Psychological Reporb, 1990, 66, 739-753. @ Psychological Reports 1990
THEORETICAL UNDERPINNINGS OF PRACTICE I N FAMILY SERVICE AGENCIES ' LUCILE E. CANTON1
AND
LOUIS J. CANTON1
Family Service of Detroit And Wayne Country Summary.-1,334 counselors from 123 Family Service America (FSA) agencies participated in a survey to assess which theories of counseling and psychotherapy were used in their day-to-day work with clients. Counselors were not asked directly which theories they used. Rather, use was ascertained from the interventions they employed in the counseling process. Although 3 theories predominated, findings showed that FSA practitioners were eclectic in their practice-they chose certain interventions from 11 theories. Comparison of subgroup scores for demographic characteristics with total group scores for theory use showed remarkable consistency in the order of theories used.
The Directors of Professional Services-Family Service America are those persons in each agency charged with monitoring quality of services and providing staff development. This group decided that they needed a clear understanding of the theoretical approaches which line staff used in their practice, so the group proposed the current study. During the past 25 years there has been a virtual explosion of new treatment modalities within the psychotherapeutic community. Various psychotherapists have conducted workshops and have written articles and books on what they believe to be better ways of helping emotionally distressed people. Family Service agencies have been influenced by the new theories and new techniques, or interventions, to such an extent that many Family Service practitioners refer to their practice as eclectic. What does "eclectic" mean? What is the mix that makes up current practice in Family Service America agencies? The present study was undertaken to answer these and related questions.
Earlier Studies I n 1976 Family Service America (FSA) asked member agencies to include in their annual report new treatment modalities which had been developed within the past decade and which were being used in their agencies. However, the following modalities were excluded from the FSA study because they had already achieved some acceptance: ". . . variants of the psychoanalytic approach (Freudian, Adlerian, Jungian, Rankian, existential, supported by a grant from the Directors of Pro€essional Services, Family 'This study was Service America, Milwaukee, WI, and partly by a grant from the College of Education, Wayne State University, Detroit, MI. Request reprints from L. and L. Cantoni, 2591 Woodstock, Detroit, MI 48203.
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L. E. CANTON1 & L. J. CANTON1
etc.), related approaches based on a lagnostic, functional, or ego psychology base, brief task-oriented treatment, joint and family interviews which utilize a systems approach, Rogerian-type counseling, dynamically oriented group therapy, long accepted approaches to family life education, approaches utilizing the wider social network as a major therapeutic tool, and approaches achieving their results primarily through modifying the environmental and institutional supports provided to the client" (Beck, 1978, p. 2). In 1978, then, these percentages of 268 FSA member agencies reported using, to some extent, certain new treatment modalities: Behavior Modification, 43%; Transactional Analysis, 41%; Training in parent-child relationships, 33%; Gestalt Therapy, 31%; Marriage enrichment, 27%; and Structured communication training, 18%. "There were also occasional reports of use of Rational-Emotive Therapy, Assertiveness Training, and selected body therapies, such as Bioenergetic Analysis and dance therapy" (Beck, p. 4). Other professional groups have also been concerned about defining the nature of psychotherapeutic practice. Jayaratne (1981) reported a study of 267 individuals selected from the 1976 NASW Register of Clinical Social Workers. In 1983 Prochaska and Norcross reported findings regarding: (1) 479 clinical psychologists (members of Division 12, American Psychological Association) and (2) 410 psychotherapists (Division 29, APA). Goldmeir (1986) reported a study which examined the private practice of 492 psychologists, 461 social workers, 371 psychiatrists, and 5 3 nurses. And, in 1988 Rait reported the results of a reader survey which drew from almost 900 practitioners in family therapy.
METHOD ~urticipunts Family Service American had 255 accredited and provisional member agencies in December, 1987. Of these, 123 or 48T0, participated in the present study by having all or some of their counseling staff fill out questionnaires. One thousand three hundred thirty-four counselors completed a questionnaire. FSA agencies of all kinds participated in the study: 28, or 38%, of small agencies participated; 48 (53%) medium-sized agencies; and 47 (59%) large agencies. Of the nonsectarian agencies, 105 (49%) participated. Ten (47%) Jewish agencies participated; 6 (85%) Catholic agencies; and 2 (40%) other denominations. Each region of the country was represented with 40% to 59% participation: North Atlantic, 10 (40To); Western, 11 (44%); Southeastern, 24 (47%); Mid-Atlantic, 26 (49%); Mid-America, 42 (57%); and Southwestern, 10 (59%). O f the 1,334 respondents in this study, 1,005 or 75% were female; 294 (22%) were male; and 35 (3%) did not reveal their sex. 1,180 (92%) respon-
FAMILY SERVICE: THEORY AND PRACTICE
74 1
dents were white, 67 (5%) were black, 30 (2%) were Hispanic, 13 (1%) reported belonging to other ethnic groups. Of respondents 136 (10%) had two or less years of experience in social work. Five hundred eighty-three (44%) had three to 10 years experience, 514 (38%) had more than 10 years experience. By way of experience in a family service agency, 391 (29%) had two years or less, 552 (42%) had three to 10 years, and 255 (19%) had more than 10 years experience in a family service agency; 136 (10%) did not report this item. Respondents holding a Bachelor's degree numbered 146 (1I % ) , 1,105 (83%) held Master's degrees, 36 (3%) had doctorates; 47 (3%) did not report their educational attainments. Soc~alworkers were the dominant profession among the respondents: 1,012 (76%) Of that number, 566 (42%) gave only social work as their profession, 446 (34%) noted both social work and another profession; 226 (17%) reported professions other than social work, and 96 (7%) did not report their profession. Respondents reported their focus of practice. Since some of the respondents reported more than one focus of practice, we give numbers but not percent in each field: clinical practice, 1,108; service to specific populations, 138; f a d y life education, 92; case management, 87; employee counseling, 36; child welfare, 36; and other, 87. The above-noted 38 demographic items, with numbers and percentages of participants, comprise the independent variables of this study.
Development of the Instrument Directors of Professional Services-FSA and practitioners in family service agencies contributed to the development of the survey instrument. Nineteen DPS-FSA members gave an open-ended questionnaire to selected clinical staff. This preliminary questionnaire had a blank space at the top for a theory, and five blank spaces below for interventions. Respondents were asked to name a theory they used and define that theory, and mention leading writers of that theory who had influenced them. Then they were asked to name and define interventions from that theory which they used in their day-to-day practice. Respondents could submit as many theories and interventions as they wished. Over 100 individuals submitted one or more theories with related interventions. The authors coded the preliminary study material and wrote a first draft of the questionnaire. Subsequently, drafts were presented at the April 1986 and April 1987 annual workshops of the group which yielded suggestions for revision. A study committee of five persons was available for consultation. The instrument represented virtually all theories and interventions used in FSA agencies. However, it was not limiting-there was space to add other interventions and theories.
