Dear Author,

Here are the proofs of your article.

• You can submit your corrections online, via e-mail or by fax.

• For online submission please insert your corrections in the online correction form. Alwaysindicate the line number to which the correction refers.

• You can also insert your corrections in the proof PDF and email the annotated PDF.

• For fax submission, please ensure that your corrections are clearly legible. Use a fine blackpen and write the correction in the margin, not too close to the edge of the page.

• Remember to note the journal title, article number, and your name when sending yourresponse via e-mail or fax.

• Check the metadata sheet to make sure that the header information, especially author namesand the corresponding affiliations are correctly shown.

• Check the questions that may have arisen during copy editing and insert your answers/corrections.

• Check that the text is complete and that all figures, tables and their legends are included. Alsocheck the accuracy of special characters, equations, and electronic supplementary material ifapplicable. If necessary refer to the Edited manuscript.

• The publication of inaccurate data such as dosages and units can have serious consequences.Please take particular care that all such details are correct.

• Please do not make changes that involve only matters of style. We have generally introducedforms that follow the journal’s style.Substantial changes in content, e.g., new results, corrected values, title and authorship are notallowed without the approval of the responsible editor. In such a case, please contact theEditorial Office and return his/her consent together with the proof.

• If we do not receive your corrections within 48 hours, we will send you a reminder.

• Your article will be published Online First approximately one week after receipt of yourcorrected proofs. This is the official first publication citable with the DOI. Further changesare, therefore, not possible.

• The printed version will follow in a forthcoming issue.

Please noteAfter online publication, subscribers (personal/institutional) to this journal will have access to thecomplete article via the DOI using the URL: http://dx.doi.org/[DOI].If you would like to know when your article has been published online, take advantage of our freealert service. For registration and further information go to: http://www.link.springer.com.Due to the electronic nature of the procedure, the manuscript and the original figures will only bereturned to you on special request. When you return your corrections, please inform us if you wouldlike to have these documents returned.

Metadata of the article that will be visualized inOnlineFirst

ArticleTitle Training Family Therapists for Working in the SchoolsArticle Sub-Title

Article CopyRight Springer Science+Business Media New York(This will be the copyright line in the final PDF)

Journal Name Contemporary Family Therapy

Corresponding Author Family Name HaberParticle

Given Name RussellSuffix

Division Marriage and Family, Counselor Education Program

Organization University of South Carolina

Address Columbia, SC, 29208, USA

Email russdeuce@bellsouth.net

Author Family Name Cooper-HaberParticle

Given Name KarenSuffix

Division

Organization Family Intervention Services

Address Richland District #2, 7500 Brookfield Road, Columbia, SC, 29206, USA

Email

Schedule

Received

Revised

Accepted

Abstract Historically the schools have not been substantial employers of family therapy professionals. Yet, theissues of school violence and dropout prevention have raised awareness of the need to work with familiesas pro-social deterrents. Since Marriage and Family Therapists are trained to work systemically andproductively with families in many contexts, the next step is to provide new trainees with general andspecific skills for working within the schools where they can activate and connect the resources in thefamily and in the school. The following manuscript describes an overview of how a district-wide MFTprogram trains inexperienced therapists to work in the schools.

Keywords (separated by '-') School-based family therapy - Supervision - Family therapy training - School - Apprentice co-therapy -Live supervision

Footnote Information

UNCORRECTEDPROOF

ORIGINAL PAPER1

2 Training Family Therapists for Working in the Schools

3 Karen Cooper-Haber1 • Russell Haber2

4

5 � Springer Science+Business Media New York 2015

6 Abstract Historically the schools have not been sub-

7 stantial employers of family therapy professionals. Yet, the

8 issues of school violence and dropout prevention have

9 raised awareness of the need to work with families as pro-

10 social deterrents. Since Marriage and Family Therapists are

11 trained to work systemically and productively with families

12 in many contexts, the next step is to provide new trainees

13 with general and specific skills for working within the

14 schools where they can activate and connect the resources

15 in the family and in the school. The following manuscript

16 describes an overview of how a district-wide MFT program

17 trains inexperienced therapists to work in the schools.18

19 Keywords School-based family therapy � Supervision �

20 Family therapy training � School � Apprentice co-therapy �

21 Live supervision

22 Introduction

23 Children spend the majority of their weekdays in school

24 and significantly less time with their families. In many

25 cases, the school and the family are not closely connected;

26 even more the case with those families whose students are

27 experiencing problems and becoming increasingly disen-

28 gaged from the learning process. Nonetheless, there is a

29 significant body of literature that supports the fact that it is

30definitely better for the student when the school, family,

31and student are working together as a team (Henderson and

32Mapp 2002; Vanderbleek 2004).

33The issues of school violence, bullying, latchkey kids,

34truancy, dropout prevention, and gangs have heightened

35the importance of linking with families as pro-social

36deterrents. Marriage and Family Therapists (MFTs) and

37other systemically trained professionals are taught to

38envision how the resources of the family can synergisti-

39cally work to resolve student problems. The authors

40describe a district-wide MFT program that has developed

41at the urging of the school board and district administration

42in their efforts to reduce the number of students suspended

43or expelled from school. They requested a program that

44would meet the unique needs and common goals of the

45family, the student, and the school.

46Why has the provision of family therapy in the public

47schools lagged behind that of other school-based helping

48professions such as school psychology, school counseling,

49and school social work? Perhaps it reflects a bias that the

50families with disobedient children are part of the problem

51and should be circumvented. Perhaps it is just less com-

52plicated to work with the child alone. This reflects a limited

53view of families and often misjudges their investment in

54their child’s future. We are at a crossroad where the family

55is viewed as essential, but difficult. MFTs are well versed

56in dealing with seemingly contradradictory messages.

