Fam Proc 20:155-166, 1981

Family Therapy Training in Clinical Psychology ProgramsAARON COOPER, PH.Da

CHERYL RAMPAGE, PH.Db

GERALD SOUCY, M.A.c

aCalifornia Graduate School of Marital and Family Therapy, San Rafael, California.bUniversity of Houston at Clear Lake City, Texas.cPh.D Candidate, DePaul University, Chicago, Illinois.

In a national questionnaire survey of graduate programs offering the Ph.D. or Psy.D. in clinical psychology, thestatus of family therapy training was examined. With a 79 per cent response rate (102 programs), the study found that 10per cent of the nationwide faculty identified themselves as primarily family therapy oriented, 32 per cent of the programshad no family-oriented faculty members, 18 per cent of all psychotherapy courses were family therapy courses, and 21per cent of the schools had no family therapy course. The ratings of the importance of providing students with familytherapy training were found to be unrelated to the number of family therapy courses available but positively correlatedwith the percentage of family therapy courses within the total curriculum.

I. PH.D AND PSY.D. PROGRAMSThe status of family therapy training among the clinical psychology Ph.D. and Psy.D. programs in this country has not

been comprehensively assessed. Mental health practitioners seem to believe intuitively that with the growing interest infamily research and treatment in the last fifteen years, graduate programs have at some level incorporated an awareness ofthe burgeoning family movement. In what way and to what extent this has occurred remain questions that have not beencarefully examined. Whereas one program may offer one or more formal courses in family treatment, another program maygive only lip service to the family approach by acknowledging family treatment when it is discussed as part of a casepresentation in a practicum course. Contrasts such as this can represent a fundamental difference in trainingphilosophyinformation that may be important to prospective students selecting a school, as well as to funding sourcesseeking to evaluate their disbursements.

Until now, there has been little discussion of family therapy's position within academic psychology training. Bodin (1)cited only three family therapy training programs within academia, noting that the literature did not yet reflect the growth ofthis modality within graduate schools. Stanton (5) wrote that "only recently has acceptance of the family systems approachto therapy begun to creep into academic psychology departments" (p. 433). Along with a number of internship facilities,Stanton cited 10 clinical programs offering family therapy training. Although extensive descriptions of several specificacademic programs with family therapy training can be found in the literature, (e.g., 3), these articles provide no sense ofthe overall national picture. Furthermore, most descriptions of programs within graduate schools or internship sites tend toneglect a discussion of family training as a distinct entity within the curriculum, separate from child or individualpsychotherapy (e.g., 6).

The present study was begun in 1977 as a response to the senior authors' observations from their own graduate trainingthat family therapy, although increasingly discussed, researched, and practiced (particularly among the many less traditionalagencies, such as community mental health centers), seemed to occupy in academic departments a distinctly third-classstatus because of its position as a newcomer to the psychotherapeutic armamentarium. We decided to investigate the natureof family therapy training among all graduate Ph.D. and Psy.D. programs, in order to determine how frequently otherschools mirrored what was true for our own.

MethodA questionnaire was developed and sent to all 131 graduate schools offering the Ph.D. or Psy.D. in clinical psychology

and listed in Graduate Study in Psychology 1977-1978, published in 1976 by the American Psychological Association.Both APA and non-APA approved clinical programs were included in this population. Second and third mailings followedthe initial mailing at approximately 10-week intervals, to those schools that had not responded to the earlier contact.

It was hoped that this study would shed light on the comparative status of family therapy training within programs havingdifferent theoretical orientations (e.g., analytic, behavioral, client-centered, eclectic). Unfortunately, many respondentsselected more than one orientation, when responding to this question, resulting in data that are not independent and for

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which valid statistical analyses cannot be performed.

Results1

The 102 responses received from 38 states and the District of Columbia represent a 79 per cent return rate. Thefollowing states were most represented: New York, 13; California, 10; Illinois, 8; Ohio, 7; and Texas, 6. The distributionby national region was: 22 responses from the 12 Northeast states, 25 from the 12 Midwest states, 33 from the 14 Southernstates, and 22 from the 11 Western states.

As stated above, because the question on theoretical orientation was not phrased according to a forced-choice format, anumber of respondents indicated multiple orientations, resulting in percentage totals exceeding 100. The three majororientations designated were "eclectic" (63 per cent), "behavior modification" (34 per cent) and "psychoanalytic" (22 percent).