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Administrative Procedures I n early October 1987, Family Service America sent information regarding this study to each of 255 member agencies. Included in the mailing was a sample copy of the questionnaire and a pamphlet defining theories. Agencies were asked to indicate whether they wanted to participate. The study was also presented to the agencies at the 1987 FSA Biennial Conference, October 22 to 25. As noted earlier, 123 of the 255 agencies (48%) participated. Questionnaires were mailed out beginning November 1, 1987. Agencies were asked to return completed questionnaires by January 31, 1988. Participants were asked to report the nature of their practice during the preceding four months. T h ~ sstudy, then, reflects practice in these agencies during the period July 1987 through January 1988. Each counselor was given a two-page questionnaire. O n one side, counselors were asked for demographic information about themselves. The other side listed theories and interventions w h c h the counselors might use in their practice. They were asked to check each intervention according to how often they used the given intervention with their family service clients during the past four months. The scale was from O = never, 1 = rarely, 2 = sometimes. 3 = half, 4 = many, to 5 = all. Each ~nterventionwas listed under the theory from which that intervention developed. We believed that, if counselors used interventions developed by a cerran theoretical approach, they had been influenced by that theory of practice. The influence of each theory should be shown by how often counselors used that theory in their practice. Definitions of theories given below reflect those described in the pamphlet. Each theory represents the views of a number of theorists. Scores for each intervention were tallied; mean scores and their standard deviations were obtained. Scores for all the interventions under each theory were tallied; mean scores and standard deviations for each theory were obtained.
Many respondents wrote notes and added various theories and interventions. Some people elaborated on theories and interventions appearing in the questionnaire. Others made statements or provided articles explaining new theories they were finding useful. However, not enough people reported any one new theory in sufficient numbers to warrant inclusion in this paper. Questionnaire responses showed that, of the 1,334 counselors, only 12 looked toward one theory in their practice. Thus, 1,322 (99%) indicated some use of more than one theory: 798 (60%) reported use of some interventions from all 11 theory groups; 278 (21%) used 10 theories, 102 (8%) used 9 theories, 57 (4%) used 8 theories, 27 (3%) used 7 theories, 24 (2%)
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used 6 theories, and less than 1% of the respondents used either 5, 4, 3, or 2 theories. These results underscore the respondents' eclectic practices.
Interventions According to Theories Table 1 provides means and standard deviations for interventions by theories. Most-used theories appear first, and least-used theories appear last. Then, under each theory, interventions are given from most-used to leastused although on the questionnaire, neither the theories nor their interventions were listed in any order. The original order on the questionnaire is indicated in Table 1 by letters A through K. Numbers under each theory show the original order of interventions. TABLE 1 ORIGINAL ORDER, MEANSAND STANDARD DEVLATIONS OF INTERVENTIONS ACCORDING TO TI-IEORIES ( N = 1,334) Original Order
B 7 5 1 6 4 2
9 8 3
F 1 4
5 2 3
A 1 4
6 5 2 3
G 3 4 2 1
M
SD
Validare strengths Cleat and open communication Empathic use of self Enhance growth potenrial Self-esteem issues Influence of family of origin Reframing Joining Differentiation of self
4.0 3.8 3.7 3.6 3.6 3.6 3.5 3.1 3.0
1.2 1.2 1.3 1.2 1.1 1.2 1.3 1.6 1.3
Problem-solving Theories Positive therapeutic relationship Encouraging decision-making Support and direct change Assessment of problem Defining self-defeating behaviors
3.8 3.6 3.6 3.5 2.9
1.3 1.3 1.3 1.5 1.4
Ego Psychology Theories Support Universalizing, reframing, clarifying, educating Problem solving Insight Ventilation and catharsis Confrontation
4.2 3.7 3.6 3.2 3.1 3.1
1.0 1.1 1.1 1.5 1.3 1.1
3.6 3.4 3.3 3.1
1.6 1.7 1.6 1.7
Theories and Interventions Family Therapy Theories
Functional Social Work Theories Provide service Terminate Help client choose service Define services of agency (continued on next page)
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L. E. CANTON1 & L. J. CANTON1 TABLE 1 (CONT'D) ORIGINAL ORDER,MKANSAND STANDARD DEVIATIONS OF INTERVENTIONS Acco~owcT o THEORIES( N = 1,334)
Original Order
Theories and Interventions
M
SD
3.4 3.4 3.2 2.8 2.8 2.8 2.7
1.4 1.3 1.2 1.4 1.2 1.3 1.3
3.3 3.3 3.3 3.2 3.1 3.0 2.6 2.4
1.3 1.4 1.3 1.4 1.6 1.5 1.4 1.9
3.8 3.1 2.8 2.6 2.4 2.0 1.6
1.5 1.3 1.5 1.3 1.3 1.2 1.2
3.2 3.0 2.9 2.5 1.4 .4
1.5 1.4 1.7 1.4 1.2 .9
2.8 2.4 2.0 1.9 1.2
1.7 1.8 1.4 1.5 1.4
2.8
1.5 1.3
Crisis and Task-centered Theories Support Clarification Analyzing and overcoming obstacles Contracting Grief work Teaching new interpersonal skills Anticipatory guidance Bio-psychosocial Therapy Theories Reflection of patterns Ventilation and exploration Reflection of past Reflection of current person in situation Sustaining relationship Medical aspects Significant others Diagnosis Human Ecology and LiFe Model of Practice Theories Relationship of mutuality Problem solving Contracting Networking Opportunities for action Concrete services Individual case advocacy Cognitive Therapy Theories Emphasize client responsibility Explore alternatives An accepting relationship Assessment of internal dialogue Teach relaxation techniques Teach biofeedback Existential Therapy Theories Enter client's world Encounter Here-and-now Counselor as total person Existential anxiety Behavior Modification Theories Positive reinforcement Parent education (continued on next page)
2.7
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FAMILY SERVICE: THEORY AND PRACTICE TABLE 1 (CONT'D) ORIGINALORDER,MEANSAND STANDARD DEVIATIONS OF INTERVENTIONS ACCORDING T o THEORIES(N = 1,334) Original Order 2 8 3
6 1 9 4 H 1 2 3 5 4
Theories and Interventions
M
SD
Assertiveness training Substance abuse education Relaxation training Prescriptions Systematic desensitization Extinction Aversive conditioning Transactional Analysis Theories Teachmg ego states Game analysis Script treatment Redecision, using double chairs Reparenting
Theories, from Most-used to Least-used Family Therapy, Problem Solving, and Ego Psychology were used most-well over half of the time-by family service practitioners. There were no significant differences in the frequencies of mean use (3.5 3.5, 3 . 3 , the standard deviations, and the two-tailed t test for analysis of variance (Table 2). Not included in Table 2 is the comparison between F a d y Therapy and Ego Psychology: in that comparison p = .87, indicating no significant difference in frequency of use. Functional Social Work, Crisis and Task-centered, Bio-Psychosocial, and Human Ecology and Life Model of Practice are all uniquely social work theories. These theories were used significantly less often than Family Therapy, Problem Solving, and Ego Psychology. But the mean scores, ranging from 3.28 to 2.56 (Table 2) indicate these theories were used by participants roughly half of the time. Cognitive, Existential, and Behavior Modification were used sometimes; mean scores ranged from 2.2 to 1.7, as seen in Table 2. However, practitioners used certain concepts from these theories about half the time, and other concepts rarely or almost not at all, as shown by the scores for their interventions in Table 1. Transactional Analysis was used rarely or almost not at all; see Tables 1 and 2.
