Continued Evolution of Family Therapy - The Last Twenty Years

CONTINUED EVOLUTION OF FAMILY
THERAPY: THE LAST TWENTY YEARS

Florence W. Kaslow
ABSTRACT: There have been numerous accounts of the history and

major trends and issues in family therapy during the fields first three
decades in the literature (see for example: Broderick & Shrader, 1981;
Framo, 1972; Guerin, 1976; Kaslow, 1973, 1977, 1980; Nichols, 1986,
1999 for some varied depictions, written from each respective authors
unique lens). Viewed as a set, packaged with different, yet interrelated
contents, they offer a multihued portrait of the emerging field during
its infancy, childhood, and adolescence. Now it is time to move on and
look at the adulthood era as it has unfolded.
KEY WORDS: family therapy history; feminist therapy; brief therapy; managed care;
integrative family therapy.
This article covers the less frequently chronicled last two decades.
It is intended as an historic and analytic account that supplements
and extends those that have appeared before. Previously, the periods
in the history of family therapy have been divided into four generations
(Kaslow, 1990, Vol. 1 & 2), and amended over time (Kaslow, Kaslow, &
Farber, 1999).
I.
II.
III.
IV.
Pioneers and Renegades (Pre-1969)

Innovators and Expanders (19691979)
Challengers, Refiners and Researchers (19801989)
Integrators and Seekers of New Horizons (19901999).
Florence W. Kaslow, PhD, is Director of the Florida Couples and Family Institute,
128 Windward Drive, Palm Beach Gardens, FL 33418. She is a Visiting Professor of
Psychology in Psychiatry at Duke University Medical Center, a Visiting Professor of Psychology at Florida Institute of Technology, and President of the American Board of
Family Psychology and President of the International Academy of Family Psychologists.
Contemporary Family Therapy 22(4), December 2000
2000 Human Sciences Press, Inc.
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CONTEMPORARY FAMILY THERAPY
Here the focus is on the era of generations III and IV in the field and
extended family of family therapists.
THE THIRD GENERATION: THE CHALLENGERS,

REFINERS, RESEARCHERS: 19801989
The developments in the field of family therapy and the contributions of some of the main leaders will be alluded to as the major trends
are highlighted. (It is recognized that it is not possible to include everyone whose work has been published and apologies are extended to those
not mentioned.)
Ascendance of Feminist Family Therapy

By the dawning of the 1980s, the feminist movement had exploded
throughout America. Professional women had embraced its tenets and
its rhetoric and were asserting their claim to equality in all domains.
Feminist thinking and therapy catapulted onto the family therapy
scene, changing it irrevocably and permanently. The centrality of the
role of the woman in the family was finally recognized as indisputable;
women could no longer be expected to be subservient or non-assertive,
and therapists who suggested that women assume a stereotypically
prescribed female role were reprimanded, even ostracized. Clinicians
were chastised and admonished to be gender sensitive and women were
to be encouraged to expect equality in all spheres of their lives. Men
had to accommodate as best they could to the needs and demands of
womenbecoming more understanding, sensitive, and empathic, more
appreciative, and more available as fathers and husbands. As a parallel
phenomenon, women moved into the leadership ranks in the field of
family therapy and its organizations, consciously seeking to serve on
editorial boards, as officers on boards of directors, and on national
conference program committees.
Whereas Virginia Satir was perhaps the only prominent woman
in the first generation of family therapists to receive much recognition,
others who were less acknowledged but who also made substantial
contributions include: Carolyn Attneave (1990; Speck & Attneave,
1972); Margaret Thaler Singer, particularly for her yeoman work in the
arena of cults (1979, 1986, 1995); Kitty La Perriere (then at Ackerman
Institute), Jeanette Kramer (1985) (Family Institute of Chicago); Sandra Coleman (1985); Bunny Duhl (1983); Rachel Hare Mustin (1978;
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FLORENCE W. KASLOW
1987); and Florence Kaslow (1981, 1982a, 1982b). These represented

the burgeoning group of female leaders who had emerged during the
first and second generation eras.
It was not until the third generation that the feminist influence
coalesced and crescendoed. Those who led the way included the foursome in the Womens Project: Betty Carter and Peggy Papp (1977,
1980, 1983); Olga Silverstein and Marianne Walters (1985; Walters,
Carter, Papp, & Silverstein, 1988). They, along with Carol Anderson,
Monica McGoldrick, and Froma Walsh (1991), as well as the women
already mentioned, were all writing journal articles and books that
have become definitive works on: genograms (McGoldrick & Gerson,
1985; Kaslow, 1995c); family life cycle (Carter & McGoldrick, 1980);
ethnicity in families (McGoldrick, Pearce, & Giordano, 1982; McGoldrick, Giordano, & Pearce, 1996); normal families (Walsh, 1982);
women in families (McGoldrick, Anderson, & Walsh, 1989); psychoeducational techniques in coping with schizophrenia and the family (Anderson, Reiss, & Hogarty, 1986); and other topics. In the early 1980s they
banded together to organize several gatherings of well-known female
family therapists at Stonehedge, Massachusetts, and attempted to inculcate others with their agenda for leadership and influence in theory
development and therapeutic practice. There was much anger against
their male counterparts, and this was articulated later in separate
group consciousness raising sessions of men and women at American
Family Therapy Academy (AFTA) conferences and later at some American Psychological Association Division 43 meetings. However, these
latter sessions never took on the same intensity or acrimony as some
of those at AFTA.
The Journal of Feminist Family Therapy was launched in 1988
with Lois Braverman as its first editor and most of the leading women
in the field on its editorial board. Evan Imber-Black became well known
for her work on secrets and rituals, along with Janine Roberts (ImberBlack, Roberts, & Whiting, 1988) and on ghosts in the therapy room
(1993). Like La Perriere, Hare-Mustin, Walsh, and Anderson, ImberBlack has served as a president of AFTA. Other feminists, all based at
Ackerman Institute, who have become noteworthy are Gillian Walker,
particularly, for her work with AIDS patients, Virginia Goldner (1985,
1993), Peggy Penn (1985), and Marsha Sheinberg (1992). (See also
Goldner, Penn, Sheinberg, & Walker, 1990.)
The publication of Feminist Family Therapy: A Casebook (Goodrich, Rampage, Ellman, & Halstead, 1988) marked another crest in
the series of waves bringing feminist family therapy to the forefront,
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as this volume presented the utilization and applicability of feminist

