Shifting the Focus of Family Therapy into Community Practice

Ellen Pulleyblank Coffey

In attempting to work in new ways that move me out of an individual office into a community practice, I've recently read the following books:

• Belenky, M. F., Bond, L. A. & Weinstock, J. S. (1997). A Tradition That Has No Name: Nurturing the development of people, families and communities. Basic Books.
• Bellah, R.N., Madsen, R., Sullivan, M., Swidler, A. & Tipton, S. M. (1985). Habits of the Heart: Individualism and Commitment in American Life. UC Press Berkeley.
• Kegan, R. (1994) In Over Our Heads: The Mental Demands of Modern Life. Harvard University Press
• Lipman-Blumen, J. (1996). The Connective Edge: Leading in an Interdependent World. Josey - Bass SF
• McKnight, J. (1995) The Careless Society: Community and its Counterfeits. New York Basic Books.
• Seitz, V. R. (1995). Women Development and Communities for Empowerment in Appalachia. Albany, State University of NY Press.
• Schorr, L. (1997). Common Purpose. Anchor Books.

This reading led to conversations with two AFTA colleagues, Jane Ariel and Daniel Kusnir. Here is a short distillation of these conversations.

From a negative point of view, political discourse and policy seem to encourage people to have needs (i.e., for material things) that, in fact, do not represent what human beings really need (care, touch, understanding, respect, multiple possibilities). This propaganda actually degrades what we need. We are delimited and polarized by these pressures. At the same time that our policies encourage these needs, there seems to be little hope that government will develop solutions to human problems, or that they are even remotely interested in coming up with programs that work and are useful. This leads to an enormous disconnection between the political system and the community and the family.

Examples: 1) Large collaboratives of agencies brought together in Oakland, CA to provide a greater range of human services, only to be given less money than they had before they came together. 2) Our insurance providers use of (in various forms) managed care that focuses only on cost and is often oblivious to the possibilities of family therapy.

Current family theories, the feminist and multicultural critique, and the economics of mental health care, are demanding that we re-evaluate our theories and our practice.

These books, my personal experiences of developing community-based programs, knowledge of innovative internships for students at Smith College School for Social Work in community and school-based programs, and other programs throughout the country, tell me that there are individuals and groups of people creating solutions to their problems and addressing wider concerns often outside the system (creative solutions often come from marginalized groups). These solutions are rarely funded, usually have collaborative leadership, and can have surprising longevity. It becomes important, therefore, for us to search out these programs, learn what they have to teach us, and then offer our clinical skills to them and work with them to get funded and be recognized.

I believe that the implications for us are: to work collaboratively across disciplines and across professional and non-professional lines, be more entrepreneurial in how we raise money and either work with managed care or become managed care. I also believe that we need to continue our move toward working with families-in-context as the basis for our theories and models of change.

Some possibilities of what this might mean for AFTA:

Our Community-Current Membership: Put out the call to hear from our members about projects that they know of or are developing that may still be in the infant stages, but reflect their latest thinking. Ask presenters to include the funding structure of their presentations. Give these presentations priority at the conferences. We currently still hear mostly from the top down of our community.

Membership: Consider becoming more of an academy and open our doors not just to clinicians and researchers in our field, but to senior members of other disciplines whose major work serves the needs of families (lawyers, economists, educators, sociologists, other health providers). We might want to consider in the future changing our name to the American Family and Community Practice Academy.

Study Groups: Since we are in a changing world, I believe that we need to create study groups that examine what is actually practiced at this time, how and/or if these programs are influenced by theory, what programs serve families well and how do successful programs survive. We have begun to already do this in some of the presentations at our last conference. We may want to re-focus our interest groups and/or roundtables in this direction, but make them more central to the conference.

Speakers: Bring to our conferences community groups (professional and non-professional) who have organized themselves to provide what they need and have them inform us of how we may bring our clinical skills to support them in what they are doing. These groups from homeless shelters, battered women's programs, school- based programs, etc. can teach us about what they need from clinicians and also help us design training programs that teach our students what they will need to know about how to practice in contexts that actually exist now.

Publications: From the study groups, write a series of short monographs that express what we think should be the direction of family therapy and treatment of families in the future. Use our web site to publish this information. The Newsletter is also on the lookout for new programs and models of service delivery to report about.