Theory Definitions and Theorists' Names The definitions of the 11 theories should give meaning to the data in Table 2. As mentioned earlier, these definitions were formulated during the planning of this study. These definitions were first used in the pamphlet
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which accompanied the questionnaire. Included also were the names of the counseling theorists cited b n the following pages. TABLE 2
TI-EORIES, FROMMOST-USED TO LEAST-USED, WITH MFANS,STANDARD DEVIATIONS, A N D PROBABILITY LEVELS Theories Family Therapy
M
SD
3.5
.9
P .88
Problem-solving Ego Psychology Functional Social Work Crisis and Task-centered Bio-psychosocial Therapy Human Ecology and Life Model of Practice Cognitive Therapy Existential Therapy Behavior Modification Transactional Analysis
Three Most-used Theories I n theories of family therapy, problematic behavior of a family member is viewed as resulting from a dysfunctional family system. Each family system has three major subsystems-marital, parent-child, and sibling. F a d e s carry out two key functions-adult emotional and sexual expression, and socialization of children. Each family goes through characteristic developmental stages, each family has a developmental history. The family can be understood by studying interactions among family members and between the family and other social institutions. Theories of family therapy used by family service counselors included (a) Psychodynamic Family Therapy (Ackerman, 1966, 1972; Framo, 1972, 1982; Scherez, 1963), (b) Communication Therapy (Satir, 1982), (c) Systems Therapy (Bowen, 1978; Kerr & Bowen, 1988), (d) Structural Family Therapy (Minuchin, 1974; Minuchin & Fishman, 1981), (e) Strategic Family Therapy (Haley, 1986). I n problem-solving theories the counseling relationship is reality-based. The counselor sustains, supplements, and fortifies the client. Counseling is structured to provide a beginning, middle, and end to treatment. These theories were developed by Haley (1977), Hallowitz (19791, and Perlrnan (1957).
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Ego psychology theories include theories regarding human development. These theories are based on Freudian concepts of psychosexual development through oral, anal, and oedipal stages (Hamilton, 1958). Erikson, (1963, 1968) extended the developmental process through aging. The early stages were expanded by Kohut (1971, 1977, 1985) and Mahler (1963) to define how the individual learns to love self and others. Hamilton (1951) and H o h s (1964) looked at ways in which economic and cultural factors interact with intrafamilial experiences. Clients who become aware of their unconscious wishes and desires are then able to effect positive changes in their relationships with self and others.
Four Much-used Theories The three above theories were most often used in family service practice. The next four theories were used much of the time: Functional Social l and Human Work, Crisis and Task-centered, B i ~ p s ~ c h o s o c i aTherapy, Ecology and Life Model of Practice. AU of these theories are uniquely related to social work. Functional social work theories were formulated at the Pennsylvania School of Social Work. Robinson wrote a book about this theoretical area in 1930. Then, in 1962 she edited a book on the contributions of Jessie Taft. I n functional theories, emphasis is placed on current life experiences and the client's capacity to grow and make choices. Diagnosis is a dynamic process concerned with the client's situation and the kinds of services which the agency offers. The counselor represents not only the agency but also society. As with problem-solving theories, structure provides a beginning, middle, and end to treatment. Crisis and task-centered theories overlap and are interrelated. Developed by Kaplan and Killilea (1976), Parad (1965), Reid (1978, 1985), and Reid and Epstein (1972, 1977)) these theories postulate that crises disrupt the homeostasis of the individual and/or family. The current crisis may reactivate old, unresolved conflicts. Counseling can help individuals and famihes to deal with crises and minimize damage to the family system. Crises provide opportunities for the system to organize more effectively. The system remains in a state of disequilibrium a limited time; to be effective, counseling must be immediately avadable. I n biopsychosocial therapy theories, treatment is based on the diagnosis of the client, made by considering perceptions, history, patterns of behavior, and social mileau. Physical, medical, neurological, psychiatric, and other factors are also included. Goals are identified. Treatment takes into account the individual's strenglhs and weaknesses. Hamilton (195I ) , Hollis (1964), Parad (1958), Richmond (19 17), and Turner (1983, 1986) are proponents. Human ecology and life model of practice theories are the last of the social work theories used to a considerable extent in family service agencies.
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Conceived and reported by Germain (1979, 1984), who coauthored a third volume (Gitterman & Germain, 1980), these theories emphasize the environment. Changes occur within the environment to which individuals must adapt. Conversely, people affect their environment. If transactions between individuals and environment do not fit, counseling is needed. Each person must attain a sense of identity, competence, autonomy and human-relatedness.
Four Least-used Theories Four theories were used sometimes or rarely: cognitive therapy, existential therapy, behavior modification, and Transactional Analysis. In cognitive therapy theories, what a client says to himself influences his behavior and his feelings. Certain behaviors promote certain feelings. Defective beliefs occasion self-defeating behaviors. Treatment looks to the present, not the past. The counselor may bring to bear approaches which lead to self-understanding and self-control. Writers who have promoted these theories are Beck (1976; Beck & Emery, 1985), E h s (1984), Glasser (1975; Glasser & Powers, 1981), and Meichenbaum (1977; Meichenbaum, Price, Phares, McCorrnick, & Hyde, 1989). Existential therapy theories, holistic in concept, focus upon exploring the individual's present life, values, attitudes, tasks, and goals. The client is encouraged to find meaningful answers to the problems of freedom, responsibility, existence. Redefinition of personal identity comes with greater awareness of one's own feelings and with heightened spontaneity in relationships with others. These theories were developed by Frankel (1965, 1984), May (1961, 1986), Rogers (1951, 1976, 1981), and Perls (1973). Behavior modification theories represent the systematic application of learning principles to analysis and treatment of behaviors. Feelings are regarded as the result of behaviors. Changed behaviors eliminate undesired feelings. Behaviors to be changed are assessed by obtaining a base line, contracting with a client for change, and prescribing new behaviors. Among theorists in behavior modification are Kanfer and Phillips (1970; Kanfer and Schefft, 1988), Lazarus (1971, 1985), Rotter (1954, 1982), and Wolpe (1982). Transactional Analysis theories recognize three ego states in each person: Parent, Adult, and Child. Some transactions between certain ego states of one individual with certain ego states of another are complementary and healthy. Other transactions are crossed-these cause breakdowns in communication. Each child writes a life script. Lifelong interactions with others are acted out according to the script unless the individual recognizes his script and changes it. Work by Berne (1961, 1964, 1972), Dusay (1977), Harris (1969), and Steiner (1971) represents these theories.
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FAMILY SERVICE: THEORY AND PRACTICE TABLE 3 OF S L ~ G R O W WITH S TOTALGROUPACCORDING TO THEORY COMPARISONS , DEVIATIONS, AND PROBABILITY LEVELS USE, WITH ~ N SSTANDARD Subgroups and Theories
Subgroup
M Nonsocial Workers, n = 226 or 17 0% Ego Psychology Crisis, Task-centered Functional Bio-psychosocial Cognitive Human Ecology Existential Social Work and Another Profession, n = 446 or 33.4% Crisis Functional Bio-psychosocial Human Ecology Sectarian-Jewish, n = 122 or 9 1% Problem-solving Crisis Cognitive Bachelor's Degree, n = 146 or 11 0% Ego Psychology Family Therapy Master's Degree, n = 1,105 or 82.8% Ego Psychology Doctorate, n = 36 or 2.7% Functional Women, n = 1.005 or 75.3% Ego Psychology Men, n = 294 or 22 0% Family Therapy Human Ecology Southeastern Region, n = 192 or 14.4% Ego Psychology Mid-America Region, n = 524 or 39.0% Existential Southwestern Region, n = 114 or 8.5% Bio-psychosocial Western Region, n = 114 or 8.5% Human Ecology Functional 2 Years or Less Experience at Family Service, n = 136 or 10.2% Crisis Over 10 Years Experience at Family Service, n = 514 or 38.5% Cognitive
SD
Total Group
M
SD
p
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L. E. CANTON1 & L. J. CANTON1
Comparison of Subgroups with the Total Group Mean scores and standard deviations were obtained on each of the 11 theories for each of the 38 independent variables, or subgroups noted under "Participants" above. This produced 418 separate variables. The 2-tailed t test for analysis of variance was used to compare the scores on each of these variables with theory scores for the total group of 1,334. Table 3 ~ n d ~ c a t e s that significant differences at the 1% level were found for only 28 (6.7%) of the 4 18 comparisons. Following are a few observations regarding some of the comparisons. Women, people with Master's degrees, and people from the Southeastern region used ego psychology more often than the total group. Nonsocial workers used ego psychology less than social workers, but more than the four much-used, uniquely social work theories. Men used family therapy less than the total group, but they used that theory more than the four social work theories. Respondents with Bachelor's degrees chose problem-solving theories more than family therapy and ego psychology. People with doctoral degrees used functional theories rarely. People working in Jewish agencies used problem-solving less than the four social work theories, and crisis and cognitive theories even less often. Some of the four social work theories were "least-used" by certain subgroups: Southwestern used biopsychosocial theory less, and people with under two years of family service experience used crisis less. Nonsocial workers and respondents Living in Mid-America rated existential therapy lower than the total group, but this theory was among the least used by 1,322 eclectic respondents. I n actuality, there were minimal differences of a consequential sort between subgroup and total group responses on the questionnaire. The few differences d o not alter the central findings that (a) counselors represented in the subgroups used family therapy, problem-solving, and ego psychology as the bases for their counseling, (b) they used selected interventions from most of the other eight theories presented in this study, and (c) their order of use, from most to least, was essentially the same as for the total group.
