Calgary Family Intervention Model: One way to think about change
Wright, Lorraine M
This article defines and describes the Calgary Family Intervention Model (CFIM). CFIM is an organizing framework conceptualizing the intersect between a particular domain (i.e., cognitive, affective, or behavioral) of family functioning and a specific intervention offered by a health professional. Examples and discussion of interventions such as storying the illness experience, encouraging respite, and asking interventive questions are presented. CFIM is one way that health professionals can conceptualize about change.
In our clinical teaching and supervision with health professionals, we have often observed a phenomenon we refer to as monocular focusing. Specifically, health professionals learning family therapy generally err in one of two ways: either too much focus on family dynamics or too much focus on interventions. The inability to employ binocular focusing (i.e., not focusing on both the family and the intervention) frequently results in little or no change. To offer a balanced conceptualization of family functioning and interventions that would enhance the possibility of change, we developed the Calgary Family Intervention Model (CFIM). This model emphasizes a “fit” between the interventions offered by the health professional and the domain of family functioning. The model also offers specific ideas for interventions in particular domains of family functioning and the fit between them.
In this article we will define and describe the CFIM. The use of interventive questions to perturb change in family functioning is discussed and examples of questions are given. Interventions to effect change in families in particular domains of family functioning are also presented and discussed. Although our trainee population is primarily health professionals, we believe that other trainees could be taught the model and would find it clinically useful.
Definition and Description
Once a comprehensive family assessment has been completed and family intervention is indicated, the health professional needs to conceptualize where it is desirable to perturb change. The CFIM was developed as a companion model to the Calgary Family Assessment Model (Wright & Leahey, in press). However, CFIM can be utilized following assessment regardless of the family assessment model and/or instrument utilized. CFIM is an organizing framework conceptualizing the intersect between a particular domain of family functioning and the specific intervention offered by the health professional. That is, does the intervention effect change in the desired domain or not? Table 1 offers a visual portrayal of the fit between a domain of family functioning and a particular intervention. (Table 1 omitted) The elements of CFIM are interventions, domains of family functioning, and fit or effectiveness. CFIM focuses on promoting, improving, and/or sustaining effective family functioning in three domains: cognitive, affective, and behavioral. We identified these domains in Nurses and Families: A Guide to Family Assessment and Intervention (Wright & Leahey, 1984) but now have incorporated them into CFIM.
Interventions can be targeted to promote, improve, or sustain functioning in one or all three domains of family functioning, but change in one domain will have an impact on another domain. One intervention can target cognitive, affective, and/or behavioral domains of family functioning simultaneously. However, we believe that the most profound and sustaining change will be that which occurs within the family’s beliefs (cognition). Change in the affective or behavioral domains is also mediated through cognition. A significant determining factor of whether change occurs is if the intervention is selected as a trigger (perturbation) for potential change by the family. We believe health professionals can only offer interventions to the family. Whether the family opens space for an intervention depends on their genetic make-up and their history of interactions (Maturana & Varela, 1992). It is also profoundly influenced by the relationship between the health professional and the family (Thorne & Robinson, 1989) and the health professional’s ability to invite the family to reflect on their health problems (Wright & Levac, 1992).
Second-order cybernetics and the work of Maturana (Maturana & Varela, 1992) have influenced our ideas about effecting change. With regard to interventions, we believe it is unwise to attempt to ascertain what is “really” going on with a particular family or what the “real” problem is. Recognizing what is “real,” whether it be the problem or the intervention, is always a consequence of our social construction of the world (Keeney, 1982). Keeney further states that since family clinicians join their clients in the social construction of a therapeutic reality, the clinician is also responsible “for the universe of experience that is created” (1982, p. 165). Maturana (1988) presents another twist on this critical notion of reality by submitting that individuals (living systems) draw forth reality-they do not construct it, nor does it exist independent of them. This has implications for health professionals’ clinical work with families in that what we perceive about particular situations with families is influenced by how we behave (our interventions) and how we behave dependson what we perceive.