Among the 102 schools in the sample, the average percentage of faculty members identifying themselves as primarilyfamily oriented was 10 per cent, with a range within individual programs of zero to 100 per cent (see Table I); 32 per centof the programs reported having no faculty member so identified.

Table 1Family Therapy Training Profile by National Region

Questionnaire Item Northeast Midwest South West Overall

% faculty having family therapy asprimary clinical interest

6% 15% 11% 10% 10%

Avg. no. individual adult therapycourses

3.00 3.04 2.41 3.59 2.90

No. child therapy courses 1.71 1.32 1.12 1.45 1.40

No. group therapy courses .84 1.24 1.00 1.00 1.00

No. family therapy courses .80 1.20 1.12 1.14 1.08

Importance of adult therapya 4.27 4.92 4.75 4.52 4.64

Importance of child therapy 3.82 4.16 4.06 3.86 3.99

Importance of group therapy 3.14 3.60 3.78 3.14 3.46

Importance of family therapy 3.32 3.60 3.87 3.29 3.56

No. required therapy courses 2.42 3.44 3.42 3.95 3.34a Importance ratings ranged from 1.0 to 5.0.

By geographical location, the Midwest (15 per cent) reported the highest percentages of family-oriented faculty, followedby the South (11 per cent), the West (10 per cent), and the Northeast (6 per cent).

An average of 2.9 and 1.4 individual adult and child therapy courses were offered, respectively, among the entire sample,followed by 1.08 family therapy courses and 1.0 group courses. Overall, 18 per cent of all available psychotherapy courseswere identified as courses in family therapy. Twenty-one percent of the academic programs reported offering no course infamily treatment.

A number of additional variables were found to be both positively and negatively correlated with the availability of afamily therapy course in a graduate clinical program. The number of family therapy courses correlated positively with thenumber of courses in individual adult psychotherapy, r (94) = .32, p < .01; child psychotherapy, r (94) = .23, p < .05; andgroup psychotherapy, r (96) = .37, p < .01. It would appear that schools with a psychotherapeutic orientation are committedto a generalist training approach and offer courses in all areas.

In the total sample, the rating of family therapy's importance was found to be unrelated to the absolute number of familycourses offered, as well as unrelated to the frequency with which such courses were offered from year to year. However, theimportance rating was positively correlated with the percentage of family courses within the total curriculum, r (98) = .21,p < .05.

A family therapy course requirement was believed to be an additional way of assessing a program's commitment tofamily training, particularly when any therapy courses were required. For the entire sample, the average number of requiredtherapy courses was reported to be 3.34, with a range of zero to 15. On this dimension, the clinical programs in the West(with 3.95) had the highest average number of psychotherapy course requirements, followed by the Midwest (3.44), theSouth (3.42), and the Northeast (2.42). Eight programs8.3 per cent of the samplereported having no psychotherapy

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course requirements whatsoever.A family treatment course was rarely cited as a requirement of a clinical program. Only 15 of the 102 schools reported

making this demand on their students.Across the total national sample, family therapy fell behind adult and child therapy but ahead of group therapy in terms of

being deemed an essential part of the graduate clinical curriculum (see Table I).

When the data for only those graduate schools offering at least one family treatment course were analyzedreducing thesample size to 79the same correlational trends were observed for the importance rating, the number of family therapycourses, and the frequency of family therapy course offerings. Additionally, the rating of family therapy's importance wasconsistently negatively related to the total number of students in the clinical program for all three sample years (1975: r(75) = -.20, p < .05; 1976: r (75) = -.22, p < .05; 1977: r (76) = -.26, p < .05). This relationship was not found when theentire sample's data were analyzed.

Comparing the group of programs offering at least one family course (N = 79) with the group offering none (N = 21), theformer rated the importance of family therapy on the average as 3.69, compared with 3.1 for the latter (t (97) = 2.53, p <.01). The first group reported 12.5 per cent of its faculty oriented primarily to family treatment, whereas the second groupreported 4.1 per cent (t (95) = 2.60,p < .01). The first group also had an average of 3.47 required therapy courses, whereasthe second had 3.0, a non-significant difference.

