See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/13297988 The Basic Skills Evaluation Device Article in Journal of Marital and Family Therapy · February 1999 DOI: 10.1111/j.1752-0606.1999.tb01107.x · Source: PubMed CITATIONS READS 20 363 2 authors: Thorana Nelson Lee N Johnson 59 PUBLICATIONS 508 CITATIONS 43 PUBLICATIONS 320 CITATIONS Utah State University SEE PROFILE Brigham Young University - Provo Main Cam… SEE PROFILE Some of the authors of this publication are also working on these related projects: Marriage and Family Therapy Practice Research Network View project All content following this page was uploaded by Lee N Johnson on 14 June 2014. The user has requested enhancement of the downloaded file. Journal of Marital and FamilyTherapy 1999,Vol. 25,NO.l,15-30 THE BASIC SKILLS EVALUATION DEVICE Thorana S. Nelson Utah State University Lee N. Johnson Friends University The Commission on Accreditation for Marriage and Family Therapy Education (COAMFirE) requires that accredited programs evaluate trainees’clinical skills at various times during trainees’ programs. The Commission does not attempt, howeve? to describe forprograms either the nature of the skills nor how they are to be evaluated, leaving this to the programs to create. %is paper describes the development and uses of the Basic Skills Evaluation Device (BSED). Using a published list ofskills (Figley &Nelson, 19891, data from the literature, and data collected from COM3TE accredited and candidacy programs, the authors and their colleagues developed a devicefor superuisors to use in evaluating beginning family therapists. Data regarding the reliability of the device arepresented, along with limitations and suggestions for various ways of using the device. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) of the American Association for Marriage and Family Therapy (AAMFT) sets standards for family therapy education. Currently, there are 108 accredited or candidacy status programs in the United States and Canada. Sxty-seven of these programs are master’s level and 18 are doctoral level; many of them include beginning-level family therapy students in their programs. In addition, 23 Post-degree Institute (PDI) programs target trainees who have had graduate education and prior non-MFT therapy or counseling training. These programs also must provide basic-level training in family therapy. As part of its standards, the COAMFTE requires that programs evaluate their students’ clinical skills frequently: prior to entering clinical training, during clinical training, and at the end of clinical training. However, the standards do not attempt to speclfy nor do they Portions of this paper were presented at the Annual Conference of the AAMFT in Atlanta, Georgia, September 1997, and the Annual Meeting of the American Family Therapy Academy in Montreal, Quebec, Canada, June 1998. Thorana S. Nelson, PhD, is the Director of the Marriage and Family Therapy Program and Associate Professor in the Department of Family and Human Development, Utah State University, Logan, Utah 84322-2905. Lee N. Johnson, PhD, is an Assistant Professor at Friends University, Foxridge Towers, Suite 1020, 5700 Broadmoor, Mission, KS 66202. The authors would like to thank the anonymous reviewers for their kind and constructive comments which helped enhance this paper. We also would like to thank Thane Palmer and Nancy Webb for participation on the BSED development team. Requests for reprints or for the BSED should be sent to the first author. January 1999 JOURXAL OF MARITAL AND F C I L Y THERAPY 15 define “clinical skills” for programs. Further, they do not suggest methods for clinical evaluation, leaving programs to devise content and methods that suit and fit their unique needs. A search of the literature does not reveal consensus on the skills needed in the early stages of MFT training. To date, no instruments or standardized methods have been devised for assessing clinical readiness or progress of family therapy trainees Several methods for evaluating therapist behaviors have been described in the literature. These include the Family Therapist Rating Scale (Piercy, Laird, & Mohammed, 1983), a scale that allows evaluation of therapists among several dimensions, including historical (freeing clients from generational attachments), structuraVprocess (of family dynamics), experiential (facilitating affective experiences for family members), structural (of the therapy session), and relationship (of client and therapist). Although this scale was carefully and scientifically developed, its items were not derived using an empirical process nor was it derived specifically for evaluating trainees. Similarly, other methods, including measures of empathy, regard, and congruence (Barrett-Leonard, 1962) and cognition, range of interventions, and so forth (Tucker & Pinsof, 1984), were developed using the researchers’ best estimates of important skills based on literature reviews and clinicaVsupervisory experience. Neither of these instruments was empirically derived or developed specifically for family therapy training evaluation. The Basic Skills Evaluation Device (BSED) was devised to address the need in training for a standardized instrument using empirically derived skills to assess and measure family therapy trainee skills and progress. This device, described below, was developed using data from the Basic Family Therapy Skills (BFTS) project (Figley & Nelson, 1989, 1990; Nelson & Figley, 1990; Nelson, Heilbrun, & Figley, 1993), additional literature review, and data from surveyed MFT training programs. The remainder of this article describes the development, testing, and potential uses of the BSED. BFIS Project The BFTS project was initiated in 1987 to gather and analyze data from experienced and expert family therapy supervisors and trainers/educators regarding their opinions and beliefs about essential skills for beginning family therapy trainees. Using a modified Delphi