Τετάρτη 27 Μαρτίου 2024

ΤΟΞΙΚΕΣ ΜΟΡΦΕΣ ΑΓΑΠΗΣ

 Γράφει ο Τιμολέων Κυριακίδης

Με το βιβλίο αυτό ο Ψυχίατρος Ψυχοθεραπευτής Νίκος Μαρκέτος,  κοινοποιεί γνώσεις, που σαν θεραπευτής έχει αποκτήσει είτε από την εκπαίδευση του, είτε από τις μελέτες του, είτε από τη θεραπευτική του εμπειρία. 

 Το βιβλίο αυτό απευθύνεται σε μη ειδικούς. Γι΄αυτό έχει αρκετά το εμπειρικό στοιχείο και πολλά παραδείγματα και λιγότερο την αυστηρή βιβλιογραφική μαρτυρία για κάθε άποψη που παρατίθεται, όπως θα είχε μια αμιγώς επιστημονική εργασία. Γι’ αυτόν τον λόγο η κριτική στο βιβλίο χρειάζεται να γίνει και ως προς το κριτήριο κατά πόσο καταφέρνει να είναι ένα κείμενο κατανοητό και εύληπτο για τον μη ειδικό αναγνώστη. Ή σε τι μπορεί να χρησιμεύσει αυτή η εργασία στον λήπτη.

 

Γιατί ένα κείμενο για την αγάπη; 

Στην εποχή μας που οι σχέσεις είναι ρευστές και αναλώσιμες, εντείνεται ο μεταφυσικός της χαρακτήρας αγάπης. Περισσότερο από ποτέ, η αγάπη αναπληρώνει το κενό της ύπαρξης, αντιπροσωπεύει την παρουσία, την υπέρβαση και τη συμβολική αθανασία.

Το παρόν βιβλίο αναφέρεται στις σχέσεις στο ζευγάρι, στις σχέσεις γονιών παιδιών, και γενικότερα στις σχέσεις μέσα στην οικογένεια.

Χρησιμοποιεί τον όρο τοξικότητα γιατί είναι ένας όρος που ακούμε παντού αυτό το καιρό, αλλά ξεκαθαρίζει από την αρχή ότι η τοξικότητα δεν είναι ατομικό χαρακτηριστικό, αλλά χαρακτηριστικό της ίδιας της σχέσης, όταν εδραιώνεται μια νοσηρή δυναμική.

Ο τίτλος αναφέρεται σε τοξικές αγάπες, αλλά επεκτείνεται σε πεδία τοξικών οικείων σχέσεων, στα οποία είναι αμφίβολο αν υπάρχει αγάπη. Έτσι το κείμενο επερωτά τι είναι αυτό το συστατικό που δένει τους ανθρώπους σε σχέσης ζωής. Πολλοί ονομάζουν αγάπη αυτό που τους κρατάει σε ένα δεσμό. Μπορεί αυτό να είναι γνήσια αγάπη ή/και έρωτας, αλλά μπορεί να είναι εξάρτηση, εξουσία, συμφέρον ή φαντασιώσεις και απωθημένα που επιχειρεί το βιβλίο να διερευνήσει.

Η ύλη του βιβλίου είναι κατανεμημένη σε τρία μέρη.

Το πρώτο μέρος παρουσιάζει μια προσέγγιση της έννοιας της αγάπης, καθώς και τη θεώρηση της αγάπης από φιλοσοφικής, ηθικής, λογοτεχνικής και κοινωνικής πλευράς.

Το δεύτερο μέρος εισέρχεται σε γνώριμες δυσλειτουργικές αλληλεπιδράσεις που φθείρουν τη σχέση, όπως είναι οι εξαρτητικές σχέσεις, σχέσεις ελέγχου, σχέσεις εξουσίας, εκμεταλλευτικές σχέσεις, μέχρι τις πιο ακραίες καταστάσεις όπως ο σαδομαζοχισμός και η βία.