DiscussionApproximately one-third of all graduate clinical Ph.D. and Psy.D. programs had no faculty member oriented primarily to

family treatment, and one-fifth of the schools did not offer a single family treatment course. Thus, as recently as 1978, asubstantial number of academic clinical psychology programs offered no didactic training in family therapy. TheMidwestnot generally considered to be the geographical region at the forefront of the family therapymovementappeared to be the region in which a clinical student could most likely receive family therapy training or comeinto contact with a faculty member whose primary professional identity was as a family therapist. The Northeast section ofthe country seemed to offer the least amount of formal coursework in family training, with both the lowest percentage offamily-oriented and the lowest average number of courses in family therapy.

What became apparent in this study was the absence of a consistent relationship between a school's estimation of theimportance of training in a certain treatment modality (relative to the estimation of other schools) and the relative number ofcourses offered in that area. For example, the schools in the Northeast gave child psychotherapy the lowest overallimportance rating among the four regions of the country, although in practice these schools offered the highest averagenumber of child therapy courses across the sample. For family treatment, the South awarded an importance value of3.87highest among geographic regionsalthough ranking third after the Midwest and the West in the average number offamily treatment courses offered. It comes as no surprise that self-report by academic programs as a means of indicatingtheir training philosophy is probably less instructive than a description of the program's actual curriculum, faculty interests,and course enrollments. To wit, the percentage of family treatment courses within the curriculum of schools offering at leastone family course proved to be one of the only variables positively correlated with the rating of family therapy as animportant component of a student's training experience. Additionally, the fact that the percentage of clinical studentsenrolled in a family therapy course was positively correlated with the importance attributed to family therapy trainingsuggests that certain programs are successful in influencing (or requiring) students to enroll in family courses and that thoseprograms tend to place a high premium on their students' exposure to family treatment. (Conversely, it may be that theimpetus toward family therapy originates from the students and that the department is merely reflectingin assigning tofamily therapy a high importance ratingwhat is in fact the students' interest, rather than the program's objectives.)

Although this research appears to suggest that family therapy training has not attained the position that child therapytraining appears to hold, a school's commitment to training in one area (e.g., adult psychotherapy) was found to be areliable predictor of a commitment to training in other areas (e.g., child and family therapy), suggesting that graduatetherapy training typically implies a commitment to all four major psychotherapy training areas (i.e., adult, child, group, andfamily). These findings suggest that a broad psychotherapeutic foundation rather than specialization is a prevailingobjective among the programs responding to this study, although the 21 per cent of programs offering no family treatmentwhatsoever were obviously falling short of this objective.

The following list identifies those schools that stood apart from the norm in the degree of their commitment to familytherapy training. As this study has shown, no single variable alone adequately indicates a program's family therapy trainingcommitment. For example, a high importance rating for family therapy did not necessarily predict the presence of even onefull course in family therapy.

The following programs awarded to family therapy the highest importance rating and reported offering and requiring atleast one full family therapy course (values in parentheses represent the number of different family therapy courses offered):

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1. Brigham Young University, Provo, Utah (1) 2. DePaul University, Chicago, Illinois (1) 3. East Texas State University, Commerce, Texas (3) 4. Georgia State University, Atlanta, Georgia (1) 5. Southern Illinois University, Carbondale Illinois (2) 6. University of Delaware, Newark, Delaware (1) 7. University of Utah, Salt Lake City, Utah (1) 8. Virginia Polytechnic Institute, Blacksburg, Virginia (1)

The following schools awarded to family therapy the highest importance rating but did not require a family therapycourse:

1. California School of Professional Psychology, Fresno, California (2) 2. Fordham University, New York, New York (1) 3. Long Island University, Brooklyn, New York (1) 4. Michigan State University, East Lansing, Michigan (3) 5. Northwestern University Medical School, Behavioral Sciences Program, Chicago, Illinois (3) 6. University of Virginia, Charlottesville, Virginia (2)

The following schools awarded to family therapy the second highest importance rating and required a family therapycourse:

1. Hofstra University, Hempstead, New York (1) 2. Memphis State University, Memphis, Tennessee (2) 3. North Texas State University, Denton, Texas (4) 4. University of Houston, Houston, Texas (3) 5. University of Kansas, Lawrence, Kansas (3) 6. University of South Dakota, Vermillion, South Dakota (1)

Possibly the next few years will witness a substantial increase in the attention given to family therapy courses in clinicalpsychology programs and a concomitant narrowing of the gap between perceived importance of such training and its actualavailability in the program.

