Master of Science in Family Therapy: Student Portfolio of Graduate Preparation and Readiness for Professional Practice

Friends University
Lenexa/Wichita,Kansas
Program Completion: August 25, 2010
GPA 4.0

Introduction to the Portfolio

Friends University’s MSFT program provides academic and clinical training for persons seeking competence in the core mental health profession of marriage and family therapy (MFT). In the program’s 23 month schedule, students complete 52 credit hours earned through 19 academic courses and three semesters (15 months) of continuous clinical internship. The MSFT degree is nationally accredited by the Commission on Accreditation of Marriage and Family Therapy Education (COAMFTE) of the American Association for Marriage and Family Therapy (AAMFT).

The MSFT Student Portfolio is completed in the concluding term of graduate study and training to promote the following objectives for each graduate of the program:
(1) the integration of academic learning and clinical practice
(2) the presentation of professional competencies to the broader services provider public
(3) student confidence and readiness to assume the professional role of the LMFT upon graduation
The portfolio project interacts with course work and clinical internship activity across the MSFT program, though it is not itself a graded project of any single course. The specific contents of the portfolio are derived primarily from learning projects and activities demonstrating student competencies required by respective MSFT components. In June of Year Two, the Portfolio is prepared for review by community professionals serving as “consultant-evaluators” of student readiness to practice.

The following outline provides a summary of the MSFT Student Portfolio project presented in this notebook:

Introduction and Presentation of Primary MSFT Learning
• Introduction of self by personal letter and resume
• Acknowledgement of the MSFT curriculum and learning context (provided)

Record of Clinical Internship Experience
• Description of placement contexts
• Description of client contact experience
• Presentation of clinical experience by diagnostic categories
• Presentation of clinical supervision experience

Theoretical Working Model of Therapy
• Establishing Therapeutic Alliance
• Personal Integration of therapeutic Models/Approaches

Demonstration of “The Transformative Journey”
• Session segments
• Working Model Response to Difference in Clinical Practice
• Summary of clinical learning
• Summary of “transformative learning” (self of the therapist)

Student Preparation and Readiness for Professional Practice
• Summary of professional and employment goals
• Description of licensure status and plans

The concluding step in completing the MSFT Student Portfolio requirement is securing feedback from a community professional serving as a consultant-evaluator who meets the following qualifications:

(a)a community professional who is not employed by the MSFT program
(b)a person trained and serving in a social services/mental health care profession as a clinician, administrator, or closely related role
(c)a person chosen specifically by the student as a professional capable of offering valued feedback on the student’s MSFT Student Portfolio project
(d)a person who is willing to read the portfolio project and submit feedback to
1) the student, and (2) to the MSFT faculty via provided rubrics and feedback sheets

As indicated in (d) above, the community consultant-evaluator provides feedback for two purposes.

First, with the graduating MSFT student, the community professional serves as a professional consultant to the student’s initial presentation of self-as-professional to the broader service provider community. In this role, the consultant-evaluator’s review of the MSFT Student Portfolio parallels an initial interview for employment, with feedback designed to help the graduate accomplish a clear presentation of professional readiness to practice upon completion of the degree.

Second, with the MSFT program faculty, the community professional serves as a professional evaluator of the student’s presentation of self for the purposes of assisting the MSFT program determine its degree of success in meeting program outcomes. Both of these roles are assisted by completing specific feedback forms defined by accompanying rubrics. Specific instructions for the consultant-evaluator’s feedback are included in the Community Consultant-Evaluator Packet provided separately by the MSFT student.

A Note about Formatting in the Portfolio

The MSFT Student Portfolio consists largely of assignments completed during the final term of graduate study and clinical training. Each of the required components that follow includes a brief description of the assignment to which the student is responding. While they each display APA writing style, they are paginated independently.

Introduction and Presentation of Primary MSFT Learning

This component of the portfolio project includes two entries. Both are intended to provide the reader an introduction to the MSFT student and to the student’s overall learning experience across the whole of the graduate program.

The personal qualities and life experience of the MSFT student are provided in these documents to give individual context to the graduate training experience presented in the portfolio.

INTRODUCTION OF SELF BY PERSONAL LETTER AND RESUME

Education is not a preparation for life: Education is life itself. John Dewey

Thank you for your interest in my Student Portfolio of Graduate Preparation and Readiness for Professional Practice. John Dewey’s statement reflects a simple and practical approach to life through education. My approach mirrors that very basic idea. As you review and evaluate the following materials,it may be helpful for you to have some personal background information.

I obtained a Bachelor of Arts Degree in English at Kansas State University in December of 1996, and attended one summer session course at Yale University in 1997 to further my education. You will note that I have spent a majority of my career in the field of education. It was there as a student that my life was greatly impacted and so it is there that I look to impact others.

My belief that our families of origin are the first relationships and the first community in which we are first influenced, led to my pursuit of my Master of Science in Family Therapy degree. Built on the "systemic thinking" that "we create each other" (Nelson,T., 2008), I believe that this advance degree has provided me with the strategies to empower others to create the lives (and relationships)for which they hoped and dreamed which in turn impacts the communities we build and support.

I have included my resume to provide you a glimpse of my experience and education. Following are a description of the program curriculum at Friend’s University. The Master of Science in Family Therapy provided rigorous coursework combined with the applied knowledge through practical clinical experience to successfully prepare me in facilitating in others sustainable change. Thank you for your interest in my work. Please feel free to contact me with any questions you may have.

Mary Kitchen-Neal

email: mary.kitchen.neal@gmail.com • Degree Portfolio: http://marykitchen-neal.blogspot.com/

OBJECTIVE: A skilled values-driven leader with the diverse experience, education, training and ability to balance the needs of the staff, students and the organization while building collaborative relationships that further the organization’s mission. Experienced coordination and development of academic and counseling programming for not-for-profit college access and readiness programs. Effective facilitation of change with a strong ability to reconcile conflicting values, foster trust & cooperation which is contributed to effective written and verbal communication skills, resourceful problem-solving, and a “strength-based” mindset.

EDUCATION: FRIENDS UNIVERSITY, Master of Science, Marriage and Family Therapy, August 2010
YALE UNIVERSITY, Contemporary Writing Techniques, August 1997
KANSAS STATE UNIVERSITY, Bachelor of Arts Degree, English Literature, December 1996

PROFESSIONAL EXPERIENCE

PROGRAM DEVELOPMENT COORDINATOR:SPECIAL PROGRAMS COORDINATOR III 06/2013-Present The University of Texas at Arlington TRIO Pre-College Programs 06/2013-Present

Devises and implements departmental programs and projects, Provides direction and recommends improvements to program processes. Supervises and coordinates the activities and personnel involved in assigned programs and projects. Ensures attainment of program objectives. Informs and consults with appropriate administrative and supervising personnel regarding program operations, Interacts with university departments, special groups and external agencies in administering programs.

EDUCATIONAL CONSULTANT: INDEPENDENT CONTRACTOR 11/2005-06/2013 The University of Texas at Arlington TRiO Pre-College Programs 10/2010-Present

Faculty/Research Associate appointment for the purpose of Data Collection, Research & Reporting Federal Grant Writing & Reporting, Curriculum Design, Class Instruction, Program Development & Supervision, Staff Training & Supervision & Student Retention Strategies. Designated Program Development Chair for the purpose of increasing program visibility. Kauffman Scholars Incorporated SCHOOL COORDINATOR . LIFE COACH STAFF 08/2004-10/2010 Tarrant County Community College Upward Bound Program 10/2011

THE UNIVERSITY OF TEXAS AT ARLINGTON COLLEGE ACCESS PROGRAMS 08/2011-05/2012 TRANSITIONS: High School Bridge Program JumpStart: College Awareness Program 5th-6th grade Fort Worth Independent School District Handley Middle School 08/2011 The University of Texas at Arlington Upward Bound Summer Program 07/2008

Experience in the College Access & Readiness field with multiple responsibilities to include Data Collection, Research & Reporting for the purpose of Federal Grant Writing & Reporting, Curriculum Development & Design, Event Planning, Class Instruction, Program Development & Management, Staff Training & Supervision, and Student Retention Strategies.

GRADUATE INTERN Center on Family Living 04/2009-08/2010 Child Abuse & Prevention Association Salvation Army Harbor Light Village

Degreed experience and training in Family Therapy Theory assessing, developing, implementing and documenting mental health treatment plans and providing supervised therapy for a diverse population of individuals, couples and families. 500+ direct client hours.

SCHOOL DISTRICT EXPERIENCE

Shawnee Mission Independent School District Shawnee Mission West High School 11/2008-05/2010 Arlington Independent School District AISD Substitute Teacher 08/2007-06/2008

Supported Classroom instruction with educational and non-educational activities for High School students with physical and mental disabilities. Directed small group, teacher-planned instructional activities. Assisted in maintaining the classroom management program and handle routine discipline. Multi-Level, Diverse Teaching assignments K-12 based on District Needs.

ACADEMIC & COUNSELING COORDINATOR 11/2004-03/2005 The University of Texas at Arlington Upward Bound Program 01/1998-08/2004

Experience in the College Access & Readiness field with progressive responsibilities to include Data Collection, Research & Reporting for the purpose of Federal Grant Writing & Reporting, Curriculum Design, Class Instruction, Program Development & Supervision, Staff Training & Supervision, Academic & Career Counseling , Student Recruitment & Retention which merged multiple administrative duties & appointments from 01/98-08/04 under the in-house program title of Academic & Counseling Coordinator and as: Faculty/Research • Counseling Specialist I & II- from 11/04-03/05, appointed responsibilities and duties as Learning Specialist and Faculty/Research Associate.

