CHOICES OF FAMILY THERAPY INTERVENTION METHODS AND

THERAPEUTIC SKILLS: THEIR RELATIONSHIP TO FAMILY THERAPISTS'

ACADEMIC BACKGROUNDS

by

Diana Ross Ruth

Thesis submitted to the Graduate Faculty of the

Virginia Polytechnic Institute and State University

in partial fulfillment of the requirements for the degree of

MASTER OF SCIENCE

in

Family and Child Development

APPROVED:

Linda F. Little, Chairman

C. James Scheirer Kenneth V. Hardy

June, 1986 Blacksburg, Virginia

CHOICES OF FAMILY THERAPY INTERVENTION METHODS AND THERAPEUTIC SKILLS: THEIR RELATIONSHIP TO FAMILY THERAPISTS'

ACADEMIC BACKGROUNDS

by

Diana R. Ruth

(ABSTRACT)

A continuing debate in the family therapy field revolves

around the issue of the academic backgrounds of therapists.

Is family therapy a separate discipline learned in programs

of Marriage and Family Therapy or a discrete set of skills

acquired during clinical training in diverse academic and

training settings? A survey of 345 student, associate, and

clinical members of the American Association for Marriage and

Family Therapy (AAMFT) was conducted to examine the

relationship between their academic backgrounds and their

preferences for particular intervention methods and skills.

Subjects rated their preferences for 50 therapeutic skills on

a revised, self-report form of the Family Therapist Rating

Scale (FTRS). When their scores were analyzed across the

five scales of the FTRS (Structuring, Relationship,

Historical, Structural/Process, and Experiential Behaviors),

no significant differences were found across academic

backgrounds, age groups, or AAMFT membership status. There

was a tendency for the therapists who had more years of

clinical experience to show less preference for the more

directive skills on the Structural/Process Behaviors Scale.

The best discriminator of therapists' choices for

intervention methods and skills was their specialized

training in specific models of family therapy.

ACKNOWLEDGMENTS

This thesis has benefited immeasurably from the very

generous contributions of the members of my research

committee. I am very grateful to Ors. c. James Scheirer and Kenneth Hardy for their precise input and steady encouragement.

As chairman of my committee, Dr. Linda Little has given

untiringly of her expert advice and thoughtful scholarship.

I am most appreciative of her enthusiastic support and

unwavering optimism throughout the entire course of this

research project.

The continuing interest of my family strengthens my

convictions about the central role of the family in today's

society. To my children, Torn, Jeff, Michael, Christopher,

Martha, and Mary, go heartfelt thanks for their

encouragernent--whether from long distances or close to home.

My deepest gratitude goes to my husband, Dr. Stephen Ruth,

for his helpful contributions to this research, and even more

for his encouragement and constant spousal support throughout

my pursuit of this degree.

This research project was made possible largely because

of the enthusiastic response of those members of AAMFT who

responded to the survey. To them, to Dr. Gary Bowen for his

aid during the early phase of this project, and to Practical

Systems, Inc., for partial funding of the project, I extend

my thanks.

iv

TABLE OF CONTENTS

ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ARTICLE: Choices of Family Therapy Intervention Methods

and Therapeutic Skills: Their Relationship to Family Therapists' Academic Backgrounds •••••••

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

APPENDIX A: Review of Related Literature . . . . . . . . . . . . . . . Development of the Profession . . . . . . . . . . . . . . . . . . . . . . . Therapist Factors Considered Influential

in Treatment Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Segments within the Profession . . . . . . . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Psychology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Counselor Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Social Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page ii

iv

v

vii

1

8

8

8

11

13

21

28

30

31

38

40

41

43

44

46

Summary • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 49

v

APPENDIX B: Additional Results . . . . . . . . . . . . . . . . . . . . . . . . . APPENDIX C: Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family Therapist Rating Scale . . . . . . . . . . . . . . . . . . . . . . . Family Therapist Rating Scale (revised form) . . . . . . . . Demographic Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . .

APPENDIX D:

APPENDIX E:

Cover Letter and Follow-up Postcard . . . . . . . . AAMFT Clinical Membership Requirements

and CHAMPUS Guidelines for

Page 51

86

87

91

95

97

Family Therapy Reirnbursement ••••••••••••••• 100

REFERENCES ••••••••••••••••••••••••••••••••••••••••••••• • 104

VI TA ••••••••••••••••••••••••••••••••••••••••••••••••••• • 10 7

vi

List of Tables

Table Page

1. Selected Demographic Variables of Subjects ••••• 15

2. FTRS Subscale Mean Scores by Groups •••••••••••• 19

3. Dominant Academic Group by Gender •••••••••••••• 54

4. Age by Gender •••••••••••••••••••••••••••••••••• 55

5. Marital Status by Gender ••••••••••••••••••••••• 57

6. Gender by Years of Experience •••••••••••••••••• 58

7. Dominant Academic Group by Category of AAMFT Membership •••••••••••••••••••••••••• 59

8. Age by Category of AAMFT Membership •••••••••••• 60

9. Membership Category by Years of Experience ••••• 61

10. Means and Standard Deviations on FTRS for All Subjects ••••••••••••••••••••••••••••• 62

11-15. FTRS Subscale Scores by Academic Groups •••••••• 64-68

16-20. FTRS Subscale Scores by Age Groups . . . . . . . . . . . . . 69-73 21. FTRS Subscale Scores by AAMFT

Membership Category •••••••••••••••••••••••••• 75

22. FTRS Subscale Scores by Reported Years of Clinical Experience ••••••••••••••••••••••• 76

23. FTRS Subscale Scores by Reported Years of Family Therapy Practice ••••••••••••••••••• 77

24. FTRS Subscale Scores by Training in Intergenerational Models of Therapy •••••••••• 79

25. FTRS Subscale Scores by Training in Experiential Models of Therapy ••••••••••••••• 80

26. FTRS Subscale Scores by Training in Strategic Models of Therapy •••••••••••••••••• 81

vii

Page 27. FTRS Subscale Scores by Training in

Structural Models of Therapy ••••••••••••••••• 82

28. Paired Comparisons of FTRS Subscale Scores by Levels of Clinical Experience within Academic Groups •••••••••••••••••••••••••••••• 84

29. Paired Comparisons of FTRS Subscale Scores by Levels of Family Therapy Experience within Academic Groups ••••••••••••••••••••••• 85

viii

CHOICES OF FAMILY THERAPY INTERVENTION METHODS AND THERAPEUTIC SKILLS: THEIR RELATIONSHIP TO FAMILY THERAPISTS'

ACADEMIC BACKGROUNDS

The emergence of family studies as a separate

discipline in the helping professions can be traced to the

first tentative probings of scholars in the 1940's and SO's

and, even earlier, to the beginning of classes and research

on the family in the 1930's (Burr, 1984; Goldenberg &

Goldenberg, 1985). While most early scholars worked within

their own respective disciplines; Groves (1946, p. 26)

foresaw the need for what he termed, 'a science of marriage

and the family'. He recommended the establishment of a

definite program for the training of specialists in the field

of marriage and the family by qualified persons committed to

common goals which transcend those of specific existing

specialties such as sociology, social work, and counseling.

The decades following Groves' recommendations saw the

emergence of several family-oriented professions: among them,

family life educator, family extension specialist, and

marriage and family therapist. Early development took place,

however, within the context of interdisciplinary study. In

the 1960's the request for consideration of a major in family

studies was denied by at least one university (Hey, 1984).

Today, entire departments whose sole focus is the study of

1

2

the family exist within many universities. The growing body

of literature within the field reflects expanding

theoretical frameworks and more sophisticated research

methodology. In addition, political, economic, and social

issues surrounding the family have been identified and

addressed.

Although Marriage and Family Therapy (MFT) stands secure

as a mental health profession, among all of the specialties

comprising the field of Family Studies it is the nexus of

perhaps the greatest variety of issues and challenges.