REFERENCES

1. Bodin, A. M., "Family Therapy Training Literature: A Brief Guide," Fam. Proc., 8, 272-279, 1969. 2. Khol, T., Matefy, R. and Turner, J., "Evaluation of APA Internship Programs: A Survey of Clinical Psychology

Interns," J. Clin. Psychol., 28, 562, 1972. 3. L'abate, L., Berger, M., Wright, L. and O'shea, M., "The Training of Family Psychologists: The Family Studies

Program at Georgia State University," Prof. Psychol., 10, 58-65, 1979. 4. Shemberg, K. M., Keeley, S. M. and Leventhal, D. B., "University Practices and Attitudes of Clinical Directors,"

Prof. Psychol., 7, 14-20, 1976. 5. Stanton, M. D., "Family Therapy Training: Academic and Internship Opportunities for Psychologists," Fam.

Proc., 14, 433-39, 1975. 6. Tuma, J. M. and Cerny, J. A., "The Internship Marketplace: The New Depression?", Am. Psychol., 31, 664-670,

1976.

In a national questionnaire survey of clinical psychology internship sites, the status of family therapy training wasinvestigated. With a 65 per cent response rate (182 sites), the study found that 11 per cent of all psychology Ph.D.'s, 9per cent of all M.S.W.'s and 2 per cent of all M.D.'s on internship faculties considered themselves to be primarily familytherapy oriented. Nationwide, 39 per cent of 177 internships indicated that some family therapy training was arequirement of the program; for the remaining 61 per cent, family therapy training was either optional or unavailableentirely. Of the five areas of adult, child, group, and family therapy, and psychodiagnostics, interns were viewed by mostprograms as being least prepared at the start of the internship to do family therapy. In terms of internship trainingphilosophy, family therapy was rated fourth in overall importance as an essential component of an intern's experience.The family training importance rating was found to be correlated positively with the number of family courses andseminars offered, family supervision received, and family clinical work performed.

II. INTERNSHIPS

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Family therapy training within clinical psychology internship programsboth APA and non-APA approvedwasinvestigated as part of a nationwide survey examining the spectrum of formal family therapy training opportunities for theclinical psychology student. Statements such as Stanton's (4) in 1975,

Of the three professions that are the source of a majority of family therapists, psychology, in comparison to socialwork and psychiatry, has shown the greatest lag (in embracing and applying a family approach in the psychotherapytraining of its students. [p. 433]

stimulated us to question the nature and prevalence of family therapy training for psychologists during the years of formalgraduate study. The research for this paper was begun in 1977.

Most descriptions of internship programs in the literature fail to differentiate family training from other psychotherapyapproaches (2, 5). One of the earliest references to family therapy training in internship settings (6) suggested that suchtraining "is probably both exceptional and fortuitous" and that students "have to learn (their) craft either through a specialpostdoctoral clinical residency year in a center specializing in this approach, or else...by doing it as the pioneers did" (p.100).

In 1975, Stanton (4) cited 12 internships that offered family-therapy-related seminars and supervision, five of which hada "major family emphasis." In a 1976 survey of APA-approved internship facilities (3), 85.3 per cent of the respondingprograms indicated the availability of a "family therapy training experience." However, information about size offamily-oriented faculty, numbers of family courses, hours of family supervision, etc., remained unspecified.

The senior authors' observation from their own graduate training was that family therapy seemed to occupy in internshiptraining programs a third-class status behind adult and child therapy training. We decided to investigate this impressionmore objectively and on a large scale.

Method

A questionnaire was developed and sent to all 280 American predoctoral sites listed in Internship Programs inProfessional Psychology, published in 1977 by the Association of Internship Centers. Both APA and non-APA approvedprograms were included in this population. Second and third mailings followed the initial mailing at approximately10-week intervals to those internship sites that had not responded to the earlier contact.

Results2

The 182 responses received from 38 states and the District of Columbia represent a 65 per cent return rate. Thefollowing states were most represented: New York, 28 responding internship sites; California, 16; Massachussetts andTexas, 12 each; Illinois 11; and Pennsylvania, 10. The distribution by national region was as follows: 66 responses werereceived from 12 Northeast states; 46 responses from 12 Midwest states; 30 responses from 11 Western states; and 39responses from 14 Southern states.3

For the entire sample, the breakdown of clinical staff by theoretical orientation was 13 per cent behavior modification, 22per cent analytic, 7 per cent client-centered, 55 per cent eclectic, and 6 per cent other.4

Table II indicates the numbers of clinical staff whose primary professional interest was family therapy, broken down byregion and profession.

