Core competencies in social constructionist supervision?

Family therapy is moving increasingly toward evidence-based practice and competency-based training. This article explores what might seem to be an unlikely link between social constructionist supervision, which is based on dialogic and fluid processes of meaning-making, and the increasing reliance on discrete core competencies in the education and training of family therapists. We propose an alternate approach to competencies for supervision with therapists in training that, among other things, invites accountability and provides evaluative props. The approach we propose is based on a set of orientations that we hope reflect the dialogic and contextual nature of social constructionist practice and supervision. These orientations consist of reflexivity and attention to power, fostering polyphony and generativity, collaborative stance, and focus on client resourcefulness. Ideas and questions for supervisors and therapists in training to address the orientations are articulated.

Social class in family therapy education: experiences of low SES students

In this article, we report the results of a national survey of students in COAMFTE-accredited family therapy programs who self-identify as coming from lower- or working-class backgrounds. Results of the study reveal opportunity and tension relative to family, friends, and community because of social mobility associated with graduate education. Participants describe family therapy education as middle-class centered, pointing to lack of attention to social class, marginalization, classism, and unacknowledged class barriers as salient experiences in their graduate programs. Finally, participants share a number of suggestions for program improvement.

Family therapy training in child and adolescent psychiatry fellowship programs

OBJECTIVE

This study describes the current state of family therapy training in a sample of child and adolescent psychiatry fellowship programs.

METHOD

Child and adolescent psychiatry fellows (N=66) from seven training programs completed a questionnaire assessing demographics, family therapy training experiences, common models of treatment and supervision, attitudes about family therapy, and perspectives on clinical training and clinical skill.

RESULTS

Fellows ascribed a high degree of importance to family therapy skills, yet most had not seen more than one outpatient family with family therapy supervision during their training. They identified structural family therapy and family psychoeducation as the primary family treatment orientations in their programs.

CONCLUSION

Although child psychiatry fellows believed that strong family therapy skills would benefit their patients, most had limited supervised experiences with families. Child and adolescent psychiatry training programs appear to offer exposure to family therapy without sufficient opportunities to develop proficiency. The author discusses educational implications for child and adolescent psychiatry.

The daily events and emotions of master's-level family therapy trainees in off-campus practicum settings

The Day Reconstruction Method (DRM) was used to assess the daily events and emotions of one program's master's-level family therapy trainees in off-campus practicum settings. This study examines the DRM reports of 35 family therapy trainees in the second year of their master's program in marriage and family therapy. Four themes emerged from the results: (i) Personal contact with peers-in-training engenders the most positive emotions during practicum; (ii) Trainees experience more positive emotions during therapy with families and couples in comparison with therapy with individuals; (iii) Positive affect increases over the course of a student's practicum year; and (iv) Trainees experience less positive affect in individual supervision in comparison with most other training activities. Flow theory offers guidance for supervisors helping trainees face developmental challenges of clinical training.

"Her energy kind of went into a different place": a qualitative study examining supervisors' experience of promoting reflexive learning in students

For family therapists in training, a key learning outcome is the development of reflexive abilities. This study explores the experience of three experienced training supervisors as they address this learning outcome with students. Transcripts of semi-structured interviews were analyzed using interpretative phenomenological analysis. The Supervisory Relationship emerged as a single overarching theme that contained and contextualized three further themes: Promoting Learning, Dimensions of Power, and The Self of the Supervisor. One theme is reported here, Promoting Learning, with an illustrative example of experiential learning in a student that demonstrates the overriding significance of The Supervisory Relationship. The findings are discussed in the context of current literature and research regarding supervision and training. This study adds richness and detail to material published on supervisory experience, and documents supervisory "micro-skills" relevant to the development of reflexive abilities in students.

Developing a contextual consciousness: learning to address gender, societal power, and culture in clinical practice

Despite the growing number of culturally sensitive training models and considerable literature on the importance of training clinicians in larger contextual issues, research examining how students learn to apply these issues is limited. In this participatory action research project, we systematically studied our own process as marriage and family therapy (MFT) practicum students developing a contextual consciousness. Using grounded theory, we identified a three-stage process: (a) raised awareness through clinical experimentation and developing a theoretical rationale, (b) reflective questioning involving challenging old perspectives and experiencing positive client-therapist interactions, and (c) an intentional new lens based on personal responsibility and commitment. Creating and maintaining a contextual lens required a safe, empowering group dynamic and accessing other forms of support and accountability after the practicum.