Several governmental agencies respond to or officially

recognize MFT as a profession. These include: Office of the

U.S. Secretary of Education; U.S. Department of Health and

Human Services; U.S. Department of Defense/CHAMPUS; and

National Institute of Mental Health. (Hovestadt, Fenell, and

Piercy, 1983). In addition, eleven states have granted

statutory recognition (licensure or certification) of MFT as

a mental health profession. Nevertheless, there are several

continuing issues of conflict and challenge surrounding the

profession.

The diverse backgrounds of the members of the MFT

profession would seem to render cohesion as a separate entity

all but impossible. Bucher and Strauss (1966) cited diverse

training and special interests and goals as but three factors

which can lead to segmentation or division within

professions. An example is the current dichotomy within the

3

social work profession between the intra-psychic casework

perspective and an ecological overview which considers the

client in the broader context of community resources, social

networks, and extended family (Mishne, 1982). Marriage and

family therapists come from a variety of academic

backgrounds. Clinical members of the American Association

for Marriage and Family Therapy (AAMFT), for example, hold

degrees in psychiatry, psychology, social work, psychiatric

nursing and educational counseling, to name a few. It is

only in recent years that graduate degrees in MFT have been

conferred.

Bloch and Weiss (1981) developed a classification system

for distinguishing among the major types of facilities

providing family therapy training. They listed degree-

granting programs at both the masters and doctoral level,

training institutes, and enrichment programs, which often

develop around a single charismatic leader. Other categories

included pastoral counseling centers, social work programs,

and hospital-based general psychiatric residency programs.

Acknowledging the difficulty inherent in interpreting levels

of knowledge, clinical skill, and experience of students both

entering and leaving these programs, Bloch and Weiss (1981)

nevertheless addressed a critical issue--that of assessing

minimal acceptable standards for the professional education

of family therapists.

4

Added to the confusion of the diverse academic and

training backgrounds of therapists is the number of differing

types of licensure granted by the various states which

recognize MFT. In a letter to the membership of AAMFT in the

Family Therapy News (1985), former AAMFT President Craig

Everett reiterated that state efforts toward legislation for

licensure and certification of marital and family therapists

would continue to receive the high priority and focus of

efforts it has in the past. A crucial area for consideration

is the assessment of the widely divergent routes taken to the

clinical practice of MFT. This was tacitly acknowledged by

the recent decision of the AAMFT Board of Directors not to

pursue a proposal by two AAMFT Task Forces to create a new

membership category called General Member. This category of

membership would have allowed family therapy practitioners

who do not satisfy the academic and supervisory requirements

for clinical membership to belong to AAMFT, possessing equal

rights as members (see AAMFT clinical membership requirements

in Appendix E). Recognizing the inequity to existing

clinical members (who had previously satisfied stringent

membership requirements) of creating one membership category

for the great diversity of family-oriented professionals, the

Board of Directors subsequently agreed to consider the

proposal that marriage and family therapists who are licensed

in states recognized by AAMFT as having acceptable licensing

or certification legislation be eligible for clinical

5

membership. At this writing, eleven states satisfy the AAMFT

criteria.

Framo (1984) raised a related training issue which is

critically important. He cited the inability of doctoral

candidates--already licensed in one state as Marriage,

Family and Child counselors--to identify leading

theoreticians and practitioners in the family therapy field.

If such laxity of standards exists in even only one state's

licensing requirements, the problems surrounding AAMFT

efforts to coordinate licensure with AAMFT clinical

membership loom monumental.

Another current issue was addressed by the Department

of Defense in a notice to providers of mental health care

(Wisconsin Physicians Services, 1985). As of February, 1985,

a provider of marital and/or family therapy who desires

reimbursement by CHAMPUS/CHAMPVA must be licensed or

certified in the state in which he or she practices; or, in

those states which do not provide for licensure, be or be

eligible to become a member of AAMFT. Although the notice

does not specify that the provider be eligible to become a

clinical member of AAMFT, additional requirements of

experience (see Appendix E) reflect the extensive numbers of

approved supervised hours of practice necessary for

reimbursement. Other insurance carriers, already limiting the

number of reimbursable therapy sessions per client per annum,

may soon follow suit and also impose more stringent

6

conditions for marital and family therapy reimbursement.

In light of the foregoing issues, it would seem

extremely important to examine some of the characteristics

which distinguish MFT professionals from each other. Framo

(1984) and others (Bowen & Carlton, 1978: Henry, Sims, &

Spray, 1971) suggested that it is not the academic degree,

but the kind of person a therapist is--along with the quality

of training and supervision he or she receives--that has

relevance and bearing upon the quality of therapy he or she

does. Warkentin and Whitaker (1967) emphasized the role of

attitudes and personal assumptions when assessing therapist

effectiveness. It is difficult to measure personality

differences in terms of therapeutic outcome. Therapists can,

however, be classified in terms of age, gender, number of

years of experience, etc., and these characteristics can be

assessed to determine whether they affect therapists' modes

of interaction.

Of more pertinent interest, especially in light of the

controversies surrounding the issue of qualifications of

marriage and family therapists, is the concept of theoretical

training of therapists. Green and Kolevzon (1982a) made the

distinction between therapists' belief systems and their

action systems. They defined the former as the body of

commonly held theory espoused by academicians of any one

particular professional orientation, while action systems

were defined as those intervention styles and therapeutic

7

skills preferred by therapists in actual clinical practice.

Most of the research to date has focused upon methods of

training and supervision, both of which have direct impact

upon the therapist's action system. The paramount importance

of clinical training must be acknowledged. However, prior

research has not yet made clear what effect various academic

programs may have upon the kinds of intervention methods and

therapeutic skills preferred by the graduates of academic

programs of various mental health professions. Does the

belief system, as defined by the therapist's academic

background, influence his or her choices of intervention

methods?

The purpose of this study was to investigate the

relationship between therapists' academic backgrounds and

their choices of therapeutic skills and intervention methods.

Therapists' choices of therapeutic skills and intervention

methods were determined by their scores on the Family Therapy

Rating Scale (FTRS) (Piercy, Laird, & Mohammed, 1983). Tests

were performed to assess the pattern of mean score

differences on the FTRS with (1) academic background, (2)

age, (3) membership status in AAMFT, (4) years of

professional clinical practice and family therapy practice,

and (5) additional theory-specific family therapy training

undertaken beyond the requirements of academic degrees. An

additional hypothesis was tested to determine whether there

were mean score differences on the FTRS as therapists within

8

particular academic groupings gained experience in terms of

number of years of practicing therapy. All hypotheses were

tested at the .OS alpha level of significance.

Methodology

Subjects

Subjects were student, associate, and clinical members

of AAMFT. An unselected random sample of six hundred

subjects was selected from the national membership list.

Three hundred forty-five (57%) of those sampled responded to

the survey--32 student members, 54 associate members, and 256

clinical members, with 3 not reporting membership status. Of

the clinical members, 22 indicated their AAMFT-approved

supervisory status.

Instruments

Family Therapist Rating Scale (FTRS). The value of the

dependent variable was determined by the administration of

the Family Therapist Rating Scale (FTRS) devised by Piercy,

Laird, and Mohammed (1983). The scale, originally intended

for use by supervisors in rating the effective use of skills

by their therapist trainees, was used in this study as a

self-report instrument to measure therapists' preferences for

intervention methods and therapeutic skills.

The FTRS consists of five categories of family

therapist skills: the general categories of structuring and

relationship skills (Barton & Alexander, 1977), and three

9

theory-specific categories of historical, structural/process,

and experiential skills (Levant, 1980). Kniskern and Gurman

(1979) define structuring skills as those behaviors involved

in gathering information, stimulating interaction, being

self-confident, and using directiveness and clarity.

Relationship skills are more associated with forming a warm

therapeutic relationship with client families. The three

theory-specific categories are based on Levant's (1980) work

wherein he clustered family therapy schools on two bipolar

dimensions. The first dimension involves present-

centeredness (structural/process and experiential) versus

past centeredness (historical). The second dimension further

refines the present-centered category by separating

structural change (structural/process) from the change which

results from providing an intense affective experience to

facilitate growth (experiential).

