This paper is based on a lecture given at a conference held in October 2024 to celebrate the 30 years of operation of the Family Therapy Unit of the Attica Psychiatric Hospital, and a farewell to the founders of the Unit.
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“I must find myself in another by finding another in myself (in mutual reflection and mutual acceptance)”. Βakhtin (1984).
I will describe certain principles and values that form the Family Therapy Unit as a training framework by conveying the voices of trainers and trainees through two levels of observation: the description of the framework, and the description of the experience.
The training program has been operating for 30 years in the Family Therapy Unit, which belongs to the Attica Psychiatric Hospital, and offers psychotherapy for both families and couples, and individuals. The training program is presented as synthetic, systemic and experiential, and “the emphasis is placed not only on the content level but also on the process e.g. the relationship between learners” (Charalabaki, Thanopoulou & Kati, 2022).
According to systemic theory, the therapist considers himself equal to the patient in the creation of the therapeutic system - the system under observation (Anderson & Rambo, 1988) - and according to Bateson (1972), the therapist does not remain outside the sphere of therapeutic influence nor does he rely solely on techniques and interventions in order to bring about change. Similarly, the systemic trainer, despite possessing knowledge and experience, is distinguished by the ability to recognize the resonances produced in each training group, and is connected to the needs of the group each time (Charalabaki, Thanopoulou & Kati, 2022).
The challenge was to create a training/learning framework within which the roles of trainer/trainee would parallel those of therapist/patient in systemic theory; by extension a training system and an educational reality would be co-created by the trainer and the trainee (Anderson & Rambo, 1988). The systemic trainers often functioned as systemic therapists who direct the therapeutic process, much like a choreographer would: they guided group members from a linear path towards a circular one, supported the assumptions made, and paid attention to individual realities.
In short, the training program is structured so that in the first year trainees come into contact with systemic thinking through theory and experiential exercises, while at the same time the framework of the group is created and shaped. The second year is more clinically oriented, enriched with the study of classic systemic texts and supervisory cases from the trainees’ workplaces. In the third year, the creation and presentation of the personal genogram constitutes an important moment in the trainees’ personal development. In the presentation of the training program, Ms. Charalabaki, Thanopoulou & Kati (2022) note: “the philosophy of our therapeutic and educational work is based on the use of the therapist’s self, which is why we focus on issues such as resonance, the reflective position and the therapist’s genogram”.
The program is based on the principle of “evolving through relating” (Fragkiadaki et al., 2013). Regarding the experiential part of the training, most of us trainees, focused on:
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The value of sharing,
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Setting distinct boundaries: a training group is not a therapeutic group. Charalabaki (2008) mentioned the program: “the training we provide is a little more than training and less than therapy”. I remember clearly our trainers’ instruction during experiential exercises “share only as much as you feel comfortable to”. The distinct boundaries are also evident in that trainers do not undertake therapeutic work with trainees, in line with Aponte (1994), who stated that “training is not therapy, it is a personal preparation for professional counselling”.
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The processes that take place within the group itself. “The experience of the evolution of the group of trainees in a safe and transitional space of experience and reflection that remains open and in continuous co-evolution with the participants themselves” (Thanopoulou, 2018).
In conclusion, the process of group-centered learning could be described as: experiencing, observing, evolving and understanding, through, together with and alongside others.
The self of the therapist
In the literature of Family and Marriage Therapy (FMT), the concept of the therapist’s self is of central importance (Aponte, 1994; Polson & Nida, 1998; Wolgien & Coady, 1997). Bochner (2000) discusses the use of the concept of self within the psychoanalytic framework of countertransference. The therapist’s self has been studied in the context of countertransference, in stress and burnout issues related to the therapist’s practice, as well as broader issues of self-awareness related to personal and professional life (Aponte, 1994; Deutsch, 1984; Polson & Nida, 1998; Sori et al., 1996; Wetchler & Piercy, 1986), and while the literature focuses on developing clinical skills for better therapeutic outcomes, understanding the experience that promotes growth and leads to the therapist’s personal transformation is of paramount importance (Polson & Nida, 1998). As Aponte (1998) wrote: “therapy challenges clinicians to use their personal selves effectively within a professional relationship”, which requires an understanding of personal and professional influences on the therapeutic system.
The program encourages the use of the self through continuous dialectic with the reflective position (Moschakou, 2018), the focus on interactions within the group of trainees, the dynamics that emerge, and experiential learning; it brings to the center of training the concept of “the person of the therapist” in a path where the trainees themselves creatively use themselves as tools for therapy.