Acknowledgement of the MSFT Curriculum and Learning Context

A display of the MSFT curriculum and description of the MSFT schedule are presented in this segment, drawn directly from the Friends University Catalog.

PROGRAM AND COURSE DESCRIPTIONS

The Master of Science in Family Therapy degree provides academic and clinical training for persons seeking competence in the professional discipline of marriage and family therapy. This degree meets the graduate education requirements for the status of Licensed Clinical Marriage and Family Therapist (LCMFT) in Kansas.
Students complete 52 credit hours earned through 19 academic courses and three semesters of continuous clinical internship completed within a 23-month period.

Two comprehensive examinations occur in Terms 2 and 4, covering academic learning and clinical skill development.

The clinical internship begins during the second semester and continues concurrent with the ongoing academic coursework. Students are responsible for completing 1,000 hours of supervised professional experience inclusive of 1) 500 client contact hours with individuals, couples, and families, and 2) 125 hours of supervision. Weekly clinical supervision, involving both individual/dyadic and group supervision, is offered throughout the clinical internship. All clinical supervision requires enrollment in the Clinical Internship series. Supervision is provided by the program’s clinical faculty and by qualified practitioners in the placement site. Video recorded segments of the student’s clinical sessions assist the supervision process. “Live” supervision through one-way mirror, camera or in-room observation is also expected. Three levels of defined learning objectives guide clinical skill development and evaluation.

Enrollment in the clinical internship series provides professional liability coverage for clinical training activities at all sites. Entry into training requires student membership in the American Association for Marriage and Family Therapy (AAMFT), child abuse registry clearance, and faculty review for student readiness to begin client contact. Recording equipment is provided at Center on Family Living facilities. Students may need to provide audio or video recorders for use in community placement settings. Basic computer skills are necessary for clinical documentation and academic coursework.

Students are responsible for accomplishing the required internship hours. MSFT students on the Wichita campus are expected to see two to six cases weekly at the University's Center on Family Living. All other clinical placements are developed and approved by program personnel according to Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) accreditation guidelines. Students may request a specific placement option matching their area of training interest dependent upon site availability.

The Master of Science in Family Therapy at Friends University is accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) of the American Association for Marriage and Family Therapy (AAMFT), 112 S. Alfred St., Alexandria, VA 22314. Friends University is accredited by the Commission on Institutions of Higher Education of the North Central Association of Colleges and Schools, 30 North LaSalle Street, Suite 2400, Chicago, IL 60603-2504, telephone 800-621-7440. The Master of Science in Family Therapy program admits academically qualified students without regard to sex, age, race, color, religion, national origin, ancestry, marital status, sexual orientation, handicap, Vietnam Era Veteran status, Special Disabled Veteran status, or disability, to all the rights, privileges, programs and opportunities generally available to students.

Interested persons not wishing to complete the entire program may request to take up to four academic modules.

SCHEDULE

The complete MSFT program curriculum is delivered separately at the Wichita campus and the Kansas City instructional site in Lenexa, Kansas. The program’s first three credit hour module is taught in one-week intensive format, occurring the first week of August (Monday through Friday). The second module, for one credit hour, occurs on two successive Thursday evenings and a half-day Saturday. Instruction of primary modules then assumes the normal schedule from 5 to 10 p.m. on Thursdays at each site through the duration of the degree with some variation dependent on the amount of required learning activity completed through the University’s computer-based Internet course management system, Blackboard. All academic courses are set in a scheduled sequence and supported by a dedicated site via Blackboard. Two week breaks from classes occur in December-January and in July-August. Spring Break is scheduled in mid-March.

In addition to Thursday evenings, clinical training adds significant time requirements as follows. At the beginning of Term 1 and continuing midway through Term 2, Clinical Foundations 1 and 2 provide additional instruction through weekly two-hour sessions supporting readiness to enter clinical training. By early April, following completion of the Clinical Foundations courses, students begin weekly clinical supervision and direct client contact, requiring seven to 10 hours weekly. By Term 3 (August), and throughout the second year, the full training schedule is required, consisting of 15 to 20 hours weekly for dyadic and group supervision, delivery of therapy services, documentation and case management tasks. If clinical training requirements are not met by the conclusion of Term 4, the student must continue the clinical internship until completed by enrolling in consecutive eight-week modules of clinical supervision (see Course Listings for FMTH 692 Clinical Internship-Extended).

COURSE LISTINGS

TERM 1

FMTH 503 Foundations of Marriage and Family Therapy
Presents the historical development of the MFT profession. Includes overview of major theoretical influences and in-depth examination of the family systems paradigm. (Taught as a one-week intensive course during the first week of August on the Wichita campus and at the Mission site.) 3 hours

FMTH 511 Research in MFT 1
Introduces role of research in professional practice and the scientist-practitioner model. Assists students to access and engage research literature specific to clinical topics. 1 hour

FMTH 512 Clinical Foundations 1
Occurs across Term 1 to address self-awareness, primary interpersonal skills, multicultural sensitivity, and basic elements of professionalism. Includes observation of psychotherapy and practice in leading the helping interview. Concludes with a review of readiness to proceed with clinical training in Term 2.
2 hours

FMTH 520 Emotion, Attachment, and Trauma
Creates a working knowledge of neuroscience to explore the power of primary human bonds. Introduces emotion and attachment theory as frameworks for adaptive relationship competence. Examines the impact of trauma on memory, physiology, and the emotion of interpersonal encounter. 3 hours

FMTH 543 Intergenerational Family Dynamics
Studies the influence of intergenerational forces upon individuals and relationships. Examines primary concepts from Bowen’s natural systems theory, Nagy’s relational justice approach, and other related theorists. Introduces clinical uses of the genogram. 3 hours

TERM 2

FMTH 565 Diagnostic Assessment of Psychopathology and Relational Functioning
Presents an integrated approach to diagnostic assessment of individuals, couples and families seeking mental health services. Addresses affective, cognitive, and behavioral problems of individuals in the context of marital and family systems. Includes training in DSM-IV and common assessment measures.
5 hours

FMTH 572 Clinical Foundations 2
Occurs in the first months of Term 2 leading to the beginning of supervised client contact. Addresses the clinical processes supporting psychotherapy including informed consent, negotiating the treatment plan, and writing the treatment record. Includes instruction on use of supervision, consultation, and referral. 2 hours

FMTH 593 Structural/Solution Approaches to Therapy
Presents the structural and solution schools of MFT practice. Focuses on the organizing elements of family life that help regulate personal and relationship behavior and how relational problems are often composites of habits, patterns, and misguided viewpoints. Addresses family roles, subsystem boundaries, interactional patterns, and strength-based and solution-oriented thinking as forces for therapeutic change. 3 hours

FMTH 581 Ethical and Professional Issues in MFT Practice 1
Introduces guidelines of ethical behavior for the MFT professional and explores primary responsibilities of assuming the role of therapist. Examines the AAMFT Code of Ethics and Kansas MFT regulations with specific application to the clinical internship. 1 hour

FMTH 591 Pharmacology in Mental Health Services
Introduces medications used in biological psychiatry and other medical treatments commonly associated with affective, cognitive, and behavioral concerns. Includes skills for effective collaboration with physicians. 1 hour

FMTH 603 Clinical Internship - Entry
Beginning segment of clinical training initiated in Term 2. Requires faculty review and approval of student's readiness to begin client contact. Clinical experience begins in April with three to five client contact hours concurrent with weekly dyadic or group supervision sessions and increases to a full caseload of 10-12 hours by August. Videotape of student's clinical work and live observation utilized in the supervisory process. Defined skill level learning objectives guide student learning and supervisory evaluation. 3 hours

TERM 3

FMTH 611 Intimacy and Sexuality in Couples
Explores the human experience of shared self in couple relationships. Theoretical concepts and clinical interventions promoting meaningful expressions of intimacy addressed. Includes examination of treatment of sexual dysfunction. 1 hour

FMTH 622 Cognitive/Behavioral Approaches to Therapy
Presents the cognitive and behavioral schools of MFT practice. Focuses on the integration of values, beliefs, and behavioral experiences that comprise the matrix of decision making guiding individual and interpersonal behavior. Addresses cognitive strategies, belief identification, and behavior modification as tools for therapeutic change. 2 hours

FMTH 625 Clinical Internship - Intermediate
Middle segment of clinical training beginning in August addressing intermediate clinical skill development. Requires a full caseload of 10-12 client contact hours concurrent with dyadic and group supervision weekly. Videotape of students' clinical work and live observation utilized in the supervisory process. Defined skill level learning objectives guide student learning and supervisory evaluation. 5 hours

FMTH 621 Treating Addictive Disorders
Addresses a spectrum of addictive disorders including chemicals, food, sex, and relationships with focus on the biological, social, and psychological aspects of the addictive process. Application to the family systems paradigm with emphasis on diagnosis and treatment strategies. 1 hour

FMTH 633 Narrative Approaches to Therapy
Presents an examination of the therapeutic approaches informed by the postmodern epistemological paradigm in the practice of MFT. Emphasis is given to an overview of the historical, philosophical and ideological aspects of the narrative/social constructionist paradigm. Students are guided through the process of externalizing problem-saturated metanarratives and locating problems within sociocultural contexts. The heart of the course is devoted to opening space for developing alternative stories that represent the preferred narratives clients have for their lives. 2 hours

