Change in Family Therapy

A fundamental theoretical premise in Structural Family Therapy (SFT) is that changes in individual members and improvements in intra-familial relations are realized by repairing the family structure. Dysfunctional families are conceptualized in terms of individuals taking on inappropriate roles (e.g., children acting as if they were parents) and the boundaries between parental executive levels and the children/sibling level are unclear, too rigid, or highly permeable. The therapist’s role is to temporarily engage (join) with family members in a way that generates in-session interactions that exemplify the desirable family structure. While the theory supporting these interventions are well developed, there has been little work done on explicating how such tasks may be interactively accomplished in clinical practice. Drawing from the methods of conversation analysis, our aim for this paper is to show how a master therapist in SFT accomplishes some of these transformations during a single therapy session. We focus on the discursive resources through which the therapist is able to readjust the role relationships between a mother and her daughter (i.e., in such a way that the mother can adopt a more agentive position vis-a-vis her children) and how the therapist’s actions indexed core SFT principles of restructuring the family.

Master Therapists

The search for the best outcomes in psychotherapy and counseling has been a long and winding trail. Traditional research methods attempting to quantify expertise have yet to map the complex path and characteristics of expert psychotherapists and counselors. This book blazes a new trail using extensive qualitative research methods to understand psychotherapy experts. Ten peer-nominated, active practitioners representing four different professions were interviewed by three interviewers for a total of over 100 hours. Based on the data from these interviews, we offer a portrait of the master therapist as well as an exploration of central characteristics, emotional wellness and resiliency of masters, how they construct the therapy relationship, ethical values of these experts, a history of the concept of expertise, and a description of our research methods. Master Therapists continues to be a valuable resource for counseling and therapy practitioners and scholars because it explicates the cognitive, emotional, and relational (CER) model of counseling expertise and provides the initial context for the more recent surge of expertise studies in counseling and psychotherapy. This research-based qualitative work provides essential signposts and markers on the road to psychotherapy expertise.

Expertise in Counseling and Psychotherapy

Expertise in Counseling and Psychotherapy features seven master therapist studies from around the world and provides an extensive synthesis of these studies to produce the first international perspective of expert counselors and psychotherapists. The study of expertise has a rich history, whereas research on psychotherapy expertise has mostly surfaced in the past two decades. Jennings and Skovholt first applied qualitative methodology to the study of expert therapists in 1996. Qualitative research has proven to be an extremely effective method for capturing the complexity of the master therapist construct. One limitation of this line of research is that most studies have been conducted in the United States. Fortunately, there are a small but growing number of international qualitative studies on psychotherapy expertise. Moreover, these studies utilized essentially the same research questions and methodologies as our first study on expert therapists, making the consolidation of the findings seamless and trustworthy. The studies include three therapist expertise research projects in Southeast Asia, including Singapore, Japan, and Korea. In North America, there are studies from the United States and Canada. In Europe, there are studies from Portugal and the Czech Republic. The qualitative meta-analysis of all seven data sets is the highlight of our book on master therapists from around the world. The findings and recommendations from this book will enhance the training of future psychotherapists and counselors. Understanding the universal characteristics of expert therapists practicing around the world offers training programs and mental health practitioners a heuristic for optimal therapist and counselor development.

Personal and Professional Characteristics of Japanese Master Therapists

This study explores the characteristics of 10 Japanese master therapists who gained the largest number of nominations from Japanese psychotherapists. Qualitative data analysis was processed utilizing the grounded theory approach and the consensual qualitative research method. Results clarified important characteristics of Japanese master therapists. First, as a foundation, they possess positive personality traits, such as modesty, warmth, sincerity, absence of self-centeredness, and resilience. Second, they possess an exceptional ability to perceive and process various cognitive and emotional information from the client, from the therapist him- or herself, and from the therapy process. Third, master therapists are able to continuously learn from their experiences, stimulated by their curiosity and creativity, as well as their sense of responsibility and discipline as professionals. Finally, cross-cultural comparison of Japanese and American master therapists are discussed, a model of master therapist development is proposed, and suggestions for future research and therapist training are offered.

Czech Master Therapists

Existing research suggests that although many master therapists’ characteristics are interculturally valid, at least some of these characteristics are culturally bound. Interviews with nine peer-nominated Czech expert psychotherapists were subjected to thematic analysis that revealed 16 themes, organized into six categories: (1) humble attitude toward mastery, clients, and colleagues; (2) relationship; (3) awareness of one’s needs, limits, and resources; (4) continuous development; (5) engagement; and (6) awareness of the complexity of psychotherapeutic work. The results are discussed in the context of cultural differences, as well as specific historical circumstances of the development of the Czech therapeutic scene. Despite the fact that master therapists’ characteristics show fundamental similarity across countries and cultures, conducting studies in diverse environments may contribute to the formulation of a rich and culturally sensitive description of what is means to be a master therapist.

Bringing It All Together

Responding to calls for international psychotherapy research, a qualitative meta-analysis (QMA) exploring the essential qualities of master therapists from a global perspective was conducted on seven master therapist studies from the United States, Canada, Czech Republic, Portugal, Singapore, Japan, and Korea. Based on the analysis of 111 themes, we identified the following eight meta-categories representing common strengths and characteristics among 72 master therapists from seven countries: (1) Distinctive Clinical Abilities, (2) Professional Development, (3) Relational Orientation, (4) Cognitive Complexity and Intricate Conceptualization, (5) Therapeutic Alliance, (6) Pursuit of Deep Self Knowledge and Growth, (7) Humility, and (8) Experience. The meta-categories are discussed in relation to the psychotherapy research literature on therapist factors and expertise. The Synthesis Model of Master Therapists from Around the World is introduced, and recommendations for research and training are provided.

Portrait of the Master Therapist: Developmental Model of the Highly Functioning Self

Skovholt, Jennings, and Mullenbach summarize and integrate data from all four qualitative studies and offer pathways to expertise taken by the ten master therapists, culminating with a portrait of the master therapist. The portrait includes central characteristics, paradoxical characteristics, eight overall themes, and a major expansion of the Cognitive, Emotional, and Relational (CER) Model of Master Therapists.