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The Therapist’s Most Important Tool - Page 3

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Over time, these experiential learnings developed into theories of how to therapeutically engage families, and institutes were created where therapists could learn how to work in this new way. To get training as a family therapist, a clinician, who was probably originally an individual therapist, might attend one of the institutes of family therapy, such as the Mental Research Institute, the Philadelphia Child Guidance Center, the Georgetown Family Institute, or the Ackerman Institute. The therapy room was the classroom, where the learning took place by doing. These institutes mainly provided a particular view of why families have difficulties and what therapists could do to help them. The people who came to learn were offered training that was grounded primarily in one approach. They weren’t bombarded with the multitude of different theories that the present generation of students is struggling to assimilate.

Currently, new practitioners in family therapy are trained in university settings, not institutes. Learning comes from textbooks for classes that try to provide a wide foundation for the field, so that people have the knowledge designated as necessary by state licensing boards. The brunt of learning comes in the classroom, rather than the therapy room. Students are expected to digest a variety of approaches, then are asked to use one or more of these theories as a guideline for their practice when they begin to see families.

A few years ago, I was invited by colleagues at Nova Southeastern University to conduct an informal training practicum for bright graduate students, who were just beginning their experience as practitioners. My goal was to offer an alternative to the type of training generally provided, in which they first learn the theories that are the foundations of the diverse schools of family therapy, and then apply theory to practice. Through this procedure, trainees are learning to be restrained, protective, and respectful of the client, to avoid entering into conflict with patients, and to search for the techniques that “truly fit” the problem that the clients present. In effect, they’re training for cautiousness, guarding against the imposition of their own framework on problems that the family presents. If my view about this training is correct, it’s a training that discourages students from looking at themselves as resources in the therapeutic practice.

In accepting the invitation of my colleagues at Nova, I joined them in exploring a different, more inductive process of training. We started out without a clear curriculum, simply asking the students to bring videotapes from the therapy sessions they were conducting in practicum situations. We observed the style and nature of their work and talked with them about their experiences. Over time, we were able to move toward the development of a method for training in the craft of family therapy.

Our first observations of the students at work provided important building blocks for this development. As they began to interview families, their styles of interviewing presented some common characteristics. They were, of course, anxious, since they had scant experience with encounters involving more than one person, and they usually proceeded with caution and were polite. They asked questions that were frequently a paraphrasing of the client’s last statement, such as “So you said that it troubled you when you saw what your daughter was doing?” They also asked questions that encouraged clients to continue explaining, as well as questions directed at tracking the narrative but without opening up new explorations. Paradoxically, they also became quickly engaged in trying to explain, support, protect, or improve the family drama.

The combination put these new practitioners in a quandary. They were engaged in monitoring narrow aspects of the family presentation before they had a clear knowledge of how the family members related, their history, or their efforts at problem solving. They felt the need to do something to demonstrate their competence and responded to family problems before knowing the family. Most didn’t know how to be silent or how to use silence as a tool. And, noticeably, they focused mostly on the pathology the family offered as the reason for requesting help, ignoring the exploration of strength, resilience, and resources by which family members might become helpers of each other.

Our students came with different life experiences, but we noticed a major commonality in their presentation of cases: they didn’t include themselves in the process. They’d describe the family dynamics, sometimes with surprising clarity, but always as if they were objective, neutral observers. When we asked for feedback from students observing the tapes, they responded with alternative descriptions of the family’s transactions, but the participation of the therapist in producing this behavior wasn’t mentioned.

These lacunae, empty spaces in observing and describing the therapeutic process, were surprising to me. I remembered that at the beginning of the family therapist movement, all training programs struggled with the issue of the participation of the therapist in the therapeutic process, and with the therapist’s awareness of that reality. At that time, most trainees in family therapy came with some experience in psychodynamic individual therapy, and many had undergone their own psychotherapy or psychoanalysis. The family therapy trainers needed to address the necessity of providing an alternative to the long, intensive involvement in self-observation that psychodynamic therapy provided.

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