The McMaster model has two main components, both of which influence the integrated model we describe:
- a model of family functioning (MMFF), which placed a particular emphasis on those attributes that lead to most effectively meeting the universal tasks of family life
- a model of therapy, which emphasised the completion of a rigorous assessment before moving on to therapy, which itself is best implemented in a staged way
As we describe elsewhere, the model of family functioning, which postulated what characteristics best suited family problem-solving, was derived from a community-based study of non-patient families in Canada. The therapy model was developed in a university medical setting, which was pioneering problem-based learning for medical education; that too is reflected in the therapy-model, which is problem-based and collaborative.
It was the mainstay of the 1st Edition of Integrated Family Therapy, a problem-centred model that took account of family structure, organisation and transactional processes (with less emphasis upon intra-psychic factors, despite its subtitle, a problem-centred psychodynamic approach). In this edition of the model, we view the McMaster approach as one position of many, especially in view of the contemporary understanding of cultural influences and inequality in problems presenting to health and social services.
Basic assumptions of the McMaster model of family functioning: this was first described in the same decade as Minuchin’s work was published. Like other family therapists since, the authors began by defining the basic principles of the general systems approach to family functioning:
- parts of the family are related to each other
- one part of the family cannot be understood in isolation, from the rest of the system
- family functioning is more than just the sum of the parts
- a family’s structure and organisation are important in determining the behaviour of family members
- transactional patterns in the family system are involved in shaping the behaviour of family members
(Epstein, Bishop and Levin 1978)
The list of principles was followed by a brief statement of the values that are implicit in the model. Their essence is the view that the purpose of the western family is to foster the optimal development of each family member and that this is the ethical position from which judgements about functional and unhelpful aspects of families are made by the therapist. In the account of family functioning that follows various dimensions of family functioning are described. The approach had a prescriptive component: value judgements about the most effective types of family functioning made on the basis of the ethical position described above.
This position can, of course, be challenged as unrealistic, too global, inappropriate for different cultures or sub-cultures, or even ‘politically incorrect’. Accordingly, the value judgement implicit in the account that follows should be borne in mind; as far as possible, we have taken care to distinguish between what is prescriptive and what is descriptive.
The universal tasks of family life: from the McMaster position, the family was seen functionally as a system that plays a central role in the social, psychological and biological development and maintenance of family members. To carry out these basic functions, families have to deal with three sets of tasks, which broadly fall between practical needs (described as ‘instrumental’) and psychological and emotional needs (‘affective’).
Basic tasks: these are principally instrumental in nature, for example, the provision of food and shelter for family members. Basic tasks of an affective type include the provision of nurturance, affection and support in the face of disappointment and frustration.
Developmental tasks: these comprise two sets of issues that arise as the result of natural processes of growth: (a) those associated with individual developmental stages, such as infancy, childhood, adolescence and mid-life; (b) those associated with family stages involving structural changes in its development, such as the beginning of marriage, first pregnancy and birth of the first child, leaving home for independent-living, etc.
Hazardous events: crises that occur in association with illness, accidents, redundancy or long-term unemployment, house moves, etc.
The family is seen as a goal-directed system that will have to accomplish these tasks in the course of discharging its ultimate goal, the optimal development of family members. Families vary in their abilities to accomplish tasks. In some families accomplishing basic instrumental tasks like the provision of food and shelter may be difficult; other families may accomplish instrumental tasks but may have problems with developmental tasks (for example, those surrounding the departure of the last child from home); other families may have coped resiliently with basic and developmental tasks, only to be knocked sideways by a hazardous event, such as major parental illness or redundancy, or sudden care-giving responsibility for an extended family member.
The recognition of complexity: even where hazardous events are considered to be the primary source of a family difficulty, in many instances pre-existing vulnerability within the family might have been crucial in determining how the family respond to the catastrophe. For instance, an accident itself might have been caused by or linked with inattention due to depressive preoccupation, or an unconscious acting-out of destructive feelings.
In one family it became clear that a fifteen-year-old young woman’s failure to attend school regularly was to be at home to support her mother, neither of whom were able to continue age-appropriate separation-individuation progression after the father’s traffic accident and serious injury. Their sadness and anger with this man, whose habitual drunken driving had finally resulted not only in his own semi-paralysis, but in the death of a youthful passenger, led to the fragmentation of family organisation and effective problem-solving. Every family member felt unable to leave home, yet felt burdened by the others in the family, and at the same time a burden to each.
Six dimensions of family functioning: family functioning was understood across six dimensions, of which the most important (or perhaps of most enduring importance) are problem-solving, roles, and communication. During an assessment, the inter-relatedness of these three dimensions is very apparent.
