A Workshop for Mental Health Professionals A

CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

EXERCISES IN DIFFERENTIATION: A WORKSHOP FOR MENTAL HEALTH

PROFESSIONALS

A graduate project submitted in partial fulfillment of the requirements

For the degree of Master of Science in Counseling, Marriage and Family Therapy

Bianca M. Rus

December 2019

The graduate project of Bianca M. Rus is approved:

______

Carine M. Keenan, LMFT Date

______

Mark J. Souris, Psy.D. Date

______

Stan Charnofsky, Ed. D., Chair Date

California State University, Northridge

DEDICATION

To my grandmother, Ileana Tataran, the kindest light I’ve known, and my tallest tower.

iii

ACKNOWLEDGMENTS

To the members of my graduate committee for the time and support they put into helping me see this project through. I look up to you and I have learned tremendously by virtue of your guidance. Thank you.

To my educators and supervisors who have given me so much along this road and will forever have altered my self-of-the-therapist. I am grateful to you all.

To myself for being able to get to the end of this program and to the divine universe for helping me get here.

TABLE OF CONTENTS

SIGNATURE PAGE ...... ii DEDICATION ...... iii ACKNOWLEDGEMENTS...... iv ABSTRACT ...... vii CHAPTER I: INTRODUCTION ...... 1 STATEMENT OF NEED ...... 3 PURPOSE OF GRADUATE PROJECT ...... 6 TERMINOLOGY ...... 7 SUMMARY ...... 10

CHAPTER II: REVIEW OF LITERATURE ...... 12 INTRODUCTION ...... 12 SELF-OF-THE-THERAPIST TRAINING MODELS ...... 14 THE SATIR MODEL ...... 15 THE APONTE MODEL ...... 18 THE BOWEN MODEL ...... 20 CRITIQUE OF BOWEN’S MODEL ...... 25 PERSONAL PRACTICES OF SELF-OF-THE-THERAPIST ...... 29 SELF-OF-THE-THERAPIST AND DIFFERENTIATION ...... 32 CURRENT SELF-OF-THE-THERAPIST TRAINING PROGRAMS ...... 42 SUMMARY AND RELATION TO PROPOSED PROJECT ...... 45

CHAPTER III: PROJECT AUDIENCE AND IMPLEMENTATION FACTORS ...... 50

INTRODUCTION ...... 50 DEVELOPMENT OF PROJECT ...... 50 INTENDED AUDIENCE ...... 53 PERSONAL QUALIFICATIONS ...... 53 ENVIRONMENT AND EQUIPMENT ...... 54 FORMATIVE EVALUATION ...... 55 PROJECT OUTLINE ...... 55

CHAPTER IV: SUMMARY AND RECOMMENDATIONS/CONCLUSIONS ...... 66 SUMMARY...... 66 DISCUSSION AND RECOMMENDATIONS ...... 67 FUTURE WORK/RESEARCH ...... 69 CONCLUSION ...... 70

REFFERENCES: ...... 72 APPENDIX A: WORKSHOP PRESENTATION ...... 100 APPENDIX B: WORKSHOP MANUAL FOR FACILITATORS ...... 125 APPENDIX C: DIFFERENTIATION OF SELF INVENTORY ...... 147

APPENDIX D: HOMEWORK ASSIGNMENTS ...... 149 APPENDIX E: WORKSHOP EVALUATION FORMS ...... 150

ABSTRACT

EXERCISES IN DIFFERENTIATION: A WORKSHOP FOR MENTAL HEALTH

PROFESSIONALS

Bianca M. Rus

Master of Science in Counseling, Marriage and Family Therapy

The development of self-of-the-therapist (SOTT) is a key component in becoming an effective therapist. Just as clients are impacted by negative instances from their past lives, therapists too have their own stories and tendencies that they inadvertently bring to the therapeutic relationship. Therapists who have explored aspects of the self and processed personal challenges are more self-aware and better equipped to guide their clients through similar journeys. While mental health professionals undergo extensive skills training on theory and skills building, few programs, if any, have components that address SOTT exploration and development with personal therapy being the sole practice required by these programs. The purpose of this project is to provide a workshop for early-career therapists to engage in SOTT personal practice in order to develop a more differentiated therapist self. The workshop’s foundations rest on guiding therapists through a self-examination based on Bowen’s three principles: emotional reactivity, fusion with others, and the ‘I’ position through a four-day workshop. The workshop will involve psychoeducation, group activities and individual reflection to encourage therapists to self-reflect and be metacognitive about their own personal aspects of the self.

vii CHAPTER I

Introduction

Closely tied with therapeutic skill building, the development of the-self-of-the- therapist (SOTT) is a significant component of becoming an effective therapist and establishing therapeutic competence (Lum, 2002). Work of SOTT can be achieved through personal practices (PP) that include any formal psychological interventions and techniques therapists use to self-reflect experientially over an extended time both in an individual or group setting, pertaining to their personal and/or professional development

(Bennett-Levy, 2019). Most notable examples of PPs are meditation programs such as mindfulness training, personal therapy, self-practice/self-reflection protocols as well as experiential/personal development groups (Bennett-Levy, 2019). Such SOTT approaches increase awareness of one’s own inner process while promoting observation and self- reflection on issues pertaining to their inner existence (Lum, 2002).

Person of the therapist work has been utilized since the beginning of the field of mental health with Freud and psychoanalysis. Since then, numerous mental health professionals have recognized the use of SOTT as the single most important factor in developing a therapeutic relationship (Andolfi, Ellenwood, & Wendt, 1993; Baldwin,

2000).

Virginia Satir, a strong advocate of SOTT, postulated that such personal practices allow the therapist to become emotionally available, and as a result, to connect deeply with the client’s inner experience (as cited in Lum, 2002). Her contention was that the therapist-applied positive use of self can be a powerful component in treatment and in building a more integrated self (Satir, 2000). Stressing the therapist’s level of

congruence, Satir argues that a therapist will fail to become congruent if they neglect to work through their own personal issues due to discomfort, denial or resistance (as cited in

Lum, 2000). If the therapist could achieve congruence, then transference and countertransference would all but fail to exist, allowing the practitioner to model for the client how to stay connected with themselves (Lum, 2002).

Similarly, Aponte and Kissil (2012) argues that the therapist also shares core psychological challenges that they must embrace and work through just like their client.

This feat can be achieved through training and personal practice of the therapist

(Apolinar, 2018). His model set out to augment the clinicians’ therapeutic effectiveness by making use of all of whom they are in the clinical work (Kissil, & Niño, 2018).

Aponte et al.’s (2009) approach gave weight to therapists’ culture, values, and spirituality as powerful forces operating inside in parallel with the therapeutic goals. He encouraged therapists to utilize their inner emotional experiences as a tool to both identify with and differentiate self from the client (Aponte et al., 2009).

Other family therapy pioneers such as Murray Bowen and Carl Whitaker applied the concept to the field of marriage and family therapy (Aponte & Kissil, 2012). Bowen

(1978) advanced the concept of differentiation of self, arguing that a therapist who has worked through understanding the dynamics of his/her family system will be better equipped to guide the client in their effort to differentiate and create a separate sense of self from the family. Supporting Bowen family systems theory’s contention, Schnarch

(1997) highlights that a therapist can only facilitate their client's growth and development within the limits of their own level of differentiation. For Bowen, the therapist’s differentiated stance is the principal intervention in the client–therapist system, while

being as differentiated a therapist as possible creates a space or invitation for the client to improve their own level of differentiation of self (DoS), and allows for growth and expansion of one’s potentialities (Bowen, 1978; Friedman, 1991).

Statement of the Need

Despite numerous reports that SOTT can have a profound impact on the therapist development and the therapeutic relationship alike, training programs with SOTT components have been slow to emerge, leaving new-career mental health professionals with scant opportunity to explore their own self as therapists in their educational setting

(Kramer, 2000). Few, if any, graduate programs do as much as touch on the development of SOTT, leaving this aspect of traineeship highly neglected (Baldwin, 2000). Despite the consistent recognition of the value that SOTT components bring to the therapeutic training, the Commission on Accreditation for Marriage and Family Therapy Education

(COAMFTE) has yet to figure out an integration of such protocols into graduate programs’ curriculums (Watson, 1993). Historically, such challenges have been attributed to the difficulty in determining ways to instruct and evaluate effective training competency in the area of SOTT. Another concern is that, through their nature, such components may pose the risk of morphing into personal therapy for trainees (Aponte et al., 2009).

Be that as it may, the literature to date supports inclusion of such practices in the training of new therapists; in particular, of models of therapist skill development that highlight the value of both the personal self and the therapist self in therapist development, as well as the role of interpersonal skills (Bennett-Levy, 2006; Bennett-

Levy, Thwaites, Chaddock, & Davis, 2009b; Rønnestad & Skovholt, 2013; Skovholt &

Rønnestad, 2001). If, for a long time, there has been minimal inquiry in the SOTT’s contribution to the therapeutic relationship (Burns & Auerbach, 1996; Gilbert & Leahy,

2007) or on the development of such practices of the therapist (Bennett-Levy, 2019), in recent years, the landscape of PP has been changing with new forms of PP emerging in therapist training. A vast array of meditation programs, such as compassion, mindfulness and loving-kindness (Boellinghaus, Jones, & Hutton, 2014; Lomas, Medina, Ivtzan,

Rupprecht, & Eiroa-Orosa, 2018), as well as self-practice and self-reflection (SP/SR) programs (Bennett-Levy, Thwaites, Haarhoff, & Perry, 2015; Farrell & Shaw, 2018;

Kolts, Bell, Bennett-Levy, & Irons, 2018), in particular, have developed a growing evidence base and a strong theoretical and empirical case to warrant PP an explicit role in therapist training and personal development (Bennett-Levy, 2019). Across the board, such research is emphasized by findings that (1) personal and interpersonal qualities of therapists play a fundamental role in client outcomes and that (2) personal practice is the most effective way to achieve growth in the therapist’s personal and interpersonal qualities (Bennett-Levy, 2019). Research on therapist effects and what makes a highly effective therapist are also enunciating the alliance-outcome relationship as possibly the most consistent finding in the therapy outcomes literature (Baldwin & Imel, 2013;

Castonguay & Hill, 2017a). Findings stress that certain therapist attitudes such as empathy and authenticity are direct contributors to better client outcomes (Barkham et al.,

2017; Castonguay & Hill, 2017b) and key-alliance-building factors (Castonguay & Hill,

2017a; Nienhuis et al., 2018; Bennett-Levy, 2019).

Such varied contentions warrant the need for further understanding of how SOTT personal practices can be applied in a training setting and what the outcome of such

practices would bring to the environment, the therapist, and the profession’s development. Also, important to consider is whether existent models of therapist skill development and competence are adequately reflecting the SOTT’s impact on the client outcomes and whether conventional training modalities meet these tasks (Bennett-Levy,

2019).

Due to the multifaceted role that the therapist plays in the therapeutic relationship and the importance of self-exploration in the development of the SOTT, the field would highly benefit from further expansion and understanding of this topic. With the growth that the field of mental health has experienced in the last few years (Bureau of Labor

Statistics, 2015), the increased demand for mental health services (National Institute of

Mental Health, 2006) and with consideration to BBS’ requirements that aspects of SOTT be included in the therapist’s training, the need for a paradigm adjustment is much warranted. Such expansion should target research pertaining to SOTT PP training for new-career therapists and it should acknowledge the value that these components bring to the practice. Furthermore, developing comfort and systematically abandoning possible awkwardness and taboos of engaging in such work would greatly serve new-career professionals and their clients alike. This approach would allow more openness towards discussion of personal challenges both amongst the peers in training, in supervision, and throughout training programs components. In adjusting this paradigm to fit the current demands of the field, professional bodies, academic institutions, supervisors and trainees alike will play important roles in supporting both trainers and researchers to include PPs in their programs, undertake evaluative research (Bennett-Levy, 2019), and expand existent knowledge of self-of-the-therapist development.

In addition, exposing clinicians to modalities of self-growth by utilizing the same theories used to explore the client-self would help support the development of increased congruence both between client and therapist and within the individual selves. With respect to Bowen theory and the concept of a differentiated self, the utilization of self-of- the-therapist for the goal of differentiation may represent the road to developing a solid sense of self, with benefits for the therapist and client alike. Consistent with Bowen’s

(1978) articulation pertaining to differentiation of self, and Satir’s (2000) argument that congruence allows for an intensified state of self and harmony, the benefits of such PP would continue to enrich both the client, the therapist, and the human field in its entirety.

Purpose of Graduate Project

Based on the need highlighted by literature and the contentions brought forth above, the purpose of this project is to provide an example of a SOTT experiential training protocol. The protocol will guide early career therapists to evaluate their own differentiation of self, utilizing Bowen’s three principles: emotional reactivity, fusion with others, and the ‘I’ position. The project itself is the creation of a four-day workshop, titled Exercises in Differentiation: A Workshop for Mental Health Professionals. The workshop aims to help early career therapists accomplish a higher level of individual differentiation through mindfulness and self-understanding pertaining to aspects of self- of-the-therapist, through Bowen’s selected concepts. This workshop will provide psychoeducation, utilize activities and discussion to encourage self-exploration and provide therapists with a safe place to reflect on their own selves, their engagement with the world, and what they may bring to the therapeutic session. This workshop is intended as an exploratory exercise in self-reflection with the hope of developing new awareness,

self-learning, and skill development of self-of-the-therapist. The goal of the workshop is to support the motivated therapist to become better differentiated: to act based on principles, to avoid emotional reactivity and fusion, and to further explore his/her sense of self by taking an ‘I’ position.

By participating in this workshop, new-career professionals and trainees alike are asked to be willing to risk and expose their vulnerabilities with the possibilities of enhanced self-understanding and personal growth. The evaluations post-workshop will serve to gauge whether the participants gained self-awareness, inner understanding and clarity into their own person, and, ultimately, if the workshop had any impact on their therapeutic competence as a result of this experience.

Due to the limited SOTT training protocols existent in graduate MFT and post- graduate programs, this workshop will serve as an experiential endeavor for the development of future SOTT trainings. By learning from the experiences brought on by the implementation of this workshop protocol, future programs and facilitators can continue to build the field’s understanding of effective SOTT training protocols with respect to BBS’s established competency standards. If not for experiential programs such as these, the field remains short of a real solution to fully comprehend the value such trainings may bring to developing competent and effective therapists.

Terminology

The following are terms that need clarifying for the purpose of this project, as they will be used throughout this paper:

• Bowen family systems theory: Bowen’s family systems theory (shortened to

‘Bowen theory’) is one of the first comprehensive theories of family systems

functioning (Bowen, 1966, 1978; Kerr & Bowen, 1988). Bowen conceptualized

the family as an emotional system having a significant impact on a person’s

behavior, symptoms and emotions and involving chronic anxiety such as

automatic physical and emotional reactions that are void of a conscious, logical

processes (Friedman, 1991).

• Differentiation of Self (DoS): One of Murray Bowen’s main concepts referring

to the balance or imbalance of two life forces and instincts: the force for

togetherness and the force for individuality (Bowen, 1978). The term is otherwise

understood as the individual’s ability to be in emotional contact with others while

remaining autonomous in one’s own emotional functioning (Kerr & Bowen,

1988). The term was used in relation to the dynamic between an individual,

his/her parents and the degree of resolved/unresolved attachments to the family of

origin (Titelman, 1998). According to Kerr & Bowen (1988), at the lowest point

on a DoS scale would be the lowest level of self also referred to as no-self or

undifferentiation while at the highest level on the scale is a complete

differentiated self, yet unachieved by humanity.

• Emotional reactivity: In the context of Bowen Theory, the term refers to how

individuals respond to potentially stressful life events, or their sensitivity to the

environment (Lee, & Johnson, 2017). Bowen argues that individuals that are more

differentiated will tolerate more intense stressors and recover more quickly from

intense or conflictual crises (Friedman, 1991). On the other hand, the less

differentiated individuals will become distressed more easily when under stress

and suffer more psychological and physiological symptoms as a result (Skowron

& Friedlander, 1998).

• Fusion with others (FO): Another Bowen family systems term denoting a type

of poorly differentiated self where individual choices are set aside to maintain a

harmony within the system (Brown, 1999). One’s fusion with others denotes the

extent to which individuals merge their thoughts and feelings with those

surrounding them (Lee, & Johnson, 2017). Carrying on the position they had as

children in their family of origin (Kerr & Bowen, 1988), highly fused individuals

fail to embrace their own convictions, accommodating and seeking constant

acceptance and approval from others (Bowen 1976, 1978; Skowron &

Friedlander, 1998).

• ‘I’ position: A Bowenian concept, the term refers to an individual’s ability to

maintain a clearly defined sense of self and to be grounded in his/her own values

and beliefs system (Lee, & Johnson, 2017). According to Bowen theory (1978),

one’s ability to take an ‘I’ position is illustrative of an increased level of

differentiation of self. Alternatively, a decreased ability to think and act

autonomously may be indicative of a low level of differentiation (Lampis,

Busonera, Cataudella, Tommasi, & Skowron, 2017).

• Personal practice (PP): Defined by Bennett-Levy (2019) as any formal

psychological interventions and techniques that therapists engage with self

experientially over an extended time individually or in a group, with a reflective

focus on their personal and/or professional development. Examples of personal

practice include personal therapy, meditation programs, self-practice/self-

reflection programs (therapists practicing therapy techniques on themselves and

reflecting on the experience), and experiential/personal development groups

(Bennett-Levy, 2019).

• Self-of-the-therapist (SOTT): The term refers to a type of training model that

views the full person of therapists and their personal vulnerabilities as the central

tool through which the practitioner does their work in the context of the client–

therapist relationship (Aponte, et al., 2009). Virginia Satir’s ‘Satir Model’ (Lum,

2002) and Harry Aponte’s ‘Person-of the-Therapist Training Model’ (Aponte, et

al., 2009) are the most recognized SOTT protocols to date.

• Therapist self: The term refers to the therapist's identity and skills, mostly (but

not wholly) acquired through training (e.g. conceptual/technical skills; therapist

beliefs, attitudes and behaviors) (as opposed to personal self, a term referring to

personal and interpersonal skills and attributes, many of which are well

established prior to becoming a therapist, and are present in normal, non-therapy

situations such as in situations when one is engaging with family and friends)

(Bennett-Levy, 2019).

Summary

Although recognized as a key component in the development of therapeutic competence, person-of-the-therapist training protocols have been consistently left out from graduate MFT programs. Person-of-the-therapist elements in establishing training competency standards have been mandated by the American Association for Marriage and Family Therapy (AAMFT), the field's primary professional organization. Due to the current expansion of the MFT field (Bureau of Labor Statistics, 2015) and the increasing

demand for mental health services (National Institute of Mental Health, 2006), effective training that ensures competent clinical services for mental health professionals is becoming an imperative (Apolinar, 2018) pushing existing protocols to expand and incorporate SOTT practices with skill training.

To understand the complexities of SOTT protocols, their implications in the development of therapeutic competency and the client-therapist alliance, it is important to evaluate existent literature pertaining to the topic of SOTT as well as Bowen theory as a concept of focus for this project. Chapter Two presents such literature including recognized SOTT models, Bowen’s family system theory and the concept of self- differentiation. The chapter will serve to substantiate the importance of SOTT-type of workshops for new-career therapists and mental health professionals. Chapter Three will address issues such as the project development, intended target population, personal and professional qualifications of those who would be able to facilitate this workshop, any equipment needed as well as the overall project outline. Chapter Four will culminate this work by providing a summary of the preceding chapters as well as any future work and proposed research to expand the field of understanding of the concepts address in the workshop. Appendix A will contain the fully developed workshop. Appendix B will include the facilitator’s manual. Appendix C will include the Differentiation of Self

Inventory. Appendix D will include the workshop’s homework assignments. Lastly, appendix E will contain the workshop’s evaluation forms.

CHAPTER II

Review of the Literature

This chapter will introduce the concept of self-of-the-therapist and its significance in clinical treatment and will build the case for the importance of SOTT programs in the training of early-career professionals. The chapter will look at most recognized SOTT models with particular emphasis on Bowen Family System Theory and the concept of differentiation as the core construct behind the workshop. While it is beyond the scope of this paper to go into detail about numerous SOTT models, some discussion is necessary to examine how existing ones can provide a framework for incorporating SOTT components to the clinical training of early-career therapists. Moreover, the chapter will highlight current personal practices (PPs) of the therapist that constitute SOTT work.

Lastly, the chapter will examine the implications of introducing SOTT components in training with consideration to the field’s continuous expansion and need for competent mental health services.

Introduction

Psychoanalysts (Freud, 1910/1959; Freud, 1937/1964; Reik, 1948), humanists

(Rogers, 1957), pioneers of family therapy (Bowen, 1972; Satir, 2000; Whitaker & Keith,

1981), postmodernists (Hoffman, 1990; White, 1993), and current social commentators

(McDowell & Shelton, 2002; McGoldrick & Hardy, 2008; Watson, 1993), have all recognized that the therapist brings more than skill and technique to the therapeutic process. The development of SOTT is a significant component of becoming an effective therapist, establishing therapeutic competence (Lum, 2002), and developing a strong therapeutic relationship (Andolfi, Ellenwood, & Wendt, 1993; Baldwin, 2000). The

therapist’s way of being (Blow, Sprenkle, & Davis, 2007; Fife et al., 2014) and their degree of self-understanding (Regas, Kostick, Bakaly, & Doonan, 2017) have been considered as the main mechanisms leading the change in the therapeutic process. Regas et al. (2017) stress that those therapists who can resolve their personal life issues and grow and mature as a result will be most effective in their client work. On a similar note,

Schnarch (1997) maintains that the therapist’s self and their maturity level greatly impact the therapist’s ability to facilitate the client's growth and that a therapist can only facilitate their client's development within the limits of their own growth and development. Moreover, studies to date have increasingly shown that the most effective therapists have stronger interpersonal skills, including verbal articulacy, acceptance, empathy, and warmth (Wampold, 2001) and a greater ability to genuinely engage with and respond spontaneously to their client (Castonguay & Hill, 2012; Orlinsky &

Rønnestad, 2005). Others contend that the therapist’s effectiveness is dependent on their emotional development, personality and degree of self-understanding (Ackerman &

Hilsenroth, 2001, 2003; Beutler et al., 2004) and that their interpersonal and intrapersonal qualities alike can impact their therapy outcomes (Regas, Kostick, Bakaly, & Doonan,

2017). In addition, Lambert & Friedlander (2008) argue that the therapeutic alliance is dictated by the therapist’s ability to respond constructively to stress, to handle anxiety, to think and to act autonomously while maintaining meaningful connections with others.