therapy in actual cases. Two books by Harriet Lerner, The Dance of
Anger (1985) and The Dance of Intimacy (1989), exhorted women to be
more outspoken about their feelings and more forceful and courageous
in acting assertively to change the nature of their intimate and important relationships. Lerners books appeal to a popular as well as a
professional audience, and have been instrumental in influencing thousands of women who read and grappled with their contents. By the
end of the 1980s it was absolutely clear that the needs and voices of
women could no longer be discounted in therapy, in marriage, or in
the political or workaday worlds.
Identification of Post Traumatic Stress Disorder

Another significant trend was, and still is, the concern for families
with a member suffering from post traumatic stress disorder (PTSD)
or syndrome (PTSS). Charles Figley has been among the front ranks
of those identifying and calling attention to this phenomenon (1985;
1986; 1989; Figley & Erickson, 1990). Initially much of the concern
emanated from dealing with those veterans of the Vietnam War who
were experiencing such symptoms as amnesia, terrifying flashbacks,
nightmares, and seemingly unprecipitated bouts of rage. Clearly military service in war zones, whether in Korea, Vietnam, Afghanistan,
or the Persian Gulf caused psychological scarring to many troopers
(Kaslow, 1993; Keane, 1998). Since PTSD was first designated and
defined as a separate syndrome, this concept has been extended to
being an often utilized diagnosis for those suffering from having been
physically and sexually abused (Guyer, 1999), and for some who have
developed dissociative identity disorders (Koedam, 1996) subsequent
to sexual abuse and other traumas, as well as for victims of incest
(Trepper & Barrett, 1989; Kirschner, Kirschner, & Rappaport, 1993).
Clinicians treating survivors of the holocaust and other genocidal
events and eras also see syndromes resembling PTSD in the survivors
and their descendants. Work by therapists concerned with the longrange sequelae of the Nazi holocaust in Europe in the 1940s also entered
the family therapy mainstream in the 1980s and 1990s (Charny, 1982,
1996; Danieli, 1985, 1988; Davidson, 1980; F. Kaslow, 1995a, 1997a,
1999; Sichrovsky, 1988). Also, as immigrants who fled repressive political regimes in some countries in Latin America, the former Yugoslavia,
Iraq, Iran, and Somalia that engage in brutal murders and savage
torture have relocated to other countries, therapists in many regions
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FLORENCE W. KASLOW
of the world have been treating severely traumatized patient families

and finding they present with perplexing and complex symptomatology
and deep personal pathology. These therapists are seeking guidance
on how to intervene to help people recuperate from the scars of massive,
continuous psychic treachery and traumatization.
During a lecture tour in Sweden (May 1997) when the author
talked on treating couples and families presenting with severe problems
and dysfunctional interactive patterns (Kaslow, 1996b), the burning
question that arose in each of the three cities visited was, How do
you treat families where one or several members have witnessed the
atrocities of warfare on their streets, been subjected to rape and beatings, been imprisoned in horrendous jails, been kidnapped, starved,
and/or had loved ones killed before their eyes? An adaptation of a
combination of ideas drawn from the literature on understanding and
treating both holocaust survivors and those suffering from PTSD became the foundation for the discussions and recommendations.
Given the number of stressors that impinge on therapists treating
severely traumatized, deprived, multi-problem, and dysfunctional populations, as well as litigious clients, some clinicians develop severe
burnout (Freudenberger, 1983, 1984), or what Figley has identified as
compassion fatiguea specific form of burnout that is one of the high
costs of caring. It partially emanates from shadow stress, the work
stress people carry home with them. Figley, (1995, 1997); Kaslow
(1984); and others like Kilburg and VandenBos (Kilburg, Kaslow, &
VandenBos, 1988) have all talked and written about professionals in
distress, and healing of the healers who experience secondary trauma.
Advent of New Theories and Methodologies

