[acb-hsp] Trends in Family therapy

[J.Rayl]

Trends in Family Therapy Supervision: the Past 25 Years and into the Future
by Robert E. Lee , David P. Nichols , William C. Nichols , Temple Odom
American Association for Marriage and Family Therapy (AAMFT) Approved Supervisors
have played an important role in the education, training, and socialization of professional
marital and family therapists (MFTs) from early in the history of the AAMFT (Nichols,
1992; Todd & Storm, 1997). In the early days of the organization and the field, before
explicit curricula and degrees were available in marital and family therapy (MFT),
supervision following attainment of a degree in any one of several fields was the
major path to practice and socialization into the field. Consequently, the organization
began a program of formally recognizing and appointing Approved Supervisors in 1971,
following several years of informally naming individuals to supervise candidates
for organizational membership. Because MFT has evolved as a profession over the last
25 years since the first study of AAMFT Approved Supervisors (Everett, 1980), it
is reasonable to assume, with the development of accreditation of MFT master's and
doctoral programs and nearly universal state regulation of MFTs, that the beliefs
and practices of its Approved Supervisors also have changed. By comparing cohorts
of AAMFT Approved Supervisors we can learn about the evolution of MFT supervision
over time and speculate about what these results portend about future MFT supervisory
trends, opportunities, and challenges.
This article reports on the third of a series of surveys of AAMFT Approved Supervisors.
In 2001 we completed a national survey of AAMFT Approved Supervisors using essentially
the same survey instrument used by Everett in 1976 (Everett, 1980) and Nichols and
his associates in 1986 (Nichols, Nichols, & Hardy, 1990). In this article we compare
these three cohorts and then focus on what the results suggest about the future evolution
of MFT supervision given its clinical, regulatory, and organizational environments.
The field of MFT has changed a great deal since the first survey 25 years ago. The
domination of major MFT theories and/or allegiance to a single orientation by practitioners
may be past (Blow & Sprenkle, 2001 ; Nichols, 1997; Sprenkle, Blow, & Dickey, 1999).
Marriage and family therapists practice with a wide range of clients in a wide range
of settings (Doherty & Simmons, 1996; Northey, 2002). The master's is the highest
clinical degree held by 75% of the individuals practicing MFT (Northey, 2002) and
by 90% of those seeking certification and licensure (Lee, 2002).
The title of MFT and its scope of practice are regulated by law (Sturkie & Bergen,
2001). Moreover, although there are approximately 46,000 practicing MFTs in the United
States, only 40% of them are clinical members of the AAMFT (Northey, 2002) and therefore
guided by that organization's standards. Finally, even though there are both master's
and doctoral programs accredited by the Commission on Accreditation of Marriage and
Family Therapy Education (COAMFTE), the various states have uniformly specified a
master's degree as the qualifying degree for certification or licensure (Sturkie
& Bergen, 2001).
Just as MFT as a profession needs to be understood within its clinical, regulatory,
and organizational environments, so does the AAMFT Approved Supervisor credential.
In the contemporary clinical environment, supervisors are expected to provide training
relevant to diverse practitioners in diverse settings. In the regulatory environment,
the AAMFT approved supervisor designation is only one of several ways to document
readiness for the supervision of postgraduate family therapy clinical experience
(Association of Marital and Family Therapy Regulatory Boards, personal communication,
April, 2003). Some states (e.g., Michigan) only require that supervisors be licensed
for independent clinical practice. Most states that currently specify AAMFT Approved
Supervisors also accept an "equivalent" based on a combination of clinical experience
(ranging from 2 to 5 years at the independent practice level) and some training in
supervision.
Moreover, current COAMFTE standards also may be limiting the need for the AAMFT Approved
Supervisor credential. Currently in the US there are 55 master's programs, 20 doctoral
programs, and 13 postgraduate institutes that are either accredited or candidates
for accreditation (AAMFT, 2003). However, although the latest accreditation standards
(COAMFTE, 2002) still require accredited programs to have a minimum of three faculty
members, only two of them now need to be AAMFT Approved Supervisors. The third can
be an "equivalent." Moreover, accredited programs do not need to have an on-site
clinical facility and supervision of students' clinical experience, including the
doctoral internship, may be by an equivalent to an AAMFT Approved Supervisor.
Despite this decline in institutional support for the AAMFT Approved Supervisor credential,
the raw number of Approved Supervisors has steadily increased over the years. In
1976 there were 233 Approved Supervisors in the United States. By 1986 the number
had grown to 1,286 and in 2001 there were 2,046. However, computed as a percentage
of the AAMFTs increasing clinical membership, the proportion has remained almost
constant. Approved Supervisors constituted 14% of the clinical members in 1976 and
in 1986, and 13% in 2001.