Table 2Number of Family-Oriented Staff, by Region and Profession

NE M W S Overall¹X % ¹X % ¹X % ¹X % ¹X %

Full-time Ph.D .74 (5) .74 (6) .79 (5) 1.10 (7) .83 (6)

Part-time Ph.D .85 (6) .91 (6) .90 (4) .51 (2) .79 (5)

Full-time MDa .14 (1) .09 (0) .18 (1) .44 (3) .19 (1)

Part-time MD .27 (2) .38 (2) .24 (1) .10 (0) .26 (1)

Part-time MD .59 (4) .63 (5) .75 (6) 1.03 (7) .72 (5)

Part-time MSW .59 (6) .43 (2) .59 (3) .26 (1) .48 (4)

Full-time other .05 (1) .04 (1) .00 (0) .26 (1) .08 (1)

Part-time other .02 (0) .07 (0) .07 (1) .00 (0) .03 (0)

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a F (3,175) = 3.46, p < .025

Overall, internships reported a mean of .83 fulltime and .79 parttime family-oriented psychologists (6 and 5 per cent,respectively). Only in the South did the mean number of family-oriented staff psychologists exceed one full-time staffmember ( ¹X = 1.10). The South also reported the highest number of family-oriented staff social workers ( ¹X = 1.03).

There was a fairly uniform perception among respondents that interns were most prepared to do adult therapy and leastprepared to do family therapy (see Table III). The majority of the programs, in fact, perceived their interns to besignificantly less prepared in family therapy than in other areas (p < .001). This observation was consistent among allgeographic regions. Overall, interns were perceived to be significantly less prepared for family therapy than for both adulttherapy (p < .01) and psychodiagnostics (p < .01). The South perceived less family therapy preparation than both group (p< .05) and child therapy (p < .01) preparation.

Table 3Interns' Level of Preparation in Five Clinical Areas, By Region

NE M W S Overall F df p

Adult Therapy 2.31a 2.18 2.52 2.29 2.30 NS

Child Therapy 1.58 1.38 1.73 1.72 1.59 3.01 3,150 .05

Group Therapy 1.63 1.60 2.07 1.62 1.70 5.47 3,168 .01

Family Therapy 1.48 1.26 1.57 1.37 1.41 2.82 3,168 .05

Psychodiagnostics 2.08 2.09 2.25 2.21 2.13 NS

2-way analysis of variance:

region effect: F (3,150) = 66.02, p < .001

clinical area effect: F (4,600) = 75.24, p < .001

region X clinical area interaction: F (4,600) = 16.48, p < .01a 1 = little; 2 = some; 3 = much.

In the area of formal training (see Table IV), the national mean for courses offered within an internship program was 4.0,with a range of 1-16.4. The national mean for weekly seminar hours was 5.49, with a range of 0-23. No significantdifferences were found by region in numbers of courses offered, although significant differences were observed by clinicalarea. Family therapy courses ranked first overall in average percentage of total course offerings (29 per cent), followed byadult (21 per cent), child (16 per cent), and group (17 per cent) therapy courses.

Table 4Number of Coursesa and Seminar Hoursb Offered in Five Clinical Areas, by Region

NE M W S Overall¹X %c ¹X % ¹X % ¹X % ¹X %

Adult Therapy

Courses .82 (22) .45 (24) .89 (18) .56 (17) .68 (21)

Seminars 1.92 (30) 1.28 (31) 1.03 (25) 1.35 (25) 1.53 (28)

Child Therapy

Courses .60 (18) .21 (12) .53 (14) .44 (15) .46 (16)

Seminars 1.15 (14) .32 (8) .53 (9) .71 (10) .77 (11)

Group Therapy

Courses .45 (16) .27 (19) .42 (15) .39 (20) .39 (17)

Seminars .93 (14) .65 (15) .78 (19) .66 (10) .79 (14)

Family Therapy

Courses .79 (28) .30 (28) .53 (33) .58 (30) .59 (29)

Seminars 1.27 (20) .97 (22) .97 (21) 1.24 (29) 1.14 (22)

Psychodiagnostics

Courses .73 (29) .45 (33) .79 (34) .55 (30) .63 (30)

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Seminars 1.48 (23) .90 (23) 1.06 (26) 1.14 (26) 1.21 (24)a F (4,304) = 13.79, p < .001.b F (4,428) = 28.18, p < .001.c Indicates average percentage of total courses/seminars within programs.