research method (Linstone & Turoff, 19751, an expert panel of 488 members, invited from the existing membership list of the American Family Therapy Academy (a group of senior family therapy educators, researchers, and clinicians) as well as the Approved Supervisor list of AAMFT, participated in the project. This expert panel nominated generic (model-‘‘free,’’necessary regardless of theoretical orientation) as well as model-specific skills that they judged essential for beginning family therapists. Beginning family therapists were defined for the panel as trainees with fewer than 500 hours of supervised clinical experience in family therapy. Thousands of generic skills were nominated. After the number of items was reduced to eliminate redundancy, the resulting list was sorted into conceptual dimensions to provide context. The expert panel was then asked in a second phase of the research to rate the items in terms of their importance for beginning family therapists. The results of this phase were used to rank-order the skills in term of those deemed most important. This empirically derived list of 101 items was published (Figley & Nelson, 1989) and has been used by family therapy training programs in many ways: screening candidates, determining which skills are most important to teach, and evaluating trainees’ progress in skill development. 16 JOURNAL OF MARITAL AND FMILY THERAPY January 1999 BSED Development The first author and several second-year graduate students in Utah State University’s MFT master’s program formed a team with the purpose of developing an instrument that could be used to evaluate beginning MFT students’ progress toward clinical skill. This group, hereafter called the BSED team, surveyed accredited and candidacy programs regarding their preferred methods for evaluating students’ progress in developing family therapy skills. The BSED team then gathered data from three sources: the EFTS top 101 skills (Figley & Nelson, 19891, skill items from additional literature review, and both content and format information from the surveyed programs. In addition, the BSED team members who were students were in a position to add their own valuable and unique perspectives to the project. Each member of the BSED team independently developed evaluation instruments that expressed essential elements from each source. BSED team members combined data from these sources into dimensions, thinking as much as possible in terms of observable skills that could be evaluated with a paper-and-pencil device. After conferring as a group and comparing results, the team decided to use common dimensions of therapist skill (Conceptual, Perceptual, and Executive skills) plus two dimensions that emerged from analyses of the collective data: Professional and Evaluative skills. The team also agreed upon a basic format for the device. The next step for the BSED team was to combine items from each team member’s individual efforts within each dimension to reduce the number of skill items. The process had been fairly exhaustive in combining information from the BFTS project, the literature, and the surveyed programs and yielded many duplicate items, some word for word and others that were very similar in meaning (e.g., “joining”and “getting to know clients”). BSED team members again worked independently and then together to determine the essence and meaning of items in each dimension. Team members also changed the format of the device as each thought appropriate. The team met and consensually determined the number and wording of items to include in each dimension of the instrument as well as its format. This process resulted in an instrument comprising five dimensions, each containing two to seven items: Conceptual Skills (four items), Perceptual Skills (three items), Executive Skills (seven items), Professional Skills (five items), and Evaluative Skills (two items). On the basis of feedback from the surveyed programs, the team also added an optional dimension of Theory Specific Skills (three items) (see Appendix for entire instrument). The resulting instrument was piloted on five experienced AAMFT Approved supervisors for content and format, and minor revisions were made to the device’s format. In order to capture and explain the depth of meaning associated with each item and to enhance consistency in the use of the device, each dimension and item is defined. These definitions clearly describe each item in terms of its original EFTS components, the literature review, and results of the program surveys. (See Appendix). Such definitions allow the evaluator to use the empirically derived definitions from the BFTS project and other sources, assist the evaluator in reducing ambiguity, and use as much as possible, behavioral and consistent referents for all students. Each item is formatted for evaluation on a five-point Likert-type scale with an option for “inadequate information.”Evaluators are given specific guidelines for using the device. Uniquely for such devices, these guidelines include evaluating each student in comparison to peers of similar experience (Beginning: first 5&75 hours of clinical experience; January 1999 JOURNAL OF MARITALAND FAMILY THERAPY 17 Intermediate: between 50-75 hours and 3 5 M O O hours; and Advanced: 350-400 to 500 hours). This process allows newer students to be rated in the “meets expectations” and above ranges rather than at the lower end of the scale, increasing self-esteem and reducing negative evaluations of students and trainees while retaining an honest and informative evaluation. The ratings and their attached comments assist supervisors in determining areas that need work as well as areas in which students are making good progress. Validityand Reliability Content validity for the device was established through its construction using MFT training experts in all phases: nomination and rating of items in the BFTS project and from the MFT training literature, family therapy program