Training and Supervision in Family Therapy

Training and Supervision in Family Therapy: Current Issues and Future DirectionsAuthor(s): Stephen A. Anderson, Sandra A. Rigazio-DiGilio and Kara P. KunklerReviewed work(s):Source: Family Relations, Vol. 44, No. 4, Helping Contemporary Families (Oct., 1995), pp. 489-500Published by: National Council on Family RelationsStable URL: http://www.jstor.org/stable/585003 .

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TRAINING AND SUPERVISION IN FAMILY THERAPY CURRENT ISSUES AND FUTURE DIRECTIONS

Stephen A. Anderson, Sandra A. Rigazio-DiGilio, and Kara P. Kunkler*

The literature on family therapy training and supervision is reviewed. Four focal developments are highlighted. These include

the emergence of school-specific models, the development of training modalities, integrative approaches to training and super-

vision, and the importance of developmental perspectives. Su.ggestions for future growth and development of this specialty area

are proposed.

Over the last 25 years, the specialty of training and supervision has developed within the field

of family therapy. Standards, policies, and learning objectives have been designed for the accreditation of family therapy training programs and for quali- fying family therapy supervisors (Ameri- can Association for Marriage and Family Therapy [AAMFT], 1991, 1993). Descrip- tions of training programs in various contexts have been published. Consider- able attention has been devoted to de- signing supervision and training modalities such as live supervision and videotape review. Numerous training models and supervision approaches have evolved. Research on the outcome and effectiveness of family therapy training and supervision has slowly begun to ac- cumulate. Finally, a number of literature reviews have been published that chronicle the above events.

Although we summarize previous literature in this article, our primary in- tent is to assess key developments in training and supervision, outline how far we have come, and propose what we view as logical steps for continued growth in this specialty area.

In this review, a distinction is made between training and supervision. Training encompasses all factors related to disseminating knowledge, including clinical supervision, curriculum development, and classroom instruction. In contrast, supervision is a more specific

means of transmitting knowledge, skills, and attitudes through a relational process that entails direct oversight of trainees' clinical work (Bernard & Goodyear, 1992).

Family therapy training and supervision has progressed through several eras (Liddle, 1988a, 1991). The first, com- prised primarily of the 1970s, was char- acterized by a burgeoning, albeit scat- tered literature that addressed several issues. These included: (a) descriptions of techniques and modalities (e.g., live supervision, videotape review; cf. Bodin, 1972; Cohen, Gross, & Turner, 1976; Montalvo, 1973; Napier & Whitaker, 1972; Sonne & Lincoln, 1964; Whitaker, 1971), (b) trainees' personal therapy and the study of their own family of origin (Guerin & Fogarty, 1972; Guldner, 1978; Nichols, 1968), (c) descriptions of training programs (cf. Berman & Dixon-Mur- phy, 1979; Constantine, 1976; Everett, 1979; Flomenhaft & Carter, 1977; Garfield, 1979; LaPerriere, 1979; Mendelsohn & Ferber, 1972; Nichols, 1979), and (d) the influence of different variables within the training context (clinical settings, trainers' professional disciplines; cf. Erlich, 1973; Framo, 1976; Haley, 1975; Liddle, 1978; Mal- one, 1974; Martin, 1979; Meyerstein, 1977; Shapiro, 1979; Stanton, 1975).

During this time, a number of seminal contributions provided direction for the field. One such development was the definition of three essential family therapy skills outlined by Cleghorn and Levin (1973): (a) perceptual skills, the ability to see and describe accurately the behavioral data of the therapy session; (b) conceptual skills, the ability to translate clinical observations into meaning- ful language; and (c) intervention skills, in-session behaviors that allow trainees to modify family interactional patterns. Another development was the specifica- tion of training models based upon major schools of family therapy (cf. Bar- ton & Alexander, 1977; Beal, 1976; Haley, 1976). This development signaled the beginning of an axiom that contin- ues today, namely, that the methods, theories, values, and skills taught to trainees parallel developments in the broader family therapy field. A third focus to emerge was the illumination of the modalities (live, videotape, group) that would become a hallmark of family therapy training (cf. Beavers, 1985; Berg- er & Dammann, 1982; Birchler, 1975;

*Stephen A. Anderson is Professor and Dean of the UJniversity of Connecticut Sclhool of Family Studies, Sandra A. Rigazio-DiGilio is an Associate Professor, and Kara P. Kunkler is a doctoral canididate in the Marriage and Family Tlherapy Program in the School of Family Studies, Uniiversity of Connecticut, 348 Mansfield Road, U-58, Storrs, CT 06269.

Kcey Words:family therapy, supervision, trainingg.

(Family Relations, 1995. 44, 489-500.)

rti FAMILY48 October 1995 489AMI ~~~~~~~~~~~~~~~RAONS48



Bodin, 1972; Montavlo, 1973; Olson & Pegg, 1979; Stier & Goldenberg, 1975). As Beavers (1985) would later note, these modalities opened the training system by providing direct observation and more immediate interaction between supervisor, therapist, trainee, and client.

The second era of family therapy training emphasized critical appraisal and evaluation (Liddle, 1991). The decade of the 1980s produced an incre- mental increase in the number of published articles on supervision and training. There were also a number of important reviews that inventoried the literature, offered critical analyses, and proposed recommendations and guidelines for the future.

A number of consistent themes emerged from these reviews. For example, family therapy training and supervision literature was described as frag- mented, lacking organizing principles, and not building upon the ideas of others. There was no consensus about what should be taught or how it should be taught (Everett & Koerpel, 1986; Ganahl, Ferguson, & L'Abate, 1985; Lid- dle, 1982; Liddle & Halpin, 1978). No coherent theory of supervision and training existed (Everett & Koerpel, 1986; Ganahl et al., 1985; Liddle, 1982; 1988a; Liddle & Halpin, 1978; Piercy & Spren- kle, 1986). There was an urgent need for empirical evaluations of the effectiveness of family therapy training and supervision and for research on the internal processes of training and supervision (Beavers, 1985; Everett & Koerpel, 1986; Kniskern & Gurman, 1979; Liddle & Halpin, 1978; Piercy & Sprenkle, 1986). Little attention had been given to the process of supervisor development or to the qualifications of family therapy trainers and supervisors. Clearly, defined standards for training trainers and supervisors were needed (Beavers, 1985; Ev- erett, 1980; Ganahl et al., 1985; Liddle, 1982; Liddle & Halpin, 1978; Nichols, 1979). Trainees needed to be made more sensitive to the politics of family therapy within the broader health care system, professional certification and li- censing, psychiatric diagnosis, and third- party reimbursement (Beavers, 1985; Ganahl et al., 1985; Liddle, 1985; Liddle & Halpin, 1978).