Το τρίτο μέρος παρουσιάζει θεωρίες που ερευνούν και εξηγούν πώς οι εκτροπές στη σχέση με τους πρωταρχικούς φροντιστές στα πρώτα χρόνια της ζωής, θέτουν το σκηνικό για τις ενήλικες ερωτικές σχέσεις και τις σχέσεις των γονιών με τα παιδιά τους.

Αυτό το τρίτο μέρος ίσως να ενδιαφέρει πιο πολύ τους ειδικούς. Ωστόσο  και σ’ αυτό το μέρος και ιδιαίτερα με τα πολλά παραδείγματα, μπορεί ο αναγνώστης να βρει κάτι που τον ενδιαφέρει προσωπικά. Αυτό το μέρος περιλαμβάνει ορισμένα σημεία από τις θεωρίες της σχολής των αντικειμενοτρόπων σχέσεων, μέσα από ένα συστημικό ενδιαφέρον για τη συνοργανωτική σχέση των διαφορετικών ιδεών. Επίσης παρουσιάζει την Θεωρία Πρόσδεσης (attachment) και τη θεωρία του Bowen.

Αναφορικά με τις θεωρίες Αντικειμενοτρόπων σχέσεων παρουσιάζει στοιχεία από τις θεωρίες της Melanie Klein, του  Ronald Fairnbairn (και ειδικά την «Ηθική άμυνα απέναντι στα κακά αντικείμενα»), του Wilfred Bion (και ειδικότερα την «προβλητική ταύτιση και Εμπερίεξη (Containment)»), της Margaret Mahler («στάδιο Αποχωρισμού – Ατομικοποίησης»), του Heinz Kohut (στοιχεία από τη «Ψυχολογία του εαυτού») και του Donald Winnicott  (ειδικότερα τον «ψευδή εαυτό»).

Συμπερασματικά, το παρόν βιβλίο πετυχαίνει να αποτελέσει ερέθισμα για μοίρασμα εμπειριών και μέσα από το μοίρασμα να αναγνωρίσει ο καθένας τη δική του συμμετοχή στη δυσλειτουργία της σχέσης και κατά συνέπεια να αποδίδει λιγότερο στους άλλους το φταίξιμο.


Δευτέρα 10 Ιουλίου 2023

TEACHING FAMILY THERAPY AT THE INTRODUCTORY LEVEL: A CONCEPTUAL MODEL EMPHASIZING A PATTERN WHICH CONNECTS TRAINING AND THERAPY*

 Howard Arthur Liddle

Institute /or Juvenile Research


George William Saba

Philadelphia Child G uidance Clinic


 

This paper details the structure and content o/ an introductory /amil y therapy course offered in an academic department. The para,llel processes between teaching and therapy are used as a metaphor /or the presentation o/ the course. Joining, restructuring, and consolidation are defined as the three stages o/ the course, each having distinct goals and methods. Finally, generic issues raised by the proposed teaching model are presented /or trainers to consider.

 

A recent review of the family therapy training and supervision literature revealed considerable inconsistency and variation on the topic of training program descriptions (Liddle and Halpin, 1978). Most of the recent literature details the clinical components of training programs and usually focuses on aspects of the adopted supervisory model (e.g., Dell, Sheely, Pullian and Goolishian, 1977; Stier and Goldenberg, 1975). Although there have been descriptions of the ingredients of complete training packages (e.g., Constan- tine, 1976; Duh1 and Duh1, 1976; Garfield, 1979; LAbate, Berger, Wright and O'Shea, 1979; Mendelsohn and Ferber, 1972; Rosenbaum and Serrano, 1979), few have been within academic departments. Because of the documented increase in family therapy training within university settings, a need exists for more work in specifying teaching models in these contexts.

This paper presenŁs a conceptual and pragmatic framework for an introductory level family therapy course or training experience. The course represented in this paper was the first level of a three-phased elective family therapy sequence in an American Psychological Association-Approved counseling psychology department.