input regarding evaluation content and procedures, and expert review during piloting and testing of the device. We established reliability of the items themselves during the early phases of the BFTS project by comparing and contrasting nominated items until redundancy suggested that we had exhausted the data from multiple sources and had captured the essence of the information. In later phases of the BFTS project, items were further reviewed by the BFTS researchers and differences were resolved by consensus. Similarly, during the BSED construction, the BSED team members worked both independently and together in several meetings until redundancy again suggested saturation and consensual agreement on the dimensions, on the items to include in each dimension, on the working definitions of items, and the on the device’s format. Results of tests for internal consistency reliability are described below. Internal Consistency Sample. Requests for participation were sent to all programs listed by the COAMFTE as accredited or in candidacy status with the Commission in 1996. We were not interested in generalizing scores from the instrument to a population of students or supervisors but were interested in testing the psychometric properties and usefulness of the instrument. Therefore, we were interested in obtaining a sufficient amount of data from an adequate sample of appropriate programs in order to conduct the reliability tests. Because all of the programs had passed minimum standard5 for accreditation and were therefore somewhat similar in terms of training content and supervisory experiences, we believed that a volunteer sample, although potentially biased, would suit our purposes. Indeed, one might consider this an expert or qualified participant sample. We sent requests to 73 programs: 10 doctoral, 43 master’s, 17 postdegree institute (PDI) programs, two combined MS/PhD programs, and one combined MS/PDI program. All programs were accredited by or in candidacy status with the COAMFTE. A cover letter explained the purpose and scope of the request, described the development and nature of the BSED, and informed the directors that participating programs were being asked to evaluate trainees using the Basic Skills Evaluation Device. A total of 19 programs, or 26% of polled programs, agreed to participate in the reliability evaluation. Twenty-nine supervisors from 12 of the 19 programs (74%: 11 MS, two PDI, one MS/PDI) returned completed evaluation instruments on 74 trainees. Supervisors indicated that 23 of the trainees were beginners (31% of the sample), 30 were intermediate (40.5% 18 JOURNAL OF MARITAL AND FAMILY THERAPY January 1999 of the sample), and 21 were advanced (28% of the sample). The mode number of supervisors per program was two, and the mode number of trainees per supervisor also was two. All supervisors were AAMFT Approved or the equivalent as indicated by the programs. Other data on supervisors or trainees, such as age or gender, were not requested. Method. Respondents were asked to use the BSED to evaluate their family therapy trainees. We asked each supervisor to complete evaluations for more than one trainee if possible. Respondents also were asked to carefully read the guidelines before evaluating trainees. Finally, respondents were asked to use the device for their own benefit but to return it to us with supervisor and trainee names removed. Results. Review of the frequencies of responses for each item revealed that respondents judged their trainees mostly as “meets expectations” and “exceeds expectations.” On only three separate items were trainees judged “deficient.”Ten items were judged with ten or more responses as “exceptional”:“Joining”and “Personal Skills” in the Executive Skills dimension and “Supervision,” “Recognition of Ethical Issues,” “ProfessionalImage,”and “ProfessionalConduct” in the Professional Skills dimension. The item with the most judgments of “inadequate information” (six responses) was “Paperwork in the Professional Skills dimension. “Evaluation of Therapy” and “Recognitionof Ethical Issues” in the Evaluation and Professional Skills dimensions each received four responses of “inadequate information.’’ Cronbach’s alpha was computed as a reliability coefficient to determine the internal consistency of the device. For the overall instrument, a was .97 (N of cases = 48; N of items = 24). Because the theory-specific items were not used by all surveyed programs, these items were removed and a was recomputed with a result of .96 (N of cases = 60; N of items = 21). Likewise, each of the dimensions separately demonstrated very good internal consistency (Conceptual Skills a = .85, N = 72; Perceptual Skills a = .85, N = 73; Executive Skills a = .93, N = 72; Professional Skills a = 85, N = 64; Evaluative Skills a = .82, N = 69; Theory-specific Skills a = .88, N = 59). These results suggest that the instrument demonstrates high internal consistency and reliability. Respondents’ comments to trainees were generally positive, and concerns were framed in constructive language (e.g., “needs to pay more attention to client feedback,” rather than “ignores client feedback”). Because no instructions were given on the use of the comments sections of the BSED, data were not analyzed. Several respondents provided feedback to the researchers, all suggesting that they found the instrument comprehensive and useful, for example, “Good work,” “May we use this instrument; we have found it valuable to us,” and “Very thorough and useful.” Summay and Discussion The process of developing the BSED has resulted in an instrument that can be used by supervisors of beginning family therapists to evaluate trainees at various stages of their training. The device is composed of five core dimensions, plus one optional dimension, that were gleaned through a multiphase process using skill items determined through (a) the BFTS project (Figley & Nelson, 1989), which used a modified Delphi method to survey