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Teaching the Structural Way

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Teaching the Structural Way

Jorge Colapinto

    1

    Teaching the Structural Way

    On finishing one year of training in structural family therapy, a group of fun-loving practitioners produced a spoof videotape that they titled “The Structural Way.” In a comic fashion, the piece demonstrated the trainees‟ understanding of a fundamental tenet in

    their teachers‟ philosophy: that structural family therapy should be learned, not as an assortment of efficient techniques, but rather as a disciplined way of looking at families in pain, at the intricacies of change, and at the role of the therapist.

    What is, however, the “structural way”? The adjective “structural” is usually employed to identify the approach originally developed by Salvador Minuchin at the Philadelphia Child Guidance Clinic. Today, however, a good number of family therapists invoke it to describe their practice in some cases without much justification while

    many others are producing excellent structural work that they do not label as such. Pinpointing the “real” structuralists is difficult by the absence of a formal model that

    would define the essential features of structural family therapy. Minuchin‟s own theoretical writings, while abundant and inspiring, display noticeable variations in emphases and are not without inconsistency probably the result of an open-minded

    interest in what other thinkers had to say about his own clinical work. The influence of Jay Haley can be detected through the pages of the classic Families and Family

    Therapy (Minuchin, 1974), and many clinicians and even taxonomists of family therapy would not acknowledge any substantial differences between the two masters. There have been attempts to systematize the essential tenets of the structural model (e.g., Aponte & VanDeusen, 1981; Colapinto, 1982; Nichols, 1984; Umbarger, 1983), but none of these renditions can be regarded as the “official” version.

THE STRUCTURAL PARADIGM

    It could certainly be argued that there is no such thing as “the structural way,” but only the inimitable style of Salvador Minuchin, an idiosyncratic expression of genius that manifests itself anew each time and does not allow for formalization. Indeed, the master himself, worried that his creation might be turned into dogma by others, has all but disowned anything resembling a comprehensive model of therapy that can be taught and learned (Minuchin, 1982). The contrary position reflected in these pages is that there exists a core system of perspectives on families, change, and therapy that directs the structuralist‟s work in the therapeutic arena and sets the “structural way” apart from

    other approaches. Such a paradigmatic core can be primarily distilled from certain redundancies in Salvador Minuchin‟s clinical operations and in his case discussions,

    more than from his theoretical presentations where the search for dialogue with other

    thinkers has occasionally blurred the shape and boundaries of the structural paradigm.

A Structural View of Families

     1 Originally published in Liddle, Breunlin & Schwartz, Handbook of Family Therapy Training and

    Supervision. New York, Guilford, 1988.

    Family therapists of all persuasions look beyond the apparent behavior of family members in search of some kind of pattern that will introduce a unifying meaning into what would otherwise be a confused bundle of unrelated observations. But they are not all searching for the same kind of pattern (Scheflen, 1978). Some pursue clues to the distribution of power; others, styles of conflict resolution; still a third group, redundancies in the sequence of speakers. The list could continue almost indefinitely.

    The structural way is one among many methods of putting together the richly complex manifestations of family life. Although generically speaking it conceptualizes the family as other systemic approaches do as a system in evolution that constantly

    regulates its own functioning it features a distinctive focus on concepts that describe space configurations: closeness/distance, inclusion/exclusion, fluid/rigid boundaries, hierarchical arrangements. The key notion of complementarity is used by the structuralist to denote not an escalation of differences (Bateson, 1972), but a fit among matching parts of a whole. Visually, the relational patterns that the structuralist “sees” can be better described by maps and jigsaw puzzle-like figures than by circular series of arrows.

    From the structural point of view, symptomatic behavior is a piece that fits into a dysfunctional organization. An adolescent‟s anorexia may be related to a mutual invasion of the patient‟s and her parents‟ territories; a school phobia may reveal excessive proximity between mother and son; a runaway may signal a “leaky” structure. Structural configurations are deemed functional or not according to how well or how badly they serve the developmental needs of the family and its members. In a dysfunctional family, development has been replaced by inertia. Stuck in a rigid arrangement, such a family cannot solve its problems and continue growing. For example, following mother‟s death, a father and a daughter maintain the same distance

    that they had kept when mother was alive; the girl becomes a truant, mother is not there to make sure that she attends school, and the vacuum in parental functions is filled neither by the father nor by the relatives who are now mediating between him and the girl.