 

Gaining and Therap y: Conceptual and Pragmatic Parallels

Several components of the training situation are mirrored in the therapeutic arena; conversely, the therapeutic model parallel.s the model used to teach it. Examples would include: the necessity of goal formulation, the inevitability of hierarchy in systems, the interface of training / family systems with broader systems, the importance of utilizing systemic feedback in modifying / designing interventions, the methods of accommodating


*This paper wa8 developed during the senior author's tenure as a faculty member in the Department of Counseling Psychology,'lémple University. Part8 of this paper were presented at the 1980 AAMFT Annual Conference, November 6—9, ’Ibronto, Canada.

Howard Arthur Liddle, EdD, is Director, Family Systems Department, Institute for Juvenile

Research, 907 South Wolcott, Chicago, IL 60612.

George William Saba, MA, is a Doctoral Candidate, Department of Counseling Psychology, Tbmple University, Philadelphia, PA 19104.

Januarv 1982                                                                                          63


various learning styles, and sequential / stage-specific nature of training and therapy.

The principles governing the essence of therapy and training can be seen as reflective of each other. For example, the constructs comprising one's theory of change in therapy reflect and can, therefore, be utilized in understanding the theory of change in training. Both therapy and training are, at their most elemental levels, concerned with demonstrable behavioral change. Both attempt, as Minuchin (1974) and Haley (1976) have said in discussing therapy, to introduce more complexity or behavioral alternatives into the repertoires of clients and trainees. From this perspective, it is our contention that trainers can be aided by a cognizance of the conceptual and pragmatic transferability of constructs from the therapeutic to the training/teaching domain.

 

COURSE DEVELOPMENT, DESIGN, AND OBJECTIVES

The teaching model described herein is the culmination of teaching various versions of an entry level graduate family therapy course over the past six years. As teaching methods and course activities were found inefficient, they were replaced with new, more productive components. This paper represents the logical and pragmatic progression of effort in course design, format, and technique.

The generic objective or meta-goal of the course was to facilitate the interpersonal or systemic paradigm shift—the capacity to conceptualize human problems and their resolution in interactional rather than individualistic w‹iys. The interactional perspec- tive emphasizes a holistic, ecologic, cybernetic, objects-as-interrelated world view. This emphasis on wholes, patterns and relationships represents a sharp contrast to the atomistic, reductionary, Newtonian image of the world as the mechanistic aggregate of parts in isolable causal relations. The meta-goal of the systemic paradigm shift served as a blueprint or foundation upon which all other objectives and course activities were based.

In becoming systemic thinkers, family therapists must be careful to remain sensitive

to the individual differences of family members. Families are systems, but so, too, are individuals. Considerable experimental evidence has accumulated verifying the human brain's hemispheric asymmetry and specialization (Watzlawick, 1978). Only recently has this research been directly applied to the therapeutic domain, although the concepts have been discussed previously. This research has direct and pragmatic implications for teachers of therapy. The introductory course was designed and modified to take into account the individual differences or idiosyncratic learning styles of the trainees. Our research on the effects of live supervision confirms the importance of appreciating individual learning styles in training therapists. The introductory course, therefore, offered a broad spectrum of activities and assignmeni:s designed to be receptive to hemispheric specialization (Prosky, 1979) and individual learning styles (Constantine, 1976; Duh1 and Duh1, 1976).

 

Gaining and Therapy in lstages

Just as therapy has been viewed in stages (Haley, 1976), an introductory course or complete training package can also be conceived in a sequential or stage-specific manner. Aspects of the strategic (Haley, 1976) and structural schools of therapy (Minuchin, 1974) were utilized to form the conceptual base of the present teaching model. Although other major schools of thought were taught in the course, these models were especially useful in serving as an organizing metaphor due to their sequential nature, goal-directed focus, and conceptual clarity. The course was punctuated in three phases: joining, Restructur- ing, and Consolidation. Th ese therapeutic stages were adapted for use in conceptualizing the stages of teaching family therapy at the introductory level.