FMTH 631 Violence in Couples and Families
Examines forms of violence and related systemic dynamics most common in abusive relationships. Domestic violence, child abuse, incest, and sexual exploitation are addressed. Includes multisystemic assessment and treatment approaches. 1 hour

TERM 4

FMTH 662 Emotion-Focused Approaches to Therapy
Examines the theoretical approaches of Marriage and Family Therapy practice which emphasize the affective/emotional aspect of human relationships. The course focuses on how emotion informs the relational patterns of therapeutic process in MFT. Experiential activities are examined that facilitate the exploration and repair of attachment bonds. Emotion awareness, emotion regulation, and emotional response patterns are also investigated as areas for therapeutic change. 2 hours

FMTH 654 Clinical Internship - Advanced
Concluding segment of clinical training beginning in January addressing advanced clinical skill development. Requires a full caseload of 10-12 client contact hours concurrent with dyadic and group supervision weekly. Videotape of student's clinical work and live observation utilized in the supervisory process. Defined skill level learning objectives guide student learning and supervisory evaluation. (NOTE: If AAMFT clinical training criteria are not met within this final internship segment, fees for additional clinical supervision will be charged.) 4 hours

FMTH 663 Developmental Perspectives of Change
Examines individual and family developments and integral variables such as stress, gender, cultural context, spirituality, and diverse family forms. Addresses perspectives of change defined by the major MFT models and introduces a meta view of the change process. Explores use of a developmental approach in clinical assessment, diagnosis, and treatment. 3 hours

FMTH 642 Research in MFT 2
Reengages the scientist-practitioner model and role of research in clinical practice. Adds basic skills needed to identify the research process including methodology, variability, significance, reliability, and validity. Promotes integration of research and practice by examining selected evidence-based treatment approaches. 2 hours

FMTH 672 Ethical and Professional Issues in MFT Practice 2
Explores ethical behavior and decision making for the MFT professional. Includes topics related to standards of care, collaboration, practice/reimbursement issues, and court testimony. Examines MFT regulation and the process of state licensure. Concludes with presentation of the student’s personal theory of therapy to external panel of evaluators. 2 hours

FMTH 691 Clinical Internship - Extended
Provides additional clinical supervision to FMTH clinical students unable to complete client contact hour requirements within the program's 23-month schedule. Includes two hours weekly of supervision in individual, dyad, or group formats over eight weeks per section. Course awards no additional credit toward degree. Tuition charge for 1 credit hour is nonrefundable. 1 hour

Record of Clinical Internship Experience

OVERVIEW OF THE MSFT CLINICAL INTERNSHIP

The clinical internship begins during the second semester and continues concurrently with the ongoing academic coursework.

Students are responsible for completing at least 1,000 hours of supervised professional experience inclusive of (a) 500 client contact hours with individuals, couples and families, and (b) 100 hours of clinical supervision. Of the 500 client contact hours, at least 250 must be with relational systems rather than individuals.

Supervision occurs weekly by MSFT program supervisors who have earned the designation of AAMFT Approved Supervisor or Supervisor Candidate. Additional weekly supervision is also required at the community placement site.

Videotaped segments of the student’s clinical sessions assist the supervision process, along with “live” supervision through one-way, camera or in-room observation.

Evaluation occurs at three points during the 15 months, utilizing the MSFT Comprehensive Clinical Competency Framework included for review at the close of this portfolio component.

Description of placement contexts
Most students complete portions of their internship in the Friends University Center on Family Living and one or more approved community placement sites. In this segment, the MSFT student provides description of the specific placement sites in which the student practiced during the clinical internship.

Description of client contact experience
The client contact experience accomplished by the student is summarized in this section. This provides an outline of the student’s clinical practice during the internship noting the amount of practice with individuals, couples, families, groups, etc. plus identification of primary populations and presenting problems.

Presentation of clinical experience by diagnostic categories
The student’s clinical experience is presented by DSM diagnostic categories in this section, providing an additional overview of the client population represented in the clinical internship component of the degree.

Presentation of clinical supervision experience
This section summarizes the clinical supervision received by the student as provided both by the MSFT clinical faculty and the placement supervisor noting amount, schedule, context, and primary supervisory focus.

Description of Placement Context

Placement One: Center on Family Living
8207 Melrose Suite 200
Lenexa,KS 66214-1625
(913) 233-8709

Supervisor: Dr. Jennifer Nelson
% of Total Hours: 80%

Description: The mission of the Friends University Center on Family Living (CFL) is to provide compassionate and affordable therapeutic services to individuals, couples and families. We believe that clients are best understood and supported in the context of their relationships.

Placement Two: Salvation Army Harbor Light Homeless Shelter
7527 State Avenue
Kansas City,KS 66112
(913) 788-8108
www.usc.salvationarmy.org

Supervisor: Carolyn Martin
% of Total Hours: 17%

Description: The Salvation Army Harbor Light Homeless Shelter Center ministries provides an temporary and transitional housing and rehabilitation services with a focus on basic necessities to families with children. Each program participant is provided with a clean and healthy living environment, good food, work therapy, leisure time activities, group and individual counseling, spiritual direction, and resources to assist each person to develop life skills and a personal relationship with God as provided by Jesus Christ.

Placement Three: The Child Abuse Prevention Association (CAPA)
503 East 23rd Street
Independence,MO 64055
816-252-8388
www.childabuseprevention.org

Supervisor: Karen Costas
% of Total Hours: 3%

Description: The Child Abuse Prevention Association (CAPA) is a 501(3) c not-for-profit organization, relying on donations and grants to provide essential services to children and families. CAPA helps children and their families overcome the traumatic effects of child abuse, especially in child molestation. CAPA also provides educational programs designed to increase awareness of abuse and how to prevent it as well as providing case management and other support services to help create strong families and decrease the chances of abuse/neglect.

Description of Client Contact Experience

Placement One: Center on Family Living
Total Couple/Family Hrs: 165
Total Individual Hrs: 203.5
Total Group Hrs: 0
Other Contact Hrs: 0

Description of Contact

The Center on Family Living is a clinic of the Marriage and Family Therapy Program of Friends University providing affordable clinical service to individuals, couples and families and is a clinical training facility for students in the MSFT program of Friends University. During my internship at the CFL, I provided 165 clinical hours with couples and families. Approximately 22% of the hours were with families of two or more people and the remaining 78% reflect hours working with various expressions of relational partnerships such as married couples, pre-married couples, and separated couples. While at the CFL, I also delivered 203 hours of services to individuals representing a variety of presenting issues such as various mood disorders, anxiety disorders, relational concerns, phase of life problems, and adjustment displays. I delivered close to 55% of the clinical services by myself, but did deliver services with a co-therapist. The population of those I served was primarily Caucasian living in the Johnson County area.


Placement Two: Salvation Army Harbor Light Homeless Shelter
Total Couple/Family Hrs: 20
Total Individual Hrs: 45
Total Group Hrs.
Other Contact Hrs

Description of Contact

The Salvation Army Harbor Light Homeless Shelter Center is a community agency that offers Christian ministries that provide temporary and transitional housing and rehabilitation services with a focus on basic necessities to families with children. Including group and individual counseling. During my internship at the Shelter, I provided 65 clinical hours with families and individuals. Approximately 40% of the hours were with families of two or more people and the remaining 60% reflect hours working with individuals representing a variety of presenting issues such as various mood disorders, anxiety disorders, relational concerns, phase of life problems, and adjustment displays. I delivered close to 100% of the clinical services by myself. The population of those I served was primarily lower socio-economic homeless African-American females and their families located in the Wyandotte County area.


Placement Three: CAPA: The Child Abuse Prevention Association
Total Couple/Family Hrs: 6
Total Individual Hrs: 0
Total Group Hrs: 8
Other Contact Hrs: 0

Description of Contact

The Child Abuse Prevention Association (CAPA) is a 501(3) c not-for-profit organization, relying on donations and grants to provide essential low-cost or no-cost services to children and families. During my internship at CAPA, I provided ** clinical hours with families and individuals. Approximately 90% of the hours were with families of two or more people and the remaining 10% reflect hours working with individuals representing a variety of presenting issues such as child molestation, sexual abuse, domestic violence and child abuse. I delivered close to 100% of the clinical services by myself. The population of those I served was primarily lower socio-economic Caucasians living in the Jackson County area.

Summary of Clinical Experience by Diagnostic Category

The following document serves as a summary of the experience the above named student intern has had with each of the DSM-IV-TR Axis I and Axis II diagnostic categories. For each of the following DSM-IV-TR categories, the total number of cases treated by the student is indicated.