Table 5Hours of Clinical Experiencea and Supervisionb in Five Clinical Areas, by Region

NE M W S Overall¹X % ¹X % ¹X % ¹X % ¹X %

Adult Therapy

Clinical Work 5.59 (36) 6.20 (35) 6.34 (34) 6.00 (32) 5.98 (35)

Supervision 2.49 (32) 2.29 (32) 2.05 (28) 2.80 (30) 2.44 (31)

Child Therapy

Clinical Work 2.10 (13) 2.44 (13) 2.29 (13) 3.00 (16) 2.38 (14)

Supervision 1.00 (12) 1.17 (12) 1.00 (15) 1.69 (19) 1.18 (14)

Group Therapy

Clinical work 2.44 (15) 2.78 (15) 3.19 (19) 2.93 (15) 2.74 (16)

Supervision 1.32 (16) 1.42 (20) 1.17 (20) 1.07 (12) 1.26 (16)

Family Therapy

Clinical Work 2.10 (15) 2.69 (14) 1.92 (10) 2.60 (13) 2.32 (14)

Supervision 1.12 (18) 1.08 (14) 1.11 (16) 1.60 (19) 1.21 (17)

Psychodiagnostics

Clinical Work 3.43 (21) 3.88 (22) 4.58 (24) 4.79 (24) 3.98 (22)

Supervision 1.71 (22) 1.73 (22) 1.61 (21) 2.22 (21) 1.80 (22)a Significant differences by clinical area: F (4,420) = 37.02, p < .001.b Significant differences by clinical area: F (4,480) = 47.88, p < .001.

In terms of the philosophy of internship training, family therapy ranked fourth in overall importance, followed only byindividual child therapy (see Table VI). Family therapy experience was rated significantly less important than adult therapyexperience (t (644) = 11.97, p < .001), group therapy experience (t (644) = 3.1, p < .01), and psychodiagnostic experience(t (644) = 9.45, p < .001).

Table 6Importance Ratings of Five Clinical Areas Within Training Philosophy, by Region

NE M W S Overall

Adult Therapy 4.21a 4.22 4.48 4.38 4.30

Child Therapy 3.10 2.76 2.93 3.24 3.01

Group Therapy 3.79 3.49 3.97 3.58 3.70

Family Therapy 3.68 3.30 3.52 3.45 3.49

Psychodiagnostics 4.25 4.09 4.34 3.87 4.13

2-way analysis of variance:

region effect: F (3,161) = 17.77, p < .001

clinical area effect: F (4,644) = 291.67, p < .001

region X clinical area interaction: F (12,644) = 6.45, p < .001a 1 = minimal importance; 2 = somewhat important; = moderate importance; 4 = very important; 5 = essential.

Only 39 per cent of 177 respondents indicated that some form of family therapy training was a requirement of theprogram.

The importance ratings for the four psychotherapeutic approaches tend to reflect the percentages of ongoing therapy at

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internship sites. Nationwide, 17 per cent of all clinical cases were seen in family therapy, the lowest percentage of the fourapproaches. Adult therapy was used in 43 per cent of the cases, followed by group therapy (24 per cent) and child therapy(18 per cent). Differences among regions were not significant.

The importance rating assigned to family therapy was found to be highly correlated with the percentage of family courses(r = .37, p < .001), percentage of family seminar hours (r = .33, p < .001), percentage of ongoing family therapy at the site(r = .51, p < .001) and percentage of family supervision (r = .29, p < .25).

Data on specific aspects of family training included the finding that approximately equal amounts of cotherapist andsingle therapist treatment were utilized (48 percent and 44 per cent, respectively). The percentages for length of familytreatment sessions were reported as follows: 1-6 sessions, 28 per cent; 7-12 sessions, 27 per cent; 3-6 months, 20 per cent;and over six months, 12 per cent.

Sixty-four percent of 175 internship programs reported that new cases received formal diagnostic evaluations. Only 32per cent of those programs indicated having a special format for family diagnostics. Of eight family supervision formatsspecified in the questionnaire,5 individual supervision was most widely used ( ¹X = 2.67), followed bysupervisor-as-cotherapist (2.08), group supervision (2.06), live supervision (2.02), videotape (1.95), process notes (1.89),role play (1.77) and family of origin (1.62).

