COUPLE AND FAMILY PSYCHOTHERAPY
General Goals:
The goal of training is to enable residents to integrate psychodynamic, cognitive and behavioral
principles in dealing with couples or families.
Couple therapy refers to the conjoint process in which two persons in a close relationship
(marital, common-law, prenuptial or other, homo or heterosexual, or two members of a family
subsystem) meet with the therapist to redefine the causes, the dynamics and the possible
solutions to conflicts that have obstructed their joint development and well-being.
Family therapy refers to the conjoint process in which all available/interested members of a
multiperson system meet with the therapist to redefine problems and solutions. The term
"Family" refers to the many ways in which kith and kin systems are lived and constructed.
Requirements
1.
2.
3.
4.
Attend Family/Couple core seminars
Attend one Family or Couple Workshop/Day during residency training.
Provide supervised treatment for six sessions with one couple or family.
Observe 20 Couple/Family sessions.
Revised Nov 3, 2014
Page 1
TRAINING OBJECTIVES – Junior Residents
MEDICAL EXPERT
Knowledge
1. The trainee can describe:
a. The indications and contraindications of Couple and Family Therapy
b. The role of the therapist with each member of a couple or a family
c. The common objectives in a couple or family assessment
d. The impact of culture, socio-economic status and life cycle stage on a couple or
family
2. The trainee can explain the basic concepts of the following theories applied to a couple
or family.
a. Systems
b. Developmental
c. Communication
d. Psychodynamic
e. Cognitive-Behavioral
Skills
1. The trainee can apply the theoretical concepts to develop treatment goals for a course
of couple or family therapy.
Revised Nov 3, 2014
Page 2
2. In supervision and case discussion, the trainee is able to anticipate some challenges
which will arise in the therapy based on both the assessment of the couple/family and
the psychopathology of the individual patients.
3. The trainee is able to demonstrate the following in the clinical care of a couple or family:
a. Negotiating a therapy contract with the couple or family.
b. Interviewing couples and families while maintaining a neutral stance.
c. Support patients to explore in the session where their problems come from and
what solutions they have tried.
d. Engage patients in experimenting with ways of communicating and addressing
conflict.
e. Regulate the emotion and aggression level of the sessions, using support and
psycho-education, so the sessions do not overwhelm the patients.
4. The trainee is able to use supervision to discuss counter transference and couple/multiperson specific issues such as the pull towards taking only one side and the therapist
role in family triangles.
COMMUNICATOR
1. The trainee effectively manages multi person interactions, including: setting an agenda,
balancing input from all participants, supporting communication between participants
and providing feedback and psychoeducation during the session.
2. The trainee maintains clinical notes that meet practice standards and capture the
ongoing therapeutic process, including evidence of review of departmental and CPSO
standards.
3. The trainee can receive and give feedback in supervision.
COLLABORATOR
Revised Nov 3, 2014
Page 3
1. The trainee demonstrates a respectful attitude to all clinicians involved in the care of
the couple or family as demonstrated by timely written and verbal communication and
interest in seeking feedback and input from other providers.
MANAGER
1. The trainee balances competing clinical demands to ensure the provision of safe clinical care and
timely case supervision.
HEALTH ADVOCATE
1. The trainee is able to explore, in supervision, the desire to advocate on behalf of patients, appreciate
both therapist and patient factors leading to that desire, and appreciate the effect such behavior
might have on the therapy
SCHOLAR
1. The trainee demonstrates familiarity with the basic literature in family/couple therapy
related to the topics outlined in Medical Expert. (See Appendix 2)
PROFESSIONAL
1. The trainee demonstrates awareness of the personal prejudices we all have
regarding couples and families and discuss these in supervision.
2. The trainee will adhere to the ethics of couple and family therapy, which excludes
exploitation of patients (sexual, financial or otherwise) or omnipotent deciding for them
what their destiny should be; this includes accepting and respecting the couple's or
family's goals and constructive methods of problem solving.
Revised Nov 3, 2014
Page 4
TRAINING OBJECTIVES – Senior Residents
All trainees seeking proficiency in Couple & Family Therapy are expected to consistently
demonstrate the knowledge and skills required for WORKING KNOWLEDGE.
