Table Of Content“For anyone who has ever been a family therapist or dreamed of being
one, Fishman’s book brilliantly expands the lens and redirects us to focus
on creating coordinated and effective systemic interventions, especially
in situations where all systems are failing our children. His book is the
clearest, most inspiring and challenging presentation of what it could
mean to really deal with human problems from a systemic perspective.
It is a breath of fresh air, offering an eye-opening review of our notions
of ‘evidence’ and ‘research’ and our failure to think and act systemically
and effectively in our clinical work. By not paying attention to clients’
systemic context or even trying to measure or track the success of our
clinical efforts, we have lost our way in misguided non-systemic men-
tal health research and practice. This book can help us turn the corner
toward promoting health.”
Monica McGoldrick, LCSW, PhD (h.c.), Director of the
Multicultural Family Institute, Highland Park, NJ; Adjunct Clinical Faculty,
Rutgers Robert Wood Johnson Medical School
“Performance-Based Family Therapy is a huge leap forward in addressing the
woes that limited the growth of system’s-based treatment. Fishman has
established a clear argument for what is needed to strengthen this field,
and it is a model of treatment that is both clearly articulated and provides
Performance-Based Accountability. Through his updating of Intensive
Structural Therapy and the introduction of outcome measurement tools,
this text gives the reader the knowledge and means to practice family
therapy in a manner that highlights clinical change and accountability.
All therapists, not just those working with couples and families, will
benefit from reading his approach and the accompanying case studies.”
Scott Browning, PhD, ABPP, Professor of Psychology,
Chestnut Hill College, Philadelphia
“In this practical clinical guide, Dr. Fishman, a brilliant, early collabora-
tor with Salvador Minuchin and other pioneers in family therapy, stresses
the need for a results-based, collaborative family systems approach with
struggling youth and families, recognizing larger contextual influences
in their distress. His Integrative Structural Family Therapy model, devel-
oped for effective training and practice, measures success in light of the
strengths and aims of youths and their families, understanding their
complex life challenges. His clear guidelines and case illustrations are
especially useful for practitioners working multi-stressed families in
low-income, marginalized, and under-resourced communities.”
Froma Walsh, PhD, Professor Emerita, University of Chicago;
Co-Director, Chicago Center for Family Health; Author,
Strengthening Family Resilience, 3e
“Who else, but Charles Fishman, could write a book that brings us closer
to understanding the beginnings of family therapy, by incorporating his
comradeship with Minuchin, Haley and Montalvo. Inside this notewor-
thy book, one can see the need for systemic research, the usefulness of
Intensive Structural Therapy, and proposals for cost effective treatment,
especially children and adolescents, Fishman’s forte. Those who have
been working in the field will delight in learning the helpfulness of out-
come-based supervision as a means of assisting supervisees to develop
mastery. Those who are students will have a chance to consider the needs
of mental health and where family therapy will fit into our future. This
book should be on the shelf of every practicing family therapist and
supervisor as a review and assigned as a text for every family therapy
student.”
Linda Metcalf, Professor of Graduate Counseling Programs,
Texas Wesleyan University
“I highly recommend this excellent book. It takes Results Based
Accountability (RBA), a framework that has transformed government
and non-profit agencies around the world, to the front line of psychiatric
care. Dr. Fishman’s model integrates Intensive Structural Therapy with
RBA and holds the promise for struggling families that therapists will
have the capacity to work towards achieving excellent clinical outcomes.”
Mark Friedman, original author of RBA in Trying Hard Is Not Good
Enough: How to Produce Measurable Improvements for Customers and
Communities
“In 1981, Charles Fishman co-authored (with Salvador Minuchin) a
classic book on family therapy techniques. Now, in Performance-Based Fam-
ily Therapy, he brings us another lucid and highly informative guide to
the practice of family therapy.”
Michael Nichols, PhD, Professor, William and Mary College
“Charles Fishman’s latest book not only uncovers the family’s hidden
strengths, it is also like a reciprocal, juried assessment of our craft –
therapists and families alike growing together.”
Jay Lappin, MSW, LCSW, Minuchin Center for the Family
“Dr. Charles Fishman has dedicated his esteemed career to promoting
the benefits of family therapy and advocating for access for economically
disadvantaged families. His work is rooted in research into best practices
and demonstrating what actually works for family health and well-being.
