training family therapists in observational skills

Journal of Family Therapy (1984) 6: 335-345

Training family therapists in observational skills

Eddy Street* and Hugh Foot?

A study was conducted to develop procedures for training observational skills using concepts derived from structural family therapy. Experienced family therapists provided operational definitions of key concepts in family interaction, and videotaped segments of interactions were prepared which exemplified the concepts. A group of trainee family therapists was com- pared with a group of experienced therapists in the way they applied the concepts to interaction sequences in therapeutic sessions. In demonstrating that inexperienced trainees can be instructed relatively rapidly to identify and use structural concepts, the results suggested that this analytical approach to the training of family therapists shows considerable promise.

Introduction

The field of psychotherapy in general, and family therapy in particular, is characterized by a wide variety of theories on the relative effectiveness of different techniques and intervention strategies. Such has been the growth of family therapy that many training courses for would-be therapists have recently sprung up. Unfortunately developments in training research and evaluation have not kept pace with course development.

A central problem for the training of family therapists lies in oper- ationalizing both the concepts and the skills that are to be imparted through training. Attempts have been made to identify relevant therapeutic skills (e.g. Tomm and Wright, 1979) or to provide a general framework for defining such skills in terms of their conceptual, per- ceptual and executive functions (e.g. Cleghorn and Levin, 1973). But such descriptions are not sufficiently prescriptive for developing specific training programmes. In this paper an attempt is made to develop a set

Received 8 March 1984; revised version received June 1984. * Principal Clinical Psychologist, Preswylfa Child and Family Centre, Clive Road,

t Senior Lecturer, Department of Applied Psychology, University of Wales Institute Canton, Cardiff. (Address for reprint requests.)

of Science and Technology, Llwyn-y-Grant Road, Penylan, Cardiff. 335

0163-4445/84/040335 + I 1 903.00/0 0 1984 The Association for Family Therapy

336 E. Street and H . Foot

of procedures for trainingobservational skills in novice family therapists. Although the procedures described are focused upon a particular con- ceptualization of family process, that of Minuchin (1974), there is no reason to suppose that they could not equally be applied to other concept systems.

The procedures adopted owe their origin to the micro-counselling approach of Ivey (1971) and Ivey and Authier (1978), which essentially involves the defining and breaking down of component skills to be taught and a subsequent routine for practising and synthesizing them. In Ivey's technique the trainee is presented with written examples of the skills to be acquired supplemented by videotape demonstrations of good and bad models of the performance of those skills. The trainee practises each skill on a collea'pe and learns via the video playback of hidher own performance. The value of this explicitly analytical and practical approach has been confirmed in a variety of other counselling studies (cf. Kelley, 1971; Boyd, 1973; Canada, 1973; Moreland et al., 1973; Authier and Gustafson, 1975), but none of these studies has involved the training of family therapists. Street and Treacher (1980) have argued that this micro-counselling approach may be particularly suited to theories of family therapy and interaction, such as those of Minuchin (1974) and of Haley (1976), where the basic concepts of family functioning and dysfunctioning are couched in terms of repeated interactional sequences. Within these conceptualizations the therapist's initial task is to tap into and observe the typical interactional patterns of a given family. Thus the therapist typically becomes integrated into the family system and injects interventions which trigger different interaction patterns among members of the family. Different types of interaction will necessitate the adoption of different strategies by the therapist. The trainee therapist, therefore, needs to be instructed in the identification of typical interaction sequences as a prerequisite for developing the executive skills necessary to intervene effectively.

This study is designed to develop procedures for instructing trainee therapists in identifying and using the concepts derived from Minuchin's theory of structural family therapy.

The study

The study fell into two distinct stages. The first stage involved compilation of appropriate teaching material including a list of concepts and their definitions used in structural family therapy and videotape examples demonstrating the application of these concepts to inter-

Training family therapists 337 actions in family therapy sessions. In the second stage the use of the teaching materials with novice therapists was investigated by comparison with a Lgroup of experienced therapists.

Stage l : concept development

The generation of structural concepts and video material. Four therapists (including the senior author) who were utilizing the structural model in a weekly clinical workshop, produced, a list of the most important concepts from Minuchin’s theory. This list was based upon a consensus, by which eight major concepts were readily identified:

(1) Enmeshment (2) Disengagement (3) Lack of maintenance of generational boundaries (4) Chaotic parental discipline (5) Autocratic parental discipline (6) Non-resolution of conflict (7) Conflict avoidance (8) Rigidity of approach.