The following family therapists were cited most often as strongly influencing family training: Minuchin, 27 citations;Haley, 13; Satir, 11; Bowen, 8; Whitaker, 7; Watzlawick, 6; Erickson, 5; and Ackerman, 5. These data were fairlyconsistent among regions, although there was a tendency for programs to acknowledge theorists working in their owngeneral locale.

The four elements of family seminars, courses, supervision, and clinical work were all found to be highly positivelycorrelated to one another, with correlation coefficients ranging from .46 for the percentage of family courses with thepercentage of family supervision (p < .025) to .87 for the percentage of family courses with the percentage of familyseminar hours (p < .001). The amount of family training was not related to the interns' level of preparation in the familyarea, although family courses, seminars, supervision, and clinical work were all positively correlated with the importancerating awarded to family therapy (r = .37, p < .001; r = .33, p < .001; r = .51, p < .001; r = .29, p < .025, respectively). Theamounts of family training along the four measured dimensions were also related beyond the .001 level to the percentage ofclients seen in family treatment, and this percentage was highly positively correlated with the family therapy importancerating (r = .48, p < .001).

DiscussionThe fact that internship programs nationwide reported that clinical psychology students came to them least prepared in

the area of family therapy did not seem to influence the amount of available family therapy training; prior family preparationand extent of family training were not found to be statistically associated. Rather, family training was related to a program'sassessment of the importance of such training as a part of the students' development. Those programs that valued familytraining more highly tended to offer courses, seminars, supervision, and direct clinical experience in this area to a greaterdegree than programs that rated family training as less valuable. At the same time, there were programs that rated familytraining as "essential" but offered little formal instruction in it. Several factors may account for this apparent discrepancy.

A number of sites that rated family therapy "very important" or "essential" reported having few or no staff whose primaryprofessional interest was families. This would necessarily place contraints on the quantity of family teaching andsupervision. Perhaps, too, the "training philosophy," as reflected by the persons completing the questionnaire, wasinconsisent with the hiring philosphy of the agency. Or perhaps internship sites, like graduate schools (see Part I), maintaina broad generalist training philosphy, while in practice the staff orientation, hours of coursework and supervision, etc.,reflect primarily the service needs of the agency. The results of this study support the view that the work of interns generallyreflects an agency's clinical service priorities, with formal training justifying this practice by establishing (via numbers ofcourses and seminars, etc.) certain views of psychopathology and approaches to psychotherapy as more important thanothers. Given that only 17 per cent of the clientele for this sample were seen in family therapy and that the importancerating assigned to family training was comparatively low, it is not surprising that only 39 per cent of internship programsrequired any family therapy training at all.

Two factors that reflect the second-class status of family therapy in this sample and impede its movement to a higherstatus are the absence in many programs of either full- or part-time family-oriented psychologists, and the absence of afamily diagnostic format. The absence of family-oriented psychologists as teachers and supervisors reduces the likelihoodof an intern adopting a primary identification as a family therapist or even seeing family therapy as a viable clinical tool fora psychologist. And because internship sites often hire their own students, the status of family therapy within the agency isperpetuated.

Furthermore, the format in which intake/admission data is organized shapes the definition of problems as well as the

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approach to treatment. Intake material oriented around a single identified patientwhich seems to be the format in mostagenciesinhibits the utilization of family treatment as a logical response to the presenting complaint. Only 32 per cent ofthe sample reported having an evaluation format that encourages a problem definition in family terms.

Albeit a discouraging view of family therapy's status among internship programs, the picture as represented in this studyis not without an encouraging element. In terms of formal training, the overall average percentage of courses was higher forfamily therapy than for the other treatment areas, with the percentage of family courses significantly greater than group andchild courses. Although this finding might be biased statistically by several programs whose coursework was almostentirely family oriented, alternatively it does indicate the presence of didactic family training at a level comparable to adultand psychodiagnostic training. It will probably require fundamentaland long-termchanges in agency practice at thelevels of intake and direct service provision before family training can move ahead in its position in graduate psychologyinternship training.