Gaining continued support in the psychotherapy literature (Blow, Sprenkle, &

Davis, 2007; Fife et al., 2014), SOTT work is recognized as a key component in training that allows therapists to identify personal issues, develop comfort and command over them (Aponte & Carlsen, 2009; McGeorge & Carlson, 2011; Weeks, Gambescia, &

Hertlein, 2016) and expand their therapeutic effectiveness as a result. Due to the value that SOTT brings to the therapeutic alliance and to client outcome, the concept serves as the fundamental component of the proposed Exercises in Differentiation workshop.

Making use of the research base and existent support for such SOTT personal practices, the workshops creates an opportunity for participating early-career therapists to experiment with a type of SOTT protocol. The component will be utilized to encourage self-reflection, expand self-awareness and help participants apply learned concepts in their own lives.

Self-Of-The-Therapist Training Models

SOTT training aims to help mental health professionals reflect on how their background and experiences shape their identity, values, beliefs, and biases and how these may both facilitate and impede their work with clients (Laszloffy & Davis, 2019).

Some mental health professionals prioritize the ability to consciously and purposefully use the self over the traditional goal of the therapist working to resolve the client’s issues

(Aponte & Kissil, 2014). Some stress that all therapists are “wounded healers” (Hanshew,

1998; Nouwen, 1979; Sedgwick, 1994; Stone, 2008) and that, beyond skill or technique, what makes the difference is how they make use of their wounds (Aponte & Kissil,

2014). In addition, some address the ability to become fully human and develop congruence with self and client as a means of reaching therapeutic effectiveness (Satir,

1983) while others emphasize the ability to have mature connections while remaining autonomous by way of differentiating (Bowen, 1978). Proponents of SOTT argue that, like clients, therapists, have stories and struggles they bring to the therapeutic relationship. They articulate that it is important for therapists to resolve such unfinished

issues to heal and become therapeutically congruent with their clients (Lum, 2002).

Therapists who fail to address such issues may bring their own stories in the therapeutic dynamic, and while having a variety of possible reactions, may fail to be fully present for the client (Lum, 2002).

Exploration of self-of-the-therapist is becoming recognized as a powerful tool for the development of the therapist (Aponte, 1994; Aponte & Carlsen, 2009; Aponte &

Kissil, 2012; Aponte & Kissil, 2016; Aponte et al., 2009; Aponte & Winter, 2013; M.

Bowen, 1978; Hoffman, 1990; McDowell & Shelton, 2002; McGoldrick & Hardy, 2008;

Satir, 1983; Watson, 1993; Whitaker & Keith, 1981; White & Epston, 1990). Several models of self-of-the-therapist are foundational for creating the principles behind this workshop.

The Satir Model. Virginia Satir’s model integrates her conceptual vision into the development of a therapeutic method to train therapists in the utilization of the self in the therapeutic relationship (Lum, 2002). Satir postulates that SOTT personal practices allow the therapist to become emotionally available and, as a result, to connect deeply with the client’s inner experience (Lum, 2002). This approach, Satir argues, increases the therapist’s awareness of their own inner process and allows them to observe themselves and to reflect on their own experience (Lum, 2002). Supporting the client and the therapist alike, awareness of the self means knowing one’s self, accepting what is and looking ahead at what is possible. Such a recognition will ultimately benefit the client’s growth and their therapeutic processing, thus strengthening the alliance between the two and promoting a respectful and creative engagement (Banmen, 1997; Lum, 2002). A strong advocate of the self-of-the-therapist, Satir delineates four personal practice goals

for therapists: increasing self-esteem, fostering better choice making, increasing responsibility, and developing congruence, goals not only applicable to client work but also invaluable in the development of the self of the therapist (Banmen, 1997).

Increase Self-Esteem. Satir et al. (1991) recognize self-esteem as imperative in the ability to connect deeply with one’s self. She argues that self-esteem allows for confidence and self-empowerment and that the self-esteem of the therapist impacts how the therapist will work with the client. If a therapist has a solid self-esteem, they are better able to make choices and be flexible in relation to client work. When therapists feel good about themselves, they are more self-trusting and better equipped to advance their interventions (Lum, 2002). As the therapist develops stronger self-esteem, they are better able to trust their own therapeutic abilities and what they bring to the therapeutic relationship (Satir et al., 1991).

Satir et al. (1991) encourage therapists using her model to work on this aspect of the self by accepting who they are and their capabilities and not judging, but instead, developing kindness and gentleness towards themselves. Satir emphasizes self-care, strengths, and resources of the therapist as key factors in the development of self-esteem

(Lum, 2002). For example, Satir’s Self Mandala outlines eight areas of a therapist’s life that need consideration and care including the physical, sensual, nutritional, intellectual, emotional, interactional, contextual and spiritual (Satir et al., 1991). If therapists are to promote the wellness of their clients, she postulates, they must pursue wellness in all these areas, whereas if they become too emotionally involved with their client, they risk neglecting their own needs and experiencing burnout as a result (Satir et al., 1991).

Foster Better Choice-Making. The Satir model proposes that there is always a minimum of three choices in any given situation, and as a result, it is of importance to move the client away from an either/or choice. The Satir model therapist is trained to develop awareness pertaining to such choice-points, as they occur during the client session. Fostering better choice-making in their clients is dictated by both the awareness of the therapist as well as the therapist’s perception of the world and those they work with. Congruent therapists, Lum (2000, 2002) explains, have more freedom to choose from an empowered place and point out discrepancies the client may be communicating.

As a result, therapists trained in the Satir model are encouraged to make choices as a mean of developing congruence in their lives and facilitating similar choice-making in their client’s (Lum, 2000, 2002).

Increase Responsibility. Satir also stresses that the therapist needs to be able to take responsibility for their unresolved issues so that they respond to those they serve in a compassionate, non-judgmental, and transparent fashion (Lum, 2002). To be able to truly hear what is behind the client’s words and processes, therapists need to be finely attuned to and be able to differentiate between issues that are triggered by the therapeutic process, and those that are the client’s personal issues (Satir & Baldwin, 1983). As clients are very sensitive to the therapeutic attunement, they may sense any bias, disrespect, discomfort, or resistance coming from the therapist. As a result, the therapist’s responsibility extends to maintaining credibility and accountability within the general public, being mindful of their own conduct, and ensuring acceptable and ethical practices (Satir & Baldwin, 1983).

A therapist can assume responsibility by making use of SOTT practices by developing integrity and competence through participation in continuing educational and

professional development programs as well as making use of clinical supervision (Lum,

2002).

Develop Congruence. Within the Satir model, the development of congruence is a key element in establishing a healthy therapeutic alliance with the client (Lum, 2002).

Satir outlines three levels of congruence, including: (1) accepting feelings as they are, (2) being in harmony within oneself, with others, and with the world and (3) being in harmony with Self, perceived as the I am, life energy, spirituality, and God (Satir et al.,

1991). To develop stronger congruence with oneself and the client, Satir proposes making use of the spiritual self of the therapist by creating a connection with the client’s energy at the spiritual level (Satir & Baldwin, 1983). Viewing therapy as a spiritual experience between herself and the client, Satir’s aim remains to honor the client’s essence by combining one’s intuition and groundedness to facilitate a sense of connectedness and understanding (Banmen & Banmen, 1991; Satir & Banmen, 1983). Development of such congruence, Satir postulates, would deem transference and countertransference unnecessary. Furthermore, it would allow the therapist to model staying attuned and connecting with oneself for the client, an attunement that would lead to a state of presence and peaceful harmony (Satir, Banmen, Gomori, & Gerber, 1991). Although arduous to accomplish, developing congruence is fundamental for the therapists as they explore their own issues while maintaining a sense of respect for the client regardless of what is being shared in the therapeutic relationship (Satir & Baldwin, 1983).

The Aponte Model. While Satir emphasizes the positive use of self in the client- therapist relation, Aponte et. al’s (2009) model views the full person of the therapist, and their personal vulnerabilities as the central tool through which therapy does its work in

the context of the client–therapist relationship. The model stands part in its recognition of the totality of the therapist, as encompassed by their psychological, cultural, and spiritual as well as their social and political beliefs and values (McDowell & Shelton, 2002;

Watson, 1993). Special attention is paid to the therapist’s own emotional wounds and their recognition which promotes an empathic and resonant engagement with the client’s own wounds (Aponte & Kissil, 2016). The model goes even further to consider therapists as wounded healers (Nouwen, 1979), who, making use of their own struggles, can truly connect with their client’s humanity. This, in turn, can profoundly enrich the therapeutic alliance (Zeytinoglu, & Niño, 2018). It is ultimately how the therapist utilizes the awareness of such wounds that makes the difference in the therapeutic relationship, surpassing skill or technique in the human experience of therapy (Aponte & Kissil,

2014).

For this protocol to fully serve the intended therapeutic purpose, the therapist’s training is aimed at recognizing who they are and what aspects of the self they bring to the therapeutic encounter. This allows both the positive and the more challenging parts of the self to exist in the therapeutic process while the therapist remains well-grounded and differentiated from the client. By virtue of engaging in this fashion, the therapist achieves two concomitant goals: that of gaining insight into themselves and of developing acceptance and comfort with their own vulnerabilities. This, Aponte argues, ultimately frees the therapist to a positive and active use of all aspects of the self to give depth to the therapeutic alliance (Aponte et al, 2009). As a result, the therapist also frees themselves from the dysfunctional ties to their own families (Aponte et al., 2009), an idea similarly proposed by Bowen’s stance of differentiation from the family of origin.

Signature Themes. A pivotal concept of the POTT model is that of signature themes. The concept refers to the lifelong struggles at the core of our human challenges, which impact both our behavioral and emotional functioning and shape our human interactions and self-understanding (Aponte & Kissil, 2014; Aponte & Winter, 2013).

Making use of this concept, therapists training in the POTT model get to engage in several assignments with the purpose of recognizing their own themes and the emotional and relational implications they may have both in their personal lives and in the client session (Kissil, Nino, & Aponte, 2014). The assumption at the core of these practices is that, through a better knowledge and a non-judgmental understanding of the signature themes and their manifestation, trainees get in touch with various aspects of themselves, including those that elicit more difficult emotions. Accessing such emotions and getting comfortable with, and tolerant of them, trainees become more present and available to their clients throughout the therapeutic journey. Moreover, they may apply the discovered aspects of the self in the clinical process by way of understanding their own reactions, tracking their responses and participating in a more intentional and less reactive fashion

(Nino, Kissil, & Apolinar, 2015). The use of such signature themes has a multifaceted role and impacts not only the trainee’s self-knowledge and self-acceptance but also the trainees’ interpersonal relationships with client, peers and supervisors alike (Kissil &

Nino, 2017; Nino et al., 2015).

The Bowen Model. The Bowen model is a third model reviewed for the purpose of this workshop and represents the main model on which the workshop is based. Murray

Bowen was one of the first to recognize the potential of SOTT training for the development of future therapists setting the stage for therapists’ examination of their own

family-of-origin issues. The model generated from his Family Systems Theory, one of the few comprehensive ways of conceptualizing an individual’s psychological development from a systemic perspective (Gurman, 1991; Nichols & Schwartz, 1998, Skowron &

Friedlander, 1998). Making use of the multigenerational family process, Bowen’s work endeavors to reduce chronic anxiety in the family by creating awareness of how emotional systems work and increasing levels of differentiation for its members

(Bregman, 2011). Advancing the concept of differentiation from the family of origin to conceptualizing the therapeutic relationship as well, Bowen (1978) argues that a therapist who developed understanding of their own family system’s dynamic will be better equipped to guide the client in their effort to differentiate and create a separate sense of self in the world. This approach distinguishes Bowen’s work from others’ and places the emphasis on the practitioner’s level of differentiation as a principal tool and less on the therapeutic technique used (Brown, 1999). Bowen emphasizes the need for the therapist to first become differentiated to be of most use to the client. He stresses that the therapist's differentiated stance is the principal intervention in the client–therapist system

(Bowen, 1978; Friedman, 1991) and that the therapist’s level of differentiation, by itself, can have a profound impact on the clinician’s ability to facilitate the client's growth

(Bowen, 1978). In Bowen’s perspective, a therapeutic alliance is most solid with a therapist who can maintain autonomy in his emotional functioning while being able to stay emotionally present with the client (Bowen, 1978). Being as differentiated a therapist as possible, creates a space or invitation for the client to improve their DoS and allows for growth and expansion of one’s potentialities (Bowen, 1978; Friedman, 1991).

Bowen also encourages therapists to move out of the healing or helping stance and rather than wait for a cure, to encourage clients to accept responsibility for their own change. By implication, the therapist puts more emphasis on the client’s patterns of emotions and relationships and less on the specific presenting problem. He firmly asserts that, to successfully relate to the family unit, the practitioner needs to avoid over- involvement and assist without embracing and interpreting transferences (Bowen &

Butler, 2013). Bowen’s brilliance ultimately resides with his ability to endeavor new therapists in the field to examine their preexisting assumptions about the forces that govern human behavior as an alternative to the use of a therapeutic method. For him, this can be one of the strongest learning components for the trainee as a means of working toward personal and professional responsibility and growth (Titleman, 2014).

Differentiation of Self from The Family of Origin. Of Bowen’s many constructs, the DoS represents a personality aspect most critical to an individual’s development and attainment of maturity and psychological health (Skowron &

Friedlander, 1998). Due to its call for the individuals to establish self separate from others while functioning interpersonally with them, it has also been considered a universal developmental target (Lampis, & Cataudella, 2019).The concept is viewed by Bowen as a way of balancing two life forces and instincts: the force for togetherness, and the force for individuality and stresses the degree to which one’s self fuses with another in a close emotional relationship (Bowen, 1978). One beholds solid self, composed of firmly held beliefs and convictions formed slowly and unchanged by coercion, whereas, the other presents like a pseudo-self, constructed by intellect and beliefs acquired through others

(Bowen 1978).

Bowen theory establishes the concepts on two levels: the intrapersonal and interpersonal. On an intrapersonal level, the concept refers to the individual’s ability to distinguish feeling processes from intellectual ones (Peleg-Popko, 2002) and to be guided by rational thinking or intellect instead of by emotions (Kerr & Bowen, 1988). On the interpersonal level, DoS denotes an individual’s ability to express their own views, limits, beliefs and values while maintaining close and meaningful relationships with others (Lam

& Chan-So, 2015). A person who is poorly differentiated is guided by emotional impulses and, consequently, such a person tends to lead a chaotic life with fluctuation in mood and behavior (Lam & Chan-So, 2015). The well differentiated person experiences a solid sense of self and operates on well-thought-out principles (Kerr & Bowen, 1988).

They can state succinctly who they are and articulate their position while maintaining their calm (Kerr & Bowen, 1988). A poorly differentiated person appears either dogmatic, domineering or submissive – stances that illustrate a need for approval and acceptance from others (Bowen, 1976). Such stances are descriptive of a strongly fused individual (Lam & Chan-So, 2015). Moreover, a poorly differentiated person feels threatened by separation and establishing distance from others while having difficulties with intimacy (Lam & Chan-So, 2015) and being overwhelmed by others’ anxiety

(Schnarch, 1997).

Empirical Support for Differentiation of Self. In line with Bowen’s theory

(Bowen, 1976, 1978), recent studies recognize that those low on the DoS struggle to manage anxiety (Farber, 2004; Murdock & Gore, 2004), self-regulation (Skowron et al.,

2003), and interpersonal problems (Choi & Murdock, 2017; Skowron, Stanley, &

Shapiro, 2009). On the opposite end, highly differentiated people have higher level of

psychological functioning and experience better adjustment than their less-differentiated counterparts (Peleg & Rahal, 2012). Similar studies found higher levels of DoS to be associated with less chronic anxiety and fewer psychological symptoms (Skowron &

Friedlander, 1998), less general psychiatric distress (Tuason & Friedlander, 2000), better spiritual development (Jankowski & Vaughn, 2009), and greater marital satisfaction

(Kosek, 1998).

In the therapist-client relationship, Lambert and Friedlander (2008), found that higher levels of therapist DoS are associated with higher levels of therapeutic alliance.

Similarly, work by Bartle-Haring, Shannon, Bowers, and Holowacz (2016) contend that the therapist’s level of differentiation may be a necessary factor in creating a sense of trust between therapist and client, independent of the model of therapy used.

Additionally, Kerr (2019) highlights that therapists who seek to treat their clients should not bypass addressing their own functioning and that it is their responsibility to define themselves outside of their families. She stresses that DoS promotes one’s and others’ health, well-being and productivity while lack of DoS has the opposite effect. Lastly,

Bardill (2000) notes that a well-differentiated person experiences better self-management in areas such as self-regulation, self-definition and self-distinction, a recognition with subsequent implications for the therapist and the client-therapist relationship as well.

Based on such contentions, this project focuses on the therapists’ DoS both as an instrument for personal development of the therapist and, indirectly, as a therapeutic tool in the client relation. With recognition to the value that DoS gives to the therapeutic self, this workshop proposes varied exercises, discussion and self-reflections that target the participants understanding and applying of the concept in their personal lives. By being

exposed to such concepts, the workshop hopes participating therapists will expand both their self-knowledge and acquire practical tools they can use in the client session.

Although such work may have an indirect effect on the participants’ clinical work, the workshop doesn’t endeavor to make this an outcome objective.

Critique of Bowen’s Model

Bowen theory is recognized in the field of family therapy as a new theory of human behavior and, like other theories, has been vulnerable to becoming a “closed system” or a dogma. Although Bowen’s ideas have been crucial to the development of the family systems theory, they were not equally received by all his contemporaries in the psychoanalytic field (Horne & Hicks, 2002; Wylie, 1991). Bowen’s theory received initial criticism from his contemporaries from the psychoanalytic sphere (Wylie, 1991) pertaining to items related to mother blaming (Hare-Mustin, 1978; Luepnitz, 1988), ascribing healthy attributes only to characteristics for which males are socialized (Ault-

Riche, 1986; McGoldrick, Anderson, & Walsh, 1989), and embracing a conservative political agenda oppressive to women and minority groups (Luepnitz, 1988).

The Feminist Critique. By far the most criticized concept of Bowen theory, differentiation of self has been attacked as overly promoting individuation both as a

Westernized value and a stereotypically masculine characteristic (Knudson-Martin, 1994;

Tamura & Lau, 1992). Knudson-Martin (1994) argues that women develop a connected sense of self and define themselves through attachments to others and that defining development as creating a separate sense of self, as Bowen theory suggests, denigrates the female experience. Using supporting studies of female development at the time

(Apter, 1990; Belenky, Clinchy, Goldberger, & Tarule, 1986; Chodorow, 1978;

Josselson, 1987; Lyons, 1983; Tannen, 1990), Knudson-Martin contends that the women’s challenge is becoming different while maintaining connection with others at the same time. She adds that, for women, identity formation involves balancing many commitments and aspirations and requires success in relatedness both at home and at work. In line with Knudson-Martin’s contention, others (Davenport & Yurich, 1991;

Moody-Adams, 1991) stress that it is of importance that both theory and studies recognize the plurality of women’s voice, with some others (Jagger, 1991; Pierce, 1991;

Spelman, 1991) noting the importance that the female ideal is not stereotyped uncritically.

Knudson-Martin’s (1994) feminist perspective on the applicability of therapy with women, and Tamura and Lau’s (1992) multicultural perspective on the applicability of therapy with the Japanese culture, offer modifications to Bowen’s theory to address such critiques. Knudson-Martin invites a reconceptualization of Bowen Theory that would bridge the gaps with accepted research on female development. She realigns the connection between one’s level of differentiation and their need for togetherness or separation and recognizes them as reciprocal life forces that can increase simultaneously, and as a result of the other. She also annotates Bowen’s argument pertaining to the development of the intellectual system at the expense of the development of the feeling system, stressing instead that the feeling system may be the central source of self- awareness for women and suggesting that the two can co-exist and be mutually reinforcing. Lastly, she proposes the alternative that, unlike men, who may seek a separation, women do not develop in this linear fashion and that relationships are at the core of their development (Knudson-Martin, 1994).

Critique Pertaining to Bowen’s Constructs as Universal. As Bowen believed that his theory describes life, not merely family systems (Bowen, 1978), he proposed that its constructs are universal to all cultures and genders. Such de-emphasis of cultural considerations, despite being well intended, has spurred criticisms of Bowen’s approach

(Essandoh, 1995; Rothbaum, Weisz, Port, Miyake, & Morelli, 2000; Skowron, 2004), leading some to misconstrue his theory as biased pertaining to gender and culture

(Bregman, 1993; Horne & Hicks, 2002). Such contentions imply that culture, ethnicity, race, gender, beliefs, values and traditions that exist between people do not matter, and do not affect the capacity for change to take place in the therapy session. Others (e.g., Carter

& McGoldrick, 1999; Skowron, 2004) disagree with the critics, maintaining that Bowen family systems theory is one of the few theories that adequately elevates the value of healthy connections with others to a place of central importance for maturity and health

(Alaedein, 2010).

As a result of the theory’s perceived neglect towards cultural consideration, an accumulation of theoretical and empirical work currently focuses on expanding Bowen theory to be more culturally expansive to include gender, ethnicity, race, social class, and sexual orientation, as well as family history, values, and rituals (Erdem & Safi, 2018).

Despite the need for a better understanding of the multicultural factors in the application of therapy, however, few researchers to date have offered evidence-based examinations of the cross-cultural applicability of Bowen’s theory and its constructs (Miller et al.,

2004). A study by Tuason and Friedlander (2000) in the Philippines found no differences in levels of differentiation between the Philippine sample and a U.S. sample and reported a significant influence of differentiation on psychological well-being and anxiety, like the

results from U.S. sample. Similarly, studies by Skowron and Schmitt (2003) as well as

Skowron (2004) found inconsistent results (Aladein, 2010). However, the studies suggested that ethnicity, income and education do have an impact on one’s level of differentiation.