A more personal approach to training and supervision was recommended, including greater attention to learning styles (cognitive and interpersonal) and personal and professional growth (Duhl, 1985; Ganahl et al., 1985; Liddle, 1982, 1988a). Critiques of school-specific approaches to training appeared and calls for integrative approaches became more prevalent (cf. Duhl, 1985; Keller &

Protinsky, 1985; Lebow, 1984; Liddle, 1985; Nichols, 1988; Piercy & Sprenkle, 1986). Feminist critiques of family therapy and family therapy training models began to emerge (cf. Ault-Riche, 1988; Avis, 1988; Caust, Libow, & Raskin, 1981; Okun, 1983; Reid, McDaniel, Don- aldson, & Tollers, 1987; Wheeler, Avis, Miller, & Chaney, 1985). Ethnic and cultural diversity was introduced into family therapy training (cf. Falicov, 1988a; McGoldrick, Preto, Hines, & Lee, 1991; Montalvo & Gutierrez, 1988). A developmental perspective began to emerge. Trainees were expected to know about family life-cycle transitions and supervisors were asked to consider stages of trainee development (Duhl, 1985; Fried- man & Kaslow, 1986; Hess, 1986; Lid- dle, 1988a, 1988b, 1991; Mead, 1990).

We now examine what we consider to be the primary themes in the literature during the 1980s and 1990s. This review serves as a prelude to the final section in which we note other less prominent themes and propose directions for future growth. In our view, there have been four major emphases in this literature. These include: (a) school- specific models of training and supervision, (b) modalities of supervision and training, (c) integrative approaches, and (d) developmental perspectives.

School-Specific Models Many of the developments in the

area of supervision and training have paralleled the major trends in the broader field of family therapy. Until most re- cently, the field of family therapy has been organized primarily around the work of seminal leaders, each with their own systemic model of therapy, and a second generation of adherents and sup- porters who have carried that work for- ward. These same therapy models have, then, informed the content and method of supervision and training models. The essence of this connection between therapy and training is captured in the concept of isomorphism, which sug- gests that patterns, content (e.g., theoretical orientation, assumptions about change, treatment method), and affect tend to be replicated at different levels of the training system (Liddle, Breunlin, Schwartz, & Constantine, 1984; Liddle & Halpin, 1978; Sluzki, 1974). Although the concept of isomorphism has a number of implications and applications in therapy and supervision (cf. Liddle,

1991), one important aspect is the simple notion that supervisors train their trainees in the method and model of therapy that they themselves practice.

Each of the major models of family therapy has, thus, developed approaches to supervision and training that reflect its basic theoretical assumptions, methods, and techniques. For instance, structural family therapy training has emphasized teaching trainees to think and operate at the level of family structure and organization, both within the family and within broader therapeutic and supervisory systems (Minuchin, 1974). The proper maintenance of hier- archy and boundaries among supervisor, therapist, and client subsystems are emphasized (Aponte & VanDeusen, 1981; Colapinto, 1988, 1991; Umbarger, 1983). Training in strategic therapy is focused upon the presenting complaint, which is viewed as nonpathologic and persisting because of the solutions that have been tried to resolve it (Cade & Seligman, 1982; Fisch, 1988; Fisch, Weakland, & Segal, 1982; Haley, 1976, 1988; Madanes, 1981, 1991; Watzla- wick, Weakland, & Fisch, 1974). The functionalfamily therapy model brings together concepts from systems (e.g., context, interactional sequences, affective and cognitive patterns) and behavioral approaches to therapy (e.g., identi- fying and measuring specific elements of intervention, therapist behaviors, and client outcomes (Alexander & Parsons, 1982; Haas, Alexander, & Mas, 1988). Behavioral approaches promote a skills- oriented model based principally upon social learning theory and an empirical research approach employing observation, assessment, intervention, and follow-up evaluations of clinical outcomes (Falloon, 1991; Strosahl & Jacobson, 1986).

Transgenerational models (e.g., Boszormenyi-Nagy & Ulrich, 1981; Bowen, 1978; Framo, 1981) share a common emphasis upon the importance of trainees and clients developing awareness of how their own family of origin experiences affect their current functioning (Boszormenyi-Nagy, Grunebaum, & Ulrich, 1991; Friedman, 1991; Kerr & Bowen, 1988; McGoldrick, 1982; Pap- ero, 1988; Titelman, 1987). The symbolic experiential model encourages trainees to eschew clinical theory and technical skill and instead develop the courage to face impossible problems, tolerate their own and their clients' anxiety, trust their own unconscious and creative impulses, develop their own personal power, and struggle with their own personal growth (Boylin, Anderson, & Bartle, 1992; Connell, 1984; Connell

490 FAMILY October 1995 Sr



& Russell, 1986; Connell, Whitaker, Garfield, & Connell, 1990; Keith, Con- nell, & Whitaker, 1992; Mitten & Piercy, 1993; Whitaker, 1976; Whitaker & Keith, 1981). The Milan approach, based upon the earlier work of Selvini- Palazzoli, Boscolo, Cecchin, and Prata (1978), teaches an epistemological focus that emphasizes the way trainees make sense of phenomena, which, in turn, de- termines what they observe, how they assess, and how they intervene with families (Boscolo & Cecchin, 1982; Bos- colo, Cecchin, Hoffman, & Penn, 1987; Campbell & Draper, 1985; Campbell, Draper, & Crutchley, 1991; Pirrota & Cecchin, 1988; Shilts & Aronson, 1993).

School-specific models have had a tremendous impact on the richness and variety of training and supervision approaches available in the field. Attention to the development of training models for each school has had the added bene- fit of further refining each model's core assumptions and essential treatment methods. Effective family therapy training and supervision is dependent upon having developed clear conceptions about the therapeutic context, the nature of change, the role of the therapist, and the specific therapeutic skills needed for positive client outcomes. Howev- er, as noted earlier, the emphasis upon the development of school-specific models of training and supervision has con- tributed little to the development of theories for supervision and training. The development of family therapy schools has not led to agreement about what should be taught and how.

