The first time I worked for money outside of my parents’ home I was 12 years old.  The Morongo Basin Ambulance Association hired me and my best friend John to move a pile of gravel from one spot to another with shovels.  I think we got paid a dollar an hour.  It was summer in Joshua Tree, and so around 100 F (maybe 45 C for Canadians), and the pile of gravel was huge.  After a couple hours I still could not see that we had made a dent in the pile and I complained that we would never finish this job.

John was bigger and stronger than me and remained more in touch with his logical faculties.  He said, “It doesn’t matter if we can’t see a dent.  As long as we keep shoveling gravel, we know that we are making progress, and that we will eventually be done.”

It is hard to argue against that, so I am thinking of John while I am working on my Formal Client Presentation, which is the Master’s thesis of my Couples and Family Therapy program: a monster paper incorporating all of the theory and practice that we have learned in two years, plus a presentation of video of me using all of that during therapy sessions.  It is going so slowly that each time I come back to it, I feel as if I had made no progress. But I know as long as I am typing new words each time I must be making progress, and that means eventually I will be done.

Thanks John!

(First published April 27, 2011 on Nathen’s Miraculous Escape.)

OK, I’m done with my comps exam. It went well, I think. I’ll find out in a couple weeks. I’m already a week into my new term and am starting my reading. Here’s my reading list for the next 9 weeks. Each one of these is a chapter or an article for either Child & Family Assessment, Group Therapy, Wellness & Spirituality Throughout the Life Cycle, or Beginning Practicum.

[First posted on Nathen’s Miraculous Escape, April 2, 2010.]

[First posted on Nathen’s Miraculous Escape, March 31, 2010.]

At 8 o’clock tomorrow morning, I am taking my first round of comprehensive exams for my couples and family therapy program. The purpose is to make sure we understand all of the theory we’ve been learning before we start seeing clients. If I don’t pass, I will be given another chance at it in the summer–I won’t be able to see clients this summer, but I could start in the fall.  I feel good about it. I am ready.

We will be graded Pass, Fail, or Pass With Distinction. I expect to get a Pass. I know the material quite well, but we’re supposed to write 3-4 single spaced pages on each of three questions, all in five hours. With citations. That’s a lot of typing. I’ve done three dry runs through the test, and the most I’ve been able to type, even with my outlines in front of me, is 7 1/2 pages, total. I’m not a fast typist, and I still have to think some about what I’m going to write. I’m fine with a “Pass.” Part of my learning curve is learning how to stop at “good enough.”

We’re allowed to bring food, drinks, ipods, and our reference lists with the references in any order. (I’ll paste in my list below). I’m also bringing my own keyboard (Microsoft Natural Keyboard Elite) and mouse (Logitech TrackMan Wheel). Five hours of fast typing–I need to be comfortable! I’d like to bring my chair, too (Herman Miller Aeron), but it’s difficult to bike with.

Tonight I’m treating myself to some food someone else made and getting into bed early.

Here are the questions. I’ve had them since December. Below them is my reference list. Wish me luck!

Question 1

Describe in detail systems theory, contrasting it with modernism (aka positivism). Be sure to include central concepts of both epistemologies and explain them fully. Also detail the main concepts of communication theory, and the connections between communication theory and system theory. Describe a family problem in detail using a specific model of family therapy (Structural, Strategic, Solution Focused, Experiential, EFT, Bowen) to describe the relevant associated concepts to understand the situation. What are the model specific concepts you will use to understand the family? How will it direct your treatment? What interventions might you utilize to help this family? Why are these interventions systemic? How will you evaluate outcomes based on this model of therapy? How will the common factors research influence your view of intervention with this family?

Question 2

Research ethics includes principles of social justice and dictates competence at each of the following levels: a) conducting research, b) consuming research, and c) utilizing the research literature.

Describe the key social justice considerations when conducting research, when evaluating the merits of a research study, and when utilizing research data as a clinician. In your response include notions of consent, validity, and the characteristics of a well-constructed qualitative and quantitative research designs. Finally, specifically describe how you will incorporate your knowledge of research and its relationship to social justice while a clinician at the CFT.

Question 3

Please describe a process for how you will develop a systemic diagnosis and treatment plan for the client system depicted in the vignette below. Carefully describe how your diagnostic impression and treatment plan are informed by your knowledge of (1) diversity, (2) empirically validated treatments, (3) relational ethics, (4) the diagnostic and statistical manual and (5) CFT theoretical frameworks (systems and communications theories). Finally, based on the vignette below, talk about your treatment approach and how it is informed by the five areas mentioned above. Clearly articulate your systemic diagnosis and treatment plan for this client system.

Kelly (39) and Kris (26) presented for couples therapy. The couple reports they have been together for about two years and are very serious about their future together. Kris reports they have “problems understanding each other. We just can’t communicate.” Kelly agrees and reports it’s been that way for several months. Every time they try to talk with each other about their problems they don’t get along and often engage in escalating verbal arguments. The arguments often lead to Kelly leaving the house very upset and not coming home until the next day. Each partner is hoping for it to get better and want to engage in ongoing couples therapy. Kris reports feeling down and “out of sorts” most of the time and has had difficulty in getting out of bed and making it to work on time the past few months; however, is able to have some good days feeling happy and energetic. After the third session, Kelly discloses to you over the phone that he is thinking of engaging in a sexual relationship with another partner but doesn’t want to bring it up in therapy yet, and doesn’t want you to, either. He states that he feels having another partner will help the relationship because he will “be able to get my needs met.” He further reports to you that they both occasionally seek out partners outside the relationship and feel an open relationship works for them, though made the decision years ago to just not talk about it when it is happening.

