"If I can grapple with this i can truly be of use in the therapy room": using the therapist's own emotional struggles to facilitate effective therapy

Emotion regulation in emotionally focused therapists working with high-conflict couples

Guided by the Person-of-the Therapist Training (POTT) Model, the current qualitative study explores emotional experiences and emotion regulation strategies of emotionally focused trained therapists who work with high-conflict couples in Turkey. Twenty-one therapists who completed at least the externship in emotionally focused couple therapy (EFCT) and had prior or current clinical experience working with high-conflict couple(s) were recruited through various social media platforms and professional organizations' listservs. Semistructured individual interviews were conducted, audio-recorded, and transcribed verbatim. Thematic analysis of the qualitative data revealed five main themes: (1) Different Compelling Emotional Experiences of the Therapists, (2) Sun After Storm, (3) Triggers of Therapists' Emotions, (4) Perceived Adaptive Emotion Regulation Strategies, and (5) Positive Impact of the Therapist's Regulation Strategies on the Therapy Process. Overall, the findings supported the three phases of the POTT model: namely, knowledge of self, access to self, and use of self. Our study demonstrates the need for integrating self-of-the-therapist work into the clinical practice, training, and supervision of therapists working with distressed couples.

The changing face of telesupervision and digital training in response to COVID-19

The COVID-19 pandemic has rapidly changed the ways in which marriage and family therapists (MFTs)/couple and family therapists (CFTs) engage in clinical supervision. Traditional face-to-face supervisory relationships have transitioned to telesupervision, which refers to supervisors using the internet as a training medium for their supervisees. Supervisors and supervisees alike are necessarily adapting to telesupervision relationships in an evolving world. As emergency protocols begin to give way to more routine procedures, it is important for supervisors to engage in meaningful conversations around the benefits, the challenges, and the future of telesupervision. This article discusses the various facets of telesupervision, including ethical implications, supervision modalities, the virtual supervisory alliance, the impact of telesupervision upon self-of-the-therapist work, and the potential benefits of telesupervision.

The Soul of Therapy: The Therapist’s Use of Self in the Therapeutic Relationship

This paper is based on the premises that the conscious, active and purposeful use of self by the therapist in the therapeutic process is an essential aptitude in establishing an effective therapeutic relationship, and that this therapeutically purposeful use of self can and should be incorporated in the training of all therapists in a explicitly systematic manner. The paper will attempt to identify the contributions of the “what and how” the use of self by therapists contributes to the therapeutic process. First of all, therapists’ use of self is meant to be viewed as a Common Factor as defined by Sprenkle, Davis & Lebow (2009), which is a perspective about the effectiveness of therapy that “asserts that the qualities and capabilities of the person offering the treatment are more important than the treatment itself” (p. 4). Secondly, the use of self by therapists emphasizes developing the skill set of the therapist in the conscious, active and purposeful use of self as is in the moment of the therapeutic engagement with clients, and does so without denying the importance of therapists working to resolve personal issues of theirs that may interfere with the therapist's professional effectiveness. Therapists’ use of self gives particular emphasis to the purposeful use of self as is in therapy’s relationship, assessment and interventions whatever the therapy model (Aponte & Kissil, 2016). Thirdly, the use of self represents an aptitude that can be developed and refined through well elaborated structures for schooling therapists in the therapeutic use of all they bring of their personal selves to the therapy relationship including through the use of their human vulnerabilities as they exist at the moment of empathic engagement with clients.