Other studies looking at levels of differentiation between men and women were reported. Studies that compared men's and women's levels of differentiation, showed inconsistent results. Haber (1993) and Maynard (1997), discovered no gender differences in mean levels of differentiation. Similar research making use of the DSI scale also registered no differences in the overall level of differentiation (Elieson & Rubin, 2001;

Skowron & Friedlander, 1998). Some differences were recorded pertaining to levels of the scale measuring emotional reactivity (Kosek, 1998; Skowron & Friedlander, 1998;

Skowron & Schmitt, 2003), and the "I" position (Kosek, 1998; Skowron & Schmitt,

2003). Mixed results on the fusion subscale were reported with one study finding gender differences (Kosek, 1998) and another study reporting no significant differences

(Skowron & Schmitt, 2003). These results represent preliminary evidence that, although there are gender differences in some components of differentiation, there are no differences in the overall levels of differentiation, as measured by the DSI (Alaedein,

2010).

Other Critiques. From a different angle, other critics and family therapists deemed Bowen’s perspective as overly focused on the client and their family’s history and not adequately targeting interventions in the present moment (Titelman, 1998). The argument is often defended as a misplaced comment explained by the fact that, through its multigenerational approach, the model deals with the client’s current challenges by

use of themes, patterns and functioning positions that, although originating in the past, are encountered in the client’s present challenges. Bowen’s use of differentiation of self thus sponsors just that: going back into the family of origin and making contact with it in the present (Titelman, 1998). This endeavor continues through life and is ever-present for the self-aware individual.

A similar misunderstanding of Bowen theory pertains to the often-heard characterization that it is a highly intellectualized approach that sees dysfunction and promotes emotional distancing among family members. Bowen himself (1978), recognizes the challenges of finding ways to relate to the healthier side of the client’s and their family instead of their differences. He argues that it is often more effective to work through the healthier side of the family yet admits that the search for the most responsible and resourceful part of the family can often be elusive.

Despite crediting Bowen with contributing significantly to the field of family therapy, few theorists and clinicians recognize that his theory represents a comprehensive and radical new approach in the field of family systems therapy. The understanding revolves around the fact that Bowen had primarily created a unique method of family therapy focused on the multigenerational family and regarding it as another school of thought in the field. It is primarily this outlook that influences Bowen to focus more profoundly on theory as the guide for therapy and less on therapeutic technique

(Titleman, 1998), an approach that makes his theory conducive to criticism.

Personal Practices of Self-Of-The-Therapist

The literature shows the use of personal practices (PP) as a way of expanding aspects of one’s SOTT. PPs are defined by Bennett-Levy (2019) as any formal

psychological interventions and techniques that therapists engage in experientially both in an individual or group setting and with a reflective focus on their personal and/or professional development. Such models are framed around the context of two selves: the

“personal self ” and the “therapist self ” and are reported to support mental health professionals in developing both personal and interpersonal qualities while refining and deepening the conceptual and technical skills already learned (Bennett-Levy, 2019).

As early as Freud and the field of psychoanalysis, personal practices, in the form of personal therapy, have been a core requirement for psychotherapy training (Freud,

1910/57) that allowed trainees to gain insight into their transference and unconscious motivations (Malikiosi-Loizos, 2013; Murphy, Irfan, Barnett, Castledine, & Enescu,

2018). Moreover, in numerous surveys through history, the practice of personal therapy was regarded as highly valuable to developing therapists (Macran & Shapiro, 1998;

Rønnestad, Orlinsky, & Wiseman, 2016; Wigg, Cushway, & Neal, 2011). Prior to the past couple of decades, personal therapy was the only form of personal practice for therapists (Bennett-Levy, 2019). In more recent years, the landscape of PP has expanded exponentially bringing to surface new forms of PP including meditation protocols

(mindfulness, compassion, loving-kindness) (Boellinghaus, Jones, & Hutton, 2014;

Lomas, Medina, Ivtzan, Rupprecht, & Eiroa-Orosa, 2018) as well as self-practice/self- reflection (SP/SR) programs (Bennett-Levy, Thwaites, Haarhoff, & Perry, 2015; Farrell

& Shaw, 2018; Kolts, Bell, Bennett-Levy, & Irons, 2018). The primary motivations for the use of PP, include personal problems, personal growth, self-care and therapist skill development (Bennett-Levy et al., 2001; Lomas et al., 2018; Orlinsky, Rønnestad,

Willutzki, Wiseman, & Botermans, 2005; Shapiro, Brown, & Biegel, 2007).

Empirical support for PPs. PP models highlight primary impacts in four domain areas including: personal development/wellbeing, self-awareness, interpersonal beliefs/attitudes and reflective skills. Literature also suggests a secondary impact on therapists’ conceptual/technical skills when therapists use reflection to consider the implications of their PP for their “therapist self” (Bennett-Levy et al., 2019). Meditation- based programs have been suggested to enhance self-care—often as a means of addressing personal problems or supporting personal growth (Boellinghaus et al., 2013;

Christopher, 2006; Shapiro et al., 2007) whereas SP/SR programs support therapist skill development as their primary outcome (Gale & Schröder, 2014; Thwaites, Bennett-Levy,

Davis, & Chaddock, 2014). In addition, some practices developed around personal therapy, meditation, and SP/SR interventions identify both personal (self-care, personal problems or growth) and professional (skill development) objectives as their outcomes

(Bibeau et al., 2016; Gold et al., 2015; Pakenham, 2015). In line with research, although targeting different aspects of growth, all these programs recognize the impact that the development of personal self can have on the therapist self and vice versa (Beaumont,

Durkin, Hollins Martin, & Carson, 2016; Bennett-Levy et al., 2019; Kumaria, Bhola, &

Orlinsky, in press; Nissen-Lie, Havik, Høglend, Monsen, & Rønnestad, 2013; Råbu,

Moltu, Binder, & McLeod, 2016; Skovholt & Rønnestad, 2001). This overlap is particularly evident when addressing issues of self-awareness, interpersonal beliefs, skills or attitudes as well as reflective skills and wellbeing. Despite endorsement for the value of PPs from some researchers, more work is needed to fully understand the role of PPs in the development of an effective therapist and in client outcome (Bennett-Levy, 2019).

Future research however, should focus on asking how PPs might be beneficial in the

therapeutic dynamic rather than whether they are (Macran & Shapiro, 1998; Wigg,

Cushway, & Neal, 2011).

Self-Of-The-Therapist and Differentiation

The most targeted PP themes for therapist skills development are countertransference (Freud, 1910), differentiation of self (Bowen, 1978), self-awareness and self- esteem (Satir, 1983), therapist self-efficacy (Leach et al.1997; Mutchler & Anderson,

2010), therapist personal world views (Blow et al., 2007; Simon, 2006), personal mythologies (Anderson & Holmes, 2007), therapist values (Beutler et al., 2004;

Grunebaum, 2006), as well as inner conversations (Rober, 1999). For the purpose of this workshop, the theme of differentiation of self-of-the-therapist will be explored utilizing the concept of differentiation of self from the family of origin as introduced by Bowen

(1978) in his Family Systems Theory.

Instruments and Components of Differentiation. Despite recognizing that the

DoS is not a finite goal and is instead an ongoing process, Bowen did not endeavor to create a means of measuring the concept. In the clinical and research contexts, DoS has been measured primarily by one of four instruments: the Differentiation of Self Inventory

(Skowron & Friedlander, 1998), the Differentiation of Self Inventory–Revised (DSI–R;

Skowron and Friedlander 1998; Skowron & Schmitt, 2003), the Differentiation in the

Family System Scale (DIFS; Anderson & Sabatelli, 1992), the Level of Differentiation of

Self Scale (LDSS; Haber, 2003), and the Chabot Emotional Differentiation Scale (CEDS;

Licht & Chabot, 2006). Of these, Miller, Anderson, & Keala (2004) indicate that the

LDSS and the DSI-R are the two scales that are most often used to assess differentiation

of self while Drake (2011) articulates that, the multifaceted assessment and its psychometric properties make the scale most equipped to measure Bowen’s concept.

This workshop too will utilize the scale as a tool for participating therapists to evaluate their DoS. Due to the revised scale not being available for public use, the workshop will utilize the original version of the inventory (DSI; Skowron & Friedlander,

1998). The DSI is a 43-item self-report questionnaire with four subscales measuring four dimensions of differentiation: emotional reactivity (ER), items), emotional cutoff (EC), the ‘I’ position (IP), and fusion with others (FO). Based on the scale, higher levels of differentiation involve less ER, FO, and EC, and more IP in relationships. Scores are reversed, summed and range from 1 to 6. Higher scores indicate lower ER, EC, and FO and an enhanced capacity to assume an IP in personal relationships which results in greater differentiation (Messina, Kolbert, Bundick, Crothers, & Strano, 2018). Of the four concepts, the emotional reaction and the ‘I’ position target the intra-psychic aspects of differentiation, such as the ability to regulate emotions and maintain self-agency, whereas emotional cutoffs and fusion with others address one’s interpersonal ability to connect in close relationships (Skowron et al. 2003; Xue et al., 2018). These components could be further understood in terms of how they apply to the individual’s development. Thus, an individual with higher DoS is likely to experience less ER in emotionally charged situation and to maintain their IP, or their identity in the face of stressors and influence from significant others. For an individual with low DoS, ER may occur in the context of emotional intimacy, leading to EC. An individual who experiences considerable psychological distress as a result of real or perceived separations from others, alternatively, can be said to be fused (Xue et al., 2018).

For the purpose of the workshop, the participants are given the scale to fill out at the beginning and end of the workshop and, to ensure confidentiality and minimize discomfort, only the participants are privy to their own results. Although the scale includes the four components designated by Bowen as measurements of DoS, including emotional reactivity (ER), the ‘I’ position (IP), fusion with others (FO) and emotional cutoff (EC), (Bowen & Kerr, 1988; Skowron & Friedlander, 1998) the workshop leaves out emotional cutoff as an organizing concept. The author reasons that evaluating emotional cutoff is not a difficult task as the concept either exists or doesn’t in one’s experience. A person will either be cut off from family members or not, with the task of establishing that necessitating little reflection. Instead, the author chose to include constructs that required participants to engage in a more extensive self-reflection. Also, as the purpose of the workshop is to allow the participants to sit with each of the explored concepts for a week’s time, such a task is deemed redundant in relation to the emotional cutoff component of DoS.

Emotional reactivity. A first concept the workshop makes use of is that of emotional reactivity. The term is defined by Rothbart & Derryberry (1981) as the amplitude of emotional response to internal or external stimuli across subjective, physiological, or expressive domains. Others recognize the three aspects of emotional response: activation, intensity, and duration stressing that they can be positively or negatively valenced and differ from person to person (Becerra & Campitelli, 2013;

Davidson, 1998). The three dimensions specify (a) how easily an emotional response is activated in an individual, or how strong a stimulus is required to elicit an arousal response and how quickly arousal levels rise to peak amplitude; (b) how intense the

emotional response is, or the highest amplitude that the levels of arousal reach; and (c) the duration of the emotional response, or how long it takes an individual to return to baseline (Preece, Becerra, & Campitelli, 2019).

The goal promoted by Bowen model is to assist trainees in becoming as differentiated as possible to prevent emotional reactivity in the therapist’s session with clients (Papero, 1990), particularly in client systems that resemble emotional processes in the therapist’s family of origin. Ken and Bowen (1988) stress that the therapist must remain aware, and in charge of his or her own emotional reactions in the room to be able to think clearly in the face of intense content. This allows the therapist to make use of such reactions and help guide therapy. To accomplish this task, the therapist must have at least a higher level of differentiation than that of the client. Bowen argues that individuals with a more differentiated sense of self are better equipped to tolerate intense stressors in their environment and that they experience faster recovery from crises (as cited in

Friedman, 1991). Those with less differentiated sense of self have a lower threshold for experiencing distress and, as a result, suffer more psychological and physiological symptoms (Skowron & Friedlander, 1998). Like Bowen, Satir & Baldwin (1983) note that an emotional reaction is in fact, a clue that there are still things to be healed in the individual. They encourage therapists to resolve hurts from the family of origin to prevent an impact on the therapist’s life and diminish the potential for emotional responses in the clinical session.

Recognizing the importance played by adequate emotional responses in the therapeutic process, this workshop provides participating therapists with an opportunity to closely evaluate and reflect on their own level of emotional reactivity. In the format of

the workshop, the concept is utilized as a mean for participants to develop insight into their own responses, evaluate such responses and develop new ways to respond to situations that elicit more intense reactions in them. The participants will also evaluate their own scores pertaining to emotional reactivity by utilizing the DSI scale. The concept is measures by eleven statements on the scale (Skowron & Friedlander, 1998) including:

• People have remarked that I'm overly emotional.

• When someone close to me disappoints me, I withdraw from him or her for a

time.

• I wish that I weren't so emotional.

• At times my feelings get the best of me and I have trouble thinking clearly.

• At times, I feel as if I'm riding an emotional roller coaster.

• I'm overly sensitive to criticism.

• If I have had an argument with my spouse or partner, I tend to think about it all

day.

• If someone is upset with me, I can't seem to let it go easily.

• I'm very sensitive to being hurt by others.

• I often wonder about the kind of impression I create.

• I feel things more intensely than others do.

The concept is further explored through activities in which participants engage with

peers as well as through a discussion portion in the first session of the workshop. In

addition, participants take home an assignment relating to the concept and are asked

to journal their observations of self throughout the week. Lastly, they are exposed to

the concept again upon return to the workshop (session two) through a brief check in.

Fusion with others. A second concept the workshop utilizes is that of fusion with others. The term refers to another Bowen family systems term denoting a type of poorly differentiated self where individual choices are set aside to maintain harmony within the system (Brown, 1999). According to Bowen theory (1978), interpersonal patterns of fusion with others or emotional cutoff both represent behavioral mechanisms for distance regulation and are used to manage emotional overwhelm or perceived threats.

In line with Bowen’s claims, studies yield considerable evidence linking dimensions of interpersonal fusion with a range of deficits in adult psychosocial development (Skowron & Schmitt, 2003) including delays in the developmental tasks of intimacy and identity achievement (Garbarino, Gaa, Swank, McPherson, & Gratch, 1995) and career decision making in emerging adulthood (Larson & Wilson, 1998). Adults reporting greater fusion in their intimate relationships also experienced more psychological symptoms, including interpersonal distrust, perfectionism, body dissatisfaction, poor interoceptive awareness, a drive for thinness and bulimic behaviors

(Meyer, 1997). Interpersonal fusion further plays a detrimental role in adult intimate relationships with less cognitive flexibility (Winn, Crawford, & Wampler, 1995), frequent boundary violations (Bartle & Sabatelli, 1998), greater marital distress

(Christensen & Heavey, 1990; Gottman & Krokoff, 1989) and less marital satisfaction

(Waring & Patton, 1984). Those who use emotional cutoffs tend to distance themselves from others under stress projecting an exacerbated independence. Individuals predisposed towards emotional fusion have blurred boundaries between themselves and others borrowing and trading “self” in these relationships (Skowron & Schmitt, 2003). This leads to greater role constraint, difficulty tolerating differences of opinion, difficulty

making decisions while merging thoughts and feelings with others (Lee, & Johnson,

2017; Skowron & Schmitt, 2003). Carrying on the position they had as children in their family of origin (Kerr & Bowen, 1988), highly fused individuals fail to embrace their own convictions accommodating others and seeking constant acceptance and approval from them (Bowen 1976, 1978; Skowron & Friedlander, 1998).

Data pertaining to the impact of therapist fusion on the therapeutic relation, however, is virtually nonexistent. Bowen himself addresses very little about the role that fusion could play in the client-therapist relationship only briefly notating the importance that the therapist avoids being drawn into the client’s fusion with the family. He emphasizes that, for the therapist to maintain his objective stance, staying out of the group is central as the clinician can only support others to overcome their fusion if able to remain outside of it himself. Despite such absence of research work, the value of maintaining clear boundaries with the client could be explained by the need for a holding environment that the therapist offers the client as a necessary condition for the therapeutic progress to take place (Winnicott, 1965). For the therapist to be able to provide such a space, he/she needs to be close enough to the client for the client to feel secure while maintaining clear emotional and physical boundaries in the therapeutic alliance (Pick, 1986). Psychoanalytic therapy supports the contention stressing firm boundaries as ideal and any acceptable fluidity being from the client to therapist alone.

The general accepted notion assumes that fusion will occur at times and that the core therapeutic process is to work through the fusion toward viable separation, a process to be repeated with each session as is necessary (Pick, 1986).

For the purpose of the workshop, the construct is used as more of a tool for establishing the therapist’s DoS from their own family of origins and significant relationships than as a tool impacting the therapeutic engagement with the client.

Inadvertently, by establishing such boundaries on a personal level, the therapist asserts their choices while maintaining their thought processes and ideas. This endeavor allows them to mirror an established sense of self from others in the client relation. On the DSI scale (Skowron & Friedlander, 1998) utilized in the workshop, fusion with others is assessed by the following nine statements:

• I'm likely to smooth over or settle conflicts between two people whom I care

about.

• It has been said (or could be said) of me that I am still very attached to my

parent(s).

• Whenever there is a problem in my relationship, I'm anxious to get it settled right

away.

• It's important for me to keep in touch with my parents regularly.

• When my spouse or partner is away for too long, I feel like I am missing a part of

me.

• I try to live up to my parents' expectations.

• Arguments with my parent(s) or sibling(s) can still make me feel awful.

• I find myself thinking a lot about my relationship with my spouse or partner.

• I worry about people close to me getting sick, hurt, or upset.

Alternatively, the concept will be explored by use of activities and discussion through session two of the workshop and by personal observation and self-reflection of the

participants in the week following session two of the workshop. Additionally, the concept will be revisited through a brief check in at the beginning of session three.

‘I’ position: The last Bowenian concept considered for the purpose of the workshop refers to an individual’s ability to maintain a clearly defined sense of self and to be grounded in their own values and beliefs system (Lee, & Johnson, 2017). According to Bowen theory (1978), one’s ability to take an ‘I’ position suggests an increased level of DoS. Alternatively, a decreased ability to think and act autonomously may be indicative of a low level of DoS (Lampis, Busonera, Cataudella, Tommasi, & Skowron,

2017). In a couple’s relationship, progress occurs as one partner redirects his or her focus from the perceived failings of the other toward his or her own functioning in the relationship and the pursuit of life goals. As a result, the person begins to adjust their position of helplessness assumed in the relationship. They no longer focus on the shortcomings of the other and the failure to make the other change (Papero, 2014). The person gradually begins to formulate solid and thoughtful positions such as ‘I-positions’ or ‘I-statements’ through which the client communicates their thoughts, beliefs and desired actions. Through the newly established stance and the use of ‘I-statements’, the person emphasizes the slowly developing internal strength of being responsible for self and acting responsibly towards others (Papero, 2014).

With consideration to the client-therapist alliance, Kerr and Bowen (1988) stress that, to prevent triangulation into the client’s family system, the therapist should take an

‘I’ position to maintain autonomy of self. The clinician accomplishes this by using their own I-statements and expressing their thoughts, beliefs and their conduct (Papero, 2014).

This allows one or both of the spouses to establish ‘I’position between themselves and

encourages them to work towards their own differentiation and the establishment of an independent held position (Bowen, 1978). However, maintaining an ‘I’ stance in the face of an overwhelming ‘we’ is key for the therapist. It promotes establishing a solid, well- defined sense of self in spite on outside pressures and models the same for the client.

With regards to the workshop, the concept is assessed by the following eleven items on the DSI scale:

• I tend to remain pretty calm even under stress.

• No matter what happens in my life, I know that I'll never lose my sense of who I

am.

• I usually do not change my behavior simply to please another person.

• When I am having an argument with someone, I can separate my thoughts about

the issue from my feelings about the person.

• There's no point in getting upset about things I cannot change.

• I'm fairly self-accepting.

• I am able to say no to others even when I feel pressured by them.

• I'm less concerned that others approve of me than I am about doing what I think is

right.

• My self-esteem really depends on how others think of me.

• I usually do what I believe is right regardless of what others say.

• I tend to feel pretty stable under stress.

Moreover, the concept will be explored by use of activities and discussion through session three of the workshop and by personal observation and self-reflection of the

participants in the week following session three of the workshop. Lastly, the participants will revisit the concept through a brief check in at the beginning of session four.

Current Self-Of-The-Therapist Training Programs

Although recognized by the literature and the mental health community alike as key to the development of an effective therapist, SOTT training protocols are still only marginally incorporated in graduate programs curriculum.

Aponte’s Person-of-the-Therapist Training (POTT) is currently one of the only structured models in psychotherapy developed for training the personal aspects of clinicians (Aponte & Kissil, 2016). The application of Aponte’s model to Drexel’s

Master of Family generated significant growth in the clinical sensitivity and acuity of the students who participated in the volunteer experience for the full two years (Aponte el al,

2009). The program produced benefits not available in individual supervision such as increasing the trainees’ comfort to share their own stories, increasing their personal insight and compassion for both their peers and their clients and increasing their self- command in client sessions while making them less anxious (Aponte et al., 2009). The outcome was of importance particularly with consideration to the numerous dropouts of students from the training program as a result of the added pressure to an already demanding curriculum (Aponte et al., 2009).

The program’s strengths were multifaceted. First, it allowed trainees to make direct use of the client session by showcasing segments where the therapist-in-training’s personal issues appeared in their clinical performance. This allowed trainees to make connections with the own lives and how their stories can often guide their intervention models. Second, the protocol increased compassion and acceptance of personal

difficulties by encouraging nonparticipating trainees to share the commonalities of such occurrences they too had experienced. Other components looked at how significant themes related to the students’ clinical performance and encouraged participants to gain a handle on their thematic life struggles. Students were directed to reference their own personal experiences and create emotional distance from their own histories so that they can call on them as needed in the therapeutic session without becoming too overwhelmed by their emotional intensity. The trainees were encouraged to interpret these experiences and utilize them as clues to better understanding the client and how to utilize themselves strategically to implement intervention. Furthermore, the curriculum encouraged an ongoing dialogue about personal challenges to integrate the behavior and make it feel natural for trainees to look within themselves through their work with clients. Lastly, the organizers firmly established that these training programs were not therapy but rather a personal, well-attuned preparation for doing professional counseling (Aponte, 1994,

Aponte et al., 2009). This was accomplished by creating an environment that normalized talking about personal challenges in the context of the professional training where the participants could feel comfortable to take such personal risks. The program was further augmented by the videotaping of the participants and their use of journaling as means to better see themselves and get in touch with their own process during the training. The journals also served as platforms of self-observation to reflect on their personal experience in the professional setting (Aponte et al., 2009).