Conclusion I n this study, practitioners were not asked directly for their theoretical viewpoints. Rather, they were asked what interventions they used in their day-to-day practice. Their theoretical viewpoints were inferred from the nature of their practice. Findings of the study indicate that Family Service America practitioners used an eclectic theoretical approach. This approach to counseling and psychotherapy was comprised primarily of an integration of family therapy, problem-solving, and ego psychology. Social work theories-
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75 1
functional, crisis and task-centered, bi~ps~chosocial, and human ecology and life model-also contributed to their eclectic orientation. Certain concepts from cognitive, existential, and behavior modification theories were also evident. Present findings showed that the above approach to practice was observed consistently throughout the agencies, regardless of geographical location, size, the educational preparation of practitioners, or other subgroup factors. REFERENCES ACKERMAN, N. (1966) Treating the troubledfamily. New York: Basic Books. ACKERMAN, N. (1972) Psychodynamics o/family life: diagnosis and treatment offamily relationships. New York: Basic Books. BECK,A . T. (1976) Cognitive therapy and the emotional disorders. New York: International Univer. Press. BECK, A. T., & EMERY,G . (1985) Anxieq disorders and phobias: a cognitive perspective. New York: Basic Books. BECK,D. F. (1978) New treatment modalities: an outline of some options and source materials. New York: Family Service of America. BERNE,E. (1961) Transactional Analysis in psychotherapy. New York: Grove. BERNE,E. (1964) Games people play: the psychology of human relationships. New York: Grove. BERNE,E. (1972) What do you say after you say hello? New York: Grove. BOWEN,M. (1978) Family therapy in clinical practice. New York: Jason Aronson. DUSAY, J. (1977) Egograms: how I see you and you see me. New York: Harper & Row. ELLIS,A. (1984) Reason and emotion in psychotherapy. New York: Lyle Stuart. ERIKSON,E. (1963) Childhood and society New York: Norton. em so^, E. (1968) Identi@: youth and crisis. New York: Norton. F m o , J. (Ed.) (1972) Family interactions: a dialogue between family researchers and family therupis&. New York: Springer. F m o , J. (1982) Explorations in mari&l and family therapy: selected papers of James L. Framo. New York: Springer. FRANKEL, V. (1965) The doctor and the sorrl. (2nd ed.) New York: Knopf. FUNKEL, V. (1984) Man's search for meaning. (3rd ed.) Englewood Cliffs, NJ: Simon & Schuster. GERMAM,C. (Ed.) (1979) Social work practice: people and environments, an ecological perspective. New l'ork: Columbia Univer. Press. GERMAMC. (1984) Social work practice in beahb care: an ecological view. New York: Free Press GI~RMAN A,, , & GERMAIN,C. (1980) The life model of social work practice. New York: Columbia Univer. Press. GLASSER,W. (1975) Reality therapy: a new approach to psychiatry. New York: Harper & Row. GLASSER,W., & POWS, W. (1981) Stations of the mind: new directions for realily therapy. New York: Harper & Row. GOLDMEIER, J. (1986) Private practice and the purchase of services: who are the practitioners? American Jorrrnal of Orthopsychintry, 56, 89-102. HNEY, J. (1986) Uncommon therapy: the psychiatric techniques of Milton H. Erickson, M.D. (2nd ed.) New York: Norton. HALEY,J. (1987) Problem soluing therapy. (2nd ed.) San Francisco, CA: Jossey-Bass. HALLOW IT^, D. (1979) Problem solving theory. In F. Turner (Ed.), Social work treatment. (2nd ed.) New York: Free Press. Pp. 93-123. HAMILTON,G. (1951) Theory and practice of social case work. (2nd ed.) New York: Columbia Univer. Press. HAN~JLTON, G. (1958) A theory of personality: Freud's contribution to social work. In H . Parad (Ed.), Ego psychology and dynamic casework. New York: Family Service Association of America. Pp. 11-37. H m s , T. (1969) I'm OK-you're OK. New York: Harper & Row.
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HOLLIS, F. (1964) Casework: a psychosocial therapy. New York: Random House. JAYARATNE, S. (1981) A study of clinical eclecticism. Social Service Review, 52, 621-631. KANWR,F., & PHILUPS, S. (1970) Learning foundations of behavior therapy. New York: Wiley. KANFER,F., & SCHEFFT,B. (1988) Guiding the process of therapeutic change. Champaign, IL: Research Press. KAPUN, C., & KILLILEA,M. (Eds.) (1976) Support systems and mutual help. San Diego, CA: Grune & Stratton. KERR, M., & BOWEN,M. (1988) Family evaluation: an approach based on Bowen theory. New York: Norton. KOHUT,H. (1971) The analysis of self. New York: International Univer. Press. KOHUT,H. (1977) The restoration of the self. New York: International Univer. Press. KOHUT,H . (1985) Self psychology and the humanities: reflections on a new psychoanalytic approach. New York: Norton. LAZARUS, A. A. (1971) Behavior therapy and beyond. New York: McGraw-Hill. LAZARUS, A. A. (Ed.) (1985) Casebook ofmultimodal therapy. New York: Guilford. MAHLER, M. (1963) Thoughts about develo ment and individuation. In R. Eissler (Ed.), The psychoanalytic study of the child. (2n8 ed.) New York: International Univer. Press. Pp. 307-324. MAY,R. (Ed.) (1961) Existential psychology. (2nd ed.) New York: Random House. MAY,R. (1986) The discovery of being: writings in existentialpsychology. New York: Norton. MEJCHENBALIM, D. (1977) Cognitive-behavior modification: an integrative approach. New York: Plenum. D., PRICE,R , PHARES, E., MCCORMICK,N., & HYDE,J. (1789) Exploring MEICHENBAUM, choices: the psychology ofadjustment. Glenview, IL: Scott, Foresman. MINUCHIN,S. (1974) Farnll~esand family therapy. Cambridge, M A : Harvard Univer. Press. MINUCHIN,S., & FISHMAN,H. (1981) Family therapy techniques. Cambridge, M A : Harvard Univer. Press. PARAD,H . (Ed.) (1958) Ego psychology and dynamic casework. New York: Family Service Association of America. PARAD,H. (Ed.) (1965) Crisis intervention: selected readings. New York: Family Service Association of America. PERLMAN,H. (1957) Social casework: a problem-solving process. Chicago, IL: Univer. of Chicago Press. PERLS, F. (1973) The Gestalt approach and eyewitness to therapy. Palo Alto, CA: Science & Behavior Books. PROCHASKA, J., & NORCROSS, J. (1983) Contemporary psychotherapists: a national survey of characteristics, practices, orientations, and attitudes. Psychotherapy: Theory, Research and Practice, 20, 161-173. RAIT, D. (1988) Survey results. The Family Therapy Networker, 12, 52-56. REID, W. (1978) The task-centered system. New York: Columbia Univer. Press. REID,W. (1985) Family problem solving. New York: Columbia Univer. Press. RED, W., & EPSTEIN,L. (1972) Task-centered casework. New York: Columbia Univer. Press. REm, W., & EPSTEM,L. (1777) Task-centered practice. New York: Columbia Univer. Press. RICHMOND, M. (1917) Social diagnosis. New York: Russell Sage. V. (1730) A changing psychology in social case work. Philadelphia, PA: Univer. of ROBINSON, Pennsylvania Press. ROBINSON, V. (Ed.) (1962) Jessie Tajt, therapist and social work educator. Philadelphia, PA: Univer. of Pennsylvania Press. ROGERS,C. R. (1951) Client-centered therapy. Boston, MA: Houghton Mifflin. ROGERS, C. R. (1976) The therapeutic relntionship and its impact. Westport, CT: Greenwood. ROGERS,C. R. (1981) A way of being. Boston, M A : Houghton Mifflin. R ~ E R J., B. (1954) Social learning and clinical psychology. Englewood Cliffs, NJ: Prentice-Hall. R o ~ RJ., B. (1982) Development and application ofsocial learning theory. New York: Praeger. SATIR,V. (1982) Conjoint family therapy. (3rd ed.) Palo Alto, CA: Science & Behavior Books. SCHEREZ,F. (1963) Family interaction: some problems and implications for casework. New York: Family Service Association of America. STEINER,C. (197 1) Scripts people liue. New York: Grove.