The FTRS was revised and refined by its authors from

its original pool of 375 family therapy skills identified

from the writings of a wide variety of family therapists.

Construct validity was achieved after duplicate items had

been rejected and two of the three doctoral level judges

agreed upon the importance of and placement of each of the

remaining items in specific categories. To determine

criterion-related validity, videotaped vignettes were

devloped for the remaining items. Two vignettes were made

for each skill, one depicting the effective use of the

10

therapeutic skill, and the other showing the actor/therapist

demonstrating the skill in an ineffective manner. The ten

items within each of the five scale categories which best

discriminated between effective and ineffective use of the

particular skills were the items retained for the final

version of the scale. All of the final items discriminated

significantly between effective and ineffective conditions.

Additional validational data were gained when 44 family

therapists were asked to choose the category of their

preferred theoretical orientation. In more instances than

could be ascribed to chance, they chose the category in which

they were rated most highly skilled by independent judges.

Interrater reliability for the initial set of vignettes

was assessed by computing Pearson product-moment correlation

coefficients between all possible pairs of the ten raters.

Correlation coefficients ranged from .61 to .87 with a mean

of .77. All correlation coefficients were statistically

significant.

Internal consistency for the items within each of the

five scales was based on the ratings of the 44 therapists.

The use of Cronbach's (1970) alpha produced relatively high

correlations, ranging from .72 to .95.

In this study, the FTRS was revised before being given

to the subjects as a self-rating instrument. With the

permission of the senior author of the FTRS, a table of

random numbers (Bailey, 1982) was used to randomize the 50

11

items in the 5 categories, removing all labels which identify

the items as belonging to a particular category or index. In

addition, the Likert-type response scale was reduced from

seven to four items, and the items were relabeled to

facilitate responses on a scale of l to 4. Although the verb

forms were changed to facilitate self-response, all other

wording of the original scale items was retained.

Demographic ~YIY~Y Questionnaire

A survey questionnaire was devised by the researcher to

obtain demographic information about each respondent.

Questions were chosen to elicit relevant information about

respondents' personal attributes and professional experience

that could be helpful in determining influences upon their

FTRS scores. Besides the usual demographic data regarding

age, gender, and marital status, detailed information was

sought regarding respondents' academic backgrounds, amounts

of clinical experience, and training in specific models of

therapy beyond the requirements of earned academic degrees.

Procedure

Both the revised form of the FTRS and the demographic

questionnaire were administered to a class of seven advanced-

standing students in a university marriage and family therapy

program. Although the number of subjects was not great

enough to perform tests of significance on the FTRS,

valuable feedback was obtained from the pre-test population

12

which aided the researcher in refining the demographic

questionnaire for greater ease in understanding by the test

population.

A random sample of 600 members of AAMFT provided the

subjects for the study. Following the Total Design Method

advocated by Dillman (1978), the two questionnaires were

printed on a single fold, four-page sheet and mailed to the

subjects in mid February, 1986, along with cover letters and

stamped, pre-addressed return envelopes. Although the return

envelopes were coded to facilitate follow-up contact of non-

respondents had that become necessary, assurances of

confidentiality were made to the subjects, along with the

promise to use only group data when reporting results of the

research. The opportunity to request results of the research

project was afforded the respondents; 63% of those responding

requested results, indicating substantial interest in the

project.

As Dillman (1978) suggests, follow-up postcards were

sent to all of the subjects one week following the date of

the initial mailing. Subjects were thanked for their

participation in the study and urged to return the

questionnaires at their earliest convenience, had they not

already done so.

Upon receipt of the completed questionnaires, the

answers were coded and entered into the computer. It was

13

discovered that 8 replies yielded substantially incomplete

data; these were excluded from the data analysis procedure.

Results

Using StatPac (Walonick Associates, 1985), the data

were analyzed to ascertain group differences. Descriptive

statistics and frequency distributions yielded the following

demographic data:

Respondents represented their respective membership

categories to the following degree: 9.3% were student members

(n = 32), who represent 10.8% of the national membership; 15.7% were associate members (n ~ 54), who comprise 14.8% of

the national membership; and 74.2% of those responding to the

survey were clinical members (n = 256), who make up 73.6% of

the total membership. The distribution of respondents was "J,.

very close to population distributions ()'. (2) = 0.96,

p>.05).

Graduate academic degrees were conferred upon the

respondents in a wide variety of disciplines. Three (.87%)

had earned medical degrees, 128 (37.1%) had earned doctoral

degrees, and 303 (87.8%) had earned at least one masters

degree. Forty-nine respondents (14.2%) indicated that they

had earned an additional masters degree.

Respondents ranged in age from under 30 (n = 8) to 70 plus (n = 3). Subjects were evenly divided by gender (170

males and 173 females), with females predominating slightly

14

(60%) beyond age 50. Three hundred nineteen respondents

(92.5%) reported professional experience doing therapy. The

number of years of post-degree clinical experience practicing

therapy ranged from 1 to 42, the mean being 10.2. Subjects

were asked to further define their years of professional

clinical experience by stating the specific number of years

they had practiced family therapy. Of those engaging in

family therapy practice (n = 293 or 84.9%) the number of years of such clinical experience ranged from 1 to 30, the

mean being 8.5.

Of the respondents who reported experience practicing

therapy, 64%, (n = 202) had between 1 and 10 years of post-degree clinical experience. Twice as many females (n = 54)

as males (n = 27) had 5 or fewer years experience. Beyond 10 years of professional experience, males (n = 74) predominated over females (n = 42).

Respondents were asked to indicate their marital status.

It is of interest to note that all of the widowed (n = 5) were female and that eighty-three percent (n = 30) of all those divorced were female. Demographic differences among

respondents are presented in Table 1.

Before performing statistical tests, the data were

regrouped to form more homogeneous clusters and to facilitate

analysis of data. This was done to obtain more manageable

groupings and to increase the power of the statistical tests.

When the subjects were categorized by academic disciplines,

15

Table 1

Selected Demographic variables of Subjects

AAMFT MEMBERSHIP

Student Associate Clinical

(missing data)

AGE

under 30 30-39 40-49 50-59 60-69 70 plus

(missing data)

GENDER

Male Female

(missing data)

MARITAL STATUS

Single, never married Married Separated Divorced Widowed

(missing data)

ADVANCED DEGREES

Masters Additional Masters Doctorate M.D.

PROFESSIONAL EXPERIENCE

No Clinical Experience General Clinical Practice

(Family Therapy Practice)

n

32 54

256 ( 3)

8 118 110

77 24

3 ( 5)

170 173

(2)

33 261

l 37

5 ( 8)

9.3 15.7 74 .2

(. 9)

2.3 34.2 31. 9 22.3

6.9 .9

( 1. 4)

49.3 50.1

( • 6)

9.6 75.7

.3 10.7 1.4

(2.3)

Overlapping Data

303 49

128 3

26 319

( 29 3)

87.8 14.2 37.1

.8

7.5 92.5

(84.9)

16

age, and AAMFT status, some of the resulting subgroups

contained insufficient data to perform the required

statistical tests. Therefore, some subgroups were combined

with others in order to increase their numbers.

Subjects indicated their respective ages by checking

appropriate interval ranges. Those over 70 (n = 3) were combined with the 60-69 year age category renamed 'over 60'

to facilitate analysis of data. The 8 subjects under 30 were

combined with the 30-39 year age category, resulting in an

'under 40' age group. A related decision was made to

eliminate the students from comparisons of AAMFT categories

by other demographic variables because of insufficient

numbers to perform the required statistical tests. To

further facilitate analysis of data, four groups were created

to define the subjects in terms of their clinical experience:

a) 1-5 years, b) 6-10 years, c) 11-15 years, and d) 16 years

and over.