several hundred experienced family therapy supervisors and educators; (b) extant January 1999 JOURNAL OF MARITAL AND FAMILY THERAPY 19 literature on MFT skills; and (c) data from surveyed MFT training programs. The five core dimensions include Conceptual, Perceptual, and Executive skills, common in the literature, and Professional and Evaluative skills, developed from the data sources. Because many programs use particular theoretical orientations or help trainees focus on particular orientations at different points during training, an optional dimension of Theory Specific skills also was added. Skill items for each dimension of the device are described in detail in the instrument, assisting evaluators in being as precise as possible in terms of meaning for each item within the categories. The device also suggests using the dimensions’ scoring options within various experience levels so that trainees are compared with others with similar levels of experience rather than trainees with more or less experience. The BSED is currently being used in several COAMFTE accredited and candidacy programs for candidate screening, evaluation of clinical readiness, and evaluation of trainees’ progress. The device also is being used for other purposes and in other ways. For example, keeping signed copies of the instrument in students’ files facilitates the writing of letters of recommendation that may be requested after the students graduate. Unfortunately, students sometimes need to be counseled out of or dismissed from programs. Filed copies of the BSED, along with copies of suggestions or contracts for improvement, may provide data to determine the need for such procedures and to document them. Variations of content. Recently, a graduate student of the first author (Nancy Webb) conducted a survey of accredited and candidacy program students in a fashion similar to that of the original BFTS project. That is, students were asked to nominate the skills that they believed were most important to their development of readiness to do family therapy. Pertinent to this discussion the results suggest that students need to learn skills in the areas of gender, culture, and diagnosis (manuscript forthcoming). These areas were just becoming prominent in the conceptualizations of requisite Family therapy training in 1987 (compared to 1997) but had not made their way into general training vocabulary and practice (the COAMFTE added gender and culture to its standard requirements in late 1980s; diagnosis is not yet a required component of training programs although it is becoming more and more standard in program curricula). The BSED includes issues related to culture and gender in a “mainstreaming”way; that is, several of the existing items include references to these as important within dimensions. For example, the Knowledge Base dimension contains several references to these areas (see Appendix). However, programs that use the device might wish to add specific items in order to highlight their importance as either separate items or dimensions or in the comments sections. Other skill areas that are believed essential in programs (for example, “attends to issues of alcohol or substance use”) could be added as well. However, the named areas and items are the only ones derived from empirical data. Variations of process. Several programs use the instrument in self-reflexive ways. That is, students are asked to complete the instrument themselves. These responses along with the supervisor-completed instrument are used to help determine students’ awareness of their own behavior and self-evaluative processes. Many students are better therapists than they think they are and some are not as skilled as they would like to believe; this comparative process can assist supervisors and trainees in evaluating and addressing such issues. 20 JOURNAL OF MARITAL AND FMILY THERAPY January 1999 The guidelines for using the BSED call for evaluating trainees against expectations for trainees with similar experience, resulting, over time, in profiles that are very similar. That is, trainees do not progress from a rating of “4”to one of “5” as they gain skills. This process does not allow supervisors or researchers to examine changes that trainees make in training programs nor does it produce the variance needed to use the device in therapy outcome studies related to therapist skill. By adjusting the anchors for the scale from “compared to peers with similar levels of experience” to a Likert scale ranging from “no demonstrated skill” to “skill level of a program graduate” or “skill level of a very experienced clinician,”programs could evaluate trainees in reasonably positive ways and also measure the success of their programs in facilitating skill development. The authors request that persons wishing to use the instrument in this fashion or otherwise modify it contact the first author. The device also was developed using data requested regarding beginning family therapy trainees (those with less than 500 hours). At this time, the device has not been tested with trainees with more than 500 hours of experience or with more experienced family therapists. It is possible that the device could be used to rate therapist behavior in a single session, across sessions, or across cases to evaluate overall performance. Limitations and Potential Hazards As in much research and instrument development, what some consider limitations may be considered strengths by others. In many respects, the BSED is inadequate. The items are not clearly and behaviorally or quantitatively defined. Such definitions would allow more precise evaluation of therapists’ skill/behavior as well as allow us to compare behaviors across clients related to outcomes. Although the flexibility afforded by the current BSED format allows programs and supervisors to use their own breadth and depth and uniqueness, its imprecision could lead to inappropriate comparisons. For example, student A could