The Dual Process of Intuitive Responsivity and Reflective Self-supervision: About the Therapist in Family Therapy Practice

Psychotherapy research shows that-in individual therapy as in family therapy-some therapists are more effective than others. This highlights the crucial role the therapist plays in a client's improvement. Furthermore, it seems that training may make a difference, as deliberate practice can improve the therapist's effectiveness. In the context of the current renewed awareness of the importance of the person of the therapist in the psychotherapy field, this paper's focus is specifically on the therapist in family therapy practice. There is a long tradition of reflecting on the person of the therapist in the family therapy field, often inspired by the metaphor of the wounded healer. In contrast, focusing on the person op the therapist in the present moment of the therapy session is fairly new. In this paper, we use of the dual process models from cognitive psychology as a frame to reflect on the person of the therapist. We review these dual process models and propose that the intuitive responsivity of the therapist relies on the fast, implicit cognitive system (system 1) and the therapist's self-reflection on the slow, deliberate system (system 2). The therapist's actions in therapy practice then emerge moment-by-moment as an echo of the way these two cognitive systems balance each other. It is optimal if the therapist, attuned to the family's rhythm, can flexibly oscillate between the two systems. In the concluding comments of this paper, reflective questions are posed about what this perspective may mean for family therapy practice, training, and supervision.

Developing Reflexivity through Group Processes in Psychotherapy Training: An Interpretative Phenomenological Analysis of Systemic Family Therapy Trainees' Experience

Constructionist approaches in the field of systemic family therapy prioritize reflexivity to promote personal development within training, often leaning on group processes. Drawing from a qualitative study we conducted to address the lack of related research, we present how systemic family therapy trainees experience reflexivity development through group processes. Ten systemic family therapy trainees participated in semi-structured interviews, transcribed and analyzed with interpretative phenomenological analysis. Analysis presented here reports three superordinate themes: Developing reflexivity through challenges and rewards, A conditional reflexive space within the training group, and Encountering the dynamics of identity via reflexive group processes. Our findings suggest that trainees experience reflexivity development as a complex relational process of personal development, highlighting the training group's critical role, nonetheless depending on certain preconditions. The importance of further exploring group processes' potential for reflexivity development in psychotherapy training is underscored.

Systemic teletherapists' meaningful experiences during the first months of the coronavirus pandemic

Fifty-five clinicians who provided teletherapy to couples, partnerships, families, and kin networks during the first two months of the coronavirus pandemic responded to a survey about their most and least meaningful experiences. Reflexive thematic analysis indicated that the participants experienced adjustments to their schedule or routines, they used technology glitches to promote client growth, and they altered how they engaged clients. Participants noted shifts in their personal and relational dynamics. They reported feeling fatigued and resilient. Participants described their adaptability, gratitude, digital and relational connectivity, and an ability to reframe negative experiences into opportunities for growth.

Systemic Practice in the Time of COVID: Conversations Among Culturally Diverse Therapists

The COVID-19 pandemic has changed the delivery of clinical services and education of health professionals, including family therapists. This paper distils two separate Zoom conversations between myself (as the lead author) and two eminent family therapists, Professors Maurizio Andolfi and Harry Aponte, where challenges and opportunities for the profession during and after the pandemic are discussed. Creativity and resourcefulness are two important elements therapists and educators have needed to access during the pandemic to find alternative ways to continue to provide clinical services and teaching. Most therapists have transitioned using online technology and various platforms such as Zoom and Skype; for some this has been a somewhat familiar experience, for most it has been a novel one. Key themes emerged from the conversations including the personal and professional 'lived experiences' of the pandemic; the financial impact on clients and students; the importance of touch for human social connection; the use of 'self' as an instrument of change and alternative platforms of service delivery and teaching. We reflected on what has been lost, such as the nuances inherent in face-to-face human interactions, and what has been gained, such as observing families in situ in their own environments.

Clients' perceptions of marriage and family therapists' way-of-being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way-of-being, a relational concept that refers to how the therapist regards a client-either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20-33). Although this case has been made conceptually, there is little empirical research on therapists' way-of-being with clients. The primary purpose of this research is to investigate clients' perceptions of their therapists' way-of-being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists' way-of-being and (b) the influence therapists' way-of-being has on clients' engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi-structured face-to-face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way-of-being as an overarching construct for several well-established therapist factors. Clinical and training implications are discussed.