Several additional theories and/or intervention approaches became
prominent during this decade.
Psychoeducational strategies. This approach moved to the forefront, particularly for use in enabling families to cope better with a
member with a schizophrenia spectrum disorder (see for example Anderson, Reiss, & Hogarty, 1986; Falloon, Boyd, & McGill, 1984; McFarlane, 1983). Families and many therapists came to favor this approach
over more traditional family therapy interventions since psychoeducational methods, particularly when conducted in groups, are associated
with family members feeling less blamed and criticized for the problem.
Rather, families perceive that they are receiving support and empathic
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responses and that they are being viewed as cooperating with patient
and therapist to understand and handle the illness more effectively
and to gain control over their own style of expressing emotions and
how to communicate more clearly (Leff & Vaughn, 1985).
Brief therapy. Brief therapy also gained many adherents during
this era, and the leaders promulgating this methodology ascended into
prominence. At the vanguard in the family therapy arena have been
Steve de Shazer (1985, 1988) and Insoo Kim Berg (Berg & de Shazer,
1993), of the Milwaukee Family Institute, who have focused on rapidly
finding a solution to the problem being presented. They have developed
catchy interventions like asking the miracle question, which others
can quickly learn to do. Those practicing brief, solution-focused therapy
are not interested in diagnosis or formal assessment, in developing
self-awareness, or in any personality reconstruction. Their sole aim is
problem resolution. With the advent of managed care since the late
1980s and its accompanying cost containment policies, insurance companies have favored such brief approaches and helped them gain in
popularity because of their reimbursability.
Functional family therapy (FFT). This behaviorally based and
structured approach to treating families with a delinquent or oppositionally defiant adolescent, also came into its own (Alexander & Parsons, 1982; Alexander & Barton, 1990). It has become a well-researched
and documented treatment methodology (Alexander & Barton, 1995;
Alexander & Pugh, 1996). FFT has been designated one of two Family
Based Empirically Supported Treatments (FBESTS) that are effective
and reproducible with families representing a wide range of cultures,
ethnicities, rural and urban living contexts, . . . socio-economic levels,
and primary languages (Fraenkel, 1999, p. 35).
Integrative approaches. Integrative approaches also began to have
great appeal in the 1980s as more and more practitioners and theoreticians spoke out against doctrinaire leaders and schools of thought that
held that their approach was either the only right one, or certainly the
best of all possible ones. Among the integrationists are Larry Feldman
(1992); Alan Gurman (1981, 1990; Gurman & Kniskern (1981, 1991);
F. Kaslow (1981, 1987a); Diana and Sam Kirschner (1986); William
Nichols (1986, 1988a,b, 1999); William Pinsof (1990, 1998); and Carlos
Sluzki (1983). Those of this persuasion believe that the treatment approach should be selected judiciously based on such factors as the
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FLORENCE W. KASLOW
patients problems and symptomatology, personality, resiliency, family

dynamics and issues, and time they are willing and able to devote to
therapy. Whether ones own interpretations of the situation to oneself
as well as ones assessment and treatment techniques are drawn concurrently from several approaches or sequentially, depending on how
the therapy unfolds, all concur that one should have a variety of viable
alternatives in ones treatment armamentarium to be chosen wisely
and flexibly when most appropriate.
Rising Divorce and Remarriage Rates

During this period, as the number of divorces and remarriages
continued their upward spiral, the literature on this vast topic expanded. More and more therapists found themselves treating families
pre, during, and post divorce. Constance Ahrons wrote about the coparental divorce and the binuclear family, and developed a typology of
divorced couples (1979, 1983; Ahrons and Rodgers, 1987). Craig Everett, who became the second editor of the Journal of Divorce (now Divorce
and Remarriage) founded in the 1970s by Esther Fisher, has made this
a major focus of much of his writing (Everett & Volgy, 1993). Florence
Kaslow has written about a seven-stage model of divorce, elaborating
on the legal and economic facets as well as the parenting and visitation
issues (Kaslow & Schwartz, 1987; Kaslow, 1994, 1995b; Schwartz &
Kaslow, 1997), and promulgated a divorce ceremony (1993). Judith
Wallerstein and Joan Kelly wrote about surviving the breakup (1980),
and Wallerstein later reported on men, women, and children a decade
after divorce (Wallerstein & Blakeslee, 1989). Hetherington and her
associates have conducted significant research into divorce and its
aftermath (Hetherington, Bridges, & Isabella, 1998; Hetherington,
Cox, & Cox, 1997).
The fledgling field of divorce mediation burgeoned in the 1980s
and presented couples pursuing divorce with a viable and more humane
alternative route than an adversarial proceeding. Mediation provides
marital and family therapists who are seeing couples in the throes of
marital dissolution with the option of suggesting mediation instead of
litigation, and recommending this pathway, which is usually more
constructive and more compatible with such therapeutic goals as maximizing client self determination and being considerate of the needs of
all family members affected by the decisions. The literature on mediation also proliferated during this era and was written by professionals
drawn from the mental health disciplines as well as from law. (See for
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example Erickson & Erickson, 1988; Folberg & Milne, 1988; Haynes,
1981).
Clifford Sagers work on marriage contracts (1976) looked at contracting prior to marriage; his illuminating ideas were extended in a
later volume on treating the remarriage family (Sager et al., 1983).
Emily and John Visher (1979, 1991) also have made a substantial
contribution to the understanding of the dynamics and treatment of
stepfamilies, and were the co-founders of the Stepfamily Association
of America. F. Kaslow has written about psychosocial prenuptial agreements as a prelude to marriage and remarriage (1991, 2000b) and has
developed a therapeutic remarriage ritual (1998). Others like James
Bray have been conducting research on developmental issues in stepfamilies (Bray & Berger, 1993). Roni Berger (1999) has evolved a classification schema of stepfamilies. Thus, there are now many extant resources for academicians, researchers and clinicians working in the
areas of divorce and remarriage.
Multicultural and Ethnic Diversity