Challenges that arose spoke to the fact that, to be effective and fully utilized, any

SOTT training should be fully integrated into the schedule and curricula of the program and that well-defined policy should be establish pertaining to the use of personal

information. This constitutes a barrier as enforcing strict confidentiality can be a difficult task. Furthermore, any personal materials the trainees shared were accessible to faculty who hold responsibilities to make judgments about their professional development. Other challenges dealt with helping students connect deeply with issues of self and learn to work with personal life issues with clarity and within the boundaries of their therapeutic roles. Of important concern was providing orientation to the POTT model to all clinical supervisors with consideration to possible implications the program might have on their roles. Lastly, some administrative concerns existed pertaining to program planning with regards to the emotional reactions that trainees may have to this type of exploration and how to best deal with highly charged issues pertaining to the use of self (Aponte et al.,

2009).

The POTT model implementation stand out on its own as, prior to its establishment, the development of a course titled “The Therapist’s Experience” in the same graduate program was the only other protocol that allowed students a chance to explore their challenges pertaining to their family of origin (Braverman, 1997).

Other programs such as the Evangelical Seminary’s Marriage and Therapy program promote their curriculum as having a self-of-the-therapist emphasis that focuses on the emotional development of the student as a mean to release their restraints and access their resources (“MA in Marriage and Family Therapy”, n.d.). The program uses a

SOTT emphasis in every course to various degrees and increases such practices as students advance in the program.

Similarly, the Marriage and Family Therapy MS at Seattle Pacific University mentions as one of the key distinctives of the program the SOTT orientation. The

program emphasizes understanding of the moral, values and spiritual dimensions of the trainees’ lives and how they interact with the client’s life stressing that the trainees become an instrument of healing through their development and self-understanding

(“Marriage and Family Therapy MS,” 2019).

Moreover, Oklahoma State University Marriage and Family Therapy program requires that students develop SOTT competence thought the program by continually evaluating self in terms of conceptual, perceptual, executive, processional, and evaluative skills, accepting feedback in a non-defensive fashion from both supervisors and peers alike, illustrating awareness of and ability to manage personal anxiety and attitudes, demonstrating authenticity and flexibility in the client session, showing understanding of and engaging in ongoing self-monitoring as well as demonstrating professionalism in their interactions with other professionals and peers (“MFT Program Handbook,” (n.d.).

Furthermore, the program includes a SOTT components as part of the trainees’ graduation project.

Summary and Relation to Proposed Project

It is vital for the growth of the mental health field that future professionals receive self-of-the-therapist training. The purpose of such training programs is not only to sharpen the skills and knowledge of the therapist but also for the trainees’ own self- empowerment. Being continuously exposed to client’s issues and problems, the therapist’s health and wellbeing can be put at risk yet, the idea of therapists needing therapy or personal practices work, for the same reasons as their clients, is relatively unexplored. Learning to be aware of how their own and their clients’ issues can impact them is of profound importance both for the therapist, and for the therapeutic alliance.

According to Yalom (1980), without the authentic self of the therapist, developed through self-exploration, using technique may have little value or even cause harm for the client.

Getting in touch with one’s self by developing congruence allows the therapist to show up and make full use of the self in the therapeutic work.

Commencing with the practice of personal psychoanalysis and Freudian principles, person-of-the-therapist PPs have been utilized since the beginning of the field of mental health and have been recognized as key in the building of therapeutic alliance and client outcome. Numerous studies confirm that the role of the clinician has the highest effectiveness in the therapeutic outcome, more so than the treatment modality

(0%–1%) (Wampold, 2001;Wampold & Brown, 2005), client-rated alliance (5%–15%)

(Crits-Christoph, Gibbons, Hamilton, Ring-Kurtz, & Gallop, 2011; Horvath, Del Re,

Fluckiger, & Symonds, 2011), or use of an empirically supported treatment (0%–4%)

(Wampold & Brown, 2005). While the Satir SOTT model emphasizes the positive use of self with the client (Satir, 2000), Bowen lends greater emphasis to helping the trainee address their own emotional functioning as it pertains to their family of origin (Kerr,

1981). Adding to his predecessors’ models, Aponte also encourages work of SOTT with emphasis on the therapists’ ability to use the person they are today, rather than who they aspire to be tomorrow in the client relationship (Aponte, 1994). Despite their different conceptualization, all these models recognize that a positive change in the self of the therapist and the development of self-awareness, by its very nature, translates into a more competent therapist (Aponte el al., 2009). This allows for a clinical relationship that is safe, has a constructive tone of interaction and facilitates the therapeutic process for the client, empowering them to heal (Titelman, 1998).

For such a therapeutic alliance to be possible, work of SOTT should become integrated practice for developing therapists. Programs that allow trainees to:

• freely explore their personal issues and address them in relation to the

therapeutic relationship

• pursue personal insights and develop self-awareness

• encourage seeking out changes in their personal lives that will further both

their personal and professional development

• make use of the self to enhance the therapeutic alliance provide valuable skills and allow a closer look at the stories unraveling in the therapist and the challenges these stories bring to the therapeutic relationship. Giving trainees permission to accept and sit with their human flaws and struggles challenges the assumptions behind standard models of training and behind what it means to be a ‘good’ therapist (Aponte et al., 2009). As a result of adapting and evolving training orientation to include SOTT components, trainees are given permission to see the challenges of their own humanity as a bridge, rather than a barrier to connecting with their clients.

It was the conviction of the need for more such training that prompted Marlene

Watson (1993), program director of Drexel’s Couple and Family Therapy Department, to join Harry Aponte in testing his POTT model (Aponte et al., 2009), making a move towards SOTT training curriculums to be implemented in graduate MFT programs. The

Aponte model POTT training is currently an integral part of the first-year curriculum of

Drexel’s Couple and Family Therapy Department and it represents one of the only protocols existent that address issues of SOTT (Aponte et al., 2009). More programs like

Aponte’s POTT are imperative from the premise that, in our humanity, we therapists all

have personal wounds, that, in our professional role, have an obligation to be conscious of and take active, ongoing responsibility for in the therapeutic process for the sake of the families with whom we work. Taking the example of differentiation of self, and with knowledge that a differentiated person can establish a solid sense of self, operate on well- thought-out principles, articulate succinctly who they are while maintaining their calm

(Kerr & Bowen, 1988), by virtue of this workshop, participating therapists have access to a powerful tool for self-growth that can have profound impact on the therapeutic outcomes as well.

The Exercises in Differentiation Workshop addresses the current lack of SOTT training programs in the mental health profession. The purpose of the project is to create an environment where graduate trainees and early-careers therapists alike can get in touch with issues of self and family of origin in a way that is safe and pertinent to the therapeutic relationship without such exploration being a therapy session. As mental health professionals, therapists endeavor to keep up with evidence-based practices and emerging research to promote client growth. Grounding the foundation of the protocol in existent SOTT models, the project aims to invite a conversation for what is possible in the field of therapist’s growth as well. In line with concurrent research, the project stands to challenge old models of training that leave the development of the self-of-the therapist out of the equation.

With the anticipated growth of the field of mental health and MFT (Bureau of

Labor Statistics, 2015) as well as the increasing demand for mental health services

(National Institute of Mental Health, 2006), the workshop endeavors to go beyond professional skill building as most workshops do and help professionals start a dialogue

pertaining to self-examination as part of the therapeutic training. It is the defining goal of this project to emphasize not only the need for more such components in training programs, but the promotion of ongoing SOTT personal practices for both early-career and seasoned therapists alike. Remaining open and curious to learning about our own selves, as we do about the clients we see, is imperative in our development as competent therapists. The use of personal practices protocols such as the one proposed in this workshop, together with proper training and supervision will enrich both the therapists and the mental health field, and, as a result, will benefits our clients.

CHAPTER III

Introduction

This project proposes a four-day workshop that will guide early career therapists to evaluate their own differentiation of self from the family of origin by utilizing

Bowen’s three principles: fusion with others, emotional reactivity, and the ‘I’ position.

The current chapter delineates the components of the workshop, the intended audience, the qualifications of the professionals who can facilitate this workshop, the description of the environment where it can be introduced as well as the needed equipment. The project outline can be found at the end of the chapter.

Development of Project

The person-of-the-therapist and their self-awareness are recognized by the mental health profession as critical elements in establishing therapeutic effectiveness (Apolinar,

2018) and key to the therapeutic outcome (Wampold, 2001; Wampold & Brown, 2005).

Moreover, literature to date stresses that the therapist's level of differentiation, by itself, can have a profound impact on the therapist’s ability to facilitate their client's growth

(Bowen, 1978). Schnarch (1997) highlights that a therapist can only facilitate their client's growth and development within the limits of their own level of differentiation, in line with Bowen’s assertion that the therapist’s differentiated stance is the principal intervention in the client–therapist system (Bowen, 1978; Friedman, 1991).

This project will provide early-career therapists with an opportunity to self- examine their own level of DoS as a mean of developing as professionals and improving the effectiveness of the therapeutic relationship with their clients. While graduate programs in the area of mental health provide future practitioners with a general

overview of Bowen Family System Theory and the principles behind DoS, these programs rarely facilitate a comprehensive look at the person-of-the-therapist through this angle. Moreover, existent workshops exploring Bowen theory focus more on the application of the theory to the client and their family system as a tool for the therapist, rather than applying these concepts to the therapist’ own self development. Existent workshops that may address such SOTT topics might not always be accessible geographically and may be expensive to attend by graduates and early-career professionals. Due to the implications that Bowen’s concept may have on an individual’s development both for the client and the therapist, the necessity to further explore this topic is much warranted. Recognizing such need, this workshop was developed with the intent to make SOTT information such as this accessible to graduate programs and clinics that provide traineeship for MFTs within the educational context and at an affordable price.

This project was inspired by the author’s own personal experiences of growth and development both as an individual and as a mental health professional. Through a thorough self-examination, Bowen’s principles provided the author with further understanding of the reasonings behind behaviors as well as responses in varying types of relationships. These principles helped the author orient towards a better-organized sense of self and engagement with others. Due to the benefits rendered by this knowledge in both personal and professional experiences, the author hopes to support other therapists in exploring these concepts and how they pertain to their own selves.

The workshop is developed with a strong emphasis on self-exploration for those in participation. It was created utilizing Bowen family systems theory and its principles

relating to differentiation of self from the family of origin. Online databases were utilized to retrieve peer-reviewed articles that addressed existent research on Bowen’s concepts and their implications for personal self-development. The research focused on finding literature pertaining to models of self-of-the-therapist, Bowen’s concept of DoS as well as the implications of SOTT work for the therapist’s development. Topics of importance were outlined to create slide presentations and to develop activities and exercises for the audience.

The workshop will be introduced over four different weeks, with one session taking place each week and allowing for personal exploration in between sessions in the form of homework assignments. Each workshop session will build on the next to facilitate the navigation and processing of the subject matter. Each session will be divided into three sections: a psychoeducational section, an activity section, and a discussion section. The first three sessions will culminate with a homework assignment while the final session will culminate with concluding remarks. The psychoeducational portion will introduce the topics and the context of the workshop. The activity portion will address the topic in an exercise-style, hands-on fashion to allow participants an applicable understanding of the subject matter. Lastly, the discussion section brings psychoeducation and practice together to explore the implications of the topics and allow participants to draw inferences and consolidate the learning.

The workshop is marketed to graduate programs and agencies that support mental health professionals such as universities and clinics that hire recent graduates, MFT associates and other early-career mental health professionals. The curriculum can be adapted to fit other programs seeking to supplement student training in topics dealing

with the therapist’s own development. The workshop will be made available to up to 25 participants at the time and can be facilitated by two therapists or mental health professionals at most. Participation costs will be determined according to the circumstances, including the type of agency and available funding. Such considerations will ensure that the workshop will be accessible to a variety of participants.

Intended Audience

The proposed project is intended for graduate students in the field of mental health, associate marriage and family therapists, and other early-career mental health professionals seeking to develop their self-understanding as therapists. The project will be made accessible to these professionals independent of age, race, sexual orientation and language proficiency. The workshop curriculum will serve as a supplemental training tool to augment these young professionals’ SOTT work and understanding of such personal practices. The project intends to enrich the instruction gained through graduate training and support the therapists’ examination of their own challenges and strengths pertaining to differentiation of self from the family of origin. The workshop aims to provide a safe and supportive environment for mental health professionals to examine their relationship with these concepts and to develop a better understanding of themselves both as individuals and as professionals in the therapeutic process. This curriculum acknowledges both the strengths as well as the critique behind this model and is introduced with sensitivity to the cultural and racial diversity of the possible participants.

Personal Qualifications

This proposed workshop can be facilitated by either a licensed MFT, a Psy.D. or other mental health professionals that have received licensure within a period of at least

five years. The ideal facilitator would be curious about or shares interest in the subject matter. The facilitator should have a solid understanding of family systems theories,

Bowen theory, as well as SOTT models. He/she will illustrate curiosity in the subject matter, in discussions pertaining to the topic and towards their own self-examination. The facilitator is encouraged to inspire an emphatic and curious approach of the subject matter and to communicate with consideration to diversity issues through the duration of the four workshops. The facilitator will encourage the audience to participate in thoughtful discussion about the implications of topics addressed and to respond in ways that expands the knowledge of the subject for those attending. Furthermore, the facilitator should maintain an open mind and respond in a calm and neutral demeanor to any sensitive topics or to any sign of hostility or defensiveness. With these considerations, it is of importance that the facilitator can create and maintain a safe space for everyone in the audience while being prepared to establish boundaries with any attendee threatening the harmony of the space. This workshop can be facilitated by up to two mental health professionals that meet the previously mentioned criteria.

Environment and Equipment

This project was created for use in either an educational institution or in a clinic to benefit MFT trainees, associate MFTs, and other early-career mental health professionals.

The ideal space to hold the workshop would be a conference room or auditorium equipped with tables and chairs to house all those in the audience as well as the necessary audio-visual equipment. Basic office supplies such as name tags, pens and paper should also be made available to each participant. A black or white board and erasable markers can be used by the facilitator to communicate any additional information as part of the

curriculum. Printed handouts containing the outline of the presentation will be provided to all in attendance at the beginning of the session and materials for any activities will be handed out through the duration of the workshop.

Formative Evaluation

This workshop serves as a training opportunity for mental health professionals seeking to expand their self-knowledge and understanding as outlined by three key principles behind Bowen’s DoS: emotional reactivity, fusion with others and the ‘I’ position. To evaluate the benefits and effectiveness of the workshop in training future therapists, the author will request feedback from professionals with experience in both a supervisory and clinical setting role such as Dr. Dana Stone, Dr. Deborah Buttitta, and

Dr. Mark Souris as well as committee chair, Stan Charnofsky, Ed.D. These mental health professionals will be given a copy of the workshop presentation to review and provide comments. Peer feedback will also be utilized in gauging the possible questions and directions for the topics essential to include. Moreover, to ensure the continuous improvement of the protocol, participants will be asked to complete a survey at the end of each session of the workshop to gauge the strengths, areas of improvement as well as the value provided by the training.

Project Outline

Each of the four-day workshops will contain three sections, including a psychoeducational component (concomitant with a PowerPoint presentation), an activities section, and a discussion section. Short informational videos will be used to exemplify concepts or to help convey the topic. Discussions and activities will support the application of the concepts and self-exploratory assignments will allow the

participants to apply the newly learned concepts to impacting change in their own lives.

No more than two facilitators are recommended for this workshop and a maximum of 25 attendees. The following is an outline of the content that will be included in the four workshops. The fully developed workshop can be found in Appendix A while the facilitator’s manual will be in Appendix B. Appendix C will include the Differentiation of Self Inventory while Appendix D will include the workshop’s homework assignments.

Lastly, Appendix E will contain the workshop’s evaluation forms.

Exercises in Differentiation

A Workshop for Mental Health Professionals

Session One (4 hours)

Introduction (20 minutes)

• Introduce the workshop facilitator, context, outline, and learning objectives of the

workshop.

• Introduce the rules and guidelines for participation.

• Pass out workshop outline handout, pen, and paper to the audience.

Activity: Icebreaker: Differentiation of Self Inventory (20 minutes)

• Hand participants a copy of the DoS Inventory and direct them to answer the

listed questions.

• Direct participants to keep the inventory for their own reference after filling it out.

Psychoeducation (1 hour)

• Introduce value of self-of-the-therapist training for professional development of

mental health practitioners.

• Introduce models of SOTT

• Introduce types of personal practices that support self-of-the-therapist growth.

• Introduce differentiation of self as a form of personal practice.

• Provide basic assumptions and scientific basis of Bowen family systems theory

including the family as an emotional and natural system and counterbalancing

forces for individuality and togetherness.

• Cite the importance of differentiation of self in the emotional system according to

Bowen and studies looking at his contention.

• Provide examples of a highly differentiated versus a low differentiated individual.

• Provide psychoeducation on the value of a differentiated therapist.

• Provide information on strengths and critique of the model.

• Introduce first key concept in developing self-differentiation: Emotional

reactivity.

• Provide psychoeducation on the concept according to Bowen.

• Provide information on the importance of emotions and the distinction between

emotional response and emotional reaction.

Break (15 minutes)

Activities (50 minutes)

• Welcome audience back and introduce activity: You won’t believe what

happened! (25 minutes)

• Instruct participants to pick a partner and explore a recent situation where they

were involved in an argument with another person.

• Each person of the pair will be allotted to explore for 10 minutes.

• Instruct the participants to answer the following questions pertaining to the story:

o What happened?

o What was said?

o How did the people involved respond?

o How did the situation culminate?

o How did the participants feel about what happened?

• Introduce activity: My Response Model (25 minutes)

• Direct participants to return to their partner and take turns in evaluating each of

the statements with True/False. Instruct the participants to then think of a situation

when these statements may have applied to them:

o At times my feelings get the best of me and I have trouble thinking

clearly.

o Sometimes my responses are more than what is warranted in a situation.

o Other people close to me have remarked that I have strong emotional

reactions to some situations.

o Direct participants to practice formulating alternative ways of responding

to similar situations (eg. calming down prior to providing a response,

taking a break, using ‘I statements’).

Discussion (45 minutes)

• Create a safe space for reflections on the psychoeducation and activities.

• Encourage participants’ questions and clarify any concept discussed.

• Explore with participants their experience engaging in the activities outlined. The

facilitator can use the following questions to encourage engagement:

o How was that experience for you?

o What are some implications of this information for our own self-

development?

o What have you learned about yourself though these exercises?

Conclusion (30 minutes)

• Provide concluding remarks on the discussion and psychoeducation.

• Pass out homework assignment and directions.

• Pass out workshop survey and ask participants to fill out and turn in.

Session Two (4 hours)

Check in (20 minutes)

• Explore participant’s experience with homework assignment and discuss utilizing

questions to prompt participants to engage:

o What did you observe through the week pertaining to how you engage

with situations?

o What did you observe about other people’s way of engaging?

o Where there some situations that may drive you to respond reactively

more than others?

o Was there any specific event that elicited a response from you? Would you

like to share?

• Provide answers and clarifications to any questions from participants.

Psychoeducation (1 hour)

• Introduce Bowen theory concept: Fusion with others.

• Utilize videos to help audience understand the concept.

Break (15 minutes)

Activities (1 hour 10 minutes)

• Welcome back the audience and introduce activity: Role play.

• Encourage audience to separate into 3 groups. Assign each of the three groups one

of the following scenarios:

o Scenario 1: Role play for us an example of fusion one would see in an

intimate partner relationship. Portray relational dynamics between partners

in their engagement with each other (and with outside people) that may be

suggestive of fusion.

o Scenario 2: Role play for us an example of fusion one would see in a

relationship to family. Portray relational dynamics between family

members that illustrate they may be fused.

o Scenario 3: Role play for us an example of fusion one would see in a

friendship relationship. Portray dynamics between friends that illustrate

fusion with one another.

• Instruct participants to utilize what they have learned in the psychoeducation

section to develop their scenario. Allow participants 35 minutes to brainstorm and

up to 10 minutes for each group to role play.

Discussion (45 minutes)

• Create a safe space for reflections on the psychoeducation and activities.

• Encourage participants’ questions and clarify any concept discussed.

• Explore with the group their experience engaging in the activities outlined. The

facilitator can use the following questions to encourage engagement:

o What have you learned about fusion with others from the material and

activities?

o What are some implications of this information for your own self-

development?

o How do we avoid such fusions in our relationships?

Conclusion (30 minutes)

• Provide concluding remarks on the discussion and psychoeducation.

• Pass out homework assignment and provide directions.

• Pass out workshop survey and ask participants to fill out and turn in.

Session Three (4 hours)

Check in (20 minutes)

• Explore participant’s experience with homework assignment and discuss utilizing

questions to prompt participants to engage:

o What did you observe through the week pertaining to your fusion with

others?

o Was there any specific event that elicited a response from you? Are you

willing to share?

• Provide answers and clarifications to any questions from participants.

Psychoeducation (1 hour)

• Introduce Bowen theory concept: The ‘I’ position.

• Use videos to help audience understand the concept.

Break (15 minutes)

Activities (1 hour 10 minutes)

• Welcome audience back and introduce activity: Exploring the past (30 minutes).

• Provide directions to participants to pick a partner. Have each partner explore a

past situation where they felt that they may have forgone their ‘I’ position in a

situation with another person.

• Each of the partners will explore for 15 minutes.

• Instruct the participants to answer the following questions pertaining to the

situation:

o How did that situation/moment shape you? What kind of impact did it

have on how you view yourself?

o How did that scenarios come to affect you through other experiences?

o Would you do anything different if you had the chance? If so, what would

you do in order to differentiate yourself and bring out the ‘I’ position?

o What would it look like if you were in the ‘I’ position most often than not?