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TURNER, F, (Ed.) (1983) DiJJerential diagnosis and treatment in social work. (3rd ed.) New York: Free Press.
TURNER, F. (Ed.) (1986) Social work treatment: interlocking theoretical approaches. (3rd ed.) New York: Free Press. WOLPE,J. (1982) The practice of behavior therapy. (3rd ed.) New York: Rrgamon. Accep~edMarch 26 1990.
THEORETICAL UNDERPINNINGS OF PRACTICE I N FAMILY SERVICE AGENCIES ' LUCILE E. CANTON1
AND
LOUIS J. CANTON1
Family Service of Detroit And Wayne Country Summary.-1,334 counselors from 123 Family Service America (FSA) agencies participated in a survey to assess which theories of counseling and psychotherapy were used in their day-to-day work with clients. Counselors were not asked directly which theories they used. Rather, use was ascertained from the interventions they employed in the counseling process. Although 3 theories predominated, findings showed that FSA practitioners were eclectic in their practice-they chose certain interventions from 11 theories. Comparison of subgroup scores for demographic characteristics with total group scores for theory use showed remarkable consistency in the order of theories used.
The Directors of Professional Services-Family Service America are those persons in each agency charged with monitoring quality of services and providing staff development. This group decided that they needed a clear understanding of the theoretical approaches which line staff used in their practice, so the group proposed the current study. During the past 25 years there has been a virtual explosion of new treatment modalities within the psychotherapeutic community. Various psychotherapists have conducted workshops and have written articles and books on what they believe to be better ways of helping emotionally distressed people. Family Service agencies have been influenced by the new theories and new techniques, or interventions, to such an extent that many Family Service practitioners refer to their practice as eclectic. What does "eclectic" mean? What is the mix that makes up current practice in Family Service America agencies? The present study was undertaken to answer these and related questions.
Earlier Studies I n 1976 Family Service America (FSA) asked member agencies to include in their annual report new treatment modalities which had been developed within the past decade and which were being used in their agencies. However, the following modalities were excluded from the FSA study because they had already achieved some acceptance: ". . . variants of the psychoanalytic approach (Freudian, Adlerian, Jungian, Rankian, existential, supported by a grant from the Directors of Pro€essional Services, Family 'This study was Service America, Milwaukee, WI, and partly by a grant from the College of Education, Wayne State University, Detroit, MI. Request reprints from L. and L. Cantoni, 2591 Woodstock, Detroit, MI 48203.
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L. E. CANTON1 & L. J. CANTON1
etc.), related approaches based on a lagnostic, functional, or ego psychology base, brief task-oriented treatment, joint and family interviews which utilize a systems approach, Rogerian-type counseling, dynamically oriented group therapy, long accepted approaches to family life education, approaches utilizing the wider social network as a major therapeutic tool, and approaches achieving their results primarily through modifying the environmental and institutional supports provided to the client" (Beck, 1978, p. 2). In 1978, then, these percentages of 268 FSA member agencies reported using, to some extent, certain new treatment modalities: Behavior Modification, 43%; Transactional Analysis, 41%; Training in parent-child relationships, 33%; Gestalt Therapy, 31%; Marriage enrichment, 27%; and Structured communication training, 18%. "There were also occasional reports of use of Rational-Emotive Therapy, Assertiveness Training, and selected body therapies, such as Bioenergetic Analysis and dance therapy" (Beck, p. 4). Other professional groups have also been concerned about defining the nature of psychotherapeutic practice. Jayaratne (1981) reported a study of 267 individuals selected from the 1976 NASW Register of Clinical Social Workers. In 1983 Prochaska and Norcross reported findings regarding: (1) 479 clinical psychologists (members of Division 12, American Psychological Association) and (2) 410 psychotherapists (Division 29, APA). Goldmeir (1986) reported a study which examined the private practice of 492 psychologists, 461 social workers, 371 psychiatrists, and 5 3 nurses. And, in 1988 Rait reported the results of a reader survey which drew from almost 900 practitioners in family therapy.
METHOD ~urticipunts Family Service American had 255 accredited and provisional member agencies in December, 1987. Of these, 123 or 48T0, participated in the present study by having all or some of their counseling staff fill out questionnaires. One thousand three hundred thirty-four counselors completed a questionnaire. FSA agencies of all kinds participated in the study: 28, or 38%, of small agencies participated; 48 (53%) medium-sized agencies; and 47 (59%) large agencies. Of the nonsectarian agencies, 105 (49%) participated. Ten (47%) Jewish agencies participated; 6 (85%) Catholic agencies; and 2 (40%) other denominations. Each region of the country was represented with 40% to 59% participation: North Atlantic, 10 (40To); Western, 11 (44%); Southeastern, 24 (47%); Mid-Atlantic, 26 (49%); Mid-America, 42 (57%); and Southwestern, 10 (59%). O f the 1,334 respondents in this study, 1,005 or 75% were female; 294 (22%) were male; and 35 (3%) did not reveal their sex. 1,180 (92%) respon-
FAMILY SERVICE: THEORY AND PRACTICE
74 1
dents were white, 67 (5%) were black, 30 (2%) were Hispanic, 13 (1%) reported belonging to other ethnic groups. Of respondents 136 (10%) had two or less years of experience in social work. Five hundred eighty-three (44%) had three to 10 years experience, 514 (38%) had more than 10 years experience. By way of experience in a family service agency, 391 (29%) had two years or less, 552 (42%) had three to 10 years, and 255 (19%) had more than 10 years experience in a family service agency; 136 (10%) did not report this item. Respondents holding a Bachelor's degree numbered 146 (1I % ) , 1,105 (83%) held Master's degrees, 36 (3%) had doctorates; 47 (3%) did not report their educational attainments. Soc~alworkers were the dominant profession among the respondents: 1,012 (76%) Of that number, 566 (42%) gave only social work as their profession, 446 (34%) noted both social work and another profession; 226 (17%) reported professions other than social work, and 96 (7%) did not report their profession. Respondents reported their focus of practice. Since some of the respondents reported more than one focus of practice, we give numbers but not percent in each field: clinical practice, 1,108; service to specific populations, 138; f a d y life education, 92; case management, 87; employee counseling, 36; child welfare, 36; and other, 87. The above-noted 38 demographic items, with numbers and percentages of participants, comprise the independent variables of this study.