Phase I.’ Joining. Learning about family therapy, perhaps more than other academic

 

 

 

64                       JOURNAL. OF MARITAL. AND FAMIET THERAPY                                        January 1982


content areas, requires a student's willingness to suspend, at least temporarily, his existing view of reality. Further, it requires the trainee to adopt, at least in experimental spirit, ideas about the etiology and treatment of human problems which are often quite alien to the student's previous training and experience. As in therapy, experimentation with untried and foreign ways of thinking and behaving can pose substantive personal threat in the learning situation. From this perspective, the importance ofjoining can be discussed.

In Structural Family Therapy, all therapeutic operations are classified into the two categories of accommodation and restructuring. The latter set of techniques is more obvious, dramatic, and represents the core of Minuchin's model of therapy. However, the accommodating or joining procedures make the stress of the restructuring techniques tolerable to the family system. These joining maneuvers, which sow the seeds of conceptual and perceptual change, comprise the initial phase of the course.

The difficulty of shifting a beginning trainee's intrapsychic, monadic epistemology of human behavior cannot be over-emphasized. The process is similar to that which occurs with a family upon their entrance to the therapeutic context. Families, like all other rule-governed, homeostatic systems, are naturally resistant to change, yet the forces of homeostasis and transformation are balanced in the course of its lifp. ’IYainees operate according to identical principles. The alteration or abandonment of intrapersonal theories of behavior is a major transformational process in the trainee's life. This change has reverberations in both the trainee's personal and professional contexts. ’IYainers must be cognizant of the ways the homeostasis/transformation principle is applicable to and altered by a systemic paradigm shift. The present model relies on the joining/ accommodation operations to set the stage for later unbalancing and eventual transformation.

Different therapy schools have slightly different ways of describing this process. Haley (1976) refers to changing the patient and family's metaphor; Watzlawick, Weakland and Fisch (1974) describe initial goals of therapy in terms of changing the world view of clients; while Minuchin (1974) excludes the possibility of creating new relational realities until the therapist first joins with the family system.

These representations are useful in describing the goals of the beginning phase of teaching. Students present world views and experiences of relational reality which are linear (caus effect) and intrapsychic. Just as Haley's model of therapy stresses an initial joining with the family's view of the identified patient as the problem, our teaching model stresses a first phase characterized by strategies ofjoining and non-confrontation. This prepares the trainee for the eventual conceptual and perceptual restructuring—the essential goals of the course. In this phase, it is important that the teacher be respectful and non-critical in evaluating the previous experience and training of the student. Students, who have sometimes made considerable investments of time, energy and money in previous training, cannot be expected to respond receptively to new views when informed of the uselessness of their previous experience and training. In sum, the initial joining operations, as in therapy, seem essential to successful family therapy teaching.

Phase I generally occurs during the first two class meetings, or approximately 159c of the total available classes. The two units of study in Phase I include the role and function of theory in family therapy and the major principles of the systems or contextual view. For these units, students were required to give two-page written reactions to six assigned readings. Students grapple with such questions as: What is a theory of therapy? What is its usefulness? What are the characteristics ofa usable theory? At this beginning phase of the course, they are asked to make explicit their own views on a personal theory of dysfunction (pathology) and theory of change. This is stressed so that students can begin to understand how one's theory, world view, or way Of defining therapeutic reality is relative and not absolute. Students are taught that one's theory does not reflect a given

January 1982   JOt/ftNAL OF MARITAL AND FAMILY THERAPY                        65


"true" or "objective" reality, but instead, one's theory or view creates one's reality (Weakland and Watzlawick, 1977). In this way, "truth" or "reality" become more one's creation than one's discovery.

The second unit of study within this initial phase is the major constructs of systems theory (Lilienfeld, 1978). Further, this phase consists of a redefinition of symptoms from an interactional perspective as well as an appreciation for how symptoms serve relational functions in stabilizing and maintaining the individual/family at any given developmental level. Basic descriptions of these crucial concepts are available for trainees in a variety of sources (Haley, 1971a, 1971b; Haley, 1980; Minuchin, 1974; Watzlawick et al., 1967). Although nearly twenty years since its publication, Haley's (1963) first chapter in his book lstrategies o( Psychotherap y, "Symptoms as tactics in human relationships," is still a useful source in this regard.