57‘‘Yes, your family has problems; and, yes, as a key player

58in the life of your student(s), we need your help’’, can

59transform to ‘‘Yes, let me understand how your family and

60the student are cooperating in doing your best.’’ The same

61transformation can happen with an approach to the mis-

62behaving student such as ‘‘your misbehavior is reflecting

63your feeling of having no other choices.’’ These multiple

64dilemmas that are influenced by peers, school, and family

A1 & Russell Haber

A2 russdeuce@bellsouth.net

A3 1 Family Intervention Services, Richland District #2, 7500

A4 Brookfield Road, Columbia, SC 29206, USA

A5 2 Marriage and Family, Counselor Education Program,

A6 University of South Carolina, Columbia, SC 29208, USA

AQ1

AQ2

AQ3

AQ4

AQ5

AQ6

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Contemp Fam Ther

DOI 10.1007/s10591-015-9361-7

Au

tho

r P

ro

of

UNCORRECTEDPROOF

65 are best handled by a family therapist because the family

66 therapist can view the child from a multiplicity of different

67 angles (Boszormenyi-Nagy and Krasner 1986). Perhaps

68 that is why we are beginning to see an increase around the

69 country of Marriage and Family Therapists on behavioral

70 health teams offering front-line services in schools.

71 This article discusses the training of MFT students in a

72 school-funded family therapy program. The distinction will

73 be made for school-based programs as opposed to the more

74 limited adjunctive family therapy services provided by

75 non-school district personnel. Trainees in an on-site, dis-

76 trict-based MFT program can be immersed in a systemic

77 perspective of the school, the family, the community and

78 the many connections among these multiple systems. The

79 following is a description of how one such school district

80 managed to create opportunities that met the practica and

81 internship needs of university MFT and school counseling

82 training programs.

83 The training process of MFT’s in the schools is much

84 like most other family therapy training placements, except

85 that referrals for services can come from a range of sources

86 for many different reasons. In this program, the majority of

87 students are referred for disciplinary problems. When stu-

88 dents are referred for disciplinary problems, they often

89 come with a history of failure and blame on both sides of

90 the equation—the family and the school. Who is to blame

91 for the failure of a child to progress through the academic

92 and social rigors of the school program: the child/student,

93 family, school, or the helping professionals? Of course, the

94 search for blame is a fruitless endeavor. All parties must

95 work together for the benefit of the child. It is particularly

96 poignant now that there have been many studies that have

97 documented the existence of a ‘‘school to prison pipeline’’

98 (Elias 2013), where hasty, ‘‘zero-tolerance,’’ policies can

99 have far reaching consequences. Many of these children

100 can and should be saved from such a destructive trajectory.

101 The school setting can prove to be daunting for the MFT

102 trainee because they come into a context where there may

103 be a litany of blame, pain, and utter frustration among all

104 parties. How new trainees can stay ‘‘meta’’ to the blame

105 game is an essential skill that they must master. Also, it is

106 vital to elicit the vast resources of the school such as the

107 school psychologists, school counselors, social workers,

108 special education staff, teachers, and administrators. Sim-

109 ilarly, the trainees must acquire the skills necessary to

110 access the social network of the family such as extended

111 family members, friends, the faith community, mentors,

112 law enforcement and other support figures; resources typ-

113 ically sought in the initial stages of therapy.

114 The different agendas brought by the student, the family

115 and the school to the sessions can also complicate the

116 process of looking for new and different ideas about

117 solving the problem. With so many agendas, there may be a

118constriction of new ideas about how to improve the situa-

119tion. Therefore, inexperienced trainees need a progressive,

120developmental program paced to develop the different

121skill-sets that are needed to work with the family in the

122context of the schools.

123Review of the Literature

124There has been little research measuring the effectiveness

125of MFT’s in the schools and even less assessing family

126therapy training programs at school-based facilities.

127Despite the clear link between behavior problems at

128home and at school, mental health service delivery does not

129usually actively involve the family in seeking solutions to

130school problems. Even school psychologists admit, ‘‘Most

131school counselors and psychologists are not trained in

132family systems and use the individual model for service

133delivery’’ (Stormshak et al. 2005, p. 724). Other authors

134have also singled out the need for MFT services in the

135schools; yet there are logistical, territorial, and theoretical

136problems with actually having a separate staff of family

137therapists who view the world from a no-blame, circular

138perspective. Rather than asking the family what kind of

139trouble the student got into and to talk about it, the therapist

140might ask, ‘‘Who wants to be here most? Who in the family

141is most worried about you?’’ MFTs do not consider the

142individual issue, often related to the reason for referral, as

143necessarily the most important issue to be addressed

144(Crespi and Uscilla 2014; Mince 2000).

145In a dissertation, all studies reviewed indicated that

146family therapy works well in the schools (Powell 2012).

147Two empirically validated approaches, Multi-Systemic

148Therapy (MST) and Multi-Dimensional Family Therapy

149(MDFT) have developed ample evidence of their effec-

150tiveness with adolescent problems. Although they do not

151work inside the school on a standard basis, MST and

152MDFT (Henggeler et al. 2009; Liddle et al. 2009) always

153assess for, and often deal with, school related problems.

154In a large study of students who were involved in inci-

155dents of violence, families who went through a 4-session

156structured program showed a sevenfold decrease in all

157suspensions and a fourfold decrease in suspensions for

158physical violence (Breunlin et al. 2006). Similarly, Cooper-

159Haber and Sanchez’s 2013 comprehensive 7-year study

160firmly established that school-based family therapy with

161disciplinary referrals significantly reduced school dropouts.

162Kumpfer and Alvarado (2003) maintained that coordina-

163tion of interventions including the family is essential for

164positive outcomes. Mince (2001) maintained that having a

165family therapist on the team made the family feel safer and

166more approachable when dealing with school-related

167problems.

AQ7

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

168 In a summary report, Vennum and Vennum (2013)

169 found that the MFT’s surveyed felt that their role was

170 important to providing comprehensive services to students;

171 even though the work was not without challenges. Some of

172 these were:

173 • Time restraints

174 • Outsider with different theoretical constructs and

175 priorities

176 • Gaining trust in establishing collaborative relationships

177 • Keeping a systemic view in an individually focused

178 environment

179 • Lack of privacy in the school setting

180 • Negative connotations of school on part of parents.

181 According to Wetchler (1986), treating the family

182 without including the school often leads to a poor outcome.