Development of the Instrument Directors of Professional Services-FSA and practitioners in family service agencies contributed to the development of the survey instrument. Nineteen DPS-FSA members gave an open-ended questionnaire to selected clinical staff. This preliminary questionnaire had a blank space at the top for a theory, and five blank spaces below for interventions. Respondents were asked to name a theory they used and define that theory, and mention leading writers of that theory who had influenced them. Then they were asked to name and define interventions from that theory which they used in their day-to-day practice. Respondents could submit as many theories and interventions as they wished. Over 100 individuals submitted one or more theories with related interventions. The authors coded the preliminary study material and wrote a first draft of the questionnaire. Subsequently, drafts were presented at the April 1986 and April 1987 annual workshops of the group which yielded suggestions for revision. A study committee of five persons was available for consultation. The instrument represented virtually all theories and interventions used in FSA agencies. However, it was not limiting-there was space to add other interventions and theories.
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Administrative Procedures I n early October 1987, Family Service America sent information regarding this study to each of 255 member agencies. Included in the mailing was a sample copy of the questionnaire and a pamphlet defining theories. Agencies were asked to indicate whether they wanted to participate. The study was also presented to the agencies at the 1987 FSA Biennial Conference, October 22 to 25. As noted earlier, 123 of the 255 agencies (48%) participated. Questionnaires were mailed out beginning November 1, 1987. Agencies were asked to return completed questionnaires by January 31, 1988. Participants were asked to report the nature of their practice during the preceding four months. T h ~ sstudy, then, reflects practice in these agencies during the period July 1987 through January 1988. Each counselor was given a two-page questionnaire. O n one side, counselors were asked for demographic information about themselves. The other side listed theories and interventions w h c h the counselors might use in their practice. They were asked to check each intervention according to how often they used the given intervention with their family service clients during the past four months. The scale was from O = never, 1 = rarely, 2 = sometimes. 3 = half, 4 = many, to 5 = all. Each ~nterventionwas listed under the theory from which that intervention developed. We believed that, if counselors used interventions developed by a cerran theoretical approach, they had been influenced by that theory of practice. The influence of each theory should be shown by how often counselors used that theory in their practice. Definitions of theories given below reflect those described in the pamphlet. Each theory represents the views of a number of theorists. Scores for each intervention were tallied; mean scores and their standard deviations were obtained. Scores for all the interventions under each theory were tallied; mean scores and standard deviations for each theory were obtained.
Many respondents wrote notes and added various theories and interventions. Some people elaborated on theories and interventions appearing in the questionnaire. Others made statements or provided articles explaining new theories they were finding useful. However, not enough people reported any one new theory in sufficient numbers to warrant inclusion in this paper. Questionnaire responses showed that, of the 1,334 counselors, only 12 looked toward one theory in their practice. Thus, 1,322 (99%) indicated some use of more than one theory: 798 (60%) reported use of some interventions from all 11 theory groups; 278 (21%) used 10 theories, 102 (8%) used 9 theories, 57 (4%) used 8 theories, 27 (3%) used 7 theories, 24 (2%)
743
FAMILY SERVICE: THEORY AND PRACTICE
used 6 theories, and less than 1% of the respondents used either 5, 4, 3, or 2 theories. These results underscore the respondents' eclectic practices.
Interventions According to Theories Table 1 provides means and standard deviations for interventions by theories. Most-used theories appear first, and least-used theories appear last. Then, under each theory, interventions are given from most-used to leastused although on the questionnaire, neither the theories nor their interventions were listed in any order. The original order on the questionnaire is indicated in Table 1 by letters A through K. Numbers under each theory show the original order of interventions. TABLE 1 ORIGINAL ORDER, MEANSAND STANDARD DEVLATIONS OF INTERVENTIONS ACCORDING TO TI-IEORIES ( N = 1,334) Original Order
B 7 5 1 6 4 2
9 8 3
F 1 4
5 2 3
A 1 4
6 5 2 3
G 3 4 2 1
M
SD
Validare strengths Cleat and open communication Empathic use of self Enhance growth potenrial Self-esteem issues Influence of family of origin Reframing Joining Differentiation of self
4.0 3.8 3.7 3.6 3.6 3.6 3.5 3.1 3.0
1.2 1.2 1.3 1.2 1.1 1.2 1.3 1.6 1.3
Problem-solving Theories Positive therapeutic relationship Encouraging decision-making Support and direct change Assessment of problem Defining self-defeating behaviors
3.8 3.6 3.6 3.5 2.9
1.3 1.3 1.3 1.5 1.4
Ego Psychology Theories Support Universalizing, reframing, clarifying, educating Problem solving Insight Ventilation and catharsis Confrontation
4.2 3.7 3.6 3.2 3.1 3.1
1.0 1.1 1.1 1.5 1.3 1.1
3.6 3.4 3.3 3.1
1.6 1.7 1.6 1.7
Theories and Interventions Family Therapy Theories
Functional Social Work Theories Provide service Terminate Help client choose service Define services of agency (continued on next page)
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L. E. CANTON1 & L. J. CANTON1 TABLE 1 (CONT'D) ORIGINAL ORDER,MKANSAND STANDARD DEVIATIONS OF INTERVENTIONS Acco~owcT o THEORIES( N = 1,334)
Original Order
Theories and Interventions
M
SD
3.4 3.4 3.2 2.8 2.8 2.8 2.7
1.4 1.3 1.2 1.4 1.2 1.3 1.3
3.3 3.3 3.3 3.2 3.1 3.0 2.6 2.4
1.3 1.4 1.3 1.4 1.6 1.5 1.4 1.9
3.8 3.1 2.8 2.6 2.4 2.0 1.6
1.5 1.3 1.5 1.3 1.3 1.2 1.2
3.2 3.0 2.9 2.5 1.4 .4
1.5 1.4 1.7 1.4 1.2 .9
2.8 2.4 2.0 1.9 1.2
1.7 1.8 1.4 1.5 1.4
2.8
1.5 1.3
Crisis and Task-centered Theories Support Clarification Analyzing and overcoming obstacles Contracting Grief work Teaching new interpersonal skills Anticipatory guidance Bio-psychosocial Therapy Theories Reflection of patterns Ventilation and exploration Reflection of past Reflection of current person in situation Sustaining relationship Medical aspects Significant others Diagnosis Human Ecology and LiFe Model of Practice Theories Relationship of mutuality Problem solving Contracting Networking Opportunities for action Concrete services Individual case advocacy Cognitive Therapy Theories Emphasize client responsibility Explore alternatives An accepting relationship Assessment of internal dialogue Teach relaxation techniques Teach biofeedback Existential Therapy Theories Enter client's world Encounter Here-and-now Counselor as total person Existential anxiety Behavior Modification Theories Positive reinforcement Parent education (continued on next page)
2.7
745
FAMILY SERVICE: THEORY AND PRACTICE TABLE 1 (CONT'D) ORIGINALORDER,MEANSAND STANDARD DEVIATIONS OF INTERVENTIONS ACCORDING T o THEORIES(N = 1,334) Original Order 2 8 3
6 1 9 4 H 1 2 3 5 4
Theories and Interventions
M
SD
Assertiveness training Substance abuse education Relaxation training Prescriptions Systematic desensitization Extinction Aversive conditioning Transactional Analysis Theories Teachmg ego states Game analysis Script treatment Redecision, using double chairs Reparenting
Theories, from Most-used to Least-used Family Therapy, Problem Solving, and Ego Psychology were used most-well over half of the time-by family service practitioners. There were no significant differences in the frequencies of mean use (3.5 3.5, 3 . 3 , the standard deviations, and the two-tailed t test for analysis of variance (Table 2). Not included in Table 2 is the comparison between F a d y Therapy and Ego Psychology: in that comparison p = .87, indicating no significant difference in frequency of use. Functional Social Work, Crisis and Task-centered, Bio-Psychosocial, and Human Ecology and Life Model of Practice are all uniquely social work theories. These theories were used significantly less often than Family Therapy, Problem Solving, and Ego Psychology. But the mean scores, ranging from 3.28 to 2.56 (Table 2) indicate these theories were used by participants roughly half of the time. Cognitive, Existential, and Behavior Modification were used sometimes; mean scores ranged from 2.2 to 1.7, as seen in Table 2. However, practitioners used certain concepts from these theories about half the time, and other concepts rarely or almost not at all, as shown by the scores for their interventions in Table 1. Transactional Analysis was used rarely or almost not at all; see Tables 1 and 2.
