information from abroad," she said during a presentation this year at the World Psychiatric Association meeting in Bucharest, Romania.

"In 1990, freedom occurs, but nobody tells you what to do. You cannot count on anything. It alienated people seeking help. It was a process that took time," said Dr. Botezat-Antonescu, a psychiatrist and psychoanalyst who was trained in the mid-1990s by trainers from the Dutch Psychoanalytic Association and serves as chair of the National Center for Mental Health.

Psychotherapists in Romania must somehow address the traumatic environment that lasted a generation. Young people strive to gain their sense of identity and belonging and, at the same time, are challenged with reestablishing a connection between the generations. The sense of intergenerational trauma and loss extends back to grandparents who lost their farms, houses, and social position.

An understanding of the intergenerational transmission of trauma can inform psychotherapists across the globe in their care of young people. Family therapy is a type of psychotherapy that is well suited to address this intergenerational trauma.

Psychological trauma is passed down through the generations in subtle and unspoken ways. It is important for therapists to recognize when this is occurring and work with the whole family. Family therapy that specifically addresses the intergenerational transmission of trauma can help move a family from feelings of helplessness toward resilience.

Development of family therapy

Family therapy developed in Romania through training courses in Cluj, Târgu Mures, and Timisoara. As there were no Romanian trainers, these courses were taught by family therapists from countries such as Ireland, France, and Yugoslavia. Families and trainees spoke Romanian or Hungarian, and during live supervision, simultaneous translation occurred. All courses, readings, and assignments were in English. Family therapy developed in Romania through training courses in Cluj, Târgu Mures and Timisoara.

Trainees saw families in their own work contexts, for example, psychotherapy centers; psychiatry hospitals; and community centers, such as family planning clinics and domestic violence shelters. Currently, there are 16 family therapy professional organizations (Contemp. Fam. Ther. 2013;35:275-87), including:

• Systemic Family Therapy Association in Cluj

• Association of Family Therapy in Bucharest

• Romanian Association for Family and Systemic Therapy in Timisoara

• Association Crisdu Areopagus in Timisoara

• Pro Familia – Family Therapy Association in Miercurea-Ciuc

• Association for Couple and Family Psychotherapy in Iasi

• Association for Family Counselling and Therapy in Iasi

Dr. Zoltán Kónya and Dr. Ágnes Kónya run the family therapy center in Cluj and have written about the challenges of practicing family therapy in Romania (Context 2007;92:2-4 and Contemporary Family Therapy 2013;35:1). Since family therapy training courses developed at different times, in different places, with trainers invited from different countries, the sense of what constitutes family therapy varies across Romania.

The meaning of the word "systemic" has proved particularly contentious. For some, systemic is synonymous with the Milan approach – which is based on the notion that "families are self-regulating systems that function based on self-developed rules tested over time through a process of trial and error" (Case Conceptualization in Family Therapy, Boston: Pearson, 2013). However, others consider family therapy as more than a systemic approach. Some promote systemic thinking as an all-encompassing epistemological frame for consultation with individuals, families, and organizations, but others do not attach much importance to the term "systemic."

The challenge of organizing into one Romanian family therapy institution with one outlook is great. This challenge also replicates one of the major problems in our field – the idea that family therapy means different things to different people. In Romania, well-meaning outside attempts ended up in a fractured national family therapy identity.

The Kónyas, trained by Irish family therapists, identify additional challenges of introducing family therapy into a culture unfamiliar with the concept. "The fit between systemic therapy and Romanian culture has been a concern of ours since the beginning of our training," they wrote in 2003. "There had been no tradition of people seeing psychotherapists in times of distress. Also, the vast majority of health care professionals had not even heard about family therapy. Would families come to therapy?"

They found that not only did clients come to therapy, but they also were ready to work hard when they did.

