• The TRIBAL HOTBED TRAINING (THT) Model: Utilizing Both Sides of the Mirror Haviva Ayal PhD*& Sara Ivanir PhD** Published: Human Systems – The Journal of Therapy, Consultation and Training. Vol. 19, Issue 1-3 2008 "Metalogos".Greek systemic jounral .(2008) "Context", The Journal of the British Association for Family Therapy (2008). The use of the male form implies equally to the female gender Names and other ways of identification have been changed to protect the privacy of both families in treatment and therapists *Haviva Ayal - co-founder and past Director of Training at Shinui Institute, Israel e-mail: ayalmeir@zahav.net.il ** Sara Ivanir - co-founder and past Clinical Director at Shinui Institute, Israel e-mail: sarailan@netvision.net.il *** We wish to express our thanks and appreciation to our colleagues, students and clients at Shinui Institute who contributed to the thinking, feeling and experimenting that lead to the design of the model presented here.
Abstract The THT model aims at training family therapists to regard their work as something that they are and not only something that they do. The model uses the metaphors of the Tribe and the Hotbed to describe the training as a space that integrates traditional knowledge, innovations and transformations while combining nurturing and challenging the individual and the group at the same time. Eight basic principles describe the model as: (1) Providing a secure space for transformation, (2) Holding a basic belief that each person has rich inner resources whose effective use is developed by the training. (3) All participants are committed and involved in each other's learning, (4) Integrating old and new ideas, (5) Moving from rational to relational knowledge, (6) Maintaining a structure of equality but not symmetry, (7) Providing multilevel learning experiences. (8) Creating an atmosphere of love, compassion, honesty and non-judgment. Interventions at critical moments in training that demonstrate the model in action are presented and analyzed.
Introduction When we come to discuss training models it seems natural to ask: "Is there a model of an "ideal family therapist" that should guide our training?�
1
We found various references to different training models (Liddle et al 1988, Laughlin 2000) but we could not find the answer to our question. Consequently we decided to study our own experiences. We conducted a small survey among our colleagues and advanced students asking the following question: "What makes us good and effective therapists?" (Assuming that being effective is desired and closest to the "ideal"). This exploration yielded a few common factors: a) Possession of a wide base of knowledge embedded in divergent fields such as psychology, philosophy, social studies and spiritual studies. This creates a rich frame of reference utilized to observe and understand human phenomena. b) An acknowledgment of personal experiences as valid sources for dealing with human situations. c) A capacity for attunement, curiosity and a willingness to take risks in human relationships. d) A sense of inner balance and clarity regarding personal and professional identity. This creates an ability to combine two qualities: the quality of a seismograph; a stable position that identifies and anticipates the subtle vibrations in the therapeutic environment. At the same time using the talents of the juggler who keeps many balls in the air simultaneously. Effective therapists view themselves as affecting their environment by virtue of creating a space of growth for the people around them. They live and breathe their work, regarding it as an integral part of their lives, fulfillment and vision. Based on these observations, we developed the THT model with the aim of training therapists to regard their work as something that they are and not something that they do. In other words, our focus in this model is the ‘self of the therapist’ rather than his knowledge or techniques. Training the Self of the Therapist seems inherently paradoxical – how can we train one’s "self"? Usually the context of the term “self” encompasses processes such as evolvement, development and the achievement of one's own uniqueness. “Training” refers to teaching and molding one's knowledge and practice in a certain way. Accordingly, how can we teach wisdom, compassion, morality and humor? The answer lies in the facilitation of the trainee's self-exploration skills leading to higher self-awareness, not only of his motivations and needs but also of values, strengths, capabilities and internal resources. (Ayal 1999) Another question we asked ourselves in the process of designing a training program was: How do we utilize the context of the training in the best way possible?
2
Systemic thinking entails understanding the person within his organically human environment. We utilize this principle by creating a context that enhances professional and personal development of the trainees in the same way that we encourage our clients to utilize their own contexts and resources to improve and enrich their lives. By “context” we mean both the personal and cultural resources of the trainees, teachers and clients as well as the general environment of the institute, the educational system and other relevant agencies. Throughout the training we encourage processes that validate students' unique life experiences. We invite them to review their own insights following each new stage in their professional learning, share family interactions that were meaningful to them, and bring poems or proverbs that they would hang on their clinic walls. The following story of Rabbi Zosha, is an example: He used to say: "When my judgment time in heaven comes and I am asked why I wasn’t more like Moses the Prophet – I will have a good answer. But if I am asked why I had not been Zosha – I will have nothing to say in my defense".