Therefore, one way to change the “reality” that family members have drawn forth is to assist them in the development of new ways of interacting. The interventions we use in this endeavor are focused on changing cognitive, affective, or behavioral domains of family functioning. As family members’ perceptions and beliefs about each other and their health problems change, so will their behavior. Interventions that are directed at challenging the meanings or beliefs that families give to behavioral events also have an impact on decreasing or eliminating physical/emotional symptoms and suffering (Watson, Bell, & Wright, 1992; Watson & Nanchoff-Glatt, 1990; Wright, Bell, & Rock, 1989; Wright & Nagy, 1993; Wright & Simpson, 1991; Wright & Watson, 1988).
Interventions
Interventions represent the core of clinical practice with families. There are myriad interventions that health professionals could choose, but interventions should be tailored to each family and to the chosen domain of family functioning. Particular interventions will vary for each family although there may be occasions when the same intervention is used for several families with differing problems. However, we wish to emphasize that each family is unique and that even though labeling particular interventions is useful, it does not represent a cookbook approach. The interventions we have listed are examples of interventions that could be utilized and are not intended to be inclusive. We have also given examples of interventive questions that have emerged from our clinical practice and research that have been found to be very useful. The interventions that we cite are based on several important theoretical foundations: systems, cybernetics, communication, and change theories.
There are several factors which enhance the likelihood that interventions will perturb change in the desired domain of family functioning. These factors are outlined in Table 2. (Table 2 omitted)
First, interventions should be related to the problems that health professionals and the family have collaborated and contracted to change. Second, interventions should be derived from health professionals’ hypotheses about problems and domains of family functioning. Third, interventions should match the family’s style of relating. Fourth, interventions should be linked to a family’s strengths and previous useful solution strategies. We believe families have inherent resources and that the health professional’s responsibility is to invite families to use these resources in new ways to tackle problems. Fifth, interventions should be consistent with a family’s ethnic and religious beliefs. Sixth, the health professional should devise a few interventions so that their relative merits can be considered. For example, are these new interventions for the family or are they “more of the same” solutions the family has already tried? We do not believe that there is one right intervention, but several useful or effective interventions. In our experience, we have found that health professionals sometimes reach an impasse with families when they persist in either using the same intervention over and over or switching interventions too rapidly.
We must also keep in mind the element of timing with regard to interventions. Interventions do not just begin within a particular intervention stage of family work. Rather, they are an integral part of family interviewing, spanning engagement to termination. Normally, interventions used during family interviewing are based upon the health professional’s assessment of the family. Adequate engagement and assessment of the family will generally increase the effectiveness of the interventions.
CFIM is not a list of interventions nor is it a list of family functioning. Rather, CFIM provides a means to conceptualize a fit between domains of family functioning and interventions offered by the interviewer. It assists in determining the predominant domain of family functioning that needs changing and what is the most useful intervention that will effect change in that domain. Through therapeutic conversations, the family and health professional collaborate and co-evolve to discover the most useful fit. We use the qualitative term fit in a slightly different way than de Shazer (1988) as we emphasize whether or not the interventions effect change in the presenting problem. Fit involves a recognition of reciprocity between the health professional’s ideas/opinions and the family’s illness experience. Therefore, determining fit may involve some experimentation or trial and error. It also entails a belief by health professionals that each family is unique and has particular strengths.
INTERVENTIVE QUESTIONS
One of the simplest, but most powerful, interventions for families experiencing health problems is the use of interventive questions. Interventive questions are intended to effect change in any one or all three domains. Health professionals conducting family interviews should remember, though, that knowledge of when, how, and to what purpose to pose questions is more important than simply choosing one type of question over another (Lipchik & de Shazer, 1986).
