New Collaborative and Feedback-Informed Family Therapy Approach

Attempts to bridge the gap between research and practice result in a family therapy approach which employs clients as co-researchers

Zenobia Morrill
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A recent article, published in the Journal of Family Therapy, covers the development of a family therapy approach centered around honoring accountability and transparency in psychotherapy. The process involves clients as co-researchers to promote improvisation, collaboration, and feedback in line with personal, constructivist, and systemic approaches.

“We do not want to generalize knowledge and establish a uniform approach. We rather constitute a ‘learning community’ and learn how therapist and family members learn together.”

Photo Credit: “Family Dynamics,” Flickr

Researchers Robert van Hennik and Bruno Hillewaere from the Netherlands found, in their practices as systemic therapists, that they were unable to exclusively commit to a singular mode or manual of practice. Instead, they developed a fluid manual they call Feedback Informed Integrative Therapy within Systems (FITS).

“With FITS we seek to balance structure with spontaneity in a way that allows the methodical exploration of uncertain processes and outcomes.”

Manualized treatments and standardized therapies are encouraged by healthcare policies emphasizing control, systematized measurement, and accountability over the process of change in psychotherapy. Beneath this push lies the notion that psychotherapy is legitimized through accountability, although this seems to have given rise to approaches that compromise the very elements that make psychotherapy effective, the authors argue. For one, the drive to control and standardize therapy fails to address the benefits of incorporating multiple theories flexibly and dynamically to appropriately customize care. Systematizing interventions also risks undervaluing the quality of the relationship formed between the practitioner and the client, the very factor established to be most facilitative of positive therapy outcomes.

Additionally, these rigid structures overlook the spontaneity and improvisation that naturally occur in effective therapy practice, and their emphasis collides with systemic perspectives which address how individuals and therapy relationships occur in complex, non-linear systems.

As they looked into creating FITS, van Hennik and Hillewaere posed the following question: “Could accountability be offered with a focus on relational ethics rather than control?”

In concert with their response to this, they write that with FITS, “Accountability will be offered by using a fluid manual, multi-methods research, and collaborative inquiry. The outcomes of research are the inputs for collaborative learning in the system that the therapist and family members co-create together.”

The FITS approach focuses on what researchers call Practice Based Evidence Based Practice (PBEBP). PBEBP works as an expansion of “evidence based practice,” to emphasize that research and practice inform one another in ways that can be integrative and fluid.

The FITS manual builds off of this emphasis on fluidity and challenges traditional manualized therapies through the inclusion of personal, systemic, and constructionist values. It acknowledges the value in improvisation and spontaneity:

“The FITS therapist improvises and invites family members to improvise in moments where they, previously, got stuck in repetitive patterns and fixations. We escape from these patterns and fixations if we co-create a ‘zone for unforeseen connections’ and allow for some randomness and disorder in our interactions.”

In psychotherapy, feedback is often spoken about through individualistic terms (i.e. how the individual might share their experience of the therapist with the therapist). The FITS approach seeks to expand upon these previous models to incorporate the systemic, co-created environment that constitutes a family structure, and the dynamic within family therapy.

Collaborative feedback, featuring the inclusion of family members as co-researchers, is critical to the FITS process. How the therapist and the family members learn from feedback is carefully considered through multiple epistemological frameworks that honor the nuanced subjectivity constituting each person’s experience throughout the therapy process.

Finally, both quantitative and qualitative data inform the process. Quantitative therapy outcomes serve as conversational tools within sessions, and qualitative research is used to better understand “unplanned organic change in FITS,” write the researchers.

In the FITS manual, the therapy process is divided into six main phases which occur over 15 to 17 sessions. In this process, family members establish personal and group goals. They are given the opportunity to rate how they, and other family members, have collaborated to achieve these goals. Transcripts and evaluations are analyzed in session while the therapist is tasked with learning from both their in-session navigation and what the supplementary data describes.

“With FITS we account for unplanned organic processes as the main focus in our practice by co-creating a fluid manual and doing multi-methods research. Family therapist and family members constitute a ‘collaborative learning community’. Together they learn how they learn, evaluating effects, developments and collaboration in therapy.”

In an effort to subvert notions of control and accountability that confine psychotherapy to unhelpful iterations of care, van Hennik and Hillewaere seek to broaden manualized treatment toward an accountability and effectiveness that is relational and multi-faceted.

“The world in which we live arises in the interplay of our living together. Collaborative learning is co-creating a world in which we would like to work and live.”

 

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van Hennik, R., & Hillewaere, B. (2017). Practice Based Evidence Based Practice. Navigating based on coordinated improvisation, collaborative learning and multi‐methods research in Feedback Informed Systemic Therapy. Journal of Family Therapy39(3), 288-309.(LINK)

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Zenobia Morrill
MIA Research News Team: Zenobia Morrill is a graduate of the dual master’s counseling psychology program at Columbia University. As a doctoral student and researcher at the University of Massachusetts in Boston, she seeks to understand the context informing psychology research and the underlying social factors that influence individual psychology. She is currently involved in projects examining the impact of structural violence.