As the tried and true American philosophy heralding this being a
melting-pot country began to be eroded by groups not wanting to give
up and ultimately lose their earlier national identity, and as more
respect was demanded for each persons ethnicity and cultural roots,
family theory and practice reflected the emerging concern that multicultural pluralism become a dominant valuesuperceding the homogenization process. McGoldrick, Pearce, and Giordanos book, Ethnicity
and Family Therapy (1982; McGoldrick, Giordano, & Pearce, 1996) has
become a standard text. Others who have contributed to the growing
awareness of ethnic and cultural diversity, the reverberations of political repression, and the need to be respectful of these differences and
not to obfuscate them are: Carlos Sluzki (1990); Lillian Comas-Diaz
(1992, 1996); F. Kaslow (1982b, 1997b); and Nadine Kaslow (Kaslow,
Celano, & Dreelin, 1995; Celano & Kaslow (in press).
Celia Falicov (1983, 1988, 1995) has done yeoman work in promoting the importance of cultural sensitivity and in increasing the awareness of the dynamics, values, and traditions of Latino families. Similarly, Nancy Boyd-Franklin has been one of the premier standard
bearers in heightening sensitivity to the concerns of African Americans
in therapy, in their families, and in the larger community (1989, 1995).
Kenneth Hardy has also made a significant contribution to consciousness raising about life as experienced by African Americans, and ad-
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dresses the continuing legacy of slavery many generations later (Hardy,

1989; Saba, Karrer & Hardy, 1989). In addition, he has addressed the
concerns of minority therapists in training and treatment. Likewise,
Terry Tafoya (1989) has helped rally interest in the circumstances of
the lives of Native Americans and the issues they present in family
therapy. Man Keung Ho (1987); Derald Wing Sue and David Sue (1990);
and Berg (Berg & Joya, 1993), among others, have highlighted the
strengths, attitudes, and values of Asian Americans, particularly as
these are manifested in treatment.
The Expansion of Family Systems Medicine and Its Impact

Another major happening has been the mushrooming of family
systems medicinewith increasing numbers of family therapists now
working in tandem with physicians in hospitals, medical schools, and
physicians offices. It is a collaborative model in which co-equals from
different fields team up in the treatment of the various family members
to enhance their own understanding of patient needs and provide optimal health care interventions for emotional and physical problems.
Prime movers have been Donald Bloch (1988), first editor of the journal,
Family Systems Medicine (1983); Susan McDaniel (McDaniel & de
Gruy, 1996), current editor of this journal; Sylvia Shellenberger, Jeri
Hepworth, and William Doherty (McDaniel, Hepworth, & Doherty,
1995; Doherty & Baird (1983, 1987); John Rolland (1984, 1994); Anne
Kazak (Kazak & Simms, 1996)) and Betsy Wood (1991). This group
has its own annual conference, and their work is also featured prominently in presentations at conferences of other organizations such as
the American Association for Marriage and Family Therapy (AAMFT),
AFTA, and APA. A similar development has occurred in Israel where
Cynthia Carel has blazed the path for medical family therapy. This
trend is increasing in scope, with therapists participating actively in
primary care teams with family practitioners, pediatricians, cardiologists, obstetricians, and other specialists; it is likely to continue accelerating.
Mounting Concern Over Professional Identity

In the more political arena of the field concerns over licensure,
professional identity, and status issues escalated. As more states
passed marriage and family therapy licensure/certification laws, spearheaded by state AAMFT chapters and supported by the national organi-
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zation, that might be either scope of practice or title protection acts,

they also set the academic requirement level at the masters degree.
(Currently AAMFT has about 23,000 members; AFTA numbers about
1,000, and there is some overlap.) Many family oriented psychologists
and psychiatrists, who concurred with the criteria of both APAs (the
American Psychological Association and the American Psychiatric Association) that the basic level for independent practice should be a
doctoral degree, became disgruntled, particularly when they found they
were ineligible because their specific training was different than that
required for marriage and family therapy licensure. Another source of
consternation was that some marriage and family therapists, not
trained rigorously in psychological test administration and interpretation, still wanted testing to fall within their scope of practice. Turf
battles ensued; some took sides while others straddled the fence and
maintained two licenses. This dilemma continues.
At the opposite end of the spectrum, others pressed for inclusion
of indigenous therapists on treatment teams, stressing that shared
values and demographic factors between therapists and patients are
essential and overshadow the emphasis on academic background. Such
a position runs contrary to the push for credentialing based on objective
education and training requirements, while coinciding with the voices
of those who press for non-hierarchical treatment models and eschew
the belief that the therapist should have a carefully honed knowledge
and skills base.
For these and other reasons, the American Academy of Psychologists in Marriage, Family and Sex Therapy, a group with a history of
several decades, decided to mount a campaign to become a formal
division of the American Psychological Association. In 1985 it achieved
this status as the Division of Family Psychology (Division 43). The
division not only provided family psychologists with a home base in
APA, but also saw that part of its mission was, and remains, to inculcate
systemic thinking and awareness of multi-patient units (i.e., couples
and families) into APA (F. Kaslow, 1987b). A representative list of
those who have served as division president include James Alexander,
Arthur Bodin, James Bray, Gary Brooks, Florence Kaslow, Ronald
Levant, Susan McDaniel, and Carol Philpotall of whom have contributed a great deal to both the family psychology and family therapy
literature, as well as to the growing body of research-based materials.
About 2000 family psychologists currently belong to Division 43.
In 1987 the Journal of Family Psychology was launched under
Division 43 auspices. Several years later it became an official APA
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FLORENCE W. KASLOW
journal. Howard Liddle served as its first editor, Ronald Levant as its
second, and Ross Parke as its third. The journals circulation figures
place it among the most widely read of the family journals that are
primarily research oriented.
Also during the 1980s, the American Board of Family Psychology
(ABFamP) began its diplomating process and has achieved growing
recognition. ABFamP became one of the boards under the long existing
American Board of Professional Psychology (ABPP), which added credibility to family psychology as a specialty. There are three steps to
becoming board certified, a rigorous credentials review process; submission and review of two work samplesone in family assessment and
diagnosis, the other in treatment intervention; and a 3-1/2 hour oral
examination with a committee of three diplomates. As of May 2000
there were approximately 115 board certified family psychologists in
the United States.
Concurrently, many family psychologists have remained involved
in AAMFT and AFTA and some are licensed as both psychologists and
family therapists and are AAMFT approved supervisors. They also are
on the editorial boards of such interdisciplinary journals as Journal of
Marital and Family Therapy, Family Process, The American Journal
of Family Therapy, Contemporary Family Therapy, and Journal of
Family Psychotherapy.
THE FOURTH GENERATION:

INTEGRATORS AND SEEKERS OF NEW HORIZONS:
19901999
Enter Managed Care and Its Emphasis on Brief Therapies
A major upheaval beset all mental health practice, including family
therapy, with the advent of managed care. Although this phenomenon
had started in the 1980s, the full impact of this onslaught was not felt
until the early 1990s. Various organizations have scrambled to advocate
for inclusion of their members as professionals eligible for reimbursement. Fees have been driven downward and many therapists have
faced decreased incomes while feeling pressured to see many more
patients for shorter therapy sessions in order for their practices to
survive. Some practitioners banded together to form group practices.
Other more senior therapists have opted to continue to cater to the
fee-for-service market only and not to cut fees; if they have achieved
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fine reputations and have vast referral networks, they have fared well.
By the end of the last century, an increasing number of clinicians were
so dissatisfied with drastic limits on number of sessions and severe
reductions in fees that they resigned from the panels of providers. This
has had an effect on the quality of service available to people with
limited financial resources in under-served geographic locales.
Since a major thrust of the managed health care industry is cost
containment, third party payers have a decided preference for brief
and thus less costly therapies. They are loathe to reimburse for longer
term psychodynamic or intergenerational therapies; their goals are
rapid restoration of functioning and solving the presenting problem as
quickly as possible. Thus, approaches like de Shazers (1985, 1988) and
Bergs (Berg & de Shazer, 1993) solution focused brief therapy model
used for individual and family problems have gained popularity. Many
patients like talk of miracles and the probability of needing only a few
sessions; they do not want to delve into their families of origin and
rehash old issues in order to feel better in the here and now.
Behavioral marital and family therapies (Budman & Gurman,
1988; Wood & Jacobson, 1990; Jacobson & Gurman, 1986), like brief
therapies, also garnered new adherents as these time limited, problem
focused, clear and structured modalities lend themselves to managed
care constraints and reporting specifications. Cognitive behavioral approaches also are receiving more attention (Baucom, 1990; Baucom,
Epstein, & Rankin, 1995; Dattilio & Padesky, 1990; Seligman, 1991)
as many therapists now prefer focusing on changing cognitions as well
as behaviors. Not surprisingly, some cognitive behaviorists have become more integrative and include the other component of the triad,
affects or feelings. This has emerged as the approach with the most
empirical data supportive of its efficacy.
Other Therapeutic Modalities of Increasing Popularity

Another methodology that came to play a dominant role in the
therapeutic world during the 1990s encompasses the externalization
and narrative techniques of Michael White (1989), and David Epston
(White & Epston, 1990) from Australia. These pied-piperish pioneers
have spread their approach to having everyone tell their story, listen
to each others versions, and then become actively involved in changing
the direction the narrative will take, i.e., geared to helping patients
feel empowered to proactively participate in shaping their futurea
goal shared with many other approaches. The appeal of the narrative
school lies not only in its brevity, but in the drama and optimism
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inherent in the approach (Sluzki, 1992). OHanlon Hudson and HudsonOHanlon promulgated their own variation of the restorying theme in
their volume, Rewriting Love Stories (1991).
Social constructionism also has come to occupy a prominent place
in the theoretical and therapeutic array of choices. Inherently an antidiagnostic, anti-labeling paradigm, like the narrative approach, it focuses on the use of language in communication and how people construct their own meanings for their personal realities and relationships
through language. Therapy occurs through the meaning that emerges
in the dialogue and the language of the session; the therapist and
family co-construct the meanings to be attached to events and relationships. This is essentially a non-hierarchical model that eschews the
role of the therapist as either conductor, coach, or expert. Instead the
client/consumer is an equal participant in determining what will transpire and evolve. Leaders in formulating and promulgating this approach have been Harry Goolishian and Harlene Anderson (1990), Tom
Andersen (1990, 1996), Kenneth Gergen (Gergen & Davis, 1985), and
Lynn Hoffman (Gergen, Hoffman, & Andersen, 1996); all are persuasive
writers and speakers, and they have found adherents, particularly in
the more non-conformist, non-traditional wings of the profession.
Other noteworthy methodologies that have achieved some popularity in this era are Imago Therapy (Hendricks, 1992), Eye Movement
Desensitization and Reprocessing (EMDR) (Greenwald, 1994; Shapiro,
1994), and various hypnotherapy approaches (Hudson-OHanlon, 1987;
Lankton & Lankton, 1989; Zeig, 1985a, 1985b). All of these fall under
the rubric of brief therapies.
Besides the new entries in the realm of therapeutic approaches,
there have been some other shifts in the field in this decade, and
different attitudes and values have come to the fore. The voices of the
third and fourth generation have grown more forceful; sometimes they
are very innovative, other times they build upon and crystallize ideas
already expressed. For example, as discussed earlier, feminist family
therapy began in the late 1970s and crested in the 1980s. It has become
a generally accepted part of the field, which now has many more female
members and leaders than was the case during the first two decades
of the evolution of family therapy.
The Mens Movement Evolves

