Family Therapy for Continuing Professional Education

Betty R. Matter

ABSTRACT: This is a report on a program of family therapy instruction intended as a continuing professional education service to mental health personnel. The rapid expansion of the program since its inception in late 1971 is due to increasing demand from human service agencies in and around the Greater Philadelphia area. By the end of 1978 more than 550 had participated. Approximately 15% went on to higher levels of family therapy training available at the Department of Family Psychiatry of Eastern Pennsylvania Psychiatric Institute. Some characteristics of participants are described: most are master's level personnel representing a wide variety of human service agencies within a 100-mile radius of Philadelphia; most had a positive response to the training; most did not intend to become family therapists, but wanted an exposure to theory and methods. Comments are included by selected category of how participants use what they learn.

Family therapy training programs have been geared to produce trained family therapists and various programs are described in the literature (Kaslow, 1977; Constantine, 1976; Flomenhaft & Carter, 1974; Cleghorn & Levin, 1973; Ferber and Mendelsohn, 1969). Indicating widespread application and acceptance, Beal (1976) compared training programs for family therapists at 15 dif ferent centers in nine major United States cities. Recent literature reveals that some fami lytherapytra in ing programs may be changing to meet a wider range of consumer needs.

The author is aff i l iated wi th the Off ice of Menta l Retardat ion, Harrisburg, Pennsyl- vania. Reprint requests should be sent to the author at 302 Health and Welfare Building, Harrisburg, PA 17120.

International Journal of Family Therapy, Spring 1980 0148-8384/80/1300-0039 $00.95 @ 1980 Human Sciences Press

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Reflecting a changing emphasis, Meyerstein (1977) reported on a program designed to train indigenous para- professional family therapists to treat previously unreached populations and to help maintain (through traditional agencies) patients and their families at functional levels in the community. Taynor, Perry, and Frederick (1976) described a training pro- gram based on a staff development model in which the primary goal was to train community caregivers in family-intervention techniques and to produce more favorable attitudes toward family intervention. Recognizing the need for family-oriented training for community caregivers, Buckland (1977) proposed an educational model of family consultation that could be taught to school counselors, clergy trained in counseling pro- cesses, and lay counselors. Such programs reflect the field's ability to be responsive to the training needs of consumers who hold various key roles in the community mental health approach.

This paper describes the progress of a family therapy training program that is responsive to continuing education needs of mental health and related agencies. It is primarily directed at sensitizing agency and institutional staff to family therapy theories and methods. Participants may pursue a full course of family therapy training but most do not because it is not their intention to become full-fledged family therapists. Since the program's inception in 1971, approximately 550 individuals have received training in the Introductory Series (Steps I and II) offered by the Family Psychiatry Department of Eastern Pennsylvania Psychiatric Institute in Philadelphia. About 200 of the 550 participants completed Step II. Most of the trainees came from the Greater Philadelphia area, including contiguous areas of New Jersey and Delaware. Some trainees travelled 100 miles or more one way to attend sessions.

DESCRIPTION OF TRAINING PROGRAM

The topics presented in the Introductory Series range across the spectrum varying according to the therapist/presenter's own orientation. The method of presentation is mainly lecture with the use of audiovisual aides for reinforcement. The most recent Step I program (Step II has the same list) had the following lecturers/presenters: Gerald Zuk, Ph.D. (first and last

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sessions); Ivan B. Nagy, M.D., Leon Robinson, M.D.; Geraldine Spark, MSSW; Barbara Krasner, Ph.D.; Bernice Tucker, Ed.D.; Margaret Cotroneo, MSN (all from the Family Psychiatry Department); Andrew Bambrick, M. Div., Chaplain at Allentown State Hospital; Bette Ignatowski, Ph.D., and Uri Reuveni, Ph.D. of Eastern Pennsylvania Psychiatric Institute. Anyone familiar with the literature will recognize the wide diversity of view- points represented bythe individuals listed above. It is believed diversity is a plus at the introductory level.

Pioneers in family therapy training and research, staff members of the Family Psychiatry Department, began planning for this introductory series in 1971 because of the perceived need for public education in the area of family therapy, then still a relatively new approach to treatment. Dr. Gerald Zuk, Associate Director for Training in the Family Psychiatry Department, was instrumental in the beginning phases of the program and in its later development.

Initially, the program was offered once a year only and consisted of six 2-hour sessions. Because of the enthusiastic response of the'participants, in 1972-73 the hours were increased from 12 to 20 and the program was named "Intro- duction to Family Therapy." In April of 1973, the first brochure was written to describe the training program. Since then, the brochure was revised twice because of the expanding goals of the program.