Linear versus Circular Questions
Interventive questions are usually of two types: linear and circular (Tomm, 1987, 1988). Linear questions tend to inform the health professional while circular questions are meant to effect change (Tomm, 1985, 1987, 1988). The important difference between these kinds of questions is their intent. Linear questions are investigative; they explore a family member’s descriptions/perceptions of a problem. For example, when exploring family members’ perceptions of their daughter’s anorexia nervosa, the health professional might begin with a linear question: “When did you notice that your daughter had changed her eating habits?” “How much does she eat now?” These linear questions, while informing the health professional of the history of the young woman’s eating patterns, also help illuminate family perceptions of or beliefs about eating patterns. Linear questions are frequently utilized to begin gathering information about families’ problems; circular questions reveal families’ understanding of problems.
Circular questions are directed more toward explanations of problems. For example, the health professional could ask of the same family, “Who in the family is most worried about Cheyenne’s anorexia?” “How does Mother show that she’s the one worrying the most?” Circular questions help discover valuable information because they seek out relationships among individuals, events, ideas, or beliefs.
The effect of these questions on families is quite distinct. Linear questions tend to be constraining; circular questions are generative. Circular question introduce new cognitive connections, paving the way for new or different family behaviors. A linear form of questioning implies that the health professional knows what is best for the family; it also implies that the interviewer has become purposive and invested in a particular outcome. Linear questions are intended to correct behavior; circular questions are intended to facilitate behavioral change.
The primary distinction between circular and linear questions lies in the notion that information reveals differences in relationships (Bateson, 1972). With circular questions, a relationship orconnection is always sought among individuals, events, ideas, or beliefs. With linear questions, the focus is cause and effect. The idea of circular questions evolved from the concept of circularity and the method of circular interviewing developed by the originators of Milan systemic family therapy (Fleuridas, Nelson, & Rosenthal, 1 986; Selvini-Palazzoli, Boscolo, Cecchin, & Prata, 1980; Tomm, 1984, 1985, 1987). Circularity involves the cycle of questions and answers between families and health professionals that occurs during the interview process. The health professional’s questions are based on information that the family gives in response to the questions the health professional asks, and thus the cycle continues (Watson, 1992). The family’s responses to the questions provide information for the health professional and the family. Questions in and of themselves also provide new information/answers for the family. In these circumstances, they are considered interventions (Fleuridas et al., 1986). Interventive questions may invite family members to see their problems in a new way and subsequently to see new solutions. Thus, as the family’s answers provide information for the health professional, the health professional’s questions may provide information for the family (Watson, 1992).
Tomm (1987) embellished the types of circular questions utilized by the Milan systemic family therapy team and identified, defined, and classified various circular questions. Loos and Bell (1990) have creatively applied the use of circular questions to critical care nursing. Watson ( 1988a, 1988b, 1988c, 1989a, 1989b) demonstrated the therapeutic aspect of circular questions with families experiencing chronic illness, life-shortening illness, and psychosocial problems. The circular questions identified by Tomm (1987) that we have found most useful in clinical practice with families are difference questions, behavioral effect questions, hypothetical/future-oriented questions, and triadic questions. We have expanded the use of circular questions by providing examples of questions that can be asked to intervene in the cognitive, affective, and behavioral domains of family functioning. The type of question, definition, and examples are given in Table 3. (Table 3 omitted)
There are four types of circular questions (i.e., difference, behavioral effect, hypothetical, and triadic) that can be used to perturb change in any one or all of the domains of family functioning. Table 4 illustrates the intersect of various types of circular questions and the domains of family functioning. (Table 4 omitted) We wish to emphasize strongly that what is most critical is the effectiveness/usefulness/fit of the question in perturbing change rather thant the specific question itself.
CASE EXAMPLE
Following is a case example illustrating how to intervene using circular questions in a situation that health professionals commonly encounter.
Question: How Can Health Professionals Help Families Cope with Chronic Illness?