    Thus, unlike other systemic approaches that focus on the function of the

    symptom (“Joey‟s temper tantrums distract his parents from their marital conflict”), the structural view focuses on the organizational flaw (“The couple‟s avoidance of conflict is

    crippling their parenting of Joey”).

A Structural View of Therapeutic Change

    Breaking away from such an organizational impasse requires the mobilization of resources that the family already possesses in latent fashion and which are often apparent in a different context; the widower of our example was a competent professional who could display leadership in his job but not in relation to his adolescent daughter. Systemic change, in the structural view, equals an increase in the complexity of the structure an increment in the availability of alternative ways of transacting. The function of the therapist is to create a -context for the family to experience those alternative patterns as accessible (father does have an influence on daughter), possible (neither father nor daughter will collapse while dealing with each other), and necessary (daughter is in for trouble if she and father abdicate their relationship). This definition of the therapist‟s role explains the structuralist‟s preference for changing transactions in the therapy room, where he or she can punctuate sequences of behavior and literally create a different experience.

    What the structural therapist is trying to build through his or her restructuring efforts is more important than -what he or she is trying to uncover. If father becomes

    Jorge Colapinto (1988) Teaching the Structural Way p. 2

paralyzed when his truant daughter blames him for her mother‟s death, identifying the

    accuser defendant pattern that renders him impotent is only a preliminary step toward the promotion of a more functional father-daughter relationship. This health-oriented search for the “missing pattern” is a characteristic mark of the structural approach: the

    survey of differing views about the nature of the problem, the gathering of information on family background arid history, and other diagnostic operations are guided by the need to assess the system‟s resources and weaknesses in preparation for a reorganization.

    The structural therapist does not emphasize the pursuit of individual change or the prescription of specific solutions. Instead, he or she tries to modify, enrich, and make flexible the family structure. The goal is to help the family discover patterns that are missing and that will, when developed, provide the scenario for the solution of individual problems. The family (like a recovered ecosystem) is the healer, while the therapist‟s job is to recruit individual resources for the project and to provide a context that can defeat inertia. Unlike other systemic approaches that prescribe for the therapist the role of an invariably neutral commentator, the structural view requires therapists to become protagonists as well. The creation of healing scenarios and the mobilization of individual resources demand the therapist‟s active involvement as well as a broad perspective. In helping a father to find better ways of relating to his children, the structural therapist may resemble a coach mostly straightforward, in principle benevolent, sometimes impatient, and rarely neutral. In undoing a rigid triangle in a psychosomatic family, he or she will enter into selective alliances, and will alternately imbalance, support, and push. Rather than cautiously operating from an invariable distance, the structural therapist constantly changes positions, oscillating between the objectivity of the removed observer and the intensity of the direct participant. From any of these two vantage points, families are seen not as passive mechanisms that resist the therapist‟s input, but as active

    organisms that need to be joined, explored, and expanded.

PHILOSOPHY OF TRAINING

    The first trainers of family therapy did not need to pay much attention to the specifics of alternative paradigms. They were vanguard explorers, marching in different directions, somewhat ahead of their disciples, but participating with everybody else in the overriding excitement of a revolutionary, somewhat underground movement. They were expanding the frontiers of therapy, deriving techniques from new concepts and concepts from new techniques. Then, as the field grew in scope and respectability, the explorers “staked the

    unmarked corners with their trade names” (Minuchin, 1982), and schools developed.

    Today, clinicians are trained not just in family therapy, but in the structural, strategic, systemic and/or other model of family therapy each one separated from the next by

    differences in the conceptualization of both families and therapy.

