The Narratives Which Connect…

Views of the Necessity of Working with One’s Own Family in Family Therapy Training

Several attempts have been made to find ways to work with the relation between personal and private background and psychotherapy. Cross and Papadopoulos (2001) point out that our own family, culture, gender and ethics, are four areas to focus on. In this literature overview, I have chosen to divide the literature connected to the views of working with our own family in family therapy training into two main topics connected to my research question. These are “the therapist’s own family of origin” and “contemporary life”.

Three points of view emerged from my reading of this literature and from conversations with colleagues in the field of family therapy. These three points of view are relevant for my project and for the subsequent analyses. The three points of view (see below) are connected to how the family therapy literature discusses and views the patterns that connect family therapists’ personal lives with their clinical practice. I will discuss these points of view under The Therapist’s Own Family of Origin.

The Therapist’s Own Family of Origin

In “Family of Origin as a Therapeutic Resource for Adults in Marital and Family Therapy: You Can and Should go Back Home Again” (Family Process, 15, 1976) James L. Framo (1976) argues that this turn home is necessary in therapy. I will consider if the return to home also could be meaningful in the developmental process of becoming a family therapist. There are three relevant points of view:

1. Our own family of origin is irrelevant to clinical training.

2. Working with one’s own family is optional.

3. Working with the relationship between our own family and clinical practice is compulsory.

Working with Our Own Family of Origin is Irrelevant to Clinical Training

In modernistic thinking and positivistic research the idea of neutrality and objectivity is central both to understanding practice and as a guideline for clinical practice. From this perspective our own family can be viewed either as irrelevant or as a disturbance. In cognitive behavioural therapy (CBT) working with our own family is not a part of clinical training. These therapists take the stand that it is the therapeutic intervention that works. Therapists need to be well trained to deliver the interventions, but the therapist’s personal background and culture does not influence the therapeutic intervention. Jennings refers to Daws, who is one of the critics of the notion of the therapist as an expert, and Jennings notices that according to Daws the experts simply exist. Jennings refers to Daws’ claim that “the experience level of the therapist was not a significant factor. Daws claims that the effects of therapy and counselling are almost entirely determined by the client” (Jennings et al., 2003, p. 60). This builds on the idea that change as a therapeutic effect is only a result of the client’s personal effort.

In the psychoanalytic tradition the idea of the therapist as a neutral medium for the patient’s transference demands that the therapist clarifies his / her relationship to their own family history. This work should be done to keep neutrality through therapy and to manage transference from the therapist to the patient.

Strategic Family Therapy

In “Teaching Family Therapy” (Draper et al., 1991) working with one`s own family is not mentioned as a topic at all. Jay Haley and the strategic family therapy tradition do not view the therapist’s own family as relevant. In Haley’s book about learning, and learning the teaching of family therapy from 1996 is the claim that if trainees’ biases should cause problems in therapy these should be dealt with in supervision. Personal therapy is not the solution, he remarks (Hildebrand, 1998, p. 3). As mentioned earlier, Richard Fisch at the Mental Research Institute in Palo Alto, claims that the Brief Therapy education program supports the same viewpoint. In a brief comment on my project, he responded¹⁶:

“In any of the training I do, I do not use the concept that a therapist can be more effective in examining his family of origin. That concept implies that current problems stem from earlier experiences, e.g. within the family. This is a very different model (concept) than what I find useful in problem resolution. That model explains problems as a result of persistence by the client in attempting to resolve his/her problem by methods that continue to fail to resolve the problem, what we call ‘the Attempted Solution’.

  As you can see, such an explanation would find ‘the past’ as irrelevant as well as the notion that one's problem is a reflection of an enduring influence by others in the past. Those concepts are much more related to earlier methods of ‘family therapy’ developed by Virginia Satir and Murray Bowen, among others. They differ from the ‘Brief Therapy’ model also in retaining the idea that current problems reflect psychological or social pathology, e.g. ‘the dysfunctional family’. We discarded the notion of pathology altogether since we did not see that it was useful and, in fact, prolonged therapy unnecessarily. I hope all this clarifies my position and I appreciate your interest in what we have been doing.”

Working with Our Own Family is Optional.

The Trainee’s “Trigger” Family

Monica McGoldrick (McGoldrick, 1992) writes about the meaning of working with the relationship between personal life history and clinical casework as a part of family therapy training. She states that: “There is much need for research to determine the value of work on the therapist’s own family in training” (ibid p. 19). Here I will point out three topics from her article that I find important and interesting because they are directly linked to my research question.