The TRIBAL HOTBED TRAINING (THT) Model The focus of this model is in creating a training environment that challenges the trainees to "push the limits' of their comfort zone while maintaining the safety and the "holding" context. A ‘tribe’ is defined as a "social group comprising people united by a common denominator" (Babylon(. This group shares common values, customs, traditions and purpose. The tribal social structure develops healthy people both physically and mentally while transferring principles of living, heritage and values to future generations. The literary definition of a ‘hotbed’ is “a glass or plastic structure in which constant heat is preserved for growing plants" (Sapir Dictionary), or "a place favorable to the growth of…" (Oxford Dictionary) Metaphorically used – the term "hotbed" denotes “a place to unfold gradually, as a flower from the bud, to advance and promote the growth of each member in a protective yet empowering environment.” (Babylon) In this model, both sides of the mirror become one cohesive learning and growing community. The therapist-in-training, the family and the observing group become one tribe with very clear goals with one of them being the development of healthy people able to transmit principles and values to future generations. Influenced by the Strategic approach as well as Gestalt and mind-body practices, THT has a clear hierarchical structure, definable terms of belonging and a spontaneous and intuitive flow of personal and group development.
3
Basic Principles of the THT Model • Provision of a secure space for transformation - allows members the • •
• • • •
•
freedom of being, expressing and experimenting without fear. A basic belief that each person has rich inner resources and that the purpose of the training is to allow their effective use. All the participants are committed to and involved in the process. Each trainee has a vested interest in the learning and successful practice of all other members of the group and in the well-being of the family in therapy Integrating Old and New ideas - This is a chorus of voices sharing stories and memories of traditions, wisdom and knowledge (personal and professional) by the participants and family in treatment. Moving from rational to relational knowledge - A new way of "knowing" is created through the sharing of perceptions and experiences, meanings with active mutual feedback. Equality but not symmetry - Each member has equal opportunity to express oneself, yet the hierarchical structure regarding the responsibility for the process is clear and explicit. A multilevel experience - Cognitive, emotional, perceptual, imaginative and physical elements are used in the training. Learning experiences include verbal and non-verbal means such as sculpting, story telling, rituals, music, food, body awareness and movement. An atmosphere of love, compassion, honesty and non-judgment, encouraging spontaneity, humanness, fun and humor.
The THT Model in Action In the application of the model we were inspired by experiential body work (Fisher & Rob 2002), Focusing (Gendlin 1996) Psychodrama and Sculpting (Papp1976) as well as other creative approaches to therapy. The following components illustrate the way we use the training group as a Tribal Hotbed. Creating a safe and secure space The group setting as a secure space is a central concept in our model. This is a space where experimenting with new behaviors, emotional experiences, confrontations and challenges is not only possible but also encouraged as a means of learning and growing. The group is framed as a place of being and learning – cognitive and emotional. The first opening workshop of the training program lasts a whole day and is aimed at creating an atmosphere of trust and collaboration, while maintaining the fact that it is a training group (and not a therapy group). This is done by
4
clarifying some rules of the "empowering feedback" (appendix 1) and creating experiences where participants share aspects of their personal lives. Framing every experience as a "learning experience" allows free brainstorming and emotional sharing, together with challenging and experimenting with new behaviors. Thus a "common value system and a common language" of openness and honesty in expressing one's feelings and thoughts are created. The shared responsibility of all trainees towards their own and the others' learning needs and wishes is manifested in an instrument we developed for individual evaluation and appreciation of the therapist-in-training. A written structured feedback form is completed by each of the participants following the session. The form includes a personal, cognitive and emotional response to the therapist's work as well as "gifts of growth" (appendix 2). This represents the commitment of all participants towards each other. Our experience shows that trainees who work behind the mirror treasure these forms of feedback, recalling that they learn a lot from their peers' comments. Inserting a new event - transforming a "stuck" scenario into a "flowing" one Being “stuck” means that the therapy cannot continue to “flow” towards its goals because