Mission of Training

    The diversification of family therapy has brought about a rapid increase in available technology and with it a danger. The numerous and heterogeneous techniques

    developed by various schools are sometimes presented to the beginning therapist as an assortment of free-standing tools, each one endowed with its own efficiency, independent of the conceptual frame from which it emerged. Such an approach can generate a field

    Jorge Colapinto (1988) Teaching the Structural Way p. 3

    full of clinicians who change chairs à la Minuchin, give directions à la Haley, go

    primary process à la Whitaker, offer paradoxes in Italian, tie people with ropes à

    la Satir, add a pinch of ethics à la Nagy, encourage cathartic crying à la Paul,

    review a tape of the session with the family à la Alger, and sometimes manage to

    combine all of these methods in one session. (Minuchin & Fishman, 1981, p. 9)

    The problem is that techniques do not work by themselves. Knowing how to join, reframe, or unbalance is useless if one does not know when and why to do it. Therapeutic competence requires a synthesis of many different and even contradictory abilities; the structural therapist needs to engage clients intensely and also to keep an efficient distance from them; to accept and disrupt the ways of the family; to be a leader and a follower, firm and flexible, poised and humble. In order to choose, organize, and time specific interventions, the therapist needs to rely on the master blueprint, the therapeutic world view that is provided by the structural paradigm. The heuristic value of the paradigm as a propeller and organizer of the therapist‟s operations surpasses the efficacy of any collection of techniques, and therefore its acquisition constitutes the main mission of training. Technical skills need to be learned as a natural expression of a consistent paradigm (Colapinto, 1983).

Training Strategy

    The early emphasis on techniques in the teaching of structural family therapy was a reaction to the limitations of traditional training, with its deductive sequence from theoretical constructs to specific interventions; the availability of live and videotape supervision exposed the huge discrepancies that may exist between the apparent understanding of concepts and the actual behavior of the therapist in the session. The idea then, as Minuchin recalls, was to teach the “steps of the dance,” to focus on the specific skills of therapy “without burdening the student with a load of theory that would slow him down at moments of therapeutic immediacy.” Theoretical integration, it was

    hoped, would emerge spontaneously: “Through an inductive process the student, in „circles of decreasing uncertainty,‟ would arrive at the „aha!‟ moment: the theory.” (Minuchin & Fishman, 1981).

    Experience with this approach eventually showed that spontaneous theoretical integration was the exception more than the rule. The tactic of concentrating on the practice of skills while leaving conceptual understanding for later may require from the student a strong and lengthy attachment to the teacher. In Zen and other Eastern models of learning (often cited as an inspiration by family therapy trainers) the student is sometimes even -prevented from attempting to practice the master‟s teachings in the real world while in training (Herrigel, 1953). But in our world of licensing boards, third-party payers, and workshop show business, the relation of trainer to trainee offers little room for pure aesthetic contemplation and personal renunciation. Apprentices just will not wait for the master‟s anointment.

    The student of structural family therapy should not be expected to infer the theory from the practice any more than the other way around. The conceptual understanding of the model and the practical operations in the therapy room need to be taught simultaneously and as an integral paradigm. A mere “balance” of theory and practice

    such as the interspersion of theoretical seminars in a clinical program that otherwise focuses strictly on the practice of skills is not enough, and may in fact defeat the

    purpose of integration by maintaining “theory” and “practice” as separate realms. A real

    integration of theory and practice can occur only in the arena of supervised clinical work,

    Jorge Colapinto (1988) Teaching the Structural Way p. 4

    and the best opportunity for the supervisor to facilitate it is immediately before or during the therapeutic encounter with a family when the therapist is at the highest point of motivation and alertness.

