by Patricia Minuchin, Jorge Colapinto, and Salvador Minuchin, New York, NY, Guilford Press, 2007, 259 pp, Paperback, $25.00.
In 2007, 12.5% of the U.S. population, or 37.3 million people, lived in poverty. Children are particularly likely to live in poverty: in 2006, 21% of preschool-aged children were poor and 43% were low-income children. Pediatric providers are, therefore, particularly likely to work with low-income children and their families. Given that the central role of a pediatric provider is working to improve the child's health and well-being in partnership and, through the parent, an improved understanding of the unique aspects of working with families in poverty could be very helpful.
This book is written for clinicians working with families and is divided into 2 parts and 8 chapters. Part I, Fundamentals of Family-Oriented Thought and Practice includes the following 4 chapters: “The New Edition: Elements of Constancy and Change”; “The Framework: A Systems Orientation and Family-Centered Approach”; “Working in the System: Family-Supportive Skills”; and “Changing the System: Family-Supportive Procedures.” Part II, Implementing a Family-Oriented Model in Service Systems also includes the following 4 chapters: “Substance Abuse: A Family-Oriented Approach to Diverse Populations”; “Foster Care: Children, Families, and the System”; “The Mental Health of Children”; and “Moving Mountains: Toward a Family Orientation in Service Systems.” The authors include a developmental psychologist, family therapist, and psychiatrist.
The major strength of the book is its case-based approach, which provides a salient and practical model for clinicians, bringing the ideas presented in the book out of the realm of theory and into practice. One of the most unique and helpful aspects of the book is its emphasis on a strength-based approach to working with families in poverty. Families in poverty often have so many stressors that clinicians often view the family in a deficit model or even as a barrier to overcome in helping the child. However, the book emphasizes that instead of entirely seeking supports and services outside the family, the clinician would often be wise to identify who within the family can serve as a support to the child and assist in implementing the plan to improve the child's well-being. The authors illustrate this concept with several poignant examples. The book also focuses specifically on children in foster care from a family systems perspective, guiding the clinician to understand the potential strengths of the biological family when looking toward reunification. The book also provides a practical and straightforward overview of family systems theory, describing the patterns and subsystems within families, and pointing out that social service systems generally identify the individual as the “unit” receiving the service, when intervention would likely be much more effective if the family as a whole was considered the unit of service. The book also is careful not to pathologize or label, pointing out that difficulties within families during periods of transition (e.g., following a birth or illness of an older family member) are not necessarily pathologic or permanent. The book does not take moralistic views toward poor families and, likewise, does not portray poor families as purely victims of society. The authors point out that regardless of the clinicians' view of the family's poverty, its etiology, and its consequences, the clinician typically views the family as part of the problem and not as part of the solution for the child's presenting concern. Shifting toward a strength-based approach presents a significant opportunity.
I have been working clinically nearly exclusively with poor children and their families as a developmental and behavioral pediatrician for 10 years and found myself rereading and underlining many lines in this book that reshaped my thinking. As therapists, the authors seem to be particularly skilled at helping the reader to come to a realization about the concept being presented in the book, as opposed to simply dictating facts and concepts to the reader. I found this book valuable and believe that it would be useful to all levels of clinicians—both seasoned and relatively inexperienced. In addition, I would expect that it would be appreciated by both those who work intensively with families in poverty and those with less frequent contact. In short, the book is not only a practical guide but also encourages the clinician to reflect on his or her own preconceived notions, often shining a light on belief systems that he or she did not even recognize in him or herself. This ability to engage the clinician at this level is the book's greatest strength.
Julie Lumeng, MD
Division of Child Behavioral Health
Department of Pediatrics and Center for Human Growth and Development
University of Michigan
Ann Arbor, MI