See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/233162852

Brief Family Therapy Training in India

Article in Journal of Family Psychotherapy · September 2000

DOI: 10.1300/J085v11n03_04

CITATIONS READS

13 1,393

7 authors, including:

Anisha Shah Mathew Varghese

National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neuro Sciences
67 PUBLICATIONS 191 CITATIONS 251 PUBLICATIONS 5,195 CITATIONS

SEE PROFILE SEE PROFILE

Ahalya Raguram Sobhana Hariharasubramanian

National Institute of Mental Health and Neuro Sciences LGB Regional Institute Of Mental Health
26 PUBLICATIONS 289 CITATIONS 3 PUBLICATIONS 24 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Anisha Shah on 06 February 2015.

The user has requested enhancement of the downloaded file.

This article was downloaded by: [NIMHANS National Institute of Mental
Health & Neuro Science], [Anisha Shah]
On: 05 February 2015, At: 20:51
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954
Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,
UK

Journal of Family
Psychotherapy
Publication details, including instructions for
authors and subscription information:
http://www.tandfonline.com/loi/wjfp20

Brief Family Therapy Training

in India
a b
Anisha Shah , Mathew Varghese , G. S. Udaya
b b a
Kumar , Ranbir S. Bhatti , Ahalya Raguram , H.
b c
Sobhana & J. Srilatha
a
Department of Clinical Psychology , National
Institute of Mental Health and Neuro Sciences ,
Bangalore, India
b
Department of Psychiatry , National Institute of
Mental Health and Neuro Sciences , Bangalore, India
c
Department of Medical and Psychiatric Social
Work , Tata Institute of Social Sciences (TISS) , Sion
Trombay Road, Deonar, Mumbai, 400088, India
Published online: 12 Oct 2008.

To cite this article: Anisha Shah , Mathew Varghese , G. S. Udaya Kumar , Ranbir
S. Bhatti , Ahalya Raguram , H. Sobhana & J. Srilatha (2000) Brief Family Therapy
Training in India, Journal of Family Psychotherapy, 11:3, 41-53, DOI: 10.1300/
J085v11n03_04

To link to this article: http://dx.doi.org/10.1300/J085v11n03_04

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the
information (the “Content”) contained in the publications on our platform.
However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness,
or suitability for any purpose of the Content. Any opinions and views
 expressed in this publication are the opinions and views of the authors, and
are not the views of or endorsed by Taylor & Francis. The accuracy of the
Content should not be relied upon and should be independently verified with
primary sources of information. Taylor and Francis shall not be liable for any
losses, actions, claims, proceedings, demands, costs, expenses, damages,
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

and other liabilities whatsoever or howsoever caused arising directly or

indirectly in connection with, in relation to or arising out of the use of the
Content.

This article may be used for research, teaching, and private study purposes.
Any substantial or systematic reproduction, redistribution, reselling, loan,
sub-licensing, systematic supply, or distribution in any form to anyone is
expressly forbidden. Terms & Conditions of access and use can be found at
http://www.tandfonline.com/page/terms-and-conditions
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

FAMILY THERAPY AROUND THE WORLD

Brief Family Therapy Training in India:

A Preliminary Evaluation
Anisha Shah
Mathew Varghese
G. S. Udaya Kumar
Ranbir S. Bhatti
Ahalya Raguram
H. Sobhana
J. Srilatha

ABSTRACT. The Family Psychiatry Center, NIMHANS, India, has

been conducting a structured training program in family therapy for
over a decade. This paper presents findings from a preliminary evalua-