Communities of practice
Networking – network – community – active bonds
Becoming a therapist has been described in the literature as a type of apprenticeship where the process of socialization takes place, and trainees learn and practice ways to become and be therapists (Carlsson et al., 2010).
When talking about the group, it is important to refer to the broader context that created it, which at the same time also grew itself: a community of practice.
The concept of communities of practice has been developed in the professional, organizational and everyday spheres for 25 years, and refers to groups of people who are genuinely interested in the same real-life issues or other important issues, and who on this basis interact regularly to learn together and from each other (Wenger et al., 2002). When individuals interact with a common axis, regarding the same problem, the same concept, then thinking together with the other is introduced as an interpersonal process of knowledge, through which tacit knowledge is indirectly shared. This is what ultimately creates a community of practice. Indeed, without the common basis of “thinking together”, communities of practice cannot exist. By definition, mutual commitment is an essential element of these social structures.
The process of thinking together is conceptually based on Polanyi’s (1962) idea of indwelling. Central to Polanyi’s view of personal knowledge is the idea of the tacit component that is a necessary ingredient of all knowledge. ‘Personal’ implies that knowledge, in its richest form, can only exist within individuals and that it is necessarily grounded in the tacit dimension that people cannot easily express with language. A popular assertion of Polanyi (1966) is the following: ‘we can know more than we can tell’. In other words, the tacit dimension can be considered as the submerged part of an iceberg, representing the bulk of what people know. This tacit dimension of knowledge, therefore, guarantees that the personal factor is present in every form of knowledge. Knowledge develops through indwelling, which is an aspect of knowledge processes that explains learning (Pyrko et al., 2017). The process of indwelling captures the relationship of a knower’s body to the external world about which they learn as an experience of everyday life. In communities of practice, individuals with different personal knowledge manage to find ways to address their common issues, and can indirectly share their tacit knowledge, thus extending their identity in the same area of knowledge.
In conclusion, two key elements constitute a community of practice: learning and practice. In communities of practice, learning is depicted as the social formation of an individual and not just as the acquisition of knowledge. Learning involves a change in one’s identity as well as a renegotiation of the meaning of experience. Practice, on the other hand, is seen as ‘a set of frameworks, ideas, tools, information, language, styles, stories and documents’ (Wenger et al., 2002). According to Wenger (1998), the negotiation of meanings by the members of a community of practice leads to the development of three basic constitutes of communities of practice: mutual commitment, shared action, and shared repertoire. In the spirit of this approach, knowledge can be put into action in the sense that it is developed in the social context, but also ‘leaks through practice’ when professionals from different workplaces learn from each other (Brown & Duguid, 2001).
Thus, thinking together is defined as both the core and the scope of a community of practice, and explains why a community of practice can be cultivated as an entity rather than imposed by a manager or set up as another agency. The process of thinking together places the focus on the potential for developing learning partnerships and strengthens the sense of community.
Many aspects of the training contributed to this: clinical cases regarding patients who set into motion the trainees’ own personal reflection, feedback to the trainee group on clinical and personal material, but also trainers-supervisors who ‘lived the paradigm’ as they allowed the creation of a safe trainer-trainee relationship that involves self-disclosure, safely explores ‘blind spots’, encourages the inclusion of each person’s personal story in experiential exercises, but at the same time strengthens relationship of trust in the training group, which is gradually called upon to function as a reflective group (Rhodes, 2011). The trainer-supervisor functioned as a mentor, where according to systemic theory his values in the consulting room are consistent with his role as supervisor, always keeping in mind to gently remind the importance of personal development ‘incorporating only those of our teachers’ qualities that we can assimilate, avoiding the temptation of imitating them’ (Charalabaki et al., 2022).
Within such communities, members share a common meaning and/or passion, and collectively and individually develop their skills through sharing and interaction (Wegner, 1998). The relationships created, allowed us to learn through our interactions, creating communities of concern of peers and trainers - communities of people who help rather than judge (Carlson & Ericson, 2001). In this community we shared tools, techniques, stories, ways of dealing with family issues - in other words, practices. Ultimately, the concept of belonging, in which each trainee developed his own mentality, values, and ideas related to the field, seems to play an important role in shaping the therapist’s self (Wegner, 1998).
As for myself, I started my relationship with the Family Therapy Unit and the training group in 2017, completing the training program in 2021 and returned in 2023 for a year, as part of my internship for the Master’s degree of Counselling program. My individual process and my personal relationship with the Unit and the group presents the characteristics of the life cycle of a group and the dynamics that develop within it. As Charalambaki, Thanopoulou & Kati (2022) mentioned ‘…giving promises of eternal loyalty to the group or realistically keeping in touch’…with whatever means one has at one’s disposal.
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