Modalities Supervisory modalities can be cate-

gorized according to a continuum that describes how close the supervisor is to the raw clinical data of the therapeutic encounter. At one end of the continuum are modalities that directly engage the supervisor with therapists and clients. Here, the supervisor plays an active role in assessing, intervening, and evaluating the immediate impact of therapeutic interactions. Live modalities include cotherapy, direct consultations with clients, and a variety of live supervision approaches from behind the one-way mirror (Andersen, 1987; Byng-Hall, 1982; Cade, Speed, & Seligman, 1986; Carter, 1982; Heath, 1982; Liddle & Schwartz, 1983; Papp, 1980; Pegg & Manocchio, 1982; Piercy & Sprenkle, 1986; Prest, Darden, & Keller, 1990; Roberts, 1983; Schwartz, Liddle, & Bre- unlin, 1988; Wright, 1986).

In the middle of the continuum are modalities that lack the immediacy of the therapeutic encounter but that,

nonetheless, provide raw data in the form of audio- or videotapes. At the other end of the continuum are clinical data that are first interpreted and then reported by the therapist via case presentation. Within these more distant modes of supervision, the therapist alone assesses, intervenes, and evaluates clinical progress, and the supervisor uses the therapist's frame of the therapeutic encounter as a point of reference.

There are advantages and disadvan- tages inherent in each modality. Al- though co-therapy enables supervisors to provide immediate intervention to families and trainees, it may delay the development of the trainee's perceptual and conceptual skills (Latham, 1982; Storm, York, & Sheehy, 1990; West, Bubenzer, Pinsoneault, & Holeman, 1993) and also may make it difficult for the trainee to relinquish the role of novice (Boylin et al., 1992; Liddle & Schwartz, 1983). The various forms of live supervision can ensure the quality of treatment for the client (Cormier & Bernard, 1982; West et al., 1993) by helping trainees pull back from a mis- take and avoid getting stuck (Mc- Goldrick, 1982). However, although ex- perts behind the mirror can heighten the intensity of treatment (Papp, 1980), they also can foster overfunctioning on the part of the supervisor (Berger & Dammann, 1982; Liddle & Schwartz, 1983; McGoldrick, 1982) and generate feelings of "robotization" (Schwartz et al., 1988) and performance anxiety (Carter, 1982; Liddle, Davidson, & Bar- rett, 1988) as trainees simply enact the supervisor's directives. Further, the invisible supervisory team can produce an impersonal quality, and repeated inter- ruptions can disrupt the session's flow (Liddle, Davidson, et al., 1988).

Audio- and videotapes provide supervisors with the raw data of therapy and also time to review, reflect, and con- ceptualize what transpired without the need to respond to the immediacy of the therapy encounter (Whiffen, 1982). Other advantages of this supervisory modality include the opportunity to iso- late interactional sequences or particular types of therapeutic impasses within one session (Olsen & Stern, 1990; West et al., 1993) or across numerous sessions (Rigazio-DiGilio & Anderson, 1991, 1994), and the opportunity to elicit information about trainees' internal states during key exchanges (Breunlin, Karrer, McGuire, & Cimmarusti, 1988). Al- though portions of an audio or video can be shared with clients to facilitate greater awareness of interactional styles (Olsen & Stern, 1990; Whiffen, 1982) the major drawback with this modality

is that supervisors cannot directly influence clients or alter the trainee's execu- tive skills during the immediacy of the therapeutic encounter (Liddle, David- son, et al., 1988; West et al., 1993). An- other potential pitfall is that trainees can become anxious about presenting themselves on tape and, therefore, be less able to take advantage of the learning experience. Finally, little attention has been given to developing guidelines for the effective use of audio and video review (Breunlin et al., 1988), and many supervisors, therefore, do not have the essential skills necessary to take advantage of this supervisory tool.

Case presentations are useful in teaching trainees history-taking and clinical assessment skills. They also provide a forum for planning and evaluating therapeutic goals, refining theoretical skills, addressing issues related to the development of a professional role, and ex- amining the trainee's use of self in therapy and supervision. The principle limita- tion is that supervisors do not have direct access to clients for the purpose of monitoring the quality of their care. Fur- thermore, in the absence of corroborat- ing data, the supervisor must rely exclu- sively upon the perspective of the trainee (Biggs, 1988; Prichard, 1988).

The extant literature tends to be more descriptive than critical of the modalities supervisors have available to support the development of the therapist's perceptual, conceptual, and exec- utive skills. Despite the extensive use of the above modalities in supervision and training, surprisingly little empirical data exist to document their effectiveness. Additionally, a major omission in the literature on modalities to date is the lack of supervisory theories that can guide the selection of modalities based on the developmental orientation or learning style of the therapist.

On the surface, movement across the continuum, from direct to less direct supervisory participation, may appear to follow a simple developmental path. However, reliance on linear, invariant, and hierarchical perspectives of supervisee development may be inconsistent with the supervisee's changing needs and learning styles at different points in time or in response to a particular therapeutic situation. For example, as some therapists develop, their creativity and risk taking increases. This may require more, rather than less, live supervision to ensure client protection and to facilitate thoughtful integration of new clinical practices and perspectives. Greater specificity is needed in supervisory models so that available modalities can be more systematically matched to specific

hi October 1995 FAMILY 491 October 1995 ~~~RELATlO



situations, taking into account the needs of supervisees, clients, and the therapeutic and supervisory context (Rigazio- DiGilio & Anderson, 1991,1994).

Integrative Approaches When surveyed, most family thera-

py supervisors and trainers report that they use multiple models to inform their supervision and training approaches (McKenzie, Atkinson, Quinn, & Heath, 1986; Saba & Liddle, 1986; Wetchler, 1988). However, the establishment of integrative training and supervision models remains in its infancy (Liddle, 1991).

