family therapy training research: systems model and review

Journal of Family Therapy (1988) 10: 383-402

Family therapy training research: systems model and review

Eddy Street

This paper proposes that a systems approach to the organization of family therapy training courses would be advantageous to trainers and researchers alike. A family therapy training programme development model is outlined. Using the stages of this model as a framework, the research into family therapy training is reviewed. The field still remains in its infancy and the quantity of research is relatively sparse. Developments have, however, been made and these auger well for the future.

Introduction

Recent years have seen the rapid increase in the need for family therapy training and there has been a proliferation of training programmes of various types. Unfortunately, in common with psychotherapy training generally, these programmes have been constructed in pragmatic ways because the availability of empirical evidence to aid course building is very sparse. Research into the training of family therapy is therefore necessary in order to ensure that training courses and programmes are organized in the most efficient and effective manner. The training process is a very complex and multifarious activity, and the researcher needs to be able to select out and specify particular issues for particular study. This paper sets out a scheme which attempts to organize this field and hence offer course designers, trainers and researchers a model on which to base their decisions.

A variant of the application of systems theory is an approach to general organizational issues and planning (Gagne, 1966). The objective of this approach is to reduce complex problems and relationships to simple outputs which can be used by the planner in arriving at the ‘best’ decision in terms of effectiveness and erkiency.

Accepted version received March I 988. Preswylfa Child and Family Centre, Clive Road, Cardiff, South Glamorgan.

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384 E. Street There is, therefore, clear specification of objectives and an attempt at continual control of these objectives during their formation, rather than waiting until the end of a programme for outcome data. Thus, evaluation is concerned with analysis of all operational aspects of the programme in relation to how these operations meet both formative objectives and final outcomes.

In a related field, Zifferblat (1972), discussing schools' counsellor training, notes that too many evaluative studies focus on final outcomes as opposed to evaluations of the various components of a programme. He goes on to argue that the systems approach offers an evaluation model which can analyse training programmes which are individualistic with respect to their students, staff and environmental characteristics. Gottman and Markman (1978) reach a similar conclusion in their review of experimental design in psychotherapy research; they state:

no research effort can answer all or most of its questions with one grand factorial study. It is more feasible to consider a programme of small studies, each of which deal with a specific set ofresearch questions (p. 3 1 ) .

In their attempt to shift the focus on to the evaluation of the components of the service, they outline a systems based approach. Simi- larly, Gottschalk et al. (1967), Luborsky et al. (1971) and Gelford and Hartford (1968) have used the approach for the evaluation of therapeutic services. With regard to training programmes for parents in behavioural management, these have been described in systems terms by Berkowitz and Graziano ( 1972) and Miller ( 1975). Hosford and Ryan (1970) have outlined a systems approach in their discussion of personnel guidance counseller training programmes. Garfield ( 197;) in his review of research into training therapy skills has argued that the systems approach is one of the principal trends in the field that could lead to sorne development if applied further.

I n the case of systems devoted to the training of family therapy, the outcome must ultimately be framed in terms of the activity and performance of the trained family therapists. In order to achieve accept- able performance at outcome, information on personnel, context, material, time and techniques will need to be explicitly identified, broken down into their component parts and included in the planning, operating and evaluating strategies. The system will require feedback of formulative and final objectives so that evaluation of the programme leads to continual systems changes and improvements.

Family therapy training research 385 Based on such an approach, the stages of the process of family

therapy training can be specified and a flow chart of the ‘training system’ constructed (see Figure I , following Gottman and Markman, 1978). It is proposed that this model be known as the Family Therapy Training Programme Development (FTTPD) model. It contains eight stages, and each stage is associated with one or more type of activity designed to collect data.

In the ideal situation, a programme would be developed systematically and empirically by conducting relevant research at each stage. This would allow the planner to acquire information to assist in the modification and adaptation (the re-design) of each component of the programme. Whether or not research is undertaken as a major activity in the development of the programme, the adoption of the FTTPD model does require the programme planner at some stage to undertake the collection of data; data that will be dependent on the specified programme objectives.