Descriptions of AAMFT Approved Supervisors are important. A large number of individuals
continue to pursue this credential, most regulatory statutes continue to grant it
a privileged status, and AAMFT Approved Supervisors continue to be the primary socialization
agents for those entering family therapy through COAMFTE-accredited training programs.
Furthermore, descriptions of AAMFT Approved Supervisors may "offer significant clues
to the general status of supervision in the family therapy field" (Nichols et al.,
1990, p. 276). Clinical supervisors are primary agents in both transmitting theoretical
knowledge and clinical skills and inculcating the values and norms of the MFT professional
culture (Everett, 1980; Nichols & Lee, 1999). Clinical supervisors may be the only
such socializing agents for the approximately 35% of those currently seeking credentials
as MFTs whose formal educations are in disciplines other than MFT (Lee, 2002).
Nichols and his associates (1990) found that the population of AAMFT Approved Supervisors,
and probably clinical supervisors, had changed substantially since Everett's (1980)
first survey in 1976. For example, there were more females, a shift towards systemic
theoretical orientations, a great increase in the use of video recordings, a decline
in the popularity of personal psychotherapy as part of training, and a greater inclination
to identify themselves professionally as MFTs. In light of this information, we expected
significant changes also to have occurred between 1986 and 2001, and felt that it
was important to track them.
METHOD
Participants and Procedures
There have been some differences in the AAMFT Approved Supervisors participating
in the three national surveys. The 1976 Everett study surveyed all 233 Approved Supervisors.
For the 1986 replication, 30% of Approved Supervisors were selected in a random fashion.
For this survey, a list of 721 potential respondents (30% of 2,046) was compiled
by matching random numbers to the zip code digits on a master list provided by a
commercial mailing service.
Because we wished to compare the present cohort with those in the earlier studies,
essentially the same survey instrument was used, containing 56 items on demographic
information, specifics of practice, and attitudes with regard to supervision. A cover
letter with informed consent and privacy information, the questionnaire, and a self-addressed,
stamped envelope were sent to the sample of 721 Approved Supervisors. All those on
the address list who had not responded within 3 weeks were sent a follow-up post
card.
Statistical Methods
In the current paper, all statistical comparisons of the 1986 group to the 1976 group
are simply representations of the results presented in Nichols et al. (1990). The
2001 sample selection used a random method that selected all Approved Supervisors
with particular digits in their zip codes, resulting in a single-stage cluster sample.
The effect of clustering is likely to be that obtained significance levels or p-values
using standard methods are too small. To compare the 2001 results with those of the
other two cohorts we formed 99% confidence intervals around estimates of population
differences using methods appropriate for finite population inference (and for the
2001 to 1986 comparisons, stratified samples) from Kish (1965), and claimed significance
at the .05 level if these intervals did not contain 0.
RESULTS
For ease of reporting, percentages have been rounded to the nearest whole number
and the results have been labeled by the year of their collection, that is, 1976,
1986, and 2001. Of the 721 questionnaires sent out for the 2001 survey, 330 (46%)
were returned. This was substantially less than the 72% return rate in 1986 and the
79% of 1976. However, the respondents closely matched the population of AAMFT Approved
Supervisors with regard to gender and level of academic degree. Of the respondents,
17% were male with a master's degree, 28% were male with a doctoral degree, 33% were
female with a master's degree, and 22% were female with a doctoral degree. The contingency
coefficient of gender by degree was .210 (ns). The AAMFT (personal communication,
April, 2003) provided the gender and the highest academic degree of all current AAMFT
Approved Supervisors. Of all current AAMFT Approved Supervisors, males with master's
degrees were 18% of the sample, males with doctorates, 30%, females with master's
degrees, 31%, and females with doctorates, 21%. The contingency coefficient was .212
(ns). Because the AAMFT does not keep additional demographic data, further comparisons
of the respondents with the total population were not possible. However, with regard
to these two variables, the contingency coefficients suggest that the two groups
are almost identical.
Demographic Description
The demographic data for the three cohorts are given in Table 1. The 2001 respondents
were not as young as their predecessors. Their mean age was 54 years old and 67%
of the respondents were between 45 and 63 years of age. The percentage of females
increased from 22% to 55% since the first survey. However, there were no statistically
significant changes in ethnic representation. There was a small but statistically
significant increase in the number of respondents who currently were unmarried. Respondents'
practice communities were diverse in size. The majority of the supervisors continue
to provide services in large urban settings.