Pragmatics and Aesthetics of Training

    The integrated approach to training presented in these pages offers one possible answer to the debate about the aesthetics and pragmatics of family therapy. Some authors (Allman, 1982; Keeney & Sprenkle, 1982), reacting to the pragmatic lure that cookbooks” of techniques may exert on therapists, have argued for a more “aesthetic” attitude -one that would temper or counterbalance the pragmatic trend by enhancing a more contemplative understanding of underlying patterns of interconnectedness The opposition, however, is a false one. The cookbook approach thrives not on excessive, but on defective pragmatism. Therapists who only learn techniques that “work” turn out

    to be as “practical” as actors who only impersonate others: the effectiveness of their performances diminishes as a function of their narrowed creativity. An awareness of “underlying patterns of interconnectedness” -like the ones depicted by the structural

    paradigm- is necessary, not to temper the therapist‟s pragmatic goals but to improve his or her chances of achieving them. Aesthetics, far from being the opposite of pragmatics, constitutes its highest form.

    To help the therapist develop an aesthetic perspective, the trainer must begin by acknowledging and respecting the therapist‟s pragmatic concerns. If a trainee is anxious

    to learn how to do better therapy, attacking his or her motivation as being too pragmatic will not help in promoting a paradigm shift. But the trainer also can and should challenge the trainee‟s notion of how this pragmatic concern is to be satisfied. For instance, if the

    trainee attributes his or her performance deficits to ignorance of the right recipe,” the

    trainer can demonstrate that what is needed is better thinking; the pragmatic motive thus provides the incentive for a more integrated, “aesthetic” learning. This training strategy is evocative of the structural model of therapy, which accepts the focus on the presenting problem while repositioning it within a structural frame: the clients‟ immediate concerns

    with their symptoms are acknowledged and respected, but the clients are also told that in order to get rid of these symptoms their transactional patterns and views will need to change.

TRAINING CONTEXT

    The training philosophy presented in the previous section has been implemented through several training programs. The example to be presented here is the Extern Program, a clinical practicum offered by the Family Therapy Training Center of the Philadelphia Child Guidance Clinic, and designed to teach generic concepts as well as 2specific techniques of structural family therapy.

    Extern students meet one day a week, from October through May. Organized in groups of eight, they work together with two supervisors for the entire training-day. The program is structured around live supervision, of family sessions that are also observed by the colleagues in the training group and subsequently reviewed on videotape. An additional one-day seminar, where all- groups participate, is held every month.

     2 The author was affiliated with the Philadelphia Child Guidance Clinic from 1976 to 1986. The description offered here reflects the program as it was in the mid-1980s.

    Jorge Colapinto (1988) Teaching the Structural Way p. 5

Setting

    The Family Therapy Training Center is part of the Clinic‟s Department of Training, which also offers other practica as well as internship programs for psychiatrists, psychologists, and social workers. In addition, a continuing education program offers workshops and conferences led by both Clinic staff and guest speakers. The Philadelphia Child Guidance Clinic is a large facility created in 1925 that provides outpatient and inpatient treatment to children and adolescents -within a family perspective. The ecosystemic orientation of the services provides the Extern program with a “friendly” environment that facilitates consultations, transfers, and other communications within the broader context. The Clinic is the primary source of mental health services for a large catchment area and has access to the entire range of mental health problems, which permits direct supervision of treatment as a preferred training modality. A close liaison has been established with the Children‟s Hospital of Philadelphia in the areas of psychosomatic dysfunctions and chronic illnesses.

    Each group of eight students and two supervisors has permanent access to two videorooms with observation and videotaping facilities. Group discussions and review of videotapes are conducted in a separate conference room. A student room functions as a relief office for paperwork, phone calls, and individual review of videotapes. The program also makes extensive use of the video and library department, which includes hundreds of edited and unedited videotapes of sessions conducted by Salvador Minuchin and other experienced therapists. Students have the same responsibilities as regular staff members concerning the medical records of the families in treatment.

Trainers and Trainees

    The core faculty of the Extern Program consists of supervisors who have been associated with the Clinic, in various clinical capacities, for periods ranging from 4 to 13 years. Their varied experience in the practice of structural family therapy within different contexts and populations is complemented by other members of the large and multidisciplinary Clinic staff, which covers nearly the entire range of specialties in the mental - health field and is available for backup supervision and consultation.

    Students are required to possess a master‟s degree or equivalent in a mental health area, and a minimum of one year‟s experience in the practice of family therapy.

