Couple and Family Therapy in Counselling Psychology: Competence and Context

1. Couple and Family Therapy in Counselling Psychology: Competence and Context Tanya Mudry, Emily Doyle, E. Aiofe Freeman-Cruz, & Jeff Chang Canadian Counselling Psychology Conference October 28, 2018

2. Outline and Introductions • Couple and Family Therapy: A Distinct Competency (Jeff Chang) • Considering the Therapeutic Alliance in Marriage and Family Therapy (E. Aiofe Freeman-Cruz) • Marriage and Family Therapy and Psychology: All in the Family (Tanya Mudry) • Finding Your Feet: Practicum Supervision and Practice in a Family Therapy Centre (Emily Doyle)

3. Couple and Family Therapy: A Distinct Competency Jeff Chang, PhD, R. Psych.

4. Defining “family therapy” • What is “family therapy”? We usually mean one or more of five definitions (sometimes simultaneously) • a professional discipline/license (in all 50 US states) • a professional identity (663 AAMFT Clinical Fellows in Canada, about 50 of whom are psychologists) • an intervention modality (having more than one person in the room) • a way of conceptualizing human problems (“relationships, interactions, and context” – Ken Hardy) • a distinct area of practice requiring specific competencies

5. How much CFT do psychologists do? • Quite a bit! • 75% of the American Psychological Association’s (APA) Division of Psychotherapy regularly conduct couples therapy, while 33% do family therapy (Norcross & Rogan, 2013) • APA Division 12 (Society for Clinical Psychology). Of those practicing psychotherapy, 55% performed couples therapy and 39% performed family therapy (Norcross, Karpiak, & Santoro, 2005) • 68% of private practice psychologists in southern California regularly delivered couples or family therapy (Kozora, 2008) • 78% APA Division 29 (Society for the Advancement of Psychotherapy) reported conducting couples therapy, and 38% reported offering family therapy (Norcross & Karpiak, (2012).

6. How much CFT do psychologists do? • 62% of Canadian Register of Health Service Psychologists (CRHSP) reported regularly conducting family or couple therapy (Hunsley & Lefrebvre, 1990) • 26.6% of Canadian psychologists who do therapy offer couple or family therapy, and 20.8% espouse a family systems theoretical approach (Hunsley, Ronson, & Cohen, 2013)

7. How is competence in CFT recognized? • AAMFT credentials Clinical Fellows (entry-to-practice) • requiring 3 courses each in human development, family studies, and family therapy • 1000 hours of direct client contact, and 200 hours of supervision by an AAMFT Approved Supervisor. • June 2017: 663 Clinical Fellows in Canada; 46 (7%) identified as psychologists AAMFT credentials Clinical Fellows

8. How is competence in CFT recognized? • ABPP: Diplomate in CFT (advanced postdoctoral training) • CPA or APA accredited doctorate • Graduate coursework or extensive continuing education • 1 year of postdoctoral supervision • Oral exam based on video work sample • 64 ABPPs in Canada, none in CFT

9. Competence: “Knowledge, skill, judgment and diligence” • We are not taking the position that psychologists must have one of these designations to practice CFT. • For example, the College of Alberta Psychologists defines competence as: “knowledge, skills, judgment, and diligence” acquired through “education, training, and experience.” • How do Canadian psychologists acquire competence?

10. Competence: “Knowledge, skill, judgment and diligence” Knowledge: Educational programs • I reviewed websites of 5 CPA accredited counselling psych programs and 22 English language instruction clinical psych programs (total=27) • 13 have family therapy courses “on the books”; their availability is uneven -- understandable based on curricular demands of accreditation • Out of 27, only Counselling Psych at McGill requires a family therapy course

11. Competence: “Knowledge, skill, judgment and diligence” Knowledge: Educational programs • Masters programs do somewhat better • All CACEP-accredited programs have a family therapy elective • US-based masters programs (e.g., City U, Gonzaga) and Yorkville require one

12. Competence: “Knowledge, skill, judgment and diligence” Skill: Supervised Practice • Largely driven by student choice and self-advocacy • Family service agencies • Anecdotally, few internship sites have much opportunity to practice family therapy. • 3 CPA-accredited counselling psychology internship sites: 2 are university counselling centres • 35 CPA-accredited clinical psychology internship sites: more variety, but access for counselling psychology PhD students might be an issue

13. Some tentative ideas about MFT competencies for counselling psychologists Knowledge (theoretical) • What goes on between people is just as important (sometimes more important) as what goes on within people • “normal” family development (e.g., McGoldrick, Garcia Preto, & Carter 2015) • interpersonal patterns (Tomm, Wulff, St. George, & Strong, 2014) • diverse family structures based on ethnicity (McGoldrick, Giordano, & Garcia Preto, 2005), divorce (Carter, 2011; Papernow, 2013 ), illness (McDaniel & Hepworth, 2004), immigration (Zagelbaum & Carlson, 2010), and many other factors.