I have been working with a family in which the wife is experiencing multiple sclerosis. For several years the couple have coped fairly well. Within the past year, the wife has become progressively more physically and emotionally dependent. She insists that her husband stay at home every evening and that they spend every weekend together. He is anxious and told me he feels trapped. He feels more and more unable to help his wife. Yet he does not want to abandon her or have her permanently hospitalized. How can I help this couple cope more effectively with the wife’s multiple sclerosis?
Discussion
The extent to which a person’s illness affects the family often depends on the nature of the illness itself. If the illness is a prolonged and complicated one, such as multiple sclerosis, it will most likely lead to differences in family relationships.
In working with a family in which one member has a chronic illness and requires additional care, the health professional should intervene and explore the family’s cognition and beliefs about the illness. This intervention is aimed at the cognitive domain of family functioning. For example, the health professional in this instance may ask the husband and wife what they understand about multiple sclerosis, how the disease progresses, how long the periods of remission are, and so forth. In so doing, the health professional may be able to clear up misconceptions and provide further information.
When the health professional has established a baseline of the couple’s understanding of multiple sclerosis, then he or she can begin to explore their catastrophic expectations about the progression of the disease. Circular questions can be asked, such as:
To husband: What is the worst thing your wife fears as her multiple sclerosis progresses?
To wife: What is your husband’s most pressing worry for the future?
These types of circular questions can be interchanged for husband and wife. Circular questions aimed at exploring one person’s understanding of the other person’s beliefs, expectations, and emotions can also be asked. These questions could also be asked directly to the patient or spouse. For example, the health professional could ask the patient, “What is the thing you fear most about your multiple sclerosis progressing?” By exploring the other person’s understanding first, however, the health professional gains more information. If the husband answers that he thinks his wife fears most that he will have an affair, then this can be discussed during the interview. This two-step technique of asking the husband about the wife’s expectations and then asking the wife directly about her own expectations is generally quite helpful in eliciting differences in beliefs.
After catastrophic expectations have been uncovered, they can be discussed realistically. When these fears of impending catastrophe remain hidden, they tend to impede problem solving and promote isolation of maladaptive interaction patterns. In this case, if the wife fears that the husband will lose interest in her as her disease progresses, then this fear needs to be explored further. If the husband feels trapped and resentful about future care for his wife, then this feeling too needs to be explored. Some questions that may guide the discussion include:
To wife: How do you show your feelings of fear? What do you do? What effect does this have on your husband? Is that the effect you would like it to have?
To husband: How do you deal with the extra demands of the illness? How do you show your feelings to your wife? What effect does this behavior seem to have on her?
These types of circular questions aim at increasing the family’s understanding of the present situation. They provide a focus for the health professional to explore not only the family’s cognition but also their underlying emotional responses. For example, the husband may feel resentful, anxious, and trapped and may be dealing with these feelings by isolating himself. The wife may be fearful and behave in a clutching, clingy fashion. Neither person may be aware of the circular nature of the maladaptive pattern.
When the health professional has helped the couple to recognize the nature of their problem, then the health professional can help them explore alternative coping strategies leading to new solutions. For example, the health professional may stimulate the discussion by asking the following questions:
*How can you deal more realistically with the extra demands on both of you?
*What possibilities might work?
*What probably would never work?
*Who might be most in favor, for example, of inviting a volunteer from the church in on Saturdays to assist with the caretaking?
In summary, the main way the health professional can assist a family with a chronic illness is to help them remove cognitive and affective blocks to problem solving. If the husband is immobilized by guilt and a belief that he is losing his wife because of her illness and the wife is immobilized by fear, then these blocks need to be gently dislodged to permit creative problem solving to take place.
OTHER INTERVENTIONS
To illustrate the intersection of three domains of family functioning (cognitive, affective, and behavioral) and various interventions, we have chosen several other examples of interventions in addition to circular questions. These examples are not meant to be an exhaustive list. Rather, they are interventions we have found useful in our own clinical practice and research. The examples include (a) commending family and individual strengths, (b) offering information/opinions, (c) externalizing the problem, (d) validating/normalizing emotional responses, (e) storying the illness experience, (f) drawing forth family support, (g) encouraging respite, and (h) devising rituals.