The first topic concerns a trainee meeting his or her “trigger family” and how it is possible to work through a process in family therapy training that gives new meaning to both personal history and development in one’s own clinical practice. The “trigger family” in this case study by Monica McGoldrick is defined as a family where the relation between the issues in the trainee’s own family and the family in therapy “…were so close to his own” (ibid p.17). The second topic is connected to the idea that this type of work is optional in the education program she writes about. The third topic comes from a footnote where she claims that in the eight years she has done family therapy training only one trainee “was able to maintain his level of clinical competence while going through a separation or divorce” (ibid p. 37).

“A Quantum Leap”¹⁷

McGoldrick argues strongly for trainees to work with their relationship to their own family. She writes: ”It is our impression that such work benefits the trainee’s clinical work, and that is particularly helpful in aiding trainees to shift from linear to systems thinking” (ibid p. 19) and that: “Understanding one’s functioning in his/her own most important system, his/her own family, seems to facilitate the ability to understand the operation of other natural systems and the ability to generate hypotheses about families on a systems level” (p. 20). She sums up by stating that: “…it is my strong impression that one tends to get blocked with clinical families in the same ways one does in one’s own family” (p. 20).

McGoldrick tells the story about “Peter” (the trainee) and the “Arthur” family. Through a supervised process, “Peter” identifies common themes from his own family in working with the “Arthur” family. He finds himself stuck, but through supervision and willingness to open up and bring these themes into the therapy room through self-disclosure, he gains new experience both with his own family and as a family therapist. McGoldrick states that: “Successful work on their issues and clarifying the connection to the trainee’s own (family) may produce a quantum leap in clinical development” (p. 17).

Optional

McGoldrick argues that the part of the program that is connected to working with the relationship between the trainee’s own family and clinical practice should be optional. “Many factors influence a trainee’s willingness or interest in pursuing work on his/her own family, and such pursuit cannot be dictated by a training programme” (p. 20). Everybody is encouraged to take part in this process and about 50% did it in the program from which she reports. As mentioned earlier, according to AAMFT´s ”Manual of Accreditation” from 1997, all students must finish the module named: “Personal development and family relations.”

Crises and Training

In this article, McGoldrick connects “Peter’s” story to his family of origin, and it can be useful to make a distinction between family of origin and current family issues. This indicates that the links between personal life and clinical training and possible clinical practice are significant. In this perspective and from her own arguments and from the stories she tells about “Peter” and the “Arthur” family it is not obvious that this part of the program should be optional. To understand this position I believe it will be fruitful to look at our educational traditions within family therapy in Europe and the USA and within the psychotherapy field.

Re-membering

In “Narratives of Therapists’ Lives” (White, 1997) Michael White clarifies how re-membering is used to create new narratives. Re-membering is a way of connecting someone in your history to your own life today, to become a “member” of your history again. Barbara Mayerhoff calls re-membering “a purposive, significant unification” (White, 1997, p. 22). Going into a re-membering process is like re-creating thick descriptions of one’s history. For White, “thin” and “thick” stories are alternatives to “surface” and “depth” (ibid p. 63) and these alternatives help avoid the expert position.

In the intensive training courses at Dulwich Centre, the participating therapists have the opportunity to be interviewed about their lives and work. These interviews are structured in four phases with an outsider-witness group as part of the session. Through interviews like this, White shows how therapists’ personal and private experiences from life can be connected to their professional practice as family therapists.

Working with the Relationship between our Own Family and Clinical Practice is Compulsory.

As mentioned earlier Personal and Professional Development is a compulsory part of family therapy education in some countries. It is not obvious however, that PPD work involves working with the relationship between our own family and clinical practice. Judy Hildebrand’s book “Bridging the Gap, A training Module in Personal and Professional Development” (1998) focuses only indirectly on the relation between the trainee’s own family and the trainees’ clinical practice. The situation is much the same in Barcelona¹⁸ and Cardiff¹⁹.

Finally, I wish to point out that in addition to the family of origin, family therapists are influenced by contemporary family life and by private and personal values and cultural influences over time.

Contemporary life

The area of contemporary life includes working with the therapist’s personal and private life and working with the therapist’s cultural, political personal and private values.

In some family therapy traditions (e.g. Bowen Family Systems Therapy), the link between one’s own family and clinical training and clinical work seems obvious. Family therapists who combine parts of psychoanalytic thinking with the family perspective seem to take students’ and clients’ own families as important parts of both training and practice (Framo, 1976; Lieberman, 1987).

When students are working with genogram and cultural difference, PPD work may offer an opportunity to link clinical work closely to own family. However, the culture of origin is larger than one’s family. It refers to the major group(s) to which an individual belongs (Hardy and Laszloffy, 1995), such as social, work, community, faith etc.

“What are your motives and what’s your agenda?”

Odell and Campbell advise teachers in family therapy programmes to ask students who want to study family therapy: “What are your motives and what’s your agenda?” (Odell and Campbell, 1998 p. 10-14). They point out both internal and external motives. They claim that most often students tend to emphasize external motives when they must explain why they have chosen the profession. However, they claim that internal motives play a more important role and should be examined. The agendas students have for becoming a family therapist may be connected to how they believe family life should be lived and to their own experiences of family life.