Requirements
1. Attend additional (non-core) seminars and workshops when offered.
2. Get supervision for two family or couple cases – with a minimum of 6 sessions each.
3. Observe and discuss 40 Couple/Family sessions conducted by another clinician.
MEDICAL EXPERT
Working Knowledge
1. The trainee is able to describe the history and evolution of couple or family therapy.
2. The trainee can identify the key components associated with the following specific
approaches and theories:
a. Systems (Constadine, 1986)
b. Communication (Watzlawick et al, 1967)
c. Developmental Life Cycle (Carter et al, 1980)
d. Psychodynamic - Classical and Object relations (Scharff et al, 1987 and 1991)
e. Cognitive/Behavioral (Dattilio et al, 1990)
f. Sex therapy (Singer, 1987)
g. Psychoeducation (Falloon et al, 1981)
h. Divorce therapy (websites)
Revised Nov 3, 2014
Page 5
Clinical Skills
1. During observed or supervised care of a couple or family, the trainee demonstrates the
ability to:
a. Keep redefining goals during therapy, according to its evolution,
b. Delineate the obstacles found in the treatment with input from the participants
c. Assess the willingness of the couple or family to continue treatment and address
ambivalence
d. Manage confidentiality issues without breaking the therapeutic alliance with
each system member.
2. The trainee can provide a succinct and accurate oral summary of couple or family in
therapy, including a formulation that is both theoretically informed and relates to the
specific processes in therapy with that couple or family.
3. In clinical care and supervision, the trainee demonstrates the ability to use the self as a
therapeutic tool, with full awareness of how the therapist uses his/her verbal and nonverbal communication, to support or modify couple or family stances as the treatment
proceeds.
COMMUNICATOR
1. The trainee establishes and maintains a therapeutic alliance with each member of the
therapeutic system including managing alliance ruptures with supervision.
2. The trainee allows the time required for the process of working-through and avoids
premature closure of therapeutic challenges with supervision.
3. The trainee is able to communicate to the couple/family an understanding of the issues
facing them and the therapist’s understanding their etiology.
4. The trainee maintains clinical notes that meet practice standards and capture the
Revised Nov 3, 2014
Page 6
ongoing therapeutic process, and can describe departmental and CPSO standards
5. The trainee can receive and give feedback in supervision
COLLABORATOR
By the end of the rotation the resident will be able to
1. Describe couple/family therapy to other health care professionals, including describing suitability of
patients, the therapeutic process and general principles of couple/family therapy.
MANAGER
1. The trainee balances competing clinical demands to ensure the provision of safe clinical care and
timely case supervision.
HEALTH ADVOCATE
1. The trainee is able to explore, in supervision, the desire to advocate on behalf of patients, appreciate
both therapist and patient factors leading to that desire, and appreciate the effect such behavior
might have on the therapy
SCHOLAR
1. The trainee can identify the evidence-based interventions available for couple and
family therapy.
2. The trainees demonstrate familiarity with the literature through application of evidence
and literature to case discussion and treatment planning in supervision.
PROFESSIONAL
1. The trainee displays openness to recognizing when the therapeutic relationship
becomes dysfunctional, when to refer the couple or family to another therapist, or for
the therapist to seek a consultation with a colleague.
2. The trainee can identify indications for the need for supervision or consultation postresidency.
3. The trainee uses supervision to reflect upon and refine his/her own therapeutic style
and is able to identify areas of strength and vulnerability in their therapeutic style
Revised Nov 3, 2014
Page 7
Couple and Family Therapy Appendices
Appendix 1 – The Three Levels of Family Therapy Training
Whitaker et al (1981) distinguish three levels of training:
1) Learning about family therapy;
2) Learning to do family therapy, and
3) Becoming a family therapist.
The first level involves acquiring some theoretical knowledge about the method. This is
achieved in the core training seminars.