of overt or covert barriers. Of course, stagnation in the therapeutic flow does not necessarily stem from being “stuck”. The flow, however, is important for increasing the receptivity and acceptance of therapeutic messages. When the therapist-in-training is stuck, he is encouraged with the support of the group, to externalize restricting internal dialogues and negative emotional processes which may have created barriers. When the trainee’s cognitive understanding of his emotions is not enough to change his approach towards the clients, the group offers itself as an extension in order to curtail the “more of the same” process. This teamwork produces a transformative event, such that when the trainee reenters the session, he can insert a new dimension that creates an alternative script to the previous family narrative. Example*: The trainee feels stuck and breaks away from the therapy session to consult with the group. When asked to verbalize her inner reactions she says: “Oh my god, I can’t stand this castrating woman. The husband is just shrinking and shrinking. How did he marry her anyway, he must be stupid.” The supervisor suggests that the trainee get closer to the woman, find something to love about her and create a friendlier and more understanding atmosphere based on mutual interests. The trainee then reenters the room but fails to relate positively to the woman. The supervisor suggests sitting closer, asking her about her work, about the children, giving her a compliment... It doesn't work. The trainee continues to relate to the husband who gives long philosophical lectures. The wife seems lost, feeling unwanted and humiliated. The supervisor asks and receives the trainee’s permission to enter the session. The supervisor enter the room with three other female trainees –
5
creating a small “women’s group”, chatting with the wife about raising children and voicing personal dilemmas about asserting or relinquishing control over one’s environment. After some time, the “group” leaves and the trainee moved on smoothly with the therapy. After the session the trainee confides in the group: “as I saw you talking and flirting with this woman I could see how sweet she is and could feel her pain. I could get closer to her and help her get closer to her husband, not through controlling but through empathy… That was amazing, as it was so unexpected. How did it happen?” Changing roles and positions to connect with different family members In the “tribe” of the trainees each member may play different roles to improve synchronicity with the clients and the situation being presented. Exchanging various roles is not only an intellectual process but also an emotionalexperiential one. The group process sets the stage for the trainee to rehearse new ways of “being” and evolving. Many playful exercises are designed to access and practice how to move spontaneously from one position to another. For example: a trainee is asked to create a situation where the parent behaves in a new way towards the son (e.g. more authoritarian). In a preparatory exercise he is instructed to move from one group member to the next, inducing their authority towards him by applying different styles such as ‘the wise man’ style, ‘the fairy’, ‘the joker’, ‘the child’, ‘the educator’, ‘the seducer’, ‘the good friend’, and so forth. In the following example the supervisor creates verbal and non-verbal experiential episodes within which the group members can shift: Example: The therapist is pleasantly conversing with the parents about their difficulties in convincing their youngest adolescent son to take responsibility for his studies. The son, a sweet and docile boy, sits quietly, slouching and offering only one-word responses in a very low voice. The therapist is stuck in the role of "interrogator". The group invites the trainee to the observation room and suggests that he "sculpt" the session. Using the group members as a human “sculpture" the trainee creates a very rigid, tight-knit structure in which he positions himself as a conductor of a choir while the parents are on the same level as the boy. The trainee is asked to change the rigid structure by physically trying out different positions. He then positions himself next to the boy on one common level. In doing so, his whole posture changes; He seems to embody a provocative teenage himself, with a mischievous spark in his eyes. Upon returning to the therapy session, the trainee turns to the son, asks him to straighten his back and look him in the eye: Trainee: "How long are you going to let your parents run your life?' The boy looks startled and then gradually smiles. The trainee continues: "… until you're 17, 27or 37?" Smiling, the boy replies: "18, until I go to the army" Trainee: "Tell this to your parents; tell them what they have to do to run your life until then and how all this will change when you are 18 years old." This intervention commences a different kind of discussion, where the boy and his parents speak directly to each other about a relevant issue and the
6
trainee stays out of it except to remind the boy to raise his voice and keep his back straight.
