AFTA AWARD

Distinguished Contribution to Family Systems Research:

Ira D. Glick

By Lyman C. Wynne

The 2002 AFTA Research Award for significant and cumulative research contributions to the field of family therapy is given to Ira D. Glick. In response to the request from Volker Thomas to write a piece for the AFTA Newsletter about Ira, I first retrieved from my files reprints of many of his research publications, dating, to my surprise, back to 1964. Then I looked over the books on my shelves and re-discovered a 1971 volume by Glick and, as junior co-author, none other than Jay Haley. On a modern note, I also found the fourth edition, year 2000, of his splendid textbook, Marital and Family Therapy, with an eminent assemblage of co-authors. This wide range of contributions led me to request a copy of Ira's CV. And there I found, considerably beyond what I had expected, a truly far flung diversity of publications, presentations, teaching assignments, and past awards. Even though he has maintained an enduring focus on issues in family therapy, I became aware that much of Ira's productivity has involved the integration of family therapy with other approaches. Many, if not most, practicing family therapists have not, I am sure, given appropriate attention to his important work that extends beyond our disciplinary boundary.

Ira Glick, born in Brooklyn in 1935, has shuttled, almost annually, between east coast and west coast for 40 years, exposing himself to an exceptionally wide range of programs and mentors. Easterly, he has trained and been on the faculty of Cornell, Columbia, Hillside Hospital, and NIMH. Westerly, he has worked in various programs in San Francisco and since 1993, at Stanford as Professor of Psychiatry & Behavioral Sciences. Cross-culturally, he has worked most intensively in Japan and Italy, but also in Peru, Uruguay, Netherlands, Korea, and Australia.

As a co-author, his first publication in the Archives of General Psychiatryin 1964 was a study of indications and rationale for family therapy with a series of 20 inpatients, mostly schizophrenic, with, what was almost unique at that time, study of outcome at 6-month follow-up. This could be viewed as a prologue to what perhaps was Ira's most important later research. With John Clarkin, Gretchen Haas, and James Spencer as his most frequent colleagues, he published an extensive series of papers on inpatient family intervention.

There were several special features of this study. First, and quite unusual in family therapy research, the design was a randomized clinical trial, in which families were randomly assigned to one of two treatment conditions, with and without family intervention during the inpatient stay of 84 schizophrenic and 60 major affective disorder patients.

Second, the family intervention was brief, a minimum of 6 to 9 sessions over an average 5-week hospitalization of the patient family member. Third, the family interventions were not split off from other approaches, but were carried out with attention to a specific question: Does adding an family intervention during inpatient care improve the outcomes obtained with medication and standard hospital multimodal treatment? And fourth, another question was: Is family intervention more beneficial for one gender than the other or for certain diagnostic subgroups?

This study came close on the heels of the pioneering work by Michael Goldstein and Carol Anderson using psychoeducational and problem-focused family intervention with seriously ill patients, with the goals of helping the patient and family cope with hospitalization and prepare for better posthospital adjustment. The Glick study was the first randomized clinical trial to take place during inpatient stay. Given the brevity of the intervention in the face of what are commonly long-term clinical problems, the likelihood of enduring posthospital benefit seemed dubious at best.

However, a unique feature of the study was the follow-up, beginning at hospital discharge and recurring at 6 months and again at 18 months. In my view, perhaps the most significant finding from this study was that there actually was superior 18-month outcome in role functioning in the group that had had family intervention during the inpatient stay. Somehow, it seems to me that a systemic process had been set in motion by the intervention so that the family's posthospital participation was lastingly altered. At a statistically significant level, at 18-month follow-up the families that had received the inpatient intervention had entered into and spent more time in posthospital family therapy, in self-help support groups, and in patient vocational rehabilitation. Another interesting result was that females benefited from the intervention more than males, consistent with other studies that suggest that interpersonal interventions are more effective with females.

Quite contrary to the trends over the last half century in which psychiatrists have become less and less involved in family therapy and family therapists have received less and less training and experience with families of seriously ill patients, Ira Glick has maintained an identity as a family therapist at the same time that he has become highly skilled in psychopharmacology. Perhaps more than any other family therapist, he has actively participated in many studies in which medication and family therapy are integrated. In honoring Ira Glick with the AFTA Research Award, AFTA does credit not only to him but to itself as an organization that can still reach out to encompass attention to a great diversity of serious psychiatric problems.

Lyman Wynne, MD, PhD, was President of AFTA (1986–87) and was long-time President of the Board of Family Process. After 20 years at NIMH, he became Chair of Psychiatry in 1971 at the University of Rochester, where he continues as Professor Emeritus and co-founder, with wife Adele, of the Wynne Center for Family Research.