Bridging the Gap

A Training Module in Personal and Professional Development

Judy Hildebrand

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367323592
• eBook ISBN: 9780429911590
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The book opens a very important debate for the family therapy field. At a ie of treatment rationing and standard setting, it aptly draws our attention to an issue of increasing importance: training the highest-quality family therapists. In addition, it offers trainers and supervisors an invaluable "howto-do-it" guide to tried-and-tested methods of taking trainees through a programme of personal and professional development. Judy Hildebrand is known throughout the family therapy who has always spoken for integrating formal aspects of with personal development, and she has designed and run for courses in Britain and Europe for many years. But the picture would be incomplete without understanding the effect that the exercises have on personal development, and for this volume she is joined by Collette Richardson and Frankie Zimmerman, two colleagues and ex-trainees, who have collated the experiences of a range of trainees from several courses and are able to complement Hildebrand's ideas with the voice of the trainee.

Chapter One
Aims and rationale

In the early stages of its development, one way of distinguishing family therapy theory and practice from other psychotherapies was by the lack of focus on the person of the systemic therapist. However, given that family therapy has now become an established therapeutic modality and a profession in its own right, this urge to be so strongly differentiated in this respect may no longer be so pressing. I would suggest that the time has come to reappraise the role of self and its significance in clinical practice.

Over the years I had become increasingly aware of the division drawn between personal and professional dimensions of training, as if they were not mutually influential. In addition, whilst I felt confident about the quality of academic achievement on training courses, I was less sanguine about the overall level of clinical expertise. In my view, therapists needed a more sophisticated degree of self-knowledge not only to differentiate between their clients' and their own attributions and belief systems, but also in order to become more sensitive to the experience of being in therapy.

... I want to engage the family in an interactive process that leads to an experiential exchange. In order for the process of therapy to be impactful rather than merely educational or social, it must consist of real experiences, not just head trips. [Whitaker & Bumberry, 1988, p. 56]

I share Haber's (1990) view that

... asking trainees to share their personal histories creates a fine boundary between therapy and training. However, it offers trainees an opportunity to evolve individually, interpersonally, and professionally. Most importantly, working with personal rules and myths derived from one's family of origin could offer a shortcut to dealing with professional handicaps.

A model of personal work therefore seemed an essential component in the movement from academic learning to clinical practice. However, it had become evident from contact with many trainees over the years that some had little or no previous experience of personal, couple, or family therapy.

In their survey on stress and the practice of family therapy, Street and Rivett (1996) asked family therapists to indicate their experience of personal therapy: 54% reported that they had undergone individual therapy and 24.7% marital therapy, compared to only 9.4% who had undergone family therapy. Interestingly, many of those who had had experience of family therapy had also experienced marital or individual therapy. The authors expressed the view that since

. . . few family therapists have experienced marital or family therapy as consumers . . . [t]hey may consequently fail to appreciate their clients' perspective. . . . Since personal therapy appears to reduce stress by increasing personal resources, trainers should consider including an element of therapy in training courses. [p. 317]

At the Association of Family Therapy conference in 1994, an audience of approximately 150 family therapists was asked how many of them had been in therapy; in response, more than three-quarters indicated that they had. When asked how many of them had been in individual therapy, the vast majority kept their hands up; when asked how many had been in couple therapy, approximately 10 indicated that they had. However, when asked how many people had opted for family therapy, only 5 people put their hands up, and they were nearly all Dutch!

Stemming from the early discussions with Arnon Bentovim, I had hypothesized that personal therapy—that is, a structured opportunity for self-reflexivity—would lead to better-prepared and possibly less biased and more understanding therapists. Clearly, we had been influenced by our personal experiences of being in individual therapy; both of us had been in psychoanalytically based therapies and had recognized the relevance of the process in linking our personal and professional lives. I still wonder what I may have missed by not having a personal experience of family therapy. However, not all family therapists agree with the premise that personal therapy necessarily improves the quality of clinical practice. Haley (1996), discussing whether or not personal therapy makes for a better therapist, states that where trainees' biases cause problems in therapy, that should be dealt with by the supervisor and that personal therapy is not the solution.

In practice, however, in supervision there is little time to pursue all the issues that arise. Furthermore, trainees may feel inhibited about exposing themselves too much in supervision, because it is an assessed component of their training. "People cannot reconsider their prejudices when they feel under threat" (Cecchin, Lane, & Ray, 1994, p. 30).