14. Some tentative ideas about CFT competencies for counselling psychologists Knowledge (theoretical) • A theoretically coherent approach to family therapy. • Some models of CFT are adaptations or applications of individually-based theories of psychotherapy we’ve all learned • However, many are based on models of social interaction, not individual psychology • Milan systemic therapy (Campbell, Draper, & Huffington, 1992) • social constructionist family therapy (Tomm et al., 2014) • strategic family therapy (Haley & Richeport-Haley, 2003) • structural family therapy (Lynch & Lynch, 2000).

15. Some tentative ideas about CFT competencies for counselling psychologists Skill • Minimally, managing the working alliance with multiple clients in the room • Excellent training available that includes supervised practice (e.g., Gottman, EFT) My premise • Sue’s story…. • I think there is a competence gap among psychologists

16. A (perhaps) provocative question, and a call to action • As counselling psychologists, one of our distinctives is an orientation toward social justice • This leads us to attend to systemic factors of culture, ethnicity, migration, gender, (dis)ability, sexual orientation, and ancestral stories – that often include historic and systemic colonization, trauma, and discrimination, and marginalization

17. A (perhaps) provocative question, and a call to action Should Canadian counselling psychology include a more intentional focus on family systems (in all their diverse forms) as the mediator between individuals and larger systems? If so, how do we accomplish this – in our curriculum development, teaching, and supervision?

18. Considering the Family Working Alliance Aiofe Freeman-Cruz, PhD CPCC – October 28, 2018 Calgary, AB

19. Outline • Introduction of topic • Brief overview of the working alliance (WA) in individual contexts • The problem in applying traditional WA principles to systemic therapies • WA in marriage and family therapy (MFT) • Pinsoff and Catherall’s (1986) Integrative Systems Perspective of the Alliance • Friedlander, Escudero, and Heatherington’s (2006) System for Observing Family Therapy Alliances (SOFTA) • Implications for practice and training

20. A curiosity to enhance my training… • Working with families, I found myself fumbling with the alliance • Realized I had a knowledge gap in my training • I questioned my competency in creating an alliance with families • Knowledge, skills, and attitudes • Sought to better theoretically understand what was happening in the room as I was aware that there were various alliances at play

21. Working Alliance in Individual Therapy: The History • Psychoanalytic theory • The alliance was mentioned briefly as part of the therapeutic relationship that also holds transference and counter-transference • Humanistic movement in therapy • Rogers (1957) emphasized the therapeutic relationship built on empathy, genuineness, and unconditional positive regard • The Pantheoretical Concept of the Working Alliance • Bordin (1979) outlined three important components of the alliance: Agreement on goals, agreement and collaboration on tasks, and bonds of trust and attachment. This Photo by Unknown Author is licensed under CC BY-SA-NC

22. The Problem… • The working alliance outlined by Bordin (1979) • Created to represent one-to-one relationships • Does not account for multiple people with multiple relationships • Does not account for pre-existing relationships of families • Does not account for how the alliance between therapist and family members is perceived by other family members • There was a call for MFT researchers and practitioners to consider the role of the alliance as a common-factor in therapy

23. The Integrated Systems Perspective of the Alliance • Pinsof and Catherall (1986) responded to this call by adapting the WA proposed by Bordin (1979) to make it applicable to systems theory • Two systems to consider in the alliance • The patient (client) system • The therapist system • Both have direct and indirect influences on the therapeutic process • Also composed of two dimensions: • Content • Interpersonal • Perceptions of self-therapist, other-therapist, and group-therapist alliances

24. System for Observing Family Therapy Alliances (SOFTA) Friedlander et al. (2006) responded to the criticisms of previous models to create a new framework for the therapeutic alliance in families • A transtheoretical model • Differed from Bordin’s (1979) framework • Created as a set of observational and self-report tools to investigate the family therapy alliance