Integrative training and supervision approaches are diverse and difficult to classify. To some, integration means helping trainees to develop a personal theory from schools of family therapy (Kramer, 1980; Lebow, 1984, 1987; Nichols, 1988; Piercy & Sprenkle, 1986). To others, integration involves teaching trainees to work across psychotherapy methods (e.g., group, individual, couple, family, ecosystemic; Bagarozzi, 1980; Feldman, 1985; Friedman, 1981; Kahn, 1986; Pinsof, 1983). To still others, integration means helping trainees construct metatheoretical frameworks that classify theories and therapies across schools and methods, providing comprehensive frames of reference from which to conduct assessments and treatment tailored to the unique needs of clients (Anderson & Holmes, in press; Breunlin, Rampage, & Eovaldi, in press; Rigazio-DiGilio & Anderson, 1991, 1994).

Initial attempts at integration. In the early 1980s, family therapy supervision and training remained primarily faithful to major family therapy schools. Although several articles introduced the issue of integration to the broader field (Gelcer & Schwartzbein, 1989; Grunebaum & Chasin, 1982; Stanton, 1981), these works had their challengers in training and supervisory arenas (Kolevzon & Green, 1983). However, five articles did embrace the concept of integration in training and supervision. Two articles suggested that a core training curriculum could be blended with different supervisory models based upon supervisor preference. Garfield (1979) presented a family therapy program based upon the contextual model of Boszormenyi-Nagy and Spark (1973) that included a sequence of courses and clinical experiences designed to train therapists who, in an integrated fashion, could construct their own styles of therapy. McDaniel, Weber, and McKeever (1983) proposed that structural, strategic, and family-of-origin therapy models could be sequenced within a unified program. Supervision was based upon

the trainee's level of experience. Begin- ners received supervision from a "purist" supervisor, preferably from the structural or strategic models. Advanced trainees were supervised concurrently by a "consortium of purists."

A third article suggested that supervision should be reflective of an integrated curriculum (Falicov, Constantine, & Breunlin, 1981). Learning objectives that delineated observational, conceptual, and therapeutic skills were developed based upon a structural, strategic, and experiential training and supervision program. Bagarozzi (1980) presented a holistic approach based upon psychodynamic/object relations, structural/strategic, and socio-behavioral models. Final- ly, Grunebaum and Chasin (1982) described an approach based upon a synthesis of historical, interactional, and ex- istential theories.

The common assumption undergird- ing each of these articles was that training and supervision should assist therapists to derive a personal model of treatment that is syntonic with their person- ality and that serves the needs of their clientele. However, this was accomplished by introducing students to various school-specific family therapy models at different junctures in their development. What remained unexplored was how to construct training and supervisory environments that modeled integrative practice.

In 1983, Sluzki articulated several theoretical assumptions underlying integrative therapy models, providing the field with a coherent rationale for constructing integrative perspectives in therapy, training, and supervision. He suggested that the various schools of family therapy represented mid-level constructs derived from the broader systems perspective. In his view, each family therapy pioneer highlighted particular vantage points within the broader perspective. Sluzki then delineated three categories of family therapy models, each representing different aspects of a wider systemic paradigm: process oriented, structure oriented, and world view oriented. These categories established a theoretical niche for integrative training and supervision models by providing a set of consolidated dimensions.

Liddle and Saba (1982, 1983) provided a second premise that further laid the groundwork for developing integrative training and supervisory models. Ex- tending Haley's (1976) notion of the similarity between a therapy theory and a training theory, they suggested that an isomorphic relationship should exist between theory, practice, and training.

Their work established the idea that a well articulated theory of human and systemic growth and adaptation over the life span could be isomorphic with client growth and adaptation in therapy and with supervisee growth and development during supervision and training.

Integrative approaches take form. During the last half of the 1980s, as more attention was focused on integrative training and supervision approaches, two clear themes emerged. Either integration was accomplished by a careful sequencing of school-specific models or by guiding trainees in the development of a personal theory and method of therapy.

Articles emphasizing the sequencing theme stressed the importance of at- tending to trainee self-development and family-of-origin experiences. Many suggested that Bowenian theory could be used along with structural and strategic models to better prepare trainees and supervisors for the intense affective exchanges unleashed during clinical practice (Forman, 1984; Keller & Protinskv, 1984, 1985; Westheafer, 1990). Duhl (1985, 1987) described how the faculty at the Boston Family Institute used metaphor, as well as spatial and physical enactments, to help trainees discover the importance of the therapeutic use of self.

The second trend was the personal theory-building perspective. Lebow (1984, 1987) provided a rationale and an integrative structure for helping clinicians to organize their own model of integrative practice. Using Lebow's model, Piercy and Sprenkle (1986, 1988) presented learning activities and questioning strategies that could be incorporated in academic family therapy training programs.

An additional noteworthy development during this period that was inde- pendent of the two trends noted above was the introduction of articles on the subject of integrative training for supervisors. Liddle et al. (1984) presented a sophisticated model for training supervisors based upon the integration of structural and strategic therapies. Storm and Heath (1985) proposed that, in the absence of clearly articulated theories of supervision, supervisors could use their therapy theories to guide their supervisory functioning. Todd and Greenberg (1987) provided useful insights into how combining structural/strategic and experiential models of supervision could ex- pand the supervisor's perspective and options for training.

Towards the end of the decade, more comprehensive models of integra-

492 FAMILY October 1995 rj



tive supervision and training began to move beyond the limits of systemic paradigms to include treatment of indi- viduals, networks, and larger social units (cf. Nichols, 1988). Several models were grounded in their own conceptualization of integrative treatment. Catherall and Pinsof (1987) intimated a training and supervisory model based on their integrative problem-centered approach to treatment. Bagarozzi and Anderson (1989) described a specific training and supervisory model that supported their integrative and mythological approach to therapy.

Current status. The early 1990s has witnessed a greater emphasis on developing integrative training and supervision models. Many have been derived from integrative approaches to therapy. For example, Breunlin et al. (in press), using the metaframeworks model (Bre- unlin, Schwartz, & Kune-Karrer, 1992), describe five lenses through which to examine training and supervision. Ivey's (1986) cognitive-developmental therapy model has been used to develop a supervision and training approach that is based upon individual and collective world views and holistic developmental concepts (Rigazio-DiGilio, 1994b; Rigazio-DiGilio & Anderson, 1991, in press). Bagarozzi and Anderson's (1989) mythological approach to therapy has served as a basis for further articulation of an integrative model of supervision (Anderson & Holmes, in press).