In response to the original havoc wreaked by the feminist movement and the incessant demand it made on men to change in reactivity,
responsively and responsibly, a serious mens movement evolved. Rob-
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ert Bly, a poet, was the founder of the mythopoetic movement that
stressed the importance of men nurturing men (Erkel, 1990). Mens
groups formed in which the men sought acceptance and friendship from
each other, and many bemoaned the lack of emotional involvement of
their fathers during their childhood years. Some gatherings occurred
to the accompaniment of tom-tom beats and men began to express
their fears, their needs, and their dreams. Well-known therapist Frank
Pittman (1990) wrote about the masculine mystique and the longing
for fathers to endow sons with masculinity, and about the endeavor to
understand what masculinity is and encompasses. At meetings of AFTA
and the APA Practice Divisions Mid-Winter conferences, special sessions for male therapists only were held. There and elsewhere, men of
the current generation of fathers, therapists and non-therapists alike,
vowed to be more emotionally accessible, especially to their sons. The
Family Therapy Networker (1990) devoted the major portion of a full
issue to this topichighlighting and extending its significance. In the
mid-1990s, initiated by such men as Ronald Levant (Levant & Kopecky,
1995; Levant & Pollack, 1995), Gary Brooks (1995) and Don-David
Lusterman (Philpot, Brooks, Lusterman & Nutt, 1997), a new division
for the study of men and masculinity was begun in APADivision 52.
Probably the newest mass variation on the mens movement theme
has been the rapid evolution of The Promise Keepers, a recently formed
organization that supposedly numbers more than a million men asserting their manhood. A headline on Time Magazines cover raised the
query, Should they be cheeredor feared? around the time the million
man march on Washington occurred (Stodhill, 1997). A fervent Christian movement, led by a former college football coach, Bill McCartney,
the positive goal is for men to assume greater responsibility for themselves, their wives, and their children. Two of the aspects that are
frightening to many outside of the movement are: (1) they believe that
when men and women disagree, the mans view and decision must
prevail as he is ultimately in charge of the family, and this is perceived
as Gods will; and (2) members view homosexuality as a sin and not
acceptable in Gods eyes or theirs. Although many Promise Keepers
claim their wives welcome their taking a stronger role in the family,
feminists and othersmen and women alikedecry turning the clock
back to glorify the male dominant/female submissive role relationship
of men and women and the censuring of homosexuality as sinful. Certainly this gigantic and seemingly fundamentalist segment of the mens
movement will change the dynamics of many families, hopefully without promoting spouse abuse and corporal punishment of children as
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the husband/father attempts to reassert his authority. Therapists

will do well to be mindful of the principles and precepts of the Promise
Keepers when treating men/couples who adhere to these, and to find
ways to communicate with them effectively as they chant their particular catechism.
Bridging the Gender Gap

At the same time the mens movement was ascending in popularity,
others felt it was time to bridge the gender gap and the separate gender
worlds, and became concerned instead with having men and women
communicate and interact more cordially and meaningfully with each
other (Philpot, 1990; Philpot, Brooks, Lusterman, & Nutt, 1997). These
authors and others are purporting that all therapy and therapists
should be gender sensitive, that those of both genders can and should
co-evolve, and that violence in male-female relationships, in all settings
and across the age spectrum, is not acceptable in any form. No doubt
we will continue to see some who harken more to the feminist mission, others who continue to beat the masculinity tom-tom, and a
third corps of professionals who believe it is time for rapprochement
to occur. Two of the most sensitive books on helping couples foster more
loving, empathic, and intimate relationships as they bridge the gender
gap are The Fragile Bond (Napier, 1988) and The Sexual Crucible
(Schnarch, 1991).
Emphasis on the Necessity of Solid Research and Evaluation

The interest in both qualitative and quantitative research has
mounted and AFTA, AAMFT, and the Division of Family Psychology
of APA have all held conferences devoted to family research during
this decade. Journals such as JMFT, JFP, and Family Process all devote
a great deal of space to research-based articles. Highlighting the greater
importance being placed on research, partially because third party
payers want documentation regarding which approach works best and
fastest for which problems, and data on psychotherapy efficacy and
outcomes, an oversized issue of JMFT concentrated on this topic (Pinsof & Wynne, 1995). Others, including Pauline Boss (1990), Fred Piercy
and Douglas Sprenkle (1986), James Alexander and Cole Barton (1995),
Nadine Kaslow (Kaslow, Wood, & Loundy, 1998b), Anne Kazak (Kazek & Simms, 1996), Howard Liddle, Jose Szapocznik (Szapocznik,
Rio, Perez-Vidal, Kurtines, Herves, & Santisteban, 1986), David Reiss
372
(1981, 1988), and Luciano LAbate and Dennis Bagarrozi (1993) also
continue to conduct research in numerous areas of endeavor.
Utilization of Testing and Assessment Instruments