Anisha Shah is Assistant Professor and Ahalya Raguram is Associate Professor,

Department of Clinical Psychology; Mathew Varghese is Additional Professor, De-
partment of Psychiatry; G. S. Udaya Kumar is Senior Psychiatric Social Worker;
Ranbir S. Bhatti is Professor of Psychiatric Social Work; and H. Sobhana is PhD
Scholar, Department of Psychiatric Social Work, all at National Institute of Mental
Health and Neuro Sciences, Bangalore, India.
J. Srilatha is Lecturer, Department of Medical and Psychiatric Social Work, Tata
Institute of Social Sciences (TISS), Sion Trombay Road, Deonar, Mumbai-400088, India.
Address correspondence to Anisha Shah, Department of Clinical Psychology,
NIMHANS, Bangalore, India-560029 (E-mail: anishah@nimhans.kar.nic.in).
The first author may be contacted regarding the instruments used in this study.
This paper was presented at the Annual National Conference of Indian Psychiat-
ric Society and Regional Meeting of World Psychiatric Association, Jaipur, India, in
January 1998.
Journal of Family Psychotherapy, Vol. 11(3) 2000
E 2000 by The Haworth Press, Inc. All rights reserved. 41
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

42 JOURNAL OF FAMILY PSYCHOTHERAPY

tion of this program based on pre and post data from thirty-one students
who completed a one-month training program. Two measures were
developed at the center (Student-Training Rating Scale and Trainee
Assessment Form) to evaluate perceptual and interview skills. Analysis
of the pre and post scores showed that the trainees report an improve-
ment on many of the basic family therapy skills (p < .001), and show
enhancement of conceptual skills. Results suggest that some of the
training objectives have been achieved. [Article copies available for a fee
from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address:
<getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com>]

KEYWORDS. Basic family therapy skills, training, evaluation, super-

vision, India, self report measures

Family therapy training and supervision programs are gradually

becoming a very important part of training in mental health care.
Though psychotherapy literature views all helping relationships as
having many common skills, it acknowledges that family therapy does
differ from other helping relationships and requires some specific
skills (Figley and Nelson, 1990). There is a need to have structured
family therapy training programs to improve trainees’ skills, and that,
in turn, can ensure better family therapy outcome. Literature suggests
that the evaluation of these training programs remains problematic due
to: the complexity of measuring change; the ambiguity about a ‘stan-
dard family’ against which trainee skills can be measured; lack of
adequate and appropriate instruments for measuring change, and in-
sufficient knowledge about therapist skills or behaviors associated
with positive therapy outcome (Tucker and Pinsof, 1984). Developing
appropriate measures of change in trainees’ skills is a very complex
task (Breunlin, Schwartz, Krause, and Selby, 1983). Research on eval-
uation of training programs suggests that testing conceptual and per-
ceptual learning, and systemic thinking, is more relevant compared to
assessing mere acquisition of facts about family therapy (Avis and
Sprenkle, 1990).
There is considerable accumulated knowledge in this field in the
Western countries but in India the field is still very young. Training
programs in the West are assuming a very heterogeneous character,
whereas family therapy training in India continues to be a part of
generic mental health training programs. The practice of family thera-
py in India started in the late 60’s with the first document published in
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

Family Therapy Around the World 43

1971 (Bhatti and Varghese, 1995). Since then, the National Institute of
Mental Health and Neuro Sciences (NIMHANS) has been one of the
major centers engaged in the training and practice of family therapy.
Currently, family therapy services are offered by psychiatry depart-
ments in some of the teaching hospitals, as well as by mental health
professionals in private practice. However, there is no information on
structured training programs from any of these centers except from
NIMHANS, Bangalore. Bhatti, Janakiramaiah, and Channabasavanna
(1980), Channabasavanna, Andrade, Rasquinha and Desai (1987), and
Bhatti and Varghese (1995) have described the practice of family
therapy at the Family Psychiatry Center, NIMHANS. A structured
family therapy training program was evolved at the center in the 80’s
and this has remained fairly constant since then (Varghese et al.,
1996).
Since the practice of family therapy is colored by the prevailing
cultural ethos, family therapy training in India must train therapists to
work within a multicultural setting. Therapists need to understand the
rural and urban differences, linguistic diversity, as well as variations in
family interactions across different regions (for example, permitted
physical intimacy, acceptance of nuclear structures, and relationships
with in-laws). Further, therapists have to be aware of the influence of
various social phenomena (for example, caste, religion, and communi-
ty) and social problems (for example, poverty, dowry, and unemploy-
ment) on a family’s identity. The above must be learnt within the
broader cultural conceptualization of an Indian family as one with (1) a
benevolent hierarchical structure, (2) altruistic parental behaviors in
response to children’s demands, (3) prolonged dependency on family
of origin even after initiating family of procreation, and (4) a need to
preserve relationships despite various constraint factors. Moreover,
with varied family stereotypes widely prevalent in the social system,
therapists have to learn to recognize and work through these in therapy.
The faculty for the training program believed that it was necessary
to evaluate this program formally in order to document if the training
objectives are being realized. Thus, a study was carried out to evaluate
trainees before and after training.
The institute, where the training is conducted, is the largest multi-
disciplinary mental health training center in Asia offering postgradu-
ate courses in the four mental health disciplines. The teaching faculties
also operate on a multidisciplinary principle through interdepartmen-
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