The inclusion of family-of-origin work within integrative models of training and supervision has become almost standard (Constantine 1986; Daines, 1990; Guttman, Feldman, & Braverman, 1990; McCollum, 1990; McDaniel & Lan- dau-Stanton, 1991; Resnikoff & Lapidus, 1990; Taibbi, 1990). Additionally, as the broader field of family therapy wrestles with issues related to gender and cultural diversity, these same issues are being integrated into models of supervision and training (Bernstein, 1993; Coleman, Avis, & Turin, 1990; Falicov, 1988a; Kaiser, 1992; Munson, 1987; Nelson, 1991; Reid et al., 1987; Roberts, 1991; Sheinberg & Penn, 1991; Twohey, 1993; Watson, 1993; Wheeler et al., 1985).

Finally, several authors have stressed the theory behind models of integrative training and supervision. Olsen and Stern (1990) provided a map com- prised of five dimensions (contextual issues, assessment issues, supervisory techniques, stages of supervision, and roadblocks to effective supervision) that can help supervisors design their own integrative approach. Rigazio-DiGilio (in press) compared four current integrative supervisory models and identified the

underlying assumptions guiding the construction of these models (e.g., trainee growth is a holistic, recursive process; supervisory impasses reflect incon- gruities between supervisee need and supervisory context; and integrative frameworks provide multiple reference points and options for growth).

Developmental Models of Training and Supervision

Developmental models of training and supervision can be classified into four types: (a) stage models of trainee development, (b) process models, (c) family life cycle models, and (d) stage models of supervisor development.

Stage models of trainee development. Stage models have been proposed in many disciplines, including clinical psychology (Friedman & Kaslow, 1986; Grater, 1985; Hess, 1986), counseling psychology (Hogan, 1964; Johnson & Moses, 1988; Loganbill, Hardy, & Del- worth, 1982; Stoltenberg & Delworth, 1987), and family therapy (Bagarozzi & Anderson, 1989; Duhl, 1985; Liddle, 1988b; Sprenkle, 1988). Most of these models share several basic premises: (a) trainee development is a continuous process that can be broken down into pre- dictable stages; (b) trainees move from using simple or concrete therapeutic constructs to more complex and abstract conceptualizations; (c) trainees move from dependency upon supervisors to in- creased levels of autonomy and self-di- rectedness; and (d) the supervisor and supervisee relationship is centrally important (Stoltenberg & Delworth, 1987).

Although developmental assumptions regarding stage-specific models have received some empirical support (cf. Borders, 1986, 1989; Guest & Beut- ler, 1988; Heppner & Roehlke, 1984; Lid- dle, 1991; Mead, 1990; Worthington, 1984, 1987), they have not always been upheld (cf. Fisher, 1989; Moy & Good- man, 1984). For example, Fisher (1989) studied veteran supervisors and found that they did not modify their interaction with either beginning or advanced supervisees. Holloway (1988) analyzed the methods used in studies that supported a developmental model and found these lacking in the areas of design and inter- pretation. Some have criticized developmental models for being overly simple and obfuscating other important aspects of trainee development, such as the supervisory relationship, the quality of the training experience, and personal matu- ration (Holloway, 1987, 1988; Russell, Crimmings, & Lent, 1984). Further research is clearly needed before the field fully accepts stage models.

Process models. Even though many articles have been written about the developmental processes inherent in family therapy (Breunlin, 1988; Combrinck- Graham, 1985; Kovacs, 1988; Liddle, 1988b; Melito, 1985, 1988; Rigazio-Di- Gilio, 1994a; Tucker, Hart, & Liddle, 1976), only two models of training and supervision based upon nonhierarchial developmental concepts have been noted to date. Both models rely on the assumptions of human and systemic growth identified by Piaget (1955), most notably the equilibration process and the dynamics of accommodation and as- similation. Both models stress the importance of matching the training process and content to the cognitive styles or world view of the trainee. Each model recognizes the unpredictable nature of human growth and does not attempt to assert, a priori, a sequential system of development on either the supervisee or supervisor.

Recognizing that human learning is dependent on the individual's cognitive- developmental stage, the preferred modality of taking in information, and the dominant means of processing information, Duhl (1983, 1985) designed an interactive mode of training that hon- ored the individuality of the learner. This first process model uses analogies and metaphors to help trainees make the connection between intrapersonal understanding and interpersonal competence as a therapist.

The second model is a co-constructive approach that directly links developmental theory (Piaget, 1923/1955; Vy- gotsky, 1987) to the supervisory process. Systemic Cognitive-Developmental Supervision (SCDS; Rigazio-DiGilio, 1'994b; Rigazio-DiGilio & Anderson, 1991, 1994) offers an assessment framework that classifies supervisees' cognitive-developmental orientations into four categories that are identifiable in trainee language during the supervisory encounter (sensorimotor, concrete operations, formal operations, and dialectic/systemic). Further, the model outlines supervisory environments (di- rective, coaching, consultative, and collaborative) that correspond with these orientations and that serve to enhance therapeutic competence. Supervision is tailored to the immediate needs of supervisees and their clients by matching trainee orientations with supervisory environments (Rigazio-Digilio, 1994a, Kun- kler & Rigazio-DiGilio, 1994; Rigazio- DiGilio & Ivey, 1993).

Although both models provide frameworks that can be easily learned, applied, and researched, neither has received empirical support to date.

Ot 1 FAMILY 493 October 1995 RELATIONS



Family life cycle models. Family life cycle concepts have become part of the mainstream of family therapy (cf. Breun- lin, 1988; Carter & McGoldrick, 1989; Liddle, 1988b) and family therapy supervision and training (Duhl, 1983, 1985; Falicov, 1988b; Liddle, 1983, 1988b; Lid- dle et al., 1984; Quinn, Newfield, & Protinsky, 1985; Stratton, 1988; Walsh, 1987; Worthington, 1987). However, some authors contend that normative conceptualizations of family and individual development should not be part of training and supervision (Fisch, 1988).

There is a lack of empirical evidence supporting the value of including family life-cycle content in training and supervision. A systematic approach to assessing the value of life cycle concepts to training and supervision has yet to be developed.