    They need to be currently employed in an agency setting where they must carry a minimum of five families. Applicants submit a letter of interest, letters of recommendation, and curriculum vitae. A preliminary screening of the written applications leads to the exclusion of candidates with insufficient academic and/or experiential background; the rest of the candidates are interviewed by at least two faculty members, and final decisions are made by a selection committee. Typically, the therapist who joins the Extern program is acquainted with the concepts of structural family therapy through readings, workshops, and edited videotapes, but is not consistently operating under a structural paradigm. He or she may juxtapose straightforward structural moves with psychodynamic interpretations or paradoxical injunctions, and not recognize the differences and eventual incompatibilities between the structural and other models.

    Jorge Colapinto (1988) Teaching the Structural Way p. 6

TRAINING FORMAT

    The Extern program begins with a three-day seminar on structural family therapy, intended to set a basic common ground for the training process. The seminar also provides the faculty with an opportunity to observe the students‟ responses to the concepts and clinical material presented, and Compare their understanding of families, the process of change, and the role of the therapist to the structural paradigm. The rest of the program revolves around direct supervision of the -trainees‟ work with families.

    Clinical work is conceptualized as the arena where an integration of theory and practice can best occur. Each trainee conducts one or two sessions per day under live supervision, and receives on the average an additional half hour of videotape supervision for each hour of therapy. The unit of training is a cycle that includes a pre-session discussion, live supervision, post session review, and videotape review.

Pre-session Discussion

    The preliminary discussion of hypotheses about family dynamics and therapeutic strategies, based on intake information or the previous session, provides an opportunity to examine the trainee‟s thinking how the trainee organizes the available material and

    perceives his or her own role. For instance, when the intake information on a case of school avoidance mentioned that mother had been beaten by her boyfriend, one trainee automatically focused his attention on mother‟s own “pathology.” The supervisor then offered an alternative perspective, establishing a conceptual boundary between the woman‟s presumed incompetence in choosing partners, and her potentially competent

    role as a mother.

    To facilitate the exploration of a trainee‟s paradigm, he or she is encouraged to participate actively during the pre-session discussion, presenting ideas and objections, as Opposed to passively receiving instructions for the conduct of the session.

    Initial interviews are minimally structured in advance; they are mostly devoted to entering the system, listening, and redefining the problem. As therapy progresses, pre-session discussions may focus more on specific treatment and/or training goals (“Today

    you should make an effort to mobilize the sibling subsystem”). Role playing may be utilized to enhance the trainee‟s understanding of complex therapeutic processes, such as unbalancing or entering into multiple alliances. The primary roles of the supervisor in this stage are to help the therapist develop a structural frame for the upcoming session (“What do you think the daughter is doing that keeps mom ineffective?”) and to correct faulty frames (“You won‟t get very far if you keep regarding mom as a 100% slob”).

Live Supervision

    In the session, the previously discussed structural frame helps the therapist to keep one foot out of the system; for instance, it prevents him or her from being organized into thinking of mother as a slob. Overviewing the process of the session to make sure that the trainee protects that frame from homeostatic-tic pulls or distractive contents is one of the functions of the supervisor at this stage. Other functions are to assist the therapist in dealing with unexpected developments (“My wife and I decided to divorce yesterday”), to correct the course if the unfolding of-the session requires a change in focus, and to take maximum advantage of opportunities to enhance the process. For instance, when a depressed mother who has all but given up on her family lights up a cigarette, the supervisor suggests, “Challenge her to refrain from smoking; make it a test of will.”

    Jorge Colapinto (1988) Teaching the Structural Way p. 7

Deciding to intervene

    Sometimes supervisor and trainee can preplan the entire sequence of stages in a session, including a few “walkouts” by the therapist at specified times, for consultation purposes. The most frequent scenario in structural family therapy, though, is one that requires on- the-spot planning in response to feedback from the family, as the session progresses. Thus, live supervision usually demands quick decisions- as to whether, when, in which way, and to what degree to interfere with the process in the room. The supervisor who expects the session to flawlessly follow his or her own conceptualization —and proceeds to “proofread” it from behind the mirror— will at best make a puppet out

    of the therapist, and at worst ruin the process of therapy. Allowance needs to be made for the idiosyncrasy of the student, whose course of action may not totally agree with the supervisor‟s, but may still aim at the same goal. On the other hand, if the supervisor is too passive and accepting, both treatment and learning may suffer. Like the structural therapist, the supervisor is both an observer and an active participant in the process of change.