Stages of the family therapy training development model

Stage I . Selection o f personnel for the training system

The personnel relevant to the programme will need to be selected with the criteria for their selection clearly specified. This indeed applies to both the trainers and the trainees. The feedback that research will give a t this stage would involve investigation into the personality characteristics of candidates, comparison of selected versus non-selected candidates and evaluation of selection procedures.

Stage 2. Selection of ‘context’ o f training

Context will naturally be an issue relevant to all stages of the process of training. However, the prime area in which context will be particularly important will be the context in which the trainee ultimately practises. As family therapy is applied differently in different settings, it will be necessary for trainers to specify the context for which they intend to train. Questions concerning the generalization of training could be addressed at this stage. Comparisons between uni and multi- contextual training programmes could be made as well as the investigation of the effectiveness of on-site training for particular settings.

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. I

I Selectlon of personnel for tralnlng system

i

i

Personnel studles

II Selection of 'context' of trolnlng

Context studles 1 III Outline of what IS to

be taught

Theoretlcol model stgdles

E Selectlon of methods Skllls studies of trolnlng

l c Methodology studles I I -

P Assessment of training efficiency .

Studies of student

trolnlng \I changes during

XI Assessment of trolnees efflclency

Therapy outcome studies

YU Speclflcotion of programmes costs, benefits and l lmltat ions

Figure I . Model for Family Therapy Training Programme Development.

Family therapy training research 387

Stage3. Outline o f what is to be taught Each training programme will need to outline the theoretical model that it intends to teach and to specify the skills that it intends to impart. Ideally, the skills will emanate directly from the adopted theory, but the development of family therapy is not yet at a stage where theories are expressed in such a way that it is possible to operationally define all the skills that a therapist requires in order to operate that particular model. Although some courses follow particular specific theoretical frameworks, many courses offer a more general review of family therapy theory and teach a large variety of skills. Other courses only offer didactic teaching and do not attempt to teach or supervise skills development directly. As there often is this separation between theoretical input and skills training, i t would be expedient for research into this aspect of training to also maintain some differentiation of theory and skill.

Comparative research of uni-theory versus multi-theory programmes would be applicable as well as comparison of the training of different theoretical systems. Research into skills would in the first instance depend on an appropriate and empirically verified skills analysis of family therapy. From this base, questions relevant to issues such as the centrality of some skills and the ordering of the skills to be trained could be investigated.

Stage 4. Selection o f methods f o r training

Once the content of the course has been determined, the programme planner would then need to select the method(s) by which the content was to be imparted. Research would focus on the relevance of a particular training technique to a particular skill and theoretical model. Means of adapting and generating new techniques could be established by collecting data on the outcome of a specific type of skills and theory training.

Stageg. Assessment o f training efficiency

At this stage, the trainer would need to construct means of assessing whether the course objectives specified particularly at stage 3 had been achieved. The researcher would not only be interested in the achieve- ment of the objectives but whether or not other changes in trainee behaviour occur as a result of training.

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Stage 6. Assessment of trainees’ efficiency

The ultimate means by which training can be demonstrated as effective will be in the evaluation of trainees’ performance after the training process has been completed. It will need to be shown that individuals who receive training offer a more effective and efficient service to families than those seen by individuals who have not been trained. This may well involve a major service evaluation if the training course has been designed for staff at a particular location.

Stage 7 . Speczfication o f programmes costs, benefits and limitations

The penultimate stage is concerned with an analysis in terms of time, personnel, finances and the weight of these against the assessments of the outcome of the programme. Some outcomes may not correspond with the specified objectives and these will need to be dealt with in terms of the programme’s limitations.

Stage 8. Re-design

Having obtained specification of the programme’s actual as opposed to desired output, and considering the various resources and technologies used to achieve such outcomes, the programme can now be re- designed in total.