44 JOURNAL OF FAMILY PSYCHOTHERAPY

tal inputs in academic schedules. Clinical services are managed by

faculty and students from all the departments. Students undergo a
series of clinical postings in psychiatry and specialty areas while
working towards post-graduate qualifications in mental health. All
courses provide training in individual psychotherapy, behavior thera-
py, group therapy, family and marital therapy, and rehabilitation thera-
py. The trainees get opportunities to work with spouses and family
members of clients throughout their training period. All trainees have
a mandatory posting at the Family Psychiatry Center where they re-
ceive family and marital therapy training.
The program aims to introduce them to a systemic perspective, and
to help consolidate basic family assessment and therapy skills (Ragu-
ram, 1996; and Varghese et al., 1996). The objectives of the training
program are to develop skills for basic family interview, family assess-
ment, and therapy; learn the application of systemic perspective to
problem behavior or symptoms; gain theoretical knowledge; and
create goals for family therapy. The program content covers family
assessment, circular questioning, family systems theory, circular hy-
pothesis, structural, strategic, psychodynamic, and behavioral family
and marital therapy, specific psychiatric disorders and family therapy,
and marital theory and therapy. Trainees are helped to develop basic
skills in family interview and assessment, and provided with opportu-
nities to practice basic family interventions and therapies as therapists
and co-therapists.
Training is through live therapy experience with dysfunctional fam-
ilies, lectures, seminars, tutorials, role-play, video demonstrations,
one-way mirror sessions, and reflecting team inputs. The supervisors
meet regularly to share their experiences and focus on training goals.
Trainees receive 200 hours of training inputs per month during which
time they may work with 3-4 inpatient families, either as a main
therapist or as a co-therapist. All the supervisors hold dual consultan-
cy–one with the family center and the other with an adult psychiatry
unit–with primary affiliations to their respective departments (psy-
chiatric social work, clinical psychology, and psychiatry). They have 5
to 25 years of clinical experience in family therapy and supervision.
Each trainee receives supervision from each of the supervisors during
the posting. Four to five trainees are posted at the center during a
given month. This ensures 1:1 trainee-supervisor ratio in the training
program. The duration of the postings ranges from 1-3 months across
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

Family Therapy Around the World 45

the four disciplines. In this study we have analyzed the data of trainees
from psychiatry, clinical psychology, and psychiatric nursing who
came for a one-month training. Evaluation was through certain mea-
sures used with the trainees before and after receiving the training, and
skills acquired with the program were examined. Currently, data from
trainees who have received three month training at the center is being
analyzed.

METHOD

Sample

Students pursuing mental health training through the following

courses were included in the study: psychiatry residency programs
through the department of psychiatry, M.Phil. in clinical psychology,
and M.Sc. in psychiatric nursing. Generally, these departments send
38 students for training in a given academic year. The data was col-
lected over a period of one year (1996-1997). Seven students were not
included in this sample. The reasons for this were: (1) trainee being on
leave for more than a week during the posting, (2) incomplete pre or
post data on either measure due to absence from work on the dates of
evaluation. Trainees completed the evaluation measures before and
after their one month program. Complete data on Student Training
Rating Scale was available for 31 trainees. Since three of these train-
ees gave incomplete data on Trainee Assessment Form, on this mea-
sure only 28 trainees’ data was available for analysis. They completed
the measures on the first and the last day of the posting, in the presence
of one of the supervisors. They were informed about confidentiality of
their responses, and that their participation in this evaluation will not
affect the formal evaluation of their training as part of their course
completion requirement.
In the sample of 31, 52%(16) were psychiatry residents, 32%(10)
were trainees in clinical psychology, and 16%(5) were psychiatric
nursing students. The mean age of the trainees was 28.5 years (stan-
dard deviation = 6.2), with a range of 23-47 years. Sixty-one percent
of the trainees were men, and the majority were single (61%). They
came from nuclear family structures in their families of orientation
(74%), though some came from joint or extended families.
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