    In extreme cases, such as when the continuity of treatment or the well-being of the family is at risk, the need to intervene may be obvious. More frequently, however, the decision is not simple. A typical situation might be the “inconclusive maneuver,” where the therapist begins to unbalance the structure but falters halfway, allowing the system to reestablish homeostasis. In such a case the supervisor needs to decide whether to “let it go” or insist that the job be finished. Numerous factors are weighed in the decision: the more or less serious implications that an aborted unbalancing could have for the family; the strength of the therapist; the status of his or her relation to the family and the supervisor; whether there will be a next time; whether the supervisor‟s intervention really has a chance of bringing about success.

    Another example is the “golden opportunity,” where the therapist is not in error but the supervisor sees a chance of moving the process of training and/or therapy one notch up. For instance, while the therapist may be doing a good job of helping a family with teenage children negotiate curfews or schoolwork, the supervisor may react to a tender remark by the 15-year-old daughter, and indicate a change of subject -to her relation with the apparently distant father.

Forms of intervention

    The supervisor can choose among various modes of intervention: talking to the therapist on the phone; calling the therapist out of the room for a quick consultation; entering the therapy room. (The same alternatives are of course available for the therapist at his or her request.) If the same goal can be achieved through any of these methods of intervention, the least disruptive should be chosen. However, an ostensibly intrusive intervention like walking into the room is not always the most disruptive. If the supervisor needs to communicate a brief message (“I think that father has the answer to this one”) in the middle of an intense discussion, calling the therapist out of the room or on the phone might cause an undesired distraction. It may be better for the supervisor to join the session briefly, without even taking a seat, offer his or her input, and leave. 1f on the other hand, the therapeutic moment is so complex that the supervisor‟s message would either be too long (“Talk to father even if the girl cries. When she stops ask her about her mother, but if she does not stop, or if father gets distracted . . .“), or require minute-by-

    minute interruptions - of the session, the best solution may be for the supervisor to demonstrate the idea directly.

    Jorge Colapinto (1988) Teaching the Structural Way p. 8

    In the context of the Extern Program, where both families and trainees get used to the presence of the supervisor and the group behind the mirror, these interventions can be assimilated into the therapeutic process as a form of ongoing consultation or cotherapy. Families are informed at the beginning of treatment that the therapist is part of a team, which provides a rationale for the interventions of the supervisor and minimizes the risk of a negative impact on the family‟s relation to the therapist. When the supervisor walks into the room, he or she frames the intervention as a cooperative effort (“I came here because I wanted to tell mother that. . .“), and/or addresses the therapist in a collegial way (“You know, Susan, I think that. . .”).

Content of interventions

    If the supervisory intervention consists of a dialogue with the trainee (a phone call or a consultation behind the mirror), the supervisor needs to pay special attention to the con tent of the message. Ideally, it should include a request for a specific action, with a rationale for that action, as a way of promoting the integration of paradigm and technique: “Husband needs to feel your support as he stands up to his wife [rationale]. Move your

    chair closer to him [action].” Occasionally, however, the supervisor will need to prescribe an action without offering any rationale. One therapist, for instance, had been struggling unsuccessfully to motivate a 16-year-old girl to fix a dinner for her family. The family was already leaving when the supervisor rang and told the therapist; “Ask the girl if they have

    candlelight at -home”. Puzzled but appropriately curious, the therapist asked the question; the girl then nodded slowly, looked intensely at the therapist, and answered, “I see what you mean.” (“What did I mean?” asked the therapist after the session.) But these are exceptions, justified when time is running out or events are unfolding too rapidly. Of course, as supervisor and trainee progress in their mutual understanding, the rationale may not need to be explicit:

    “Spend some time talking to the boy about his friends” may implicitly carry the comment, “You need to join the identified patient.” Conversely, it may be the specific action that does not need to be detailed. When a trainee is told, “You are losing mother,” or, “The kids have too much power in this family,” that may be enough for him or her to implement the appropriate therapeutic interventions.