• Introduce activity: Taking the ‘I’ position (40 minutes).

• Provide directions to participants to return to their partner or pick a different

partner.

• Instruct the pairs to explore together ways in which they each embrace the ‘I

position’ in their lives (eg. I as woman, I as man, I as professional, I as

perfectionist, I as dreamer). For each of these stances, encourage partners to

recognize what qualities and values that distinguish and ground these self-

positions.

Discussion (45 minutes)

• Encourage participants’ questions and clarify any of the concepts discussed.

• Create a safe space for reflections on the activities and psychoeducation provided.

• Explore with the group their experience engaging in the activities outlines. The

facilitator can use the following questions to encourage engagement:

o How was that experience for you?

o What have we learned?

o What are some implications of this information for our own self-

development?

o What have you learned about yourself though these exercises?

Conclusion (30 minutes)

• Provide concluding remarks on the discussion and psychoeducation.

• Pass out homework assignment and provide directions.

• Pass out workshop survey and ask participants to fill out and turn in.

Session Four (3 hours)

Check in (20 minutes)

• Explore participant’s experience with homework assignment and discuss utilizing

questions to prompt participants to engage:

o What did you observe through the week pertaining to your use of the ‘I’

position?

o Was there any specific event that elicited a response from you? Are you

willing to share?

• Provide answers and clarifications to any questions from participants.

Psychoeducation: Tying it all together (50 minutes)

• Revisit the 3 concepts of Bowen Differentiation of Self. Explain why they were

chosen for the workshop, what they mean for the developing therapist and how

they can be used in therapy with clients.

• Revisit briefly the value of SOTT personal practices and encourage participants to

continue to explore with SOTT elements.

• Utilize videos to help convey the point.

Break (15 minutes)

Activities: Differentiation of Self Inventory – Retest (20 minutes)

• Welcome audience back and pass out DoS inventory for participants to retake.

• Direct participants to answer the listed questions as per scale.

• Direct participants to keep scale when done.

Discussion (45 minutes)

• Create a safe space for reflections on the activities and psychoeducation provided.

• Encourage participants’ questions and clarify any concept discussed through the

workshop.

• Explore with the group the experience of taking the DoS inventory at the

beginning and end of the workshop.

• Explore with the group their experience engaging in the activities outlined. The

facilitator can use the following questions to encourage engagement:

o How was this experience for you?

o What have we learned from this workshop about yourself? What have you

learned about others close to you?

o What are some implications of this new information for our own self-

development?

o What are some implications for your therapeutic work with clients?

Conclusion (30 minutes)

• Provide concluding remarks on the workshop.

• Allow participants to communicate and gain closure with peers and facilitators.

• Pass out final workshop survey and ask participants to fill out and turn in.

CHAPTER IV: CONCLUSION

Summary

The purpose of this project is to provide a four-day workshop that will guide early career therapists to evaluate their own DoS utilizing Bowen’s three principles: fusion with others, emotional reactivity, and the ‘I’ position. The emphasis on exploring the clinician’s SOTT is utilized in the workshop to foster curiosity about the self and to support personal growth and self-reflection. This approach is supported by literature highlighting that personal practice coupled with self-understanding are central to the development of the most effective therapists and are strong determinants of client outcomes (Bennett-Levy, 2019). While the differentiated self-of-the-therapist represents a medium or tool in the therapeutic process (Bowen, 1978) few programs or workshops, if any, exist that support early-career professionals and their development in this self- exploratory journey. This project addresses these limitations and provides an accessible workshop for both early-career and seasoned mental health professionals interested in exploring their own selves and becoming better differentiated individuals in the process.

To supplement graduate courses in the implementation of SOTT practices, this workshop will focus less on Bowen’s general theory and more on applying the constructs of his theory to the self of the participants in the workshop.

Chapter One of the project introduced the topic of the SOTT and the importance of PP for the development of the therapist. Additionally, the chapter stressed the limited resources available to early-career therapists interested to further explore aspects of

SOTT for both personal and professional development. Lastly, the chapter defined applicable terminology relevant to the subject matter and discussed the need for a

workshop that will guide mental health professionals towards higher levels of differentiation as a SOTT personal practice protocol.

Chapter Two included a review of literature relating to the concept and existent models of SOTT, Bowen theory and DoS, as well as critiques of such models. The intent of this literature review was to provide a comprehensive look at these concepts and establish a solid literature-base foundation and rationale to support the totality of this workshop.

Chapter Three reiterated the need for a resource to guide early-career mental health professionals through SOTT practices and towards a more differentiated self-the- therapist. Secondly, the chapter delineated topics such as the project development and factors that engaged the author’s interest in developing this workshop. Moreover, the chapter established that the workshop is intended for early-career mental health professionals and was to be facilitated by clinicians that meet specific criteria. Lastly, any necessary equipment for the workshop facilitation as well as the overall project outline were provided.

Discussion and Recommendations

For the successful implementation of this protocol, the clinicians must hold a solid understanding of SOTT models and Bowen’s Family Systems theory. Specifically, the facilitator(s) must have a profound understanding of Bowen’s concepts of differentiation of self, emotional reactivity, fusion with others and the ‘I’ position.

Moreover, facilitator(s) must have knowledge pertaining to the value rendered by SOTT work, as evidenced by the literature. Lastly, it is of importance that the facilitator(s) be

culturally sensitive to all participants and engage the workshop with consideration to diversity when addressing these topics. It is of importance that the facilitator(s):

• Establish a safe environment for learning, activities and related discussions

• Communicate clear-defined boundaries of participation in activities and

discussion at the onset of the workshop

• Provide guidance for steps throughout the duration of the workshop

• Ensure everyone, regardless of age, sex, or race is treated with dignity and respect

• Ensure that the workshop’s goals and objectives are clearly stated and achieved

• Ensure that limitations to models or theories presented are acknowledged

• Ensure that the discussion develops beyond polarizing issues

Special consideration should be given to the participants’ comfort level to engage in discussions involving aspects of self and any issues such exploration may bring up for them. To address such concerns, facilitators may allow participants to turn in written responses in lieu of sharing with the group or with individual partners in the discussion section of the workshop.

Confidentially issues could also represent an obstacle in both the participation and the open engagement of those in attendance. The facilitators may address such concerns by ensuring that the environment in which the workshop is taking place is equipped to ensure everyone’s privacy and that the parameters of participation are clearly stated.

For future versions, this manual will be reviewed and evaluated based on feedback received from workshop participants, peers in the field of mental health, and clinical supervisors. After each of the four workshop sessions, participants will be asked to complete a brief survey rating their experience. Both the content of the workshop and the

process/development logistics will be reviewed, and adjustments will be made based on received feedback.

Future Work/Research

In the future, the project can be expanded to include other concepts of Bowen theory, other models for self-of-the-therapist PPs and topics relevant in the development of the therapist self. This will expand the duration of the workshop and add several additional psychoeducational elements, activities and self-exploration prompts.

The workshop can also be adapted to become an immersive four-day retreat that includes personal practices such as meditation programs (mindfulness, compassion, loving-kindness), self-reflection programs and experiential/personal development groups.

Lastly, a continuous evolution of this project with respect to the latest research on the subject matter remains vital for the progress and success of this protocol. This may include the need for qualitative research data and analysis to better gage the effects and effectiveness of the protocol and its importance for the development of mental health professionals.

Besides such changes, this author hopes to develop a manuscript further exploring the process of becoming a person and addressing, among other things, the development of self-differentiation from the family of origin. The intention behind the project would be to create a more comprehensive way of looking at the processes transpiring within us as we develop individual identities away from family and others and towards a well- established sense of self. Such a manual would serve individuals of all ages as they navigate their continuous life development towards more authenticity and a more actualized self.

Conclusion

Personal practices such as personal therapy, formal self-understanding, and psychological interventions and techniques that therapists use to engage with self experientially are not only valuable to the self-of-the-therapist’s development but also key for client outcomes (Bennett-Levy, 2019). Part of such self-exploratory practices help establish self-differentiation from others, which is key to a successful connection to life’s realities (Bardill, 2000) both for the therapist and the client alike. In line with the emergent mindfulness and self-care-based landscape that promotes PPs as an imperative for clients and therapist-selves alike, better familiarity and application of such tools is a necessity for the needs of therapy trainees both in university settings and in agency development programs (Bennett-Levy, 2019). While conventional, non-PP strategies are of great value for providing technical skills to graduate students and trainees (Bennett-

Levy, McManus, et al., 2009a), they are not as well adapted as PPs for enhancing personal and interpersonal therapist qualities associated with being an effective therapist

(Bennett-Levy, 2019). Both practice and empirical evidence suggest that the construct for therapist training should not be whether to include PP components but rather, what PPs should be included to enhance self-of-the-therapist-development at different stages in the career process (Bennett-Levy, 2019). Lastly, person-of-the-therapist and PP elements in established competency standards are mandated by the American Association for

Marriage and Family Therapy (AAMFT), the field's primary professional organization.

Due to the current expansion of the MFT field (Bureau of Labor Statistics, 2015) and the increasing demand for mental health services (National Institute of Mental Health, 2006), effective therapist training that ensures competent clinical services should include

development of self-of-the-therapist and related PP components. Professional bodies, academic institutions and supervisors alike need to support both trainers and researchers to include PPs such as DoS workshops in their programs, undertake evaluative research

(Bennett-Levy, 2019), and expand current knowledge of SOTT development and its implications pertaining to issues of self.

By using this program, the author welcomes clinicians to practice with one such

PP concept and to develop more comfort in examining their inner selves and what they bring into the therapeutic relationship. The author hopes that, by virtue of this workshop, early-career professionals can explore what is possible in the way of encouraging change within themselves both as individuals and as mental health professionals.

References

Ackerman, S. J., & Hilsenroth, M. J. (2001). A re-view of therapist characteristics and

techniques negatively impacting the therapeutic alliance. Psychotherapy: Theory,

Research, Practice, Training, 38, 171–185.http://dx.doi.org/10.1037/0033-

3204.38.2.171

Ackerman, S. J., & Hilsenroth, M. J. (2003). A re-view of therapist characteristics and

techniques positively impacting the therapeutic alliance. Clinical Psychology

Review, 23,1–33.http://dx.doi.org/10.1016/S0272-7358(02)00146-0

Alaedein, J.M. (2010). Is Bowen Theory Universal? Differentiation of Self among

Jordanian Male and Female College Students and between them and A Sample of

American Students through Bowen's Propositions. Dirasat, Educational Sciences,

35, 2. Retrieved https://eis.hu.edu.jo/deanshipfiles/pub101795557.pdf

Anderson, S. A., & Holmes, S. (2007). Personal mythologies: A framework for dealing

with therapeutic and supervisory impasses. In S. Krippner, M. Bova, & L. Gray

(Eds.), Healing stories: The use of narrative in counseling and psychotherapy (pp.

126–139). San Juan: Puente Publications.

Anderson, S. A., & Sabatelli, R. M. (1992). The Differentiation in the Family System

Scale (DIFS). American Journal of Family Therapy, 20, 77–89. https://doi-

org.libproxy.csun.edu/10.1080/01926189208250878

Anderson, S., Sanderson, J., & Košutić, I. (2011). Therapist Use-of-Self Orientations

Questionnaire: A Reliability and Validity Study. Contemporary Family Therapy:

An International Journal, 33, 364–383. https://doi-

org.libproxy.csun.edu/10.1007/s10591-011-9146-6

Andolfi, M., Ellenwood, A. E., & Wendt, R. N. (1993). The creation of the fourth planet:

Beginning therapist and supervisors inducing change in families. The American

Journal of Family Therapy, 21,301–312.

https://doi.org/10.1080/01926189308251001

Apolinar Claudio, F. L. (2018). Perceived impact of person-of-the-therapist training

(POTT) model on Drexel university master of family therapy postgraduates’

clinical work: A grounded theory study. Dissertation Abstracts International:

Section B: The Sciences and Engineering. ProQuest Information & Learning.

Retrieved from

http://gateway.proquest.com.libproxy.csun.edu/openurl?url_ver=Z39.88-

2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqm&rft_dat=x

ri:pqdiss:10744247

Aponte, H. J. (1994). How personal can training get? Journal of Marital and Family

Therapy, 20, 3–15. https://doi.org/10.1111/j.1752-0606.1994.tb01007.x

Aponte, H., & Carlsen, J. (2009). An instrument for person-of-the-therapist supervision.

Journal of Marital and Family Therapy,35,395–405. doi:10.1111/j.1752-

0606.2009.00127.x

Aponte, H. J., Powel, F.P., Brooks, S., Johnson, E., Lawless, J., Litzke, C., Watson, M.F.

(2009). Training the Person of the Therapist in an Academic Setting. Journal of

Marital & Family Therapy, 35, 381–394. https://doi-

org.libproxy.csun.edu/10.1111/j.1752-0606.2009.00123.x

Aponte, H. J., & Kissil, K. (2014). “If I can grapple with this I can truly be of use in the

therapy room”: Using the therapist’s own emotional struggles to facilitate

effective therapy. Journal of Marital & Family Therapy, 40, 152–164. doi:10

.1111/jmft.12011

Aponte, H. J., & Kissil, K. (Eds.). (2016). The person of the therapist training model:

Mastering the use of self. New York, NY: Routledge.

Aponte, H. J., & Winter, J. E. (1987). The person and practice of the therapist: Treatment

and training. In M. Baldwin & V. Satir (Eds.), The use of self in therapy (pp. 85–

111). New York, NY: Haworth Press.

Aponte, H. J. & Winter, J. E. (2013). The person and practice of the therapist: Treatment

and training. In M. Baldwin (Ed.), The use of self in therapy (3rd ed., pp. 143–

163). New York, NY: Routledge.

Apter, T. (1990). Altered loves: Mothers and daughters during adolescence. New York:

St. Martin's.

Ault-Riche, M. (Ed.). (1986). Women and family therapy. Rockville, MD: Aspen

Baldwin, M. (Ed.). (2000). The use of self in therapy. 2nd ed. New York: Haworth Press.

Baldwin, S., & Imel, Z. E. (2013). Therapist effects: Findings and methods. In M. J.

Lambert (Ed.). Bergin and Garfield's handbook of psychotherapy and behavior change

(pp. 258–297). (6th ed.). New York: Wiley.

Banmen, J. (1986). Virginia Satir’s Family Therapy Model. Individual Psychology: The

Journal of Adlerian Theory, Research & Practice, 42, 480. Retrieved from

https://www.alfredadler.org/journal-of-individual-psychology

Banmen, J. (1997). Invitational training: Satir’s systemic brief therapy. Bellingham, WA:

unpublished video.

Banmen, A. & Banmen, J. (Eds.). (1991). Meditations of Virginia Satir: Peace within,

peace between, peace among. Palo Alto, CA: Science and Behavior Books.

Bardill, D. R. (2000). The Relational Systems Model: Reality and Self-Differentiation.

Journal of Family Social Work, 4, 65–77. https://doi-

org.libproxy.csun.edu/10.1300/J039v04n03_05

Barkham, M., Lutz, W., Lambert, M. J., & Saxon, D. (2017). Therapist effects, effective

therapists, and the law of variability. In L. G. Castonguay, & C. E. Hill (Eds.).

How and why are some therapists better than others? Understanding therapist

effects. Washington, DC: American Psychological Association.

Bartle, S. E., & Sabatelli, R. M. (1998). The Behavioral and Emotional Reactivity Index:

Preliminary evidence for construct validity from three studies. Family Relations,

44, 267-277. 10.2307/585525

Bartle, H. S., Shannon, S., Bowers, D., & Holowacz, E. (2016). Therapist differentiation

and couple clients’ perceptions of therapeutic alliance. Journal of Marital and

Family Therapy, 42, 716–730. https://doi-

org.libproxy.csun.edu/10.1111/jmft.12157

Beaumont, E., Durkin, M., Hollins Martin, C. J., & Carson, J. (2016). Measuring

relationships between self-compassion, compassion fatigue, burnout and well-

being in student counsellors and student cognitive behavioural psychotherapists:

A quantitative survey. Counselling and Psychotherapy Research, 16, 15–23.

https://doi.org/10.1002/capr.12054

Becerra, R., & Campitelli, G. (2013). Emotional reactivity: Critical analysis and proposal

of a new scale. International Journal of Applied Psychology,3, 161–168.

doi:10.5923/j.ijap.20130306.03

Belenky, M. F., Clinchy, B. M., Goldberger, N. R., & Tarule, J. M. (1986). Women's

ways of Growing: The development of self; voice, and mind. New York: Basic

Books.

Bennett-Levy, J. (2006). Therapist skills: A cognitive model of their acquisition and

refinement. Behavioural and Cognitive Psychotherapy, 34, 57–78.

https://doi.org/10. 1017/S1352465805002420.

Bennett-Levy, J. (2019). Why therapists should walk the talk: The theoretical and

empirical case for personal practice in therapist training and professional

development. Journal of Behavior Therapy and Experimental Psychiatry, 62,

133–145. https://doi-org.libproxy.csun.edu/10.1016/j.jbtep.2018.08.004

Bennett-Levy, J., McManus, F., Westling, B., & Fennell, M. J. V.(2009a). Acquiring and

refining CBT skills and competencies: Which training methods are perceived to

be most effective? Behavioural and Cognitive Psychotherapy,37, 571–

583.https://doi.org/10.1017/S1352465809990270.

Bennett-Levy, J., Thwaites, R., Chaddock, A., & Davis, M. (2009b). Reflective practice

in cognitive behavioural therapy: The engine of lifelong learning. In J. Stedmon &

R. Dallos (Eds.), Reflective practice in psychotherapy and counselling (pp. 115–

135). Maidenhead: Open University Press.

Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from

the inside out: A self-practice/self-reflection workbook for therapists. New York:

Guilford.

Beutler, L. E., Malik, M. L., Alimohamed, S., Har-wood, T. M., Talebi, H., Noble, S., &

Wong, E.(2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and

Garfield’s handbook of psychotherapy and behavior change (pp. 227–306).

NewYork, NY: Wiley.

Bibeau, M., Dionne, F., & Leblanc, J. (2016). Can compassion meditation contribute to

the development of psychotherapists’ empathy? A review. Mindfulness, 7, 255–

263. https://doi.org/10.1007/s12671- 015-0439-y

Blow, A., Sprenkle, D., & Davis, S. (2007). Is who delivers the treatment more important

than the treatment itself? The role of the therapist in common factors. Journal of

Marital and Family Therapy,33, 298–317. doi:10.1111/j.1752-0606.2007.00029.x

Boellinghaus, I., Jones, F. W., & Hutton, J. (2013). Cultivating self-care and compassion

in psychological therapists in training: The experience of practicing loving-

kindness meditation. Training and Education in Professional Psychology, 7, 267–

277. https://doi.org/10.1037/A0033092

Boellinghaus, I., Jones, F. W., & Hutton, J. (2014). The role of mindfulness and

lovingkindness meditation in cultivating self-compassion and other-focused

concern in health care professionals. Mindfulness, 5, 129–138.

https://doi.org/10.1007/s12671-012-0158-6.

Bowen, M. (1966). The use of family theory in clinical practice. Comprehensive

Psychiatry, 7, 345–374. https://doi-org.libproxy.csun.edu/10.1016/S0010-

440X(66)80065-2

Bowen, M. (1972). Toward a differentiation of a self in one’s family. In James L. Framo

(Ed.), Family interaction (pp.111–173). New York: Springer.

Bowen, M. (1976). Theory and practice in psychotherapy. In P. J. Guerin (Ed.), Family

therapy: Theory and practice (pp. 42–90). New York: Gardner Press.

Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson.

Bowen, M., & Butler, J. (2013). The origins of family psychotherapy: The NIMH Family

Study Project. Lanham: Jason Aronson.

Braverman, S. (1997). The use of genograms in supervision. In T. Todd & C. Storm

(Eds.), The complete systemic supervisor: Context, philosophy, and pragmatics

(pp.156-172). Boston: Allyn and Bacon

Bray, J. H., Harvey, D. M., & Williamson, D. S. (1987). Intergenerational family

relationships: An evaluation of theory and measurement. Psychotherapy, 24, 516–

528. doi:10.1037/h0085749

Bregman, O.C., & White, C., (2011). Bringing Systems Thinking to Life. Routledge.

Bregman, O.C. (1993). Bowen Theory. Family Process, 32: 377-378. doi:10.1111/j.1545-

5300.1993.00377.x

Brown, J. (1999). Bowen Family Systems Theory and Practice: Illustration and

Critique. Australian and New Zealand Journal of Family Therapy, 20, 94-103.

doi:10.1002/j.1467-8438.1999.tb00363.x

Beutler, L. E., Malik, M. L., Alimohamed, S., Harwood, T. M., Talebi, H., et al. (2004).

Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of

psychotherapy and behavior change (pp. 227–306). New York: Wiley.

Bureau of Labor Statistics. (2015). Mental health counselor and marriage and family

therapists. Retrieved from http://www.bls.gov/ooh/community-and-social-service

/mental-health-counselors-and-marriage-and-family-therapists.htm

Burns, D. D., & Auerbach, A. (1996). Therapeutic empathy in cognitive-behavioral

therapy: Does it really make a difference? In P. M. Salkovskis (Ed.). Frontiers of

cognitive therapy (pp. 135–164). New York: Guilford

Carter, E. and McGoldrick, M. (1999). The Expanded Family Life Cycle: Individual,

Family, and Social Perspectives 3rd ed.. Boston: Allyn and Bacon.

Castonguay, L. G., & Hill, C. E. (2012). Transformation in psychotherapy: Corrective

experiences across cognitive behavioral, humanistic, and psychodynamic

approaches. (L. G. Castonguay & C. E. Hill, Eds.). Washington, DC: American

Psychological Association. https://doi-org.libproxy.csun.edu/10.1037/13747-000

Castonguay, L. G., & Hill, C. E. (2017a). How and why are some therapists better than

others? Understanding therapist effects. Washington, DC: American

Psychological Association.

Castonguay, L. G., & Hill, C. E. (2017b). Therapist effects: Integration and conclusions.