46 JOURNAL OF FAMILY PSYCHOTHERAPY

Instruments

Literature on evaluation recommends the use of multi-method ap-

proaches for documenting impact of training. At the Family Psychia-
try Center we are aiming to develop a few methods for evaluation of
the training. These will include a self-report measure as well as an
objective measure for basic family therapy skills, written responses to
a case vignette, and supervisor ratings of therapy sessions. While other
methods are being developed and standardized currently, two mea-
sures have been developed at the center specifically to match the goals
of the training program, and to overcome certain limitations of the
setting.
Student-Training Rating Scale (STRS): This self report rating scale
was developed at the center. It is based on Figley and Nelson’s (1990)
empirically derived list of basic family therapy skills relevant for
beginning family therapists. This list was scanned by the supervisors
at the center in order to mark the skills that match our program goals
and contents. We had reservations about the relevance of 8 of the 100
skills listed by them. From the remaining skills we selected twenty-
four skills, as we believed that these could be evaluated through self
report. Figley and Nelson (1990) had categorized these under per-
ceptual, behavioral, conceptual, and personality related skills. These
skills were listed as items to form the STRS (for example: track
evolution of themes, know how to talk for a client, use genogram).
These were listed on a rating scale with the response options of: not
applicable, absent, minimally present, adequate, and good, and scored
0 to 4 respectively. Total score on this scale ranges from 0 to 96. The
trainees select the option that best reflects their own competence on
the skills. The first and second categories are necessary as some of the
terminology used to describe the skills may not be known to the
trainees prior to the posting, or the trainees may know the meaning of
a particular skill but may not have acquired the skill as yet. The tool
taps trainees’ subjective judgment of competence on these skills.
Trainee Assessment Form (TAF): There was a need to develop a
method of assessing trainees’ skills more objectively. The best method
for this would have been to have a live session or a video recording of
a session rated by a supervisor or a trained observer. However, re-
source constraints could not permit this in the current research context.
So a paper-pencil test was developed to achieve this aim. This was
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

Family Therapy Around the World 47

developed by the first author based on supervision discussions with

trainees and supervisors’ discussions. The scoring procedure was vali-
dated by the third author. Since supervisors often judge the level of
trainees’ conceptualization based on what they say/plan to do in fami-
ly sessions, we targeted in-session trainee behaviors through TAF.
This measure has two parts: the first part has 10 statements that reflect
therapists’ formulation and conceptual understanding of certain family
situations, and therapists’ decisions for family interview strategies.
Trainees mark each statement true or false (for example: in a single-
child family with problems between father and son, I will interview all
three together). The second part has 15 items with a set of family
interview questions listed under each item. Trainees select their
preferred question for interview settings from each set (for exam-
ple: (a) Why are you angry with your son? (b) What does your son do
that makes you angry?). The total score ranges from 0-25, with higher
scores indicating better conceptual and family interview skills.
For both measures, reliability and validity studies are in progress.
The two forms were tried out for trainees posted at the center over a
period of six months, in order to check for suitability and clarity of the
measures. The pilot study reassured us that the items were compre-
hended by all the trainees, irrespective of their grades in their respec-
tive courses and examinations.