25. System for Observing Family Therapy Alliances (SOFTA) Composed of 4 dimensions: • Safety within the therapeutic system: The extent to which clients feels comfortable to participate fully • Shared sense of purpose: the extent to which family members see themselves working collaboratively to improve relationships and achieve goals • Engagement: the extent to which the client views the therapy as useful and meaningful • Emotional connection to therapist: the extent to which the clients sees the therapist as an important person in his/her life and to the change process

26. Implications for Practice and Training A framework to: • begin to intentionally create, maintain, and work with the therapeutic alliance, • identify problems in the therapeutic alliance, and • address problems using a targeted approach to enhance various domains (Escudero, Boogmans, Loots, & Friedlander, 2012; Escudero, Friedlander, Varela, & Abscal, 2008; Escudero, Heatherington, & Friedlander, 2010). • train new family therapists

27. Implications for Practice and Training A set of tools (i.e., self-report, observation, and video) can be applied to: • Better understand and research the therapeutic processes in the room (Escudero et al., 2008) • Monitor and train practitioners in building family alliance dimensions (Carpenter, Escudero, & Rivette, 2008; Escudero, Friedlander, & Heatherington, 2011) • Enhance supervision efforts to address the therapeutic alliance between a supervisee and their clients (Escudero et al., 2011).

28. Conclusions • Knowledge gap is now filled! But… • Given limited focused training programs in Canada, it is questionable how many MFTs are learning about the therapeutic alliance. • The alliance is a common-factor in family therapy, too (Sparks & Duncan, 2010) • Few training programs offer courses dedicated to learning how to create, monitor, and maintain the alliance in families • Unknowingly unprepared to deal with the complexity of a family therapeutic alliance as novice MFTs • A fruitful starting point

29. Marriage and Family Therapy and Counselling Psychology: All in the Family: OLLU as a case example Tanya Mudry, PhD, R.Psych

30. Our Lady of the Lake University • San Antonio • Small University • ”c” catholic institution • Spanish serving institution • Located in inner-city

31. Department of Psychology • School of professional studies • PsyD in Counselling Psychology (APA accredited) • MSc in Marriage and Family Therapy (COAMFTE) • MSc in School Psychology • Psychological Services for Spanish Speaking Populations (PSSSP)

32. Shared Foci (MFT & PsyD)

33. PsyD Program • 117 Credit Hours • PsyD—Practitioner-Scholar Model • APA Accredited since 1995 • Some courses from Master’s degree transfer • Dissertation required: Qualitative methodology • APA Accredited Internship required (Match Process) • Specialty tracks • Health Psychology, Family and Child, PSSSP, Autism

34. Community Counseling service • Therapy teams with live supervision • Spanish teams • Offer walk-in services • Contracted services with other organizations • PsyD student can supervise after taking PSYC 9351 (spring of second year) • Practicum at CCS - 5 semesters • Off-campus placement in third year

35. Shared courses • PSYC 8357: Advanced Systemic Approaches to Psychotherapy I • CATALOG DESCRIPTION: Presentation and analysis of contemporary methods in systemic therapy. Emphasis on development of a metatheoretical perspective in psychotherapies in general and systemic therapies in particular.

36. APA Discipline Specific Knowledge Competency AAMFT Core Competencies Means of Assessment

37. Professional Identity Systems Problem located between people Therapeutic alliance with multiple people Relational assessment Gatekeeping Competence-Assessing Mentoring Role model Multiplicity Problem located outside person Co-constructed alliance Co-constructed assessment Critical of DSM Individual Problem located in person Therapeutic alliance with 1 person Assessment DSM

38. Experiences of Students I don’t believe I would be the emerging psychologist I am today without mentorship from marriage and family therapists. The systemic perspective is lived throughout the program. Masters and doctoral students work together, and marriage and family therapists work with psychologists throughout our program. In my opinion, the power differentials between psychologists and marriage and family therapists that I have seen out in the field, are challenged in our program. It has taught me to work collaboratively with all types of disciplines and to value not just academic knowledge but the knowledge of lived experience. (Cata)