The second involves residents performing Couple/Family Therapy as part of their training. The
trainee is expected to be able to:
• assess couple/family structure and dynamics,
• recognize couple/family processes which generate, use and promote individual or family
symptoms as defenses against anxiety.
• intervene in SOME couple/family crises.
• utilize consultation with an experienced couple/family therapist.
These objectives are achievable by giving Residents: a) theory seminars, b) the opportunity to
observe a clinician doing the therapy and c) supervision of the treatment of two or three
couples or families during one year.
The Psychotherapy Committee has stated that Residents can request protected time to attend
Couple/Family Therapy workshops or events.
For the third level (becoming a family therapist) a Psychiatrist would have to undertake a two
or three year immersion training program in the specialty. The time allotted for Couple and
Family therapy in our Psychiatric Residency precludes this.
Revised Nov 3, 2014
Page 8
Appendix 2 – Relevant References & Readings
Bertolino B, O’Hanlon B: Collaborative, Competency-Based Counseling and
Therapy. Toronto. Allyn and Bacon. 2002
Carr, A: Failures in family therapy: A catalogue of engagement mistakes.
Journal of Family Therapy 12:371-386, 1990.
Carter E, McGoldrick M: The family life cycle and family therapy: An overview. in
Carter EA, McGoldrick M (eds): The Family Life Cycle. A Framework for Family
Therapy. New York. Gardner Press Inc. 1980 p 3-20
Chagoya L, Chagoya C: Training eclectic family therapists. Unpublished
manuscript. McMaster University, 1983.
Cleghorn J, Levin S: Training family therapists by setting learning objectives. Am J
Orthopsychiat 43:439-446, 1973.
Constadine L: Family Paradigms: the Practice of Theory in Family Therapy. New
York-London. Guilford. 1986
Dattilio F M, Padesky C A: Cognitive Therapy with Couples.
Professional Resource Exchange, Inc. Sarasota FL. 1990
de Shazer S, Berg IK, Lipchik E, Nunnally E, Molnar A, Gingerich W, Weiner-Davis
M: Brief therapy: Focused solution development. Family Process 25: 207-222,
1986.
Dickerson V, Simmerman J: A narrative approach to families with
adolescents. In Friedman S (ed): The New Language of Change: Constructive
Collaboration in Psychotherapy. New York. Guilford. 1993.
Ehrlich FM: Psychoanalysis and couple therapy. Psych Times 15: #12, Dec 1998
Falloon IR II, Boyd JL, McGill GW, et al.: Family management training in the
community care of schizophrenia. in: Goldstein M (Ed) New Developments in
Revised Nov 12, 2014
Page 9
Interventions with Families of Schizophrenics. San Francisco CA: Jossey-Bass,
1981.
Fisch R, Weakland H, Segal L: The Tactics of Change: Doing Therapy Briefly. San
Francisco. Jossy-Bass. 1982
Freeman J, Combs G: Narrative Therapy: The Social Construction of Preferred
Realities. New York
WW Norton. 1996
Freeman J, Epston D, Lobovits D: Playful Approaches to Serious Problems:
Narrative Therapy with Children and their Families. New York. WW Norton.
1997
Frelick LF, Waring EM (Eds): Marital Therapy in Psychiatric Practice: An Overview.
New York. Brunner/Mazel Publishers. 1987
Friedlander ML, Escudero V, Heatherington L: Therapeutic Alliances in Couple
and Family Therapy. American Psychological Association. Washington, DC. 2006
Furman B, Ahola T: Solution Talk: Hosting Therapeutic Conversations. New
York. WW Norton. 1992
Gottman J: Why Marriages Succeed or Fail. New York-London-TorontoSydney-Tokyo- Singapore. Fireside Books. Simon & Schuster. 1994
Gottman J M: The Marriage Clinic. A Scientifically Based Marital Therapy. New
York-London W W Norton & Co. 1999
Gurman AS, (ed): Clinical Handbook of Couple Therapy. 4th. ed. New York-LondonThe Guilford Press. 2008
Heru A M, Keitner G L, Glick ID: Family Therapy: The Neglected Core
Competence. Academic Psychiatry 36: 6: pp 433-35, November 2012
Hoyt MF (ed): Constructive Therapies. New York. Guilford Press. 1996
Revised Nov 12, 2014
Page 10
Hubble MA, Miller SD, Duncan BI (eds): The Heart and Soul of Change: What
Works in Therapy, Washington DC: APA. 1999
Kadis LB, McClendon R: Concise Guide to Marital and Family Therapy.