RESULTS AND DISCUSSION

On TAF the pre scores range from 1-24, with a post score range of
4-24 (N = 28). Figure 1 shows the pre and post scores for each trainee.
The median for pre scores is 17.5, and 20 for post scores. These
indicate that the trainees enter the program with some conceptual
skills about families, and some basic skills for family interviews. The
high pre TAF median could be reflecting the skills gained by trainees
in the general mental health training received by them. It is quite
common for family members to accompany clients to the clinics, and
participate in interviews. This could be prompting the trainees to pick
up some family interview skills prior to receiving family therapy
training. Further, since theoretical inputs across all disciplines include
family theories of mental illness, expressed emotions, communication
pathologies in families, and unhealthy relationships, the pre TAF
scores here may be reflecting these skills. The increase in scores, as
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

48 JOURNAL OF FAMILY PSYCHOTHERAPY

FIGURE 1. TAF Raw Scores (N = 28)

30

20
Value

10

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31

Case Number
Lower box shows pre score
Upper box shows post score

reflected by the post TAF median of 20 indicates that the training

program does enhance these skills further. This suggests that most of
the trainees reach a fairly homogeneous level in basic family interview
skills, and conceptual skills. However, these results must be inter-
preted cautiously as TAF needs to be made more sensitive for tapping
training gains. The current response format also increases the proba-
bility of giving a correct response by chance. Since TAF is at a prelim-
inary stage of development, it may be too simple for trainees’ level.
We need to add more items to the tool. The tool should be standardized
further so as to strengthen its measurement of the basic interview and
conceptual skills. Yet, the above analysis does show the potential of
the tool in tapping these skills through a paper-pencil method. This can
be a major advantage in a resource-constrained context.
Pre and post mean total ratings on STRS were compared (Figure 2).
This showed a significant increase in the trainees’ overall self-rating
on basic family therapy skills following the training (pre training total
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

Family Therapy Around the World 49

FIGURE 2. STRS Raw Scores (N = 31)

100

90

80

70
Value

60

50

40

30
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
Case Number
Lower box shows pre score
Upper box shows post score

rating mean = 55.6, standard deviation = 11.8; post training total rating
mean = 70.5, standard deviation = 10.9; t = 7.44, p < .001).
Next, we compared mean pre and post ratings for each of the 24
items. On 22 items, there was a significant difference in the mean
ratings (see Table 1). This indicates that the trainees perceive an im-
provement in perceptual skills required for keeping focus on certain
issues in the session. This skill may involve tracking of themes, dis-
criminating multiple messages from the family members, and seeking
clarifications. Further, trainees perceive that they have learnt to reflect
neutrality, keep family connected to the therapy process, manage pro-
cess issues in session, work with alternatives in therapy, use of fami-
ly’s strengths, and handling family crisis. They are able to understand
the family, hypothesize about the family problem, and develop family
assessment skills.
There was no significant change at the pre and post assessment of
STRS on two specific skills (Item 11 and Item 18): displaying flexibil-
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

50 JOURNAL OF FAMILY PSYCHOTHERAPY

TABLE 1. Comparison of Pre and Post Mean Rating on STRS Items

ITEM NUMBER MEAN–PRE(S.D.) MEAN–POST(S.D.) T-VALUE

1 2.26 (0.87) 2.83 (0.93) 2.47*

2 2.61 (0.76) 3.16 (0.64) 3.44**
3 2.65 (0.88) 3.19 (0.64) 2.88**
4 2.42 (1.12) 3.00 (0.63) 2.97**
5 2.68 (0.70) 3.22 (0.81) 3.77**
6 1.61 (0.99) 2.48 (1.00) 3.78**
7 1.77 (0.85) 2.45 (0.89) 3.99**
8 2.58 (0.89) 3.16 (0.86) 3.50**
9 2.26 (1.03) 2.97 (0.80) 3.05**
10 2.71 (0.69) 3.10 (0.83) 2.55*
11 2.74 (0.97) 2.77 (0.88) 0.17
12 2.03 (1.02) 2.87 (0.89) 3.68**
13 2.45 (0.81) 3.13 (0.72) 3.99**
14 1.87 (1.02) 2.61 (0.76) 2.87**
15 2.22 (1.05) 2.94 (0.85) 3.69**
16 2.19 (0.87) 2.94 (0.68) 4.00**
17 2.22 (0.96) 3.03 (0.75) 4.93**
18 2.97 (0.60) 3.25 (0.68) 1.96
19 2.00 (0.82) 2.58 (0.85) 4.23**
20 1.83 (0.97) 2.55 (0.72) 4.57**
21 2.29 (0.94) 2.90 (0.87) 3.14**
22 2.71 (1.13) 3.38 (0.62) 3.85**
23 2.16 (0.78) 2.77 (0.81) 3.57**
24 2.32 (0.95) 3.16 (0.69) 5.43**