The golden pig, reflections as ancestral blessings: the reflecting process in teaching family therapy

This is an example of a postmodern, dialogical approach to teaching family therapy based on the work of such practitioners as Tom Andersen, Michael White, and Lynn Hoffman, among others. It demonstrates the way in which the reflecting process connects all of the participants in a web of meanings both educational and transformational. This particular consultation, which includes the author, her graduate students, the client, and guest participant Lynn Hoffman, ends with an unexpected ritual of intergenerational appreciation. Privileging the transcript, it is presented as a kind of theatre where the learning is revealed more through the dialogue than through authorial analysis. The experience is embedded in an "ethics of participation" (Hoffman, 1992) where social connectedness and attunement are key.

The role of the therapist: what effective therapists do

After expressing enthusiastic agreement with Blow, Davis, and Sprenkle's (in press) call for research focused on what effective therapists do in therapy, this article dissents from two notions that serve as the foundation for these authors' ongoing advocacy of client-worldview/model-worldview matching as a privileged means of enhancing therapeutic outcome. In response to their assumption that client-worldview/model-worldview dissonance almost inevitably produces a therapy-threatening disruption of the therapeutic alliance, two scenarios are described in which such dissonance can not only be compatible with, but might also even contribute to, positive therapeutic outcome. In response to Blow and colleagues' notion that extant research supports the superior efficacy of client-model matching, this article underlines that the research they cite is substantially mute on the matter of switching models in order to accommodate to client worldview.

Training for collaboration: collaborative practice skills for mental health professionals

The purpose of the study was to identify skills that mental health practitioners need for successful collaborative practice in medical settings. Known experts in the field of collaborative health care completed a survey designed to elicit their suggestions about what is needed for successful collaborative care practice. Through qualitative analysis, a set of 56 skills was developed. These skills are organized into three general categories of competency: (a) skills for working in a medical setting; (b) skills for working with patients; and (c) skills for collaborating with healthcare providers.

Centering the voices of international students in family studies and family therapy graduate programs

In this article, we report the results of a survey that accessed the perceptions of family studies and family therapy international master's and doctoral students across the United States. Our goals included giving collective voice to the experience of international students and gathering their suggestions for improving programs. Themes that emerged from responses to open- and closed-ended questions included feeling (mis)understood and (de)valued; forming personal connections and experiencing marginalization; the importance of including international perspectives in curricula; considering the relevance/transferability of knowledge; and attending to barriers to learning. Based on the results, we share suggestions for improving family studies and family therapy graduate programs relative to program planning, curricula revision, teaching strategies, and faculty development.

Making a difference in making miracles: common roadblocks to miracle question effectiveness

This article describes a clinical investigation of student-therapists' use of the miracle question (MQ). Data used for this project came from transcribed role-play videotapes by six student-therapists. Transcripts were coded, and findings highlight challenges that prevent beginning therapists from effectively using the MQ. The primary themes that emerged were problems related to introducing, framing, and following up on the MQ. Practical recommendations are offered for improving therapist training in effective use of the MQ.

Transformative learning through international immersion: building multicultural competence in family therapy and counseling

This study explores the experiences of graduate students who completed one of two international courses facilitated by family therapy faculty in a U.S. master's-level counseling psychology department. Participants reported that international courses were personally and professionally transformative. Spending time in a foreign country gave them opportunities to learn from cultural differences, ultimately increasing the social and global awareness required for multicultural sensitivity. Experiential learning, reflection, and dialogue resulted in raised critical consciousness among participants. In this article, we discuss the transformational learning processes embedded in international courses and the potential benefits of these experiences on the development of multicultural sensitivity in family therapists and counselors in training.

Implementation of AF-CBT by community practitioners serving child welfare and mental health: a randomized trial

The Partnerships for Families project is a randomized clinical trial designed to evaluate the implementation of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT), an evidence-based treatment for family conflict, coercion, and aggression, including child physical abuse. To evaluate the effectiveness of a training program in this model, 182 community practitioners from 10 agencies were randomized to receive AF-CBT training (n = 90) using a learning community model (workshops, consultation visits) or Training as Usual (TAU; n = 92) which provided trainings per agency routine. Practitioners completed self-report measures at four time points (0, 6, 12, and 18 months following baseline). Of those assigned to AF-CBT, 89% participated in at least one training activity and 68% met a "training completion" definition. A total of 80 (44%) practitioners were still active clinicians in the study by 18-month assessment in that they had not met our staff turnover or study withdrawal criteria. Using an intent-to-train design, hierarchical linear modeling analyses revealed significantly greater initial improvements for those in the AF-CBT training condition (vs. TAU condition) in CBT-related knowledge and use of AF-CBT teaching processes, abuse-specific skills, and general psychological skills. In addition, practitioners in both groups reported significantly more negative perceptions of organizational climate through the intervention phase. These significant, albeit modest, findings are discussed in the context of treatment training, research, and work force issues as they relate to the diverse backgrounds, settings, and populations served by community practitioners.