American Psychiatric Publishing Inc. 1998
Miller W, Rollnick S: Motivational Interviewing: Preparing People for Change.
2nd ed New York Guilford Press. 2002
Minuchin S: Families and Family Therapy. Cambridge Mass. Harvard. 1978
Myers Avis J: Deepening awareness: A private guide to feminism and family
therapy. Journal of Psychotherapy and the Family 3(4): 15-46, 1988.
Myers Avis J: Where are all the family therapists? Abuse and violence within families
and family therapy's response. Journal of Marital and Family Therapy 18(3): 225-232,
1992.
Roth S, Epston D: Consulting the problem about the problematic relationship:
An exercise in experiencing a relationship with an externalized problem, in Hoyt
M (ed): Constructive Therapies New
York. Guilford. 1996.
Satir V: Conjoint Family Therapy. Palo Alto CA. Science and Behavioral Books. 1967.
Scharff DE, Scharff JS: Object Relations Family Therapy. Northvale, New JerseyLondon: Jason Aronson, Inc., 1987.
Scharff DE, Scharff JS: Object Relations Couple Therapy. Northvale, New JerseyLondon: Jason Aronson, Inc., 1991.
Schmidt Gl, Bonjean MJ: Family therapy education for psychiatric
residents. Academic Psychiatry 9: 74-80, 1995
Sexton TL, Weeks GR, Robbins MS (eds): Handbook of Family Therapy. New York
and Hove- Brunner-Routledge. 2003
Singer-Kaplan H: The Illustrated Manual of Sex Therapy. 2nd ed. New York:
Revised Nov 12, 2014
Page 11
Brunner/Mazel Publishers. 1987.
Sprenkle DH, Davis SD. Lebow JL: Common Factors in Couple and Family
Therapy. The Overlooked Foundation for Effective Practice. The Guilford Press.
New York-London. 2009
Tomm K: Interventive interviewing. Part I: Strategizing as a fourth guideline
for the therapist. Family Process 26:3-13, 1987
Tomm K: Interventive interviewing. Part II: Reflective questioning as a means
to enable self healing, Family Process 26: 167-184, 1987a
Tomm K_ Interventive interviewing. Part III: Intending to ask lineal, circular,
strategic or reflective questions? Family Process 27: 1-15,1988.
Watzlawick P, Beavin JH, Jackson DD: Pragmatics of Human Communication. A
Study of InteractionalPatterns, Pathologies and Paradoxes. New York. Norton.
1967
Webber T, McKever JE, McDaniel SJ: A beginner's guide to the problemoriented first family interview. Family Process 24: 357-364, 1985
Whitaker CA, Keith DV: Chapter 6: Symbolic-Experiential Family Therapy, in:
Gurman AS, Kniskem
DP (Eds): Handbook of Family Therapy. New York: Bruner/Mazel Publishers, 1981.
Zuk G: Family Therapy: A Triadic-Based Approach. New York: Behavioral Publications, Inc.,
1971.
Websites:
http://www.camh.net/about addiction mental health/couple therapy,
html http://www. articles.
flndarticles.com/p/articles/mi_mOAZV/is_2_41
http://www.psyc.leeds.ac.uk/research/lftrc/index.htm
Click on Manuals: SFT&TAP
Revised Nov 12, 2014
Page 12
This document was originally prepared by: Charlotte Chagoya, RN, Fam Ther,
Leopoldo Chagoya MD, FRCPC and Richard Sugarman MSW.
It was reviewed in 2014 by the first two, plus Jeffrey Genik, MD, FRCPC,
Kalam Sutandar MD, FRCPC and Toula Kourgiantakis, MSW, RSW, RMFT
Revised Nov 12, 2014
Page 13