The Narratives Which Connect…

Ethical implications for family therapy education and practice

The findings in this research project could also be discussed from an ethical point of view. Some of them are closer to ethical considerations than others. One example of a finding that needs ethical consideration is Elisabeth’s story about the relation between her own personal and private values and experiences with a half-brother and her encounter with a family in a parallel situation (see p 106). That she, in cooperation with a colleague, nearly forced her own values on the family could have resulted in a violation of the father’s ideals and way of organising his own family life. According to Elisabeth, this was not what happened. However, stories like this bring up the need for discussions of family therapy practice in an ethical framework and the need for ethical guidelines.

The Norwegian government does not officially recognise psychotherapists (including family therapists). This is a task professional unions in Norway currently perform. Only the Psychological Association and the Medical Association offer recognition to psychotherapists. In these circumstances it may seem peculiar that the Norwegian Family Therapy Association does not engage in family therapy training or in recognition of family therapists in Norway. However, academic and therapy staff at the Master degree in Family Therapy and Systemic Practice at Diakonhjemmet University College in Oslo do therapeutic evaluations as part of the students’ exams. We not only evaluate students’ academic standards but also their therapeutic skills. This imposes responsibilities on us that go further than merely delivering certificates to students.

Ethical guidelines

Most clinical practitioner psychotherapists do their work supported by an ethical standard and ethical guidelines. Ethical guidelines are drawn from culture, personal background, theory and professional training. Professional unions in Norway have developed specific and formally articulated ethical guidelines for clinicians.

In psychotherapy, only clinical psychologists and psychiatrists are supported by ethical guidelines when they practice as psychotherapists. The Norwegian Association for Psychotherapy (NAP), a member of the European Association for Psychotherapy (EAP), has developed guidelines for psychotherapists that are in line with EAP’s guidelines. Only a few Norwegian family therapists are members of NAP. The Norwegian Family Therapy Association is a special interest organization for family therapy and systemic practice in Norway, and this union is not involved in family therapy training or in developing ethical standards for practitioners. There are health laws and other ethical guidelines that support and regulate family therapy practice in Norway. However, social workers, nurses and other family therapists outside the psychological and medical associations are not supported by any ethical guidelines for family therapy practice.

As a university college that offers the students clinical evaluation, and in that way communicates that they are qualified to practice, we should also develop ethical guidelines and seek to tell both our students and their clients that such guidelines exists. We should develop the PPD programme further in establishing an ethical base in the formation of guidelines communicated to our students and their clients.

Summary

In the discussions of the key findings, the research shows that both the practice of family therapy and the therapist’s personal life may be mutually influential. Family therapy education may also be affected by new knowledge of how personal and private influences may affect clinical practice. Is it time to make personal and professional development programmes compulsory in family therapy training? Is it time to rethink the role of our own therapy as a part of family therapy education? The ethical considerations, among others, point to the need for ethical guidelines for family therapy practice. This research project may also be seen as an invitation to rethink how family therapy practice can be understood. The project shows that personal and private experiences sometimes form a central framework for understanding sequences of family therapy practice. This realization should not be overlooked in the future and calls for further development.

PPD has not been part of family therapy education in Norway as a formal part of any programme. This research process has pointed out the need for such a programme in Norwegian family therapy education.

We do not have ethical guidelines for psychotherapy from the Norwegian state or from the Norwegian Family Therapy Association. As a university college offering students clinical evaluation and thereby communicating to them that they are qualified to practice, we should also develop ethical guidelines and seek to tell both our students and their clients that such guidelines exist.

9. Areas for further research

Introduction

The areas for further research within this research project are numerous. Here I will first take a look at the areas where there are parallel connections between family therapists’ lives and their clinical practice. I will then raise several areas for further research that I view as particularly important and interesting to explore in the years to come. Development of these areas will probably result in many new research questions.

Further research on parallel connections

Throughout this research project and looking back on my own experience as a family therapist and contacts in the clinical field, I can identify ten areas for parallel connections. In the Appendices 9, I will briefly give an overview of these ten areas with their 40 sub- categories. This will broaden the possibilities for further research on parallel connections.

Alternative research questions

An open research question would probably give the participants in the research project more freedom to explore more ideas. An open research question might ask among other things what and how the participants think about relations between personal and private life and systemic family therapy practice. They might also be asked how they think these areas should be handled, for example: Which ideas do you have about the possible connections between personal and private life and your practice as a systemic family therapist? The influence of clinical practice on the therapist’s personal and private life is an area that is open to a research project in its own right. An independent research project in this area would probably produce further interesting findings and analyses.

New research questions

Areas such as culture, religion and socio-economic background are topics of major importance. There are numerous possible research projects in connection with developing understanding of how these areas are an integrated part of systemic family therapy and how they may influence clinical practice. These are areas of high importance also for family therapy education in Norway because we have changed from a rather homogeneous culture to a multi-cultural society.

The question could be raised of whether it is time to try to answer the question of which therapist can best serve which client. This question emerged in my discussion of evidence-based research and evidence-based practice. Examples of such research are the works of Skovholt and Jennings (2004) about master therapists and Orlinsky and Rønnestad’s (2005) ongoing research on how psychotherapists develop.

When we talk about therapists’ experience we most often refer to their trained background and professional life. Personal and private experiences are often left out or overlooked as part of what belongs in a professional context in terms of the experience considered to be part of clinical competence. The process of learning family therapy while grounded in the connection between personal and private experiences and clinical practice might provide a research area with many exciting topics (Simon, 2006). In this research project, the context for studying connections between family therapists’ personal and private lives and clinical practice has mostly been the study of episodes in the therapeutic process. Further research might focus on such connections in the context of complete therapy processes.

None of the participants in this research project used any form of manual in their practice. It could be interesting to compare two groups of therapists (one group of therapists using manuals in their clinical work and one group that do not use manuals) to explore the influence of personal and private life on family therapy. Would there be any differences and if so, how could these be described and understood?

The different concepts and the relation between the concepts in “the map of relational resonance” represent a framework for further research. The map of relational resonance carries out some questions and challenges that need further research to widen our understanding of systemic family therapy and systemic practice.

The map of relational resonance also offers a language and carries a potential as an evaluation tool both in family therapy education, and in evaluating clinical practice in general. New research questions might be asked to explore and develop this aspect of our understanding of clinical practise.

PPD research

The last area I will mention for further research is connected to the development of the modules often called “personal and professional development” (PPD) in family therapy education. Research projects in this area might be projects where more than one education programme might cooperate in developing, evaluating and performing PPD-modules as a part of ongoing education programmes.

How do family therapy students handle situations when the student’s own values and culture are challenged? Are such topics avoided? This could be seen as the opposite side of influence of the therapist’s personal and private values. When the therapist does not even raise questions that are in line with her or his own values, this might be seen as avoiding difficult situations. The question could be asked about what therapists do when topics that are close to their own value systems appear. Do they enter into these topics? Do they avoid them? How do they influence topics like this? These are some additional areas for further research.

Finally, I will suggest that research questions be asked and developed regarding the relation between PPD work and clinical practice.