In L. G. Castonguay, & C. E. Hill (Eds.). How and why are some therapists better

than others? Understanding therapist effects (pp. 325–341). Washington, DC:

American Psychological Association.

Chodorow, N. (1978). The reproduction of mothering: Psychoanalysis and the sociology

of gender. Berkeley, CA: University of California Press.

Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., …

Zitrin, C. (1991). Meta-analysis of therapist effects in psychotherapy outcome

studies. Psychotherapy Research, 1, 81–91. https://doi-

org.libproxy.csun.edu/10.1080/10503309112331335511

Crits-Christoph, P., Gibbons, M. B. C., Hamilton, J., Ring-Kurtz, S., & Gallop, R.

(2011). The dependability of alliance assessments: The alliance–outcome

correlation is larger than you might think. Journal of Consulting and Clinical

Psychology, 79, 267–278. https://doi-org.libproxy.csun.edu/10.1037/a0023668

Choi, S.-W., & Murdock, N. (2017). Differentiation of Self, Interpersonal Conflict, and

Depression: The Mediating Role of Anger Expression. Contemporary Family

Therapy: An International Journal, 39, 21–30. https://doi-

org.libproxy.csun.edu/10.1007/s10591-016-9397-3

Christensen, A., & Heavey, C. L. (1990). Gender and social structure in the demand-

withdraw pattern of marital conflict. Journal of Personality and Social

Psychology, 59, 73-81.doi:10.1037//0022-3514.59.1.73

Davenport, D., & Yurich, J. M. (1991). Multicultural gender issues. Journal of

Counseling and Development, 70, 64-70. https://doi.org/10.1002/j.1556-

6676.1991.tb01562.x

Davidson, R. J. (1998). Affective style and affective disorders: Perspectives from

affective neuroscience. Cognition & Emotion, 12, 307–

330.doi:10.1080/026999398379628

Drake, J.R. (2011). Differentiation of Self Inventory - short form: creation and Initial

evidence of construct validity. Retrieved from:

https://pdfs.semanticscholar.org/cdf7/19c7cef606f0a57c6bf6e49b85a814ce0835.p

Elieson, M. V., & Rubin, L. J. (2001). Differentiation of self and major depressive

disorders: A test of Bowen theory among clinical, traditional, and Internet groups.

Family Therapy, 28, 125–142. Retrieved from

https://openlibrary.org/publishers/Libra_Publishers

Erdem, G., & Safi, O. A. (2018). The cultural lens approach to Bowen family systems

theory: Contributions of family change theory. Journal of Family Theory &

Review, 10, 469–483. https://doi-org.libproxy.csun.edu/10.1111/jftr.12258

Essandoh, P. K. (1995). Counseling Issues with African College Students in U.S.

Colleges and Universities. The Counseling Psychologist, 23, 348–360.doi:

10.1177/0011000095232009

Farber, A. J. (2004). Examining remarried couples through bowenian family systems

lens. Journal of Divorce and Remarriage, 40, 121–133.

http://dx.doi.org/10.1300/J087v40n03_08

Farrell, J. M., & Shaw, I. A. (2018). Experiencing schema therapy from the inside out: A

self practice/ self-reflection workbook for therapists. New York: Guilford.

Fife, S., Whiting, J., Bradford, K., & Davis, S. (2014). The therapeutic pyramid: A

common factors synthesis of techniques, alliance and way of being. Journal of

Marital and FamilyTherapy,40, 20–33. doi:10.1111/jmft.12041

Friedman, E. H. (1991). Bowen theory and therapy. In A. S. Gurman & D. P. Kniskern

(Eds.), Handbook of family Therapy: Volume II (pp. 134–170). New York:

Brunner/Mazel.

Freud, S. (1910/59). The future prospects of psychoanalytic therapy. In J. Strachey (Ed.).

Complete psychological works of Sigmund Freud. London: Hogarth Press.

Freud, S. (1937/1964). Analysis terminable and interminable. In J. Strachey (Ed. and

Trans.) The standard edition of the complete psychological works of Sigmund

Freud (Vol.XXIII, pp. 249). London: Hogarth Press. (Original work published

1937).

Friedman, E. H. (1991). Bowen theory and therapy. In A. S. Gurman & D. P. Knisken

(Eds.), Handbook of family therapy, Vol. 2 (pp. 134–170). New York:

Brunner/Mazel.

Gale, C., & Schröder, T. (2014). Experiences of self-practice/self-reflection in cognitive

behavioural therapy: A meta-synthesis of qualitative studies. Psychology and

Psychotherapy: Theory, Research and Practice, 87, 373–392.

https://doi.org/10.1111/papt.12026

Garbarino, J., Gaa, J. P., Swank, P., McPherson, R., & Gratch, L. V. (1995). The relation

of individuation and psychosocial development. Journal of Family Psychology, 9,

311-318 doi:10.1037/0893-3200.9.3.311

Gilbert, P., & Leahy, R. (Eds.). (2007). The therapeutic relationship in the cognitive

behavioural therapies. London: Routledge.

Gold, S. H., Hilsenroth, M. J., Kuutmann, K., & Owen, J. J. (2015). Therapeutic alliance

in the personal therapy of graduate clinicians: Relationship to the alliance and

outcomes of their patients. Clinical Psychology and Psychotherapy, 22, 304–316.

https://doi.org/10.1002/cpp.1888

Gottman, J. M., & Krokoff, L. J. (1989). Marital interaction and satisfaction: A

longitudinal view. Journal of Consulting and Clinical Psychology, 57, 47-52. doi:

10.1037//0022-006x.57.1.47

Gross, J. J., & Jazaieri, H. (2014). Emotion, emotion regulation, and psychopathology:

An affective science perspective. Clinical Psychological Science,2, 387–401.

doi:10.1177/2167702614536164

Grunebaum, H. (2006). On wisdom. Family Process, 45, 117–132.doi: 10.1111/j.1545-

5300.2006.00084.x

Gurman, A. S. (1991, March/April). Family therapy's neglected prophet. The Family

Therapy Networker, 77, 25 – 37. Retrieved from:

https://www.psychotherapynetworker.org/magazine/article/947/family-therapys-

neglected-prophet

Haber, J. E. (1993). A Construct Validity Study of a Differentiation of Self Scale.

Scholarly Inquiry for Nursing Practice: An International Journal, 7, 165-178.

doi:10.1891/0889-7182.7.3.165

Haber, J. (2003). The Haber level of differentiation of self scale. In L.Strickland & C.

Dilorio (Eds.), The measure of nursing outcomes (2nd ed., pp. 320–331). New

York: Springer.

Hanshew, E. R. (1998). An investigation of the wounded healer phenomenon: Counselor

trainees and their self-conscious emotions and mental health. Dissertation

Abstracts International, Vol 58 (10-A), Apr 1998, 3846, US: University

Microfilms International.

Hare-Mustin. R. T. (1978). A feminist approach to family therapy. Family Process, 17,

181-194. doi:10.1111/j.1545-5300.1978.00181.x

Hoffman, L. (1990). Constructing realities: An art of lenses. Family Process, 29, 1–12

https://doi.org/10.1111/j.1545-5300.1990.00001.x

Horne, K. B., & Hicks, M. W. (2002). All in the family: A belated response to Knudson-

Martin’s feminist revision of Bowen theory. Journal of Marital and Family

Therapy, 28, 103–113. https://doi-org.libproxy.csun.edu/10.1111/j.1752-

0606.2002.tb01178.x

Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in

individual psychotherapy. Psychotherapy, 48, 9–16.

https://doi.org/10.1037/a0022186

Jagger, A. M. (1991). Feminist ethics: Project, problems, prospects. In C. Card (Ed.),

Feminist ethics (pp. 78-104). Lawrence, KS: University Press of Kansas.

Jankowski, P. J., & Vaughn, M. (2009). Differentiation of Self and Spirituality: Empirical

Explorations. Counseling & Values, 53, 82–96. https://doi-

org.libproxy.csun.edu/10.1002/j.2161-007X.2009.tb00116.x

Josselson, R. (1987). Finding herself: Pathways to identity development in women. San

Francisco, CA: Jossey-Bass.

Kerr, M. E. (1981). Family systems theory and therapy. In A. S. Gurman & D. P.

Kniskern (Eds.), Handbook of family therapy (pp. 226–264). New York: Brunner ⁄

Mazel.

Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen

theory. New York, NY: W W Norton & Co.

Kerr, M. E., & Bowen, M. (2019). Bowen Theory's Secrets: Revealing the Hidden Life of

Families. New York, NY: W W Norton & Co.

Kissil, K., Nino, A., & Aponte, H. (2014). Facilitating clinician development using

themes of personal issues. In R.A. Bean, S. Davis & M. Davey (Eds.), Clinical

supervision activities for increasing competence and self-awareness (pp. 3–7).

Hoboken, NJ: Wiley.

Kissil, K., & Nino, A. (2017). Does the Person-of-the-Therapist Training (POTT)

promote self-care? Personal gains of MFT trainees following POTT: A

retrospective thematic analysis. Journal of Marital and Family Therapy, 43, 526–

536. https://doi.org/10.1111/jmft.12213

Kissil, K., & Niño, A. (2018). The person-of-the-therapist training’s state of affairs:

Evaluating research and implementation of the model. Journal of Family

Psychotherapy. https://doi.org/10.1080/08975353.2018.1477383

Knudson-Martin, C. (1994). The female voice: Applications to Bowen's family systems

theory. Journal of Marital and Family Therapy, 20, 35-46.

doi:https://doi.org/10.1111/j.1752-0606.1994.tb01009.x

Kolts, R., Bell, T., Bennett-Levy, J., & Irons, C. (2018). Experiencing compassion-

focused therapy from the inside out: A self-practice/self-reflection workbook for

therapists. New York: Guilford.

Kosek, R. B. (1998). Self-differentiation within couples. Psychological Reports, 83(1),

275. https://doi-org.libproxy.csun.edu/10.2466/pr0.1998.83.1.275

Kramer, C. (2000). Revealing our selves. In Baldwin, M. (Ed.), The use of self in therapy.

2nd ed. (pp. 61–96). New York: Haworth Press

Kumaria, S., Bhola, P., & Orlinsky, D. E. (in press). Influences that count: Professional

development of psychotherapists and counsellors in India. Asia Pacific Journal of

Counselling and Psychotherapy. https://doi.org/10.1080/21507686.2017.1416416

Lam, C., & Chan-So, P. (2015). Validation of the Chinese Version of Differentiation of

Self Inventory (C- DSI). Journal of Marital & Family Therapy, 41(1), 86–101.

https://doi-org.libproxy.csun.edu/10.1111/jmft.12031

Lambert, J., & Friedlander, M. (2008). Relationship of differentiation of self to adult

clients’ perception of the alliance in brief family therapy. Psychotherapy

Research,18, 160–166.doi:10.1080/10503300701255924

Lampis, J., Busonera, A., Cataudella, S., Tommasi, M., & Skowron, E. (2017).

Psychometric Properties of an Italian Version of the Differentiation of Self

Inventory-Revised (It-DSI-R). Journal of Adult Development, 24, 144–154.

https://doi.org/10.1007/s10804-016-9253-6

Lampis, J., & Cataudella, S. (2019). Adult Attachment and Differentiation of Self-

Constructs: A Possible Dialogue? Contemporary Family Therapy: An

International Journal, 41, 227–235. https://doi-

org.libproxy.csun.edu/10.1007/s10591-019-09489-7

Larson, J. H., & Wilson, S. M. (1998). Family of origin influences on young adult career

decision problems: A test of Bowenian theory. American Journal of Family

Therapy, 26, 39-53 https://doi.org/10.1080/01926189808251085

Laszloffy, T. A., & Davis, S. D. (2019). Nurturing Nature: Exploring Ecological Self-of-

the-Therapist Issues. Journal of Marital & Family Therapy, 45, 176–185.

https://doi-org.libproxy.csun.edu/10.1111/jmft.12312

Leach, M.M., Stoltenberg, C.D., McNeill, B. (1997). Self-efficacy and counselor

development: testing the integrated developmental model. Counselor Education

& Supervision, 37, 115–124. doi:10.1002/j.1556-6978.1997.tb00537.x

Lee, H., & Johnson, R. W. (2017). Differentiation of self as a predictor of Asian-

American immigrants’ perceptions of cultural harmony. Journal of Family

Therapy, 39, 151–168. https://doi.org/10.1111/1467-6427.12154

Licht, C., & Chabot, D. (2006). The Chabot Emotional Differentiation Scale: A

Theoretically and Psychometrically Sound Instrument for Measuring Bowen’s

Intrapsychic Aspect of Differentiation. Journal of Marital and Family Therapy,

32, 167–180. https://doi.org/10.1111/j.1752-0606.2006.tb01598.x

Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., & Eiroa-Orosa, F. J. (2018). A

systematic review of the impact of mindfulness on the well-being of healthcare

professionals. Journal of Clinical Psychology, 74, 319–355.

https://doi.org/10.1002/jclp.22515.

Luepnitz. D. A. (1988). The family interpreted: Feminist theory in clinical practice. New

York: Basic.

Lum, W. (2000). The lived experience of the personal iceberg metaphor of therapists in

Satir’s systemic brief therapy training. Unpublished master’s thesis, University of

British Columbia, Vancouver.

Lum, W. (2002). The use of self of the therapist. Contemporary Family Therapy, 24,

181–197. doi:10.1023/A:1014385908625

Lyons, N. (1983). Two perspectives: On self, relationships, and morality. Harvard

Educational Review, 53, 126-145.

MA in Marriage and Family Therapy. (n.d.). Retrieved from

https://evangelical.edu/admissions/ma-in-marriage-family-therapy/

Macran, S., & Shapiro, D. (1998). The role of personal therapy for therapists: A review.

British Journal of Medical Psychology, 71, 13–25. doi:10.1111/j.2044-

8341.1998.tb01364.x

Malikiosi-Loizos, M. (2013). Personal therapy for future therapists: Reflections on a still

debated issue. The European Journal of Counselling Psychology, 2, 33–50.

https://doi.org/10.5964/ejcop.v2i1.4

Marriage and Family Therapy MS. (2019). Retrieved from

https://spu.edu/academics/school-of-psychology-family-community/graduate-

programs/marriage-and-family-therapy

Maynard, S. 1997. Growing Up In An Alcoholic Family System: The Effect On Anxiety

And Differentiation Of Self. Journal of Substance Abuse, 9, 161-170.

https://doi.org/10.1016/S0899-3289(97)90014-6

McDaniel, S. H., & Landau-Stanton, J. (1991). Family-of-origin work and family therapy

skills training: Both-and. Family Process, 30, 459–471. https://doi-

org.libproxy.csun.edu/10.1111/j.1545-5300.1991.00459.x

McDowell, T., & Shelton, D. (2002). Valuing ideas of social justice in MFT curricula.

Contemporary Family Therapy,2, 313–

331.https://doi.org/10.1023/A:1015351408957

McGeorge, C., & Carlson, T. (2011). Deconstructing heterosexism: Becoming an LGB

affirmative heterosexual couple and family therapist. Journal of Marital and

Family Therapy,37, 14–26. doi:10.1111/j.1752-0606.2009.00149.x

McGoldrick, M., Anderson, C. M., & Walsh, F. (1989). Women in families: A framework

for family therapy. (M. McGoldrick, C. M. Anderson, & F. Walsh, Eds.). New

York, NY: W W Norton & Co.

McGoldrick, M., & Hardy, K. Y. (2008). Introduction: Re-visioning family therapy from

a multicultural perspective. In M. McGoldrick & K. V. Hardy (Eds.), Re-visioning

family therapy: Race, culture, and gender in clinical practice., 2nd ed. (pp. 3–24).

New York, NY: The Guilford Press.

Messina, K. C., Kolbert, J. B., Bundick, M. J., Crothers, L. M., & Strano, D. A. (2018).

The Impact of Counseling on Bowen’s Differentiation of Self. Family Journal,

26, 150–155. https://doi-org.libproxy.csun.edu/10.1177/1066480718776197

Meyer, D. F. (1997). Codependency as a mediator between stressful events and eating

disorders. Journal of Clinical Psychology, 53, 107–116. https://doi-

org.libproxy.csun.edu/10.1002/(SICI)1097-4679(199702)53:2<107::AID-

JCLP3>3.0.CO;2-Q

MFT Program Handbook. (n.d.). Retrieved from

https://humansciences.okstate.edu/hdfs/mft/images/mfthandbook.pdf

Miller, R. B., Anderson, S., & Keala, D. K. (2004). Is Bowen theory valid? A review of

basic research. Journal of Marital and Family Therapy, 30, 453–466.

doi:10.1111/j.1752-0606.2004.tb01255.x

Moody-Adams, M. M. (1991). Gender and the complexity of moral voices. In C. Card

(Ed.), Feminist ethics (pp. 195-212). Lawrence, KS: University Press of Kansas.

Murdock, N. L., & Gore, P. A. (2004). Stress, coping, and differentiation of self: A test of

Bowen theory. Contemporary Family Therapy, 23, 319 –335.

http://dx.doi.org/10.1177/1066480718776197

Murphy, D., Irfan, N., Barnett, H., Castledine, E., & Enescu, L. (2018). A systematic

review and meta‐synthesis of qualitative research into mandatory personal

psychotherapy during training. Counselling & Psychotherapy Research, 18, 199–

214. https://doi-org.libproxy.csun.edu/10.1002/capr.12162

National Institute of Mental Health. (2006). Mental healthcare cost data for all

Americans (2006). Retrieved from http://www.nimh.nih.gov/statistics/4COST

_AM2006.shtml

Nichols, M. P., & Schwartz, R. C. (1998). Family therapy: Concepts and methods (4th

ed.). Boston: Allyn & Bacon

Nienhuis, J. B., Owen, J., Valentine, J. C., Winkeljohn Black, S., Halford, T. C., Parazak,

S.E., & Hilsenroth, M. (2018). Therapeutic alliance, empathy, and genuineness in

individual adult psychotherapy: A meta-analytic review. Psychotherapy Research,

28,593–605. https://doi.org/10.1080/10503307.2016.1204023.

Nino, A., Kissil, K., & Apolinar, F. L. (2015). Perceived professional gains of master’s

level students following a Per-son-of-the-Therapist Training program: A

retrospective content analysis. Journal of Marital and Family Therapy,41, 163–

176. https://doi.org/10.1111/jmft.12051.

Nissen-Lie, H. A., Havik, O. E., Høglend, P. A., Monsen, J. T., & Rønnestad, M. H.

(2013). The contribution of the quality of therapists’ personal lives to the

development of the working alliance. Journal of Counseling Psychology, 60, 483–

495. https://doi.org/10.1037/a0033643

Nouwen, H.J.M. (1979). The wounded healer. New York, NY: Image

Orlinsky, D. E., & Rønnestad, M. H. (2005). How psychotherapists develop: A study of

therapeutic work and professional growth. Washington, DC: American

Psychological Association. https://doi-org.libproxy.csun.edu/10.1037/11157-000

Orlinsky, D. E., Rønnestad, M. H., Willutzki, U., Wiseman, H., & Botermans, J.-F.

(2005). The prevalence and parameters of personal therapy in Europe and

elsewhere. In J. D. Geller, J. C. Norcross, & D. E. Orlinsky (Eds.), The

psychotherapist’s own psychotherapy: Patient and clinician perspectives (pp.

177–191). New York, NY: Oxford University Press.

Pakenham, K. I. (2015). Effects of Acceptance and Commitment Therapy (ACT) training

on clinical psychology trainee stress, therapist skills and attributes, and ACT

processes. Clinical Psychology and Psychotherapy, 22, 647–655.

https://doi.org/10.1002/cpp.1924

Papero, D. (1990). Bowen Family Systems Theory. Boston, MA: Allyn & Bacon

Papero, D. V. (2014). Assisting the Two-person System: An Approach Based on the

Bowen Theory. Australian & New Zealand Journal of Family Therapy, 35, 386–

397. https://doi-org.libproxy.csun.edu/10.1002/anzf.1079

Peleg-Popko, O. (2002). Bowen Theory: A Study of Differentiation of Self, Social

Anxiety, and Physiological Symptoms. Contemporary Family Therapy: An

International Journal, 24, 355. https://doi-

org.libproxy.csun.edu/10.1023/A:1015355509866

Peleg, O., & Rahal, A. (2012). Physiological symptoms and differentiation of self: A

cross-cultural examination. International Journal of Intercultural Relations,36,

719–727.doi: 10.1016/j.ijintrel.2012.04.001

Pierce, C. (1991). Postmodernism and other skepticisms. In C. Card (Ed.), Feminist

ethics (pp. 60-77). Lawrence, KS: University Press of Kansas.

Preece, D., Becerra, R., & Campitelli, G. (2019). Assessing Emotional Reactivity:

Psychometric Properties of the Perth Emotional Reactivity Scale and the

Development of a Short Form. Journal of Personality Assessment, 101, 589–597.

https://doi.org/10.1080/00223891.2018.1465430

Pick, T. M. (1986). A fusion/separation model of psychotherapy. Psychotherapy: Theory,

Research, Practice, Training, 23, 390–394. https://doi-

org.libproxy.csun.edu/10.1037/h0085629

Rabu, M., Moltu, C., Binder, P. E., & McLeod, J. (2016). How does practicing

psychotherapy affect the personal life of the therapist? A qualitative inquiry of

senior therapists’ experiences. Psychotherapy Research, 26, 737–749.

https://doi.org/10.1080/10503307.2015.1065354

Regas, S., Kostick, K., Bakaly, J., & Doonan, R. (2017). Including the self-of-the-

therapist in clinical training. Couple and Family Psychology: Research and

Practice,6, 18–31.doi:10.1037/cfp0000073

Reik, T. (1948). Listening with the Third Ear: The inner experience of a psychoanalyst.

