Preparation Workshop for the Marriage & Family Therapy National Licensing Exam mftlicense

1. Preparation Workshop for the Marriage & Family Therapy National Licensing Exam www.mftlicense.com

2. Introduction • Instructors • Rob Guise • email: licprep@fso.com • Michael Vickers • Email: m-vickers@comcast.net • FSI History • KFI & integration of MFT models • MFT licensing in Massachusetts • Expansion into new materials and national workshops

3. Plan for the Workshop • Thursday • The Exam • Test-taking strategies • MFT Models: Historic overview • MFT Models: Geographic overview • Friday • MFT Models: Comparing core concepts • Saturday • Simulated exam: 100 questions • Score exams / 1: review each question and answers • Sunday • Score exams / 2: review each question and answers • Profiling strengths & weaknesses • Preparation strategies based on exam outcomes

4. The Test / 1 • “National” Exam • Assoc. of Marital & Family Therapy Regulatory Boards (AMFTRB) • www.amftrb.org • vs. California exam • Has anyone already taken the exam? • Caution: confidentiality of questions. • Has anyone attended FSI workshops? • Info available from AMFTRB • FSI preparation materials

5. The Test / 2 • 200 multiple choice questions • 4 hours • How much time per question? • On computer • You can make notes and you can go back • Need to get how many right? • Most states require a score of 72 - 76% (144 - 152 out of 200 questions correct).

6. Exam History and Construction • Exam constructed c.1992 • AAMFT gathered together MFT leaders • Knowledge & Practice Domains • Weighted each based on importance of domain • Questions contributed and validated • Each exam draws same weighted percentage of each domain from among the question pool. • Questions added each year and some removed • Compare: recent grad’s vs. senior clinicians? • What does this suggest about your preparation and about how to understand questions?

7. How to Prepare for the Exam Question: how much prep to date? 125 Hard study hours Create a study plan Assemble your study materials

8. Create Your Test-taking Strategy • Mental Preparation & Self-care • Structure your test-taking behavior • Know how much time you have for each question • Monitor your progress • Know and respect your attention limits • How do you test in the beginning vs. after 3 hours? • It’s a marathon, not a sprint - conserve energy • Refuse to obsess about troublesome questions • Be patient: • Don’t answer until you understand the question • Eliminate alternatives: never guess 1 out of 4 (until the end) • Trust your instincts • Don’t trust your impulses

9. Understand “Testing Mentality” • Need both:Knowledge of MFT field and Test-taking skills • 1. De-construct the questions to identify the info wanted. FSI approach: don’t answer until you can identify at least 2 significant elements in each question. • 2. Construct answers using common sense and your knowledge. FSI approach: Compare models & remember historical derivations Example: “Identify one way in which Structural and Strategic differ in their use of cybernetics?” • Step # 1. De-construct the question (what is it looking for?) • Step # 2. Construct the answer from your knowledge - start with basics.

10. “Testing Mentality / 2 • Think LINEAR to find the “right” answer! • Suspend good systemic clinical skills. • What if: no right answers, or 4 right answers - then what? • Questions may require differential judgment • Think “best” answer instead of “right” answer • Refuse to argue with the test-makers—you can’t change their minds anyway. • Arguing reliability and validity problems • Argue with FSI now, not the test later • In clinical vignettes, determine who’s method of therapy is being addressed. • If a particular model is being addressed, then use language consistent with that model (“enmeshed” vs. “fused”) • What if it says, “a family therapist would…?”

11. Understanding Test Structure • Standardized tests have 3 common elements: 1. Question 2. Lead-in to the alternatives 3. Alternatives • Every question has at least 2 (useful) pieces of information: • Sample #1: “Smith said…” • Sample #2: “ Smith’s research on operant conditioning demonstrated…” • Four kinds of questions: • Straight • Exceptions • Vignette • Comparison (includes Comparison-Exception Questions)

12. Test Structure / 2 • Leads: • Should be grammatically correct • Can include exception indicators • 4 Types of Alternatives: • Example: “Which family therapist wrote Psychosomatic Families?” • Right answer - Minuchin • Close - Structural Family Therapy • Distracter - Munchausan • Wrong answer - Munich • Important tip: Right vs. Close often = more specific answer