These interventions can trigger change in any one or all of the domains of family functioning. For example, the health professional can use the intervention of offering information to promote change in cognitive, affective, or behavioral family functioning (see Table 5). (Table 5 omitted)
We will now describe each intervention and offer a case example illustrating its application. We have chosen to cluster the sample interventions around a particular domain of family functioning. In doing this, we do not wish to imply that one intervention can only be used to perturb change in one domain of family functioning. Nor do we want to imply that one intervention is a “cognitive intervention” and another an “affective intervention.” Rather, these are examples of the fit between a specific problem, a particular intervention, and a domain of family functioning.
INTERVENTIONS TO CHANGE THE COGNITIVE DOMAIN OF FAMILY FUNCTIONING
Interventions directed at the cognitive domain of family functioning are usually those which change a particular family’s perceptions and beliefs about their health problem in order that they can discover new solutions to their health problems. We offer the following interventions as ways to change the cognitive domain of family functioning.
Commending Family and Individual Strengths
We routinely commend families in each session on the strengths observed during the interview. Commendations differ somewhat from compliments. De Shazer (1988) describes compliments as statements from the therapist “about what the client has said that is useful, effective, good or fun” with the purpose of promoting “client-therapist fit and cooperation on the task at hand” (p. 96). Commendations are the therapist’s observations of patterns of behavior that occur across time (e.g., “your family is very loyal toward one another”), whereas a compliment is often an observational comment of a one-time event (e.g., “you were very praising of your son today”). Families coping with chronic, life-shortening illness and/or psychosocial problems frequently feel defeated, hopeless, and/or failures in their efforts to overcome their illnesses or live alongside of them. Commonly, families coping with health problems have not been commended for their strengths or made aware of them (McElheran & Harper-Jaques, 1994). The immediate and long-term positive reactions to such commendations indicate that they are effective therapeutic actions. Families who internalize commendations appear more receptive to other therapeutic actions that may be offered.
In one family, an adopted son’s behavioral and emotional problems had kept them involved with health professionals for 10 years. The family clinician commended this family by telling them that she believed they were the best family for this boy because many other families would not have been as sensitive to his needs and would probably have given up years ago. Both parents became tearful and said that this was the first commendation given to them as parents in many years.
By commending families’ competence and strengths and offering them a new opinion of themselves, a context for change is created, allowing families to discover their own solutions to problems. By changing the view they have of themselves, families are frequently able to view the health problem differently and thus move toward more effective solutions.
Offering Information/Opinions
In our experience, families with a hospitalized member have indicated that a high priority is obtaining information. Many families have expressed frustration at their inability readily to obtain information or opinions from health professionals. Health professionals can offer to provide information about the impact of chronic and/or life-shortening illnesses on families. On the other hand, health professionals can also empower families to obtain information about resources. We have learned that the latter approach is more useful in some circumstances.
One clinical example concerns a family of two aging parents and their 34-year-old son experiencing severe multiple sclerosis. The parents were constant, devoted caretakers but had not had any respite for several months. The son was asked by the health professional if he would be willing to challenge his belief about himself as being “helpless.” The health professional asked him to take the leadership role in exploring possible resources for caregivers in order that his parents might have a vacation. As a result of his search, the son discovered that he was eligible for many financial benefits (e.g., to hire professional caregivers) of which he had previously been unaware. Shortly afterward, the son made arrangements for 24-hour in-home nursing care while his parents took a vacation. His parents reported that they felt much less stressed and that their son was also much happier. He began making efforts to walk using parallel bars, an activity which he had not done in several months.
In this case example, the health professional offered an opinion to empower the son to change his cognitive set. The intervention fit the cognitive domain and results also took place in the affective and behavioral domains of family functioning.