*p < .05, ** p < .01

ity in interventions, and maintaining a hopeful attitude. This could

mean that these two specific skills may be more difficult for trainees
since our training program may not be providing enough opportunity
to assimilate these skills. The second skill may also be a function of
trainees’ vulnerable emotional state. One of the factors that may have
an indirect bearing on these skills is the trainees’ youth (as they are
mostly unmarried and in their mid twenties). This often makes family
members challenge their competence to judge relationships. More-
over, our trainees are usually dealing with families in older life cycle
stages. Thus, quite often, families relate to the trainee as a son or a
daughter, thus making therapeutic alliance difficult. Similarly, male
‘doctor’s’ authority is more acceptable to families than female thera-
pists from other disciplines. Some of these factors may have in-
fluenced the scores on the above two items. Further, since most of the
trainees are in the launching out stage, they may be holding an idealis-
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

Family Therapy Around the World 51

tic view of relationships. This may be a problem across all therapeutic

interventions. We need to reconstruct our thoughts on this issue.
Should it be evaluated at all? Should the training emphasize more on
creating an optimistic view of dysfunctional families?
Thus, the study offers preliminary evidence towards the effective-
ness of our one month family therapy training program in improving
certain basic family interview and therapy skills. We are aware that
some of the findings may be an artifact of the small sample and
limitations of our measures. The methods used in this study are not
completely comparable to various evaluation studies described by
Avis and Sprenkle (1990). However, we developed the measures at the
center, since reliable and valid Western measures do not match the
short-term training objectives of our training program. The item selec-
tion procedure used ensures that our measures have face validity and
content validity, but other reliability and validity studies are still in
progress. Moreover, with this small sample it was not possible to study
the impact of trainee variables like: gender, marital status, clinical
experience level, and previous experience in psychotherapy. Current-
ly, we are examining these issues in ongoing evaluation, along with
new efforts to evolve multiple measures of change. Data from trainees
receiving three-month training at the center is currently being ana-
lyzed.
These findings provide empirical support to the positive feedback
from the trainees regarding the training program. The results also
support that part of the training objectives is being achieved. We hope
that in the future these evaluation programs will be useful to generate a
database for restructuring the training programs, and matching these to
different types of trainees. It would also be beneficial for comprehend-
ing family therapy training requirements in this kind of multidiscipli-
nary mental health context.
The study points out the usefulness of running family therapy train-
ing programs as a part of mental health training. Perhaps the unique-
ness of the training center has made it possible to have specific gains
within a short period of one month exposure. Further, the background
being a multidisciplinarian training through clinical practice, this may
have also affected the impact of the training. The setting does not use
systemic understanding in general but the primary aim of the family
therapy training is to introduce trainees to a systemic framework when
working with patients and their families. Shields, Wynne, McDaniel,
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