13. Emerging Trends in Systems Thinking Bateson Freud von Bertalanffy Cybernetics Psychoanalytic General Systems MRI/Brief/Strategic Bateson/Jackson • Weakland • Fry • Fisch • Satir • Haley StructuralMinuchin Ackerman (father of Family Therapy) Object Relations Dicks, Fairbairn, Framo Bowenian • Contextual • Boszormenyi-Nagy • Experiential • Whitaker

14. Emerging Trends in Systems Thinking Cybernetics MRI Milan Systemic Solution Focused Feminist Narrative Collaborative Language

15. Cultural Periods • Dark Ages • Enlightenment (Age of Reason) Period • Romantic Period • Modern Period • Postmodern Period

16. Cultural Periods Reactionary Evolution Cultural periods tend to react to the proceeding period, much like moving from one generation of a family to another + Dark Ages - Enlightenment Period (Age of Reason) + Romantic Period - Modern Period + Postmodern Period

17. Cultural Periods • Dark Ages • a long period of doubtful tradition, full of irrationality, superstition, and tyranny • Religion emerges as a means to create order and meaning in life

18. Cultural Periods • Enlightenment (Age of Reason) Period • based on reason, order and rules • Class (Aristocracy) becomes more stratified during this period • Rationality as a means to establish an authoritative system of ethics, aesthetics, and knowledge. • Attempts to use rationalism to demonstrate the existence of a supreme being.

19. Cultural Periods • Romantic Period • overturning of previous social conventions, particularly the position of the aristocracy through individualism and imagination. • stressing the importance of "nature" in art and language. • Truth through beauty and nature • Closer one gets to nature, the closer one get’s towards God

20. Cultural Periods • Modern Period • Truth through science and reductionism • Industrial Revolution • Medical Model • Expert Knowledge

21. Cultural Periods • Post-Modern Period • Distrust toward claims about truth, ethics, or beauty being rooted in anything other than individual perception and group construction • Reality is constructed, ambiguous at best • Non-expert stance towards reality • Comfortable with not knowing

22. MFT - Post-Modern Age • Post-modern movement • Solution-Focused • Constructivist Approach • Narrative • Collaborative Language • Feminist Critique and methods • Integrative models • Empirically Validated Models

23. Philosophical Influences John Locke Immanuel Kant

24. Philosophical Influences • John Locke • Truth or ultimate truth can be discovered through or senses • Locke’s empirical stance, that truth • Basis for reductionism as we attempt to discover the truths of life

25. Philosophical Influences • Immanuel Kant • There are no great conforming principles that lie beyond nature • A table is a table only because we choose to view it as such and have a need for such. • Reality is a construction that emanates from aesthetics and purpose. • Hence, we construct reality, rather than discover it.

26. Modern Theories General Systems Theory Psychoanalysis Object Relations MRI Structural Cybernetics Bowenian Contextual Network Milan Systemic Solution Focused Experiential (Whitaker, Satir, EFT) Psychoeducational Behavioral (+ Cognitive) Narrative Feminist Postmodern Theories Collaborative Language

27. Constructivism vs. Constructionism Question: Can we use these terms interchangeably? • Constructivism tells us that the mind is filled with concepts or other structures that bias and control our consciousness.  • Social constructionism, on the other hand, focuses on the social institutions and language processes that shape our concepts and way of life.  • Constructivism is person focused.  • Social constructionism is interpersonal.

28. MRI

29. World Map of Training Sites Norway

30. Toronto - General Systems Theory • Ludwig von Bertlanffy (1901 - 1972) • Biologist • Problem of reductionism: living systems vs. mechanical • General Systems Theory • Living systems are self-organizing • They process inputs from environment, but not controlled • Called this: “Open Systems” • They are not exactly predictable - internal organization • Seek steady-state: homeostasis • Squeeze a balloon vs. stress a family … • Principles of GST describe the self-regulation process

31. GST: Principles of Self-Regulation If living systems regulate themselves, and are not strictly controlled by outside influences, what dynamics are at work instead? • Non-summativity • A living system is a unique entity that is not predictable by knowing it’s components. • Homeostasis • Self-regulation means managing change to protect continuity of “life”. • Variation around a point. • Entropy • Measure of DIS-order in a system. • Neg-entropy • Measure of order in a system.

32. Steady-state Dynamics / 1 5 yearsold… 25 yearsold ?? • 1. Equipotentiality • You cannot predict where a self-regulating system will end up by knowing where it will start. • All outcomes are (almost) equally possible.