New York: Farrar and Strauss

Rober, P. (1999). The therapist’s inner conversation in family therapy practice: Some

ideas about the self of the therapist, therapeutic impasse, and the process of

reflection. Family Process, 38, 209–228. doi:10.1111/j.1545-5300.1999.00209.x

Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality

change. Journal of Consulting Psychology,21,95–103. doi:10.1037/h0045357

Rothbart, M. K., & Derryberry, D. (1981). Development of individual differences in

temperament. In M. E. Lamb & A. L. Brown (Eds.), Advances in developmental

psychology (pp. 37–86). Hillsdale, NJ: Erlbaum

Rothbaum, F., Weisz, J., Pott, M., Miyake, K., And Morelli, G. (2000). Attachment and

Culture:Security in the United States and Japan. American Psychologist, 55,

1093–1104. http://dx.doi.org.libproxy.csun.edu/10.1037/0003-066X.55.10.1093

Rottenberg, J.E., & Johnson, S.L. (2007). Emotion and psychopathology: Bridging

affective and clinical science. New York, NY: Guilford Press.

Rønnestad, M. H., Orlinsky, D. E., & Wiseman, H. (2016). Professional development and

personal therapy. In J. C. Norcross, G. R. VandenBos, & D. K. Freedheim (Eds.),

Handbook of Clinical Psychology, Vol. 5 (pp. 223–235). Washington, DC:

American Psychological Association.

Rønnestad, M. H., & Skovholt, T. M. (2013). The developing practitioner. Growth and

stagnation of therapists and counselors. New York: Routledge.

Satir, V. (2000). The therapist story. In M. Baldwin (Ed.), The use of self in therapy (2nd

edn). (pp. 17–28). New York: Haworth

Satir, V. & Baldwin, M. (1983). Satir step by step: A guide to creating change in

families. Palo Alto, CA: Science and Behavior Books.

Satir, V. & Banmen, J. (1983). Virginia Satir verbatim 1984. North Delta, BC: Delta

Psychological Associates

Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir model: Family therapy

and beyond. Palo Alto, CA: Science & Behavior Books

Schnarch, D. M. (1997). Passionate marriage: Love, sex, and intimacy in emotionally

committed relationships. WW Norton & Company.

Sedgwick, D. (1994). The wounded healer: Countertransference from a Jungian

perspective. London: Routledge.

Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers:

Effects of mindfulness-based stress reduction on the mental health of therapists in

training. Training and Education in Professional Psychology, 1, 105–115.

https://doi.org/10.1037/1931-3918.1.2.105

Simon, G. M. (2006). The heart of the matter: A proposal for placing the self of the

therapist at the center of family therapy research and training. Family Process, 45,

331–344. https://doi.org/10.1111/j.1545-5300.2006.00174.x

Skovholt, T. M., & Rønnestad, M. H. (2001). The long, textured path from novice to

senior practitioner. In T. M. Skovholt (Ed.), The resilient practitioner: Burnout

prevention and self-care strategies for counselors, therapists, teachers, and health

professionals (pp. 25–54). Boston, MA: Allyn and Bacon.

Skowron, E. A. 2004. Differentiation of Self, Adjustment, Problem Solving, and Ethnic

Belonging among Persons of Color. Journal of Counseling and Development, 82,

319-328. doi: 10.1002/j.1556-6678.2004.tb00333.x

Skowron, E., & Friedlander, M. (1998). The differentiation of self inventory:

Development and initial validation. Journal of Counseling Psychology, 45, 235–

246. https ://doi.org/10.1037/0022-0167.45.3.235.

Skowron, E. A., & Schmitt, T. A. (2003). Assessing interpersonal fusion: Reliability and

validity of a new DSI Fusion with Others subscale. Journal of Marital and Family

Therapy, 29(2), 209–222. https://doi-org.libproxy.csun.edu/10.1111/j.1752-

0606.2003.tb01201.x

Skowron, E., Stanley, K., & Shapiro, M. (2009). A Longitudinal Perspective on

Differentiation of Self, Interpersonal and Psychological Well-Being in Young

Adulthood. Contemporary Family Therapy: An International Journal, 31(1), 3–

18. https://doi-org.libproxy.csun.edu/10.1007/s10591-008-9075-1

Skovholt, T. M., & Rønnestad, M. H. (2001). The long, textured path from novice to

senior practitioner. In T. M. Skovholt (Ed.). The resilient practitioner: Burnout

prevention and self-care strategies for counselors, therapists, teachers, and health

professionals (pp. 25–54). Boston: Allyn and Bacon.

Skowron, E. A., Holmes, S. E., & Sabatelli, R. M. (2003). Deconstructing differentiation:

Self regulation, interdependent relating, and well-being in adulthood.

Contemporary Family Therapy, 25,111–129. https ://doi.org/10.1023/A:10225

14306 491.

Skowron, E. A., & Schmitt, T. A. (2003). Assessing interpersonal fusion: Reliability and

validity of a new DSI fusion with others subscale. Journal of Marital and Family

Therapy, 29, 209–222. https ://doi.org/10.1111/j.1752-0606.2003.tb012 01.x.

Skowron, E. A., Stanley, K. L., & Shapiro, M. D. (2009). A longitudinal perspective on

differentiation of self, interpersonal and psychological well-being in young

adulthood. Contemporary Family Therapy: An International Journal, 31, 3–18.

http://dx.doi.org/10.1007/s10591-008- 9075-1

Spelman, E. V. (1991). The virtue of feeling and the feeling of virtue. In C. Card (Ed.),

Feminist ethics (pp. 213-232). Lawrence, KS: University Press of Kansas.

Stone, D. (2008). Wounded healing: Exploring the circle of compassion in the helping

relationship. The Humanistic Psychologist, 36, 45–51. https://doi-

org.libproxy.csun.edu/10.1080/08873260701415587

Tamura, T., & Lau, A. (1992). Connectedness versus separateness: Applicability of

family therapy to Japanese families. Family Process, 31, 319–340. https://doi-

org.libproxy.csun.edu/10.1111/j.1545-5300.1992.00319.x

Tannen, D. (1990). You just don't understand: Women and men in conversation. New

York: Ballantine Books.

Thwaites, R., Bennett-Levy, J., Davis, M., & Chaddock, A. (2014). Using self-practice

and self-reflection (SP/SR) to enhance CBT competence and meta-competence. In

A. Whittington & N. Grey (Eds.), How to become a more effective CBT therapist:

Mastering metacompetence in clinical practice (pp. 241–254). Chichester: Wiley-

Blackwell.

Timm, T. M., & Blow, A. J. (1999). Self-of-the-Therapist Work: A Balance Between

Removing Restraints and Identifying Resources. Contemporary Family Therapy:

An International Journal, 21, 331–351. https://doi-

org.libproxy.csun.edu/10.1023/A:1021960315503

Titelman, P. (1998). Clinical applications of Bowen family systems theory. United States

of America: Haworth Press.

Titelman, P. (2014). Clinical Applications of Bowen Family Systems Theory. Hoboken:

Taylor and Francis.

Tuason, M. T., & Friedlander, M. L. (2000). Do parents’ differentiation levels predict

those of their adult children? and other tests of Bowen theory in a Philippine

sample. Journal of Counseling Psychology, 47, 27–35. https://doi-

org.libproxy.csun.edu/10.1037/0022-0167.47.1.27

Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings.

Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers.

Wampold, B. E., & Brown, G. S. (Jeb). (2005). Estimating variability in outcomes

attributable to therapists: A naturalistic study of outcomes in managed care.

Journal of Consulting and Clinical Psychology, 73, 914–923. https://doi-

org.libproxy.csun.edu/10.1037/0022-006X.73.5.914

Waring, E. M., & Patton, D. (1984). Marital intimacy and family functioning. Psychiatric

Journal of the University of Ottawa, 9, 24–29. Retrieved from

http://ww.cma.ca/jpn

Watson, M. F. (1993). Supervising the person of the therapist: Issues, challenges and

dilemmas. Contemporary Family Therapy, 15, 21–31. doi:10.1007/BF00903485

Weeks, G., Gambescia, N., & Hertlein, K. (2016). A clinician’s guide to systemic sex

therapy. New York: Routledge

Weisinger E. (2016). The person of the therapist and therapeutic efficacy: A

differentiation based approach. Dissertation Abstracts International: Section B:

The Sciences and Engineering. 77(1-B(E)).

Whitaker, C.A., & Keith, D.V. (1981). Symbolic-experiential family therapy. In A.

Gurman & D. Kniskern (Eds.), Handbook of family therapy (pp. 187–225). New

York: Brunner/Mazel

White, M. (1993). Deconstruction and therapy. In S. Gilligan & R. Price (Eds.),

Therapeutic conversations (pp. 22–61). New York: W.W. Norton.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY:

Norton.

Wigg, R., Cushway, D., & Neal, A. (2011). Personal therapy for therapists and trainees:

A theory of reflective practice from a review of the literature. Reflective Practice,

12, 347–359. https://doi.org /10.1080/14623943.2011.571866

Winn, K. I., Crawford, D. W., & Wampler, K. S. (1995). An intergenerational

perspective on marital interaction styles. Journal of Social Behavior &

Personality, 10, 215–228. Retrieved from https://www.sbp-

journal.com/index.php/sbp

Winnicott, D. W. (1965). The Maturational Process and the Facilitating Environment.

New York: International Universities Press.

Wylie, M. Sykes., 1991. Family Therapy's Neglected Prophet, The Family Therapy

Networker, March-April: 25-37

Xue, Y., Xu, Z., Zaroff, C., Chi, P., Du, H., Ungvari, G. S., … Xiang, Y. (2018).

Associations of Differentiation of Self and Adult Attachment in Individuals With

Anxiety‐Related Disorders. Perspectives in Psychiatric Care, 54, 54–63.

https://doi-org.libproxy.csun.edu/10.1111/ppc.12200

Yalom, I. D. (1980). Existential psychotherapy. New York, NY: Basic Books.

Zeytinoglu, S. S., & Niño, A. (2018). A tool for connection: Using the person‐of‐the‐

therapist training (pott) model in emotionally focused couple therapy

supervision. Journal of Marital and Family Therapy.

https://doi.org/10.1111/jmft.12349

Appendix A

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124 Appendix B

Exercises in Differentiation: A Workshop for Mental Health Professionals

Workshop Facilitator Guidebook

Bianca Rus

California State University, Northridge

Michael D. Eisner College of Education – Department of Educational Psychology and

Counseling

125

Contents of Guidebook

This Workshop Guide 3 Self of The Therapist and Personal Practice: Differentiation of self 4 Workshop Objectives 5 Workshop Outline 6 Workshop Set Up 11 Welcoming Participants 12 Rules of Engagement and Boundaries 13 Facilitating Discussions 14 Facilitating Activities and Exercises 15 Homework Assignments 18 Dealing with the Unanticipated 19 Conclusion of the Workshop 21 References 22

126

This Workshop Guide

This manual is a guide for mental health professionals who will be facilitating the workshop Exercises in Differentiation: A workshop for Mental Health Professionals. The manual presents a complete overview of the workshop. This workshop was developed as a sequence of four consecutive sessions and can be run by up to two facilitators who are licensed mental health professionals including licensed MFT, PsyD or other mental health professionals that have been licensed for a period of at a minimum of five years. The manual offers a personal practice protocol to allow new-career therapists to explore aspects of self-the-therapist as outlined by Murray Bowen’s three selected principles: emotional reactivity, fusion with others, and the ‘I’ position.

127

Self of The Therapist and Personal Practice: Differentiation of self

The workshop Exercises in Differentiation: A Workshop for Mental Health Professionals has been developed as a personal practice protocol for early-career therapists to explore aspects of self-of-the-therapist (SOTT). This protocol was created as an experiential program to be used by graduating marriage and family therapy programs and clinics that provide training to mental health students and associates. It is to be used as an auxiliary to any skill and SOTT training. The workshop you are leading was created as a solely exploratory practice. This workshop does not propose solutions and is intended simply as an exercise in self-understanding for those in the audience. The operational framework of the workshop is based on principles drawn from existent literature including: Self-of-the-therapist (SOTT): Refers to the therapist’s awareness of one’s inner processes and emotional development. Personal practice (PP): Refers to formal psychological interventions and techniques that therapists engage with self experientially over an extended time period both in an individual or group setting and with a reflective focus on their personal and/or professional development.

Bowen theory (also known as Bowen Family Systems theory): Murray Bowen’s family systems theory of human behavior that views the family as an emotional unit being part of the natural world of living organisms. Differentiation of Self (DoS): A concept inherent in Bowen’s theory that refers to an individual’s ability to distinguish feeling processes from intellectual ones and self from others.

128

Workshop Objectives This workshop aims to: • Guide early career therapists through a self-of-the-therapist personal practice by utilization of three key principles: emotional reactivity, fusion with others, and the ‘I’ position • Encourage exploration of issues pertaining to the self-of the therapist • Encourage the development of improved self-understanding for the participating therapist At the end of this workshop, participants will: • Have a general understanding of the importance of self-of-the-therapist development for mental health professionals • Have a general understanding of the personal practices of the therapist • Recognize the concepts discussed and how they present in participants’ personal experiences • Develop increased understanding of own behaviors, interactions with others, personal values and aspects of self • Exercise critical self-reflection utilizing the principles outlined • Employ the principles learned to achieve increased differentiation

129

Workshop Outline

Exercises in Differentiation

A Workshop for Mental Health Professionals

Session One (4 hours) • Introduction (20 minutes) • Introduce the workshop facilitator, context, outline, and learning objectives of the workshop. • Introduce the rules and guidelines for participation. • Pass out workshop outline handout, pen, and paper to the audience. • Activity: Icebreaker: Differentiation of Self Inventory (20 minutes) • Hand participants a copy of the DoS Inventory and direct them to answer the listed questions. • Direct participants to keep the inventory for their own reference after filling it out. • Psychoeducation (1 hour) • Introduce value of self-of-the-therapist training for professional development of mental health practitioners. • Introduce models of SOTT • Introduce types of personal practices that support self-of-the-therapist growth. • Introduce differentiation of self as a form of personal practice. • Provide basic assumptions and scientific basis of Bowen family systems theory including the family as an emotional and natural system and counterbalancing forces for individuality and togetherness. • Cite the importance of differentiation of self in the emotional system according to Bowen and studies looking at his contention. • Provide examples of a highly differentiated versus a low differentiated individual. • Provide psychoeducation on the value of a differentiated therapist. • Provide information on strengths and critique of the model. • Introduce first key concept in developing self-differentiation: Emotional reactivity. • Provide psychoeducation on the concept according to Bowen. • Provide information on the importance of emotions and the distinction between emotional response and emotional reaction. Break (15 minutes) • Activities (50 minutes) • Welcome audience back and introduce activity: You won’t believe what happened! (25 minutes) • Instruct participants to pick a partner and explore a recent situation where they were involved in an argument with another person. • Each person of the pair will be allotted to explore for 10 minutes.

130

• Instruct the participants to answer the following questions pertaining to the story: • What happened? • What was said? • How did the people involved respond? • How did the situation culminate? • How did the participants feel about what happened? • Introduce activity: My Response Model (25 minutes) • Direct participants to return to their partner and take turns in evaluating each of the statements with True/False. Instruct the participants to then think of a situation when these statements may have applied to them: • At times my feelings get the best of me and I have trouble thinking clearly. • Sometimes my responses are more than what is warranted in a situation. • Other people close to me have remarked that I have strong emotional reactions to some situations. • Direct participants to practice formulating alternative ways of responding to similar situations (eg.calming down prior to providing a response, taking a break, using ‘I statements’). • Discussion (45 minutes) • Create a safe space for reflections on the psychoeducation and activities. • Encourage participants’ questions and clarify any concept discussed. • Explore with participants their experience engaging in the activities outlined. The facilitator can use the following questions to encourage engagement: • How was that experience for you? • What are some implications of this information for our own self- development? • What have you learned about yourself though these exercises? • Conclusion (30 minutes) • Provide concluding remarks on the discussion and psychoeducation. • Pass out homework assignment and directions. • Pass out workshop survey and ask participants to fill out and turn in.

Session Two (4 hours) • Check in (20 minutes) • Explore participant’s experience with homework assignment and discuss utilizing questions to prompt participants to engage: • What did you observe through the week pertaining to how you engage with situations? • What did you observe about other people’s way of engaging? • Where there some situations that may drive you to respond reactively more than others? • Was there any specific event that elicited a response from you? Would you like to share? • Provide answers and clarifications to any questions from participants. • Psychoeducation (1 hour)

131

• Introduce Bowen theory concept: Fusion with others. • Utilize videos to help audience understand the concept. Break (15 minutes) • Activities (1 hour 10 minutes) • Welcome back the audience and introduce activity: Role play. • Encourage audience to separate into 3 groups. Assign each of the three groups one of the following scenarios: Scenario 1: Role play for us an example of fusion one would see in an intimate partner relationship. Portray relational dynamics between partners in their engagement with each other (and with outside people) that may be suggestive of fusion. Scenario 2: Role play for us an example of fusion one would see in a relationship to family. Portray relational dynamics between family members that illustrate they may be fused. Scenario 3: Role play for us an example of fusion one would see in a friendship relationship. Portray dynamics between friends that illustrate fusion with one another. • Instruct participants to utilize what they have learned in the psychoeducation section to develop their scenario. Allow participants 35 minutes to brainstorm and up to 10 minutes for each group to role play. • Discussion (45 minutes) • Create a safe space for reflections on the psychoeducation and activities. • Encourage participants’ questions and clarify any concept discussed. • Explore with the group their experience engaging in the activities outlined. The facilitator can use the following questions to encourage engagement: • What have you learned about fusion with others from the material and activities? • What are some implications of this information for your own self- development? • How do we avoid such fusions in our relationships? • Conclusion (30 minutes) • Provide concluding remarks on the discussion and psychoeducation. • Pass out homework assignment and provide directions. • Pass out workshop survey and ask participants to fill out and turn in.

Session Three (4 hours) • Check in (20 minutes) • Explore participant’s experience with homework assignment and discuss utilizing questions to prompt participants to engage: • What did you observe through the week pertaining to your fusion with others? • Was there any specific event that elicited a response from you? Are you willing to share? • Provide answers and clarifications to any questions from participants. • Psychoeducation (1 hour) • Introduce Bowen theory concept: The ‘I’ position. • Use videos to help audience understand the concept.

132

Break (15 minutes) • Activities (1 hour 10 minutes) • Welcome audience back and introduce activity: Exploring the past (30 minutes). • Provide directions to participants to pick a partner. Have each partner explore a past situation where they felt that they may have forgone their ‘I’ position in a situation with another person. • Each of the partners will explore for 15 minutes. • Instruct the participants to answer the following questions pertaining to the situation: • How did that situation/moment shape you? What kind of impact did it have on how you view yourself? • How did that scenario come to affect you through other experiences? • Would you do anything different if you had the chance? If so, what would you do in order to differentiate yourself and bring out the ‘I’ position? • What would it look like if you were in the ‘I’ position most often than not? • Introduce activity: Taking the ‘I’ position (40 minutes) • Provide directions to participants to return to their partner or pick a different partner. • Instruct the pairs to explore together ways in which they each embrace the ‘I position’ in their lives (eg. I as woman, I as man, I as professional, I as perfectionist, I as dreamer). For each of these stances, encourage partners to recognize what qualities and values that distinguish and ground these self- positions. • Discussion (45 minutes) • Encourage participants’ questions and clarify any of the concepts discussed. • Create a safe space for reflections on the activities and psychoeducation provided. • Explore with the group their experience engaging in the activities outlines. The facilitator can use the following questions to encourage engagement: • How was that experience for you? • What have we learned? • What are some implications of this information for our own self- development? • What have you learned about yourself though these exercises? • Conclusion (30 minutes) • Provide concluding remarks on the discussion and psychoeducation. • Pass out homework assignment and provide directions. • Pass out workshop survey and ask participants to fill out and turn in.

Session Four (3 hours) • Check in (20 minutes) • Explore participant’s experience with homework assignment and discuss utilizing questions to prompt participants to engage:

133

• What did you observe through the week pertaining to your use of the ‘I’ position? • Was there any specific event that elicited a response from you? Are you willing to share? • Provide answers and clarifications to any questions from participants. • Psychoeducation: Tying it all together (50 minutes) • Revisit the 3 concepts of Bowen Differentiation of Self. Explain why they were chosen for the workshop, what they mean for the developing therapist and how they can be used in therapy with clients. • Revisit briefly the value of SOTT personal practices and encourage participants to continue to explore with SOTT elements. • Utilize videos to help convey the point. Break (15 minutes) • Activities: Differentiation of Self Inventory – Retest (20 minutes) • Welcome audience back and pass out DoS inventory for participants to retake. • Direct participants to answer the listed questions as per scale. • Direct participants to keep scale when done. • Discussion (45 minutes) • Create a safe space for reflections on the activities and psychoeducation provided. • Encourage participants’ questions and clarify any concept discussed through the workshop. • Explore with the group the experience of taking the DoS inventory at the beginning and end of the workshop. • Explore with the group their experience engaging in the activities outlined. The facilitator can use the following questions to encourage engagement: • How was this experience for you? • What have we learned from this workshop about yourself? What have you learned about others close to you? • What are some implications of this new information for our own self- development? • What are some implications for your therapeutic work with clients? • Conclusion (30 minutes) • Provide concluding remarks on the workshop. • Allow participants to communicate and gain closure with peers and facilitators. • Pass out final workshop survey and ask participants to fill out and turn in.

134

Workshop Set Up The facilitator(s) should ensure the following items are in place prior to the start of the workshop:

Parameters The workshop will be made available to a maximum of 25 attendees at a time. The workshop will be facilitated by maximum two facilitators. Allow 4 hours for the first three sessions of the workshop and 3 hours for the concluding session (This will not include time allotted for the room and equipment setup). Ensure that every attendee receives a printed handout packet, paper and pen for activities at the beginning of each session. A Workshop Evaluation Form will be given out at the end of each session.

Equipment Computer connected to the internet Projector and Projector Screen Audio system Chairs and tables to accommodate all participants and facilitators

Materials Name tags for each participant PowerPoint presentation slides Workshop handouts Pens and paper for activities Workshop evaluation forms Refreshments (TBD/as applicable)

135

Welcoming Participants

Welcome and Introduction The beginning 20 minutes of the workshop will be utilized to briefly welcome the audience and to introduce the facilitator(s), their background as well as the premises of the workshop. The facilitators should include the following in their introduction: • Name and title • Educational background and experience • Their interest and investment in the topic of development of self-the-therapist

Setting the Tone of the Workshop The facilitator(s) should strive to begin the workshop on a positive note, utilizing a jovial remark or an icebreaker to engage the audience. The facilitator(s) should establish an open and safe space for participants to share and ask questions about the material presented while introducing the content in a friendly and nonjudgmental demeanor.