Post session Review

    Immediately after the session there is a short debriefing, limited by the time that remains until the next family arrives. Emphasis now shifts to the therapist‟s progress in training. Successes -and failures are briefly discussed and linked to the paradigm: “You really

    joined mother today; that is what we mean when we insist that joining is not necessarily being nice,” or, “I think the reason why you couldn‟t engage grandma was that you saw her only as a saboteur” This stage is also an opportunity to explain the reasons behind the supervisor‟s interventions, if they could not be provided during the session itself: “I asked you to mention the candlelight because they were really talking about wanting to be closer, not about chores.” Finally, the trainee is instructed to locate specific segments in the tape for later review.

    Jorge Colapinto (1988) Teaching the Structural Way p. 9

Videotape Review

    The review of the session videotape, prior to the next appointment, facilitates a more thorough discussion of the trainee‟s perceptions and actions. Rather than reviewing the

    entire session, segments are chosen that highlight the family‟s dynamics and/or the therapist‟s performance; in-depth analysis of the implications of micro sequences is

    preferred to an-extensive overview. In this way the supervisor can concentrate on specific training needs of the therapist as reflected in the concrete clinical experience. The supervisor may ask- various questions to assess and eventually correct the therapist‟s perception: “What do you see happening here? What can you tell, from that

    dialogue, about the relation between husband and wife? Did you notice any differences in the responses of father and mother to the girl‟s temper tantrum?” Other questions, such as, “Why did you decide to support father?” or, “Do you think it was necessary for you to teach mom how to control the kid?” address the trainee‟s understanding of his or her own role. The supervisor may also comment on the family (“I don‟t think -this is an

    overinvolved dyad; look how mother responds to the child”), and on the therapist‟s

    performance (“You created an instant climate of comfort, but then became too careful not to risk it”).

    The trainee, in turn, asks for specific inputs: “What is going on in this family?” “How can I

    be less central?” He or she is primarily motivated to improve performance -in general

    and in the next session. The supervisor capitalizes on this legitimate interest and stimulates the therapist‟s integration of action and thinking, turning “what-should-I- do-

    next” questions into opportunities to develop the therapist‟s paradigm. The focus is on the clinical practice, but not in a theoretical vacuum: “Yes, you can go for the differences between mother and father, but are you clear as to why that is important at this point?”

    or, “I think you are not pushing father enough because you think too much of the function that the child‟s symptom may have for the couple.”

The Group Format

    The group format is essential to the process of supervision in the Extern Program. The group functions as a sounding board for the relation between the supervisor and each individual trainee, contributes useful suggestions and observations, and provides a safety net of mutual support. Through its comments, questions, and sheer presence, the group helps the supervisor to keep distance from the therapy itself- and to maintain the perspective of a trainer particularly during live supervision, when the immediacy of the therapeutic process might blur that perspective. Alternating between the -roles of therapist and-observer, the group members learn both through the intense experience of conducting a supervised session, and through the more relaxed participation in the dialogue between the supervisor and other trainees.

    On the other hand, the group context places extra demands on the supervisor. When reviewing a videotaped session, for instance, the supervisor must double as a group leader, balancing the need for group participation with the need for a focus on the specific training needs of the individual trainee. In live supervision, the supervisor has to be careful not to become subtly induced by the group into taking too much control of the session (“Is Carl doing what you asked him to do?”). By maintaining an equidistant relation to all members, staying clear of coalitions, and sticking to the function of guiding the trainees‟ learning, the supervisor fosters group cohesiveness and discourages destructive competition.

    Jorge Colapinto (1988) Teaching the Structural Way p. 10

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