A large number of videorecordings was viewed for the purpose of selecting tape sequences illustrating typical patterns of family interaction observed in family therapy sessions. These tapes were of initial interviews with clients in which the presenting problem was usually one relating to a single child. Sequences from four suitable tapes were selected on the basis of (a) good sound and visual quality, (b) there being at least three interacting people involved, and (c) no major intervention on the part of the therapist. The sequences also displayed a variety of clinical problems and employed different therapists. They varied in length from five-and-a-half to nine-and-a-half minutes, and each sequence was segmentalized on the basis of homogeneity of social interaction. In practice, segments tended to be opened and closed by major changes of topic or questions by the therapist. Each secpent was thus capable of being understood as a unit by itself. The four sequences of interviews were edited onto a single tape (Tape l) , yielding a total of twenty-one se<gments with ten-second pauses between each segment. Se,gments varied in length from thirty seconds to 215 seconds with a mean of eighty-eight seconds.

Concept definitions. Fifteen ‘judges’ were recruited (nine males and six females): four were clinical psychologists, nine were social workers and

338 E. Street and H. Foot

two were psychiatrists. All identified themselves as family therapists by virtue of currently practising in the family therapy field and having had an average of 5.3 years of experience (range: 2.5- 11 .O years). All were familiar with the theory of structural family therapy. The judges were given a checklist of the eight concepts but no other defining character- istics. Prior to observing the therapy interviews they were instructed that, for each segment of interaction (as defined by the edited sequences of Tape l ) , they had to decide whether any of the concepts applied. They entered a tick on a response matrix to indicate the presence of a concept; for each segment they were permitted to tick a number of concepts or no concepts at all.

The distribution of judges' responses across segments revealed considerable inter-judge agreement on certain segments and less on others. Segment 5, for example, showed considerable agreement about the presence of both enmeshment and rigidity of approach; se'gment 20 showed little agreement about the applicability of any particular concept. There was no evidence that segment length influenced the likelihood of judges reaching agreement. By examining agreements it was possible to select out secvents which constituted the best examples of each concept by virtue of showing the maximum amount of agreement. For five of the concepts (enmeshment, lack of maintenance of generational boundaries, non-resolution of conflict, conflict avoidance and rigidity of approach) agreements were in the order of thirteen out of fifteen judges or better. For two (disengagement and chaotic parental discipline) agreements were amongst ten judges or more. The one concept about which there was little agreement was autocratic parental discipline: either none of the interaction se<gments successfully represented this concept or therapists found it difficult to apply. Five of the fifteen judges never checked the concept. For these reasons autocratic parental discipline was dropped from further use.

Having derived exemplars of the seven concepts about which there was substantial agreement, the help of a similar group of ten experienced judges was enlisted. These judges consisted of six females and four males: two were clinical psychologists, three were child psychiatrists and five were social workers. Their average experience as family therapy practitioners was4.6 years(range: 2.5- 10.0 years) and all were familiar with Minuchin's theory. The checklist of seven concepts was given to these judges who met as a group, and they were asked to write down their own general definition of each concept. Following this they read out their definitions in turn and discussed fully the differences and similarities that emerged. After discussion an opportunity was

Training family therapists 339

provided to amend any portion of their own individual definitions if they wished. The videotape exemplars of each concept were then shown and in each case judges were told how many of the earlier panel of therapists had agreed on the appropriate concept. After viewing each example, judges wrote down individually their reasons for considering that the concept was applicable. Individual reasons were read out to the group for discussion; further amendments of judges’ definitions were permitted. The final set of definitions for the seven concepts are presented below. They represent a composite of the ten sets of definitions produced by the individual judges, with minimal alterations except the elimination of duplicated ideas.

At the conclusion of Stage 1, therefore, a set of identified concepts had been derived based upon Minuchin’s structural model; each of these concepts was associated with a fairly comprehensive definition and an agreed videotaped exemplar.

The definitions of concepts were as follows:

Enmeshment: a lack of separateness and individuality in family members, where generation and latent boundaries are so blurred as to lead to the intrusion of one person into another’s life; where family members are very wrapped up together such that they believe what other people think and feel although this is not necessarily true; family members think, feel and speak for one another; overinvolvement of family members where they share common beliefdmyths and opinions; no disagreements are allowed; there is a difficulty in isolating individuals; a lack of individuality; an inability to separate and to allow individuality; differentiation is forbidden in the family rble system; there are no clear boundaries between people, everyone knowing what the others are thinking; there is a lack of definition of heirarchical boundaries; a general lack of identity separation within the members of any system.