Externalizing the Problem
Externalization of a problem is an innovative intervention developed by Michael White of Australia (Tomm, 1989; White, 1984, 1986, 1988-1989; White & Epston, 1989). It involves separating the problem from the personal identity of the client. Instead of viewing the problem as residing in the person, the problem is externalized and viewed as being outside the person. Rather than a client being objectified, a problem is objectified (White, 19881989). Externalization can be achieved during a family interview by introducing questions that encourage family members to map the influence of the problem in their lives and their influence in the life of the problem. This is called relative influence questioning (White, 1988). The family is asked, “How much influence do you have over the problem?” and reciprocally, “How much influence does the problem have over you and your relationship?”
We have externalized chronic pain (Watson et al., 1992), phobias, epileptic seizures (Wright & Simpson, 1991), and depressions with dramatic positive results with adults. Externalization of the problem is also particularly useful with children experiencing phobias, encopresis (White, 1994), enuresis, behavioral problems, and chronic pain. Externalizing the problem has even proven useful with a teenager who was experiencing depression related to her jealous feelings about a friend who reminded her of Marilyn Monroe. The problem of jealousy was externalized as “a case of Marilynitis” and had a very positive outcome (Wright & Park Dorsay, 1989).
INTERVENTIONS TO CHANGE THE AFFECTIVE DOMAIN OF FAMILY FUNCTIONING
Interventions aimed at the affective domain of family functioning are designed to reduce or increase intense emotions that may be blocking families’ problem-solving efforts. Following are examples of interventions that can change the affective domain of family functioning.
Validating/Normalizing Emotional Responses
Validation of intense affect can alleviate feelings of isolation and loneliness and assist family members to make the connection between a family member’s illness and their emotional response. For example, following a diagnosis of a life-shortening illness, families frequently feel out of control and/or frightened for a period of time. It is important for health professionals to validate these strong emotions and to reassure and offer hope to families that in time they will adjust and learn ways to cope.
Storying the Illness Experience
Too often family members are only encouraged to tell the medical story or narrative of their disease rather than the story of their experience of their illness (Frank, 1991). Through therapeutic conversations, health professionals can create a trusting environment for open expression of family members’ fears, anger, and sadness about their illness experience. Having an opportunity to express the impact of the illness upon the family and the influence of the family upon the illness from each family member’s perspective validates their experience. This is very different from limiting or constraining family stories to symptoms, medication, and physical treatments. Providing a context for the sharing of the illness experience among family members legitimizes intense emotions.
Drawing Forth Family Support
Health professionals can enhance family functioning in the affective domain by assisting family members to listen to each other’s concerns and feelings (Craft & Willadsen, 1992).
This can be particularly useful at times when a family member may be dying or has died (Wright & Nagy, 1993). Through fostering opportunities for family members to express this painful experience, the health professional can enable the family to draw forth their own strengths and resources to support one another. This type of family support can prevent families from becoming unduly burdened or defeated by an illness.
INTERVENTIONS TO CHANGE THE BEHAVIORAL DOMAIN OF FAMILY FUNCTIONING
Interventions directed at the behavioral domain assist family members to interact and thus behave differently in relation to one another. This change is most often accomplished by inviting some or all family members to engage in specific behavioral tasks. Some tasks will be given during a family meeting so that the health professional can observe the interaction; others may be experimented with between sessions. Sometimes, it is necessary to review with the family what the particular task and experiment is in order to check their understanding of what the health professional is suggesting.
We offer the following examples of interventions that could change the behavioral domain of family functioning.
Encouraging Respite
Often, it is very difficult for a caretaking family to allow themselves adequate respite. Too frequently, family members feel guilty if they need or want to withdraw themselves from the caregiving role. Even the ill member must disengage himself from time to time from the usual caregiving and accept another person’s assistance. Each family’s need for respite varies. The issues affecting respite requirements include the severity of the chronic illness, availability of family members to care for the ill person, and financial resources (Leahey & Wright, 1987). All of these issues must be considered before a health professional recommends a respite schedule. S. Tucker (personal communication, October, 1984) reports that she advises families to buy a less expensive prothesis and use the extra money for a family vacation. In this way, caregiving and coping are balanced. Such “time outs” or “time away” are essential for families facing excessive caretaking demands. Another example is to recommend to a mother and father with a leukemic child to have grandparents babysit for a day while the couple have time together.