In sum, an organizing principle of this stage is to begin students' thinking in

interactional terms so that family, rather than individual process, is emphasized. In this way, family therapy can be seen as an orientation rather than as a modality method of solving human problems (Haley, 197 la). Guerin's (1976) historical overview of the field provides useful reading in this regard.

'l'his first phase loosens some of the previously held conceptions of the nature and locus of dysfunction and therapeutic change in a manner which transcends schools of thought. The goal is to provide a conceptual groundwork of systems thinking upon which the various schools of family therapy can be built.

Sluzki (1974) clearly stated the importance of a trainer's work at this phase, observing that trainees initially come to training with either a "traditional medical model or an intra-personal psychological model, both of which tend to channel their initial observations and reasoning along dichotomous lines" (p. 483). Sluzki concludes,

Thi8 poses a serious additional problem for training because, until that primary, often unrecognized injunction is modified, no broader epistemological basis can be transmitted. Before being able to learn alternative perspectives, a trainee may have to unlearn the constrictive conviction that there are no alternatives (p. 454).

In addition, Minuchin often refers to his structural model as a "therapy of alternatives." Like therapy, training then becomes a broadening enterprise, oriented toward expanding the cognitive and affective range of trainees.

Phase II. Restructuring. In Structural Family Therapy, restructuring is the second stage of the therapeutic proce.ss. The therapist's joining with the family has prepared them for the new relational realities they will experience both within and outside of the sessions. The principle of enactment allows the therapist, through his direction, to give old interactional scenarios new, more productive endings. The therapist uses tasks to both test the family's flexibility for change and begin the actual process of changing the relational sequences. Again, the teaching paradigm parallels the therapeutic processes of this stage. The instructor has laid the conceptual groundwork for more content- oriented and substantive input and change. By this stage, the systems or contextual framework has begun to take hold and students find themselves more able, at least experimentally, to view therapy from this new lens. Our framework for the family therapy schools provided both a comparative schema across schools and a comprehensive set of dimensions within each perspective (see 3hble 1).

Videotape and film presentations of the various models assume considerable importance during this second phase. These methods have empirically demonstrated their usefulness in motivating students to learn more about and sustain interest in the particular model under discussion (Stone, 1975). In Minuchin's terms, this phase of teaching allows for enactments. The theories (schools) can be enacted in the class or their enactment illustrated via film and videotape.

 

 

 

66                       JOURNAL OF MARITAL AND FAMILY THERAPY                                        January 1982


The use of simulated family sessions has been described positively (Bardill, 1976; Weingarten, 1979) and criticized in the literature (Haley, 1976). Simulated family sessions were used as part of one class per term, and involved one student therapist meeting with the simulated family for at least 30 minutes. The session was observed by other students and a live supervision component was built into each simulation.

Another integral component of Phase II was the observation papers to all films and videotapes. The observation papers were included to sharpen student's perc•.ptual,

 

 


 

-.      .


'Ihble 1

Dimension.. s of Wi-thin-Sch-o- ol .Theo..ry.Ana. lysi.e.


 

I.      Introduction

1.   Biographical Sketch: personal background training orientation of main proponent/ theorist.

2.  Background/Development: historical and developmental aspects of the approach. Diacussea settings in which approach was developed and problems/populations with which it haa been used.

 

II.    Conceptual Elements o[ the Approach

1.  Philosophy and Aaaumptiona: philosophical roots and ba8ic assumptions.

2.  Normative Family Development: examines the theory of functional families and normal family development.

3.  Theory of Individual/Family Dysfunction: components of dysfunctional behavior, critical event8 (developmental and innate) in the development, and acquisition of dysfunctional behavior (how are symptoms formed and maintained?).

 

III.     Clinical Elements o[ the Approach

1.   Goals of Therapy: nature and kind of therapeutic objectives (expected outcomes). Address the importance and role of therapeutic goals, effects of therapist values, and the process of goal definition (Who definea goals and by whom are they evaluated?).