Theory Definitions and Theorists' Names The definitions of the 11 theories should give meaning to the data in Table 2. As mentioned earlier, these definitions were formulated during the planning of this study. These definitions were first used in the pamphlet
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which accompanied the questionnaire. Included also were the names of the counseling theorists cited b n the following pages. TABLE 2
TI-EORIES, FROMMOST-USED TO LEAST-USED, WITH MFANS,STANDARD DEVIATIONS, A N D PROBABILITY LEVELS Theories Family Therapy
M
SD
3.5
.9
P .88
Problem-solving Ego Psychology Functional Social Work Crisis and Task-centered Bio-psychosocial Therapy Human Ecology and Life Model of Practice Cognitive Therapy Existential Therapy Behavior Modification Transactional Analysis
Three Most-used Theories I n theories of family therapy, problematic behavior of a family member is viewed as resulting from a dysfunctional family system. Each family system has three major subsystems-marital, parent-child, and sibling. F a d e s carry out two key functions-adult emotional and sexual expression, and socialization of children. Each family goes through characteristic developmental stages, each family has a developmental history. The family can be understood by studying interactions among family members and between the family and other social institutions. Theories of family therapy used by family service counselors included (a) Psychodynamic Family Therapy (Ackerman, 1966, 1972; Framo, 1972, 1982; Scherez, 1963), (b) Communication Therapy (Satir, 1982), (c) Systems Therapy (Bowen, 1978; Kerr & Bowen, 1988), (d) Structural Family Therapy (Minuchin, 1974; Minuchin & Fishman, 1981), (e) Strategic Family Therapy (Haley, 1986). I n problem-solving theories the counseling relationship is reality-based. The counselor sustains, supplements, and fortifies the client. Counseling is structured to provide a beginning, middle, and end to treatment. These theories were developed by Haley (1977), Hallowitz (19791, and Perlrnan (1957).
FAMILY SERVICE: THEORY AND PRACTICE
747
Ego psychology theories include theories regarding human development. These theories are based on Freudian concepts of psychosexual development through oral, anal, and oedipal stages (Hamilton, 1958). Erikson, (1963, 1968) extended the developmental process through aging. The early stages were expanded by Kohut (1971, 1977, 1985) and Mahler (1963) to define how the individual learns to love self and others. Hamilton (1951) and H o h s (1964) looked at ways in which economic and cultural factors interact with intrafamilial experiences. Clients who become aware of their unconscious wishes and desires are then able to effect positive changes in their relationships with self and others.
Four Much-used Theories The three above theories were most often used in family service practice. The next four theories were used much of the time: Functional Social l and Human Work, Crisis and Task-centered, B i ~ p s ~ c h o s o c i aTherapy, Ecology and Life Model of Practice. AU of these theories are uniquely related to social work. Functional social work theories were formulated at the Pennsylvania School of Social Work. Robinson wrote a book about this theoretical area in 1930. Then, in 1962 she edited a book on the contributions of Jessie Taft. I n functional theories, emphasis is placed on current life experiences and the client's capacity to grow and make choices. Diagnosis is a dynamic process concerned with the client's situation and the kinds of services which the agency offers. The counselor represents not only the agency but also society. As with problem-solving theories, structure provides a beginning, middle, and end to treatment. Crisis and task-centered theories overlap and are interrelated. Developed by Kaplan and Killilea (1976), Parad (1965), Reid (1978, 1985), and Reid and Epstein (1972, 1977)) these theories postulate that crises disrupt the homeostasis of the individual and/or family. The current crisis may reactivate old, unresolved conflicts. Counseling can help individuals and famihes to deal with crises and minimize damage to the family system. Crises provide opportunities for the system to organize more effectively. The system remains in a state of disequilibrium a limited time; to be effective, counseling must be immediately avadable. I n biopsychosocial therapy theories, treatment is based on the diagnosis of the client, made by considering perceptions, history, patterns of behavior, and social mileau. Physical, medical, neurological, psychiatric, and other factors are also included. Goals are identified. Treatment takes into account the individual's strenglhs and weaknesses. Hamilton (195I ) , Hollis (1964), Parad (1958), Richmond (19 17), and Turner (1983, 1986) are proponents. Human ecology and life model of practice theories are the last of the social work theories used to a considerable extent in family service agencies.
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Conceived and reported by Germain (1979, 1984), who coauthored a third volume (Gitterman & Germain, 1980), these theories emphasize the environment. Changes occur within the environment to which individuals must adapt. Conversely, people affect their environment. If transactions between individuals and environment do not fit, counseling is needed. Each person must attain a sense of identity, competence, autonomy and human-relatedness.
Four Least-used Theories Four theories were used sometimes or rarely: cognitive therapy, existential therapy, behavior modification, and Transactional Analysis. In cognitive therapy theories, what a client says to himself influences his behavior and his feelings. Certain behaviors promote certain feelings. Defective beliefs occasion self-defeating behaviors. Treatment looks to the present, not the past. The counselor may bring to bear approaches which lead to self-understanding and self-control. Writers who have promoted these theories are Beck (1976; Beck & Emery, 1985), E h s (1984), Glasser (1975; Glasser & Powers, 1981), and Meichenbaum (1977; Meichenbaum, Price, Phares, McCorrnick, & Hyde, 1989). Existential therapy theories, holistic in concept, focus upon exploring the individual's present life, values, attitudes, tasks, and goals. The client is encouraged to find meaningful answers to the problems of freedom, responsibility, existence. Redefinition of personal identity comes with greater awareness of one's own feelings and with heightened spontaneity in relationships with others. These theories were developed by Frankel (1965, 1984), May (1961, 1986), Rogers (1951, 1976, 1981), and Perls (1973). Behavior modification theories represent the systematic application of learning principles to analysis and treatment of behaviors. Feelings are regarded as the result of behaviors. Changed behaviors eliminate undesired feelings. Behaviors to be changed are assessed by obtaining a base line, contracting with a client for change, and prescribing new behaviors. Among theorists in behavior modification are Kanfer and Phillips (1970; Kanfer and Schefft, 1988), Lazarus (1971, 1985), Rotter (1954, 1982), and Wolpe (1982). Transactional Analysis theories recognize three ego states in each person: Parent, Adult, and Child. Some transactions between certain ego states of one individual with certain ego states of another are complementary and healthy. Other transactions are crossed-these cause breakdowns in communication. Each child writes a life script. Lifelong interactions with others are acted out according to the script unless the individual recognizes his script and changes it. Work by Berne (1961, 1964, 1972), Dusay (1977), Harris (1969), and Steiner (1971) represents these theories.