An interesting example of how to think about links between personal experience and the choice of profession are given by Kim Larsen (2006). In an article in the journal for the Norwegian Psychological Association, he gives an example of how he thinks some persons’ personal and private experiences make them unsuitable for vocational rehabilitation through certain education programmes. He also discusses whether, for example, an experience such as “incest sufferer” can be viewed as a qualification for a position working with “incest sufferers”. According to Larsen, a person’s personal and private experience might make him or her unfit for some professions. Larsen points out that occupational psychologists should more often give priority to the best interests of society and clients instead of the subjective interests of persons who want to use their traumatic background in an effort to help clients with similar experiences.

Ways of focusing on the therapist’s own family are many and different, from political (White, 1997) to private and personal (Hildebrand, 1998; Faris, 2002; Burck and Campbell, 2002). Julia Halevy claims that her fundamental belief is “…that in order to become competent and ethical practitioners, students must understand themselves and how they see others” (Halevy, 1998, p. 233).

Bridging the Gap?

In her book “Bridging the Gap” Judy Hildebrand (1998) gives a rationale for including personal and professional development (PPD) as a part of family therapy education. She describes the aims and the process of the group meetings and she presents in detail 27 exercises that have been used in PPD-work in two different family therapy education programmes in England. In Institution A they had a large group and in Institution B a small group. A survey from these practices is presented along with her reflections about the future.

She says that they started this work to help ”…linking the past to the present, the personal to the professional” (ibid p. 4). As an alternative to depicting this process as a critical endeavour she emphasises it as a process of self-reflexivity (ibid p. 6). Her aim is, among other things, to include “professional dilemmas” and “personal experience” in each group meeting (ibid p. 12). The cores of the PPD module are 27 experiential exercises. They are meant to link the past and present experiences with current professionals’ dilemmas. After my careful reading of the 27 exercises, it appears that only seven focus on the link to clinical work. Every exercise that focuses on the link to clinical work does so in a general way. That is in line with what her experience is when she claims:

“Much of the time in the PPD module is spent in general discussion about issues brought up by the participants, as well as in doing exercises relevant to the feelings and subjects that they raise” (ibid p. 11).
In my research, I look for how personal and private experiences influence the therapist’s own clinical practice. None of the exercises in Judy Hildebrand’s book “Bridging the Gap” invite the student to reflect directly on the possible links between the student’s own personal history and their specific clinical practice. Even when role-plays of clinical situations are a part of the exercise, students are only invited to do general reflection on the consequences for clinical practice (ibid p. 52).

In “Becoming a Therapist” (Cross and Papadopoulos, 2001) have developed a manual for personal and professional development. Here they ask some very relevant questions like: “What does my family have to do with my practice as a therapist?” (p. 5), ”What does culture have to do with how I work as a therapist?” (p. 28), “What does it mean to be male or female, and, perhaps more importantly, what are the implications of these meanings?” (p. 48), “What is the relationship between my personal morals, values and professional ethics? (p. 60) and “What can I personally bring to the practice of therapy? (p. 68). They do not intend to answer these questions but have developed the manual for professionals in training.

In their article “Arts and literature in a personal development process and systemic psychotherapy training” (Cox, Faris and Hardy, 2004) about their “Personal Development Group” (PDG) program, Brenda Cox et al from The Family Institute at the University of Glamorgan point out that: “Not since Hildebrand (1998) has there been a focus on the nature and process of PPD in the training context.” They claim that their shift to second order cybernetics, among other things, has contextualised the choice to “focus upon the therapeutic relationship.”

In their article, they use three examples. The first example they call “Desert island discs,” the second is called “Back to the future,” and the third they call “Cultural project”. Yet, none of these three examples focuses on the relationship between the student’s private and personal history or experiences and their clinical practice.

Joyce Scaife and Sue Walsh point out areas in which the connections between experience from work life and private life may influence clinical practice and they say that:

“Supervision may provide the only context in which it is possible to stand back from relationships in order to analyze and understand the interpersonal processes taking place and to construct action plans in order to alleviate the distress arising from them” (Scaife & Walsh, 2001, p. 34).

To bridge the gap between psychotherapy and the influence on psychotherapy from the therapist’s private and personal history and life, is the background for this research project. By illustrating how therapists’ personal and private backgrounds influence therapy, it may give inspiration to further develop the work on personal and professional relations.

Summary

In this last section, the different views of the necessity of working with one’s own family in family therapy training have been examined. The views here move from the idea that own background and own family are irrelevant, to a position where working with own background and family is viewed as compulsory. Also contemporary life and own cultural and political as well as religious affiliation are highlighted as relevant areas to examine.