The respondents had specified more than fifty areas of

specialization for their earned academic degrees. The

highest earned degree of each subject was assigned to one of

six categories, picked to represent areas of common academic

content. The five dominant academic disciplines consisted of

Education (n = 42), Psychology (n = 103), Religion (n = 36),

Family Studies and Family Therapy (n = 79), and Social Work (n = 57). A sixth category (n = 20) was created to include

17

all other degrees which could not easily be classified as any

of the above.

Descriptive statistics were performed on each of the

five scales scores of all of the subjects. It was discovered

that, as a group, the subjects rated themselves highest on

the Relationship Behaviors Scale (mean = 3.33, sd .356)

and lowest on the Experiential Behaviors Scale

(mean= 2.77, sd .361). The remaining three scale scores

were: Structuring Behaviors Scale (mean= 3.19, sd .338),

Historical Behaviors Scale (mean= 2.85, sd .377), and

Structural/Process Behaviors Scale (mean = 2.83, sd .403).

It was hypothesized that there would be significant

differences in the scale scores of the FTRS for therapists of

differing academic degrees. Separate analyses of variance

were used to test for equality of means on each of the

subscales of FTRS for the six dominant academic groupings.

No statistical significance at the .OS level of confidence

was found between the disciplines on any of the five scales.

The use of analysis of variance rests on the assumption

that the sampled populations are normally distributed with

equal variances. Goodness of fit tests performed on the five

scale scores revealed that they were not normally distributed

(all chi-square statistics were significant at .05 or less).

A nonparametric statistical procedure, the Kruskal-Wallis

One-Way Analysis of Variance, was applied to rank the scale

scores and test for differences in all subsequent analyses.

18

The Kruskal-Wallis test also failed to find any significant

differences at the .OS level of confidence in the 5 mean

scores of the subjects when grouped by academic discipline.

It was also hypothesized that there would be differences

in the FTRS scale scores for those subjects in different age

groups. The Kruskal-Wallis test revealed differences among

subjects only on the Experiential Behaviors Scale

([ = 9.55 ~ < .049). The 40-60 year age group scored higher than those in both the younger and older age brackets.

It was further hypothesized that there would be

differences in the FTRS scale scores for the subjects in each

of the three membership categories of AAMFT. The Kruskal-

Wallis test failed to reveal any significant differences at

the .05 level of confidence in the scale scores of student,

associate, and clinical members of AAMFT. For a summary of

subscale mean scores as tested by hypotheses 1, 2, and 3,

see Table 2.

It was hypothesized that there would be significant

differences on the scale scores for those therapists of

differing amounts of professional clinical experience as

measured by years of clinical practice doing therapy and,

more specifically, by years of family therapy practice.

Based on years of general clinical practice, the Kruskal-

Wallis test revealed no significant differences between the

scores of those clinicians with different amounts of

experience. One significant difference was revealed among

19

Table 2

FTRS Subscale Mean Scores by Groups

Groups Structuring Relationship Historical S/Process Experiential

n. mean mean mean mean mean

Academic Di~~i'11J.D~

EDU 42 3.21 3.43 2.86 2.82 2.88 REL 35 3.24 3.36 2.94 2.80 2.80 PSY 103 3.16 3.32 2.81 2.77 2.85 FAM 77 3.18 3.31 2.84 2.84 2.78 soc 56 3.19 3.27 2.84 2.86 2.73 OTB 20 3.27 3.32 2.89 3.03 2.85

~

under 30 8 3.34 3.10 2. 71 2.88 2.73 30-39 118 3.19 3.29 2.81 2.84 2. 71 40-49 108 3.22 3.35 2.88 2.85 2.81 50-5 9 75 3.15 3.38 2.86 2. 79 2.85 60 and over 25 3.16 3.31 2.86 2.76 2.70

AAMFT .St~t!Ul

stud. 32 3.25 3.36 2.87 2.97 2.88 assoc. 53 3.19 3.33 2.83 2.82 2.75 clin. 251 3.19 3.32 2.85 2.81 2.77

20

subjects with clinical experience practicing family therapy.

Those therapists with more than ten years experience

practicing family therapy scored lower on the

Structural/Process Behaviors Scale than the therapists with

ten or fewer years experience (li = 9.89 R

21

with training in the structural model of therapy (n = 147). It was hypothesized that there would be significant

differences between therapists of the same academic

background but with differing amounts of professional

clinical experience. Subjects who had specified their number

of years of both general clinical (n = 311) and family therapy (n = 285) practice were divided into two groups, those with 1-10 years of experience, and those with over 10

years experience. Pairwise comparisons were performed on the

mean scores of the subjects as grouped within their dominant

academic disciplines. The pairwise comparisons among the

mean scores of all five FTRS scale scores for both general

clinical and family therapy experience revealed two

significant differences at the .OS level of confidence. The

more experienced therapists with educational degrees scored

higher (~ = 4.08, ~

22

therapy. When the FTRS subscale scores were tested by

academic groups, no significant differences were revealed.

This result is supported by the works of Henry, Sims, and

Spray (1971), Bowen and Carlton (1978), and Warkentin and

Whitaker (1967), who suggested that it is not academic

coursework, but the social and cultural backgrounds, plus the

personal values and biases of therapists, along with the kind

of training and supervision they receive, that determine the

type of therapy they practice. It was interesting to note

the wide variety of academic backgrounds of the subjects of

this study. The largest number of degrees earned by the

clinical members of AAMFT were in Psychology, while the

largest number of degrees among the associate and student

members were in the fields of Family Studies and Marriage and

Family Therapy. Many therapists in this study had fewer

years of family therapy experience than general clinical

experience, indicating that they began their clinical

practice doing individual therapy, switching to or adding

family therapy practice as the field became more firmly

established. It appears that newcomers to the field are

pursuing the more specialized academic degrees in family

therapy before beginning their clinical practice. These

findings support the contention of Bloch and Weiss (1981)

that many professionals merely add family therapy as a

modality to their treatment armamentaria, whereas others

become specialists in the field.

23

When subjects were grouped by number of years experience

in family therapy practice, only one subscale revealed

significant differences. Therapists with more than ten years

of experience scored lower on the Structural/Process

Behaviors Scale, and of this group, the therapists with 16 or

more years of experience scored the lowest. The

Structural/Process Behaviors Scale includes skills that are

directive by nature. They are representative of the skills

advocated by Haley, Watzlawick, Minuchin and other proponents

of systems-oriented family therapy models. It is not

surprising that the therapists who have been practicing for

longer periods of time did not choose intervention methods

and therapeutic techniques advocated by the more recent

models of family therapy.

Although a longitudinal study would be a preferable

method of assessing the relationship between years of

clinical practice to practitioners' preferences for

intervention methods and therapeutic styles, this study

nevertheless made an attempt to do so. When the scale scores

of the more experienced practitioners within each academic

grouping were tested against those of lesser experience,

there were some significant differences. The more

experienced practitioners in both the social work and

educational counseling fields appeared to value relationship

skills more than structuring skills.

The more experienced subjects with social work

24

degrees scored lower on the Structuring Behaviors Scale than

their less experienced colleagues with similar academic

degrees. This result may be an indication of changing

emphases in the orientation of the newcomers into the field.

It could also be a reflection of the current controversy

within the social work profession. Mishne (1982) cited the

historic discord within the profession of social work between

proponents of traditional client-oriented casework and those

who espouse the broader ecological systems perspective whch

considers clients in their environment. Educational

programs at some schools of social work have recently

concentrated less upon the individual's intrapsychic system

and more upon systems theory. Less emphasis has been placed

upon the traditional 'warm and nurturing' skills of social

workers in favor of the more directive behavioral

interventions which are components of the FTRS Structuring

Behaviors Scale. That the more recent social work

practitioners of family therapy scored higher on Structuring

skills may be an indication that the dissatisfaction of

social work students of the 1970's with the relative lack of

emphasis upon coursework in marriage and family therapy

(Siporin, 1980) has begun to be addressed.