For example, in the above family, prompting an enquiry about who became involved in discussing the young woman’s absence from school? how was this talked about and to whom? whether her mother was solely fulfilling the parental tasks for her daughter? was that a change from before the accident? how – apart from supporting her father – were other family tasks fulfilled? what roles if any did her elder siblings take? and how did these happen? how far did this reflect a shared understanding of each other’s positions and needs? were such developments reviewed? were others always aware if some family members felt over-burdened or distressed? was it possible to talk about what was no longer happening in the family or for some of them as individuals? did unresolved affective tasks undermine the recognition and completion of practical tasks? etc.
As the example illustrates, an assessment usually begins with an exploration of the presenting problem and associated family relating before a more general exploration of family problem-solving.
Care is taken to explore both affective and instrumental problem-solving, and to ensure the account does not become problem-saturated. An assessment would be considered incomplete that had been concluded without understanding family strengths, what previous challenges had been experienced and how past problems had been dealt with, and without a reasonably full understanding of how family members relate at an emotional level (that is, affective responding – how distress is shown, comfort is provided and how they have fun together – and also the level of affective involvement between its members – from close to distant).
Family communication styles is therefore considered central to task accomplishment, so this is always directly enquired about e.g. when direct and open talking is possible? under what circumstances is it not? what is difficult to talk about except in indirect (i.e. via a 3rd party) or ‘masked’ (i.e. semi-concealed) ways? etc.
Further details of these dimensions are available elsewhere.
In summary, MMFF had evolved to take account of the multiple cultural variations of ‘family’ in Canada. While the model continues to view certain norms in family structure and organisation as healthier than others, contemporary application of the model in practice requires recognition of the many external constraints families may experience (discriminatory power structures, marginalisation and general power imbalances within society).
Several basic principles of the McMaster approach remain and this edition invites practitioners to view these as one of a range of potentially useful positions when meeting with families and collaborating with them to deconstruct problems. In summary, the principles include:
- collaboration with family members, taking into account power, social context and John Burnham’s Social GGRRAAACCEEESSS when forming a therapeutic alliance with families.
- open and direct communication by therapists, to make transparent for families the actions taken, questions used and reasons for taking a particular stance.
- all family members are included to elicit a range of perspectives on each dimension within the assessment process.
- retaining the emphasis on the current presenting problems, and on the behavioural change that requires.
- as noted below, the family’s responsibility for change, where the therapist is a facilitator and catalyst for change, with a reducing need for the therapist as the intervention progresses.
- the problem-focus results in a time-limited expectation of involvement with a family, rather than ongoing without a clear end-point; meeting with families may start as frequent (perhaps weekly), then reducing in frequency over time as progress is made.
The McMaster staged model of family therapy: a model of therapy, which emphasised the completion of a rigorous assessment before moving on to therapy, which itself is best implemented in a staged way.
Therapeutic contact with a family was considered to occur in four stages that most family therapists would accept (assessment, contracting, therapy, and closure) but it was the sequential way this was undertaken at McMaster that distinguished it from other approaches. A McMaster therapist would often deliberately avoid making early, potentially therapeutic, interventions since this might prejudice the completion of an assessment and the development of a negotiated therapeutic contract.
The completion of an assessment was itself undertaken as a sequence of four stages: orientation; data gathering and problem description; problem clarification (during which a comprehensive understanding of the family functioning is established); and the development of a formulation that makes sense of the family’s difficulties.
This was undertaken in a collaborative way, where the overall plan was explicit, and family concerns and reservations explored and resolved before going on to the next stage. The formulation was similarly explicit, and provided the rationale for the subsequent therapy – both its aims and how these would be approached. Although developed more than thirty years ago, the overall approach provides a good ‘fit’ with most contemporary service-philosophy.
For this reason, the approach has strongly influenced the Integrated Family Therapy model we describe, where every stage was described in considerable detail.
For example, after assessment and formulation, a detailed exploration of contracting, where the therapist returns to orientation, that includes how options will be outlined, expectations negotiated, and a therapy contract established. A similarly detailed exploration of the intervention stage, which also includes orientation, where priorities are clarified. Family tasks may be set, and subsequently evaluated, although in this edition we do not emphasise this aspect of the model (as discussed elsewhere, McMaster’s strong emphasis upon task-setting as a means to address therapy-aims has not been adopted). Finally on endings, which as with the other stages includes orientation, summarising what interventions have occurred and changes resulted, collaborating with the family to set long-term goals, and an offer made to follow-up to explore progress and setbacks.
Epstein N., Bishop D., & Levin S. (1978). The McMaster model of family functioning. Journal of Marriage and Family Counseling, 4: 19–31.
Wynette L., Ryckoff I., Day J., & Hirsch S. (1958). Pseudomutuality in the family relations of schizophrenics. Psychiatry, 21: 205-220.