This model, therefore, allows trainers to be clear about the decisions they take in the construction of their courses as well as specifying the data they require in order to make those decisions. This model also provides a means for organizing the sparse field of family therapy training research, for although there has been a growth in family therapy and its literature there has only been the smallest of developments in research interest in the training of family therapy. In the sole review to date of the field, Kniskern and Gurman (1979) state, ‘After reviewing the literature on family therapy training, we have to confess our field’s empirical ignorance about this topic’ (p. 83). They offer a set of research questions relevant to the issues of selection, didactic teaching, supervision and experiential methods. They also suggest a number of ways in which a training programme could assess its efficacy. However, their review does not construct a comprehensive model for organizing this field because they do not systematically go through the process of training in family therapy and specify all the areas that can potentially be researched.


The FTTPD model assists in framing a critical analysis of the research presented in this field. Clearly, each research project should specify basic characteristics of its staff and students, the contexts of training and practice, the theory and skills being taught and the means by which they are taught. Studies of changes during training should be carried out using reliable and valid measures, as should follow-up evaluations and therapy outcome studies. Unfortunately, many of the published projects do not maintain these minimum requirements of reporting research. Utilizing the stages of the FTTPD model, the remainder of this paper will review the reported research studies to date in the field.

Personnel studies

The large variety of courses available for those wishing to study family therapy has meant that a considerable number of individuals from a host of differing personal and professional backgrounds and at differing stages of life and career development have received training. Unfortunately, this is the first of many areas in which there has been virtually no research activity. There have been no reported studies which deal with candidate personality characteristics that affect the course and outcome of training. Tucker and Pinsof (1984) report that professional candidates on a one-year part-time course obtained scores on a measure of self-actualization that. placed them close to the ‘ideal self-actualization’ group, and the authors suggest that the training programme may have attracted high self-actualizers. However, their candidates were self-selecting, being experienced professionals, whereas a considerable amount of training is undertaken with individuals on general professional training programmes, of which family therapy is just a component (e.g. Tomm and Leahey, 1980).

It is possible to receive family therapy training by a variety of routes, the most common being as part of a professional training and also as a post-qualification experience. Given that there are these two distinctly different paths for entering family therapy training, the differences produced by these two approaches to acquiring therapeutic skills is an issue which needs to be addressed in the future. This is particularly the case as Tucker and Pinsof (1984) also produce some evidence that pre-experience of family interviewing had some effect on the outcome of in-therapy behaviour in that those with prior experience performed more ably than those who did not have such experience.

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There have been no studies which have investigated the characteristics of trainers. Similarly, there have been no studies which report on the predictability of selection procedures on the development of therapeutic skills. The issue of being able to predict the successful uptake of therapy skills is an essential one that all trainers need to be mindful of. Unfortunately, no methodology has yet been developed for examining this personnel issue.

Context studies

Kniskern and Gurman (1g7g), amongst others, note that specific training programmes may only be relevant in specific contexts. It is evident that that nature of context will influence how family therapy is practised. Clearly, in the stating of training objectives a course would need to specify the contexts in which it believes its skills are relevant. However, in the literature which describes courses, let alone those on which research is conducted, there is a clear failure to specify those contexts for which the course is intended. There is such a variety of courses ranging from those that are single agency-specific (e.g. Bishop et al., 1984), to those that are multi-professional and presumably multi- contextual (e.g. Tucker and Pinsof, 1984). The Bishop et al. course, being confined to a single agency, was well able to set context objectives and the follow-up study on this course (Byles et al., 1983) found that the number of family interviews throughout the agency increased. Dowling et al. (I 982) ran a course for individuals training to be social workers, and even though most workers became employed in social service departments the course was not organized in a similar setting. Their follow-up data showed that a high proportion of their ex-students maintained a practice in family therapy following qualification, suggesting that the practice acquired in one context could transfer to another. Unfortunately, both of these studies merely evaluated their course in terms of the stated frequency of family interviews their ex-students undertook, and this is not an adequate evaluation of therapist activity in itself. However, as studies, they do tackle the problem of follow-up evaluation by relating it to the context in which the ex-student will operate.

