Ethical Use of Power in Therapeutic Relationships

Power is a highly misunderstood and loaded word, but one highly relevant to the therapeutic relationship. A power differential is always present in the therapeutic relationship, and can be used effectively, ineffectively, or even abused. The ‘right’ use of power in the therapeutic relationship involves developing an awareness of the power differential, the implications for clients and families served, and a thoughtful application of our ethical codes. This course, comprised of five brief webinars, challenges clinicians to rethink the definition of power and dispel myths and biases around the word that can hinder the ethical, right use of power in therapy.

This is an edited version of a live-streamed training provided to therapists working in a community-based setting. You will hear contributions from some of the participants’ who attended this training (with consent).

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

Objectives:

As a result of participating in this training, participants will be able to:

Identify common myths and biases about power that can undermine the effectiveness of individual and family therapy
Identify common ways therapists’ underuse, overuse, misuse and abuse power with clients and families
Identify the link between the ‘right’ or ethical use of power in relation to therapeutic alliances, engagement in treatment, and positive outcomes in individual and family therapy

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 1.5 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.

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

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.

EcoSystemic Case Conceptualization

An ecosystemic case conceptualization both describes the interactional patterns creating and maintaining presenting symptoms and also provides an explanation of why family members are so vulnerable to falling into these patterns. It creates a story that humanizes family members and evokes empathy for all the key players. The webinars in this course introduce a critical thinking clinical tool designed to assist therapists in developing a meaningful ecosystemic case conceptualization, the EcoSystemic Assessment Worksheet. A step-by-step guide is provided on how to use it to understand the vulnerabilities and strengths of the child, the caregivers, and the family system. When used together, the NIP (Negative Interactional Pattern) and the EcoSystemic Assessment Worksheet result in a case conceptualization. A webinar is devoted to describing what an NIP is and how to map the different steps comprising it.

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 nature of an ecosystemic case conceptualization.
Describe how to complete the three sections of the Eco-Systemic Assessment Worksheet.
Describe the nature of a Negative Interactional Pattern (NIP) and how to map patterns onto the NIP Case Conceptualization Worksheet

Facilitating Change Enactments

Enactment, an experiential method grounded in systems theory that brings interactional problems into the session for direct observation and change, is a component of all current evidence-based child and adolescent-focused family therapies. Enactment is the cornerstone of ESFT, where it is used to disrupt and shift negative interactional patterns to more functional ones. This course introduces the method, describes what it is, differentiates it from other widely used interventions, and explains how and why it works. A four-phase model based on Nichols and Fellenberg’s work and the Change Enactment version of the Family Therapy Enactment Scale is introduced as a framework for doing an enactment, including setting the stage and using the NIP to look for opportunities to initiate emotionally meaningful conversations, facilitating family members through the ups and downs of the process, and meaning-making. A step-by-step guide to implementing a change enactment using excerpts from a family therapy session is provided.

The course incorporates edited excerpts from a live training with therapists working in PA’s FBMHS program.

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 what change enactments are and how they work.
Identify when to use enactments in treatment.
Explain the actions involved in each of the four stages of a change enactment.