33. Steady-state Dynamics / 2 What causes depression? • 2. Equifinality • Ability of the system to reach a given final outcome from different initial conditions and in different ways. • You cannot determine single causes of self-regulating system events. • An outcome can have many different causes.

34. Palo Alto: Mental Research Inst. • Gregory Bateson • Anthropologist: unobtrusive observation of social systems • Interpretations of behavior: Understandable and meaningful in their natural context. • Primitive culture has its ritual dance, what does it mean? • What do you conclude from observing schizophrenic language?

35. Palo Alto: Mental Research Inst. / 2 • Cybernetics: how information controls systems • Feedback loops: • Positive loops: variety • Negative loops: constancy • “Should we change?” • First Order vs. Second Order Cybernetics • 1st Order: you can observe a system and be independent of it • 2nd Order: you are always a part of the system • Levels of communication: Command vs. Report • Congruence of communication is essential • Double-bind: what happens when you can’t be congruent?

36. Palo Alto: Mental Research Inst. / 3 • Don Jackson • Homeostasis: (ex. wife feels better, husband is worse) • Symmetrical vs. Complementary relationships • Jay Haley • Taught English • Gathering and spreading ideas • Virginia Satir - • Watzlawick - • “Pragmatics of Human Communication” - Cannot NOT communicate - Communication can be punctuated in many ways • Steve deShazer • Milton Erickson - consultant • and many others… More MRI concepts later on…

37. Arizona - Milton Erickson • Psychiatrist consulting with MRI • Haley studied with Erickson • Brief Therapy • Using the strengths of the client • Paradoxical therapy • Hypnosis

38. Philadelphia - Child Guidance • Haley studied with Minuchin • Structural Family Therapy • Organization of the family determines it’s behavior • Subsystems are purposeful • Boundaries regulate access to subsystems • Interference with a sub-system’s goals -> symptoms • Haley took hierarchy as one element of structure

39. Philadelphia - Contextual Family Therapy • Ivan Boszormenyi-Nagy • Transgenerational Model • Fairness and balance keep families functioning well • Entitlement • accrue merit for behaving in an ethical manner • Invisible Loyalties • unconscious commitments to help the family

40. Washington DC - Bowenian Family Therapy • Founded by: Murray Bowen • Transgenerational Model • Differentiation of self vs. anxiety • Teaching principles of family dynamics to families • Coaching to experiment with differentiation outside of the therapy

41. NYC - Ackerman • Nathan Ackerman • “Father” of Family Therapy • Work with unemployed men and their families

42. Milwaukee, WI - Solution-Focused • Steve deShazer & Insoo Kim Berg • Shift to 2nd-Order Cybernetics • From Problem-dominated systems to Solution-dominated • “Solution is the solution” • Finding the exception and replicating it

43. Madison, WI - Carl Whitaker • Symbolic Experiential Family Therapy • Use of therapist’s own “craziness” • Battle for Structure • Battle for Initiative • Encouraged use of co-therapy teams

44. Italy - Milan Systemic • Mara Selvini-Palozzili • Cybernetic - linked to Bateson group • Belief system becomes rigid • Change is inevitable • Create rituals that reveal errors in the prevailing belief systems • Invariant Prescription • Circular Questioning • Use of therapy team - disengaged from family • Emphasis family beliefs not relationship with therapists

45. Australia - Narrative Family Therapy • Michael White • Cybernetic: juxtapose differing information • “The Story” and evolution of stories • Externalizing the Problem • Sneaky Poo

46. New Zealand - David Epston • Narrative Therapy • Biographies and letter writing

47. Bowenian Scale of Differentiation 0 25 50 75 100 Low Moderate Good

48. Bowenian Scale of Differentiation 0 25 50 75 100 Low Moderate Good Chronic Anxiety Levels High Low

49. Trans-Generational Models • Bowenian Family Therapy • Contextual Family Therapy • Object Relations Family Therapy Commonalities: 1.Psychoanalytic based 2. Insight and educational 3. Internalized experience transmitted between generations

50. Bowenian Family Therapy Major Concepts Unresolved anxiety transmitted from one generation to the other keeps families unstable. • Anxiety • Differentiation • Cutoff and Fusion • Family Projection Process • Functional Level of Differentiation • Sibling Position • Triangulation