2.  Role and Function of the Therapist: major techniques utilized to achieve the goals. 'Tbchniquea are discussed in terms of the kind of influence they are intended to have. Definea the behaviors required of a therapist working from this approach. (What therapist characteristics are necessary to function from this mode?)

3.  Process of Therapy: the expected nature of the course or development of therapy (stages of treatment).

4.  Mechanisms and Theory of Change: describes the proceaa and ingredients that produce expected change. Address sequence or order of change, and transferability of in-therapy change to life outside of therapy. Defines principles governing behavior changes rind waya these propositions are related.

5.   Basic Concepts: summary.

 

IV.    fiuofuotion, Current istatus, end Futune Directions

1.   Contributions: defines the unique contributions of the model in terma of both theoretical constructs and clinical utility, and research that the approach has generated.

2.  Limitationa: evaluates the model on the criteria used for evaluating a theory: preciaeneaa and clarity, simplicity, comprehen8iveness, operational, heuristic value, defines the process and mechanismß of planned therapeu*vic change, predictive value, capable of evaluation, usefulness to practitioners, teachability.

3.  Application: explores the difficultiea of implementing the approach in various contexts, discusaes the current statua of the model's application, and offers hypothesea on future direction of the model'8 development and applicability.


 

 

 

 

January 1982          JO(/ftNAL OR’ MARITAL AND KiAMILY THERAPY                          67


conceptual (2bmm and Wright, 1979), and intervention-generating capacities through the use of film or video. Students were asked to provide their written observations to the media stimuli in the four areas on which they would be tested in the final exam—family processes, therapist behavior, process of the session, and proposed direction of future sessions.

Phose III: Consolidation. This phase consisted of the student’s capacity to integrate the systemic paradigm shift into their professional lives. Here, the personal and professional consequences of adopting a family-oriented view assume prominence.

In therapy, families are eventually helped to become accustomed to the changes achieved in therapy. Rainees need assistance in "sealing" or "cementing" these changes as well. In our teaching, this phase consisted of the students' efforts to integrate the systemic paradigm shift, to the degree that they have achieved it, into their work setting. In their fieldwork and work contexts students were challenged and awakened to the political and pragmatic implications of adopting a family-oriented view (Haley, 1975). At the course's conclusion, most students developed at least some cognizance of what has been termed the politics of family therapy (Liddle, l978ii. During this phase, students faced a decision point and stage of crisis. They learneil the pragmatic gap between learning about systems theory and being able to implement it in non-systemic therapeutic contexts, i.e., their work settings.

The reactions to the assigned readings and observation papers continued through

this third phase and were joined by two other central course activities—the family therapist interview and the critical analysis paper. The family therapist interview was an opportunity for students to meet and interview a local practicing family therapist for the purpose of operationalizing some of their assumptions about the role and function of a therapist working from a family perspective. The critical analysis paper was an opportunity for students to read the original sources of one of the many theorists covered in Phase II of the course, present the model in an organized way, and critique the model according to relevant, predetermined dimensions (see Table 1).

The concluding activity of Phase III was the final exam. Since the course was not only oriented toward the facilitation of a theoretical expertise, but was also aimed at understanding the model's concepts along with its prescribed therapeutic behavior, a different kind of final evaluation was devised. 2b test the students only through their ability to define and differentiate concepts, apart from the clinical situation, would have been inconsistent with the previous focus of the course. The final exam consisted of students viewing a 60-minute videotape of an actual family session, and then answering the series of questions appearing in Table 2.

As previously stated, these content areas corresponded exactly with those with which the students had gained considerable practice during the course of the semester. This made the final evaluation a natural culmination of the term's activities. This evaluation procedure, easily replicable in any context wii.h videotape equipment, serves as a useful indicator of a trainee's capacity to think of problems interactionally, critique therapist behavior, conceptualize overall strategy, and generate specific interventions for future sessions.

Sizmmarizing the course, during the Joining phase, students become familiar with an interactional (sequences of behavior) rather than intrapsychic (internal mental or emotional processes) epistemology and language. They begin to perceive reality, and more specifically, human problems, in units broader than individuals. The ftes/ruc/ttring phase challenges students to learn and experiment with new concepts from differing schools. In the Consolidation phase, students are required to take personal and theoretical risks in integrating the various approaches into their professional identities.