New assessment instruments have been developed and refined,
such as the Marital Satisfaction Inventory (Snyder, 1990; Snyder, Cavell, Heffer, & Mangrum, 1995) and the Family Assessment Device
(FAD) (Epstein, Baldwin, & Bishop, 1983). These are being utilized
more widely as diagnostic and screening tools, and because clients
derive meaning from participating directly in the assessment process.
Nurses recent book (1999) on family assessment describes the effective
uses of personality tests with couples and families, thus anchoring
assessment in more objectively-derived data than clinical interview
techniques alone can provide. Terry Pattersons Couple and Family
Clinical Documentation Sourcebook (1999) brings together a panoply
of the questionnaires and assessment instruments used in acquiring
information about patients, including their self and partner perceptions. These devices are extremely valuable aids for those who believe
sound treatment is predicated on thoughtful diagnosis.
Development of Relational Diagnoses

The press for a taxonomy of relational diagnosis also crested during
the past two decades (Wynne, 1984, 1987) and was punctuated emphatically by the inclusion of the Global Assessment of Relational Functioning (GARF) scale in the Diagnostic and Statistical Manual of Mental
Disorders-IV (Wynne, 1994). Some of the work of members of the Coalition on Family Diagnosis, an interorganizational task force in existence
from 19871994, was pulled together in the Handbook of Relational
Diagnosis and Dysfunctional Family Patterns (Kaslow, 1996) and supplemented by pertinent chapters especially written for this classification schema by non-task force members. It is hoped this work will
continue in the forthcoming decade and eventuate in a separate Diagnostic Manual of Relational Disorders which will be a supplement to
the existing DSM of Mental Disordersseparate and equal (American
Psychiatric Association, 1994).
Interest in Long-Term Successful Marriages

Perhaps as a reaction to all of the sadness and disillusionment
many therapists hear about from patients during and after divorce,
some clinicians and researchers turned their attention to studying
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couples married more than 20 years who deem their marriages satisfying and successful. Numerous articles, published by researchers collaborating in an eight-country study that spanned five continents, found
respondents identified remarkably similar factors as the basis of their
marital satisfaction, including trust and respect in all areas of the
relationship, shared goals and values, strong commitment to the partner and to the marriage as a special entity, the continuing ability to
have fun together, much affection and ongoing sexual activity, reciprocity and mutuality, consideration and the ability to compromise, and
deep friendship (Kaslow & Hammerschmidt, 1992; Kaslow & Robison,
1996; Sharlin, 1996; Roizblatt et al., 1999; Sharlin, Kaslow & Hammerschmidt, 2000). Wallerstein and Blakeslee (1995) also sought to ascertain how and why love lasts. One goal of all of these researchers has
been to generate a profile of the ingredients and kinds of interactions
that are conducive to creating satisfying long-term partnerships that
can be utilized to help guide unhappy couples toward finding greater
satisfaction and harmony.
Miscellaneous Trends
We have also witnessed increasing emphasis on certain content
areas, i.e., syndromes, symptoms, and specific maladies. These include
chronic illness (Barth, 1993), suicidology (N. Kaslow, Thompson et al.,
1998a), depression (N. Kaslow, Ash, & Deering, 1996), ADHD (Culbertson & Silovsky, 1996), eating disorders (Levine, 1996), and AIDS (Landau-Stanton & Clements, 1993). Some of these disorders are treated
by therapists involved in the area variously designated family systems
medicine, medical family therapy, and behavioral medicine discussed
earlier. Other therapists see them in their private individual or group
practices.
Another trend has been the evolution of outreach approaches, including at home therapy. These practical team approaches are being
utilized increasingly with severely distressed inner city populations.
For example, the Philadelphia Child Guidance Clinic, part of the Childrens Hospital and the Department of Psychiatry at the University of
Pennsylvania in the 1990s, served a patient population largely comprised of multi-problem, hard to reach, inner city families and reached
into their homes and communities to do so (Lindblad-Goldberg, Dore, &
Stern, 1998). This well respected training center has both an APA
approved internship and an AAMFT accredited training programone
of the few facilities in the country to have both. Similar outreach programs have evolved in other countries, like Israel, for utilization with
374
their large, chaotic, often newly arrived immigrant families (Sharlin &
Shamai, 1999).
The Focus on Values

Other luminaries are diligently pursuing the issue of values (Doherty, 1989) in family therapy (Doherty & Boss, 1995). They posit that
therapists values, their cherished beliefs and preferences, play a role
in treatment and should be acknowledged, where relevant. One should
not superimpose his or her own ideology on families without revealing
what that ideology is. In addition, they hold that therapists should
engage in dialogue with clients about their moral choices when these
are pertinent to the issues and dilemmas they are confronting in therapy. Doherty and Boss (1995) tackle critically a bevy of deceptions
that characterize some family therapy methods, particularly strategic
models and paradoxical interventions that often are utilized in very
manipulative ways. They attest that such deceptions erode the foundations of trust that clients . . . hold for family therapy (p. 621). We agree
that inauthentic interactions should be avoided, not only because they
impede the formation of a strong therapeutic alliance, but also because
it is almost impossible to help patients become more trustworthy, candid, and accountable when we are not modeling exemplary behaviors.
Two decades ago Abroms (1978) wrote a thoughtful article on The
Place of Values in Psychotherapy. He indicated that we are increasingly
confronting the myths of the amoral stance and of the value neutrality
of the therapists. He admonished therapists to recognize their biases
and learn to use these in a disciplined, rational way in caring for
patients. For example, he stated that parents should be the executives
in the family, or it is healthy for adolescents to individuate are value
statements and opinions and need to be honestly posited as such in
the therapy. It is interesting to ponder why this area of concern is
resurfacing at this time with much more momentum.
Mounting Ethical and Legal Concerns

