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