Another important influence on our thinking was the way in which we ourselves had trained as family therapists. In the mid-1970s, when I was first involved, family therapy was at the toddler stage in this country, and, in company with colleagues, we all had to learn by experimentation. Aside from reading the literature, which was predominantly American, we engaged in workshops, drawing genograms, sculpting, trying out new techniques, discussing new ideas, and sharing life stories. Inevitably this was an active phase in our learning, and, for many of us, that lively process continued to have a significant effect on the way we taught and trained subsequent generations of therapists. Having been stimulated and enthused by the various active methods of learning more about my own experiences of being a family member, I wanted to provide a similar opportunity for others.

I was fortified and strongly influenced by Whitaker's view

. . . that we must all reinvent the wheel in order to be therapists. We must grapple with life and ourselves until we can see beneath the surface. We must have some connection with and access to our own impulses, intuitions and associations. Only when you've struggled with yourself are you free to bring your person, not just your therapist's uniform, into the therapy room. [Whitaker & Bumberry, 1988, p. 40]

As a result, rather than waiting for consensus between family therapy trainers about a policy regarding therapy, we took the decision to begin some personal work in a new module focusing on linking the past to the present, the personal to the professional. As if to emphasize the latter, the module also included experimentation with a range of alternative interventions to deal with clinical difficulties that the trainees encountered in their practice.

By designing the original module to encourage more personal exploration, Bentovim and I were demonstrating our view that this issue should be more actively addressed and incorporated in the training of family therapists. However, we were under no illusion that the module could either replace or provide the same resource as personal therapy. We hoped to focus on the effects of personal experience on professional practice rather than on a consideration of the significance and meaning of each trainee's personal experience. The point was whether the module could provide a rich source of learning and experimentation even in cases where a trainee had prior experience of personal, couple, or family therapy. Despite the fact that the majority of senior family therapy trainers and many trainees have some experience of personal therapy, there is still a lack of consensus about whether therapy should be a requirement prior to or during training and, if so, what form this should take. As Cooklin (1994) comments, "the exact paths whereby therapists are to expand their repertoire, overcome blocks, or discover and utilise hidden resources ... is usually not spelt out" (p. 287).

Chapter Two
The use of self-reflexivity in family therapy training

The focus of this discussion is based on the view

. . . that family therapy has reached a cross-roads in respect of its attention to the exploration of 'self'—in therapy and thus in training. . . . It is imperative that the personal is addressed . . . in order to successfully complete a training, a trainee must be able to recognise and understand patterns from within their own significant relationship systems (past and present) and culture which may help and/or hinder their work. [Mason, 1997]

Despite the fact that many British family therapy training institutions have considered previous personal therapy an advantage, there have been no concerted moves towards integrating this in a systemic framework and making the experience a condition of training. Although they share an overarching systemic theory, different schools of family therapy have, over time and to varying degrees, addressed or by-passed the issue of the person of the therapist and her use of self. The major stumbling block appears to be finding a way to attend to the issue that would be generalizable to all models within the systemic framework. Significant influences for change have included the major shift in the theoretical position of the post-Milan group when the therapist was recognized as part of the system. This resulted in a reappraisal of the use of self, of the therapist's own values, and of the need to incorporate these aspects in theory and practice.

Another influence was the development of the constructionist orientation to family therapy, which promoted a reconceptualization of the therapeutic use of self (Real, 1990). Following this, Aponte (1994) introduced his innovative person/practice model of training based on the premise that therapy challenges clinicians to use

. . . their personal selves effectively within the professional relationship. The personal component of this relationship is not about some general liking and acceptance of clients. It is specific to the goals and means of therapy. Thus therapists need training that both opens them to themselves and teaches them vulnerability, discipline, and freedom within the relationship. [p. 3]

In discussing this topic I have chosen to use the term self-reflexivity, with its connotation of a more systemic stance, to differentiate it from the concept of self-awareness; the latter is reminiscent of a person-centred, objective "truth-seeking" position as described by Hedges and Lang (1993). They also clearly delineate the similarities, differences, aims, and intended outcomes of self-reflexivity and self-awareness (p. 285). I agree with Boscolo and Bertrando (1996) that "Both the therapist's and the client's inner and external worlds and the relationship with the social systems in which they are embedded have become the territory to be explored. Self-reflexivity has taken clearly a central position" (p. 14).