The summary reflects the number of cases for which the diagnostic category was the primary focus of treatment. Co-morbid presentations are counted independently (Example: Husband and wife present with a Partner Relationship Problem and the husband suffers from Bipolar I disorder. This case would be counted for both Bipolar I Disorder and Partner Relationship Problem)

DSM-IV-TR Category: Number of Cases

Mood Disorders
Major Depressive Disorder
Dysthymic Disorder
Bipolar I Disorder 2
Bipolar II Disorder
Cyclothymic Disorder
Total 2

Anxiety Disorders
Panic Disorder
Agoraphobia w/o Panic
Specific or Social Phobia 1
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder
Acute Stress Disorder
Generalized Anxiety Disorder
Adjustment Disorder
Total 1

Psychotic Disorders
Schizophrenia
Schizophreniform
Schizoaffective Disorder
Brief Psychotic Disorder
Delusional Disorder
Shared Psychotic Disorder
Total 0

Dissociative Disorders
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Depersonalization Disorder 1
Total 1

Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Total 0

Disorders Diagnosed in Children
Mental Retardation
Learning Disorders (read, math etc) 1
Developmental Coordination Disorder
Communication Disorders
Autism/Aspergers
Attention Deficit/Hypoactivity D/o
Other Pervasive Developmental D/o
Conduct Disorders
Feeding & eating (infancy) disorders
Tourette's & other TIC disorders
Encropresis or Enuresis
Separation Anxiety
Reactive Attachment Disorder
Tourette's/Other TIC Disorders
Selective Mutism
Stereotypic movement disorder
Total 0

Sleeping Disorders
Dyssomnia
Hypersomnia
Narcolepsy
Circadian Rhythm d/o
Parasomnia (nightmares etc)
Total 0

Impulse Control
Intermittent Explosive
Other Impulse
Total 0

Substance Related Problem
Alcohol Dependence
Substance Dependence
Alcohol Abuse 3
Substance Abuse 2
Alcohol/Substance intoxication
Alcohol/Substance Withdrawal
Total 5

Personality Disorders
Paranoid, Schizoid, Schizotypal
Antisoc, Bor.lin., Hist. Narcissistic 1
Avoid, Depend, OCD
Total 1

Cognitive
Delirium
Dementia, Alzheimer's Type
Dementia, Vascular Type
Amnesia
Total 0

Somatoform Disorders
Somatization Disorder
Conversion Disorder
Pain Disorder 1
Hypochondriasis
Body Dysmorphic disorder
Total 1

Sexual and Gender Identity Issues
Low Sexual Desire Disorders 2
Sexual Arousal Disorders
Orgasmic Disorders
Sexual Pain Disorders
Paraphilias
Gender Identity Disorders
Total 2

Factitious Disorders
Factitious Disorder
Total 0

V-Codes
Parent child relational 5
Partner relational 13
Physical abuse of child 3
Sexual abuse of a child 2
Malingering
Bereavement 2
Academic/Occupational
Identity Problem 8
Religious or spiritual 2
Acculturation
Phase of life 6
Total 41

Disorders Summary
Mood 2
Anxiety 1
Psychotic 0
Delirium, Dementia & Cognitive 0
Somatoform 1
Dissociative 0
Eating 0
Disorder dx in children 1
Sexual 2
Factitious 0
Sleeping 0
Impulse 0
Substance 5
Personality 1
V-Code 41

Description of Clinical Supervision

Program Supervision Information

Program Supervisor One: Jennifer K. Nelson, Ph.D., LCMFT
AAMFT Approved Supervisor Yes
Years Experience of Supervisor 11

Total Supervision anticipated to complete by August 25, 2010

Total Individual Supervision 61.25
Total Group Supervision 37.00
Total Supervision 144.75
Total Case Report Supervision 98.25
Total Direct Supervision 0

Description of Supervision
I attended 1.25 hours per week of dyadic supervision and 2.0 hours per week for group supervision from August 2008 through June 2010. In dyadic supervision, our process generally involved a initial review of any legal or ethical concerns or any other case issue requiring additional attention. My dyadic partner and I then generally presented our files and/or videos for a case review for our supervisor’s feedback, direction and recommendations.

The group process involved six students. Two people were assigned each week to present a case for review. In preparation for our case presentation, we completed a Case Presentation report form that detailed the presenting problem, our working hypothesis, a five axis diagnosis, the treatment goals, models of intervention, legal/ethical concerns, self of the therapist matters and working genogram. Copies were provided to each member of the group for consideration and discussion prior to the presentation of the video. On occasion, group supervision was utilized to discuss various working models of therapy, to review theoretical approaches.

Placement Supervisor Information

Placement Supervisor Two: Carolyn Martin
Primary Credential LCMFT
AAMFT Approved Supervisor Yes
Yrs Experience of Supervisor 13

Total Supervision anticipated to complete by August 25, 2010
Total Individual Supervision 10.25
Total Group Supervision 0
Total Supervision 10.25
Total Case Report Supervision 10.25
Total Direct Supervision 0

Description of Supervision
I met with Carolyn Martin for a minimum of one hour monthly, with the primary task of presenting my clinical file for her review and signatures to determine that all required documents for both Friends University and for the Salvation Army Harbor Light Homeless Shelter were adequately completed. I utilized the additional time to address administrative questions regarding my function at The Homeless Shelter. Supervision was also utilized for case presentation, management and direction. Video was occasionally reviewed to ensure client care.

Placement Supervisor Two: Karen Costa, MSW
Primary Credential Clinical Social Worker
Yrs Experience of Supervisor 5

Total Supervision anticipated to complete by August 25, 2010
Total Individual Supervision 10
Total Group Supervision 0
Total Supervision 10
Total Case Report Supervision 10
Total Direct Supervision 0

Description of Supervision
I met with Karen Costas for one hour with the primary task of presenting my clinical file for her review and signatures to determine that all required documents for both Friends University and CAPA were adequately completed. I utilized the additional time to address administrative questions regarding my function at CAPA. Supervision was also utilized for case presentation, management and direction. Legal, crisis, and emergent matters were a priority for discussion. No cases were observed live or with video.

Theoretical Working Model of Therapy

This required component of the portfolio presents a two-part section highlighting the student’s core beliefs and assumptions related to: establishing the therapeutic alliance and the development of the student’s working model of therapy.

Establishing Therapeutic Alliance
The purpose of this section is to demonstrate understanding and describe the application of the concepts related to the development of therapeutic alliance. This section occurs at the end of the first year of the program having focused largely on the self-of-the-therapist and student’s readiness to begin clinical practice. The student will indicate how clients are engaged, what is done to establish a working relationship, and how that influences subsequent work with client systems.

Personal integration of therapeutic models/approaches
This section provides a description of the student’s current working model of therapy as the MSFT clinical training component nears completion. The student identifies specific theoretical approaches that inform the theoretical working model including a summary of specific intervention models, concepts, techniques, and/or processes that underpin her/his current therapy practice.

Establishing Therapeutic Alliance

The research is clear. The client’s experience of the therapeutic alliance is the greatest predictor of client success and change (Duncan, B. & Miller, S., 2000). It is crucial to the health of their clients and to their practice that student-therapists train to develop the necessary skills to create this vital link. This paper will illustrate how through adapting, acknowledging and participating in the clients’ process facilitates the process of establishing the therapeutic alliance and the specific methods the student-therapist uses to begin to establish this working relationship.

According to Minuchin and Fishman, creating this alliance is “more an attitude than a technique” (1981, p. 31). I discovered when I took a college-level modern dance class that the word attitude is used in reference to position. How a dancer holds his hands, his head or feet (position) relative to the body influences the fluidity (flow or progression) of the dance. For the therapist, alliance is also about position or how a therapist views and “holds” the problem in the beginning and through-out the process of working with their client(s). Central to the process is the therapists’ personal work to understand and adapt to the clients’ experience of their lives. Therapists must challenge their own assumptions, expand their lens of compassion and heightened their understanding of the problem by being curious about their client’s own perception of the problem.

Acknowledging that “The family is the natural context for both growth and healing” (Minuchin & Fishman, 1981, p. 11) and then utilizing this context, allows the therapist to join the family’s process of growth and healing. Adapting to the family perception of the problem and the family process of healing allows the therapist to rely less on the therapist’s expertise to solve the family problems and more on the family’s experience. Although the therapist participates in the process, the process is dependent on the clients’ readiness, willingness and ability; qualities that influence the client(s) active participation and autonomy towards change. The research as noted in Duncan, B. & Miller, S., Sparks, J. (2000) The heroic client, that “the quality of the patient’s participation in therapy stands out as the most important determinant of outcome” (Orlinsky, Grawe, & Parks, 1994, p. 361) reinforces the importance of the client’s initial investment in the solution.

The therapist must not resign him/herself to a passive role however, he/she “must be comfortable with different levels of involvement” (Minuchin & Fishman, 1981, p.31) and remain fluid (flexible) during the therapy process by adapting the process as the clients vacillate between change and the “status quo.” The therapist adapts his/her participation to create a complementary exchange (Nichols & Schwartz, 2008) which challenges and encourages the client to continue involvement in the process towards change. Minuchin reported that ‘whenever a therapist can be helpful to a patient, he also likes that patient (1981, p.41). This mutual admiration further encourages the client/therapist complementary exchange and allows for the therapist to “join” (Minuchin & Fishman, 1981, p. 31) the process. Minuchin and Fishman’s definition of joining; “letting the family know that the therapist understands them and is working with and for them” (1981, p. 31-32) through the process of “listening, understanding, validating and empathizing” (Nelson, 2008) reinforces successful interaction between the client and the therapist by communicating to the client the therapist’s mutual investment in their process.

The methods of creating a safe environment, regulating my anxiety and eliciting the client’s story are used to begin to establish a working relationship that supports the therapeutic alliance. The work to create a warm, accepting and supportive (safe, non-threatening) environment includes creating a visually and physically welcoming (safe) environment and regulating my anxiety. Initial questions in the process of therapy orientate the therapist to the clients’ context and illustrates the importance of the process of “listening, understanding, validating and empathizing” (Nelson, 2008) to the continued work of building the alliance.