Counselor training in several evidence-based psychosocial addiction treatments in private US substance abuse treatment centers

BACKGROUND

Given that most addiction counselors enter the field unprepared to implement psychosocial evidence-based practices (EBPs), surprisingly little is known about the extent to which substance abuse treatment centers provide their counselors with formal training in these treatments. This study examines the extent of formal training that treatment centers provide their counselors in cognitive behavioral therapy (CBT), motivational interviewing (MI), contingency management (CM), and brief strategic family therapy (BSFT).

METHODS

Face-to-face interviews with 340 directors of a nationally representative sample of privately funded US substance abuse treatment centers.

RESULTS

Although a substantial number of treatment centers provide their counselors with formal training in EBPs that they use with their clients, coverage is far from complete. For example, of those centers that use CBT, 34% do not provide their counselors with any formal training in CBT (either initially or annually), and 61% do not provide training in CBT that includes supervised training cases. Sizable training gaps exist for MI, CM, and BSFT as well.

CONCLUSIONS

The large training gaps found in this study give rise to concerns regarding the integrity with which CBT, MI, CM, and BSFT are being delivered by counselors in private US substance abuse treatment centers. Future research should examine the generalizability of our findings to other types of treatment centers (e.g., public) and to the implementation of other EBPs.

Relationship education research: current status and future directions

The overarching aim of this article is to review the research on relationship education programs and approaches that has been published or accepted for publication since the last review article in 2003. This article provides a critical overview of the relationship education field and sets an agenda for research and practice for the next decade. A theme weaved throughout the article is the ways in which relationship education is similar and different from couples therapy, and we conclude that there can be a synergistic, healthy marriage between the two. We then provide recommendations for future directions for research in the relationship education field. Finally, the coauthors comment on our experiences in both the relationship education field and the couples therapy field as both researchers and interventionists.

Developing an outcome-based assessment for family therapy training: the Rochester Objective Structured Clinical Evaluation (ROSCE)

This paper addresses a growing need for cost-effective, outcome-based assessment in family therapy training. We describe the ROSCE, a structured, evidence-informed, learner-centered approach to the assessment of clinical skills developed at the University of Rochester Medical Center. The ROSCE emphasizes direct observation of trainees demonstrating clinical competencies. The format integrates both formative and summative assessment methods. It can readily be adapted to a wide variety of educational and training settings.

Preliminary results of a video-assisted psychotherapist workshop in alliance strategies

This study examined the preliminary results of an integrative, video-assisted training workshop aimed at helping psychotherapists build strong therapeutic relationships with their clients. Participants were 57 clinicians across five community mental health clinics, who were randomly assigned to the brief alliance-training workshop (in which they participated prior to starting treatment with a new client) or to a delayed-training control condition. Outcomes assessed included therapist-reported use of alliance strategies during Session 1, therapist-rated alliance quality after Session 1, and client engagement across the first 4 weeks. In contrast to hypotheses, one-way analyses of variance and chi-square analyses revealed no statistically significant differences between the training and the delayed-training conditions. However, the therapist-reported impact of using the workshop's alliance strategies was positively correlated with therapist-rated alliance quality (r = .30, p = .03) and marginally correlated with number of sessions attended (r = .25, p = .06) across the two conditions. The findings hold promise for the utility of a brief alliance-focused workshop, and for collaborations between researchers and clinicians seeking to bridge science and practice.

Core competencies in advanced training: what supervisors say about graduate training

In an attempt to identify needed mental health skills, many professional organizations have or are in the process of establishing core competency standards for their professions. The AAMFT identified 128 core competencies for the independent practice of MFT. The aim of this study was to learn the opinions of AAMFT Approved Supervisors as to how well prepared postgraduate trainees are when compared to the core competencies. One hundred thirty-five AAMFT Approved Supervisors provided their perspectives on (a) which competencies are most commonly learned in MFT graduate programs, (b) how well the graduates have mastered these competencies, and (c) the level to which the supervisors need the competencies to be mastered prior to entering advanced training. Results suggest that a gap exists between the level of mastery that the postgraduate trainees exhibit and the level desired by supervisors. Implications are suggested for closing this gap.