The group as a surrogate family, identifying and changing personal patterns and behaviors Frequently the trainee is stuck when his inadequate personal patterns are triggered by someone or something in the family. The group can then function as a surrogate family to facilitate the reenactment of old destructive behaviors affording an opportunity to search for and practice new, more adequate patterns. (Rubinstein-Nabarro 1996) Frequently, after having undergone this process with the group, trainees report changes in their own family, as illustrated in the following example. Example: An experienced and skilled trainee is at an impasse in the case of an adult daughter who repeatedly fails to leave home. Regarding the daughter as weak and sickly, the parents encourage her to return home after every crisis, feeling that they are saving her from a harsh world. The trainee’s attempts to highlight the daughter's successes and strengths as proof that she can deal with her life - seem futile. The trainee agrees with the supervisor’s suggestion to confront the parents' overprotective approach, but he is unable to implement this advice. In group supervision - following the session - the supervisor asks the trainee “whose voice is it that stops you from using your confrontation skills?” To this the trainee replies: "my father". He is asked to choose someone in the group who reminds him most of his father and he chooses an older woman from the group. She is instructed to stand behind him clasping his crossed hands and to refrain from releasing her hold until he convinces her, in any way possible, that he really wishes to be free and is ready for it. . The trainee begins by explaining why he needs to be free. The supervisor asks the woman as the ‘father’ in the role-play, if she is convinced. When she says "no", she is instructed to tighten her grip. The trainee tries begging, playing, and squirming, but is not freed. Finally, when the trainee uses some force to free his arms, the woman lets go of him. Interestingly, the woman is much smaller than the trainee so it is not an issue of physical strength. In the following therapy session the trainee is able to be much more direct with both daughter and parents. He also reports that he experienced a different kind of conversation with his own father (a well-known businessman and public figure), in which he responded to his father's criticism in a more direct and open manner. Group members as a physical metaphor for the problem and its solution Metaphors or symbols are good ways to deal effectively with an impasse or resistance. The group members can "act out" the metaphor through the use of their bodies and movements. This is an experiential
7
means of communication with the right brain, where verbal - analytical processes seem rather ineffective. The group members who create the live metaphor usually share their sensations and feelings of being within the symbolic situation, verbally or non-verbally. Example: A trainee is working with a highly reactive couple in pre-marital consultation. The session is very chaotic as both partners provoke each other with verbal attacks such as “you are crazy, no one will want to marry you!” or “you are, and always will be irresponsible!” The trainee seems lost. With the trainee’s permission, the supervisor asks two volunteers from the group to engage in non-verbal physical wrestling, in front of the couple and the trainee. The couple is asked to help the wrestlers transform the fight into something more productive. Soon it becomes evident that one partner is clearly physically stronger, but his opponent beats him using laughter and mockery. Exhausted, the beaten wrestler sits down on the floor and then, suddenly, the man sits beside her. The fighting ceases and everyone sits in silence. Then the woman says: "I never knew how strong I was` I’m so accustomed to feeling like a victim that I constantly fight back but it gets me nowhere…" The couple, therapist and his group members continue sitting on the floor, in a gentle embrace. Celebrating Tribal transition and parting rituals The group serves as a supportive community and is a witness to the celebration and enhancement of the impact of transitions throughout the therapy process. This ritual serves three different purposes: Firstly, it provides a model for families who seldom celebrate anything by creating an active experiential event with greeting cards, flowers, medals. Secondly, it is a means of acknowledging transitions by celebrating the family members’ achievements in the therapy and in their lives. This serves as an affirmation to highlight and respect the effort invested in the process. Thirdly, it is used as a means of termination of the therapy, highlighting the family’s progress and its resources and strengths. Example: A family of five was referred to therapy because of the parents’ declared helplessness in handling their adolescent and adult daughters. The daughters (25, 23 and 17) lived at home but refused to take on any responsibilities around the house. Both parents worked very hard as fashion designers and manufacturers of eveningwear. Therapy came to a close with a new understanding between family members, regarding household chores and responsibilities and a fresh outlook on the relationships between the parents and their adult children. Planning the last session, the supervision group suggests that the parents bring samples of their work to show the group (all female). In this final session the family brings three exquisitely made gowns and shows the group all the secret seams that make their craft so special. They also bring a steaming pot of meatballs – one of the daughters' specialties.
8
In this way, the therapy concludes with a “fashion show” and a festive meal shared by both the family and the supervision group, celebrating the obvious talents and strengths of the family.