In 1974 the program was split into two parts, Step I and Step II, because Step I participants wanted to continue. Step II was designed to be a continuation of Step I but, since class size would be smaller, allowed more time for discussion. Initially, each part consisted of eight 2-hour sessions offered once a year, but in 1975 the demand had reached a point where each part was increased to 20 hours (10 2-hour sessions) offered twice a year, in the spring and fall.

The initial goal to sensitize agency staff to family theory and method has remained the goal of the Introductory Series. That any interested person may attend the courses (there are no prerequisites) demonstrates this program's intent to provide a community service at various levels. It began and continues as a demonstration program in continuing education in family therapy for professionals and paraprofessionals. It has also expanded, out of demand from some of the participants, into a well-defined graduated 3-year family therapy training program,

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ending with a certificate. A total of six people have obtained the certificate which signifies competency for independent work as a family therapist with special proficiency in the approach of one of the Family Psychiatry Department's senior staff members, Drs. Zuk, Robinson, and Nagy and Ms. Spark. The first certificate was granted in 1975 to Rev. Bambrick, who now teaches in the Introductory Series.

In 1976, the writer, a research associate, joined the department and implemented the first systematic evaluation and data collection for the program. A questionnaire was developed for the purpose of collecting information that would help to describe a trainee's background. In addition, questions were asked regarding the value of the training to participants. (A copy of the questionnaire is available from the author on request.)

QUESTIONNAIRE FINDINGS

The tables are presented to order the data that were collected. Table 1, showing attendance patterns for 2 years, documents the level of participation in the courses.

Trainees were asked to describe their background by answering questions about their level of education and place of employment. Table 2 shows that the majority of trainees held the master's degree.

Most of the trainees were employed in a human service agency. The wide variety of human services represented is shown in Table 3.

More than 118 different agencies and institutions were represented by the trainees in the 2-year period for which figures are shown. Table 4 condenses the 188 plus sites into eight representational categories.

TABLE 1. Number of Participants in Step I and Step II, Fall 1976 to Spring 1978

Date Step l Step II

Fall 1976 56 28 Spring 1977 42 35 Fall 1977 55 15 Spring 1978 33 24

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TABLE 2. Step-I and Step-II Participants' Level of Education

Step I, % Step II, %

Educational level Fall 1976 Fall 1977 Fall 1976 Fall 1977

Undergraduate 10 12 0 11 Bachelor 12 31 40 16 Master 66 55 50 68 Doctorate 7 2 0 5 No information 5 0 10 0

TABLE 3. Types of Services Provided by Participants of Home Agencies

Step I Step II

Fall 1976 Fall 1977 Fall 1976 Fall 1977 Category (N=41)a (N~43) (N=20) ( N = I 3)

Menta l health 5 5 4 1 Alternative services 8 5 5 3 Education 8 10 5 4 Family, children, and youth 4 10 2 3 Drug and alcohol 2 2 2 2 Criminal justice 0 2 1 0 Medical service 3 2 0 0 Religion 3 2 1 0 Other b 8 5 0 0

aNumber of questionnaires returned. blncludes unemployed and students.

In analyzing trainees' responses to the question of what they found most useful in the training courses, it was found that certain responses were repeated frequently in the eight different groups over the 2-year period. As a way of presenting the information, typical responses were selected, categorized, and labeled. Table 5 is a selection and categorization of frequently mentioned positive responses to the introductory level.

Some Step I trainees felt the course was too elementary. Others were looking for more specific techniques, e.g., working with multiproblem families, families of alcoholics, families with prolonged physical illness of a member. A few expressed disappointment that the programs were not more specifically geared to their own particular needs. The overwhelming majority indicated they benefited from the program.

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TABLE 4. Breakdown of Attendees by Type of Service Supplied, Job Title, and Type of Work Site

Category of service Job title Work site

1. Mental health Psychologist, intake worker, psychiatric social worker, administrator

2. Alternative services

3. Family, children; and youth

Psychiatric outpatient clinic, residential care, e.g., home for children, geriatric center, community mental health center, state hospital Crisis or counseling centers, marital abuse program, child advocacy program, youth services Private and public social Service agencies, city adoption and foster care, child welfare, family service

Outreach worker, administrator, counselor

Social worker, caseworker

4. Criminal justice Probation officers Family courts, probation and parole, legal aid

5. Drug and alcohol Therapist, counselor, Residential and outpatient administrator units, halfway houses

6. Medical Mental health technician, Clinics, special care nurse facilities, e.g., renal dialysis

unit 7. Education (incl. special Teacher, counselor, Schools, ranging from

education) professor nursery to colleges, public and private

8. Religious Clergymen, church school Churches, synagogues, worker church schools

TABLE 5. Categorization of Trainees' Comments Regarding Their Response to Steps I and II

Learning experience Trainees' comments

1. Increased awareness of family therapy as a treatment option

2. Understanding concepts A. Family systems

A director of social services for older adults: "1 had not known anything about family therapy previous to this course." A nursery school teachen "This (introduction to family therapy techniques) has opened up a whole new area of interest to me." A coordinator for citizens advocacy program: "What I valued about the program was becoming aware of what family therapy is exactly--making me more comfortable while working within family situations." A caseworker for family services: "1 was able to share my notes from the lectures with other staff members who are interested in family therapy but believe it is overwhelming."