Stage models of supervisor development. Hess (1986) has outlined three stages of supervisor growth and development. In stage one, supervisors may experience anxiety due to their unfamil- iarity with their new role and focus on client issues instead of supervisory issues. Supervisors may over-emphasize technical skill development and fail to attend to relationship issues within the supervisory alliance. In the second stage, supervisors begin to explore the supervisor-trainee relationship. This stage initiates the process of integrating a new identity. The third stage repre- sents the confirmation of a supervisor's identity as a facilitator of supervisee development.

Empirical evidence supporting the existence of stages of supervisor development is lacking. For example, Wor- thington (1987) reviewed the research literature regarding changes that occur in supervisees and supervisors as both gain experience in the supervisory process. Whereas findings for supervisees were consistent with theories of counselor development (cf. Heppner & Roehlke, 1984; Reising & Daniels, 1983; Wiley, 1982), the research on supervisors revealed no significant differences based upon levels of experience (Marikis, Russell, & Dell, 1985; Wor- thington, 1984; Worthington & Stern, 1985; Zucker & Worthington, 1986). For instance, supervisors did not show im- provement in their ability to discrimi- nate therapists' needs over time (Miars et al., 1983). Further, supervisors' experience was found to be unrelated to the degree to which supervisors focused on the self of the therapist, the skills of the therapist, the conceptualization of client problems (Goodyear & Robyak, 1982), or their own capacity to plan before su-

pervisory sessions (Marikis et al., 1985; Stone, 1980).

In the final section, we will review several newly emerging themes in the literature and list what, in our own view, are important directions for future growth.

Research In 1979, Kniskern and Gurman con-

cluded a review of the available research on training and supervision by stating, "4after reviewing the literature on family therapy training, we have to confess our field's collective empirical ignorance about this topic" (p. 83). Although the 1980s marked a period of significant growth in terms of the number of studies conducted (cf. Avis & Sprenkle, 1990; Kniskern & Gurman, 1988; Liddle, 1991; Street, 1988), Avis and Sprenkle concluded their 1990 review by stating, "the methodology in this area is still in its infancy and requires urgent attention" (p. 262). Despite a proliferation of studies, we still lack a coherent base of research findings from which to inform the training and supervision field.

Only a handful of studies have ex- amined the outcome of training in family therapy programs (Anderson, 1992; Per- lesz, Stolk, & Firestone, 1990; Stolk & Perlesz, 1990; Tucker & Pinsof, 1984). We still have no data on whether training is related to improved client outcomes (Avis & Sprenkle, 1990; Kniskern & Gurman, 1988; Stolk & Perlesz, 1990). Although some progress has been made in developing evaluation instruments (see Avis & Sprenkle, 1990), many basic questions remain unanswered. Does training make a difference in client outcomes? Is competence related to hours of experience? Is live supervision the most effective way to train? What are the most important qualities in selecting trainees (Kniskern & Gurman, 1988; Wampler, 1993)? What are the most effective didactic, supervisory, and experiential methods of training (Kniskern & Gurman, 1988; Sprenkle, 1993)?

Answers to these and other questions are becoming increasingly important as we enter a new era of third party reimbursement and health care reform (Gurman & Kniskern, 1992). It is essential that family therapy training be based upon a sound empirical foundation of demonstrated effectiveness in producing therapists who offer quality service to families (Avis & Sprenkle, 1990). Fur- thermore, training involves large finan-

cial investments in terms of required hours of supervision, live supervision, and videotape review. We must be sure that these investments are producing the outcomes we require.

Culture and Ethnicity Family therapists have become

more aware of culture and ethnicity (cf. Boyd-Franklin, 1989; Falicov, 1988b; Mc- Goldrick, Pearce, & Giordano, 1982; Pa- pajohn & Spiegel, 1975). We have moved from an emphasis upon differences among cultural groups and a ten- dency to attribute predetermined traits to families of a particular group (Mc- Goldrick, Pearce & Giordano, 1982) to an emphasis upon understanding each individual and family within a cultural context. Now, greater attention is paid to individual differences within cultural groups. All aspects of one's life are thought to be influenced by culture (Fal- icov, 1988a; Hardy, 1993; Hardy & Las- zloffy, 1992).

The implications of these changes for training and supervision remain unclear. Training programs are required by accreditation standards to include curriculum on cultural, ethnic, and gender diversity (AAMFT, 1991). Standards for supervisors require that they become 'sensitive to the contextual issues such as culture, gender, ethnicity, and eco- nomics" (AAMFT, 1993, p. 3). Yet, few models exist to assist programs and supervisors in their efforts to integrate cultural and ethnic diversity into training. Guidelines have been limited to sugges- tions that supervisors examine their own cultural assumptions, blind spots, and prejudices in order to become more aware of trainee and client cultures (Boyd-Franklin, 1989; Preli & Bernard, 1993; Roberts, 1992). The quality of the supervisor-supervisee relationship is viewed as critical in this regard (Watson, 1993).

One notable exception is the work of Falicov (1988a), who has presented a conceptual framework based upon the work of Bronffenbrenner (1977) and the notion of "ecological fit," or family-environment match. The model teaches trainees to locate stressful interactions between the family (its cultural identity, traditions, norms) and the social environment (dominant culture), first through readings and didactic lectures, and then through the analysis of actual cases in clinical supervision.

Training and supervision are not likely to reflect a cultural and ethnic focus until more attention is given to developing theoretical models that describe, explain, and predict the relation-

494 FAMILY October 1995 RRi<ONS Otbr19 '



ship between cultural variables and family process, growth, and adaptation. Fur- thermore, more theoretical and empirical attention should be given to clarify- ing the relationship between cultural variables and training. For instance, what is the relationship between an individual trainee's ethnic background and cultural identity and his or her preferred relational, therapeutic, and learning styles? Is there a relationship between ethnic and cultural background and a trainee's proclivity for particular conceptual models or intervention skills?

Gender Awareness Family therapists have devoted con-

siderable attention to discussing the influence of gender on family dynamics and the therapeutic context (cf. Avis, 1988; Goldner, 1985; Luepnitz, 1988; McGoldrick, Anderson, & Walsh, 1989; Walters, Carter, Papp, & Silverstein, 1988). However, less emphasis has been given to the issue of gender in family therapy training and supervision (cf. Okun, 1983; Wheeler et al., 1985) and even less to the influence of gender in the immediate process of supervision (cf. Avis, 1985, 1988; Roberts, 1991).