To create a visually and physically welcoming (safe) environment to begin to establish my working relationship, I first scan the room and consider the visual first impression of the room. Are there items present that might create a visual distraction such as trash, inappropriate signage, or items intended for storage stacked haphazardly around the room? If so, I safely and immediately remove, organize or properly store those items. Next, I step back and look at the organization of the furniture in the room and ask, “Will the room comfortably accommodate the client(s)?” Once I have determined that the room size and furniture will comfortably accommodate the client(s), I look for hazards. “Are there broken fixtures, furniture, etc., that might create a physically unsafe environment?” I also look for items that will provide for client comfort. “Are their tissues, adequate supplies for activities, etc?” “Is the lighting adequate?” Is it too glaring?” Once I am confident that I have created a visually and physically welcoming (safe) environment, I can consider the next step: regulating my anxiety.

To create and maintain a calm demeanor (and continue the establishment of a safe environment) is to evaluate and regulate my personal internal process which includes the regulation of my anxiety. A new client will stir a level of anxiety that a returning client does not stir. As indicated during a class lecture by Dr. Jennifer Nelson (2008), as student-therapists, “we have to train ourselves to know what we are feeling and to regulate those feelings.” My awareness of my anxiety response to new situations allows for me to prepare in advance for the first meeting through acknowledging my fear of the unknown (new) and regulating my anxiety. This is particularly important because fear will “influence our emotions, behaviors, or perception directly” (Class Lecture 2008, Siegel, 2001). This refers back to taking an position (attitude) of joining when treating our clients. If I am anxious it is because I perceive a threat (Nelson, J. 2008) and left unchecked, I will respond to my client(s) as though they are presenting a threat. In the same manner that I must clear the room of any hazardous items; I must clear the emotional atmosphere from positions (attitudes) that could result in harm to my client’s state of mind by unintentionally communicating rejection or disgust. Once the client feels an initial sense of safety and acceptance there are specific questions I ask to continue to build this working relationship.

Initiating questions in the process of therapy orientate the therapist to the clients’ context and conveys a sense of acceptance which strengthens the work of building the alliance. “Listening, understanding, validating and empathizing” (Nelson, 2008) provides opportunity for the therapist to connect and re-connect with the client as their story unfolds. Minuchin supports this notion by suggesting that the “therapist joins and joins again many times during a session and during the course of therapy” (Minuchin & Fishman, 1981, p.49) and it is this “joining” (1981, p.49) that “changes things (1981, p.49).”

One such question I use to engage the client in the process is to ask the client to “tell me something important” about him/herself. This question allows for an informal assessment of what the client(s) think of their individual importance or the importance of their individual concerns. My experience is that the client, who is highly anxious about the client/therapist relationship, will immediately begin with the definition of the problem. This response will provide me with a sense of where to meet the client in the process of therapy and help to assuage any initial concerns or questions. Specific things I do to handle these initial concerns, are to assess the client(s) immediate need and take a variety of “joining positions” (Minuchin & Fishman, 1981, p. 33). If I observe (assess) that the client(s) feels threatened and becomes defensive I work to take a “close” (Minuchin & Fishman, 1981, p.33) though provisional, position. This may be done in the form of short-lived “coalition” or “confirmation” (Minuchin & Fishman, 1981, p. 33) where I validate the individual’s reality. If the client(s) complaint is that they do not feel heard, I choose a “median” (Minuchin & Fishman, 1981, p. 34) position and join “as an active listener” (Minuchin & Fishman, 1981, p. 34) and help the individual to “tell their story” (Minuchin & Fishman, 1981, p. 34) by asking them to “tell me more.” My hope is that in reducing the remaining fear or doubt in the process will clear the path for establishing an alliance.

Client(s) less anxious about the relationship can invest in the process of change and will respond on a more personal level with information about their family history, occupation, hobbies, talents, passions, etc.. This response indicates their readiness, willingness and ability to integrate and interact in the therapeutic process. This allows the construction of personalized metaphors through-out the session which forms a connection to the client’s sense of self, thus deepening the quality of the joining.

This question of “importance” is posed to each individual present at the session. It is crucial that everyone involved and available contribute to the community identity in light of Minuchin’s assertion that “the identified patient is only the symptom bearer” (Minuchin, 1981, p.28). This assertion implies that there exists a context of the family that has generated the presenting symptoms. To ask a family member to reveal something “important’ allows for an opportunity for individual to communicate information that might not have been known or acknowledged in previous conversations. This allows the therapist to join the family through facilitating the process of communication thus facilitating the interactions and relationships. Dysfunctional family transactions (Minuchin & Fishman, 1981) often involve a surface level communication. This specific question provides opportunity for “healing” (Minuchin & Fishman, 1981, p.28) by “changing those dysfunctional family transactions (Minuchin & Fishman, 1981, p. 28) by facilitating “deeper” more meaningful communication (transactions).

Often, if there are minor siblings, I will ask the youngest individual in the family to define “the problem” because it has been my experience that they are less inhibited to being direct. This also provides the simplest definition of the presenting problem and informs the student-therapist of generational boundary breaches. If it is necessary for the presenting problem to be articulated in more detail because the youngest is unable to define “the problem” I will ask the oldest individual. Often a conversation between the two siblings is initiated and I work to encourage the process of interaction. Because “family therapist tend to underutilize sibling contexts and overuse therapeutic designs” (Minuchin & Fishman, 1981, p. 19) it is important to engage the sibling interaction to assess “the problem” and identify the emerging patterns of family interaction.

Two specific factors that I attend to in my initial sessions that begin to establish a working relationship and support the therapeutic alliance through the process of “listening, understanding, validating and empathizing” (Nelson, 2008) and impact subsequent work, is the client’s body language and the client’s perspective within the therapeutic context.

The first factor of body language is significant to the dialogue between the client and the therapist. Body language creates a picture and is a form of expression when words are not adequate. For adults and adolescents there are limits on the use of expressive language. Whether those limits are imposed by the relationship or individual development, they exist. Therapist can glean valuable information from the client’s body language. For instance, if an individual has expectations that are neither expressed nor met, they may express their experience as one of boredom which can be “a mask for frustration and anger” (Nelson, J. 2008). This awareness impacts and slows the “pace” of therapy by providing an opportunity for the therapist to “pause” (Nelson, J. 2008) the session and be curious around the emerging emotion. In order to understand the individual’s expression through body language requires this “pausing” of the process. This pause also allows the client space to become aware and then identify their individual experience and process of expression. This allows both the client and the therapist an opportunity to understand one another in a more meaningful way, thus strengthening the “joining” process.

The second factor I attend to in the initial sessions is the client’s perspective within the therapeutic context or their attitude about therapy. Their attitude directly affects their level of participation and openness. Is the therapist considered “the expert” or “the enemy?” My experience is that the client, who is highly anxious about the client/therapist relationship, will feel “threatened.” Understanding the client’s attitude provides me with a sense of where to meet the client in the process of therapy. Specifically, I “join” (Minuchin & Fishman, 1981) the client. As stated previously if I observe that the client(s) feels threatened and becomes defensive I work to take a “close” (Minuchin & Fishman, 1981, p.33) though provisional, position. This may be done in the form of short-lived “coalition” or “confirmation” (Minuchin & Fishman, 1981, p. 33) where I validate the individual’s reality. If the client(s) complaint is that they do not feel heard, I choose a “median” (Minuchin & Fishman, 1981, p. 34) position and join “as an active listener” (Minuchin & Fishman, 1981, p. 34) and help the individual to “tell their story” (Minuchin & Fishman, 1981, p. 34) by asking them to “tell me more.” Again, my hope is that in reducing the remaining fear or doubt in the process will clear the path for establishing an alliance.

In summary, I begin to establish a working relationship that supports the therapeutic alliance through the process of “listening, understanding, validating and empathizing” (Nelson, 2008) and through the methods of creating a safe environment which includes regulating my anxiety and eliciting the client’s story which then reinforces and communicates acceptance and joining.

References
Duncan, B. & Miller, S., Sparks, J. (2000). The heroic client. San Francisco: Jossey-Bass

Miller, W.R. & Rollnick, S. (2002). Motivational interviewing. New York: Guilford Press.

Minuchin, S. (1974). Families and family therapy. Cambridge: Harvard University Press.

Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge: Harvard University Press.

Nelson, T. (Fall 2008). Clinical Foundations I. Class Lecture. Lenexa KS.

Nichols, M.P., Schwartz, R.C. (2008). Family Therapy: Concepts and Methods (8th Ed.). Boston: Allyn & Bacon.

Personal Integration of Therapeutic Models/Approaches

Orientation by Therapeutic Model/Approach
As my work with clients continued, my awareness of the complexity of family interactions grew. An integrative model of therapy helps to unravel the growing “complexities.” My working model builds on the foundation of Murray Bowen’s perception of the family as “an emotional unit” (Nichols & Schwartz, 2008), the process of family projection and of multigenerational transmission joined by the developmental structure for “healthy family functioning” (Doherty, Colangelo & Hovander, 1991) as organized by the Fundamental Interpersonal Relations Orientation (FIRO) model (Schutz, 1958). The model then integrates the empowering perspective of the client as upheld by Motivational Interviewing (Miller & Rollnick, 2002), and the defining tasks as arranged through the “experiential” threads of Emotion-Focused and Internal Family Systems theories. My chosen process of therapy attempts to reach beyond the previous “one-size-fits-all” mentality (Nichols & Schwartz, 2008) respond to the complexities of family interactions and improve the belief and practice that formerly isolated and focused on the individual and individual behavior.