be generally evaluated as “exceptional”by supervisor B using supervision theoretical orientation Q. The same student evaluated by supervisor C on the same instrument using theoretical orientation Z could fail to measure up. In addition to being demoralizing for the student, the data could be used in inappropriate political ways to the detriment of students’standing in their programs. On the other hand, believing in the value of multiple perspectives, the data could be used to enhance the theoretical bent and clinical orientation of the student in terms of his or her unique qualities and talents. Further study is needed to determine the instrument’s value in evaluating students across time, across supervisors, and across programs. The instrument’susefulness in correlation with therapy outcome has in no way been evaluated. Users of the device should be cautious in their claims about the effectiveness of trainees in terms of positive outcomes and should limit the instrument’suse to evaluation of therapist skill with these limitations. Finally, it is made explicit that the device has not been validated concurrent with other evaluation instruments. Its content validity was established by the use of expert judgment in several phases of its development and by the fact that the BFTS and BSED researchers found much duplication across samples of experts as well as the literature. However, it also should be noted that the expert samples had their own unknown biases. It will be useful, in the future, to compare the instrument with other devices and methods for evaluating therapists’ behavior. January 1999 JOURNAL OF MARITAL AND F M I L Y THERAPY 21 CONCLUSION The BSED, used as suggested in this article, is an instrument that potentially standardizes procedures for evaluating family therapy trainees. Used consistently within programs, the device administered across time for individual trainees can produce pictures of trainee strengths and areas needing improvement according to supervisors’ judgments. Trainees and supervisors can then negotiate new training contracts. Similarly, programs that use the instrument will have data to pass along to trainees’ other supervisors, providing a common “baton-passing” procedure to enhance consistency and continuity in students’ training. Used across students for individual supervisors or within programs, the profiles can be used to suggest areas that programs need to enhance in order for their students to progress in skill development. One workshop attendee stated that he was going to use the device to evaluate the content and procedures of the courses and practica in his program. Although the authors do not suggest that family therapy training should become so standardized that we produce cookie-cutter therapists, a device such as the BSED that standardizes evaluation content and procedures but also allows flexibility for programs’ uniqueness moves us along in the quest for understanding similarities and differences between programs and in legitimizing our training practices. These descriptions could be useful to prospective students as they search for programs that will meet their needs. Finally, the BSED holds promise as a research instrument both in training and in family therapy process investigations. Tracking student progress across different practica and course experiences could yield information about patterns of learning that could then be used to enhance the timing of different aspects of clinical skill training. Similarly, comparing skill in certain areas or with certain items against intervention or therapy outcomes could tell us a great deal about which areas of therapy are most useful in meeting particular therapeutic goals. Although these uses of the BSED have not been tested, the authors hope that the development of the BSED will enhance these research efforts. REERENCES Barren-Leonard, G. (1962). Dimensions of therapist responses as causal factors in therapeutic changes. Psychological Monographs, 76(43), whole No. 562. Figley, C. R., & Nelson, T. S. (1989). Basic family therapy skills, I: Conceptualization and initial findings.Journal of Marital and Family nerapy, 15, 349-365. Figley, C . R., & Nelson, T. S. (1990). Basic family therapy skills, 11: Structural family therapy. Journal ofMarital and Family Therapy, 16, 225-239. Linstone, H., & Turoff, M. (Eds.). (1975). The Delphi method: Techniques and applicution. Reading, MA: Addison-Wesley. Nelson, T. S., & Figley, C. R. (1990). Basic family therapy skills, 111: Brief and strategic schools of family therapy.Journal of Family Psychotherapy, 4, 49-62. Nelson, T. S., Heilbrun, G., & Figley, C. R. (1993). Basic skills in family therapy, IV: Transgenerationdl theories of family therapy.Journal of Marital and Family 7herapy, 19, 253-266. Piercy, E , Laird, R., & Mohammed, Z. (1983). A family therapist rating scale.Journa1ofMarital and Family Therapy, 9, 45-59. Tucker, S., & Pinsof, W. (1984). The empirical evaluation of family therapy training. Family Process, 23, 437456. 22 JOURNAL OF MARITAL AND F M I L Y THERAPY January 1999 APPENDIX BASIC SKILLS EVALUATION DEVICE The Basic Skills Evaluation Device was developed from data gathered to determine the basic skills for family therapy that are essential for beginning level trainees. After evaluating the data, the device was developed and tested on beginning trainees who were new to family therapy in COAMFTE accredited or candidacy master’s or doctoral programs or students in PDI programs who had not developed family therapy skills. The device has not been tested on more advanced trainees or on experienced therapists. The author believes, however, that the device may have utility for these populations and encourages experimenting. The author is in the beginning stages of this next phase of instrument testing. The Basic Family Therapy Skills Evaluation Device (BSED) was developed using empirical data from the Basic Family Therapy Skills Project, conducted by