The following list identifies those internship programs that awarded to family therapy the highest importance rating andreported having some full or part-time staff whose primary professional interest was family therapy:

1. Baylor College of Medicine, Houston, Texas 2. Beech Brook Residential Treatment Center, Pepper Pike, Ohio 3. Beth Israel Hospital, Boston, Massachusetts 4. Child Guidance Center, Cleveland, Ohio 5. Children's Hospital of Michigan, Detroit, Michigan 6. Children's Psychiatric Center CMHC, Red Bank, New Jersey 7. Columbia Presbyterian Medical Center, New York, New York 8. Creedmoor Psychiatric Center, Queens Village, New York 9. Des Moines Child Guidance Center, Des Moines, Iowa 10. Eastern Pennsylvania Psychiatric Institute, Department of Family Psychiatry, Philadelphia, Pennsylvania 11. Forest Hospital, Des Plaines, Illinois 12. Hathaway Home for Children, Pacoima, California 13. Ingham CMHC, Lansing, Michigan 14. Jewish Board of Family and Children's Services, New York, New York 15. Kennedy Child Study Center, Santa Monica, California 16. McLean Hospital, Belmont, Massachusetts 17. Mendota Mental Health Institute, Madison, Wisconsin 18. Northeast Mental Health Center, Memphis, Tennessee 19. Pine Rest Christian Hospital, Grand Rapids, Michigan 20. Ravenswood Hospital CMHC, Chicago, Illinois 21. Regional Mental Health Center, Kokomo, Indiana 22. Rutgers Medical School-CMDNJ, Piscataway, New Jersey 23. San Fernando Valley Child Guidance Clinic, Northridge, California 24. Southshore MHC, Quincy, Massachusetts 25. Springfield Hospital Center, Sykesville, Maryland 26. Texas Research Institute of Mental Sciences, Houston, Texas 27. The Wheeler Clinic, Plainville, Connecticut 28. University of Arkansas Medical Sciences, Department of Psychiatry, Little Rock, Arkansas 29. UCLA School of Medicine, Division of Medical Psychology, Los Angeles, California 30. University of California Medical Center, Department of Psychiatry, San Francisco, California 31. University of Colorado Medical Center, Denver, Colorado 32. University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania 33. University of Texas Health Science Center, San Antonio, Texas 34. University of Texas Medical Branch, Galveston, Texas 35. V. A. Hospital, Durham, North Carolina 36. V. A. Hospital, Lebanon, Pennsylvania 37. V. A. Hospital, Tucson, Arizona 38. V. A. Medical Center, Albuquerque, New Mexico 39. V. A. Medical Center, Houston, Texas 40. V. A. Outpatient Clinic, Baltimore, Maryland 41. Western Missouri MHC, Kansas City, Missouri 42. Worcester Youth Guidance Center, Worcester, Massachusetts

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REFERENCES

1. Bodin, A. M., "Family Therapy Training Literature: A Brief Guide," Fam. Proc., 8, 272-279, 1969. 2. Khol, T., Matefy, R. and Turner, J., "Evaluation of APA Internship Programs: A Survey of Clinical Psychology

Interns," J. Clin. Psychol., 28, 562, 1972. 3. Matthews, J. R., Matthews, L. H. and Maxwell, W. A., "A Survey of APA-Approved Internship Facilities," Prof.

Psychol., 7, 209-213, 1976. 4. Stanton, M. D., "Family Therapy Training: Academic and Internship Opportunities for Psychologists," Fam.

Proc., 14, 433-439, 1975. 5. Tuma, J. M. and Cerny, J. A., "The Internship Marketplace: The New Depression?", Am. Psychol., 31, 644-670,

1976. 6. Williamson, D. S., "Training Opportunities in Marriage and Family Counseling," Fam. Coord., 22, 99-102, 1973.

1Only those results that seem to bear directly on our interest in assessing family therapy training are reported. Although moredata were obtained, their analysis is not reported here.

2Only those results that seem to bear directly on our interest in assessing family therapy training are reported. Although moredata were obtained, their analysis is not reported here.

3One response received from Hawaii was not included among the four major geographical regions.

4Among "other" orientations were rational emotive 8 responses; gestalt, 11; social learning, 7; and systems, 19. Because certainquestionnaire items were not worded in a forced-choice format, some respondents gave multiple answers, resulting in percentagetotals exceeding 100.

5These data were scored on a 3-point scale as follows; 1 = a little; 2 = some; 3 = a lot.

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