39. My training in MFT was in California where there are more MFTs with a license to practice than all other states combined. Yet, I found my program to be more individualistic in nature. Other than the two marriage and family courses I took, most of my classes could have just as well been mistaken for clinical psychology program classes. . . . I learned through my supervisors and peers at our community clinic what I was not exposed to otherwise in the same MFT program - the contextual, systemic, relational aspect of all our lives and the influence relationships and community have . . . . I learned that the solutions or ways of living with people often find their problems are relational. Problems are difficult to solve when faced alone and relational therapist are aware that problems are born and grow in isolation and are often solved or made better through community. I was interested in an APA approved psychology programs but found that most programs were individualistic and not rooted in relational ideas . . . . my postmodern epistemology would be something I would likely have to minimize and silo to resurrect at another time, to survive a psychology doctoral program, or risk marginalization which would reduce the chance of me honing my new therapist craft. (Michael)

40. What I noticed and was impressed with about my new home at OLLU was its ‘way of being’ as a program that was consistent throughout each or most classes. A strengths-based-postmodern-epistemology was infused in most classes, even if not the primary mode of the class. OLLU emphasized the multiplicity of persons lives and the multicultural influences that are always changing, in flux as we engage in dialogic conversations with each other and ourselves. Epistemology and multiculturalism was talked about and present within and between class so that we were able to accelerate the way we came to learn and know them in a doctoral program. This is in contrast to my master’s program, which seemed to be trumped (as a whole) by the totalized way of incorporating a postmodern worldview while leaving little room for other possibilities. Although we learned of family and systems, postmodern epistemology, narrative therapy, collaborative language systems, and solution focused therapy. We learned them siloed in a theory with little practical application (if any). I do not say this to critique the alma matter or my master’s program . . . But more to highlight a unique program that is a hybrid version, systemic in conceptualizing family system pioneering ideologies that evolved or made way for postmodern epistemologies and psychology through multiple modes of existence. (Michael)

41. Experience of Supervisor/Faculty • Teaching and supervision at the same time • Theory comes to life, examples are readily available • Clinic teams and supervision style allowed me to model collaborative, dialogic practice through teaching and supervision • Common epistemology shared by Faculty • Trust in common knowledges shared with students • Ability to critique, question, situate, contextualize • Struggles: heavy course loads and meeting APA requirements

42. Finding Your Feet: Practicum Supervision and Practice in a Family Therapy Centre Emily M. Doyle, PhD, R. Psych, CPCC – October 28, 2018 Calgary, AB

43. IP-Scope • The IPscope is a pragmatic tool that helps supervisors invite supervisees into conversations that give priority to expanding their relational understanding of problems and solutions. • Encourages a shift from seeing problems and their solutions as being located within individuals to understanding them as relational patterns in the interpersonal space.

44. IPScope

45. Interpersonal Patterns as IPScope Components PIPs = Pathologizing Interpersonal Patterns WIPs = Wellness Interpersonal Patterns HIPs = Healing Interpersonal Patterns TIPs = Transforming Interpersonal Patterns DIPs = Deteriorating Interpersonal Patterns SCIPS = Socio-Cultural Interactional Patterns

46. Components of the IPScope • A ’PIP’ or Pathologizing Interpersonal Pattern is defined as a recurrent interpersonal interaction which triggers or increases negativity, pain and/or suffering in one or both persons interacting, or which results in deterioration of the relationship. defending criticizing

47. Components, continued • A ’WIP’ or Wellness Interpersonal Pattern is defined as a recurrent interpersonal interaction that enables positivity, competence and/or effectiveness of one or both participants and/or that sustains or enhances health in the relationship. Offering constructive feedback Learning from mistakes

48. SCIPs TIPs SCIPs Transforming Interpersonal Patterns HIPs & WIPs Pathologizing Interpersonal Patterns Healing Interpersonal Patterns Wellness Interpersonal Patterns PIPs Deteriorating Interpersonal Patterns SCIPs SCIPs DIPs

49. Professional Identity Systems Problem located between people Therapeutic alliance with multiple people Relational assessment Gatekeeping Competence-Assessing Mentoring Role model Multiplicity Problem located outside person Co-constructed alliance Co-constructed assessment Critical of DSM Individual Problem located in person Therapeutic alliance with 1 person Assessment DSM

50. Looking Through the IP-Scope at the Supervisor-Supervisee Relationship “We appreciate the IPScope as a framework for supervision, as it helps us to bring forth some interconnected features of supervision that we value. In particular, we value that by looking through the IPScope, we can render supervision as a relational, responsive, participative, reflexive, and transformational practice” Chang & Gaete (page 3 of 12 – need the reference here from Jeff!!!!)