Aspects of training in family therapy in the UK

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High Quality Training Models Milan July 2009
Aspects of training in family therapy in the UK
Peter Stratton Professor of Family Therapy
Leeds Family Therapy Research Centre University
of Leeds
EFTA
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Aims and Objectives

• To demonstrate the UK approach of using systemic
  therapy as a basis for training
• Verbal approaches to experience through dialogue.
  
• Participants will be able to relate this approach
  to their own styles of training.

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Plan of the presentation

• The UK approach to systemic family therapy from
  which the forms of training are derived.
• A reflexive formulation of active learning
• The dialogical construction of the self of the
  therapist
• Creativity and humour in training and therapy

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LFTRC MSc Modules

• Theory
• Skills
• Supervised Practice
• Research
• Personal and Professional Development

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A Northern concept of systemic family therapy

• Sometimes our closest relationships lead us into
  desperate patterns of acting.
• Often our best resource for overcoming
  difficulties is our family.
• So therapy is often best done by mobilising the
  family, not just the individual
• For this to work, everyone will need to give up
  some certainties.

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How systemic FT creates change

• By changing the story (narrative) that people
  have about their family and about each other.
• First listen (without making assumptions from
  your prejudices) to what the current story is.
• Mobilise your curiosity to activate dialogue
• Use circularity to clarify and make the
  differences in understandings explicit
• Foster dialogues that lead clients to construct
  selves with greater capabilities
• Use positive connotation, reframing and
  irreverence because these head off dead-end
  processes like defending their current position,
  blaming, and anger.
• Focus on strengths and resources, because these
  are what you will need in order to create
  solutions

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An LFTRC team behind the screen
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Leeds trainee ratings of competences confidence
ranked in order of perceived need
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The Leeds SFT Manual

• Designed for use to standardise therapy for
  research, but has been mainly used as a training
  tool.
• Qualitative and quantitative research (Pote et
  al, 2003) of what therapists did and how they
  thought this would produce change.
• The full Manual available on web. A couple of
  examples

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Type of Questioning
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Item from the Adherence Manual1.6 Was the
therapist taking a self-reflexive stance?

• the therapist was able to apply systemic
  thinking to themselves and thus reject any
  thinking about families and their processes that
  does not also apply to therapists and therapy.
  Self-reflexivity focuses especially on the effect
  of the therapy process on the therapist and the
  way that this is a source of (resource for)
  change in the family.

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Therapists preferred model
Work to adapt model for this client
enhances
Repertoire of skills
How to co-construct with the client
Happy therapist
Shared optimism (allegiance)
Articulate belief in that version of the model
Therapist conviction
Create a sense of shared purpose (alliance)
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Learning and Teaching

• In twos, please say what theories of learning
  your training is based on.
• We use these micro-discussions to potentiate the
  making of connections.

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Training and therapeutic interventions

• Involve learning, if they are to have lasting
  effects.
• We draw on theories not just from systemics but
  also adult education, psychological studies of
  skill acquisition etc.

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Learning
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Tom Andersens sketch of a conversation
Andersen, T. (2004) If your pain found a voice,
what would it say? Human Systems. 15, 213-225
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The learning spiral

• Focuses us on reflections through language
• As a way of co-creating learning experiences
• Exemplified by the LFTRC Supervision Profile
  (developed by Paula Boston)
• Consolidated in PPD and reflective learning logs

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Thinking about Zones

• Vygotskys zone of proximal development (ZPD)
• An essential feature of learning (and therapy)
  is that it creates a ZPD that is, learning
  awakens a variety of internal developmental
  processes that are able to operate only when the
  trainee is interacting with people in his
  environment and in conversation with his peers.
  Once these processes are internalised, they
  become part of the trainees independent
  developmental achievement
• Vygotsky, L. (1978) Mind in Society. Harvard U.
  P. Cambridge, MA.

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Jaan Valsiner (1987)

• Zone of Free Movement (ZFM) the constraints set
  around the student by trainers, then environment
  and culture, and then by internalised forms of
  these.
• And Zone of Promoted Action (ZPA). trainers
  promote action in some directions in preference
  to others.
• The ZFM/ZPA unit guides development within the
  particular conditions of the ZPD

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Practice does not make perfect (look at your
handwriting)

• Skills are acquired through
• Deliberate working on improving the skill
• For this to happen, it is essential to have
• Feedback (which you can give yourself)
• Creativity is a skill

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So lets be creative

• Please discuss in pairs or 3s
• In a free-flowing, imaginative, dialogue of wild
  ideas
• When we train therapists, who do we want to be
  creative?
• (managers, universities, colleagues, trainers,
  trainees, their clients, their clients other
  professionals, our accountants..)

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• Creativity is one of the prime responsibilities
  of therapists. So
• Not so much what is creativity, but how to go on
  creatively.
• Without privileging creativity at the expense of
  rigour.
• Any thoughts from the exercise of what freed you
  to be creative?

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What is happening here?

• Two men meet
• John announces
• my wife is pregnant
• David replies
• congratulations

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What is happening here?

• Two men meet
• John announces
• my wife is pregnant
• David replies
• who do you suspect?

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Connections

• In pairs, brainstorm about why Peter thinks this
  joke is relevant to training.

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Some parallels I prepared earlier

• A culturally specified expectation.
• A prepared (warmed) context
• An alternative reading which
• Deconstructs and makes visible the initial
  expectation
• Offers a radical alternative which is
• Plausible energising has lots of implications
  opens scope for dialogue likely to come to mind
  next time

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Join us in co-creating a unique form of
collaborative conversation. Special Volume 19,
2008 Personal and Professional Development in
Training Containing 20 articles by a prestigious
international group of trainers including The
Use of Resonance in Supervision and Training Mony
Elkaïm, Belgium The Training Group as a
Self-Organising System Paolo Bertrando, Italy The
Landscape Genogram A Tool for Personal
Development and Supervision Jacques Pluymaekers
Chantal Nève-Hanquet, France Crossing Frontiers
Adventure and Exploration in Family Therapy
Training Judith Lask, U.K. Editors Peter
Stratton, LFTRC, U.K. Kyriaki Polychroni, AIA,
Greece Website www.humansystemsjournal.eu
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Further Information

• Visit Peters work-in-progress websitewww.psyc.l
  eeds.ac.uk/staff/p.m.stratton/

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Defining Learning

• When you stop learning you die.
• In pairs What does that say about my definition
  of learning?
• Which is that we survive and thrive through
  adaptation. So living is adaptation. But a
  learning context that will capitalise on this is
  defined by demanding adaptations of a kind that
  the teacher wants.

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Batesons dilemma

• Serious business like therapy implies rigour
• The dilemma of the tension between rigour and
  creativity.
• As Bateson said, too much creativity leads to
  madness
• But too much rigour results in death

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Humour, and therapy, need to distance from the
seriousness

• In Batesons terms, maybe humour allows you to
  test something out in the map before you have to
  get into the territory. Flagging something as a
  joke is a signal that this is map, not territory.
  we are going meta
• Alternatively it is the absence of an
  (amigdaloid) emotional reaction.

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How humour works during UK family therapy

• In 10 family therapy sessions there were 183
  episodes with an indication of humour.
• Grounded Theory analysis
• Both family members and therapists used humour
  extensively but therapists used a more restricted
  range. Humour was used with an enabling function
  by both families and therapists when confronting
  difficult issues.

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Types of humour most often used by therapists

• Were in the group likely to open up alternative
  attributions.
• Exposure of censored feelings
• Introduction of new explanation
• Comment
• Task assignment
• Challenging of beliefs
• Irreverence