Sense of coherence in systemic family therapy trainees in times of change

This study aimed at qualitatively exploring the development of a sense of coherence (SOC) among systemic family therapist trainees (FTT) over a 3-year period. It was conducted in a private family therapy training institute in central Germany. The sample consisted of 66 trainees. The components of SOC and their general health played an important role in the development of FTTs throughout the three training years. Findings show that the SOC component of meaningfulness (motivation) was most frequently mentioned and most important to participants' personal and professional development, followed by comprehensibility (understanding of self, others and the context) and finally by manageability (coping with challenges based on personal, social and professional resources). The three SOC components fostered a positive self-care approach in FTTs and improved health and well-being over the 3 years. Visions of FTT at the end of the training show that they aim at personal and professional growth and development in the Fourth Industrial Revolution (4IR).

Short-Term and Long-Term Effects of Training in EFT: A Multinational Study in Spanish-speaking Countries

This study seeks to validate the cross-cultural effectiveness of emotionally focused couple therapy (EFT) training in a sample of Spanish-speaking clinicians. The 28-hr formalized training for EFT was offered in six different Spanish-speaking countries, covering Europe, North America, Central America, and South America. Two hundred and seven therapists of 14 different Spanish-speaking nationalities completed pre-training assessments, 153 of them completed post-training assessments, and 92 therapists also completed the follow-up assessment. Using multilevel growth modeling (MLM), results indicated that therapists experienced significant and positive changes in terms of EFT competence (knowledge and skill acquisition), mature empathy, self-compassion, and attachment over time. Implications for transnational EFT training, specifically in Spanish-speaking countries, are discussed.

A Tool for Connection: Using the Person-of-the-Therapist Training (POTT) Model in Emotionally Focused Couple Therapy Supervision

Emotionally Focused Couple Therapy (EFT) was developed based on the premise that couples get stuck in negative cycles fueled by their underlying primary emotions and unmet attachment needs (Johnson [2004], Creating connection: The practice of Emotionally Focused Couple Therapy). EFT therapists need to stay in touch with and regulate their own emotions when the tension rises in the sessions, while still staying open and vulnerable to their clients. Person-of-the-Therapist Training model (Aponte & Kissil [2016], The person of the therapist training model: Mastering the use of self) aims to increase therapists' understanding, awareness, and acceptance of their own personal issues to create a more empathic connection with their clients. In this manuscript, the authors create a roadmap for EFT supervisors to use the POTT model in supervision as a tool to enhance their supervisees' connection to their clients and effectiveness of their interventions.

From Knowing to Doing: Guidelines for Socioculturally Attuned Family Therapy

Family therapists know that clinical concerns are not separate from larger sociopolitical contexts. Attunement to clients' sociocultural experience is foundational to good practice, yet few guidelines integrate attention to the larger societal processes or address social equity. The purpose of this article is to help therapists move from knowing about sociocontextual issues to doing socioculturally attuned practice. We offer an overarching framework that returns to Bateson and the roots of family therapy through a call for third order transformation. The approach is responsive to societal context and an analysis of power while working through enduring concepts of major family therapy models. Transtheoretical guidelines that can be integrated across practice models to promote third order change are illustrated with case examples.

Moving Between Dialogic Reflexive Processes In Systemic Family Therapy Training: An Interpretative Phenomenological Study of Trainees' Experience

In this article, we present a qualitative research study concerning the ways that systemic family therapy trainees experience reflexivity while in training. There is inadequate theorizing and limited research concerning reflexivity in family therapy, particularly from trainees' perspective. In our study, we used Interpretative Phenomenological Analysis to analyse transcripts of semistructured interviews with 10 systemic family therapy trainees. Here, we present one of the four superordinate analytic themes, entitled "Moving between reflexive processes". Our analysis suggests that trainees seem to experience reflexivity as a multifaceted, dialogic process, which occurs both at an inner and at an outer space and both synchronically but also subsequently to the therapeutic/training process. We conclude by raising implications for family therapy training. Video abstract accessible by clicking here.

