Johanna Shapiro, PhD
Developed and Compiled by the Society of Teachers of Family Medicine – Task Force on the Family in Family Medicine.
The Family in Family Medicine
The Family-Oriented Clinical Simulation: An Interdisciplinary Tool for Professional Growth
Johanna Shapiro, PhD
An interdisciplinary, educational technique-the family-oriented clinical simulation-is described and compared and contrasted to other commonly used role-playing techniques. Implications for training and supervision of physical therapists and other health care professionals are discussed, including the technique’s relevance as a vehicle for studying in an applied clinical context the interface of physical disease and its psychosocial manifestations. The article concludes with a description of the benefits and potential disadvantages of the technique.
Development of Family Self-Control Skills
Johanna Shapiro, PhD
Family physicians require efficient and effective means for intervening with families of patients in order to positively affect the patient’s health status. The purpose of this article is to present a new concept in behavioral intervention, family self-control skills, particularly stressing its potential use by physicians. The clinical interventions described here were developed in a family medicine clinic, and have been used successfully with several patients and families. The article identifies specific concepts and techniques found to be useful in promoting family self-control skills, and demonstrates their application in a family medicine setting. A case example is included to illustrate this approach.
Effects of a Family-Oriented Training Experience on the Role of the Physical Therapist
Johanna Shapiro, PhD
This article describes ways in which a family-oriented psychologist contributed to a reconceptualization of the appropriate role for the physical therapist in patient care. The article identifies aspects of the changing role of the physical therapist, specifically its expansion to include skilled psychosocial interaction with patient and family for the purposes of reassurance, support and instruction. A primary shift involved changing from focus on the individual and his or her disability to focus on the patient in the context of his or her family. The article briefly describes elements of appropriate psychological training which can be incorporated successfully in a physical therapy educational experience, and concludes with a case example illustrating the basic points relevant to this type of interdisciplinary collaboration.
Using Triangulation Concepts to Understand the Doctor-Patient-Family Relationship
Johanna Shapiro, PhD
Practical teaching about families remains an elusive and challenging educational goal. This article provides a brief overview of the concept of triangulation and shows how it can be easily applied to the doctor-patient-family relationship. Examples of both negative and positive triangulation are
presented. Learning to recognize and work with triangles in the clinical encounter can lead to a more family-oriented approach in residencies, particularly for those lacking formal family intervention programs.
Correlates of Family-Oriented Physician Communications
Johanna Shapiro, PhD
Family orientation in patient care has long been one of the primary tenets of the practice of family medicine. Yet we know surprisingly little about how frequently family-oriented transactions occur in actual doctor-patient encounters, or about what other aspects of physician communication patterns might be associated with increased family orientation. The purpose of this study was to investigate both frequency and correlates of family orientation in a residency-based practice.
An Extended Metaphor: Family Medicine as Family
JOHANNA SHAPIRO, Ph.D., YVES R. TALBOT, M.D., F.R.C.P.
With the development of the specialty of family medicine, family physicians and behavioral scientists have been working together in medical settings for the past 20 years. Lack of clarity of goals, divergence in values, and different professional training have resulted in tension between the two disciplines. However, these tensions need not be paralyzing for the field and, in fact, may reflect necessary developmental milestones. This article uses the analogy of the family to describe some of the difficulties in the relationship between family physician, resident, and behavioral scientist. Using a Bowenian model, it also explores solutions to these relational problems. It is hoped that a more harmonious relationship might allow both family medicine and behavioral science to differentiate from their families of origin and to begin tapping the creativity required for the ongoing development of the discipline of family medicine.
Book Review: Medical Family Therapy
Johanna Shapiro, PhD
Medical Family Therapy is a remarkable and valuable book on several counts. First, it is the first full-scale, systematic effort to define medical family therapy as a unique field, drawing on and integrating both traditional family therapy and medical science, but differentiating itself from both. Second, it successfully combines a strong theoretical foundation with a practical, clinically oriented approach full of utility for the aspiring medical family therapist. Third, it promulgates a visionary and creative model of health care possibilities at a time when the entire country is desperately seeking a reformulation of how we understand and deliver health care.