"We admire our clients’ courage in facing a series of challenges involved in the therapy process: consulting an outsider for a family problem, participating in sessions as a family, being asked unusual questions, being videotaped and, sometimes, being observed by a team and/or supervisors from abroad," they said.

In their work with patients, the Kónyas write, they have encountered difficulties tied to the use of words and phrases used in systemic therapy.

"For example, the Batesonian phrase 'a difference that makes a difference' is very difficult, if not impossible to properly translate into Romanian – of course, this may only be a problem in a training context, not in therapy. In response to the Romanian or Hungarian translation of the question: ‘And how has this been a problem for you?’ clients almost invariably demonstrate a lack of comprehension: ‘Would you please say that again? I didn’t understand.’ The difficulty here is not that the question makes no sense, but that it is culturally unusual – and therefore potentially therapeutic," they write (Context 2007)

"Also, certain words that might sound neutral in the West sometimes trigger strong emotions in our country. For example, monitoring progress on a 1-10 scale might recall painful experiences connected with school, because in Romania, marks are from 1 to 10. Also, talking about ‘systems’ may trigger discomfort, as this is the word people used during communism to describe the oppressive dictatorial regime. People who challenged the dominant ideas used to be called ‘the enemies of the system.’ "

The communist ideal of "systemization" broke families. Women were encouraged to give birth in a pronatal policy that resulted in orphans and unwanted children. After the 1989 revolution, more than 300,000 Romanians were living in psychiatric institutions. Communist factories were closed, and displaced workers had no place. Raising a voice against the regime risked imprisonment as an enemy of the system. The word "system" is associated with oppression in Romania.

Are there lessons for us in the West? I think the answer is yes and that the Romanian experience highlights several imperatives that are useful for Western mental health professionals. Among those imperatives:

• Family psychiatry needs to agree on a definition of family therapy. Is it any approach that includes families? Do we need to be systemic to be considered family therapists? Does family support qualify as family therapy? Does family psychoeducation qualify as family therapy? Can we embrace these two levels, as well as a third, more-skilled level, a systemic family therapy? Can we accept a three-level definition of family treatment?

• Can we incorporate all the family therapy models into one approach that people will recognize as a generic approach to families? Can we use the common factors approach described by Douglas H. Sprenkle, Ph.D., Sean D. Davis, Ph.D., and Jay L. Lebow, Ph.D., in "Common Factors in Couple and Family Therapy" (New York: The Guilford Press, 2009)? For couples and family therapists, common factors over and above the well-recognized individual psychotherapy factors are conceptualizing the problems in relational terms, using therapy that aims to disrupt dysfunctional relational patterns, expanding treatment to include family members of the index patient, and fostering an expanded therapeutic alliance, according to Dr. Sprenkle, Dr. Davis, and Dr. Lebow.

• Can we develop a protocol that beginners can follow? Aaron Beck’s cognitive-behavioral therapy (CBT) provides a basic template that is easy for the novice therapist and the patient to use, yet brings a unique perspective to psychotherapy. CBT has gone on to develop in several diverse directions, but all CBT models have the same basic set of beliefs. Can a family approach or protocol be both simple AND allow for more sophisticated elaboration? Can we develop a set of basic steps that define family treatment?

• Should there be an approach to families that all disciplines can follow? Family therapy is practiced by physicians, nurses, social workers, and marriage and family therapists. Each discipline tends to work with different populations. Physicians tend to see families in which one person is the identified patient. Social workers tend to see families that have been referred for social services, families who are frequently struggling with such problems as housing, financial, and legal difficulties. Marriage and family therapists are often employed by community and hospital agencies as health care extenders and might work alongside other health care professionals. Would a single approach to families be useful?

In summary, if family therapy is to endure, it must be teachable, translatable, and relevant across disciplines and national boundaries. The systemic paradigm is an important perspective from which all practitioners can benefit. We must continue to disseminate evidence-based family treatments and teach family principles that can be incorporated on a daily basis by all mental health professionals.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).