Does the Person-of-the-Therapist Training (POTT) Promote Self-Care? Personal Gains of MFT Trainees Following POTT: A Retrospective Thematic Analysis

As we recognize how taxing our profession can be, therapist's self-care has become a salient topic in mental health. However, we are still discerning how to promote self-care in our practice and in training. In this paper, we present a study on the personal gains that MFT students experienced after participating in the Person-of-the-Therapist Training (POTT). We propose that the reported changes (better understanding of self, change to self, relational changes, and change as a process) constitute improvements in the trainees' well-being, and can therefore be considered self-caring behaviors and practices. We state that models like POTT, that focus on embracing our vulnerability, can help clinicians be more caring toward ourselves. We conclude this paper by presenting clinical and training recommendations.

Addressing the Person of the Therapist in Supervision: The Therapist's Inner Conversation Method

In this study a method of retrospective case supervision is presented aimed at helping the supervisee to become a better self-supervisor. The method pays special attention to the therapist's self-reflection and has the therapist's inner conversation as a central concept. The starting point of the method is an assignment in which the supervisee reflects on a case using a tape-assisted recall procedure. The method helps trainees to develop experiential expertise to become more flexible and effective therapists. A case example of one training group of novice family therapists illustrates the use of the method.

Training for Connection: Students' Perceptions of the Effects of the Person-of-the-Therapist Training on Their Therapeutic Relationships

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use their selves to effectively connect, assess, and intervene with clients. This study explored CFT students' perceptions of the effects of POTT on their ability to create positive therapeutic relationships. Course papers and final reflections were collected from 70 CFT students. Directed content analysis looking for evidence-supported elements of positive therapeutic relationships revealed 5 elements: empathy, management of countertransference, balancing multiple alliances, positive regard, and bond. Findings support the idea that a structured program focused on the training of the personal aspects of the therapists, like POTT, can promote the evidence-supported elements that make a therapeutic relationship effective.

Most and Least Meaningful Learning Experiences in Marriage and Family Therapy Education

Marriage and family therapy educators increasingly emphasize training competencies. What we know less about is what makes family therapy education meaningful to marriage and family therapy (MFT) graduate students and what does not. In this study, through an Internet survey, we explored the most and least meaningful learning experiences of 68 MFT graduate students and recent graduates of Commission on Accreditation for Marriage and Family Therapy Education-accredited programs. We used thematic analysis to identify and illustrate resulting themes, which included the importance of experiential and personal components to learning, the professor-student alliance, tying theory to practice, and the experiences of students with their clients, among others. We discuss the implications of these findings to support family therapy education and offer tentative suggestions for formative discussions both within and across programs. Video Abstract is found in the online version of the article.

What Novice Family Therapists Experience During a Session… A Qualitative Study of Novice Therapists' Inner Conversations During the Session

"What do novice family therapists experience during a session with a couple or family?" This is the central question in this article. A videotape-assisted recall procedure was used to study novice family therapists' inner conversations. The therapists' reflections were analyzed using thematic analysis. This resulted in a coding system that distinguishes four main domains: (a) reflections concerning the self; (b) reflections about the therapy process; (c) reflections on emotions about the family members; and (d) managing the session as well as own emotions. The study furthermore revealed that during a session, novice family therapists experience strong emotions, such as self-criticism and irritation. Both emotions may encompass dangers, as well as opportunities for the therapeutic alliance and the process.

Perceived professional gains of master's level students following a person-of-the-therapist training program: a retrospective content analysis

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use themselves at the moment of contact with their clients in order to connect, assess, and intervene effectively. This qualitative study explored the experiences of 54 master's-level students who were enrolled in an accredited marriage and family therapy program in the United States and examined their perceived professional gains following a 9-month POTT course. Content analysis of trainees' reflections which they wrote at the end of the training revealed 6 primary themes: (a) increased awareness, (b) emotions, (c) improved clinical work, (d) humanity and woundedness, (e) meta-awareness, and (f) factors that contributed to the learning process. Findings suggest that key outcomes of this training curriculum are congruent with its stated goals. Clinical and training recommendations are additionally provided. Video Abstract.