749
FAMILY SERVICE: THEORY AND PRACTICE TABLE 3 OF S L ~ G R O W WITH S TOTALGROUPACCORDING TO THEORY COMPARISONS , DEVIATIONS, AND PROBABILITY LEVELS USE, WITH ~ N SSTANDARD Subgroups and Theories
Subgroup
M Nonsocial Workers, n = 226 or 17 0% Ego Psychology Crisis, Task-centered Functional Bio-psychosocial Cognitive Human Ecology Existential Social Work and Another Profession, n = 446 or 33.4% Crisis Functional Bio-psychosocial Human Ecology Sectarian-Jewish, n = 122 or 9 1% Problem-solving Crisis Cognitive Bachelor's Degree, n = 146 or 11 0% Ego Psychology Family Therapy Master's Degree, n = 1,105 or 82.8% Ego Psychology Doctorate, n = 36 or 2.7% Functional Women, n = 1.005 or 75.3% Ego Psychology Men, n = 294 or 22 0% Family Therapy Human Ecology Southeastern Region, n = 192 or 14.4% Ego Psychology Mid-America Region, n = 524 or 39.0% Existential Southwestern Region, n = 114 or 8.5% Bio-psychosocial Western Region, n = 114 or 8.5% Human Ecology Functional 2 Years or Less Experience at Family Service, n = 136 or 10.2% Crisis Over 10 Years Experience at Family Service, n = 514 or 38.5% Cognitive
SD
Total Group
M
SD
p
750
L. E. CANTON1 & L. J. CANTON1
Comparison of Subgroups with the Total Group Mean scores and standard deviations were obtained on each of the 11 theories for each of the 38 independent variables, or subgroups noted under "Participants" above. This produced 418 separate variables. The 2-tailed t test for analysis of variance was used to compare the scores on each of these variables with theory scores for the total group of 1,334. Table 3 ~ n d ~ c a t e s that significant differences at the 1% level were found for only 28 (6.7%) of the 4 18 comparisons. Following are a few observations regarding some of the comparisons. Women, people with Master's degrees, and people from the Southeastern region used ego psychology more often than the total group. Nonsocial workers used ego psychology less than social workers, but more than the four much-used, uniquely social work theories. Men used family therapy less than the total group, but they used that theory more than the four social work theories. Respondents with Bachelor's degrees chose problem-solving theories more than family therapy and ego psychology. People with doctoral degrees used functional theories rarely. People working in Jewish agencies used problem-solving less than the four social work theories, and crisis and cognitive theories even less often. Some of the four social work theories were "least-used" by certain subgroups: Southwestern used biopsychosocial theory less, and people with under two years of family service experience used crisis less. Nonsocial workers and respondents Living in Mid-America rated existential therapy lower than the total group, but this theory was among the least used by 1,322 eclectic respondents. I n actuality, there were minimal differences of a consequential sort between subgroup and total group responses on the questionnaire. The few differences d o not alter the central findings that (a) counselors represented in the subgroups used family therapy, problem-solving, and ego psychology as the bases for their counseling, (b) they used selected interventions from most of the other eight theories presented in this study, and (c) their order of use, from most to least, was essentially the same as for the total group.
Conclusion I n this study, practitioners were not asked directly for their theoretical viewpoints. Rather, they were asked what interventions they used in their day-to-day practice. Their theoretical viewpoints were inferred from the nature of their practice. Findings of the study indicate that Family Service America practitioners used an eclectic theoretical approach. This approach to counseling and psychotherapy was comprised primarily of an integration of family therapy, problem-solving, and ego psychology. Social work theories-
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functional, crisis and task-centered, bi~ps~chosocial, and human ecology and life model-also contributed to their eclectic orientation. Certain concepts from cognitive, existential, and behavior modification theories were also evident. Present findings showed that the above approach to practice was observed consistently throughout the agencies, regardless of geographical location, size, the educational preparation of practitioners, or other subgroup factors. REFERENCES ACKERMAN, N. (1966) Treating the troubledfamily. New York: Basic Books. ACKERMAN, N. (1972) Psychodynamics o/family life: diagnosis and treatment offamily relationships. New York: Basic Books. BECK,A . T. (1976) Cognitive therapy and the emotional disorders. New York: International Univer. Press. BECK, A. T., & EMERY,G . (1985) Anxieq disorders and phobias: a cognitive perspective. New York: Basic Books. BECK,D. F. (1978) New treatment modalities: an outline of some options and source materials. New York: Family Service of America. BERNE,E. (1961) Transactional Analysis in psychotherapy. New York: Grove. BERNE,E. (1964) Games people play: the psychology of human relationships. New York: Grove. BERNE,E. (1972) What do you say after you say hello? New York: Grove. BOWEN,M. (1978) Family therapy in clinical practice. New York: Jason Aronson. DUSAY, J. (1977) Egograms: how I see you and you see me. New York: Harper & Row. ELLIS,A. (1984) Reason and emotion in psychotherapy. New York: Lyle Stuart. ERIKSON,E. (1963) Childhood and society New York: Norton. em so^, E. (1968) Identi@: youth and crisis. New York: Norton. F m o , J. (Ed.) (1972) Family interactions: a dialogue between family researchers and family therupis&. New York: Springer. F m o , J. (1982) Explorations in mari&l and family therapy: selected papers of James L. Framo. New York: Springer. FRANKEL, V. (1965) The doctor and the sorrl. (2nd ed.) New York: Knopf. FUNKEL, V. (1984) Man's search for meaning. (3rd ed.) Englewood Cliffs, NJ: Simon & Schuster. GERMAM,C. (Ed.) (1979) Social work practice: people and environments, an ecological perspective. New l'ork: Columbia Univer. Press. GERMAMC. (1984) Social work practice in beahb care: an ecological view. New York: Free Press GI~RMAN A,, , & GERMAIN,C. (1980) The life model of social work practice. New York: Columbia Univer. Press. GLASSER,W. (1975) Reality therapy: a new approach to psychiatry. New York: Harper & Row. GLASSER,W., & POWS, W. (1981) Stations of the mind: new directions for realily therapy. New York: Harper & Row. GOLDMEIER, J. (1986) Private practice and the purchase of services: who are the practitioners? American Jorrrnal of Orthopsychintry, 56, 89-102. HNEY, J. (1986) Uncommon therapy: the psychiatric techniques of Milton H. Erickson, M.D. (2nd ed.) New York: Norton. HALEY,J. (1987) Problem soluing therapy. (2nd ed.) San Francisco, CA: Jossey-Bass. HALLOW IT^, D. (1979) Problem solving theory. In F. Turner (Ed.), Social work treatment. (2nd ed.) New York: Free Press. Pp. 93-123. HAMILTON,G. (1951) Theory and practice of social case work. (2nd ed.) New York: Columbia Univer. Press. HAN~JLTON, G. (1958) A theory of personality: Freud's contribution to social work. In H . Parad (Ed.), Ego psychology and dynamic casework. New York: Family Service Association of America. Pp. 11-37. H m s , T. (1969) I'm OK-you're OK. New York: Harper & Row.
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