 

 

 

 

 

68                                                                                                              Januaryl982


EVALUATION

This section discusses the evaluation and evolution of the course over its six-year history. At the end of each term, all students completed an anonymous course evaluation

 

Most beneficial aspects. The tapes and films have proven to be an indispensable element in teaching family therapy. A number of commercially available non-therapy oriented popular films can also be useful in helping students practice thinking in terms of family. These include S!cenes from a Marriage, Autumn S!onata, A Woman Under the Influence, I Neuer hang for M y Father, Interiors, The Stubject Was Roses, and Who's A fraid of Virginia JYoo//?

The required written observation reports on the film and video material have been evaluated favorably. As one student aptly said, ”It's hard for me to speak up in a class of this size. These papers forced me to concretize my observations and gave me the chance to personally check out the validity of these observations with the professor.“

Feedback on the final exam and critical analysis papers indicates that these

 


3Bble 2

Videotape observation and reactions

The following outline ahould be used to organize your response to the videotaped family interview. Answer as many of the questions aa poa8ible in the lYz-hour time limit.

 

I.   F'amil y Interactions

1.   What are the major issues this family preaent8 which need to be addressed? Rank order these content areas according to your priority for dealing with them as this family's therapist.

2.  What is the purpose of the symptom(s) in relation to the total family context?

3.  Are there observable patterns of interaction which maintain the symptomatic behavior? In other words, what perpetuates the symptom?

4.   What are the patterns/sequences of family interaction which need to be changed? Be specific.

 

II.   Therapist Behavior

1.   What topic or content area is the therapist interested in?

2.  'Ibchniques therapist used in getting this information.

3.  Select at least two (2) therapist techniques and hypothesize as to the rationale behind these interventions. Were the interventions successful, and how did you evaluate their success?

4.   What was the therapist's influence or impact on the family? How did you assess that?

5.  How could this impact have been dif'ferent?

 

III.     Direction for Future lsessiona

1.   What would be your overall therapeutic strategy or plan with thi8 family?

2.   What specific techniques would you utilize to implement this strategy?

3.  From which theoretical model/position are you working? What are the basic assumptions of this approach?

4.   What is your theory of change for this particular family? What must happen for the individuals and the family to change? What specific therapist behaviors are necessary for effective work with this family?

5.   What problems do you foresee in attempting to implement your strategy/techniques? What will you do about these problems?

6.  How will you assess your ef'fectiveness? What are your criteria?

January 1982      JOURNAL OF MARITAL AND FAMIEY THERAPY                         69


activities serve their synthesizing and integrative functions. The video final is seen as an innovative, stimulating and challenging procedure useiul in assessing one's observa- tional and intervention-generation skills.

Leost 6ene Sof aspeets. Since the goals of Phase I are often redundant for some students with previous exposure to systems thinking, this group sometimes found the beginning phase of the course to move too slowly. Before a consistent and comprehensive framework was developed to present the various models, students frequently found the course disjointed, unsystematic and lacking in coherence. The addition of this kind and degree of structure, however, allowed the course's objectives to become more immediately perceived and more consistently realized.

Outcomes

The final section on Evaluation addresses some of the students' views on the effects of the course. One pervasive effect was the course's ability to spark student interest for clinical training in family therapy.

Another outcome, which was at first unexpected, concerned the course's personal impact on the lives of the students. Although not intended to be a course which makes the students more aware of their current fami lies or families of origin, the systematic Study of certain schools within the field seemed to inevitably lead to effects in this area with some Students. Especially after exposure to the work of such theorists as Bowen, Framo, and Borzormenyi-Nagy, students requested the opportunity to write family autobiog- raphies. With or without a formal assignment in this personal impact area a course on family therapy does affect the personal life of many trainees. This finding has previously been discussed by Framo who does utilize family autobiographies as a required part of his teaching (Framo, 1979).