183 He described a macro-systemic approach that considered

184 the school and the family as essential partners in either

185 maintaining or solving the student’s problem.

186 There is a growing body of evidence that family thera-

187 pists belong in the schools; however, there is little in the

188 literature about how to most effectively train them for this

189 context. While it appears to be preferable for family

190 counseling programs to be part of the schools’ learning

191 support services, there is very little written about specific

192 steps in the developmental process of learning school-

193 based family intervention skills or in developing training

194 partnerships with Counselor Education or Marriage, Cou-

195 ples and Family training programs.

196 The Training Program

197 The establishment of a training program can serve many

198 purposes. The trainee’s energy, eagerness, and enthusiasm

199 for the learning process can foster an environment that can

200 create staff cohesiveness and excitement as they collabo-

201 rate in the process of raising strong, competent clinicians.

202 These mentoring relationships have proven to be satisfying

203 to both trainers and trainees.

204 The staff must determine the goals and philosophy of the

205 training program, which impels the staff to become clearer

206 about effective and ineffective practices. The trainees bring

207 in new information, which helps the staff to remain current

208 about theoretical and clinical innovations and best prac-

209 tices. They also extend services further than those that

210 could be provided by a small number of professional staff.

211 Trainees create a diversity that can be incorporated into

212 the professional and multi-cultural mix of the staff. The

213 contract with trainees can also require their participation in

214 various indirect and administrative tasks, which helps

215 support the program’s infrastructure. Thus, the trainees

216 make many contributions to the services provided by this

217program. Over the past 10 years, 212 trainees and volun-

218teers have provided over 90,000 h of service to our stu-

219dents and families. This number represents both direct and

220indirect hours of service to students and families required

221by trainees’ graduate programs or licensing boards.

222It is crucial that the organization have a careful selection

223process for choosing the practicum and internship students

224who would best fit into their training program. It is also

225important that the university training programs partner with

226school districts that acknowledge the importance of

227working with families. After all, the schools essentially

228become the gatekeepers for the MFT profession and must

229take seriously this responsibility. Irrespective of the duties,

230relationship, or professional growth of the trainee, the

231ethical responsibility lies with the mandate that the orga-

232nization (school program) must monitor the clinical work

233of the trainees and the effect that they are having on their

234clients. In short, the professionals working in the schools

235are responsible for the rights and welfare of all the students

236and families they serve.

237Although trainees become an essential part of the

238delivery of services, they also have other responsibilities.

239Trainees have traditionally assumed this role for no or

240minimal pay, because it is the student’s best way to learn

241specific clinical skills and the role of a professional coun-

242selor. In addition, most academic training programs require

243practicum and internship course work. Some programs also

244have pre-practica or special problem courses at training

245sites away from the main university campus. Therefore,

246there are many opportunities to work with MFT trainees in

247the schools while they are enrolled in their graduate

248programs.

249The trainees fall into several categories that include

250MFT and clinical counseling graduate students, retired

251volunteers, interns from school counseling programs, and

252doctoral students from Counselor Education or MFT pro-

253grams. Additionally, graduates from these training pro-

254grams who are seeking professional licenses (Licensed

255Marriage and Family Therapists or Licensed Professional

256Counselors) seek placement at FISP where they have

257ample opportunity to earn clinical hours and free supervi-

258sion from the staff. Thus, the school-based training pro-

259gram attracts trainees with a wide range of experiences

260from fledging, beginning graduate students to more

261sophisticated, seasoned externs. Therefore, the training

262program must be stratified in a way to best meet the diverse

263developmental needs of the trainees.

264In the initial phase of the training, trainees are limited to

265viewing of videotaped sessions and observing staff and

266other trainees from behind the one-way mirror. From there,

267they can enter the therapy room with an experienced, staff

268member as a co-therapist where they learn how to intervene

269with families. The staff is comprised of licensed clinicians

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

270 with supervisory training, who can aptly demonstrate their

271 approaches to therapy. Staff therapists, all trained system-

272 ically, operate from various therapeutic orientations from

273 experiential to cognitive behavioral. While these multiple

274 orientations of both staff and trainees can create chal-

275 lenges, the staff is able to work as a team to train inex-

276 perienced therapists in a strengths-based, collaborative, and

277 respectful approach while also appreciating and building

278 upon the unique strengths and perspectives of the trainees

279 themselves.

280 The training program is a multi-tiered approach to

281 adding to the school district’s services to students and

282 families. The services, limited by the number of staff

283 employed, have depended largely on the ability to expo-

284 nentially expand these services with the help of the grad-

285 uate and postgraduate counseling trainees. Within the

286 program itself, an initial therapist with supervisory cre-

287 dentials was able to hire staff from MFT programs who had

288 been trained as interns in the school context, provide them

289 with supervision and supervision of supervision that has

290 resulted, over time, with a staff that are mostly licensed

291 MFTs or LPC’s, three of whom are now licensed

292 supervisors.

293 Initially, one certified school counselor, LMFT/LPC

294 supervisor was able to oversee the supervision of 1–8

295 trainees from one university counselor training program. A

296 triadic model of supervision was developed where the

297 trainees received supervision from a district LMFT/LPC, a

298 site (or school-based) supervisor, usually a school coun-

299 selor, and a university instructor. Efforts were made to

300 coordinate supervision in order to avoid triangulation of the

301 trainees. This was achieved by meeting regularly with all

302 parties. When the district family services staff felt com-

303 fortable with the goals and roles of the training program,

304 they began expanding the number of partnerships with

305 other graduate programs who were seeking placement

306 opportunities for their students. Thus, training programs

307 became an essential ingredient in handling the growing

308 number of referrals from the schools in this district of

309 26,000 plus students.

310 The FISP consisting of one clinician/supervisor grew

311 from a setting in 2005–06 with initially two trainees to the

312 current staff composition of five staff clinicians and 10–20

313 trainees each year.