The field of educational counseling has also been the

locus of controversy regarding the incorporation of family

therapy courses into its programs. Cooper and Charnofsky

(1983) cited faculty resistance to the changing of

25

traditionally successful programs as the main factor

underlying the controversy. Yet the FTRS was developed, not

in the context of a marriage and family therapy training

program, but within a counselor education program which had

integrated family therapy theory and practice into its

curriculum (Piercy, Laird, & Mohammed, 1983). The lower

scores on the Relationship Behaviors Scale for the less

experienced practitioners with educational counseling degrees

may indicate a lesser valuation of relationship skills and

greater emphasis upon the more directive intervention methods

typical of the major family therapy approaches.

The FTRS scales selected by Piercy, Laird, and Mohammed

(1983) represent what they considered to be the predominant

components of family therapy. The scale scores of those

subjects who stated that they had prior specialized training

in historical, intergenerational, experiential, strategic, or

structural models of therapy were tested against the scores

of those without such training. That some subscale scores

differed significantly is both a validation of the FTRS and

an indication that it is specialized clinical training,

rather than academic coursework, that influences therapist

choices for particular intervention methods and skills (Henry

et al, 1971; Kolevzon & Green, 1983). That those therapists

with training in strategic and structural models of therapy

scored higher on the Structural/Process Behaviors Scale than

those without such training was to be expected. This finding

26

is supported by Goldenberg and Goldenberg (1985) in an

overview of therapist behaviors specific to particular models

of therapy. Kolevzon and Green (1983) also found that the

subjects with training in strategic family therapy rated

themselves higher on more directive behaviors than those who

had training in other models. Subjects with training in

intergenerational models of family therapy rated themselves

higher on the Historic Behaviors Scale than those without

such training. This result is also supported by Kolevzon and

Green (1983), who found that therapists with training in the

Bowenian model scored highest on those behaviors of their

Family Therapists Assumptions Scale which emphasized family

history and antecedent events. That subjects with prior

training in experiential models scored higher on the

Experiential Behaviors subscale than those without such

training was to be expected, and serves as further validation

of the item selection for that FTRS subscale.

Future uses of a self-report form of the FTRS, such as

the one devised for the purposes of this study, might be

beneficial in helping beginning therapists identify their

biases and predilections toward or away from particular

intervention methods and skills. When administered in

conjunction with their supervisors' use of the original form

of the FTRS to rate their assimilation of clinical skills,

perhaps a greater internalization of desired intervention

skills and methods could be achieved.

27

Any attempt to assess therapists' preferences for

intervention methods and skills in a field as complex and

diverse as that of family therapy must be guided by several

caveats. Most obvious for this study was the lack of

precision in assessing the effects of such disparate

experiences as specialized training, when these experiences

were self-reported. One must assume that there was great

diversity in the training experiences of such a heterogeneous

group of subjects. Future research might concentrate on

investigating the influence of specialized training--

including duration, intensity, and trainer qualifications--on

therapists' preferences for intervention methods. The

therapists in this study equally regarded the skills set

forth by Piercy et al as being representative of family

therapy practice. While the subjects were from different

academic disciplines, they were all affiliated with AAMFT and

had met or were in the process of meeting the rigorous

academic and clinical requirements set forth by that

accrediting organization. At this point in time, affiliation

with AAMFT may be a better predictor of therapist preferences

for family therapy skills than academic disciplines. Future

research on therapists' choices of intervention methods and

skills might best be directed toward a comparison of

graduates from programs that offer coursework in marriage and

family therapy on a limited and/or elective basis with those

from programs which meet AAMFT accreditation requirements.

References

Bailey, K. (1982). Table of Random Digits. Methods Q.f. Social Research (2nd ed.). New York: The Free Press.

Barton, c., & Alexander, J. (1977). Therapists' skills as determinants of effective systems-behavioral family therapy.

International Journal Q..f. Family Counseling, ~, 11-20.

Bloch, D., & Weiss, H. (1981). Training facilities in marital and family therapy. Family Process, 20, 133-146.

Bowen, G., & Carlton, A. (1978). Comparison of role perceptions between clinical psychology and psychiatric social work students. North Carolina Journal of Mental Health, ~' 37-38.

Bucher, R., & Strauss, A. (1966). Professions in process. The American Journal Q.f.. Sociology, 66, 325-334.

Burr, w. (1984, December). Task force activities report. Task Force fQ.r. the Development Q..f. ~ Family Discipline, !, 1.

Cooper, J., & Charnofsky, s. (1983). Curricula and program development in marriage and family counseling: process and content. In B. Okun & s. Gladding (Eds.), Issues in Training Marriage and Family Therapists. Ann Arbor, MI: ERIC Clearinghouse on Counseling and Personnel Services.

Dillman, D. (1978). Mail ~ Telephone Surveys; the Total Design Method. New York: John Wiley & Sons.

Everett, c. (1985, March-April). President declares initial priorities. Family Therapy News, p. 2.

Framo, J. (1984, November-December). Framo responds. Family Therapy ~' p. 2.

Goldenberg, I., & Goldenberg, H. (1985). Family Therapy; An Oyeryiew (2nd ed.). Monterey: Brooks/Cole Publishing Company.

Green, R., & Kolevzon, M. (1982a). Three approaches to family therapy: a study of convergence and divergence. Journal of Marital and Family Therapy, April, 39-50.

Green, R., & Kolevzon, M. (1982b). A survey of family therapy practitioners. Social Casework; The Journal Q.f. Contemporary Social Work, Feb., 95-99.

28

29

Groves, E. (1946). Professionals training for family life educators. Marriage and Family Living, ~' 25-26.

Henry, w., Sims, J., & Spray, s. (1971). The Fifth Profession. San Francisco: Jossey-Bass, Inc.

Hey, R. (1984, March). A postscript. Report from the National Council on Family Relations.

Hovestadt, A., Fenell, D., & Piercy, F. (1983). Integrating marriage and family therapy within counselor education: a three-level model. In B. Okun & s. Gladding (Eds.), Issues in. Training Marriage and Family therapists. Ann Arbor, MI: ERIC Clearinghouse on Counseling and Personnel Services.

Kniskern, D., & Gurman, A. (1979). Research on training in marriage and family therapy: Status, issues, and directions.

Journal Q..f. Marital A.nQ. Family Therapy, 83-94.

Kolevzon, M., & Green, R. (1983). Practice and training in family therapy: A known group study. Family Process, ~' 179-190.

Levant, R. (1980). A classification of the field of family therapy: A review of prior attempts and a new paradigmatic model. American Journal of Family Therapy, ~' 3-16.

Mishne, J. (1982). The missing system in social work's application of systems theory. Social Casework: The Journal Q.f. Contemporary Social Workk, November, 547-553.

Piercy, F., Laird, R., & Mohammed, z. (1983). A family therapist rating scale. Journal Q.f. Marital and Family Therapy, ~' 49-59.

Siporin, M. (1980). Marriage and family therapy in social work. Social Casework: The Journal Q.f. Contemporary Social li2..t.k_, 2..11 11-21.

Walonick Associates (1985). StatPac--Statistical Analysis Package. Minneapolis: Author.

Warkentin, J., & Whitaker, c. (1967). The secret agenda of the therapist doing couples therapy. In G. Zuk & I Boszormenyi-Nagy (Eds.), Family Therapy and Disturbed Families. Palo Alto: Science and Behavior Books.

Wisconsin Physicians Service: Champus/Champva News (1985, February). Note to providers of mental health care: Revised mental health guidelines.

Appendix A

Review of Related Literature

30

REVIEW OF RELATED LITERATURE

The following review of literature is focused upon

prior research in the field of counseling and therapy.

Particular emphasis is placed upon the dichotomous views

held by some professionals within specific disciplines of the

MFT field regarding the relative importance of various

academic backgrounds and training qualifications of MFT

professionals.