The more pervasive outcome of the course, however, was in the ways it affected the Students' view of human problems. The following comments illustrate the impact in this regard,

It challenged me to think in new ways and rethink old issues I thought I had resolved.

My eyes have been opened to a whole new way of viewing pathology. Clients are no longer isolates to me. I see them in relation to their environment which includes the family as well as myself, the therapist.

It provided a solid theoretical rationale and body of knowledge for what I intuitively

believed before.

Finally, this last quote sums up the disequilibrating process often begun by a course of this nature:

Actually, it has complicated things for m  but there's positive value in getting shook up.

The final student's experience is typical and reflective of the majority of student reactions. Once students actively involve themselves in learning about and experience first-hand the systemic view, they report difficulty in returning to their previous intrapsychic epistemology of human behavior. That is, students reach a point where they might still be confused about the interface (or lack of it) between individual and systems theory, but from a certain point onward they appear not t‹i be able to discard the systems lens.

 

DISCUSSION

In his final and synthesizing work, Mind and Nature.’ A Necessary Unity, Bateson (1979) poses some basic propositions about the relatedness of all living things. A letter to

 

 

 

 

 

70                            JOURNAL. OF MARITAL. AND FAWIL.Y THERAPY                                fl'anuacy 1982


his fellow regents of the University of California warned, “Break the pattern which connects the items of learning and you necessarily destroy all quality” (1979, p. 18). The present paper has attempted to build a teaching model for an introductory level family therapy training experience. The rationale, goals, and methods of an entry-level university-based course have been detailed using the stages of therapy as a metaphor for the presentation. In attempting to heed Bateson's dictum, we have presented one interpretation of some patterns which connects the teaching and practice of family therapy.

The process of solidifying our teaching paradigm has led to the formulation of several questions relevant for teachers of family therapy. This final section poses some of these as yet unanswered questions in a spirit of issue-generation.

1.   What are “the patterns which connect” individual learning styles and teaching methodology and content? What are the teaching / learning implications of the recent research findings on hemispheric specialization?

2.   What are the effects of a trainer adopting any given teaching / training mode as compared to other models?

3.   The present paper has attempted to describe a model of teaching family therapy principles by using the metaphor of a pattern which connects therapy and training. The strategic and structural schools of thought were accessed in this regard because of their sequential, goal-directed focus. How would other teaching paradigms (using metaphors from other schools of therapeutic thought) be alike or dissimilar to the present model?

4.   What are the available methods of evaluating trainees? Are these methods adequately linked to training objectives?

5.   What is the role of the student's personal issues and the relevance of personal growth in the training-learning process? Are these dimensions tied to particular training paradigms? Or are they inevitabilities of the training process?

6.   Whitaker (1976) has been known to declare to a family, “I'm here to get some things for myself, too.” In this way, he presents the family with the idea that he, as well as they, will be trying to obtain something positive from the therapeutic encounter. Should supervisors, at least covertly, make the same “selfish” demands of their work?

7.   Along these same lines, we might ask the question, Are there teaching / training methodologies which prematurely precipitate trainer burn-out? A recent survey assessing psychotherapy trainees' preferences regarding various aspects of supervision emphasized the importance of a supervisor's morale, motivation, and committment to supervision, at least as perceived by the trainee (Nelson, 1978). Along these lines, which supervisory models contribute to high and low supervisor interest?

8.   What usual and non-traditional mechanisms exist for sharing information, techniques, philosophies, etc., of teaching family therapy? How can trainers begin to observe, trade, and refine their teaching methods as the pioneer family therapists did with their therapeutic methods in the 1950s and 1960s? Along these lines, few conference/workshop availabilities exist specifically on training / supervision. Is it premature to hope for more effort along these lines?

In conclusion, our hope is that the teaching model presented in this paper will stimulate more interest in building theoretical paradigms of the training process—an activity that has lagged behind construction of therapy theories. This paper represents one view of some patterns connecting training and therapy and is offered as a reference point which can facilitate other training model generation and development.

 

 

 

 

January 1982        JOURNAL OF ñfARITA  AND FAñfILY THERAPY