314 Once the placement begins, there are levels of

315 involvement with clients that follow specific steps. The

316 trainee begins with a daylong orientation that familiarizes

317 them with the goals of FISP, the types of students, families

318 and referral sources they will work with, and the paperwork

319 and procedures with which they will need to become

320 familiar. They are able to watch videos of master family

321 therapists such as Satir, Minuchin, Whitaker and Andolfi

322 (Minuchin and Andolfi actually consulted with families at

323FISP, as well as tapes of staff and other trainees. As FISP

324operates during the day and in the evening (families are

325seen between 2:30 and 8:30), trainees and staff spend days

326in the schools seeing individual students, teachers,

327administrators, and other learning support personnel, as

328well as leading small student groups and attending parent

329teacher conferences, Intervention Assistance Teams, Indi-

330vidualized Education Plan and 504 meetings. Counselors in

331the schools either provide supervisory support or collabo-

332rate with FISP staff and trainees in the provision of school

333based services. This collaboration is essential to the

334effectiveness of the work with students and families.

335Additionally, the staff has found that checking in weekly

336or every other week with students has been helpful in

337keeping them mindful of their goals. This ‘‘coaching’’

338function in the schools would not be possible without the

339trainees. The parents of the students seen in the schools

340who are interested in this support from a graduate student

341have signed a permission form at the time of the first family

342session. It is rare that they do not sign the release.

343In the evening, trainees start by observing sessions

344conducted by staff or experienced externs from behind the

345mirror, usually in a room with a supervisor and other

346trainees. In this setting, trainees are able to not only watch

347a family session, but to observe and interact with the

348supervisor as interventions are phoned in, family members

349are spoken with directly, and strategies are considered by

350those behind the mirror. Once the trainee has become

351familiar with the process of working with families, as well

352as the types of families and family dynamics seen in FISP,

353the trainee works with a staff clinician as an ‘‘apprentice

354co-therapist’’ (Haber 1996) in the room with the family.

355The stages of trainee involvement with a family vary by

356readiness as assessed by staff supervisors in concert with

357the trainee. FISP staff also discusses trainee readiness

358among themselves in order to collaboratively plan the next

359best step(s) for the trainee. Some move through the stages

360toward independent therapy faster than others. Once the

361trainee has worked for a period with a staff therapist, they

362are paired with another trainee as a ‘‘peer co-therapist’’,

363where they discuss a plan for the session, assume various

364leadership roles and debrief and write notes collabora-

365tively. Sessions that are not observed and supervised ‘‘live’’

366are recorded on cameras in each therapy room or observed

367from a second portable where three or four rooms can be

368observed simultaneously on a camera monitor from four

369different therapy rooms and debriefed with trainees at a

370later time. This is not the preferred method of supervision,

371but meets a need when all rooms are full.

372In addition to the live supervision, there are opportuni-

373ties for trainees to review videotaped sessions with a

374supervisor, discuss their cases and share in a weekly

375‘‘group’’ supervision context. The FISP staff conducts two

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

376 separate supervision groups (weekly for interns and bi-

377 monthly for externs). In the weekly group supervision,

378 trainees from school counseling programs placed in the

379 district’s K-12 schools join with those from MFT and

380 clinical counseling programs. In this way, trainees are able

381 to share and learn from the different perspectives of the

382 various disciplines, sometimes having experience with the

383 same student in individual, family, or group counseling

384 contexts.

385 Supervisory Interventions

386 The following is a further explanation of the stages of

387 supervision that typically occur with trainees. Once they

388 have sufficiently learned the approach of FISP from

389 observing sessions and have an understanding of the

390 nuances of the context and intervention strategies, they are

391 ready to meet with a family.

392 Apprentice Co-therapy

393 As an apprentice co-therapist, the trainee is protected from

394 taking too much responsibility for the case while being

395 immersed in the therapeutic system. The more experienced

396 therapist makes the decisions related to the direction of the

397 session and the interventions, while eliciting input and

398 observations from the trainee/apprentice. For example, the

399 more experienced therapist would take the lead in handling

400 issues of abuse or family trauma while the apprentice co-

401 therapist would be invited to contribute, while protected, in

402 dealing with very emotional or complex cases. Over time,

403 the experienced therapist encourages the trainee to take a

404 more active role in the therapy (Haber 1996).

405 Peer Co-therapy

406 After a period of observation and apprentice co-therapy,

407 trainees are paired with one another in working with the

408 family. We have found that peer co-therapy provides a

409 context where each trainee can contribute to the therapy

410 process from a more equal position, while being protected

411 from making decisions and handling the tumult in isolation.

412 Live Supervision

413 Live supervision consists of a supervisor observing and

414 intervening in a session by phoning in thoughts, questions,

415 perceptions, and suggestions to a therapist in training. One

416 therapist in the therapy room and the other behind the

417 mirror offer a powerful approach that provides a binocular

418 (DeShazer 1988) view of the session. The supervisor and

419 observers can view the therapist and the family from one

420perspective, while the trainee(s) in the room is privy to the

421energy, feelings and emotional nuances of the family more

422acutely than do those behind the mirror.

423Having family therapists on each side of the mirror

424presents a unique perspective that offers both depth and

425breadth into the family’s reality. The multiple lens offer

426families more personal, creative viewpoints, often resulting

427in their feeling more understood. In reality, live supervision

428is a form of co-therapy where both therapist and supervisor

429have important information to share for the common good.

430Another one of the advantages of live supervision is that

431trainees can be assigned more difficult cases because they

432have the support of a more experienced senior clinician

433who is thinking through the case with the trainee while

434offering supportive feedback. The trainee is in the room

435with the clients, and is most acutely experiencing the

436feelings and the pull of the client family, while the

437supervisor behind the mirror has more of a ‘‘wide angled

438lens’’ through which to view both the trainee and the

439client/family. The fact is that the trainee cannot ‘‘see’’ how

440his or her self is reacting during the session. By assuming

441this ‘‘meta’’ position, the supervisor behind the mirror

442elevates their perceptive IQ, or ability to see the bigger

443picture, by one standard deviation (Haber 1988). This

444approach also allows for the voice and ideas of the

445supervisor to enter the therapy room and is usually well

446received by the family who may feel more secure with the

447added perspective of the supervisor.