Charles Figley and Thorana Nelson. The items and descriptions were developed from information gathered from nearly 500 experienced marriage and family therapy trainers and supervisors. The device serves several purposes, including that of evaluating therapist trainees in their first 500 hours of training. The scale is used at the experience level oftbe trainee. That is, “meets expectation” means “in your experience, compared with other trainees with this level of experience and training,” which may differ from supervisor to supervisor. Included are descriptions for each training dimension based on data from the Basic Family Therapy Skills Project. Please use these descriptions when evaluating your trainees. Included in the devise is a nongeneric theory section that you may want to use, filling in the blank for the theory that the trainee is currently working with. Evaluate each trainee using your best judgment from the descriptions given plus your subjective ideas about each item. GENERAL GUIDELINES REGARDING DEVELOPMENTAL LEVELS Beginner: First 50-75 hours of experience, less, perhaps, if under intensive live supervision. The beginner will need more direction and structure, clearer session plans, and more freedom to go in a direction that may seem less productive but which follows the trainee’s plan for the session and the supervisor’s plan for what the trainee is currently working on. For example, the supervisor may see an opportunity for a paradoxical or solution-oriented approach, but the trainee may be working o n structuring the session with parents and children. The trainee can discuss case material based on one theoretical perspective, but may get confused if trying to use more than one. The trainee is eager for supervision and may feel confused or anxious in new situations. Intermediate: Between 50 or 75 hours of experience and 350 or 400 hours. The trainee is comfortable joining with clients, can structure sessions and execute session plans, and is able to provide hypotheses or direction for therapy based o n theoretical concepts. The trainee can be flexible during a session, changing the session plan easily and with little confusion. The trainee can discuss cases from multiple theoretical viewpoints and evaluate both treatment and self-astherapist progress based on clear goals. The trainee may be uneven in evaluations of therapy and self. The trainee benefits from supervision, but may appear at times to not want supervision, wanting, instead, to be allowed to work on one’s own unless asking for help. Advanced: Between 350 or 400 hours of experience and 500 hours. The trainee is January 1999 JOURNAL OF MARITAL AND FmILY THERAPY 23 comfortable and does well in most therapy situations, managing most case situations smoothly and professionally. Supervision focuses on microskills and finer, abstract points of therapy and theory. The supervisor and trainee may engage in debate regarding theoretical perspectives and interventions. The trainee is able to evaluate both therapy and self. The trainee may appear eager for supervision and may express concern that he or she is inadequate as a therapist, unable to evaluate progress in therapy or supervision. CONCEPTUAL SKILLS Knowledge Base The trainee has a basic understanding of family systems theory. The trainee is able to articulate principles of human developmental, family developmental, and family life cycle issues pertaining to the case. The trainee communicates an understanding of human interaction and normal family processes. The trainee can articulate how gender, culture, and class have an impact on the client and on therapeutic issues (including interaction with one’s own gender, culture/ethnicity, and class). The trainee is able to determine and work within the clients’ worldview. The trainee has an understanding of human sexuality. The trainee has a knowledge of assessment strategies (e.g., interviewing skills, various assessment devices, DSM IV). Systems Perspective The trainee understands and can articulate basic systems concepts. When talking about client problems the trainee employs systemic concepts and perspectives, thus showing that he or she is thinking in systemic and contextual terms. Formed hypothesis are systemic. The trainee can articulate the difference between content issues and process issues. The trainee can recognize hierarchy problems. Familiarity with 7berapy Models The trainee has a basic knowledge of family therapy theories. The trainee’s goals, hypotheses, session plans, interventions, and evaluation strategies for terminating therapy are all linked to a specific employed and articulated therapeutic model (which may be an integrated model). The trainee also recognizes his or her own perceptions, client resources, and links between problems and attempted solutions. Selfas Therapist The trainee can articulate his or her own preferred model of therapy. The trainee is also aware of how his or her communication style impacts therapy and is curious in learning about himself or herself. The trainee is aware of and able to manage his or her own anxiety in therapy. In talking about cases the trainee is able to reframe or positively connote issues from cases for herself or himself. The trainee has an understanding of how to use a sense of humor in therapy. The trainee recognizes her or his ability to be flexible and curious and to think critically and analytically, expressing authenticity and accepting feedback. The trainee is able to recognize how her or his own developmental or other issues interact in therapy. PERCEPTUAL SKILLS Recognition Skills The trainee shows the ability to recognize hierarchies, boundaries, dynamics of triangling, family interaction, and family behavioral patterns. The trainee can also recognize gender, ethnic, cultural, and class issues in client dynamics and in therapy. 