The child welfare field was slow to move away from being primarily
child-centered to embracing a whole-family approach, but we finally
got it, and Dr. Fishman’s work has been instructive. His new book is a
brilliant marriage of Results Based Accountability and clinical practice to
help the field measure outcomes. It’s research, not novelty, and the child
welfare field will greatly benefit from this approach. More importantly,
it’s another tool to help improve family functioning and well-being.
Thank you, Dr. Fishman!”
Brenda Donald, Director, District of Columbia Child and
Family Services Agency; Former Deputy Mayor for Health and Human
“In this most recent book, Dr. Charles Fishman, a renowned clinician
and clinical teacher, expands on his previous work in family therapy
and presents how the approaches of family systems-based therapy and
results-based accountability (RBA) can, in synergy, facilitate the outcome
that all clinicians desire the most: measurable change. As summarized by
Dr. Fishman, family therapy’s ‘…prioritization of the use of low-cost or
no-cost resources was something family therapists intuitively understood
in their work. There is no lower-cost resource than the family. A major
commonality between family therapy and RBA is that both are in the
business of changing systems…’
This very readable and graspable text includes illustrative case vignettes
and examples of scorecards, rating scales, and protocols. It promises to
be a helpful and practical guide for practitioners and trainees alike. It can
further serve to address barriers behind why even the best-conceived
treatments do not always translate into meaningful improvements in the
real world, where there truly are significant needs for safe, effective,
and sustainable mental health interventions for youth and their families.
This book describes an integrative, creative, and scientifically grounded
method that will likely inspire further approaches to tackling complex
challenges in the modern world.”
Anthony P. S. Guerrero, MD, Professor and Chair, Department of Psychiatry,
The Char, McDermott; Andrade Endowed Professor of Psychiatry,
University of Hawai‘i John A. Burns School of Medicine
PERFORMANCE-BASED
FAMILY THERAPY
In this groundbreaking book, Charles Fishman uniquely incorporates and
develops results-based accountability (RBA) into the framework of structural
family therapy.
Collaborating with the founder of RBA, Mark Friedman, this approach
aims to transform the field of family therapy by allowing clinicians to track
performance effectively and efficiently with their clients. The book begins
by reviewing the historical foundations of family therapy and evaluates why
challenges in the field, alternative methods, and the reliance on evidence-
based medicine (EBM) have meant that family therapy may not have flourished
to the extent that many of us expected. It then explores how RBA can be
integrated into intensive structural therapy (IST), with chapters examining
how RBA can be applied in context, such as in treating eating disorders,
supervision, and how it can be used to transform the professional’s clinical
contexts. Relevant and practical, the book also introduces the community
resource specialist to help in the treatment of socially disadvantaged families,
as well as practical appendices and “tracking tools” to empower clinicians to
track their data and choose treatment models that obtain the best outcomes.
This new approach offers transparent and measurable outcomes for
both clinicians and training family therapists, lending a helping hand in
making family therapy the gold standard in psychotherapy. It is essential
reading for undergraduate and graduate students of family therapy, course
leaders, and all clinicians in professional contexts, such as social workers,
psychotherapists, and marriage, couple, and family therapists.
H. Charles Fishman, MD, a master family therapist, has trained and
supervised family therapists all over the world with his primary focus on
the “power of the family.” He has co-authored with Salvador Minuchin a
foundational text in family therapy and five other books, including Enduring
Change in Eating Disorders: Interventions with Long-Term Results (Routledge).
PERFORMANCE-BASED
FAMILY THERAPY
A Therapist’s Guide to
Measurable Change
H. Charles Fishman, MD
Cover image: © Getty Images
First published 2022
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2022 H. Charles Fishman
The right of H. Charles Fishman to be identified as author of this work
has been asserted in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this title has been requested
ISBN: 9780367746698 (hbk)
ISBN: 9780367751616 (pbk)
ISBN: 9781003161257 (ebk)
DOI: 10.4324/9781003161257
Typeset in Joanna
by Deanta Global Publishing Services, Chennai, India
To Tana, with love