448In addition, the family can be an instrumental player in

449the live supervision. Often, when empowered by a

450supervisor behind the mirror, a family member may be

451more equipped to change the therapeutic system by taking

452bigger risks than the therapists themselves. For instance,

453there was a case where grief and loss was a dominant

454theme, but was not really discussed in the therapy. The

455therapist was not seeing how this phenomenon was

456impacting the family.

457The supervisor called in and spoke to the mother. ‘‘It

458seems like the therapist is not addressing the losses in the

459family because she is afraid of over stressing the family. I

460feel that the family has the courage to address this issue in

461relation to the school problem your child is experiencing.

462Do you agree that it is important for the family to discuss

463this issue? (Mother agrees). Find a way to address these

464issues with your family. If you need to call me with any

465concerns, just pick up the phone and I will connect with

466you.’’

467This phone call to the mother resulted in the family

468discussing their losses and how the presenting problem was

469connected to this deeper issue. Since the supervisor can

470intervene as needed, he or she must take responsibility for

471the session. In this way, the supervisee is not being eval-

472uated; just given help with a family.

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

473 Group Supervision

474 The trainees who are accepted at FISP are expected to

475 attend a weekly (graduate students) or bi-monthly (post

476 graduate externs) supervision group. In the weekly group,

477 trainees from multiple disciplines meet together to staff

478 cases, present their personal genogram and to participate in

479 training provided by other learning support district staff,

480 community agency clinicians, or specialists in areas of

481 interest and importance to the development of competent

482 school based therapists. Those participating in this group

483 are in MFT, school counseling and clinical counseling

484 graduate programs. Those in the bi-weekly supervision

485 group are externs working on either a MFT or LPC license

486 and are all meeting with FISP families and students in the

487 schools.

488 The multi-discipline orientations bring a richness to the

489 discussions and provide opportunities for the trainees to

490 work collaboratively as they learn from one another and

491 the trainers. They present cases, share videotapes of ses-

492 sions and have opportunities to ask for assistance with a

493 student or a family they are seeing. They all are asked to

494 present their personal genograms as a way of becoming

495 more comfortable with their own narratives, their ability

496 to think both trans-generationally and developmentally,

497 and to elicit support from the supervisors and other trai-

498 nees with identifying parts of their story that may be

499 hampering their work with students or families. They are

500 helped to use this feedback to recognize where they may

501 get stuck with clients and how, often, their personal stories

502 intersect with those of their students and families in sig-

503 nificant ways. Many times, this process helps them to

504 move beyond impasses they have encountered with their

505 clients.

506 Joining with the Family

507 It is necessary for students to recognize and benefit from

508 accessing resources in multiple systems and, most impor-

509 tantly, to receive support from their families in order to

510 change. Therefore, the beginning process of intervention is

511 inviting the family to participate in a meeting with their

512 child. Often, when parents come to the initial session, they

513 feel blamed, unsupported and unheard. FISP delivers a

514 message that they prioritize the family’s beliefs (input)

515 about how to best handle the problem(s) their child is

516 experiencing in school. They also help them to see how the

517 school is struggling with their child’s behavior and while

518 the family may share information about their circumstances

519 and challenges, they also help the therapist to know what

520 resources and strengths (both internal and external) may

521 exist for dealing with their problems.

522Prepared to handle referrals from various sources for

523primarily disciplinary reasons, trainees are prepared for the

524initial meeting to explain their role, both as a trainee and as

525a family counselor working at FISP, limits of confiden-

526tiality, the conditions related to a training context such as

527video taping, observers behind the mirror and the role of

528the supervisor and services they can offer. Parents have

529been given this information in writing at the time of the

530intake and have signed an informed consent, also indicating

531if they want for the therapist to be in contact with the

532student’s teachers, counselors and administrators. In most

533cases, families agree to these conditions and the form is

534signed. When parents do not wish to be taped or have the

535school contacted, their request is honored.

536Additionally, trainees are instructed to be clear about

537their connection to the school system and the desire on the

538part of the schools to provide additional services and

539support to their students. This sometimes has to be revisited

540with trainees who may wish to say to families that they are

541‘‘not’’ a part of the school system or the ‘‘bad guys’’ (as the

542family may perceive the school to be); they are the ‘‘good

543guys’’. Trainees also tend to support the position of the

544adolescent over the parents or guardians. Trainees are

545expected to explain that FISP is a ‘‘family centric’’ pro-

546gram, offered by the district that values the family’s unique

547circumstances, culture, and view of the problem of their

548child. Their ‘‘no-blame’’ stance is also introduced to the

549family as part of the process.

550It is most useful to focus on joining and developing a

551relationship with the family, forming a therapeutic alliance,

552rather than belaboring the misbehavior of the student. As

553others have found, the solicitation of feedback about the

554quality of the relationship system is instrumental to a

555positive outcome in the therapy (Miller et al. 2013). The

556practitioners at FISP have different theoretical orientations

557but share a philosophical belief in the therapeutic common

558factors such as a respectful, strength-based, collaborative,

559and feedback-oriented approach to working with school

560and family systems (Grencavage and Norcross 1990).

561In order to insure that the trainees develop a satisfactory

562working alliance that takes into account all parts of the

563system, staff and trainees administer the Client Feedback

564Note (Haber et al. 2014) after every session. This feedback

565monitors the issues and perceptions experienced by all the

566family members. The CFN gives an opportunity to hear the

567family’s perspective of the session rather than resorting to

568just the trainee’s view of what is happening. With many

569trainees, the family members respond in a more positive

570manner than expected, which gives information that the

571trainee/therapist is on the right track and can continue in

572that direction. Other families’ reflections elucidate the

573generational conflicts, which the supervisor can take into

574consideration in future sessions. Some ruptures reflected on

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

575 the CFN may require live supervision or a consultation

576 with a supervisor or other member of the staff.

577 Quite often, disciplinary referrals are resistant to the

578 notion of compulsory therapy by a system they do not trust.