Theoretical model studies

The research questions relevant to this section concern the choices of model and whether or not the programme should be devoted to one or

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several models. The training literature to date tends to describe theoretical models with a considerable degree of vagueness. Many articles refer to various amalgamations of models with no attempt to specify the way in which these models are combined. Those that are clear about this combination process are rare (e.g. Will and Wrate, 1985) and demonstrate the amount of conceptual clarity that needs to go into the exercise.

Kolevzon and Green ( 1983) report on a comparative survey of the belief and action systems of individuals who had been intensively trained in one of three of the major models of family therapy (‘Bowenian’, ‘communications’ and ‘strategic’). The workers admin- istered a questionnaire they designed to measure therapist assumptions and styles. Factor analysis of the results demonstrated a greater divergence amongst the models than convergence. Indeed, given the degree of differences between the three groups of practitioners they question whether i t would be premature to develop a generic model. They argue that their findings strongly support the view that trainees should be instructed in one model alone, and they go on to suggest that training programmes which set out to teach a variety of models may end up teaching an inconsistent one which would be difficult to operationalize. This study unfortunately does not attempt to deal with any of the candidate and context issues; the reasons why individuals sought and were accepted for high status training programmes would need to be adequately addressed. Similarly, the context in which individuals practise may have important consequences on their beliefs and actions. Therefore, although the argument used by Kolevzon and Green is persuasive, it is by no means proven. The field still awaits for an adequate study which compares uni-model training with multi- model training, as it is from this base that an understanding of the process of theoretical integration will develop.

Skills studies

For the researcher to investigate the issues concerning the skills to be taught, i t is necessary that adequate analysis of those skills be available. Some authors concerned with training have offered categoriza- tion systems for skills that may have some training applicability. Thus, Cleghorn and Levin’s (1973) three-fold division into conceptual, perceptual and executive skills have offered a means of conceiving of skills for trainers, and this has been widely adopted. Such a method of analysing skills, however, does not rest on an empirical base.

392 E. Street Another potential source of analysis of therapist skills is in the

behavioural scales used in process research on therapist behaviour. Although process research in family therapy is very much in its infancy, some published work presents scales which offer a means of analysing therapist activity. Sigal and his colleagues (1977) have used a binary coding system, which categorizes therapist verbal statements into ‘drive’ or ‘interpretation’. This work has been extended into a twenty-six-category coding system, but as Pinsof (1981) notes, it has not shed much light on the process of family therapy. Alexander et al. (1976), in their study relating therapist characteristics to therapy outcome, fail to specify their therapist behaviour sampling procedure as well as the definitions of their scales.

Allred and Kersey (1977) developed a system for analysing the in- therapy verbal behaviour of counsellors and clients in family and marriage counselling. Dowling (1g7g), in her study of co-therapy behaviour, developed a fifteen-category system based on the developing interactive skills category system used by the British Air Transport and Travel Industry Training Board.

Piercy et al. (1983) have developed the Family Therapist Rating Scale (FTRS). This inventory rates therapist behaviour in five categories. The first two categories ‘structuring’ and ‘relationship’ contain items that relate to ‘skills’ identified by Alexander et al . (1976). The other three categories, ‘historical’, ‘structural/process’ and ‘experiential’, are derived from general statements from particular family therapy schools. However, as the authors note, their system of cate- gorization cannot and does not contain all the possible skills in family therapy, nor does it appropriately distinguish skills for other models. Consequently, this system is inadequate for the formation of a system for analysing skills.

Pinsof (1979) has developed the Family Therapy Behaviour Scale, which originally grew out of an attempt to operationalize the executive skills identified by Cleghorn and Levin. Pinsof has gone on to develop a coding system called the Family Therapist Coding System (FTCS) (Pinsof, 1980). As the author notes, this system is the most complex therapist coding system in the field of psychotherapy research, as well as the field of family therapy research. I t specifies more aspects of a therapist’s verbal behaviour than any other system.