Development Q.f the Profession

The treatment of the entire family in a clinical

setting when one member of that family has been identified

as the symptom bearer is rapidly becoming the method of

choice for practitioners in many of the helping professions

(Green and Kolevzon, 1982a). Thirty years ago, however, the

term 'family therapy' was virtually unknown. According to

Thaxton and L'Abate (1982), the decade 1951-1962 is usually

considered to be the period during which the emerging

discipline of family therapy took root. It began to flourish

simultaneously in various areas of the country, notably in

Palo Alto, California; Philadelphia, Pennsylvania; and

Topeka, Kansas. The early practitioners, Nathan Ackerman,

Don Jackson, Murray Bowen, and Carl Whitaker, among others,

were predominantly from the fields of psychiatry and

psychoanalysis.

31

32

Thaxton and L'Abate (1982) noted some changing trends in

the predominance of different educational degrees of family

therapists. In a follow-up study of prior research (L'Abate

& Thaxton, 1980), they used a citation analysis method to

identify leading authors in the field of family therapy.

While 'second-wave' first-generation pioneers in the field

(those born between 1920 and 1939) were predominantly

psychiatrists and psychoanalysts, second generation

practitioners (those born after 1939) are predominantly

clinical psychologists. According to the authors, the

greater number of non-medical degrees held by the latter

group may reflect a trend in which a systems approach is

superseding the medical model. Despite the fact that the

study was conducted with a limited sample (N=44), a widening

variety in educational preferences is evident, and the

authors suggested that a more comprehensive survey would have

shown even greater signs of diversity in terms of academic

backgrounds and fields of interest. Although their

conclusions were somewhat speculative in nature, the authors

suggested that an expanded follow-up study using a citation

analysis method not confined to English language sources

might reveal an even greater diversity in the demographic

characteristics of leading authors in the field of family

therapy.

It was during World War II and its aftermath that a

great need became apparent for additional aid for

33

psychiatrists in the treatment of soldiers and other victims

of the war (Henry, Sims, and Spray, 1971). Initially joined

by psychologists and social workers, the ranks of those

practicing therapy soon included pastoral counselors,

educational counselors, and psychiatric nurses. One reason

for the more widespread use of therapy was the concurrent

surge of growth in the mental health movement (Henry, Sims,

& Spray, 1971). With it came the opportunities to treat

increasing numbers of poor, elderly and minorities with more

diverse methods of treatment, such as group and family

therapy. With the increasing practice of therapy in the

family context came awareness of the need for specialized

training in the dynamics of the family and in effective

intervention methods when working with multiple clients. As

a result, family therapy is now being taught not only in

graduate programs designed to train Marriage and Family

therapists, but also in programs for social workers, nurses,

psychologists and psychiatrists.

A review of the literature reveals several research

articles on the general subject of MFT training for helping

professionals of various academic backgrounds. A significant

contribution to the literature is the study by Henry et al.

(1971), which concluded that, while training programs and

academic courses of study may differ among various helping

professionals, there are common threads of personal beliefs

and convictions which result in similar sets of professional

34

beliefs, orientations, and viewpoints among those

professionals who choose to become marriage and family

therapists. Studying a sample of 283 psychiatrists,

psychoanalysts, clinical psychologists, and psychiatric

social workers, Henry et al. (1971) concluded that among the

four professions studied, there was such a high degree of

coherence in common committment to a psychotherapeutic stance

that a 'fifth profession' might readily be identified, this

fifth profession to encompass the commonality of interaction

skills and professional beliefs so evident among the

practicing therapists of the various disciplines. The

authors of the study define the 'fifth profession' as •the

overlapping homogeneities in identity, beliefs, social

origins and practice--a coherence formed by high degrees of

common commitment to a psychotherapeutic stance, regardless

of profession of origin" (1971, p. 47). Henry et al. (1971)

hint at other variables of commonality that various helping

professionals possess: ethnicity, religion, politics, and

social mobility. At the present time, however, it seems

important to investigate whether there are differences among

practitioners of MFT, specifically, differences in the

academic coursework of those professionals who become family

therapy practitioners only after their careers in various

distinctive approaches to therapy are underway.

Other, more recent, studies have corroborated the

findings of Henry et al. (1971). Bowen and Carlton (1978)

35

conducted a comparison study of 126 students in both a

doctoral clinical psychology program and a graduate social

work program. Their study compared ratings by these students

of their perceptions of themselves and their respective

professions as ideal helpers with their rating of the other

profession and how they thought its members perceived both

professions. The results of their study led Bowen and

Carlton to conclude that members of these two professions are

very similar in their perceptions of professional roles in

relation to helping characteristics.

Furthermore, Bowen and Carlton (1978) questioned the

necessity and social economy of having two distinctly

different training routes for these two professions (clinical

psychologists and psychiatric social workers), and their

study lends credence to the conclusion of Henry et al. (1971)

that practitioners of psychoanalysis, psychiatry, clinical

psychology and psychiatric social work are so much alike

that they do indeed constitute a separate and distinct

profession, regardless of their differing academic

backgrounds.

Other researchers have not been so quick to conclude

that there are no differences in the basic assumptions which

professionals of various disciplines bring to the practice of

family therapy. Rubenstein and Weiner (1967), for instance,

in reporting on work done at the Eastern Pennsylvania

Psychiatric Institute, noted differences in training and

36

background between psychologists and psychiatrists. They

felt that these differences contributed to divergent

approaches, interests, and goals in the therapeutic process.

A balancing factor, however, in their opinion, was the

divergence in personalities among the trainees of the group--

some members being more emotionally 'free' and some more

restrained. This, they concluded, contributed not only to

the cohesion of the group, but to a more open learning

environment, one in which the students could learn from each

other, as well as from their supervisors.

Warkentin and Whitaker (1967) also voiced concern about

the therapist's attitudes and personal assumptions as

influencing his or her goals of therapy. They asserted that

it is vital for a therapist to be aware of his or her own

biases, values, and agenda for therapy. These factors, they

feel, have much greater influence on the goals of therapy

than do the particular 'school' the therapist belongs to or

the technique he or she uses in therapy.

The results of other studies may contribute to confusion

or at least a lack of consensus about the relevance of

academic diversity among family therapists. Meddin and

Wattenburg (1982) concluded that students' assessment of

improvement or deterioration of family situations differ

according to their own prior experience in various helping

professions. Their study did not, however, attempt to assess

the influence of the various disciplines and their attendant

37

diverse academic training upon students.

In a study of client, therapist, and treatment

characteristics Woodward et al. (1982) examined the

relationship of each of these variables (gender, discipline,

level of training in family therapy, and years of experience

as a clinician) to the outcome measures of 219 cases of

families treated with brief family therapy. Although only a

relatively low amount of explained variance could be

accounted for, among the variables most often related to an

outcome measure was the gender of the therapist. While

discipline of therapist was not strongly related to any of

the outcome measures, one significant finding was the

disinclination of social work practitioners and nurses to

assign positive prognoses to their clients. Further

investigation revealed these two groups to be composed mainly

of females, 70% and 100%, respectively. Here again, no clear

conclusions were drawn regarding the disciplines to which the

therapists belonged. An interesting result of the study was

the finding that, while the therapists of these predominantly

feminine disciplines rated their families as having changed

less in treatment and as having a poorer prognosis; these

therapist variables contributed to none of the variance in

recidivism or goal attainment. Male therapists and those

from the more prestigious disciplines did not produce better

(as measured in post-treatment interviews conducted six

months after conclusion of treatment by interviewers who were

38

independent of the therapeutic setting} outcomes on these

measures.

Therapist Factors Considered Influential in Treatment Outcome

Kniskern and Gurman (1979), in a frequently referred to

article about research on training in MFT, alluded to prior

research which indicated both positive and negative effects

of family therapy upon families and individuals. While they

listed several areas of assessment which need to be addressed

in order to clearly evaluate the outcome of training

procedures, they did not emphasize the therapist's academic

credentials alone. They did, however, note that some family

therapy training centers require videotape samples of a

family therapy interview as part of the selection process of

trainees with previous professional backgrounds in other

disciplines. Kniskern and Gurman (1979) called for more

clarification about specific therapist factors which

influence the outcome of family therapy. In particular, they

stressed therapist structuring skills, relationship skills,

and level of experience as being most influential on therapy

outcome. McDaniel, Weber, and McKeever (1983) conducted a

systematic consideration of different training approaches for

therapist trainees. Rather than provide training in one

supervisory model, they recommend a broad-based approach to

family therapy, along with training in individual and group

therapy with both adults and children. The authors'

39

experience has led them to conclude that consideration must

be given to the developmental level of the trainee before

determining which specific supervisory mode, e.g.,

structural, strategic, family-of-origin, or experiential,

should be employed. They made no mention of academic

discipline and its possible influence upon the trainee's

developmental level.