Devising Rituals
Families engage in many daily (e.g., bedtime reading), yearly (e.g., Thanksgiving dinner at Grandma’s), and cultural (e.g., ethnic parades) rituals. Health professionals can suggest therapeutic rituals that are not or have not been observed by the family. Roberts (1988) defines rituals as:
Coevolved symbolic acts that include not only the ceremonial aspects of the actual presentation of the ritual, but the process of preparing for it as well. It may or may not include words, but does have both open and closed parts which are “held” together by a guiding metaphor. Repetition can be a part of rituals through either the content, the form, or the occasion. There should be enough space in therapeutic rituals for the incorporation of multiple meanings by various family members and clinicians, as well as a variety of levels of participation. (p. 8)
In our clinical practice, we have observed that chronic illness and/or psychosocial problems frequently interrupt usual rituals. Rituals are best introduced when there is an excessive level of confusion caused by the simultaneous presentation of incompatible injunctions. Rituals serve to provide clarity in a family system (Imber-Black, Roberts, & Whiting, 1988). For example, parents who cannot agree on child-rearing practices often end up giving conflicting messages. This can result in chaos and confusion for their children. The introduction of an odd-day even-day ritual (Selvini-Palazzoli, Boscolo, Cecchin, & Prata, 1978) can often assist the family. The mother could be invited to experiment with being responsible for the children on Mondays, Wednesdays, and Fridays, and the father on Tuesdays, Thursdays, and Saturdays. On Sundays, they could behave spontaneously. On their “days off,” parents could be asked to observe, without comment, their partner’s parenting. This intervention isolates contradictory behaviors by prescribing sequence (Tomm, 1984).
CONCLUSIONS
We have found the practice of teaching the CFIM very useful for both beginning and advanced family clinicians. Beginning clinicians are often overwhelmed by the complexity of family dynamics and frequently lose sight of their role in helping families effect change. Advanced clinicians, on the other hand, are often mesmerized by the interventions they have skillfully crafted to enhance family functioning. When these interventions do not seem to work, the interviewers often either repeat the same intervention or target the same area of family functioning. With both beginners and advanced practitioners, CFIM is a useful tool to gain a metaperspective on the fit or usefulness of the intervention offered by the interviewer and the family’s domain of functioning.
Interventions can be straightforward and simple or as innovative and dramatic as the health professional deems necessary for the health problem(s) presented. Ell and Northen (1990) convincingly support this statement with abundant research documentation that “interventions intended to promote health and prevent illness should be based on the assumption that individual health behaviors are strongly influenced by those around us, and that family general well-being can promote the physical health of its members” (p. 79). Any interventions should be directed toward the goals of treatment collaboratively generated by the health professional and the family. As health professionals learn to engage actively, assess thoroughly, identify problems clearly, and set treatment goals, the conceptualizing, choosing, and implementing of specific interventions with each family becomes more rewarding and more effective. The ultimate goal, of course, is to assist family members to change through discovering new solutions to their health problems through the interventions that are offered. CFIM is one way we have found useful to conceptualize about effecting change.
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Lorraine M. Wright, RN, PhD, is Director, Family Nursing Unit and Professor, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada, T2N 1N4.
Maureen Leahey, RN, PhD, is Director, Outpatient Mental Health Program and Director, Family Therapy Training Program, Calgary District Hospital Group, 1035 7 Ave. SW, Calgary, Alberta, Canada, T2P 3E9.
Reprint requests and/or correspondence about this article should be sent to Lorraine M. Wright at the above address.
Copyright American Association for Marriage and Family Therapy Oct 1994
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