Taking a historical perspective, Hedges and Lang (1993) comment on trainers who in the 1970s and early 1980s reported moving from a psychodynamically influenced programme using experiential groups focusing on personal work, towards a preference for the teaching of skills, using video and live supervision. Where the focus has been on the person of the therapist (Aponte, 1994; Aponte & Winter, 1992; Bowen, 1978), the emphasis has predominantly been on training needs, such as the therapist recognizing trigger issues that might affect her clinical practice. This has commonly been addressed on the basis of genogram work (Francis, 1988; Hardy & Laszloffy, 1995) or in relation to sculpting (Duhl, Kantor, & Duhl, 1973; Heinl, 1987). The use of genograms and of mapping (Hedges & Lang, 1993) and the development of the self of the therapist (McDaniel & Landau-Stanton, 1991, p. 470) are well-known and valued approaches. Hopefully the more recent focus on the significance of the self of the therapist (Cooklin, 1994; Haber, 1994) signals a return to even more emphasis on the essential interplay between professional acumen and personal development, emphasising the artificiality of considering them as distinct entities. There have been other influences in this direction, too—particularly the current interest in the therapeutic use of narrative, which has played a part in reawakening interest in the significance of the trainees' personal stories. The importance of recognizing the significance of trainees' own life experience is commented on by Lindsey (1993):

Their (the trainees') personal life script contributes to how they interpret the family's stories, the meaning of therapy and the therapeutic relationship. This in turn is contexualised by the beliefs and experiences in the families they have grown up in and in the families they have created—the personal life script is affected by the norms of the community of which the therapist is a part and which may powerfully influence the values held about family life. [p. 307]

Flaskas and Perlesz (1996) also point out that

Therapists are increasingly being invited by their supervisors, their peer teams, and their own sense of professional responsibility to scrutinise the contribution made to the progress of stuckness of therapy by their own inner life, families of origin, current life circumstances, "prejudices," or culture, gender, and ethnicity. [p. 220]

It may be that as family therapy is now a respected and established form of psychotherapy, we can afford to take some further risks and look more critically at the quality of our clinical practice, its connection with the self-reflexivity of the therapist and the ways in which we prepare the next generation of therapists and trainers.

Burck (1995) comments on developments in the family therapy field over the previous five years, with reference to the training of therapists and the use of self:

In the training of family therapists, ... ideas of the importance of the therapist's contribution to what is observed and discussed in therapy, has led to a much greater emphasis on therapists' personal/professional development and their use of self in therapy. Managing the tensions of being a "participant/observer," both a participant/observer in the therapy, embedded in it, yet attempting to develop and maintain "self-reflexivity," are now crucial aspects of the training. [p. 249]

Blow and Piercy (1997) believe that to fulfil our responsibility for producing the most effective therapists possible, a significant portion of training should be in developing personal agency—that is, the ability and freedom to access personal resources. In their view, such training should be presented as a core element across theories and should be overt, focused, and experiential.

Even if the various schools of family therapy were to agree in principle that personal therapy was an appropriate and desirable context for promoting both self-reflexivity and a more sophisticated use of self in therapy with clients, we would still be faced with the issue of a possible lack of congruence between the model of personal therapy usually undertaken—predominantly individual—and a systemic model based on couple or family therapy in the professional training. This is less a question of numbers and more that of the discrepant theory bases for the trainee therapist who is in personal psychoanalytic psychotherapy while training as a systemic therapist. From the reports of trainees who attempted to juggle the two theory bases at the same time, the experience was extremely confusing.

Chapter Three
The structure of the personal and professional development module

In this chapter the focus is on four main areas:

1. The institutional contexts in which the personal and professional development module was...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• EDITORS' FOREWORD
• FOREWORD
• INTRODUCTION
• CHAPTER ONE Aims and rationale
• CHAPTER TWO The use of self-reflexivity in family therapy training
• CHAPTER THREE The structure of the personal and professional development module
• CHAPTER FOUR The use of experiential exercises
• CHAPTER FIVE The early stage of group life
• CHAPTER SIX The middle stage of group life
• CHAPTER SEVEN The final stage of group life
• CHAPTER EIGHT Trainee survey and commentary
• CHAPTER NINE Reflections
• APPENDIX
• REFERENCES
• INDEX