Whatever the merits of these scales, it is the case that no evidence has yet been produced in their related studies which materially affects the manner in which training is conducted. It is also noticeable that none of the scales are linked to any particular theory of therapy.


Unfortunately, within the field of family therapy there is a lack of what Pinsof ( 1981 ) has termed micro-therapy theory, i.e. a methodology for analysing the process of therapy into its small component parts. This lack hinders the development of training, for trainers ,do not have the empirical base on which to determine and specify the skills they will teach. Some scales, particularly those of Pinsof, do mark an innovation in technology which may allow for the development of a micro- therapy theory of family therapy. If this does occur, an empirical means of analysing the skills of family therapist will emerge. Unfortun- ately, we are not yet at that point in the development of the science of family therapy, and these scales offer little value in the constuction of a skills analysis of family therapy or in the operational outline of those to be used for a training programme. Consequently, for the present the skills analysis will need to rest primarily on the clinical method.

There have been some studies which have looked at skill uptake amongst trainees, particularly using Cleghorn and Levin’s (1973) three-fold division of skills. Unfortunately, this has always been within the context of studies which have attempted to evaluate a total training package as opposed to a specific technique for specific skills. Thus, Breunlin et al. (1983) have developed a technique for assessing students’ improvements on observational, conceptual and therapeutic (executive) skills. Tomm and Leahey ( 1980) and Byles et al. ( 1983) have developed similar instruments. Interestingly, all these authors comment on the way in which their instruments are more sensitive to changes of the observation/conceptual area than executive skills, which by definition require behavioural output.

The potential problems of the order in which skills could be trained are highlighted in a small study by West et al. (1985). Their study does not adequately outline the type of students or the contexts for which they were being trained; the students were assessed on the Breunlin et al. (1983) measure at three stages during changes. There were improvements throughout training. However, they found that conceptual skills significantly increased from the beginning to the mid- point, whereas observational skills significantly increased from the mid-point to the end of the course. They believe that these data

suggest that the novice-level therapists require a conceptual framework or cognitive map before being able to pay attention to small units of family interaction. It would seem that meaning must be attached to small units of behaviour before the behavioural sequences can be integrated within the larger theoretical understanding of the family (p. 56).

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Thus, this study would seem to indicate that conceptual skills should be taught before observation skills, suggesting that in terms of skills acquisition these particular skills are hierarchically related. Tucker and Pinsofs (1984) data support the view that skills acquisition is an ordered process as the FTBS demonstrates differences between high and low experience trainees, both prior and after training. The authors’ suggest that some therapist behaviour changes as a result of training and some as the consequence of experience. This would raise the possibility that ‘training’ is a more gradual and sequential process that takes place over many years and is not confined to the training period itself.

Apart from the above, there are no data concerning potential hier- archial relationships of skills, and consequently trainers merely must use their discretion as to which skills should be trained first. However, another explanation is possible from the West et al. and Tucker and Pinsof data, namely that the training techniques they used are not efficient for training the particular skills they focused on. The assump- tion that a training course trains all family therapy skills (whatever they may be) is unfortunately one that is held by most researchers in this area. It needs to be demonstrated that particular skills are acquired efficiently by specific techniques. If such a demonstration were available, trainers would then be in a position to choose which skills they aim to train and by which method. From that point, a training programme would become empirically established. Research into the development of skills is likely to be a very profitable and interesting area.

Methodology studies

By virtue of its infancy, this area of research in family therapy training has avoided the type of research which expresses the sentiment ‘our methods are better than yours’, recognized by Garfield (1977) as having bedevilled the field of research in training in individual psychotherapy. However, as there is a wealth of methods used by clinical teachers, choices need to be made concerning some of the principal modes in which students will generally be taught.