The Family as a System
Murray Bowen’s (1978) theory that the family was an “emotional system” (Walsh, 2003) viewed the functioning of the individual within the context of family (Nichols & Schwartz, 2008). Carter and McGoldrick (2001) clarified the individual’s functioning as the “differentiation of self in relation to others” (Walsh, 2003). “Differentiation” allowed an individual member of the system choice in both giving and allowing “influence” to familial, cultural and social “others” (Walsh, 2003). The therapist coached the client to “gather information, gain new perspectives on key family members and patterns to then redevelop relationships” (Walsh, 2003).

The Developmental Structure of FIRO
With the family system in place, a structure for this system must be defined. The Fundamental Interpersonal relations Orientation (FIRO) model first introduced by William Schutz (1958) and later expanded by Doherty, Colangelo & Hovander (1991) provides that developmental structureof my model. The three core domains of Fundamental Interpersonal Relations Orientation (FIRO) theory: inclusion, control and intimacy, provide a developmental structure for healthy family functioning (Doherty, Colangelo & Hovander, 1991). The first domain of inclusion refers to the “interactions that relate to bonding and organization within the family system” (Doherty, Colangelo & Hovander, 1991). The “three subcategories” (Doherty, Colangelo & Hovander, 1991) of this domain include; “structure, connectedness, and shared meaning” (Doherty, Colangelo & Hovander, 1991).

The second domain of control refers to “interactions that relate to influence and power exertion during family conflict” (Doherty, Colangelo & Hovander, 1991). The subcategories of this domain include; dominating, reactive, and collaborative interactions. The third and final domain of intimacy refers to interactions related to “open self-disclosure and close personal exchanges” (Doherty, Colangelo & Hovander, 1991) or the “depth” of interactions. This “depth” involves a “mutual sharing of feelings; relating to one another as unique personalities; sharing vulnerabilities” (Doherty, Colangelo & Hovander, 1991) and in couple relationship “sharing emotionally close sexual interactions” (Doherty, Colangelo & Hovander, 1991).

FIRO recognizes that when a family experiences “life-cycle transitions or major, ongoing stressful events, they must create new patterns” (Doherty, Colangelo & Hovander, 1991). FIRO suggests that first addressing categories of inclusion, then issues of control and finally issues of intimacy is the “optimal sequence for managing major family change” (Doherty, Colangelo & Hovander, 1991). This sequence informs my assessment process as I sit with clients during conflict providing guidelines on which domain(s) the task of “creating new patterns” begins and how to then proceed with the family. I utilized FIRO’s developmental structure to understand where in the family structure my clients are “stuck” (Miller & Rollnick, 2002) and work to move forward from that point.

Motivational Interviewing
In order to move forward, the perceptions of Motivational Interviewing provides the vigor by recognizing the client as the source of energy behind change. This energy is captured by my acknowledgment and treatment of the client as such. This “facilitates the natural process of change” (Miller & Rollnick, 2002) as envisioned by the client.

Motivational Interviewing (MI) is an “evidence based approached (Miller & Rollnick, 2002)” developed by William Miller and Stephen Rollnick (2002) that provides the therapist with a helpful, healthy perspective of the client. Motivational interviewing is both client-focused and draws on the client’s own perceptions and strength and recognizes that clients present in therapy at different stages of change (Miller & Rollnick, 2002).

Motivational interviewing is based upon four general principles (Miller & Rollnick, 2002). The first is the therapist’s “expression of empathy” (Miller & Rollnick, 2002) for the client through “empathetic listening”. The second principle is the development of discrepancy between how the client wants to “live their lives” (Miller & Rollnick, 2002) versus how the client currently lives. The final two principles ask that the therapist “roll” with the client’s resistance and support their “self-efficacy” (Miller & Rollnick, 2002). The primary goals of motivational interviewing are to encourage client collaboration with the therapist, elicit the clients own “perception, goals and values” (Miller & Rollnick, 2002) for their lives, and support client autonomy (Miller & Rollnick, 2002). In the process of therapy, once the family system has been acknowledged, the structure for development established and the perspective of approach is clarified, the tasks of therapy must be determined. The experiential threads of Emotion-Focused and Internal Family Systems theories have determined those tasks for my work with clients.

The Experiential Threads
I chose the experiential theories of Emotion-Focused and Internal Family Systems to influence my current work because of their connection and ability to translate Bowen’s Family System Theory Schutz’s (1958) Fundamental Interpersonal Relations Orientation (FIRO) model and Miller and Rollnick’s (2002) Motivational Interviewing in a way that is relevant to the clients’ experience.

Emotion-Focused
Emotion-focused therapy, (EFT), championed by both Les Greenberg and Susan Johnson, supports Bowen’s view of the family as an “emotional unit” (Nichols & Schwartz, 2008). EFT integrated Bowlby’s ‘basic tenets of attachment theory, (Johnson, 2004) and viewed marital distress as the result of an attachment wound that created “negative affect.” This “negative affect” impacts the organization and processing of their “emotional experiences” (Johnson, 2004) and resulted in “rigid structured patterns of interaction” (Johnson, 2004). EFT recognizes that the problem behaviors are a response to a perceived past and/or present threat that creates distress. The distress is maintained through these rigid “patterns” intended to protect the relationship.

Distressed families perceive there is a threat to their structure and attempt to control the other by controlling the response or behavior that “triggers” the fear of abandonment or connection. This theory connects to the first FIRO domain of inclusion that refers to the “interactions that relate to bonding and organization within the family system” (Doherty, Colangelo & Hovander, 1991). EFT addresses the domain of inclusion by addressing the attachment concerns and fostering the formation of a secure bond.

The key concept of EFT is the awareness of a continuous “emotional state” (Nelson, 2008) that informs our response to our experiences. The tendency is to “turn away” and/or “turn against” those “uncomfy” (Nelson, J., 2008) emotional experiences and results in a general lack of awareness on how these historical, “hidden emotions” (Johnson & Whiffen, 2003) and patterns, inform our current behavior and decision-making processes. This detachment increases the isolation and the individual sense of “abandonment and rejection” and intensifies the distress. The statement that “We cannot detach from our feelings or we cannot attach to people (Nelson, 2008),” illustrates the double-bind in which many families find themselves. They want intimacy, but this requires that they turn towards their “uncomfy” (Nelson, 2008) experiences and emotions and that of others. Emotion-focused therapy facilitates the reprocessing and expansion of the emotional experiences, fosters positive affect and sentiment and creates new interactional patterns (Johnson, 2004) from a “secure base” (Johnson, 2004).

Internal Family Systems
Internal family systems (IFS) developed by Richard Schwartz another experiential model also focuses on the productive nature of relationships through the development of a “secure” base. This model defines the secure base as the “healthy self” (Schwartz, 2010). This “healthy self” (Schwartz, 2010) is part of the internal system that then impacts the “external system” (Schwartz, 2010). The internal system creates “subdivisions” (Schwartz, 2010) of its self or “parts” (Schwartz, 2010) in response to “attachment injuries” (Johnson, 2004). IFS highlights that if there are changes in the “internal system those changes will affect changes in the external system” (Schwartz, 2010). This approach informs my work by acknowledging and empowering the contribution each individual has on the creation and maintenance of the family system.

Conclusion
All three approaches integrate the “internal (emotional, physiological and mental) processes” of the clients and encourage mutual curiosity into the “origins” of their “patterns of interactions.” This shared curiosity forms a collaboration between the client and the therapist that facilitates the initiation of new “patterns” that are “useful and lead to preferred outcomes” (Nichols & Schwartz, 2008). The models emphasize “the role of language” (Nichols & Schwartz, 2008) and reinforce the idea that the clients’ historical perceptions of internal (emotional, physiological and mental) processes greatly influence the current external behavior (reactions and responses), and can be “recreated” or “reframed” to benefit the family system’s overall functioning.

Personal Integration of Therapeutic Models/Approaches

The Genogram
Murray Bowen’s (1978) theory that the family was an “emotional system” (Walsh, 2003) informs my work when clients present in therapy. As the client tells their story I work to view each individual’s functioning within the context of family. I listen to how the individual is influenced by familial, cultural and social “others.”
I am able to accomplish this goal through the use of the genogram paired with a simple timeline. Through the use of this combination I am able to gather information about the family history. This history reveals “patterns” that emerge in the collection of general information related to the parents and grandparents including, age, marital status, siblings and sibling position, health issues, deaths and status of relationships. I am then able to connect this key information through a simple timeline, assessing the impact of these events through the context of family. The genogram can also expose the kinds of stressors (drug use/abuse, childhood trauma, violence, financial) a family has encountered. With the family system drawn out, the genogram also helps to elicit information on which domain in the family system the work should begin. The genogram can elicit information on “who’s in and who’s out” of the family structure, who holds the power and where there are “emotional’ cut-offs and lack of “intamcy.”

Drawing out this information on paper helps the family view the system in a way they have probably never attended to before therapy. I am able to then coach the client to “gather information, gain new perspectives on key family members and patterns to then redevelop relationships” (Walsh, 2003).