6 COMMENTS

  1. Great article, thank you, Zenobia. For the family members and the therapist to view the transcripts of sessions would help each to be more mindful and accountable to the healing process and to each other. When I was trained in family therapy we had one way mirrors and had supervisors call us on phones during sessions and tell us what we were doing right and wrong. We wrote process recordings that we handed in to supervisors with our thoughts and reactions to sessions. By having all those in the family session review what was said, have time to think about it and come back together to critique oneself, each other and the process takes time and effort, but I can certainly see the benefit.

  2. This sounds like what therapy should be about. It should be flexible, focused on developing options rather than “reducing symptoms,” and should change based on direct feedback from clients. The therapists should LEARN from the family what is happening, what works, and what doesn’t, rather than following some pre-digested set of “techniques” approved by someone else based on some statistical probabilities about outcomes that may be of no interest to the family involved.

    Thanks for the inspiring article. If only this would develop into the standard of care!

    • I understand your point, Jolly Roger. There is a lot of childhood abuse out there. It is a fallacy about the greatest danger for children is abuse by strangers “stranger danger”. It is actually those closest, in one’s own family, that I have seen the greatest damage to safety, trust and security. This type of collaborative approach is definitely not for all families. Safety is always first. I worked with some really abusive parents. But most of the time parents do really want to do right by their children and in a nonjudgmental environment they can learn how to be better parents. It takes real courage to look at oneself and change negative patterns. Some cannot do it and continue to abuse. Therapists also have to have the courage to tell parents who are abusive that what they are doing is causing harm. Mandated reporting is our professional ethical obligation, though not saying that solves the problem. DCF has its issues as well.

  3. I understand your point, Jolly Roger. There is a lot of childhood abuse out there. It is a fallacy about the greatest danger for children is abuse by strangers “stranger danger”. It is actually those closest, in one’s own family, that I have seen the greatest damage to safety, trust and security. This type of collaborative approach is definitely not for all families. Safety is always first. I worked with some really abusive parents. But most of the time parents do really want to do right by their children and in a nonjudgmental environment they can learn how to be better parents. It takes real courage to look at oneself and change negative patterns. Some cannot do it and continue to abuse. Therapists also have to have the courage to tell parents who are abusive that what they are doing is causing harm. Mandated reporting is our professional ethical obligation, though not saying that solves the problem. DCF has its issues as well.

  4. No one can have power over the parents except a court. And the only way the court can serve the child is if the child is being represented by an attorney.

    Without this, then any kind of a therapist is simply a hired accomplice abuser for the parents.

    Mandatory Reporting is indeed our most important legal advance. It seems like many in public practice do at least try to live up to it.

    But in private practice, not at all. The implicit understanding is that since the parents contacted the therapist, and such a good therapist at that, that therefore they are always to be held blameless. Most middle-class child abuse seems to involve doctors of one sort or another, otherwise it would be illegal.

    As I see it, the middle-class family is an extremely dicey institution at best. It only even exists because it is charged with exploiting and abusing children.

    The best alternative example which I have ever heard of are the Israeli Kibbutzes. They work because they take the 24 hour a day pressure off of parents, and they largely stop parents from using the child to give themselves social status.

    So there is always some mix of the child staying with the parents, and staying in the children’s home under assigned adult caretakers.

    This way you have back up. If there is a problem at one end, the child has refuge in the other place, until the problem is resolved.

    Reading:
    https://www.amazon.com/Somebody-Elses-Children-Struggle-Americas/dp/0517599414/ref=sr_1_1?s=books&ie=UTF8&qid=1502829199&sr=1-1&keywords=john+hubner%2C+somebody+elses

    This is about the Juvenile Dependency Court and Social Services, and the extremely difficult situations they have to deal with day in and day out.

    I am convinced that only with something like Kibbutzes, is this every going to change.

    You can’t just tell people not to have children, because the vast majority will never listen.

    So as it is now, people are told, you gain adult status by having children.

    If there are then problems, all you have to do is start reading some medical books and driving the child to doctors and getting them to do as many tests as possible, and you will gain the upper hand in dealing with the child, and you will be looked at as a saint and a martyr.

    And then you can also start driving the child to psychotherapists and disabilities doctors. Thus again you will get a lever over the child, and you may even be able to get them drugged.

    And then, even if you child does not end up seeing doctors as a juvenile, if you can make them believe they have something wrong with them, they will probably be seeing doctors as an adult, and so you the parent will be made to look right.

    And if there are still problems, you can always say that the child has a moral defect, and this is just about the only industrialized country in the world which will let you disinherit them.