Conclusion In the last chapter of his book “Family Therapy Techniques” (1981), Minuchin compares the training of the therapist to that of a Samurai. The warrior is considered a Samurai only when the sword (the techniques) becomes "an extension of his arm" (p. 286). The THT Model has been developed to rise to this training challenge by eliciting active experiences that touch different levels and aspects of trainees' personal and family life. The learning process results from these personal transformations. The group structure constitutes a tribe-like environment that facilitates and supports this learning process. The purpose of the THT model is to train competent, spontaneous, yet directed and disciplined therapists. We think that well trained therapists should be able to integrate internal and external resources, including the considerable knowledge available from the professional community and from their personal lives. They should view themselves as affecting their environment by virtue of creating a space for growth for the people around them. They live their work and regard it as an integral part of their lives, happiness and vision. To that end, the supervisor and the group function as resources for the growth of the therapist and for other members of the tribe. Epilog At the end of the training many of our students describe their learning experience as a major turning point in their personal and professional lives. We understand that working with this model deeply affects the humanness and beauty of the individual. By this we mean not only the trainees but also the supervisors who are often "pushed to the limits" in combining their personal and professional lives. Let us conclude with a story from the book of Tao by Lau Tse: Zen Master Song Sun told this story to the daughter of one of his students: "…imagine a big factory of cookies. There is one big bowl of dough of which the cookie makers makes different shapes of cookies. Some are shaped as houses, some as trees, and some as animals. Also people are made of the same dough. …" "Did you understand?" he asked "Yes” said the little girl "we are all the same cookie!"
9
Appendix #1 "Empowering Feedback"
The feedback is always given for the benefit of the receiver's growth
The commenter reports a non-judgmental observation, rather than his judgment on the object of observation. (e.g: judgmental feedback: "I saw you behaving in an overprotective way towards the children in the family" as opposed to non-judgmental observation: "I saw you reacting quickly to every sign of anger or criticism directed at the children in the family")
The feedback is based on what was observed and should not include "psychological" analysis and interpretations.
The feedback is always followed by a question verifying its value to the receiver: (e.g: "is this relevant to you?" "Does it connect to other feelings or thoughts you have?").
Associations and memories are welcomed provided they are offered as empathic expression and not as interpretations (e.g: "I can feel the stress you feel whenever the family criticizes you").
10
Appendix #2– Structured Feedback Form To be completed by all members of the group and handed to the therapist following every session. The therapist also fills in the form about himself.
Observing the session today (date), I noticed:
Physical and emotional sensations that I experienced:
An image I have of the therapy session:
What I liked about the therapist's work is:
The therapist's progress in this session is:
Alternative ideas for the therapeutic work:
A gift of growth for the therapist:
11
References Andersen, T. (1987) The Reflecting Team: Dialogue and Meta Dialogue in Clinical Work. Family Process 26 p. 415-428 Ayal H. (1999) "Training the Self of the Therapist" Context – British Newsletter of Family Therapy (May) Bateson, G. (1979) Mind and Nature New York; E.P. Dutton Byng-Hall, J. (1995) Rewriting Family Scripts – Improvisation and Systems Change. New York; Guilford Press Gendlin, E.T. (1996) Focusing –Oriented Psychotherapy – A Manual of the Experiential Method. The Guilford Press: New York Fisher, Rob (2002) Experiential Psychotherapy with Couples – a guide for the creative pragmatist. Phoenix, Arizona, Zeig, Tucker & Co Hoffman, L. (1981) Foundation in Family Therapy. New York; Basic Books Laughlin M. J., (2000) Teaching Creativity in Family Therapy Supervision: Looking Through an Improvisational Lens, J. of Systemic Therapy 19, 3. pp.55-75 Liddle H., Brenulin D.C. & Schwartz C. (1988) (eds) Handbook of Family Therapy Training and Supervision Minuchin S. & H.C. Fishman (1981) Family Therapy Techniques, Harvard University Press, England Papp, Peggy (1976) Family Choreography, in Guerin, P.J. (ed.) Family Therapy, N.Y.: Gardner Press. Papp, P. (1980) The Greek Chorus and Other Techniques in Paradoxical Family Therapy Family Process. p. 45-57 Rubinstein-Nabarro, N. (1996) Systemic Insight in Contemporary Family Therapy. 18(1) March 19-39.
Family
Therapy.
Rubinstein Nabbaro, N. & Ivanir, S. (2006) Using Maps and Visions in Family Therapy with Remarriage (ch. 16) in: When Marriage Fail: Systemic Family Therapy Interventions and Issues. Ed’s: C.A. Everett & R.E. Lee. Haworth Press: New York.
12