579 Therefore, FISP has developed a time limited (four session)

580 approach for a basic school-initiated discipline referral. In

581 essence, they work with time limits in order to facilitate a

582 contract that will best appease a family who does not desire

583 therapy or even actively disagrees with the requirements

584 for keeping their child in school. The therapists let them

585 know that it is hoped that the family meetings present an

586 opportunity, rather than a punishment. Typically, they

587 begin with developing a contract to determine what the

588 family wants to get from the therapy. Often, the family

589 begins to like the counseling process and chooses to extend

590 sessions beyond what is required. With some families

591 attending only the required number of sessions, and others

592 choosing to remain in treatment longer, the average num-

593 ber of sessions for district families is four.

594 This approach emphasizes attention to family resources,

595 strengths, challenges, perspectives, culture and perception

596 of the child’s issues at school and at home. The therapist or

597 trainee seeks to understand the family’s story, consisting of

598 their history and current circumstances. FISP staff helps to

599 model for the trainees their respect of the family’s wisdom

600 and the richness of learning more than they teach, as the

601 family gives them access to their worldview when they

602 share their personal stories.

603 The following is an example of when the therapists were

604 able to bridge the gap created by differences in race, cul-

605 ture, level of education and life experiences.

606 The family consisted of the IP, (an adolescent male

607 referred through the discipline process for smoking mari-

608 juana on school grounds), the younger sister, the grand-

609 parents/guardians and the biological mother of the children.

610 With the mother’s consent, the paternal grandparents had

611 assumed custody of the siblings after the recent death of the

612 children’s father. The grandfather shared that his grandson

613 was still using marijuana and often seemed sad and

614 depressed. The co-therapy team consisted of an experi-

615 enced African-American male staff member and a young

616 Caucasian female graduate student. The grandfather, a

617 proud, protective individual, still grieving the loss of his

618 only son, was slow to share the personal circumstances of

619 the family, the deceased son, the family’s pain, or the

620 confusion and concern related to their very talented, but

621 introverted, grandson’s drug use and school disengage-

622 ment. The therapists, when learning of the adolescent’s

623 enjoyment of art, had him draw on the white board during

624 the sessions; usually with some directive related to his pent

625 up feelings. When the grandfather stated in the 3rd or 4th

626 session that ‘‘this is very hard for me…we don’t share our

627 personal business with strangers… We keep this in our

628family,’’ … the therapist replied, ‘‘Well, how is this for

629you? Being here, sharing with us?’’ to which the grand-

630father, holding back his tears, replied, ‘‘We were

631desperate’’.

632In this case, a mandated referral from the district’s

633hearing officer, the family was able to find a safe place

634where, in spite of the differences among those in the room

635and the existence of supervisors and trainees behind the

636mirror, they could share their pain, grief, and fears as well

637as their hope for a better future for their grandchildren.

638This exchange exemplifies the opportunity that FISP can

639offer in a school system–a place to share and sort out

640experiences that children and adolescents face in school, at

641home and in the community. They have found that the

642differences in culture, background, race, age or gender of

643the therapist and the family have not impeded the thera-

644peutic relationship when the therapist/trainee is able to

645communicate respect, appreciation and commitment to

646helping the family deal with their pain.

647Joining with the School

648Inexperienced therapists must be taught to function in a

649school context that possesses political, social, cultural

650components that are unique to school systems. Their

651graduate training should include coursework that provides

652a theoretical foundation of systems unique to the schools.

653The schools’ purpose is to provide educational success

654and preparation for life after high school for its students.

655Unfortunately, some students are identified as operating

656outside of the rules and the culture of the school. Policies

657such as ‘‘zero tolerance’’ have contributed to a culture of

658exclusion of students who do not conform to the expected

659rules of the school. The students and families of these

660students are often unable to achieve the goals that will

661prepare the students to be productive members of society

662(Elias 2013).

663For example, if a child brings a toy gun to school, he

664would be processed according to the policies. This, at its

665least, would result in days of missed school attendance and

666further loss of academic progress; at worst, it would result

667in long term exclusion or failure.

668Family Intervention Services Program (FISP) works

669with students and families in the school context in order to

670help them to better handle the stress resulting from bully-

671ing, academic failure, disciplinary offenses, suspension,

672mental illness, family disruption, abuse and other trauma.

673This paper discusses the development of MFT trainees in

674the school context that enables them, with confidence and

675skills, to enter these systems and deal effectively with at-

676risk students and their distressed families. Trainees need to

677understand the complexities of schools. Therefore, the

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

678 model at FISP includes specific attention to the child’s

679 experiences in the classroom and in the school as well as

680 those in the family and in the community. The goal is to

681 include as many of the players in the school and commu-

682 nity as possible, or as needed, to understand and support

683 the student and family. This includes administrators,

684 teachers, psychologists, school counselors, social workers,

685 in-school-suspension supervisors, teachers, and coaches.

686 The therapist seeks to understand how each is involved

687 with the student and/or the family as part of the problem or,

688 most importantly, as part of the solution.

689 Training counselors to be systemic requires their

690 learning how to engage multiple systems, with the goal of

691 achieving the most success or benefit for the student. The

692 staff at FISP feels it is essential for the trainee to become

693 familiar and comfortable with intervening at the macro

694 level of school organization as well as at the micro level of

695 the individual student and family. They have found that

696 inclusion in the culture of the school such as in team

697 meetings (Individual Education Plan (IEP), 504’s, parent

698 teacher conferences) increases the level of empathy and

699 effectiveness in working with the family, the student, and

700 the school. This has been a very important contribution in

701 the treatment of the child.

702 A brief story illustrates the value of an MFT’s entry into

703 the life of the school in support of the student and the family.

704 The family of a 12-year-old middle school student was

705 referred to FISP for the child’s violation of the school’s

706 acceptable computer use policy (looking at pornography).

707 They were indignant and angrily expressed their dis-

708 agreement with the district’s requirement to attend family

709 counseling as a condition of the student’s re-entry to

710 school. The family consisted of a mother who worked as a

711 medical professional, a stay-at-home father and 5 children,

712 members of a strict religious group, who were very reluc-

713 tant to share any of their personal story with strangers.

