An Introduction to Systemic Practice

Systems theory informs case conceptualization and practice, not only in EcoSystemic Structural Family Therapy (ESFT) but in all models of family therapy. Systems theory directs therapists to focus on the social context and interactions between people in the family and the larger ecosystem. Therapists who are new to systems thinking often struggle with making the shift from a more linear perspective which privileges an individual’s intrapsychic dynamics or behavior over that of the relational context. This course is designed to facilitate this shift for therapists new to family therapy by clarifying the elements of systemic and nonsystemic treatment mindsets.

This is a Beginning Level course. The target audience is behavioral health professionals working with children and adolescents.

Course Objectives
As a result of completing this course, participants will be able to:

Describe the concept of treatment mindsets
Identify the distinguishing characteristics of a systemic mindset and how it shapes treatment
Describe four non-systemic mindsets and how they shape treatment

This course uses an online distance-learning self-paced format. It includes recorded audio, recorded video-based webinars, and selected readings. There are post-tests to ensure comprehension of the material. Participants can communicate with the instructors via the online moodle interface. Real-time communication with the instructor in our online, self-paced distance learning courses is not possible. However, participants can send an email to the instructor via the online moodle interface within the course and expect to receive a response within 48 hours. All course content, including post-tests, should take approximately two hours to complete.

Frequently Asked Questions
Visit our Self-Paced, Online Continuing Education Policies & FAQs for additional information regarding the CFBT online learning center, accommodations for disabilities, reporting problems with the course, instructions for viewing webinars, etc.

The Fundamentals of Eco-Systemic Structural Family Therapy

This course provides an orientation to the EcoSystemic Structural Family Therapy (ESFT) model. Although ESFT can be used across the continuum of care, this course primarily focuses on its application to intensive in-home treatment programs serving youth with SED. The course is comprised of webinars describing its’ history and evolution from Structural Family Therapy, characteristics of the population the model was developed to treat, how ESFT practitioners define clinical problems, the core components of the model, and the goals of ESFT treatment. In this course, the ESFT Logic Model is introduced and described in detail. The logic model presents a macro or big-picture view of treatment, showing the progressive stages of ESFT treatment, the clinical focus and actions related to each stage, and the objectives of each treatment stage. The logic model enables therapists to see the link between what they do in each stage of treatment and the ultimate outcomes of an episode of treatment. It is also helpful as a road map to treatment, helping therapists determine where they are in the treatment process and what comes next.

A webinar is also devoted to the ESFT theory of change, a session-level description of actions promoting change. While the Logic Model is descriptive and highlights the “what” of ESFT treatment, a theory of change is explanatory, highlighting specific therapist actions believed directly linked to treatment outcomes. It addresses the question, “What do I do in sessions to promote change?” Six mechanisms of change and the actions associated with each are described in detail. The final webinar in the course reviews the evidence base for ESFT.

Two of the webinars in this course are comprised of edited excerpts from a 2023 live-streamed collaborative presentation on ESFT by Dr. Steve Simms, Director of the Philadelphia Child and Family Therapy Training Center (PCFTTC), and Pinky Mehta, Associate Director of the Philadelphia Child and Family Therapy Training Center (PCFTTC).

This is a Beginning Level course. The target audience is all behavioral health professionals working with children and adolescents.

Course Objectives
As a result of completing this course, participants will be able to:

Describe the key components of ESFT and overarching goals of treatment (outcomes).
Identify the six stages of ESFT treatment and the intermediate objectives of each stage.
Identify the six mechanisms of change and the actions associated with each.
Describe the evidence base for ESFT as applied to intensive, in-home programs.

The Four Pillars of Ecosystemic Structural Family Therapy

This course addresses the question: What creates, maintains, and exacerbates social-emotional disturbance (SED) in children and adolescents? There are four major intersecting vulnerabilities in families associated with SED, each of which is described in detail in this course. They include 1) problems in individual and family emotion regulation, 2) insecure attachment and strained emotional connection between caregivers and their children, 3) problems in the caregiver’s ability to maintain an executive or leadership role in the home, and 4) inadequate support for the caregivers’ parenting role inside and outside the home. These four family vulnerabilities are referred to as the “four pillars of ESFT” because they are central in organizing both assessment and treatment. The ESFT Relational Treatment Plan is designed around these four domains.

A case study involving a single parent and her 9-year-old son is used to exemplify the types of questions to consider when viewing family interactions in each of these four vulnerabilities. The primary goal for participants in this training is to improve a general ability to recognize strengths and weaknesses in each of the four pillars as they play out in families.

This is a Beginning Level course. The target audience is behavioral health professionals working with children and adolescents.

Course Objectives
As a result of completing this course, participants will be able to:

Describe four core vulnerabilities that create and maintain a SED System.
Identify clues about individual challenges with emotion regulation and the security of parent-child attachment by listening to a caregiver’s stories about parenting.
Identify clues about a mother’s executive functioning and the level of support available for parenting by listening to her stories about her relationship with extended family

Understanding Attachment in Families

This four part webinar series provides an introduction to attachment theory and how it can be applied to the family treatment of children and adolescents with serious social and emotional issues. The first module describes the role of an attachment focus in the operationalized version of ESFT and identifies clinical competencies involved in helping caregivers become a more reliable source of emotional support to their children. The second module describes the nature of attachment problems. In the third module, the attachment system and how it creates an internal working model is explained. The fourth module focuses on the nature of secure attachments, with a particular emphasis on how the concepts of attunement and intersubjectivity can be utilized to deepen therapeutic relationships.

This is a Beginning Level course. The target audience is all behavioral health professionals working with children and adolescents.

Learning Objectives

1. Describe the attachment system and how it creates an internal working model
2. Explain the reasons working with attachment is critical in the treatment of children with SED and their families.
3. Describe the features of a secure and insecure attachment patterns in families.
4. Describe the concepts of affect attunement and miscuing emotional needs.

Course Outline

Unit 1: The Role of an Attachment Focus in Family Based Treatment (90 minutes)
- Readings on communal rituals, attachment process in family therapy, and the influence of attachment on treatment
- Webinar: The Role of Attachment in Family Based Treatment

Unit 2: The Nature of Attachment Problems (60 minutes)
- Webinar: Differentiating Attachment Problems from Attachment Disorder

Unit 3: Attachment and the Attachment System (90 minutes)
- Webinar: Defining Attachment and It’s Relationship to the Internal Working Model Video on the Strange Situation experiment
- Reading on attachment patterns from Setting the Stage for Change

Unit 4: What Secure Attachments Can Teach Us About Treatment (90 minutes)
- Reading on attachment-focused parenting
- Video on attachment theory
- Webinar: Applying the concepts of affect attunement and miscuing to Treatment