24 JOURNAL OF MARITAL AND FAMILY THERAPY January 1999 The trainee is able to recognize clients' coping skills and strengths and can understand dynamics and patterns in presenting problems. The trainee recognizes how patterns associated with presenting problems may be similar to other patterns of interaction in clients' lives. The trainee recognizes and can articulate her or his impact as part of the client/therapy system. Hypothesizing The trainee can formulate a systemic hypothesis and can generate general hypotheses as well as theory (or model) specific hypotheses. The trainee can formulate long- and short-term treatment plans based on hypotheses. The trainee is able to distinguish process from content at an appropriate level and include process issues in hypotheses. The trainee reframes patterns and problems appropriately. Integration of i%eo y and Practice The family therapy trainee is able to articulate theory as it is applied in practice, utilizing concepts appropriately, and describing interventions that fit with the theory and hypotheses. If using an integrated theory, the trainee is able to differentiate concepts and provide rationale for choices of hypotheses and/or interventions. The trainee is able to evaluate the appropriateness (positives and negatives) for a theory or integrated theory using concrete data from therapy cases. EXECUTIVE SKILLS Joining A trainee skilled in the technique of joining is able to engage each family member in a therapeutic alliance and relationship by establishing rapport through clear communication that conveys a sense of competency, authority, and trustworthiness while at the same time demonstrating empathy, warmth, caring, and respect. The trainee is capable of gathering information without making the client feel interrogated, laying down the ground rules for therapy, and setting up a workable treatment contract by exploring the client's expectations, point of view, and preparedness to make changes. These goals are accomplished in conjunction with setting appropriate boundaries and avoiding triangulation. Assessment The family therapy trainee demonstrates the ability to assess clients through use of genograms, family histories, suicide/depression interviews or inventories, and discussion of SES, employment, school, and developmental stages. The trainee is familiar and skilled in basic interviewing techniques and strategies. Assessment is formulated and appropriate to an articulated theory of change. The trainee is able to clarify the presenting problem, explore previous solutions to the problem, gather information regarding sequences and patterns in the family, and determine the strengths and resources that the family brings to therapy. Assessment strategies are sensitive to gender, race, and cultural issues. Hypothesizing The trainee exhibits the ability to formulate multiple hypotheses about a case based on articulated principles of a theory of change. She or he can develop treatment plans which include a rationale for intervention based on hypotheses; set clear, reachable goals in consultation with the family; focus the treatment toward a therapeutic goal; and modify the existing case plan when appropriate. January 1999 JOURNAL OF MARITAL AND F M I L Y THERAPY 25 Interventions The trainee demonstrates an understanding of intervention techniques by structuring interventions that defuse violent or chaotic situations, deflect scapegoating and blaming, and interrupt negative patterns and destructive communication cycles. The ability to intervene also includes appropriately challenging clients o n their position, explicitly structuring or directing interactions among family members, and helping families establish boundaries. The trainee is able to elicit family/client strengths and utilize them in both session discussions and homework assignments. Other interventions that illustrate skill include normalizing the problem when appropriate, helping clients develop their own solutions to problems, giving credit for positive changes, reframing, and appropriately using self-disclosure. The trainee uses theory-specific interventions appropriately and is able to articulate a rationale for these interventions. Communication Skills Communication skills are demonstrated by active listening and reflecting; the use of openended questions; and short, specific, and clear oral forms of communication. The trainee’s body language should convey a relaxed state and match the tone of the conversation. The trainee is also able to coach clients in learning communication skills rather than merely “lecturing” and instructing. Personal Skills Personal skills that are important for a successful therapy trainee to possess include a desire to be a family therapist, intelligence, curiosity, common sense, self-direction, commitment, patience, empathy, sensitivity, flexibility, the ability to manage his or her anxiety, authenticity, expression of a caring attitude, and acceptance of others. The trainee should also exhibit warmth, a sense of humor, a nondefensive attitude, congruency, the ability to take responsibility for his or her mistakes, the ability to apply his or her own personal mode of therapy, and possess n o debilitating personal pathology. The trainee demonstrates emotional maturity and the ability to be self-reflexive. The trainee demonstrates an appropriate attitude of expertness toward clients, congruent with her or his theory of change. Session Management The trainee is able to manage the therapy process by effectively introducing clients to the therapy room, explaining equipment and setting, if necessary, and explaining the policies and procedures of the agency/clinic. The trainee is able to engage the family in therapeutic conversation, controlling the flow of communication as per her or his therapy plan. The trainee is able to manage intense interactions appropriately, demonstrating skill at both escalating and deescalating intensity at appropriate times. The trainee is able to manage time, finishing sessions as scheduled, and is able to schedule further appointments, consultations, and