136

Rules of Engagement and Boundaries

The facilitator(s) will: • Introduce the rules for any activities and discussions at the beginning of the workshop. • Define necessary boundaries pertaining to communication and participation while attending the workshop. • Communicate and model an inclusive attitude of all diversity while supporting discussions that go beyond polarizing issues. • Address any participant questions and/or comments pertaining to the subject matter as they arise. Questions of unrelated matters will be address during the break or after the workshop.

The guidelines for participation in discussion will be shared with the audience: • Listen and communicate respectfully to all in participation. • Respect differing point of views of others. • Critique ideas introduced rather than the people sharing them. • Refrain from blaming, speculating or accusing. • Commit to learning. • Embrace open-mindedness. • Avoid inflammatory language. • Respect everyone’s confidentiality in participation and sharing.

The participants will be asked to abide by the following administrative rules: • Turn off all cellphones and media devices during the workshop. • Don’t engage in side-conversations while the facilitator is speaking. • Only one participant will speak at any given moment. • Be on time returning from breaks as to not interrupt facilitator(s). • Share all relevant information, there is no such thing as bad question/idea. • Confine your discussion to current topic.

137

Facilitating Discussions The facilitator will focus on keeping the discussion focused on the topic, clarifying any confusion for participants and helping create and maintain a safe environment for sharing and where everyone can participate in a cooperative manner. First, the facilitator will introduce the topic of the discussion. This will allow participants to know what the discussion will be about. The facilitator should be clear and specific when communicating the topic and any questions to the audience to engage their participation. Secondly, the facilitator will allow for participants to engage at their own discretion without being directive or inviting one participant over another to share. He or she will model to participants how they can participate in the discussion or may utilize an example to encourage participants to join the conversation. Throughout the discussion, the facilitator will communicate a relaxed and calm demeanor and will promote an open conversation on the topic presented. They may utilize questions to encourage and stimulate participants’ response, such as: • What are your thoughts about what we just learned? • What was your experience like through this activity? • What have you learned about yourself from this activity? • Did you encounter any challenges or difficulties while engaging in the self-reflection? • What kind of things came up for you that you would like to share? • Did you learn anything new about yourself from this lecture and activities? • Was this information of any help to developing better self-understanding? Why/Why not? Listing can be used to keep track of items shared by the audience by utilizing a white board that everyone can see. This list can also be used as the basis for other discussions or to promote further exploration of the topic. The facilitator can relate to the experiences of participants and it is encouraged that he/she normalizes such experiences. The use of humor is appropriate to navigate tense moments or boredom in the discussion and should be considered at the facilitator’s discretion. Lastly, the facilitator will ensure to: • Equalize participation for all members. • Clarify and interpret participants’ responses. • Support the audience with staying on topic. • Summarize any points communicated by the audience. • Maintain a good pace for the discussion and sharing.

138

Facilitating Activities and Exercises To successfully guide the participants through the activities, the facilitator(s) must: • Consider the group as a whole and the needs of the participants. • Have knowledge of the exercises and of possible difficulties they may bring up for the audience. • Provide clear instructions to participants and be available to clarify or address any concerns. • Support the audience in processing the experience after the activity ends.

Directions for Facilitating Activities: Session One Expected learning outcomes: This session’s introductory activity provides an opportunity for participants to test their level of DoS as per the provided scale. Through the additional activities, the participants will have a chance to explore their underlying responses in charged situations and to formulate a better understanding of themselves in relation to emotionally appropriate vs. emotionally reactive responses. Activity: Differentiation of Self Inventory Purpose: This activity provides an opportunity for participants to familiarize themselves with the DoS scale and to observe their responses as per scale. Methodology: The participants will be provided a copy of the DoS inventory to take and they will be directed to answer the listed questions to the best of their abilities. The participants will be encouraged to observe the total answers for each response category as a note to self. Activity: You won’t believe what happened! Purpose: This activity will provide the audience an opportunity to explore a recent situation they were involved in to observe tendencies of responding to challenging situations. Methodology: Each participant will be instructed to pick a teammate and take turns in exploring a recent situation they each have been involved in. The participants will be encouraged to answer the following questions: • What happened? • What was said? • How did the people involved respond? • How did the situation culminate? • How the participants feel about what happened?

139

Activity: My Response Model (25 minutes) Purpose: This activity provides an opportunity for each participant to explore how their responses to situations may be evaluated by self and others. Methodology: Participants will return to their partner and take turns in evaluating each of the statements with True/False. Then, the participants will be instructed to think of a situation when these statements may have applied to them: • At times my feelings get the best of me and I have trouble thinking clearly. • Sometimes my responses are more than what is warranted in a situation. • Other people close to me have remarked that I have strong emotional reactions to some situations. Lastly, the participants will be asked to formulate alternative ways of responding to such situations.

Session Two Expected learning outcomes: This session’s activity provides an opportunity for participants to explore their fusion with others vs. ability to establish themselves as separate selves. Activity: Role play Purpose: This activity provides an opportunity for participants to apply concepts learned to gain further comprehension of how fusion with others shows up in relationships. Methodology: The audience will be encouraged to divide into three groups. Every group will be assigned a scenario. They will be instructed to utilize what they have learned in the psychoeducation section to develop their role play around the provided scenario. The groups will be allotted 35 minutes to brainstorm and up to 10 minutes to role play for the rest of the audience. The following three scenarios will be used: • Scenario 1: Role play for us an example of fusion one would see in an intimate partner relationship. Portray relational dynamics between partners in their engagement with each other (and with outside people) that may be suggestive of fusion. • Scenario 2: Role play for us an example of fusion one would see in a relationship to family. Portray relational dynamics between family members that illustrate they may be fused. • Scenario 3: Role play for us an example of fusion one would see in a friendship relationship. Portray dynamics between friends that illustrate fusion with one another.

Session Three Expected learning outcomes: This session’s activities provide an opportunity for participants to explore their ‘I’ position in relation to others and to practice bringing it out in their lives. Activity: Exploring the past

140

Purpose: This activity provides an opportunity for participants to explore past occurrences where they felt that they may have forgone their ‘I’ position in relation to others and to situations. Methodology: The participants will be encouraged to pick a partner. Each of the two will take turns in exploring a past situation where they felt that they may have forgone their ‘I’ position in a relational dynamic with another person. The participants will be instructed to answer the following questions pertaining to the situation: • How did that situation/moment shape you? What kind of impact did it have on how you view yourself? • How did that scenario come to affect you through other experiences? • Would you do anything different if you had the chance? If so, what would you do in order to differentiate yourself and bring out the ‘I’ position? • What would it look like if you were in the ‘I’ position most often than not?

Activity: Taking the ‘I’ position Purpose: This activity provides an opportunity for participants to define their ‘I’ positions pertaining to various aspects of their lives. Methodology: The participants will be encouraged to return to their partners. The pairs will be instructed to explore together ways in which they each embrace the ‘I position’ in their lives (eg. I as woman, I as man, I as professional, I as perfectionist, I as dreamer). For each of these stances, the participants will be encouraged to recognize qualities and values that distinguish and ground their self-positions.

Session Four Expected learning outcomes: The concluding session retest will provide participants with an opportunity to bring together the self-knowledge acquired through the workshop sessions to establish a general conclusion about their own level of differentiation. Activity: Differentiation of Self Inventory – Retest Purpose: This activity provides an opportunity for participants to revisit the DoS inventory to observe for any adjustments in their level of differentiation. Methodology: The participants will be provided a copy of the DoS inventory to retake. The participants will be encouraged to answer the listed questions to the best of their abilities.

141

Homework Assignments The participants will be assigned a self-reflection homework to take home after each of the three first sessions. The facilitator will direct the participants to journal on various topics as they observe themselves through the week. Each assignment will build on the psychoeducation provided in that day’s session and will give participants an opportunity to apply the principles examined in their own lives. The facilitator will provide the following directions to participants:

Session One

As you go through your week, pay attention to how you and others engage incoming information from your environment. Journal about your observations using the following questions to guide you: • Do you tend to respond or react to situations? • How do you know if you are reacting or responding, are there any physical clues (eg. tension or stress anywhere in your body)? • What about those around you, how do they engage the world?

Session Two

As you go through your week, pay attention to relational dynamics that may betray your own fusion with others or what you may perceive to be fusion of others in close relationships. What are you observing about yourself? What are you observing about those close to you? Journal about your observations.

Session Three

As the week is progressing, are you observing yourself engage from an ‘I’ position? How does it feel to have establish that position? Are there situations where you are not fully able to assert an ‘I’ position? What adjustments would you make in such situations? Journal about your observations.

142

Dealing with the Unanticipated

Dealing with unanticipated topics The facilitator(s) will: • Acknowledge any comments or issue brought up by the audience. • Evaluate whether the topic is pertinent to the subject matter and if it should be addressed at that time. • Assess the group climate/if others are showing interest in a dialogue about the topic. • Decide to address topic or otherwise advise participant of a later time when the topic will be further explored.

Dealing with difficult participants Facilitators often must address challenges brought on by difficult participants. These participants could be very involved or know-it-all, arguers or complainers, distractors or ramblers or even actively hostile verbal responders. Should the facilitator encounter any such difficulties, he or she should remain calm and respond in a firm demeanor. While in front of the group, the facilitator can: • Thank the person and move to the next topic. • Thank the person and tactfully ask them to give others a chance to participate as well. • Utilize humor to invite participation from others. • Ignore the person’s comment and continue the conversation. • Deliberately turn to others and ask for their opinion. While in private, the facilitator can: • Encourage the participant to share of any factors that may have facilitated their challenging reaction. • Provide constructive feedback about the participant’s engagement in the discussion and how it may impact the group. • Support the participant in selecting more appropriate responses or ways to engage the group. • Encourage the participant to serve as a mentor to others and act with consideration of others. The facilitators should not: • Challenge or compete with the participant. • Insult the participant. • Become defensive or express anger.

143

Asking for help: If at any time, the facilitator has any concerns as to the behavior of any participant, he/she can ask the participant to step away and return after they feel more calm and better able to be a non- distracting force for the group. Should any further concerns arise as to the participant’s behavior, the facilitator should consult with organizers to best address the situation in a way that honors the group and ensures its safety and wellbeing.

144

Conclusion of the Workshop The purpose of the concluding session of the workshop is to consolidate participants’ learning and self-understanding pertaining to their own differentiation of self. This session will acknowledge the experiential nature of the workshop pertaining to the development of self-of- the-therapist practices and will invite participants to continue to explore aspects of the self towards further development both as individuals and as mental health professionals. The facilitator will utilize this time to encourage the audience to recognize how the workshop affected their self-understanding. The facilitator should ask questions to encourage sharing, such as: • How was this experience for you? • How was it to look at yourself from this perspective? • Did you encounter any difficulties while exploring these concepts? • What have you learned about yourself that you didn’t know before? • How will this knowledge affect your future interactions with others? • What do you think about SOTT practices? Are such practices something you would like to continue using? • Will this learning affect your work with clients and if so, how? The facilitator will: • Provide a space for closure for the group by recognizing the difficulties of having to share and be vulnerable with other participants and through issues of self. • Congratulate the participants on their ability to be vulnerable and open to self-exploration and sharing. • Encourage participants to remain curious about themselves and their stories in a way that supports their continuous growth and self-understanding. • Invite participants to rate the workshop and provide feedback on how to improve future sessions stressing the value of their input.

145

References

Bennett-Levy, J. (2019). Why therapists should walk the talk: The theoretical and empirical case

for personal practice in therapist training and professional development. Journal of

Behavior Therapy and Experimental Psychiatry, 62, 133–145. https://doi-

org.libproxy.csun.edu/10.1016/j.jbtep.2018.08.004

Bowen, M. (1972). Toward a differentiation of a self in one’s family. In James L. Framo (Ed.),

Family interaction (pp.111–173). New York: Springer.

Laurel and Associates, Ltd. (2010). How to handle difficult participants. Retrieved from

https://www.hse.ie/eng/about/who/qid/other-quality-improvement-

programmes/opendisclosure/opendiscfiles/guidetomanagingdifficultparticipants.pdf

Lum, W. (2002). The use of self of the therapist. Contemporary Family Therapy

24, 181 – 197. Kluwer Academic Publishers-Plenum Publishers.

doi:10.1023/A:1014385908625

Peleg-Popko, O. (2002). Bowen Theory: A Study of Differentiation of Self, Social Anxiety, and

Physiological Symptoms. Contemporary Family Therapy: An International Journal, 2,

355. https://doi-org.libproxy.csun.edu/10.1023/A:1015355509866

The Center for Conflict Resolution (2012). A manual for group facilitators. Retrieved from

https://ecovillage.org/wp-content/uploads/woocommerce_uploads/2005/01/A-Manual-

for-Group-Facilitators-Interior-with-Covers.pdf

146

Appendix C

Differentiation of Self Inventory

These are questions concerning your thoughts and feelings about yourself and relationships with others. Please read each statement carefully and decide how much the statement is generally true of you on a 1 (nor at all) to 6 (very) scale. If you believe that an item does not pertain to you (e.g., you are not currently married or in a committed relationship, or one or both of your parents are deceased), please answer the item according to your best guess about what your thoughts and feelings would be in that situation. Be sure to answer every item and try to be as honest and accurate as possible in your responses.

Not at all Very true true of me of me

1. People have remarked that I'm overly emotional. 1 2 3 4 5 6 2. I have difficulty expressing my feelings to people I care for. 1 2 3 4 5 6 3. I often feel inhibited around my family. 1 2 3 4 5 6 4. I tend to remain pretty calm even under stress. 1 2 3 4 5 6 5. I'm likely to smooth over or settle conflicts between two people whom I care about. 1 2 3 4 5 6 6. When someone close to me disappoints me, I withdraw from him or her for a time. 1 2 3 4 5 6 7. No matter what happens in my life, I know that I'll never lose my sense of who I am. 1 2 3 4 5 6 8. I tend to distance myself when people get too close to me. 1 2 3 4 5 6 9. It has been said (or could be said) of me that I am still very attached to my parent(s). 1 2 3 4 5 6 10. I wish that I weren't so emotional. 1 2 3 4 5 6 11. I usually do not change my behavior simply to please another person. 1 2 3 4 5 6 12. My spouse or partner could not tolerate it if I were to express to him or her my true feelings about some things. 1 2 3 4 5 6 13. Whenever there is a problem in my relationship, I'm anxious to get it settled right away. 1 2 3 4 5 6 14. At times my feelings get the best of me and I have trouble thinking clearly. 1 2 3 4 5 6 15. When I am having an argument with someone, I can separate my thoughts about the issue from my feelings about the person. 1 2 3 4 5 6 16. I'm often uncomfortable when people get too close to me. 1 2 3 4 5 6 17. It's important for me to keep in touch with my parents regularly. 1 2 3 4 5 6 18. At times, I feel as if I'm riding an emotional roller coaster. 1 2 3 4 5 6 19. There's no point in getting upset about things I cannot change. 1 2 3 4 5 6 20. I'm concerned about losing my independence in intimate relationships. 1 2 3 4 5 6 21. I'm overly sensitive to criticism. 1 2 3 4 5 6 22. When my spouse or partner is away for too long, I feel like I am missing a part of me. 1 2 3 4 5 6 23. I'm fairly self-accepting. 1 2 3 4 5 6 24. I often feel that my spouse or partner wants too much from me. 1 2 3 4 5 6 25. I try to live up to my parents' expectations. 1 2 3 4 5 6 26. If I have had an argument with my spouse or partner, I tend to think about it all day. 1 2 3 4 5 6 27. I am able to say no to others even when I feel pressured by them. 1 2 3 4 5 6 28. When one of my relationships becomes very intense, I feel the urge to run away from it. 1 2 3 4 5 6 29. Arguments with my parent(s) or sibling(s) can still make me feel awful. 1 2 3 4 5 6 30. If someone is upset with me, I can't seem to let it go easily. 1 2 3 4 5 6 31. I'm less concerned that others approve of me than I am about doing what I think is right. 1 2 3 4 5 6 32. I would never consider turning to any of my family members for emotional support. 1 2 3 4 5 6 33. I find myself thinking a lot about my relationship with my spouse or partner. 1 2 3 4 5 6 34. I'm very sensitive to being hurt by others. 1 2 3 4 5 6 35. My self-esteem really depends on how others think of me. 1 2 3 4 5 6

147

36. When I'm with my spouse or partner, I often feel smothered. 1 2 3 4 5 6 37. I worry about people close to me getting sick, hurt, or upset. 1 2 3 4 5 6 38. I often wonder about the kind of impression I create. 1 2 3 4 5 6 39. When things go wrong, talking about them usually makes it worse. 1 2 3 4 5 6 40. I feel things more intensely than others do. 1 2 3 4 5 6 41. I usually do what I believe is right regardless of what others say. 1 2 3 4 5 6 42. Our relationship might be better if my spouse or partner would give me the space I need. 1 2 3 4 5 6 43. I tend to feel pretty stable under stress. 1 2 3 4 5 6

Differentiation of Self Inventory Subscale Composition (underlined means reverse scored):

Emotional Reactivity: 1, 6, 10, 14, 18, 21, 26, 30, 34, 38, 40 I Position: 4, 7,11, 15, 19,23,27,31,35,41,43 Emotional Cutoff: 2, 3, 8, 12,16, 20, 24, 28, 32, 36, 39,42 Fusion With Others: 5, 9, 13, 17, 22, 25, 29, 33, 37

Received September 22, 1997 Revision received February 16, 1998 Accepted February 16, 1998

Skowron & Friedlander, 1998

148

Appendix D

Exercises in Differentiation – A Workshop for Mental Health Professionals

Homework Assignments

Session One

As you go through your week, pay attention to how you and others engage incoming information from your environment. Journal about your observations using the following questions to guide you:

• Do you tend to respond or react to situations?

• How do you know if you are reacting or responding, are there any physical clues

(eg. tension or stress anywhere in your body)?

• What about those around you, how do they engage the world?

Session Two

Journal about your observations.

Session Three

‘I’ position? What adjustments would you make in such situations?

Journal about your observations.

149 Appendix E

Workshop Evaluation Form (For sessions 1, 2, 3)

Thank you for participating in Session___ of The Differentiated Self: A Workshop For Mental Health Professionals. Your feedback is critical to the success of the workshop. Please answer the following questions to help us evaluate the effectiveness of this program and to learn how we can improve the workshop for future audiences. Please return this form to the facilitators at the end of the workshop. Thank you for your participation!

Date:______Location of workshop:______Name(s) of Workshop Facilitator(s):______

Circle your response to each of the following questions:

1. The workshop was interesting and informative.

Strongly Disagree Disagree Neutral Agree Strongly Agree

2. The workshop’s content and activities will be useful in my own self-exploration.

Strongly Disagree Disagree Neutral Agree Strongly Agree

3. The concepts introduced were relevant to my personal development.

Strongly Disagree Disagree Neutral Agree Strongly Agree

4. I am now able to recognize the concept discussed in my own personal experiences.

Strongly Disagree Disagree Neutral Agree Strongly Agree

5. The workshop format was easy to follow.

Strongly Disagree Disagree Neutral Agree Strongly Agree

6. The facilitator(s) had a good grasp of the subject matter.

Strongly Disagree Disagree Neutral Agree Strongly Agree

7. The length of the workshop was appropriate.

Strongly Disagree Disagree Neutral Agree Strongly Agree

150

8. My overall experience of the workshop was positive.

Strongly Disagree Disagree Neutral Agree Strongly Agree

9. Given the topic, the workshop was:

a. Too short b. The right length c. Too long

10. What topics of the workshop were MOST useful? ______

11. What topics or aspects of the workshop did you find LEAST interesting or useful? ______

12. How can we improve this workshop for future audiences? Please provide us with your comments and suggestions: ______

Thank you for your feedback! Please feel free to contact the workshop organizers with any questions or concerns.

151

Workshop Evaluation Form (For the final session of the workshop)

Thank you for participating in The Differentiated Self: A Workshop For Mental Health Professionals. Your feedback is critical to the success of the workshop. Please answer the following questions to help us evaluate the effectiveness of this program and to learn how we can improve the workshop for future audiences. Please return this form to the facilitators at the end of the workshop. Thank you for your participation!

Date:______Location of workshop:______Name(s) of Workshop Facilitator(s):______

Circle your response to each of the following questions:

1. The workshop met my expectations.

Strongly Disagree Disagree Neutral Agree Strongly Agree

2. The workshop’s contents were helpful and informative.

Strongly Disagree Disagree Neutral Agree Strongly Agree

3. After this workshop, I feel more confident in recognizing my emotional reactivity.

Strongly Disagree Disagree Neutral Agree Strongly Agree

4. After this workshop, I am better able to establish healthy distance in close relationships.

Strongly Disagree Disagree Neutral Agree Strongly Agree

5. After this workshop, I am better able to separate thoughts from feelings.

Strongly Disagree Disagree Neutral Agree Strongly Agree

6. After this workshop, I am more confident in engaging others from an ‘I’ position.

Strongly Disagree Disagree Neutral Agree Strongly Agree

7. The workshop format was easy to follow.

Strongly Disagree Disagree Neutral Agree Strongly Agree

8. The facilitator(s) had a good grasp of the subject matter.

152

Strongly Disagree Disagree Neutral Agree Strongly Agree

9. The length of the workshop was appropriate.

Strongly Disagree Disagree Neutral Agree Strongly Agree

10. I would recommend this workshop to others.

Strongly Disagree Disagree Neutral Agree Strongly Agree

11. My overall experience of the workshop was positive.

Strongly Disagree Disagree Neutral Agree Strongly Agree

12. Given the topic, the workshop was:

b. Too short b. The right length c. Too long

13. What topics or aspects of the workshop did you find MOST interesting? ______

14. What topics of the workshop were MOST useful? ______

15. What topics or aspects of the workshop did you find LEAST interesting or useful? ______

16. How can we improve this workshop for future audiences? Please provide us with your comments and suggestions: ______Thank you for your feedback!

153