Education/Training/Experience/Identity
Data for the 1976, 1986, and 2001 samples with respect to education, training, and
professional identity are in Table 2. There was a statistically significant decrease
in those possessing a doctorate in 2001 relative to 1976 and 1986, but a statistically
significant increase in those whose highest academic degree was specifically in MFT.
Moreover, even though 22% of the respondents took their advanced degree in psychology,
12% in social work, 8% in education, and 8% in theology, 70% of the respondents considered
MFT to be their primary professional identification. Aside from membership in the
AAMFT, 19% of the supervisors also indicated that they held membership in the American
Psychological Association, 16% in the National Association of Social Workers, 14%
in the American Counseling Association, 11% in the American Association of Pastoral
Counselors, and 6% in the National Council on Family Relations. Consistent with the
increased age, the 2001 cohort contains more experienced practitioners than the earlier
two samples.
Aspects of Supervision: Setting, Supervisees, and Methods
Setting. The location in which Approved Supervisors provide supervision has largely
stayed constant across the years. About one-third of such supervision continues to
take place in private practice settings, about one-quarter of it in academic institutions,
and about one-quarter in community agencies. The one place in which there has been
some variation is in private training institutes. Supervision in these settings increased
from 6% to 20% between 1976 and 1986, but by 2001 it was down to 15% of the total.
Supervisees. Half of the 2001 respondents indicated that supervisees in their particular
supervisory setting had access to more than one approved supervisor. However, the
current group differed from the two earlier ones in the extent to which MFT supervision
was considered a part of the supervisor's full-time employment position. Seventy-five
percent of the 1976 sample, 71% of the 1981 sample, but only 57% of the 2001 sample
indicated that MFT supervision was an aspect of their primary, full-time job.
Format and methods of supervision. Data on how supervision was practiced (individual
or group format), and the modalities used (e.g., case presentation, review of videotape,
live, and others) are contained in Table 3. Across the years, individual supervision
was provided by 9 out of 10 supervisors. Group supervision had an increase in popularity
in 1986, and then declined. Within these formats, supervisors typically have used
more than one method, but have varied in those they used. Verbatim reconstructions
of sessions (i.e., supervisees are required to write down a detailed description
including everything that was said) currently are at their lowest level. Nevertheless,
one-third of the 2001 supervisors still use this method. Use of audio recordings
is also in steady decline although one-half of the 2001 supervisors said that they
used them. Videotaping seems to be consistently used by two-thirds of supervisors,
whereas live observation showed a statistically significant increase from 1976 to
1986, and a statistically significant decrease in 2001. When they also were asked
to indicate their primary method, most indicated process reports (Table 4). Finally,
whatever methods they used, the supervisees of all three cohorts typically received
1-2 hours of supervision a week.
Attitudes Toward Supervision
The most recent survey of Approved Supervisors demonstrated the continuing high value
placed on performing supervision. Asked to rate the importance to them of their practice
of supervision, 80% of the current respondents indicated on a scale from 1 to 5 that
it was "important" (29%) or "very important" (51%). An additional 10% went even farther,
endorsing the sentiment "without it, work would not be meaningful." Similar responses
were obtained in 1976 and 1986, where 90% of those respondents also gave their practice
of supervision ratings ranging from "important" to irreplaceable. Asked what it would
take for them to give up doing supervision, 61% of the 2001 sample and 60% of the
1976 sample indicated that no incentive could persuade them to do so, both statistically
significantly higher than the 48% figure for the 1986 group.
Personal Psychotherapy and Supervision
Each of the surveys inquired about the use of personal therapy as a component of
professional training and there were few statistically significant differences between
the cohorts. Between 88% and 92% of each cohort believed that personal psychotherapy
helps supervisees become better clinicians; however, only 36% to 38% indicated that
at least one-half of their supervisees had received some personal therapy. Moreover,
although 76% of the 1976 supervisors made use of personal therapy for themselves,
the percentage dropped to 56% in 1986, and rose slightly to 62% in 2001. (The differences
between the 1976 percentages and those of 1986 and 2001 are statistically significant.)
Professional Activities
The picture presented for participation in professional organizations and activities
across the decades is mixed. However, the data given in Table 5 indicate that there
generally has been a decrease in participation in a variety of professional development
pursuits.
DISCUSSION
These data reveal several notable trends. First, a constant percentage of the clinical
membership is becoming AAMFT Approved Supervisors even though contemporary contextual
forces appear to be diminishing the apparent value added by this credential. Although
being an AAMFT Approved Supervisor is less necessary than formerly for the supervision
of postdegree experience, many states nevertheless require training in supervision
and, in some cases, training equivalent to that of Approved Supervisors (Association
of Marital and Family Therapy Regulatory Boards, personal communication, April, 2003).