COAMFTE accreditation and California MFT licensing exam success

Professional accreditation of graduate programs in marital and family therapy (MFT) is intended to ensure the strength of the education students receive. However, there is great difficulty in assessing the real-world impact of accreditation on students. Only one measure is applied consistently to graduates of all MFT programs, regardless of accreditation status: licensure examinations. Within California, COAMFTE-accredited, regionally (WASC) accredited, and state-approved programs all may offer degrees qualifying for licensure. Exam data from 2004, 2005, and 2006 (n = 5,646 examinees on the Written Clinical Vignette exam and n = 3,408 first-time examinees on the Standard Written Exam) were reviewed to determine the differences in exam success among graduates of programs at varying levels of accreditation. Students from COAMFTE-accredited programs were more successful on both California exams than were students from other WASC-accredited or state-approved universities. There were no significant differences between (non-COAMFTE) WASC-accredited universities and state-approved programs. Differences could be related to selection effects, if COAMFTE programs initially accept students of higher quality. Implications for therapist education and training are discussed.

Teaching accountability: using client feedback to train effective family therapists

The AAMFT Task Force on Core Competencies (Nelson et al., 2007) proposed that marriage and family therapy (MFT) educators teach and provide evidence of trainee competence beyond coursework and accrued clinical hours. This article describes the integration of a systematic client feedback protocol into an MFT-accredited program's curricula to address the call for outcome-based learning. Outcome management (OM) provides a framework for teaching and assessing trainee effectiveness. Continuous incorporation of client feedback embodies collaborative, strengths-based, integrative, and diversity-centered program values. Students learn a system for being accountable to clients, the profession, and service communities.

Integrative problem-centered metaframeworks therapy I: core concepts and hypothesizing

Over the last 20 years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders. That trend will increase. Psychotherapists will increasingly be exhorted and ultimately required to integrate empirical data and multicultural competence into their practice. Additionally, individual psychotherapy's default dominance of psychotherapeutic discourse needs to integrate and come to theoretical and clinical terms with the implications of the growing body of research demonstrating the validity and value of a multisystemic perspective. This article (and its companion article) presents a comprehensive, integrative, multisystemic, and empirically informed psychotherapeutic perspective to help therapists and psychotherapy trainers successfully address these challenges-Integrative Problem Centered Metaframeworks (IPCM) Therapy. This first article presents and illustrates IPCM's theoretical foundation, core concepts, and "case formulating" components. It delineates a Blueprint for the practice and teaching of 21st century psychotherapists who can meld science and art into best practice.

Integrative problem-centered metaframeworks therapy II: planning, conversing, and reading feedback

This is the second of 2 articles presenting Integrative Problem Centered Metaframeworks (IPCM) Therapy, a multisystemic, integrative, empirically informed, and common factor perspective for family, couple, and individual psychotherapy. The first article presented IPCM's foundation concepts and Blueprint for therapy, focusing on the first Blueprint component-Hypothesizing or assessment. This article, focusing on intervention, presents the other 3 Blueprint components-Planning, Conversing, and Feedback. Articulated through the Blueprint, intervention is a clinical experimental process in which therapists formulate hypotheses about the set of constraints (the Web) within a client system that prevents problem resolution, develop a therapeutic Plan based on those hypotheses, implement the Plan through a coconstructed dialogue with the clients, and then evaluate the results. If the intervention is not successful, the results become feedback to modify the Web, revise the Plan, and intervene again. Guided by the therapeutic alliance, this process repeats until the presenting problems resolve. IPCM Planning sequentially integrates the major empirically and yet-to-be empirically validated therapies and organizes their key strategies and techniques as common factors. Conversing and Feedback employ empirical STIC(®) (Systemic Therapy Inventory of Change) data collaboratively with clients to formulate hypotheses and evaluate interventions. This article emphasizes the art and science of IPCM practice.

The core competencies and MFT education: practical aspects of transitioning to a learning-centered, outcome-based pedagogy

The MFT core competencies and latest COAMFTE accreditation standards usher in a new paradigm for MFT education. This transition necessitates not only measuring student mastery of competencies but also, more importantly, adopting a contemporary pedagogical model. This article provides an overview of the changes, a review of parallel trends in other health professions, definitions of learning-centered and outcome-based pedagogy, and a detailed description of a systematic approach for developing a competency-based curriculum, including a list of educator competencies necessary for successful implementation.

Therapist Personal Agency: a model for examining the training context

This study reviews the creation and testing of a model of Therapist Personal Agency during MFT training. A model including self-efficacy, trainee developmental level, supervisor working alliance, family of origin relationships, and psychological states was supported by data collected from a national sample of MFT students. The model supported by the data was consistent with much of the previous research regarding the correlates of therapist self-efficacy. Furthermore, the model accounted for 20% of the variance in therapist performance as measured by therapist reports of the working alliance. The results also highlighted the importance of attending to the relationships, interactions, and experiences that take place within the training environment and secondly, the added value that may accrue from focusing on the trainee's extended network of family relationships. A brief case example serves to illustrate the importance of tending to Therapist Personal Agency. In sum, this study provides preliminary support for holistic training methods that focus upon the whole person of the therapist.