There are clear divisions within the field with regard to the extent to wlhich gender differences should be addressed during the supervisory process. At one end of the continuum are those who see gender differences as essential (cf. Bern- stein, 1993; Kaiser, 1992; Nelson, 1991; Twohey, 1993; Watson, 1993; Wheeler et al., 1985). In sharp contrast are those who ignore gender altogether. For example, many family therapy supervision texts do not include chapters on gender issues (Kaslow, 1986; Liddle, Breunlin, & Schwartz, 1988; Whiffen & Byng-Hall, 1982). Further, a survey by Coleman et al. (1990) found that supervisors in family therapy training programs were only mildly (24%) or moderately (49%) inter- ested in gender issues and that gender was not incorporated into most family therapy training programs. Other sur- veys omitted gender issues altogether (cf. Henry, Sprenkle, & Sheehan, 1986; McKenzie et al., 1986; Nichols, Nichols, & Hardy, 1990).

Although a number of authors have proposed exercises that can be used to heighten awareness and lead to the development of gender-sensitive conceptual and perceptual skills (cf. Avis, 1985; Ault-Riche, 1988; Reid et al., 1987; Roberts, 1991; Sheinberg & Penn, 1991), the literature is less vocal on how these types of exercises translate into gender- sensitive intervention skills (one notable exception is Wheeler et al., 1985). Fur- ther, although most national organiza-

tions, such as the American Counseling Association, American Association for Marriage and Family Therapy, American Psychological Association, and the Inter- national Association of Marriage and Family Counselors, have standards re- quiring gender sensitivity, none address how this is best developed or what should be done to ensure that gender be- comes part of training and supervision.

Most available research emphasizes how the gender of the supervisor and trainee influences supervisee learning, skill development, and the supervisory relationship (cf. Warburton, Newberry, & Alexander, 1989; Yogev & Shadish, 1982). Differences in male and female socialization is thought to result in men and women using different voices in clinical practice and supervision. Men use the voice of vision (seeing the truth of the matter) and justice (equality, re- ciprocity, fairness) and women use the voice of care (loving, listening, respond- ing) or have no voice because they are reluctant to speak up or be heard (Bern- stein, 1993; Twohey, 1993).

However, findings on the relationship between gender and supervision and training have been inconclusive. For instance, differences have been found between male and female trainees on such factors as assertiveness, affiliation, involvement, and confidence, but these have varied according to stage of training, the supervisor's gender and level of experience, and which family members are seen in treatment (cf. Nelson & Hol- loway, 1990; Putney, Worthington, & McCullough, 1992; Robyak, Goodyear, & Prange, 1987; Warburton et al., 1989). Putney et al. (1992) concluded that the issue of gender in supervision is extreme- ly complicated due to the interaction of at least four major variables: (a) gender, (b) sex role beliefs and behaviors of supervisor and supervisee, (c) gender match, and (d) theoretical match. We would add to this the trainee's stage of training, characteristics of the training setting, and client variables.

In our view, family therapy training and supervision have not yet reached the level of methodological sophistica- tion or theoretical development necessary to address the complex influence of gender in training and supervision. To reach this level will require gender-informed theories and approaches that can be operationalized and investigated. Such information has been called for, but has not yet emerged (cf. Bernstein, 1993; Coleman et al., 1990; Everett & Koerpel, 1986; Munson, 1987; Rigazio- DiGilio, Anderson, & Kunkler, 1995; Watson, 1993).

Postmodern Perspectives The postmodern era is replete with

alternative family therapy theories, derived from the constructivist philosophy of Kant, which return our focus to the issue of meaning-making systems (Bate- son, 1972, 1979; Watzlawick, 1984). In- stead of highlighting family roles, structures, and patterns, constructivism shifts our focus to understanding the assumptions and beliefs that maintain problem situations and narrow options for change. The emphasis is on helping indi- viduals, families, and wider system networks to co-construct alternative assumptions or narratives that are less problem saturated, more solution focused, and more empowering, thereby opening up alternative options for change (cf. Andersen, 1992; Anderson & Goolishian, 1992; de Shazer, 1993; Efran, Lukens, & Lukens, 1990; Gergen, 1991; Hoffman, 1992; O'Hanlon & Weiner- Davis, 1989; Parry, 1991; Rigazio-DiGilio, 1994a; Tomm, 1987a, 1987b; White & Epston, 1990). It remains unclear how constructivism will enhance our field, whether it will be one alternative model in a series of models, if it will take hold as a new paradigm, or if it will lose cre- dence due to criticisms that it neglects such issues as social context and power (cf. Coleman et al., 1990; Fish, 1993). It is clear, however, that this renewed focus on meaning making has led to the elevation of meaning and assumptions to a position equal in importance to behavioral interaction (Nichols & Schwartz, 1991).

Because constructivism advocates an alternative understanding of human growth and adaptation and takes an alternative perspective regarding therapeutic process, constructivist family therapy training and supervision is based upon different assumptions, principles, and practices from other approaches. For example, rather than disseminating a fixed body of knowledge, constructivist educators introduce new perspectives and create an atmosphere of dialogue aimed at developing, guiding, and shar- ing meaning systems. In this way, trainees become active participants in understanding events, co-creating meaning, and constructing their own reality (Fine, 1992; Wetchler, 1990). The supervisory process facilitates dialogues that generate multiple perspectives and practices rather than "correct" assessments or plans of action. The expected outcome is a sense of confidence, success, and problem resolution in the context of a collaborative, nondirective, symmetri- cal supervisory relationship.

As with most training and supervisory approaches, the actual theory and

October 1995 FML 9 FAMILY 495 ___Otbe 19 RBELlONS



practice of constructivist training and supervision is lagging behind the construction of this alternative approach to therapy (a notable exception is the pioneer- ing work of Andersen [1992] regarding reflecting teams). Should the constructivist movement continue to evolve, theories and methods of training and supervision must be developed and investigated. Without this grounding in theory, family therapy training could easily return to the era of "anything goes." With- out well-developed models of supervision, both supervisors and clinicians could be granted license to use any construction of reality, so long as it makes the family change or feel better (Nichols & Schwartz, 1991). In fact, this "anything goes" posture is already advocated by some clinical constructivists (e.g., Duncan & Solovey, 1989).