A counselor of socially and emotionally disturbed children: "Gaining an underlying understanding of how children develop their problems from their families and the importance of families in a counseling situation was valuable to me."

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TABLE 5 (continued)

13. Communication

3. Application of specific techniques

4. Gaining confidence in dealing with families

5. Discussing cases and methods

6. Gaining confidence in making referrals

7. Family therapy training in specific problem areas

8. Miscellaneous A. On the format of the

program

B. How trainees would use training

A college counselor: "The concept of communi- cation breakdowns in families was particularly interesting." A school psychologist and learning disability counselor: "Generally speaking, the training program has provided me with more finely honed skills for interviewing families (parents) and eliciting information necessaryto evaluate a child in this total milieu." A mental health technician from a hospital clinic: "1 wilt use the training to evaluate the family system in cases that I see for crisis intervention." A high school guidance counselor: "1 do counsel with families in my school in a very limited way. Viewing the (video) tapes and observing (family) therapists have made me feel more at ease as I work with families." An education counselor: "1 plan to arrange my cases into family groupings instead of working with each student individually and to make family involve- ment a must with each student that I counsel." A student personnel services counselor: "In the beginning I wasn't sure how I could use family therapy since I had very little contact with students' families even though clients brought problems in stemming from family environment. Upon completing the course I feel more confident about engaging in a counseling situation." A counselor from a counseling service: "The most valuable aspect of training to me was the chance to discuss cases and methods with other people." A child advocate w/th juvenile court: "The training will help me deal better with families in crisis and also help me to make more accurate referrals for family treatment." A home school visitor: "The training makes me more confident in knowing when to refer families for therapy." A nurse: "VII use the training to help families deal with medical problems."

A school counselor: "1 feel the variety of styles that were presented was one of the pluses in the program. I would hope that the methods used in Step I would not be changed." A teacher of emotionally disturbed children in a residential home: "1 was really at a basic level in family therapy and I felt that this course was a good overview." A counselor in a family counseling service: "1 took the training couse because my agency is putting emphasis on family therapy." A career counselor for a private school: "1 will use the courses to prepare myself to expand my agency's program from career counseling to a more complete program of counseling service which would include families."

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TABLE 5 (continued)

C. The program as a service to the community

D. Problems encountered

A counselor in the ministry: "1 feel a very positive aspect of this program is its availability to mental health services which otherwise could not afford to provide this type of education or seminar." A counselor in a community mental health center: "There is a difficulty in getting an entire family in an outpatient facility whose intake process is focused on individuals as opposed to families, although more attention is being given in my agency to families. It is essentially up to the therapist to initiate contact with families through the primary client." A counselor in a marital abuse project: "1 usually only see the wife. But all conversation is about the husband and children. I would like to change my work more to take advantage of this course and family therapy in general, but I may not realistically be able to change jobs."

REFERENCES

Beal, E. W. Current trends in the training of family therapists. American Journal of Psychiatry, 1976, 133 (2), 137-141.

Buckland, C. M. An educational model of family consultation. Journal of Marriage and Family Counseling, 1977, 3, 49-56.

Cleghorn, J. M., & Levin, S. Training family therapists by setting learning objectives. American Journal of Orthopsychiatry, 1973, 43, 439-446.

Constantine, L. L. Designed experience: A multiple, goal-directed training program in family therapy. Family Process, 1976, 15 (4), 373-387.

Ferber, H., & Mendelsohn, M. Training for family therapy. Family Process, 1969, 8(!), 25-32.

Flomenhaft, K., & Carter, R. Family therapy training: A statewide program for mental health centers. Hospital and Community Psychiatry, 1974, 25(12), 789-791.

Kaslow, F. Supervision, consultation, and staff training in the helping professions. San Francisco: jossey Bass, 1977.

Meyerstein, I. Family therapy training for paraprofessionals in a community mental health center. Family Process, 1977, 16(4), 477-493.

Taynor, J., Perry, J., & Frederick, P. A brief program to upgrade the skills of community caregivers. Community Mental Health Journal, 1976, 12(1 ), 13-I 9.