Comps References

Becvar, D. S. & Becvar, R. J. (2006). Family therapy: Systemic integration. Boston, MA: Pearson.

Burbatti, G. L. & Formenti, L. (1988). The Milan approach to family therapy. Northvale, NJ: Jason Aronson.

Fisch, R., Weakland, J. H., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San Francisco, CA: Jossey-Bass.

Gehart, D. (2010). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Belmont, CA: Brooks/Cole.

Haley, J. (1993). Jay Haley on Milton H. Erickson. New York, NY: Brunner Mazel.

Madanes, C. (1991). Strategic family therapy. In A. S. Gurman & D. P. Kniskern (Eds.)Handbook of family therapy (pp. 396-416). Madison, WI: Routledge.

Nichols, M. P. & Schwartz, R. C. (2008). Family therapy: Concepts and methods. Boston, MA: Pearson.

Sandberg, J. G., Johnson, L. N., Dermer, S. B., Gfeller-Strouts, L. L., Seibold, J. M., Stringer-Seibold, T. A., Hutchings, Andrews, J. B., & Miller, R. B (1997). Demonstrated efficacy of models of marriage and family therapy: An update of Gurman, Kniskern, and Pinsof’s chart. The American Journal of Family Therapy, 25(2). 121-137.

Sprenkle, D. H. & Blow, A. J. (2004). Common factors and our sacred models. Journal of Marital and Family Therapy, 30(2), 113-126.

Watzlavick, P., Bavelas, J. B., & Jackson, D. D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies, and paradoxes. New York, NY: Norton.

Sells, S. P., Smith, T. E., & Newfield, S. N. (1996). A clinical science for the humanities: Ethnographies in family therapy. In S. Moon & D. Sprenkle (Eds.), Research Methods in Family Therapy (pp. 25-63). New York: Guilford.

National Institutes of Health (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. URLhttp://ohsr.od.nih.gov/guidelines/belmont.html

National Institutes of Health (2010). The Nuremberg code: Directives for human experimentation. URL http://ohsr.od.nih.gov/guidelines/nuremberg.html

Sue, S. (1999). Science, ethnicity and bias: Where have we gone wrong? American Psychologist 54(12), 1070-1077. 

Freire, P. (1970). Pedagogy of the oppressed. New York, NY: Continuum.

Aronson, E., Ellsworth, P. C., Carlsmith, J. M., & Gonzales, M. H. (1989). Methods of Research in Social Psychology. Columbus, OH: McGraw-Hill.

Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches. Los Angeles, CA: Sage.

Corey, G., Corey, M.S., & Callanan, P. (2011). Issues and ethics in the helping professions(8^th Ed.) Belmont, CA: Brooks/Cole Cengage Learning.

Fisch, R., Weakland, H., & Segal, L. (1982). The tactics of change. San Fransisco: Jossey-Bass.

American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.-TR). Washington, DC: American Psychchological Association.

Bettinger, M. (2006). Polyamory and gay men: A family systems approach. In J. J. Bigner (Ed) An introduction to GLBT family studies (pp. 161-181). New York, NY: Haworth.

LaSala, M. C. (2001). Monogamous or not: Understanding and counseling gay male couples.

Families in Society, 82(6), 605-611.

April 9, 2010

Dear Nathen,

We are very pleased to inform you that you passed the comprehensive exam. Our standard in grading this exam is high; your work was of a very high quality. Congratulations!

You have worked very hard and you have demonstrated excellent understanding of core course material. We look forward to working with you as you move into your clinical work. In the Beginning Practicum course Dr. Tiffany Brown will continue to inform you about the Advanced Practicum course, about internship options throughout the community, and about orientation dates and plans for beginning at the Center for Family Therapy.

The vast majority of your cohort received a passing score this year. This is a statement of both your individual abilities and the support you give each other.

Again, congratulations.

Deanna Linville, Ph.D., LMFT

CFT Program & Clinical Director

Assistant Professor

Couples and Family Therapy Program

University of Oregon

[First posted as “Comps Update” on Nathen’s Miraculous Escape, April 9, 2010.]

I just spent ten weeks with these fine future family therapists. It’s pretty cool to have the same people in every class, about twelve hours a week, and all doing the same assignments and reading. (About 30 hours of reading a week and between 5 and 20 hours of writing a week.) I think I’m getting to know them pretty quickly. It’s a little like how I felt doing my honors thesis in the psychology department with a bunch of people I would be graduating with, but I only got a year with them, and only had a couple of them in each of my various classes–the CFT masters is on a set track, where two undergraduates in psychology might only have taken a couple classes in common. I’m getting something like 21 months with this cohort, and spending a lot more time with them throughout.

This is them just before I gave my presentation, “Intervention at the Level of Systems versus Individuals,” on our last day of Family Theory class. We were all pretty exhausted–on the home stretch. Marc, our instructor, is in the lower left.

My CFT Cohort

[First published on Nathen’s Miraculous Escape, December 5, 2009.]