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This research explores the question of what role medical family therapists play on a health care team when working with serious pediatric illness. Seven participants from three different health care settings were interviewed. Results were organized within the ecological systems framework (Bronfenbrenner, 1979) according to the various ways participants became a part of the family's illness experience. Participants identified roles directly with the family, with the health care team, and within the larger health care system. Clinical implications are identified concerning the preparation of the health care system for the continued growth and evolution of the field of medical family therapy. / Master of Science

Doctor of Philosophy / Department of Family Studies and Human Services / Sandra Stith / Recent years have seen a rise in the medicalization of treatments for erectile dysfunction (ED). While there has been a divide between the medical and psychological communities, some have called for a more collaborative relationship. Little research has been done on the collaboration between medical professionals and psychotherapists in treating ED. This study seeks to increase current knowledge about medical professionals’ referral practices and communication post-referral. An online survey was developed and distributed to the members of the Sexual Medicine Society of North America (SMSNA) (N = 541). Survey questions inquired as to the factors that increased participants’ willingness to refer ED patients, the form of communication participants currently desire to have with psychotherapists and the participants’ desired level of communication with psychotherapists to whom they might refer. Less than ten percent of the medical professionals invited to participate in the study completed the survey (n=50). Those who did complete the survey were primarily male, specialized in urology and practiced in the U.S. Almost half the respondents were employed in an academic setting while just over half of respondents worked in hospital-based, group, or solo practices. Just over half of the survey participants practiced in urban areas. Although the number of medical professionals who completed the survey was small, findings indicated that those who completed a sexual medicine fellowship and who had a larger percentage of their patient population being seen for ED were more likely to refer patients to psychotherapists. Participants who have referred ED patients to psychotherapists reported little-to-no communication between them and the psychotherapists to whom they refer. The study participants expressed a desire to refer patients to psychotherapists who are experienced in working with both sexual and couples issues. Questions about the desires and experiences of medical professionals who have not referred to psychotherapists were not able to be answered because of the limited number of these individuals in the data set. Although the number of participants who completed the survey limits the generalizability of the data, this study demonstrates that most medical professionals who responded to the survey are willing to refer ED patients to psychotherapists.

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At the conclusion of this session, the participant will be able to: Articulate ways that we all – across a myriad of guildmemberships, license-types, and field/practice orientations – can do better work when we work together

This article reviews the presence of family theory in health-care research. First, we demonstrate some disconnect between models of the patient, which tend to focus on the individual, and a large body of research that finds that relationships influence health. We summarize the contributions of family science and medical family therapy and conclude that family science models and measures are generally underutilized. As a result, practitioners do not have access to the rich tool kit of lenses and interventions offered by systems thinking. We propose several possible ways that family scientists can contribute to health-care research, such as using the family as the unit of analysis, exploring theories of the family as they relate to health, and suggesting greater involvement of family scientists in health research.

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This study compared the differences in treatment length, cost, cost effectiveness, dropout, and recidivism between a biomedical, talk therapy, and a collaborative mental health model for outpatient psychotherapy insurance claims. A biomedical model was the most cost effective with fewer sessions, but had a significantly higher dropout rate. Collaborative care had the least dropout, but also had higher costs and recidivism rates. Within collaborative care, differences between modality type, diagnosis, and provider type combinations were also examined. Within collaborative models, mixed modes of therapy had the lowest dropout, but at significantly higher costs and recidivism rates. Family therapy had the lowest recidivism and cost, with the highest dropout rate. In terms of specific problems, eating disorders had significantly more sessions and were significantly less cost-effective than any other diagnoses, followed by mood disorders. Relational disorders had the fewest sessions, best cost-effectiveness, and lowest recidivism rates. Finally, the MD/MFT provider type combination had the lowest dropout and recidivism rates, with the lowest cost, and a significantly better cost effectiveness than the MD/psychologist combination. The MD/psychologist combination had a significantly higher recidivism rate, and the MD/MSW combination had the highest dropout. No significant differences were found for any RN/talk therapy combination. Implications of the findings are discussed, along with limitations and future directions for research.

Chronic illness and invisible disability are impactful contexts during emerging adulthood and the launching stage of the family life cycle (Beatty, 2011; Capelle, Visser, and Vosman, 2016; Young et al., 2010). The parent-child relationship is important to both developmental and health outcomes in families coping with chronic illness during emerging adulthood (Crandell, Sandelowski, Leeman, Haville, and Knafle, 2018; Fenton, Ferries, Ko, Javalkar, and Hooper, 2015; Waldboth, Patch, Mahrer-Imhaf, and Metcalfe, 2016). While informed clinical competency in counseling families experiencing disablement is a diversity-affirmative ethical imperative among psychotherapists (Mona et al., 2017), little is known in family therapy about how parents and emerging adult children experience launching with chronic illness. This qualitative study explored the parent-child dyadic experience of living with a chronic illness called Postural Orthostatic Tachycardia Syndrome (POTS) during emerging adulthood. Seven dyads of parents and their emerging adult children with POTS were interviewed. Data analysis of in-depth interviews using Moustakas's (1994) transcendental phenomenology uncovered eight thematic clusters of meaning in the shared lived experience of POTS at the launching stage of the family life cycle. Clinical implications for family therapists were explored using Rolland's family system-illness (FSI) model of medical family therapy. Study limitations and future directions for further research were discussed. / Master of Science / More and more young adults are living with chronic illness. Postural Orthostatic Tachycardia Syndrome (POTS) is a little-known chronic illness that tends to begin during adolescence. Like many health problems that disproportionately affect women, POTS is often overlooked by doctors. POTS symptoms, such as dizziness and cognitive difficulty, impact a person's ability to engage in preferred activities and identities. Family therapists can play an impactful role in supporting parents and children with POTS through developmental tasks related to launching an emerging adult in the context of this complex and widely misunderstood chronic illness. This thesis presented the first qualitative study of parent-child dyadic experiences living with POTS. Clinical implications for medical family therapy were highlighted. To construct an interview framework, Rolland's Family Systems-Illness (FSI) clinical model for helping families cope with illness and disability was used in conjunction with Arnett's description of emerging adulthood as a developmental stage in life. Seven parent-child dyads were interviewed for 1-2 hours in fourteen separate interviews generating transcripts about 140,000 words long in total. Analysis of these interviews identified shared themes composing the essence of the parent-child experience living with POTS during emerging adulthood. Results were described through tables and narratives. Clinical implications for family therapists working with parents and children with POTS during emerging adulthood were proposed. Limitations and ideas for future studies were discussed.

This study explored the lived experiences of breast cancer survivors and their intimate partners. The research was informed by a social constructionist framework and phenomenological method of inquiry. While the body of literature on the physical, psychological, and social health of breast cancer survivors is growing, only a few studies have focused solely on the lived experience of survivorship and the uncertainty of recurrence. This study sought to explore the construction of meaning in the couples' context and experiences of surviving breast cancer. The present study examined how breast cancer survivors make meaning of their survivorship in context of living with the fear of recurrence. The researcher investigated the patients' and their intimate partners' experiences of survivorship to gain a better understanding of how their lived experiences affect their relationships to themselves and their significant other and how they cope with the uncertainty of recurrence. The study provided clinical implications for medical family therapists working with breast cancer survivors for couples managing the challenges with survivorship and uncertainty.