Other therapists have become increasingly concerned about legal
and ethical dilemmas in marital and family therapy practice (Gottlieb,
1995, 1997; Gottlieb & Cooper, 1990; F. Kaslow, 1992, 1996a; Marsh &
Magee, 1997; Woody, 1990). The AAMFT Code of Ethics (1988) details
standards of behavior related to:
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FLORENCE W. KASLOW
Responsibility to clients
Confidentiality
Professional competence and integrity
Responsibility to students, employees, and supervisees
Responsibility to research participants
Responsibility to the profession
Financial arrangements
Advertising.
The most recent revision of the APA Code of Ethical Principles of

Psychologists and Code of Conduct (1992) is more elaborate and complex and goes into greater detail regarding such dilemmas as:
Multiple relationships
Exceeding ones competence and maintaining expertise
Sexual harassment
Delegation to and supervision of subordinates
Informed consent
Maintenance of records.
In addition, guidelines are provided regarding what is considered ethical behavior in numerous other realms of professional practice.
The spiraling concerns about therapists being brought up on ethics
or malpractice charges have made many therapists more cautious regarding whom they are willing to treat. The large mental health professional organizations now often employ in-house legal counsel with
whom members can consult, and have worked with insurance companies to develop appropriate liability insurance programs. These signs of
our times reflect our feelings of vulnerability, the decrease in therapist
freedom, the increase in patients power, and the creation of external
bodies, beyond professional organizations, which rule on professional
standards of conduct.
Internationalization of Family Therapy

The number of international conferences have skyrocketed in the
last 20 years. The International Family Therapy Association (IFTA)
was born in Czechoslovakia at the East-West Bridging Conference in
Prague in 1987. The International Academy of Family Psychologists
(IAFP) was launched in 1990 in Japan. Both AFTA and EFTA (the
European Family Therapy Association) have international members.
376
All promote exchange of theoretical ideas and clinical approaches, and

foster appreciation of multi-cultural issues and diversity (Ariel, 1999),
An increasing number of books on family therapy around the world
have been published (Kaslow, 1982; Gielen & Comunian, 1997, 1999)
and numerous journal issues have been devoted to family therapy in
specific countries (particularly in Contemporary Family Therapy). It is
predicted that this globalization will continue to pick up momentum
in the 21st century and, despite some theoretical clashes and ethnocentrism, will enrich us all.
SUMMARY
It becomes apparent that the leaders in the past two decades have
shared many traits with the pioneers of the first two generationsthey
are innovative, courageous, bright to brilliant, often charismatic, determined to be heard and seen, committed to their ideas and interpretations and eager to promulgate them, and often have the requisite narcissism to be on stage and to occupy front and center position. They are
articulate, emanate strength and power, write well, think clearly, and
are willing to buck the prevailing tide. They have kept the field dynamic,
lively, multifaceted and on a perpetual pathway to finding better techniques and solutions to enable individuals and families to become happier and more functional. Today, leaders from all four generations are
active and interactivereflecting the tensions and affections of the
multigenerational and tribe-like families we treat.
As this article, which attempts to highlight the trends of the past 20
years, the contributions of key leaders and thinkers, and development of
various organizations, is drawn to a close, it is reiterated that it has
not been possible to be all inclusive, and apologies are expressed to
anyone inadvertently omitted. This author has tried to be as objective
and broad based as her own professional lens permits. Others will no
doubt chronicle the field differently, again reflecting its patchwork quilt
stylecolorful, diverse, and variegated. May it continue to be so during
this new millennium.
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Continued Evolution of Family Therapy - The Last Twenty Years

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CONTINUED EVOLUTION OF FAMILY

THERAPY: THE LAST TWENTY YEARS

ABSTRACT: There have been numerous accounts of the history and

Pioneers and Renegades (Pre-1969)

THE THIRD GENERATION: THE CHALLENGERS,

Ascendance of Feminist Family Therapy

1987); and Florence Kaslow (1981, 1982a, 1982b). These represented

as this volume presented the utilization and applicability of feminist

Identification of Post Traumatic Stress Disorder

of the world have been treating severely traumatized patient families

Advent of New Theories and Methodologies

patients problems and symptomatology, personality, resiliency, family

Rising Divorce and Remarriage Rates

Multicultural and Ethnic Diversity

dresses the continuing legacy of slavery many generations later (Hardy,

The Expansion of Family Systems Medicine and Its Impact

Mounting Concern Over Professional Identity

zation, that might be either scope of practice or title protection acts,

THE FOURTH GENERATION:

Other Therapeutic Modalities of Increasing Popularity

The Mens Movement Evolves

the husband/father attempts to reassert his authority. Therapists

Bridging the Gender Gap

Emphasis on the Necessity of Solid Research and Evaluation

Utilization of Testing and Assessment Instruments

Development of Relational Diagnoses

Interest in Long-Term Successful Marriages

The Focus on Values

Mounting Ethical and Legal Concerns

The most recent revision of the APA Code of Ethical Principles of

Internationalization of Family Therapy

All promote exchange of theoretical ideas and clinical approaches, and

Boyd-Franklin, N. (1995). Therapy with African-American inner city families. In R.

Kaslow, F. W. (1997b). The Voice of America: Culturally sensitive radio. In D. A.

Patterson, T. (1999). Couple and family clinical documentation sourcebook. New

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