In an attempt to shed more light upon the theoretical

training of family therapy practitioners, Sprenkle, Keeney,

and Sutton (1982) conducted a survey of a random sample of

clinical members of AAMFT. Their intention was to identify

the theorists regarded as most influential by members of

AAMFT. The respondents represented the professions of

Marriage and Family Counselor, Psychology, Social Work,

Education, Religion, Psychiatry, and Sociology.

Unfortunately, the 44% who identified themselves as Marriage

and Family Counselors were not further characterized by

academic background and degree.

It is striking that 67% of those polled chose a non-

family therapy theorist as having influenced them the most.

Also noteworthy was the finding that it was the younger

therapists who regarded family theorists and individual non-

psychodynamic theorists as most influential, while their

older colleagues preferred the individual psychodynamic

theorists. This study of clinical members of AAMFT suggests

that new generations of marriage and family therapists may be

40

influenced by family theorists more than their forebears. It

also suggests the very eclectic nature of the various

academic disciplines which contribute to the ranks of

marriage and family therapists. The earned academic degrees

of the respondents of this study included Ph.D., M.S. and

M.A., M.s.w., theological degrees and Ed.D.

Segments Within the Profession

In a very incisive article which they describe as a

process approach to the study of professions, Bucher and

Strauss (1983) delineated various characteristics which can

be applied to all professions. They maintained that assuming

homogeneity within a profession is not entirely useful; in

actuality, there exist conflicts and differences within all

professions, as well as many values and interests.

Coalitions develop, sometimes due to prior existing

similarities, and these in turn develop into segments within

the profession. These coalitions often develop because of a

common goal or sense of mission. Members of the coalition

often issue a statement that they and they alone can make a

specific contribution to the profession, along with the

reasons why they are uniquely qualified to do so. The

authors also mention work activities, methodology, and

techniques as among the divisions which characterize segments

within a profession. The interests of various segments not

only run along different lines, but are often in conflict.

41

Professional associations may also be considered from

this perspective, and associations must be regarded in

terms of whose interests within the profession are served.

Bucher and Strauss (1983) contend that the public image the

professional association beams to the public is that image

most reflective of the most powerful segment of the

profession.

A consideration of some of the segments of the MFT

profession would appear pertinent in the search for divergent

characteristics which might influence the mission or public

image of the entire profession. Particular attention will be

paid in the following sections to those differences in

academic background which form the basis of coalitions within

the profession.

Psychiatry

In a recent article, Sugarman (1984) delineated

some of the controversies which surround psychiatric family

therapy education: while not yet part of every residency

training program, family therapy training has increased

significantly in recent years. Questions about family

therapy are now included on the national boards and the

psychiatry board examinations. Thirty percent of the total

psychotherapeutic training in many residency programs is now

directed to family and group therapy (Sugarman, 1984,

reporting on a 1981 survey). Much of the family therapy

42

training is done on an outpatient basis, using an "eclectic

blend" of family therapy techniques.

Sugarman (1984) cites the comments of various interns on

the differing emphasis placed upon tradition within

psychiatry departments as being an inhibiting factor to the

assimilation of new treatment approaches such as family

therapy. The issue is further clouded by his observation

that educators and clinicians often fail to agree on whether

family therapy is a new concept in the field or whether it

has always been an implicit component of psychiatry. Another

aspect is the debate as to whether family therapy is

primarily a body of techniques or a conceptual body of

theory. Because of the traditional orientation of

psychiatric training towards treatment of the individual, the

latter view has crucial implications for a radical shift from

individual to relational psychology as the theoretical basis

for psychiatry.

The field of psychiatry, according to Sugarman (1984),

reflects many of the basic tensions described by Bucher and

Strauss (1983). Psychiatric educators espouse either

eclectic or traditional approaches according to their own

biases. A major controversy within the field rages around

the issue of who should teach family therapy to psychiatric

residents. Resistance to the incorporation of family

training is tempered by economic issues beyond the control of

the educators -- issues like third-party reimbursement.

43

Sugarman's most cogent conclusion is his assertion that

family therapy training in general psychiatry residency

programs is continuing to evolve. It appears that

territorial resistances within the discipline are impeding a

unified approach to academic and clinical training.

A basic conflict within the field is elaborated by

Vieland (1982). She contends that it is impossible to bring

order to what she terms the chaotic field of family therapy.

One example is the adherence by many to the medical model and

its implied standard of health versus sickness or pathology.

In fact, throughout the entire field of MFT, one of the basic

conditions for third-party reimbursement is the use of the

Diagnostic and Statistical Manual (DSM-III, 1980). The

influence of Psychiatry and the medical model is pervasive.

Even the most eclectic of approaches to family therapy cannot

avoid the concepts of 'treatment', 'diagnosis', and

'symptom.'

Psychology

In a national mail survey of graduate programs offering

the Ph.D. or Psy.D. in clinical psychology, Cooper, Rampage,

and Soucy (1981) found that approximately one-third of all

programs had no faculty member oriented primarily to family

treatment. One-fifth of all the schools (N = 102) did not offer a single family treatment course. Yet many programs

with only one or even no courses in family therapy rated

44

family therapy as a high priority. These same programs

espoused a similar high commitment to the other three main

areas of treatment--adult, child, and group-- suggesting to

the authors a broad psychotherapeutic foundation rather than

specialization in any one area as a program objective. The

results of the study by Cooper, Rampage, and Soucy (1981)

also cast a measure of doubt upon the self-report survey as a

viable means of assessing program content.

Counselor Education

According to Hovestadt, Fenell, and Piercy (1983),

very few counselor education programs currently have AAMFT

accreditation. They suggest, however, that this type of

program accreditation will become mandatory in time in order

for program graduates to become eligible for licensure or

certification as marriage and family counselors or

therapists. The authors note a division in loyalties among

counselor educators involved in marriage and family

counseling between AAMFT and the American Personnel and

Guidance Association (APGA).

Thomas (1982) reflected the concern of many counselor

educators who anticipate more stringent licensure

requirements. In a move towards greater conformity to the

standards of both AAMFT and the Council for Accreditation of

Counseling and Related Educational Programs (CACREP), many

programs which formerly consisted of one year of full-time

45

study are in a process of revision. There are areas of

overlap in the accreditation requirements of both

organizations. However, one vital area of divergence relates

to the supervised clinical practice requirements. Thomas

recommended a careful assessment process of existing

counselor education programs to ensure that they meet both

the experiential and academic requirements of both AAMFT and

CACREP.

Because many graduates of counselor education

programs are now finding employment in non-school settings,

Cooper and Charnofsky (1983) also recommended broadening the

range of courses offered in counselor programs. They

acknowledged the difficulties inherent in attempting to

change traditionally successful programs, and they

specifically cited faculty resistance to curricula revision.

In addition to focusing upon a particular curriculum, they

asserted that a complete analysis of how a faculty functions

must be conducted. This analysis must include faculty

interests, academic training, and resources in order to most

economically and efficiently effect the transitions to a

curriculum which meets the needs of students who want to

become qualified to work in nonschool settings such as mental

health agencies. Cooper and Charnofsky concluded that

students have a right to know the theoretical origins and

workings of family systems approaches. In order to meet

these needs, they recommended that faculty become familiar

46

with social psychology and systems theory, as well as the

more traditional intrapsychic models. Kosinski (1982)

advocated that counselors insist that APGA become militant

about standards, accreditation and licensure, suggesting that

a failure to do so could result in the loss of considerable

numbers of students to programs in related f ields--MFT among

them. Kosinski (1982) favored a two-year master's degree

program for counselors which could be tied to credentialing

individual members in accordance with the requirements of the

states in which they practice.