52 JOURNAL OF FAMILY PSYCHOTHERAPY

and Gawinski (1994) have touched upon these as important issues in

ongoing controversies about marginalization of family therapy from
mainstream mental health practice. One group of family therapists
believes that training should occur in a setting that provides opportuni-
ties for practice, too, and that it must remain integrated with larger
practice and services in mental health. In our setting, family therapy
training has to be integrated within a larger mental health training
program. Our brief family therapy training program does achieve this
objective. However, further research needs to examine this with a
multi method approach and identify specific impact of the program for
trainees from different disciplines, with different psychotherapy expe-
riences, and varying family related personal experiences.
Family therapy training in similar cultures may need to satisfy
complex demands in services and training. For example, in India, our
trainee-therapists often work through linguistic nuances in therapy
even when they may not be comfortable in the family’s spoken lan-
guage. This is so, as with so few family therapists available, training
centers have no other choice but to make do with therapists who can
‘manage’ the family’s language.
Similarly, training must give opportunities for trainees to compre-
hend cultural identities of their families. It must also address many
other cultural factors presented in the initial section of this paper. In
our training, we incorporate these issues in our supervision discus-
sions and in reflecting team dialogues. We have found that training
brings best results through work with live families and group discus-
sions with trainees on these issues rather than video demonstrations.
Globalization and liberalization processes are altering the family in
many ways in countries like India. For family therapy training, the
traditional hierarchy in families must be understood. Simultaneously,
the needs and conflicts of the transitional families must be acknowl-
edged. Transitional status of certain Indian families has also been
identified in a study conducted on a community sample representing
mostly Hindu, urban, educated, and middle socio economic status
families. It showed that these families have an overall pattern of being
flexibly separated on FACES II (Bhatti, Shah, and Udaya Kumar,
1998). This implies that certain Indian families are regrafting their
normative order. Family assessment procedures should be able to
comprehend these changes in families and create suitable goals. In
addition to these issues, we have discussed in one of our earlier papers
Downloaded by [NIMHANS National Institute of Mental Health & Neuro Science], [Anisha Shah] at 20:51 05 February 2015

Family Therapy Around the World 53

that involving the head of the family makes it easier to achieve radical
changes in therapy (Bhatti et al., 1980). Similarly, goals of therapy are
often set by larger systemic factors. For example, in India, family
therapy is more confidently carried out when preserving relationships
(with various constraint factors determining this) than when separa-
tion is the main agenda. We hope that some of these factors can be
identified more clearly as our training programs become more refined,
and we are able to inspire similar training programs in other centers.

REFERENCES
Avis, J. M., & Sprenkle, D. H. (1990). Outcome research on family therapy training:
A substantive and methodological review. Journal of Marital and Family Thera-
py, 16, 241-264.
Bhatti, R. S., Janakiramaiah, N., & Channabasavanna, S. M. (1980). Family psy-
chiatric ward treatment in India. Family Process, 19, 193-200.
Bhatti, R. S., Shah, A., & Udaya Kumar, G. S. ( 1998). Study of Family Dimensions
in Indian Families. Indian Journal of Social Psychiatry, 14, 22-29.
Bhatti, R. S., & Varghese, M. (1995). Family Therapy in India. Indian Journal of
Social Psychiatry, 11, 30-34.
Breunlin, D. C., Schwartz, R. C., Krause, M. S., & Selby, L. M. (1983). Evaluating
family therapy training: The development of an instrument. Journal of Marital
and Family Therapy, 9, 37-47.
Channabasavanna, S. M., Andrade, C., Rasquinha, L. P., & Desai, N. G. (1987).
Family therapy at NIMHANS. Indian Journal of Social Psychiatry, 3, 368-378.
Figley, C. R., & Nelson, T. S. (1990). Basic family therapy skills II: Structural family
therapy. Journal of Marital and Family Therapy, 16, 225-239.
Raguram. A. (1996). Training in marital therapy. In Malavika Kapur, C. Shamsunder,
& R. S. Bhatti (Eds.), Psychotherapy Training in India. NIMHANS Publication
(No. 36). Bangalore: NIMHANS.
Shields, C. G., Wynne, L. C., McDaniel, S. H. & Gawinski, B. A. (1994). The
marginalization of family therapy: A historical and continuing problem. Journal
of Marital and Family Therapy, 20, 117-138.
Tucker, S., & Pinsof, W. (1984). The empirical evaluation of family therapy training.
Family Process, 23, 437-456.
Varghese, M., Bhatti, R. S., Raguram, A., Prabha, S. C., Udaya, G. S., & Shah, A.
(1996). Training in family therapy. In Malavika Kapur, C. Shamsunder & R. S.
Bhatti (Eds.), Psychotherapy Training in India. NIMHANS Publications (No. 36)
Bangalore: NIMHANS.

View publication stats