714 They were also unhappy that they were meeting with a

715 trainee and refused to be taped or observed by other trai-

716 nees. Unbeknownst to the family, the trainee, already a

717 PhD, was an intern working on a second doctorate in MFT,

718 while working full-time as a clinician in a state agency.

719 The therapist/trainee observed the IP’s discomfort with

720 answering any questions in front of her parents and sensed

721 the stress in the room. After two difficult sessions with the

722 family where the parents continued to express their dis-

723 content with the district’s requirement and their perception

724 that the school, not their child, was at fault, the father

725 called to say they did not feel they should have to attend

726 the 3rd required session. They had already called the

727 school principal, the district hearing officer and were

728 finally directed to the coordinator of FISP. Upon learning

729 that the family had arranged for a school conference to talk

730 about the child’s re-entry to school (after a period of

731absences resulting from the suspension), the coordinator

732suggested that the intern (who she deliberately identified as

733‘‘Dr.’’ in order to increase the family’s buy-in) attend the

734conference in lieu of the 3rd session, to which the parents

735readily agreed.

736It turned out that the presence of the intern at this

737meeting was critical to the school and the family’s ability

738to work together. As the meeting became more adversarial

739and accusatory, both parents and school staff became

740increasingly more defensive. Recognizing that the child/

741student was becoming more and more uncomfortable (fid-

742geting with tears in her eyes), the intern moved to an empty

743chair next to the student. She then shared her observations

744with the group and reminded them of the main goal of the

745meeting, which was to find ways for the student to receive

746the support she needed to make a successful re-entry into

747school and adjustment once there.

748The trainee agreed to follow up on the child at school

749and to meet with the family again after three months to

750assess her progress. Later that day, the school’s guidance

751director called FISP to express her appreciation of the

752intern’s presence at the meeting and of how she had dif-

753fused a very difficult situation.

754The preceding case is an example of how a systemically

755trained MFT working in the schools (in this case, both the

756supervisor and intern), can use their skills to intervene at

757multiple levels in various ways. Being able to ‘‘re-define’’

758the rules of the intervention, to side-step the family’s

759resistance, and to act as an advocate for the child (who was

760everyone’s biggest concern), enabled them to enact a sys-

761temic intervention that worked for everyone.

762There are other times when the intern/clinician can help

763the teacher or other school staff to view the student’s (or

764family’s) behavior from a different perspective, thus

765reframing a linear, cause and effect explanation that allows

766little room for new behaviors to manifest. In this way the

767trainee can serve as a communication link between the

768family and the school and as an advocate for redefining the

769student’s actions. It is common for school personnel to

770become more receptive to alternate explanations of the

771student’s behavior or attitude once they learn more about

772the child. A student may have a sick brother, a disabled

773parent, or a violent home. Selected sharing of the child’s

774world outside of the school can create empathy between the

775student and the school as well as a change in the dynamics

776between the student and teacher/administrator.

777Discussion

778The enthusiastic reception of the families, the schools, the

779school board and the trainees in this program have pro-

780moted the concept that families are important in the

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

781 resolution of problems identified by the school. While there

782 are challenges to including MFT’s in school-based services

783 such as those enumerated earlier by Vennum and Vennum,

784 training programs and school districts should establish

785 partnerships that seek to overcome any roadblocks. The

786 ultimate goal is for family therapists to join the school’s

787 multi-disciplinary teams to work collaboratively on behalf

788 of students.

789 MFT’s have a specific skill set that equips them to work

790 systemically in the schools. This does not preclude other

791 disciplines from developing well-trained family therapists.

792 The issue is not who does the therapy, but who has the

793 skills and inclination to work with families and the school

794 system in ways that best support the students. Too often,

795 services to families get shortchanged due to turf wars. It is

796 vital that MFT’s become members of the behavioral health

797 teams in schools, where working side by side with the other

798 helping professionals becomes the norm rather than the

799 exception.

800 In our continuing dialogue, we must be mindful of the

801 importance of the student and the family’s feedback and

802 input regarding their view of services and service provi-

803 ders. While FISP uses an integrated approach, it also offers

804 a rich training opportunity where all the supervisors pos-

805 sess unique strengths and abilities. This does not preclude

806 the usefulness of considering and comparing other family

807 therapy approaches for working in the schools.

808 Since the Family Intervention Services Program has

809 many other intervention strategies, (community service, a

810 psycho-educational multi-family group curriculum, student

811 leadership, a structured six- session individual family

812 program, an academic and behavioral support group for

813 those transitioning from an alternative setting, an art/mu-

814 sic/mindfulness student group, and services for Spanish

815 speaking parents and families), further research needs to be

816 done to see what kinds of interventions best fit specific

817 families, students and trainees.

818 Conclusion

819 The school presents a unique opportunity to learn how to

820 function as a family therapist. The system includes the

821 teachers, administrators, and other special service provi-

822 ders who operate much like the family system with chil-

823 dren, parents, grandparents, friends and other

824 notable figures such as coaches, teachers, and friends.

825 Thus, the trainee is offered many opportunities to think

826 systemically and recruit available resources that can sup-

827 port the student and/or family through their developmental

828 passages and challenges.

829 School referrals also encourage the therapist to take a

830 ‘‘no blame’’ approach. Even though there is often good

831reason for the referral, the job of the trainee is to get

832beyond that and to evoke a spirit of curiosity that will

833inspire the student and the family to look for patterns that

834may be manifesting in problematic behavior. We are all

835victims of what we have learned along the way and,

836sometimes, it is imperative to find new learning that pro-

837motes an inherent desire for change that is not problem

838saturated, offering an opportunity for narratives that imbue

839hope (White and Epston 1995).

840When training programs and the schools come together

841to create opportunities for MFT trainees to further develop

842their skills, it will result in more sensitive, mature, systemic

843therapists. It is hoped that by using the model developed by

844the school district discussed in this article, more and more

845family therapists will be trained to function as necessary

846and effective members of the schools’ behavioral health

847teams.

848Acknowledgments We would like to warmly thank the Family849Intervention Services Team, each of whom has inspired us to write850this paper. They are: Danielle Allen, Karla Castro Briseno, Viki851Kelchner, Robin Morgan, Jennifer Wilson and Sarah Sanchez.