A training course will need to establish which methods fit in with their idiosyncratic needs. Tomm and Leahey ( 1980) have approached their own problem from this perspective; they were searching for the most appropriate way of training medical students in some beginning skills of family therapy. They randomly assigned seventy-two students

Family therapy training research 395 to three methods of family therapy: ( I ) traditional lecture approach using video examples; (2) small groups of six with two leaders who viewed and discussed the same video examples; (3) small groups of six with two leaders who interviewed and assessed families using videos for the interviews. The conceptual context of the course was kept constant by the written hand-outs that were distributed. The students were assessed on a variety of measures designed by the authors using questionnaires and responses to genograms, family vignettes and video examples. The authors found that all groups improved over the period of the course; no particular teaching method was shown to be superior. As a consequence of this finding, the authors were able to design a training programme based on their philosophical outlook within the constraints allowed by their budget.

Fennel et al. (1986) studied the differences between two varieties of supervision groups. The trainees were all undertaking the same doctoral course; seven students who were based on-site were able to receive live supervision of their work, while six others who were ‘commuters’ receivedpost hoc supervision. The students were assessed by their ratings on the ‘Family Therapist Rating Scale’ (Piercy et al., 1983) when they interviewed r6le-played families prior to the beginning of the programme, at the end of the programme (sixteen weeks) and sixteen weeks later. No significant differences were found between the groups, and as the authors note this finding does not support the large body of family therapy training opinion that suggests that live supervision is the method of choice for training family therapists. However, the authors do point out several factors which would need to be taken into account: the post hoc supervision had a larger case load than the live supervision group; the experience level of the trainees differed; the supervisors were different. Clearly, these authors have pointed to other areas that need to be adequately researched before much value can be placed on their findings.

Street and Treacher (1980) have briefly reviewed the types of skills training technology that are available to family therapy. They suggest that the micro-training methodology of Ivey and Authier (1978) represents the most likely framework for teaching therapists skills. Street and Foot ( I 984) have developed this approach to the training of initial observation skills using concepts derived from structural family therapy. Despite some methodological constraints, they demonstrate that social worker students with little experience of family therapy can be trained very rapidly to make appropriate observational judgements of video tape segments of initial interviews. This represents the first

396 E. Street attempt by family therapy trainers to teach specific skills by a specific methodology.

The above studies are of limited value in terms of the generality of their findings. However, they demonstrate a considerable worth in terms of decisions concerning their particular programmes. Thus, Tomm and Leahey were able to select the method of teaching which suited them best, and Fennel et al. demonstrated that on a course which of necessity used different supervision methods, students gained no advantage from being in either group. As such, therefore, they are excellent examples of research being used to establish beneficial solutions to particular setting-related problems.

Studies of student changes during training

Kniskern and Gurman (1979) suggest that as a result of training, a student should show changes, in their conceptual knowledge, in their in-therapy behaviour and in their personal life. At the time of that review, there was a paucity of research which attempted to assess such changes. However, since that time a few studies have reported on these themes.

The nature of personal change as a result of a training course is likely to vary according to many factors such as length of experience of trainee, trainee characteristics, length of course and teaching techniques used. The theoretical literature does not give any indication as to what particular ‘growth’ changes should be incorporated into a statement of aims and objectives of any course. Indeed, some theorists such as Minuchin imply that personal change should occur as a byproduct of training rather than as the result of some predetermined strategy. In contra-distinction, the approach of Bowen (1966) stresses ‘separation from family or origin’ as being a desirable goal. In terms of personal development or ‘growth’, Tucker and Pinsof (1984) assessed trainees’ ‘self-actualization’ pre and post-course and found no significant differences. They account for such finding in terms of the characteristics of individuals attracted to the course.