Integrative Focus Currently, integrative models exist

that assist trainees to: (a) develop their own personal theory of family therapy, (b) work across psychotherapy methods, and (c) construct metatheoretical frameworks that classify theories and approaches across schools and methods. Each of these approaches attempts to provide trainees with a broader, more expansive therapeutic perspective than is possible when relying upon a single model. However, the danger is that the field will develop a multitude of compet- ing integrative approaches, each assert- ing its supremacy in capturing the whole. Such a development would simply repeat the same pattern evident in the past when school-specific approaches emerged. In fact, there are several ways to organize various schools of therapy, both within and among different disciplines, and none can declare supremacy.

The essential point, in our view, is that simply developing integrative models of therapy that are then used to teach students a formula or blueprint for developing their own theories is not integrative supervision or training. Integra- tive supervision and training should offer the supervisor multiple reference points for facilitating trainees' learning processes, and provide a variety of alter- natives for enhancing trainees' growth. Thus, a true integrative model would have a number of vantage points from which to assess trainees' specific learning styles, levels of development, per- sonality attributes, and the essential elements of the training context. Such models would link assessments of these factors to specific training modalities (live supervision, videotape review), teaching strategies (didactic, role play, studying one's own family of origin),

and to the specific intervention skills that would be most beneficial to trainees at different points in the supervision and training process.

Furthermore, we need to operationalize the key constructs comprising integrative models so that they can be easily learned and applied by trainers and supervisors. Finally, and perhaps most importantly, we need to empirical- ly test the validity of these models for advancing the clinical effectiveness of students and therapists.

Developmental Perspectives Developmental theories offer much

potential in terms of defining the path of personal and professional growth for trainees and supervisors. Furthermore, developmental models offer promise in matching training and supervision with the cognitive-developmental orientation of trainees. Such models can assist supervisors in sequencing the kinds of skills trainees must learn at different junctures in training. However, although the notion that specific therapeutic skills and supervisory and training methods can be calibrated with developmental stages or constructs is appealing, the empirical basis for this conclusion has been unimpressive (Borders, 1986; Hol- loway, 1987; Russell et al., 1984; Wor- thington, 1987).

It is also noteworthy that the field of family therapy has been slow to advance developmental models as they relate to supervision and training. Much of the focus has been on teaching trainees models that emphasize the importance of recognizing the relationships between family life cycle transitions and family process and adjustment. Some attention has been paid to developing stage models of trainee development. However, much of the conceptual work and most of the empirical work on stage models of trainee development, process models of trainee development, and stage models of supervisor development have been initiated by other related professional disciplines. Family therapy has been slow to acknowledge these contributions and to build upon them.

For instance, the field of counseling has already begun to develop measures that operationalize supervisor and trainee developmental levels (e.g., Gib- lin, 1994). What is now needed are instruments that are tailored to the content of family therapy training so that further testing and refinement of these models can proceed.

Politicazl Awazreness This issue is perhaps more relevant

today than when it was first introduced

(Beavers, 1985; Ganahl et al., 1985; Lid- dle, 1985; Liddle & Halpin, 1978). It is becoming increasingly clear that greater pressure is being placed upon training programs and supervisors to be mindful of the environment into which they are graduating family therapists. Political and economic changes have created un- certainty about the future role of family therapists in the health care delivery system and the kinds of careers that will await them. To successfully compete in the job market, family therapists will need a broader range of skills than was necessary in the past.

Trainees must be socialized into the broader social and political climate within which family therapists practice and into the professional organizations that advocate for the legitimization of family therapy (Smith & Allgood, 1991; Utesch & Patterson, 1991). Curriculum should include the current and potential role of family therapists within the health care system, requirements for licensure and certification, and greater collaboration with other disciplines. New skills will be needed by the next generation of family therapists so that they can communicate with insurance providers and managed care industries, apply Diagnostic and Statistical Manual (DSM) TV diagnoses, follow third-party reimbursement procedures, maintain clinical record keeping systems, provide public education, and conduct legislative outreach.

Training for Trainers and Supervisors

Although earlier calls for standards for family therapy supervisors have been heeded, little attention has been devoted to the process of supervisor development. Standards for approved supervisors now require that they complete a minimum number of hours of clinical and supervisory experience, take an approved course on supervision, and complete a supervised experience with an approved supervisor (AAMFT, 1993). Al- though guidelines stipulate that the focus of supervision-of-supervision must be on live, audiotaped, or videotaped sessions of therapy and supervision, the content of supervision-of-supervision sessions and the process of learning to become a supervisor and trainer remains idiosyncratic and undocumented. Few articles have been published outlining specific skills needed to be an effective trainer and supervisor or detailing how learning these skills occurs most effec- tively.

Yet, it is perhaps in this area that the greatest potential exists for future development of coherent theories of supervision and training. In reviewing the

496 FAMIlY October 1995 REA11NS



focal developments of the earlier decade, we noted that training and supervision in school-specific models were greatly facilitated by the development of each model's clear conceptions about the optimal therapeutic context, how clients change, the role of the therapist, and the specific perceptual, conceptual, and intervention skills needed for positive client outcomes. Greater attention to the training and supervision of family therapy supervisors and trainers can greatly facilitate the clarification of such parallel questions as: What is the optimal supervisory and training context? How do trainees best learn to conduct family therapy? What is the role of the supervisor? and What specific supervisory skills are needed for successful training? If we are to take the training of supervisors and trainers seriously, we will need a body of knowledge that address- es these questions.

Despite some notable advances in the training and supervision literature and a proliferation of articles on the subject, the specialty remains at a relatively young stage of development. Supervi- sion and training will always lag behind developments in the field of family therapy because, by definition, their purpose is to disseminate the knowledge that comprises the broader field. Thus, we will always be catching up with regard to educating trainees about new developments and changes in the content of family therapy. The greatest need for the immediate future appears to be research and theory that details the process by which training and supervision occur. We do not yet know which are the most effective models, modalities, teaching methods, and supervisory (and learning) styles for disseminating knowledge about the core concepts, theories, and methods of family therapy.

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