852References

853Boszormenyi-Nagy, I., & Krasner, B. (1986). Between give and take:

854A clinical guide to contextual therapy. New York: Brunner/855Mazel.856Breunlin, D., Cimmarusti, R., Hetherington, J., & Kinsman, J. (2006).857Making the smart choice: A systemic response to school-based858violence. Journal of Family Therapy, 28(3), 246–266. doi:10.8591111/j.1467-6427.2006.00350.x.860Cooper-Haber, K. & Sanchez, S. (2013). A multi-systemic approach861to reducing suspensions and expulsions in schools in the United862States. International Journal for School Based Family Counsel-

863ing, 4, 113. Retrieved from http://schoolbasedfamilycounseling.864com/docs/IJSBFC%20%20suspensions%20%20final1.pdf.865Crespi, T., & Uscilla, A. (2014). Family therapy in the schools:866Considerations, concerns and credentialing. The School Psy-

867chologist, 68(1), 27–31.868DeShazer, S. (1988). The keys to solution in brief family therapy. New869York: W.W. Norton.870Elias, M. (2013). School to prison pipeline. Teaching Tolerance, 43,87139–40.872Grencavage, L., & Norcross, J. (1990). What are the commonalities873among the therapeutic common factors? Professional Psychol-

874ogy: Research and Practice, 21(5), 372–378. doi:10.1037/0735-8757028.21.5.372.876Haber, R. (1996). Dimensions of psychotherapy supervision: Maps

877and means. New York: W.W. Norton & Co.878Haber, R., Carlson, R. G., & Braga, C. (2014). Use of an anecdotal879client feedback note in family therapy. Family Process, 53,880307–317. doi:10.1111/famp.12070.881Kumpfer, K., & Alvarado, R. (2003). Family-strengthening882approaches for the prevention of youth problem behaviors.883American Psychologist, 58(6–7), 457–465. doi:10.1037/0003-884066X.58.6-7.457.885Liddle, H., Rowe, C., Dakof, G., Henderson, C., & Greenbaum, P.886(2009). Multidimensional family therapy for young adolescent887substance abuse: Twelve-month outcomes of a randomized

AQ8

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

UNCORRECTEDPROOF

888 controlled trial. Journal of Consulting and Clinical Psychology,

889 77(1), 12–25. doi:10.1037/a0014160.890 Miller, S., Hubble, M., Chow, D., & Seidel, J. (2013). The outcome of891 psychotherapy: Yesterday, today, and tomorrow. Psychotherapy,892 50(1), 88–97. doi:10.1037/a0031097.893 Mince, J. (2000). Integration of the family therapy specialist into894 public school pupil personnel services. Journal of Prevention895 and Intervention in the Community, 21(1), 139–157. doi:10.896 1300/J005v21n01_10.897 Powell, K. (2012). Dissertation abstracts international section A:898 Humanities and social sciences. In: What does the literature say

899 about family therapy in the school setting? A content analysis

900 (vol. 72 (11-A), p. 4319).901 Stormshak, E. A., Dishion, T. J., Light, J., & Yasui, M. (2005).902 Implementing family-centered interventions within the public903 middle school: Linking service delivery to change in student

904problem behavior. Journal of Abnormal Child Psychology,

90533(6), 723–733. doi:10.10007/s10802.005.7650.6.906Vanderbleek, L. (2004). Engaging families in school-based mental907health treatment. Journal of Mental Health Counseling, 26,908211–224. doi:10.17744/mehc.26.3.xbwbr27wqhcptlmk.909Vennum, A., & Vennum, D. (2013). Expanding our reach: Marriage910and family therapists in the public school system. Journal of911Contemporary Family Therapy, 35, 41–58. doi:10.1007/s10591.912012.9226.2.913Wetchler, J. L. (1986). Family therapy of school-focused problems: A914macrosystemic perspective. Contemporary Family Therapy,

9158(3), 224–240. doi:10.1007/BF00902948.916White, M., & Epston, D. (1995). Narrative means to therapeutic ends.917New York: W.W. Norton & Co.

AQ9

Contemp Fam Ther

123Journal : Large 10591 Dispatch : 30-9-2015 Pages : 10

Article No. : 9361h LE h TYPESET

MS Code : COFT-D-15-00035 h CP h DISK4 4

Au

tho

r P

ro

of

Journal : 10591

Article : 9361 123the language of science

Author Query Form

Please ensure you fill out your response to the queries raised below and return this form along

with your corrections

Dear Author

During the process of typesetting your article, the following queries have arisen. Please check your typeset proof carefully

against the queries listed below and mark the necessary changes either directly on the proof/online grid or in the ‘Author’s

response’ area provided below

Query Details Required Author’s Response

AQ1 Please check whether the mail ID ‘rhaber@sc.edu’ should appear in the publication.

AQ2 The article title mismatches between the job sheet and the manuscript. We have followed the job sheettitle. Please check and confirm.

AQ3 Please confirm the corresponding author is correctly identified and amend if necessary.

AQ4 Please provide the appropriate mail ID for the author ‘Karen Cooper-Haber’ if it is necessary.

AQ5 Please confirm the section headings are correctly identified.

AQ6 Reference Henderson and Mapp (2002), Henggeler et al. (2009), Mince (2001), Haber (1988) werementioned in the manuscript; however, these were not included in the reference list. As a rule, allmentioned references should be present in the reference list. Please provide the reference details to beinserted in the reference list.

AQ7 Nagy-Boszormenyi and Krasner (1986) has been changed to Boszormenyi-Nagy and Krasner (1986),Stormshak, Dishion, Light, and Yasuim (2003) has been changed to Stormshak et al. (2005) andDeShazer (1998) has been changed to DeShazer (1988) so that these citations matches the list. Pleasecheck and confirm.

AQ8 For your information: Please note that our publisher, Springer, uses a custom version of the standard APAformat. Your manuscript has been modified to reflect the required format changes.

AQ9 Please provide the editor names, publisher name and location for the Reference Powell (2012) if it isnecessary.

Au

tho

r P

ro

of