Walrond-Skinner (1979) is the only other author who has reported on a study of personal changes in family therapy trainees. She assessed the trainees’ construing of themselves and their families by means of a Kelly repertory grid. Using a construct based on their perceptions of professional expectations on themselves, i.e. their ‘social’ self and the constructs of ‘ideal’ and ‘actual’ self pre and post-training grids were completed. Prior to training, the students demonstrated little

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convergence between the three self-constructs; in particular, the ‘ideal’ self was seen as being isolated. Following training, some integration between the ideal self and the social self was seen; a control group demonstrated no significant changes in this respect. It was also found that the convergence of the ‘actual’ self and ‘social’ self did not occur until after six months of training. Walrond-Skinner also found that following training students improved in their ability to construe behaviour in a multi-dimensional way; similarly, their perceptions of typical family therapy situations demonstrated improvement as assessed on a questionnaire. This study’s use of a control group is to be welcomed. However, no attempt was made to assess the effectiveness of training or related ‘success’ of training to the measures of personal growth. Therefore, until such time as it has been established that particular personality characteristics and specific types of self-awareness facilitate family therapists in undertaking their job efficiently, trainers will be unaware of which ‘changes’ to sponsor. Consequently, conclusions concerning this particular aspect of training can only remain speculative.

Notwithstanding the lack of research in personal change as a result of family therapy training, there have been a number of studies which have reported on attempts to measure other changes in trainee behaviour. Byles et al. (1983) used a variety of measures designed to assess trainees’ satisfaction with the course as well as changes in their behaviour. They provided course members with written descriptions of families illustrating several dimensions of the model they were teaching. Questions were set designed to elicit the trainee’s compre- hension of the dimension and his/her ability to identify the appropriate treatment strategy. They found an improvement in the conceptual/ perceptual skills as measured by this means, but no attempt was undertaken to assess the trainees’ executive skills. No psychometric data or descriptive material are available on the instrument that Byles et al. designed, and therefore it would not seem to be readily accessible to others.

There have been three attempts to empirically design instruments that can be used to assess trainee changes. Piercy et al. (1983) have developed the Family Therapist Rating Scale (FTRS) in which they draw on a number of theoretical models. Criterion-related validity was established on the scale by experienced judges observing an actor r81e play each of the seventy-one skill items effectively and ineffectively, and then making ratings on the scale. Further validation was obtained by a group of graduate students being rated on interviewing a coached

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family. The scale distinguished between those rated as effective and ineffective by their tutors. Reasonable inter-rated reliability figures were established for the scale. As the authors note, however, this scale merely assesses whether the trainee is able to ‘produce’ the skill, and therefore it does not tackle the skill of putting all the skills together. The scale would seem to be assessing a generality of skills, and clearly the skills of any one particular model would have to be assessed on a much broader instrument than the FTRS.

Breunlin et al. (1983) set about the task of measuring student changes by another means. They developed an instrument based on multiple choice questions about a prepared video tape. They chose to replicate the type of stimulus data a family therapist encounters by preparing a video tape of one initial session rather than a series of small vignettes. A script of a session was prepared with some additional elements incorporated, including some ‘errors’ on the part of the therapist. The session was then re-recorded using actors. Four therapists reviewed the tape and ‘arrived at a consensus’ as to what was actually portrayed. The authors claim this to be evidence of a ‘high level of content-validity’. Several versions of the test were constructed, the final one being multiple choice which contained seven ‘observational’, eleven ‘conceptual’ and two ‘therapeutic’ questions. They report that the test differentiated between a group who undertook the course pre and post-course, and that there were significant differences from a control group that did not receive the course. The eleven conceptual questions showed significantly more improvement over the period of the course than the questions designed to tap the observational and therapeutic skills.

This particular instrument, unlike that of Piercy et al. (1983), is designed to assess just one model of therapy as taught by the course, and despite this lack of generalizability the methodology for test construction can be commended. However, the authors noted some difi- culty in ‘experts’ reaching agreement about certain items, and it may well be that the video tape and questions need to be constructed using more ‘expert’ judges than just the few used by these authors. The major problem with this instrument is that it does not assess any changes in actual trainee behaviour (i.e. the executive skills in action) and this should be a requirement of any instrument designed to measure trainee changes.

