Who could have predicted that in a short period of 25 or 30 years the nuclear family would have fallen from its pivotal position, that nearly 30% of the adult population would live in one-person households, that the stigma associated with children born out of wedlock would disappear, that divorce and remarriage would become commonplace, that single-parent families would become dominant, that living in common-law marriages would have legal sanction, that same-sex couples would gain some recognition and acceptance, and that dazzling technological advances would begin to reverse infertility and give rise to new types of families? These and other less prominent phenomena, such as single women choosing to have babies in their late thirties or even early forties, are current realities. A case can be made that the family therapy literature, at least in part, has not entirely kept pace with the rapid and dramatic changes in family structure in recent times. This chapter has identified this change. The data from Canada, the U.S., and the U.K. demonstrate very similar changes, which suggest that these trends may very well reflect changes in the rest of the Western world. Some of the changes are so dramatic, such as pregnancy through artificial insemination, in which the identity of the donor remains a secret, that their consequences on family dynamics are unknown.

From a practical point of view, we live in an age when any conversation about family must begin with a discussion about family structure in all its diversity. This is crucial because some of the assumptions that underlie systems-based family therapy, such as the symptom being a product of intrafamilial conflict, may not hold. Apart from that, certain family types, such as blended families, do not get adequate attention in the literature. In a review of the clinical literature, Darden and Zimmerman (1992) found that only 10 of 1061 articles in three of the major family therapy journals between 1979 and 1990 were on blended families. A cursory review of the more recent family treatment literature with blended families shows a similar paucity.

Even in relation to single-parent families, which have been around in numbers for the past two decades or more, it is clear from our brief literature review that problems encountered by these families may or may not be amenable to traditional systems-based family treatment. This is almost entirely due to the narrow base upon which systems family therapy is constructed. As noted earlier, the breadth and depth of problems confronting today's poor single-parent families require multifaceted and multimodal interventions that go well beyond the question of whether or not the problems of an adolescent daughter are the product of faulty family structure or faulty communication. This is not to suggest that systems-based family therapy has been made irrelevant by the changing family structure of the last two decades. Rather, there may be risks to view family problems strictly through the prisms of systems family therapy, and it must be used judiciously in conjunction with other methods of family interventions. It is perhaps not so surprising that not a single family therapy outcome study with single-parent families has been reported so for. Even the clinical papers that report on the application of systems-based family therapy with single-parent families give credence to its limitations. It is a sign of family therapy's coming of age and shedding some its early claims of being a panacea for all family vicissitudes.

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