Disengagement: distancing of one member of the system from the system; a ‘non-responsibility’ for things affecting other members; a refusal to become emotionally involved at any appropriate level; where a member of a family becomes so uninvolved that the family seems to function without them; a member or members of the family distancing themselves from others; members are not sufficiently involved in caring and being close to one another; a conscious or unconscious withdrawal of a family member from family life; the links between family members are tenuous; family members do not become close enough to be able to respond to one another appropriately; family members moving away from each other; moving away from the system; detachment.

340 E . Street and H . Foot Lack of maintenance of generational boundaries: The parental/

marital subsystem is not clearly differentiated from the child subsystem; the children often behave as parents and parents often demand parenting; it is not clear who is in charge; the r6les of various members of the family are blurred and inappropriate; all family members tend to be the same age emotionally and have the same expectancies; the boundaries between parents and children or grandparents are unclear and each does the others’ r61e or behaves in the way of the other generation: parental r6les are not appropriately separated from children’s rbles; family members cross boundaries resulting in them behaving in inappropriate r6les for their ages: there is no clarity between parent and child units; the child takes responsibility for parenting and the parents join the children; a failure to distinguish between different hierarchical levels within a system such that no-one takes command.

Chaotic parental discipline: there are no agreed or clear rules regarding the disciplining of the children; there is no set pattern of control; inconsistent handling of the children by the parents; there are no clear rules explicit or maintained in controlling behaviour; there is fluctuating parental control with no clear rules between the parents about handling the children; inconsistent rules with neither parent taking responsibility for them being carried out; no command is carried out or insisted upon; no one is clear what is asked of them; the parent(s) are unable to settle on any consistent method of laying down rules and keeping people to the task.

Non-resolution of confllict : conflict is allowed to continue although the means of working through it are unavoidable; conflict is never resolved in a system and this serves a maintenance function; family members argue but never solve problems; often they do not listen to one another: contentious issues in the family are brought up, but not solved; there is no mutual agreement reached; the rules of the system do not allow members to solve problems; problems and issues in the family are not faced up to for resolution; problems and rows are never finished due to a lack of problem solving skills; there is an inability to come up with any mutually satisfactory and negotiated agreement; disagreements are continually discussed but it is made impossible even to consider ways in which they might be resolved.

Conflict avoidance: arranging things in the family so that conflict is never made an issue; adopting strategies to steer conversation or action from their course when conflict is apparent or imminent; acting in such a way as if nothing has gone wrong; conflict is seen as bad and hurtful; keeping contentious issues submerged and unresolved by behaving so


that they will not surface; avoiding discussing differences of opinion; denying differences to avoid conflict; not risking an arLgument which might end up in a row; a fear of disagreement consequently family members always agree with each other; finding ways of distracting attention from basic underlying disagreements and therefore preventing tasks from being solved.

Rigidity of approach: a focusing only on one problem or symptom; a refusal to change ways of feeling, when given the opportunity; an inability to change or adapt to new situations; a lack of flexibility; family members are unbending; there is difficulty in adjusting to changing circumstances; problems are approached in set ways which do not allow for deviation; novel situations are not approached flexibly; individuals or systems with fixed thoughts and feelings; an inability to contemplate change or another’s views; the family is unable to alter course; it is fixed in ideas and change is not allowed; an inability to find new ways of problem solving; old ways are tried ad infinitum; family members must keep to the rules; everyone has hidher own place and is not allowed to move out of i t ; the repeated approach to any problem/situation by one way of thought or action.

Stage 2: training programme

Twenty-one social work students were recruited as trainees. Twelve were female and nine were male: they were all in their first term of a full-time Certificate of Social Work Qualification course. None had worked as an independent social worker and none had had any prior experience of family therapy. At the time of the investigation the course had not provided any theoretical or practical input on family therapy theory or techniques.

These trainees were given the list (from Stage 1) of the seven concepts and their definitions to study. They were then shown the seven seffments from Tape 1 which best illustrated each of the concepts, and at the conclusion of each segment the senior author read out the reasons why the experienced therapists had seen that interaction as an exemplar of that particular concept (taken from Stage 1).