The Family Therapist Coding System (FTCS) as developed by Pinsof ( 1980) has been utilized in a study by Tucker and Pinsof ( I 984) to assess the changes over the first year of a two-year course from a


variety of professions and work settings. At the commencement of the course, the trainees were required to conduct a live fifty-minute initial interview with a family simulated by four professional actors; a similar ‘family’ was provided for interview following one year of the course. Two trained raters scored transcripts of three five-minute segments of each simulated interview. I t was found that after training, trainees were significantly more active, using a wider range of interventions; they dealt more significantly with negative emotions; they increased the extent to which they dealt with the parental family of origin and the extended nuclear family. Nearly all the changes demonstrated by Tucker and Pinsof were predicted by them. Clearly, therefore, the construction of the course allowed for such predictions to be made. How- ever, being non-theoretical, the FTCS does not allow trainers to specify skills to be taught except by means of translation through the FTCS.

As the FTCS is a direct measure of verbal behaviour, Tucker and Pinsof also constructed an instrument called the Family Concept Assessment (FCA) designed to assess trainee conceptual skills. Four case vignettes were provided and written in such a way that it was possible to conceptualize the information in a variety of ways. Trainees were required to write short essays on each vignette and this was rated on a number of scales by two trained raters. I t was found that trainees demonstrated a change in how they assessed components of clinical problems as causally and temporally related. However, after the one year of the course they had not attained scores similar to those of their supervisors.

All the studies that have investigated trainee changes have done so on the beginning component of a long programme or else have been evaluations of rather short programmes. The appropriate evaluation of any course would have to be at the time of course completion and should also involve a follow-up. T o date, there has been no attempt,to follow up any in-therapy behaviour changes. The nature of follow-up will depend on the type of course and the nature of the experience of its participants. Clearly, a graduate of a part-time beginners’ course will exhibit different behavioural changes to those of a professionally qualified person who undertakes an intensive period of further therapy training. Such factors need to be taken into account when assessing outcome, and it would seem likely that the studies reported in this section are appropriately context-bound, and although their authors seek to point out to the generality of their findings the results cannot easily be applied to other settings. However, there is a developing

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methodology with regard to instrumentation for assessing outcome, whether it be at course completion or at follow-up, and this methodology shows promise for the future.

Therapy outcome studies

Kniskern and Gurman (1979) state in their review that the most important outcome measure for any course would be that of the outcomes of the families treated by the trainee.

No training programme can responsibly be said to be effective unless its graduates can be demonstrated to produce more positive effects and fewer negative effects with the families they treat after receiving training than before receiving training (p. g I ) .

Even though there are many difficulties in attempting such outcome research, it nevertheless is the most sensitive way in which the value of family therapy training can be demonstrated. There are no studies which evaluate the effectiveness of training by this means.

Conclusion

This paper has set out to present a model for family therapy training programme development and within terms of this to review the relevant research literature. The review has indicated that since the time of Kniskern and Gurman’s (1979) initial conclusions about the field, some developments have taken place, albeit in an ad hoc fashion. The issue of skills acquisition has attracted some research activity such that now there is evidence of trainers and researchers being more specific about the nature of the skills they train and of them developing specific methodologies for specific skills. Important parameters of skills acquisition are becoming visible, so that a rudimentary understanding of the ordering of skills training is now within reach, as well as a possible appreciation of the r81e of pre-training experience. The skills- teaching component of the training process will not, however, make a substantive development in itself, as undoubtedly a more empirical understanding of family therapy will provide the foundation on which the teaching of therapeutic skills will rest.

The advance of note of the last decade in the field has principally been in the developments of measures to assess trainee changes during training. Interestingly, these particular measures have grown out of projects in which workers have sought to answer situation specific

Family therapy training research 40 I

questions. It is evident from this that some general gain can be derived from tackling ‘local’ issues, and hopefully this will serve as a spur for trainers to deal with their particular dilemmas in an empirical fashion. Overall, the work in this field to date does suggest some paths that can be followed and that it is possible to investigate the assumptions held by trainers about the value of theories, skills and methods that they use. The model proposed in this paper offers a way of dealing with many of the complexities of the training process. Hopefully, it will be of use to trainers and researchers alike.

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family therapy training research: systems model and review

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