Social ~

Counselor educators are not alone in their concerns

over the impact and implications of specialized training in

family therapy. Mishne (1982) referred to a struggle within

the social work profession with identity issues. She

deplored the dearth of both in-service training opportunities

and supervision for recent graduates of social work programs

employed in social work agencies. Her main concern was the

dilution of what she termed the unique professional identity

of the social worker who is forced to seek further training

at nonsocial work institutes.

While Mishne (1982) advocated tolerance of

differences and some ambiguity within the profession, she was

adamant in her insistence of an adherence to the basic

philosophy and concepts underlying the profession as a whole.

47

She recommended basic changes within the profession, such as

educating practitioners beyond the Master of Social Work

(MSW) level and providing concentrated study tracks for

specialization at the master's level. Judging from the large

numbers of MSW's engaged in the practice of family therapy,

specialization in that field would appear a likely candidate.

Siporin (1980), however, argued that the results of a

survey he conducted indicated that family therapy content was

already included in the required methods curricula of a

majority of those graduate schools of social work which

responded to his survey. Furthermore, he cited the general

systems perspective--as opposed to the more widely accepted

psychoanalytic perspective favored by most social work

programs--to be a crucial basis upon which to formulate the

sub-specialty of family therapy training.

Green and Kolevzon (1982a) conducted a study to

clarify the ideological split within the profession. They

surveyed 328 MSW's who were members of either AAMFT or the

American Family Therapists Association (AFTA). Their

questionnaire measured the respondents' strength of

theoretical orientation to each of three major models of

family therapy: communications, systems, and strategic-

structural. In addition, the congruence of each respondent's

assumptions about the process and goals of family therapy

with the various styles or roles of a family therapist was

measured. The surprising relative lack of synchronicity

48

between the valuing of assumptions and styles, when related

to theoretical orientations, was tentatively explained as a

lack of 'fit' between the social work practitioner's belief

(theory) system and action (technique) system. Furthermore,

the lesser importance assigned to many of the assumptions and

styles which to some degree characterize the systems and

strategic-structural models suggested some tension between

the social work profession and two of the major models of

family therapy.

Green and Kolevzon (1982a) voiced concern that these two

theoretical orientations, so significant in the development

of family therapy, might be ignored in favor of the one

approach most characteristic of the social work profession in

general, the emphasis upon therapist insight, understanding,

and awareness, as well as the fostering of a warm and

nurturing relationship with the client. They called for

more openness on the part of the profession to consideration

of those other methodologies which have proved to be

effective in the treatment of families.

In an expanded version of the study, Green and Kolevzon

(1982b) surveyed the entire memberships of both AAMFT and

AFTA, with one thousand of those polled responding. Once

again, there was a congruence between the espoused principles

of the approaches to family therapy as articulated in the

literature and the belief systems of the responding

therapists oriented to each of these approaches. For

49

example, 'Insight' was rated highest for the communications

group. Analysis of all of the data led Green and Kolevzon to

conclude that it is the beliefs or assumptions (belief

system) rather than the in-session behaviors (action system)

of the practitioners which correlate more closely to their

theoretical orientation. They posit the possibility that

belief systems--closely linked to intellectual knowledge--are

more easily acquired than action systems, or intervention

techniques.

Green and Kolevzon's studies (1982a and 1982b), as

reported in the literature, leave several areas of interest

unexplored. Among these are age, gender, and amount of

experience of the respondents. Of particular interest, in

light of their previous conclusions regarding the theoretical

orientations of social workers, would be an analysis of the

academic backgrounds of the respondents as to their

theoretical orientations. If there is a process of

theoretical selectivity operant in the social work

profession, there may also be evidence of similar selectivity

in the other therapeutic professions.

Summary

It would appear useful for clinical trainers and

supervisors of aspiring family therapists to know if there

might be prevailing beliefs and assumptions that students

bring from specific academic disciplines into the clinical

50

training experience. If it can be assumed or even suspected

that students from particular kinds of graduate programs

have particular theoretical orientations, the trainer has

more knowledge at the outset--along with a better

understanding of the students' assumptions about family

therapy.

Appendix B

Additional Results

51

52

Additional Results

This study was a descriptive survey of 345 student,

associate, and clinical members of AAMFT, performed to

evaluate the relationship of participation in particular

academic programs to family therapists' preferences for

intervention methods and skills. Group comparisons were made

between the subjects as identified by their respective

academic backgrounds, as well as by age, membership status in

AAMFT, and amount of professional experience practicing

therapy.

The independent variable for this study was the belief

system of the family therapist practitioner as measured by

academic degree, e.g., M.s.w., M.D., Ph.D. in Psychology,

Psy.D., M.Ed., M.S. or Ph.D.in Marriage and Family Therapy,

The dependent variable was defined as the practitioner's

action system, or preferred theory of therapeutic change--

measured by his or her choice of intervention methods and

preferences for particular therapeutic skills chosen from the

self-report form of the Famly Therapist Rating Scale.

All data compiled in this study were analyzed by

computer using StatPac (Walonick Associates, 1985) software.

Statistical methods used included univariate analysis of

variance, the Kruskal-Wallis One-Way Analysis of Variance,

and a priori pairwise comparison tests. All data were analyzed at the .OS level of significance.

53

Survey instruments were mailed to 600 members of AAMFT;

345 (57.5%) responded. Demographic data provided by the

respondents were analyzed to determine differences on

variables not addressed by the hypotheses, as well as those

that were formulated as part of the study design. Subjects

were compared by gender, marital status, age, and specialized

training in particular models of family therapy, as well as

number of years of professional experience practicing

therapy.

Independent chi-square analyses of the subjects grouped

by their highest academic degrees earned revealed significant

differences by gender. Twice as many females as males had

earned degrees in educational fields, and males earning

degrees in religion outnumbered females 5 to 1 (see Table 3).

There were no significant differences by age or marital

status across academic groupings. Because of insufficient

numbers in the under-thirty age category (n = 8), those subjects were combined with the 30-39 age group to form a

category sufficiently large to perform a test of

independence. For the same reason, the following marital

categories--never married, separated, divorced, and widowed--

were grouped under the category of unmarried. When subjects

were grouped by gender, chi-square analyses revealed

significant differences for age, marital status, and number

of years of professional experience practicing therapy.

Females predominated in the over 60 age group (see Table 4),

54

Table 3

Dominant Academic Group

Number Row % Column % Female Total %

27 Education 64.3 15.9

8.0

43 Family 54.4 Studies 25.3

12.8

36 Social 63.2 Work 21. 2

10.7

42 Psychology 40.8 24.7

12.5

6 Religion 16.7 3.5

1. 8

16 Other 80.0 9.4

4.7

Column 170 Totals 50.4

Chi square = 34.677 = 5

0.000 Degrees of freedom Probability of chance =

£y_ Gender

Row Male Totals

15 35.7 42 9.0 12.5 4.5

36 45.6 79 21.6 23.4 10.7

21 36.8 57 12.6 16.9 6.2

61 59.2 103 36.5 30.6 18.1

30 83.3 36 18.0 10.7 8.9

4 20.0 20 2.4 5.9 1. 2

167 337 49.6 100.0

Valid cases = 337 Missing cases = 8 Response rate= 97.7%

55

Table 4

Age £y Gender

Number Row % Column % Female Total %

61 Under 40 48.4 35.5

18.0

49 40 - 49 44.5 28.5

14.5

42 50-59 54.5 24.4

12.4

20 60 and over 76.9 11. 6

5.9

Column 172 Totals 50.7

Chi square = 9.539 = 3

0.023 Degrees of freedom Probability of chance =

Row Male Totals

65 51.6 126 38.9 37.2 19.2

61 55.5 110 36.5 32.4 1