Tracking
Tracking, a technique defined by structural family therapists Minuchin and Fishman (1981) as an essential part of the therapist's joining process with the family allows the therapist to be become a part of the family system (inclusion). During the tracking process I listen to the language in the family’s story and connect the pieces to the events and their sequence uncovered during the process of mapping the genogram. Through tracking, I am able to identify the dominating pattern of relating that has the clients “stuck,” access the client’s language around the “problem,” and gather information on how the client wishes to change. To externalize the dominating pattern and provide the clients with a tangible perspective on these patterns I use another technique that was developed during the Mental Research Institute’s research on communication feedback loops.

Mental Research Institute Recursive Cycle
The Mental Research Institute’s communication assessment model although a technique of strategic therapy (Nichols & Schwartz, 2008) is useful in externalizing the “problem pattern.” This can be accomplished by mapping out the MRI recursive cycle. Externalization will help to define the problem and identify the attempts of the members to solve that problem. This will also reveal how the “problem pattern” is maintained and the client’s unique language in defining the problem. The objective is to use the clients language as a way of seeing their crisis and reframing it in a way that is meaningful to them. (Nichols & Schwartz, 2008). This can also provide insight into who in the family has influence and power and how it is exerted during family conflict (Doherty, Colangelo & Hovander, 1991) addressing FIRO’s second domain of control and influence. Externalization also reveals the reactive interactions as the drawing out of the “internal family’ system as developed by Richard Schwartz.

Mapping the Internal Family System
There are several methods to illustrating the structure of the internal family system.

Reframing
Most family therapists use reframing as a method to both join with the family and offer a different perspective on presenting problems. Specifically, reframing involves taking something out of its logical class and placing it in another category (Sherman & Fredman, 1986). For example, a mother's repeated questioning of her daughter's behavior after a date can be seen as genuine caring and concern rather than that of a non-trusting parent. Through reframing, a negative often can be reframed into a positive. The methods described above allows for the “externalization” of the problem.

Summary
As my work with clients continues, my intent is to develop my process of therapy to reach beyond the previous “one-size-fits-all” mentality (Nichols & Schwartz, 2008) and to respond to the complexities of family interactions and improve the belief and practice that formerly isolated and focused on the individual and individual behavior. My continued application of an integrative and flexible model of therapy built on the foundation of Murray Bowen’s perception of the family as “an emotional unit” (Nichols & Schwartz, 2008), joined by the developmental structure for “healthy family functioning” (Doherty, Colangelo & Hovander, 1991) as organized by the Fundamental Interpersonal Relations Orientation (FIRO) model (Schutz, 1958), the empowering perspective of the client as upheld by Motivational Interviewing (Miller & Rollnick, 2002), and the defining tasks as arranged through the “experiential” threads of Emotion-Focused and Internal Family Systems theories which considers the growing “complexities” of the family will facilitate help and healing to my clients in a meaningful and powerful way.

References
Brock, G., & Barnard, C. (1999). Procedures in Marital and Family Therapy, 3rd Edition. New York: Guilford Press.

Doherty, W.J., Colangelo, N., Hovander, D., 1991. Priority setting in family change and clinical practice: The family FIRO model, Family Process, 30:227-240, 1991.

Duncan, B, & Miller, S. (2000). The heroic client. San Francisco: Jossey-Bass

Habben, C., Nelson, J., & Nelson, T. (Fall 2008). Foundations of marriage and family therapy. Class Lecture. Lenexa, KS.

Johnson, S. & Whiffen, V. (Eds.) (2003). Attachment processes in couple and family therapy. New York: The Guilford Press.

Johnson, S. (2004). The practice of emotionally focused couple therapy. Brunner-Routledge: New York.

Kerr, M. (1988, Sep). Chronic anxiety and defining self. The Atlantic Monthly, pp. 35-58.

McGoldrick, M. & Gerson, R., Petry, S. (2008). Genograms: Assessment and Intervention (3rd ed.). New York: W.W. Norton & Co.

Miller, W.R. & Rollnick, S. (2002). Motivational interviewing. New York: Guilford Press.

Nelson, J. (Fall 2008). Emotion, Attachment, Trauma. Class Lecture. Retrieved from Lecture Notes dated 9/11/2008. Lenexa, KS.

Nelson, J. (Fall 2009). Clinical Foundations II. Group Lecture. Lenexa KS.

Nelson, J., Nelson, T. (Spring 2009). Eliciting Client Stories. Class Lecture. Retrieved from Lecture Notes dated 02/03/2009 Lenexa, KS.

Nelson, T. (Fall 2008). Clinical Foundations I. Class Lecture. Lenexa KS.

Nelson, T. (Fall 2009) Postmodern Therapeutic Approaches. Class Lecture. Retrieved from Lecture Notes dated 12/03/2009. Lenexa KS.

Nichols, M.P., Schwartz, R.C. (2008). Family Therapy: Concepts and Methods (8th Ed.). Boston: Allyn & Bacon.

Perry, B. & Szalavitz, M. (2006). The boy who was raised as a dog. New York: Basic Books.

Schwartz, R., (2010, May 7). The internal family system model outline. The Center for Self Leadership Website. Retrieved from http://www.selfleadership.org/node/7284

Demonstration of "The Transformative Journey"

This component of the portfolio serves as a summary the personal transformative journey of the last two years including the program of studies and the required 15 month clinical internship. Included in this section are four domains of personal and professional change: 1.) “Transcription of Session Segments” which gives a brief and actual description of the student’s clinical approach; 2.) “Working Model Response to Difference in Clinical Practice” which gives a overview of the student’s priority given to client differences; 3.) “Summary of Clinical Learning” which identifies the student’s perceived clinical strengths and weaknesses; and, 4.) ‘Summary of “Transformative Learning”’ which is a personal overview of how these last two years has resulted in personally important changes.

Transcription of Session Segments
With this section of the portfolio, the student provides a word-for-word transcription of videotaped therapeutic interactions. This includes notations of any relevant nonverbal/analogic communication on the part of the client or therapist (such as head nodding, tears, changing seats, leaving the room, etc.). All transcripts are fully de-identified. The student may use false names or descriptors such as “mom” or “son”. Any mentioned information that could identify a client(s) such as place of employment, street address, or name of church (as examples), are altered or shown as an “XXX” in the transcript.

Working Model Response to Difference in Clinical Practice
The purpose of this domain is to provide a demonstration of the student’s values and clinical approach to the important issue of client difference. This important outcome paper identifies three core contextual factors impacting the therapeutic process, how the student addresses these factors in the dynamic flow of treatment, and, lastly, how ongoing growth and learning will be a part of the student’s future practice.

Summary of clinical learning
As the clinical internship component of the MSFT program concludes, the student provides a brief reflection of learning specific to clinical skill development. This typically includes a description of the student’s present sense of strengths and weaknesses as a student therapist.

Summary of “transformative learning” through the MSFT program
Upon entering the MSFT program, the upcoming two years of continuous study and training is described as a “transformative journey.” This brief statement is written by the student to provide a brief yet personal description of the transformative learning and change now recognized by the student as the program concludes (self of the therapist).

Transcription of Session Segments

CLINICAL DEMONSTRATION

Family Background and Family Genogram
The family was referred by the 24 year old married daughter who lives and attends college in Chicago. The family consists of the father who is a 57 year Caucasian male who has been married for 30 years to a 57 year old Caucasian female. They also have a 19 year old son who attends college in Lawrence, Kansas. Both adult children are attending college and live away from home. The parents are struggling financially and they have begun the process of filing for bankruptcy. This has proven to be a source of increase stress and tension in the family.

Session Transcription Saturday, May 15th, 2010.
Client(s): 210.0054 Start Time: 9:09 End Time: 9:21
2nd Session Assessment Phase

Description of Therapeutic Content: This section of the video illustrates the process of continuing the alliance established during the first meeting, by eliciting their story and their experience and definition of “the problem.”

Goal: The goal of the session is to continue building an alliance with the clients, assess their motivation and elicit the client’s definition of “the problem.”

Rationale: The selected segment demonstrates my skills and techniques in assessing the family’s “readiness, willingness and ability” to do the work.
Session Description: The segment of video is during the couple’s second session which continues the assessment and joining phase of therapy.
Session Information: The therapist has welcomes the clients back to therapy and asks about their experience of the first session.

Segment begins: 9:09

Therapist: Well, Thank you for coming back. Tell me how last week went after sitting in therapy? What did you think?

She: Um (sighs) when (our daughter) set it up I thought it was gonna be a onetime deal, so I was really surprised when we were talking about doing more sessions.

Therapist: Okay. Process: this statement makes me curious because their daughter has returned to Chicago and they kept their appointment.

She: …because she talked to him (looks at husband) and he said she set up a session for us, so, I thought it was going to be a one-time deal. So, I think she… I think what she wants from it… I’m putting words in her mouth probably, but, I think what she wants from it, is for us to change our ways… as far as the whole financial thing, so…

He: (clears throat) Yea, she’s the… she’s the Dave Ramsey guru.

Therapist: Okay. (The daughter has influence. Dave Ramsey comment appears to be a half-compliment)

He: Yea, I mean it’s kind of… and I mean obviously she’s watched us over time… and I said something to her about it… how’s (our daughter), her husband, feeling about it? She said, “We both weren’t that surprised. We kind of saw it … we saw it coming.” I said, “fine.” “…because everyone else tells us they saw it coming.” I said, “I’m glad you did because… um”

She: Well, we just kept… Process : Wife continues to look at husband, husband doesn’t seem to notice her glancing at him, but is turned towards me.