After this training exercise the trainees were shown a new edited video- recording (Tape 2). This tape was made up of two or three secvents from seven different family interviews. A wider variety of clinical problems was featured on this recording than on Tape 1 ; otherwise the criteria for selecting suitable secvents were the same as those on Tape 1. Without any further ,guidance other than the written definitions, the

342 E. Street and H . Foot

trainees were shown Tape 2 and were asked to indicate, on an appropriate response form, which concepts applied.

For comparison purposes a control group of experienced therapists also viewed and responded to Tape 2. The same ten therapists used to generate definitions in the last part of Stage 1 viewed this second recording, using the definitions of concepts which they had helped establish for identifying the presence of concepts.

Results and discussion

The distribution of responses across sessions and segments for both the experienced and trainee groups is shown in Table 1. Since the sample sizes are considerably different (n[trainees] = 21, n[therapistsl = l O ) , comparison of the two samples is better achieved by taking a cut-off point for agreements in terms of a similar proportion of agreements by subjects in both groups. Adopting, therefore, an approximately two- thirds criterion (as was done in Stage 1 for choosing concept exemplars), response frequencies are asterisked in Table 1 if they reach seven out of ten in the case of the therapists and fifteen out of twenty-one in the case of the trainees. (This latter proportion is significant on a chi-squared test.) Not surprisingly the therapists recorded a much higher number of such ‘si<gnificant’ agreements (twenty-five) than the trainee group (seven). They are likely to be generally more sensitive to cues revealed in family interaction and specifically more sensitive to signs of dysfunction. Of the seven agreements amongst the trainees, all but one occurred when there was also agreement amongst the therapists about the applicability of that concept. The exception involved responses on chaotic parental discipline on Session F/Segment 1. There were, however, three other setvents on which trainees and therapists agreed about that concept. Of the seven concepts, enmeshment, conflict avoidance and rigidity of approach yielded no significant agreements by the trainees and may be more difficult to discriminate. Rigidity of approach and enmeshment in particular may not be so readily trainable since experienced therapists identified them as key concepts on five se,gments each, while trainees did not identify them once.

The selection of two-thirds agreements by which to compare the samples is both a crude and an arbitrary measure. Also it discguises the considerable concordance between the two samples about the non- applicability of some concepts for certain secpentS. Secvents were therefore, individually examined on the basis of the frequency with which each concept was mentioned by trainees and therapists.


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344 E. Street and H. Foot

Spearman rank-order correlations were calculated between the groups and these are presented in Table 2.

It is evident from Table 2 that rank ordering of the concepts by the two groups was significantly correlated for half of the secvents and, in all but one case (Gl) , positively related for the other half. This analysis provides more general evidence of convergence between the responses of trainees and therapists.

TABLE 2. Rank correlation Coefficients (Spearman? rho) comparing experienced and trainee therapists across segments of Tape 2

Session Secpent Coefficient P ~ ~ ~~~~~ ~ ~~ ~~ ~

A 1 0.64 <0.05 A 2 0.48 B 1 0.68 <O .05 B 2 0.77 <0.025 C 1 0.72 <O. 05 C 2 0.12 D 1 0.46 D 2 0.68 <0.05 E 1 0.91 <0.005 E 2 0.82 <0.025 F 1 0.59 F 2 0.46 G 1 -0.15 G 2 0.34 G 3 0.59

Overall the results of the study are encouraging: firstly, they suggest that Minuchin’s concepts of family structure can be quite clearly defined and operationalized such that experienced family therapists agree about their use and applicability. Secondly, inexperienced individuals can, with even bsief training, achieve a modest amount of success in making valid discriminations. This is not to artgue that all the concepts are equally discriminable and equally trainable. The study suggests that some of the concepts are more difficult to learn and apply than others and may need to be introduced at a later stage of training.


Conclusions

Whatever theoretical approach is adopted towards family functioning, the therapist has to define the problems presented and impose some priorities in terms of treatment strategies. This study has demonstrated the efficacy of a micro-analytic approach to training and has shown how quickly inexperienced trainees can be shaped up in the use of structural concepts and in observational skills. Of course, training should be more extensive both in terms of amounts of practice using the concepts and in terms of the variety of presenting problems through video. It is also desirable that trainees should not be encouraged to make snap judgements on the basis of brief, discrete se<gments of family interaction. More considered judgements could be taken in the context of longer sequences of family interaction, once the trainees had learned to adopt an analytical approach.

References

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BOYD, J. D. (1973) Microcounseling for a verbal response set: differential effects of two micromodels and two methods of supervision. Journal of Counseling Psychology, 20: 97-98.

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training family therapists in observational skills

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