referrals smoothly and effectively. The trainee is able to collect fees in an appropriate manner. PROFESSIONAL SKILLS Supemision The trainee attends supervision meetings as scheduled and is prepared to discuss cases with colleagues, to formally present her or his own case, and to present audio or video material as requested. The trainee is respectful and positive about other trainees’ cases and presentations, 26 JOURNAL OF MARITAL AND FAMILY THERAPY January 1999 and is helpful and not demeaning about a fellow trainee’s skills. The trainee makes use of supervision by accepting and utilizing supervisory feedback. Recognition of Ethical Issues A marriage and family therapy trainee knows and observes the code of ethics of AAMFT and is familiar with the laws of the state regarding privileged communication, mandatory reporting, and duty-to-warn issues. The trainee follows the supenTisor’s policies regarding reporting and consulting with the supervisor and/or other authorities; the trainee appropriately uses supervision and consultation regarding ethical issues. The trainee avoids potentially exploitative relationships with clients and other trainees. The trainee deals appropriately with his or her own issues as they affect therapy and is willing to take responsibility for her or his own actions. Papemork The trainee maintains case files appropriately and follows clinic procedures for paperwork in a timely manner. Professional Image The trainee dresses appropriately according to the standards of the setting. The trainee is able to present an aura of confidence without arrogance and presents herself or himself to other professionals in an appropriate manner. The trainee is on time for sessions and supervision and treats staff with respect. Prqfessional Conduct The trainee has the ability to initiate and maintain appropriate contact with other professionals along with maintaining a personal professional image. The trainee does not publicly denigrate or criticize colleagues. The trainee consults with professionals and others involved with cases appropriately, with appropriate signed releases, and in a professional manner, always keeping the client’s welfare foremost. The trainee shows the ability to handle unexpected and crisis situations with poise and skill, using consultation when appropriate. The trainee is punctual with therapy sessions and other professional meetings. The trainee follows clinic policies in setting and collecting fees. EVALUATION SKILLS nerupy A trainee skilled in evaluating therapy is able to verbalize the thoroughness of assessment; the link between theory, assessment, and hypothesedinterventions; the effectiveness of interventions; and how well the objectives of the therapy have been met in terms of both the clients’ goals and the therapist’s perspective and analysis. The trainee can articulate aspects of the clients’ feedback in relation to assessment and intervention. The trainee is able to articulate links between conceptual, perceptual, interventive, and outcome data. Self The trainee therapist is skilled in evaluating himself or herself in terms of skills: conceptual, perceptual, executive, professional, and evaluative. The trainee is able to recognize signs in himself or herself that contribute to the ongoing understanding and analysis of the case and is able to articulate personal issues that may be interacting in therapy. The trainee is not unduly January 1999 JOURNAL OF MARITAL AND FAMILY THERAPY 27 defensive about feedback, but is able to integrate multiple perspectives and incorporate them into a plan for enhancing his or her development as a family therapist. The trainees works with the supervisor in an ongoing evaluation of therapy skills and strives to improve areas that require it and, at the same time, clearly articulate strengths in behavioral terms. B e oy of Choice The previous skill areas were generic; i.e., they apply across theoretical models of intervention. This section is for the trainee therapist and supervisor to use to evaluate the trainee’s growing knowledge and expertise in a model or theory that is identified by the supervisor and trainee together. The trainee is able to identify assumptions and concepts of the theory, the primary techniques used in the theory, the role of the therapist, and evaluation strategies. The trainee is able to use the concepts and interventions in practice, identifying data to the supervisor that illustrate the concepts. The trainee is able to recognize and identify the strengths and weaknesses of the theory as used in practice. 28 JOURhHL OF MARITAL AND F M I L Y THERAPY January 1999 BASIC SKILLS EVALUATION DEVICE' Therapist Date Supervisor Experience Level Conceptual Skills Inadequate Below Meets Exceeds Exceptional Information Deficient Expectation Expectation Expectation Skills 1. Knowledge Base 2. Systems Perspective 3. Familiarity with Therapy Model 4. Self as Therapist Comments: Perceptual Skills Inadequate Below Meets Exceeds Exceptional Information Deficient Expectation Expectation Expectation Skills 1. Recognition Skills 2. Hypothesizing 3. Integration of theory practice Executive Skills Inadequate Below Meets Information Deficient Expectation Expectation 1. Joining 2. Assessment 3. Hypothesizing 4. Interventions 5. Communication Skills 6. Personal Skills 7. Session Management I I I I I I I I I I I Comments: January 1999 JOURNAL OF MARITAL AND FAMILY THERAPY 29 Professional Skills Exceeds Exceptional Meets Expectation Expectation Skills Inadequate 1. Supervision 2. Recognition of Ethical Issues I 3. Paperwork I I 4. Professional Image 5. Professional Conduct Comments: Evaluation Skills Below Meets Inadequate Information Deficient Expectation Expectation Exceeds Exceptional Expectation Skills 1. Evaluation of Therapy 2. Evaluation of Self (Use Preferred Model) Recognizes Strengths and Weakness of Theory Comments: OThorana S. Nelson, PhD 30 View publication stats JOURNAL OF MARITAL AND F M I L Y THERAPY January 1999