He: We just kept thinking we could…

She: thinking we could…

He: work our way through it.

She: Yea, but anyway, um… it was… you know it was fine. We… I guess there were a couple things I thought was interesting (our son)’s… he was just like I knew he’d be (laughter)…

Therapist: How’s that? Process: They finish one another’s sentences and thoughts.

She: Stoic.

Therapist: Okay. Process: Waiting for them to tell me more.

He: And...

She: You know… “I’m not bothered. I’m fine. I’m fine.”

He: “I’m fine. I’m fine. I’m fine. I don’t need…Thanks for the money.”

She: (laughing) Process: Her laughter seems more of a nervous laughter. They appear to be dismissing their children in an indirect way.

He: That’s uh…um, you know, I think a portion of it is (our daughter) does like to fix things…

Therapist: Okay. Process: Waiting for them to tell me more.

He: …and she…I think she…since she’s going into this field. Uh, I see some problems when she isn’t going to be able to push her way around in order to… “I said!” (pounds couch) you know…um, after we got back …like it’s a Saturday afternoon she came up when I was do…fixing doing laundry and taking care of some stuff and she said, “Why don’t you come down and have a beer with your kids?” Which is fine, I figured okay, I’m being set up for something.

Therapist: Okay. Process: Daughter is in the field of therapy, he isn’t quite convinced she knows what she is doing. Waiting for them to tell me more.

He: So, I said, “Well, let’s go on the deck.” And she goes, “Oh, it’s too cold out there.” I said, “It’s where I feel comfortable when I’m yakking and talking.” So, we went out there and set out a couple of chairs and (our son) was sitting there and lasted about two and a half minutes before he went over on the trampoline, which is… he hasn’t been on in years. And I’m like okay, so, he doesn’t want to be any part of this.

She: Yea.

He: …and (our daughter)’s like trying to convince me that I need to change jobs and you know that I should do this and I should do that and I should do all these types of things and I said, “Sweetheart, I’m 57 years old, tell me where I’m going to go and say, “Hi, I need to be …come in on a entry level of some type or other at such a salary?” I said,” those things don’t exist in a lot of...”

She: But she has a good point because if you keep making the checks you make, January, February, March…you are the eternal optimist…

Process: A pattern of communicating is emerging. They both communicate through their children. She is defending her daughter’s position.
He: I know.

She: … you keep making the checks that you made then…

He: Uh huh.

She: …we

He: Yeah

She: …this…even the bankruptcy’s not gonna help. So, she has a point.

He: I know.

She: So, you got… you can’t just blow her off…her ideas off… I mean…

He: Um.

She: …she’s got a point (clears throat) that this just… I mean… you know… this just isn’t working. And as hard as you try… it…a lot of people try things and it doesn’t always work....and so, I… I definitely understand where she’s coming from.

He: We took a credit counseling online thing yesterday which is a requirement before you can file bankruptcy. And you know…we were on it …hour and a half or something like that but…and it comes out sort of like, “You’re spending too much on your …on your dog… but you know you could possibly take a look and see if you can (chuckles) give your dog, you know…to another family member that will be more able … able to handle… to take care of it type of stuff and um…you know, you’re spending too much on food you should…you know, you should make all meals at home and take your …take lunch. You know and… I mean, it’s all very good ideas, but, it’s um… Process: He continues to dismiss and disregard any alternate suggestions.

She: Really, what we need to do is make more money.

He: Yeah, basically, basically it’s a money issue, you know? Um, it’s an income…it’s an income issue. Um…and we let …we let the debt take over and control us, so that’s…

Therapist: May I ask how long ago the debt began to kind of overwhelm you? How many years has that been? Process: Wanting a timeline when they recognized this was first a problem. How long have they been able to do this avoidance dance?

She: Oh, it’s been a long time. I mean, we…we had this, um, inherited IRA from my aunt and uncle

Therapist: Uh huh. Process: Waiting for them to tell me more.

She: … that we would pull from so when we …when we needed to. And so, there was kind of always that steady …um, well, we pull it out…we’ll pull you know, 5,000 dollars out to help pay for this and that…

Therapist: Okay. Alright, Process: Waiting for them to tell me more.

She: … and somewhere around two years ago, I suddenly realized that there wasn’t that much left and that’s uh, I remember that…that first weekend when I suddenly started just feeling totally overwhelmed.

Therapist: Okay. Process: Waiting for them to tell me more.

She: …and, I remember we went out to eat and I couldn’t eat… stomach just … you know… I just remember that first weekend…when I … just like suddenly it hit me, “You are going to run out of money!”

Therapist: Uh huh. Process: Husband is sitting back with his arms folded. He doesn’t look at her nor appear surprised at her revelation.

She: (clears throat) and um, so I would say for me it’s been a couple years.

Therapist: Okay.

She: But, I… (turns and points to husband) and here’s …here’s part of the problem! I pay the…what I call the family bills.

Therapist: Alright. Process: He doesn’t look surprised at her revelation. He lowers his head, but continues to sit back with his arms folded.

She: ...the gas, heat… anything to do with the house, the gasoline, blah, blah, blah. He would do his business bills.

Therapist: Okay.

She: He never really let me in - on what was going on

He: True. Process: He validates her statement and accepts the blame without protest.

She: so most of the … most of the charge card debt is his and it has to do with trying to keep his business going.

Therapist: Okay.

She: And I kept…I, being stupid and trying to save myself some stress (laughs) kept thinking he was dealing with it, that he was doing okay, kind of trying to put the curtain there

Therapist: um huh Process: She attacks him and defends herself. Same scenario when it came to the question of why she is in therapy. She doesn’t want to accept the responsibility directly for her experience.

She: so I wouldn’t see it. I mean, I would ask him. I’d say “we need to look at this,” he’d say “okay” and then it never got done. So you know I could have pushed more. I could have… I knew he was getting phone calls, “oh, you’re late on your payment.” So, I mean I could have… I could have pushed more, but, he really… he didn’t let me open any of his bills. He’d get mad if I opened his bills. He just kept it all from me, for the most part. So, he’s …you know.

He: I’m the one who’s responsible for it.

She: No, not all of it! Process: He accepts the blame and then she withdraws the attack.
He: Well, be honest, because I kept thinking I could make it go. And here, you know I had… I had a lease. So, it’s you know, it’s, um, you know, if I break a lease you are going be in for that. You know, You’re going to rip up your business as it is which is a big portion of what’s affected the short term.

Therapist: Um huh. Process: Not wanting to interfere with the process. Wanting to see more of the pattern.

He: Um, you know and I just…

She: There’s a very, very old, um, poem, article, something, letter to Ann Landers back probably 20 years ago that we saved about a salesman. And I save it … can’t hardly read it anymore but it’s about how they always think that they can do it. They can make the sale. They…they always think if they do this, if they change this, they can make the sale. And I kept it because that’s how he is. He al… I …I in ways I admire him because the… the ways the company has changed… and the jerky people that have taken over it at different times and the way they’ve run the business and he always dealing with this stuff that anybody else would have said, “you guys are crazy, I’m out of here!” And he’s kept, you know, trying to make it work, trying to, you know, back when he…when he first started, he had two…two different months where he got paychecks that were 10,000 dollars, now that was twenty four or five years ago,

Therapist: um huh. Process: Kick and a Kiss! She attacks him and then covers her track with sentiment to soften the impact?

She: you know, um…

He: even, even in 1999 it was about then, about the time…about the time, you know Holly was killed or something like that. Process: He skims over that detail. There is not a Holly in the family genogram. I will put that question on hold because the story unfolding seems to be more impactful than the death.

He: Um, you know, my second cousin who‘s a doctor and he said something about, “are you okay on this?” and I said, “well, you know if I was making six figures,” and he looked “whoa, okay, yea!” And then he kept introducing us to everybody else as an entrepreneur.” And I said “No, I’m not I’m a sales a person. You know. Um, you always, I mean, you always think if you fix it, you know, if you can get them…get them to see what your… what your program is and follow it and when you see somebody succeed with that and you know it’s possible… then you’re like “okay, what’s it going to take for me to get this one in that…in that position?” And you just can’t give up. You just can’t. Um…so…

Process: Language. Where have I heard the word “fix?” I’d like to go towards that because of the connection to a family pattern.

Therapist: So…I heard some interesting um, when we were talking about (your daughter) that she hopes that she can fix it … she’s always trying to fix things and then I hear you saying you know…you just hope that it’s going to be fixed.

She: (laughter and claps)

Therapist: And So, I’m curious who (your daughter) is most like?

She: (continues laughter)

Therapist: …and then in the same manner I hear that (your son) is the stoic. Process: I want both of them to make a crucial family connection to the interaction pattern emerging.

She: Um huh. (She stops laughing and appears thoughtful)

Therapist: … and who is he most like? Process: Waiting for them to tell me more.

She: Probably. Process: I looked towards her and she probably thought I was indicating her.

Therapist: and what is interesting um, is that we’re going to look at a genogram today which then helps pull out family patterns.

Process: This is an opportunity to gather more family information and build a stronger alliance and provide a valuable tool for therapy.

Segment Ends: 9:21