Moreover, a preponderance of the supervisors in each survey cohort has indicated
that supervision is an extremely valuable part of their professional lives. Therefore
it is likely that the Approved Supervisor credential remains attractive for both
business and self-development reasons.
Second, the percentage of female AAMFT Approved Supervisors has steadily increased.
That is likely to continue given the increased number of women entering the field
(Lee, 1998, 2002; Northey, 2002). However, although women now comprise one-half of
all AAMFT Approved Supervisors, minority populations are still underrepresented in
the AAMFT Approved Supervisor ranks, just as they are among those practicing MFT
(Lee, 1998, 2002). The percentages of minorities have not changed significantly in
25 years.
Third, the number of AAMFT Approved Supervisors with master's degrees seems to be
increasing parallel to those practicing MFT. The increase in degrees specifically
in MFT probably corresponds to the steady increase in accredited programs, (88, including
candidacy programs, in 2003).
Fourth, the popularity of live supervision has risen and declined in the past 25
years. It dropped from being the leading method in 1986 to third in 2001. Its earlier
popularity perhaps can be attributed to the favorable status accorded this method
in the early supervision literature (e.g., Montalvo, 1973) as well as the training
standards of COAMFTE. However, Lee and Everett (2004) observe that the form of supervision
is dictated by the clinical theories incorporated in training systems. Because live
supervision historically has been highly associated with directive models of therapy,
such as structural and strategic, the postmodern and integrative movements may be
a contributing factor to the increasing use of other modalities. The decline of live
supervision and the popularity of videotape and case presentation methods also may
be a combination of the practical difficulties and financial costs of getting supervisors,
therapists, and clients together in the same time and place, and the fact that live
approaches, for all their benefits, do not address important training needs (McCollum
& Wetchler, 1995; Nichols & Lee, 1999; Wetchler & McCollum, 1999).
Fifth, although the preponderance of AAMFT Approved Supervisors believe that personal
therapy is very useful to the training of clinicians, a large percentage continue
not to use it for themselves and also report that those whom they supervise have
not used it.
Sixth, current supervisors are significantly less involved in professional activities
than those surveyed in 1976 and 1986. Current practice environments, for example,
seeing clients at night and on weekends, managed care environments, and requirements
to work 40 hours/week in an agency, may afford less disposable time.
CONCLUSIONS
What do these things portend for the future of AAMFT Approved Supervisors and for
supervision in general? Although the AAMFT Approved Supervisor credential will remain
attractive to a constant percentage of the AAMFT clinical membership, minority voices
will continue to be underrepresented. Therapy continues to be practiced in diverse
settings with diverse clientele and probably will continue to be practiced in such
settings. Therefore, cultural competence should be a major component of AAMFT Approved
Supervisor training. Supervisors, in order to begin to serve supervisees and, indirectly,
the clients whom they treat, should be engaged in a life-long process that results
in training systems characterized by attention to preparation of clinicians to practice
in culturally competent systems of care (Corey, Corey, & Callanan, 1988; Isaacs &
Benjamin, 1991; Lee & Everett, 2004).
Our discussion of these six trends in MFT supervision also suggests the need for
further research. For example, it appears that, increasingly, AAMFT Approved Supervisors
will have terminal master's degrees. We may wish to explore the ways in which these
supervisors may be different from those possessing doctoral degrees and the significance
of any differences found.
It may prove to be less important to understand how many AAMFT Approved Supervisors
use the various modalities of supervision (e.g., live, video, and case presentation)
in individual and group formats than to ascertain how they are used. Because many
supervisors have access to more than one modality and format, it would be useful
to explore "mixes" considered beneficial for disparate clientele and settings (Lee
& Everett, 2004).
Finally, there may be general trends within the MFT profession toward less participation
with professional organizations and less professional activity. Given the importance
of AAMFT being relevant to practitioners and the central role of supervisors as socializing
agents for those entering the profession of MFT (Everett, 1980; Nichols & Lee, 1999),
the reasons behind this lack of traditional involvement are worth pursuing.
-1-
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication Information:
Article Title: Trends in Family Therapy Supervision: the Past 25 Years and into the
Future. Contributors: Robert E. Lee - author, David P. Nichols - author, William
C. Nichols - author, Temple Odom - author. Journal Title: Journal of Marital and
Family Therapy. Volume: 30. Issue: 1. Publication Year: 2004. Page Number: 61+. ©
2004 American Association for Marriage and Family Therapy. Provided by ProQuest LLC.
All Rights Reserved.
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Jessie Rayl
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"But they that wait upon the LORD shall renew their strength; they shall
mount up with wings as eagles. They shall run, and not be weary"--Isaiah 40.31
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