Whether you’re new to ESFT or deepening your practice, this conversation underscores a core truth of systemic work: context matters.
Watch the full video below — it’s the first in a series designed to expand your understanding of systemic principles and support continued professional growth. 👇
We’re excited to share the latest video from the Philadelphia Child and Family Therapy Training Center—Context Matters (Part 1)—featuring an insightful dialogue between trainers Lisa and Jennifer.
In this conversation, Lisa and Jennifer explore the essence of context in systemic family therapy, emphasizing how awareness of context transforms the way we approach families, relationships, and clinical practice. They dive into the importance of seeing beyond isolated behaviors to the broader systems in which clients live and interact—highlighting how systemic thinking elevates both assessment and intervention.
🎯 What you’ll learn in the video:
Why context is central to understanding family dynamics
How systemic awareness shapes therapeutic engagement
Practical ways to bring systemic perspective into training, supervision, and treatment
Stay tuned for Part 2, where Lisa and Jennifer continue this rich conversation!
Recently, Dr. Amber Berkoski shared her reflections after reading “A Research-Driven Flow Chart to Approach Change in Couples,” Capozzi (2025). Her response highlights an issue many systemic clinicians quietly observe—but don’t always name clearly.
Too often, therapists assume that if they are competent working with individuals, they can seamlessly transition into working with couples. But individual therapy and couples therapy are not interchangeable skill sets. They require different lenses, structures, and ethical decision-making models.
As Dr. Berkoski noted, many couples arrive in her practice having been unintentionally harmed—not by unethical therapists, but by well-meaning clinicians who lacked a clear systemic framework. Without a structured decision-making model guiding whether to provide individual therapy, couples therapy, or both (and how), the work can quickly drift into triangulation.
When a therapist works individually with one partner while also attempting couples work without clear boundaries, predictable patterns emerge:
Alliances become imbalanced.
One partner feels unheard or pathologized.
Therapy reinforces existing power struggles.
The relationship strain intensifies rather than resolves.
This is not simply a technical mistake—it is a systemic one.
Couples therapy is not “individual therapy times two.” It requires a shift from intrapsychic formulation to interactional formulation. The identified problem is not housed within one partner; it is organized between them. Without a systemic frame, therapy can inadvertently place pressure on one person to change, reinforcing the very dynamics the couple is seeking relief from.
Dr. Berkoski’s appreciation for Capozzi’s research-driven flow chart speaks to something essential: structure protects both clinicians and clients. A clear model guides ethical decision-making. It helps therapists discern:
When individual work is indicated
When systemic work is necessary
When combining modalities risks harming the alliance
When couples present for help, they are struggling with chronic problems in the relationship and want insight into who needs to be ‘fixed’. However, systemic practice tells us the question is not, “Who is the problem?” but rather, “What problems reside in the relationship we can better understand?”
In systemic practice, structure is not rigidity. It is protection. It protects the alliance. It protects the couple. And it protects the therapist from drifting into triangles that feel helpful in the moment but destabilizing over time.
Couples therapy deserves its own decision-making model and a commitment to systemic thinking. When clinicians embrace that distinction, couples experience feeling heard, understood, and held within a coherent therapeutic structure.
Joining is often misunderstood as being “nice,” agreeable, or overly supportive. In systemic family therapy—and especially in ESFT—joining is not:
Taking sides with the child or the caregiver
Agreeing with everyone to avoid conflict
Being passive, overly validating, or permissive
Avoiding tension, disagreement, or discomfort
Building rapport at the expense of therapeutic direction
Joining is not about approval. It is not about aligning with behavior. And it is not about making everyone feel comfortable at all times.
When joining becomes appeasement, it weakens caregiver leadership and undermines change.
What Joining Actually Is
Joining is the intentional process of entering the family system in a way that allows the therapist to work effectively within it. It is relational, strategic, and grounded in respect for the family’s culture, structure, and lived experience.
In ESFT, joining happens at multiple levels:
With the child or identified client
With caregivers and co-caregivers
With the family system as a whole
With the family’s social ecology
Joining Is About Understanding, Not Agreeing
Joining does not require the therapist to agree with the family’s interpretations, behaviors, or conclusions. Instead, it requires accurate understanding of how each family member experiences the problem through the lens of the family assessment tools.
When families feel understood, they are more willing to:
Portia Nelson’s poem There’s a Hole in My Sidewalk is often read as a story about individual growth and personal responsibility. But when viewed through the lens of Ecosystemic Structural Family Therapy (ESFT), the poem offers a powerful metaphor for how patterns develop—and change—within families and systems.
In ESFT, behavior is never viewed in isolation. Symptoms are signals, not defects. They emerge within a web of relationships, histories, and environmental pressures. In the poem, the “hole” represents more than a personal misstep; it reflects a negative interactional pattern that continues until the system itself changes.
In the early chapters of the poem, the narrator repeatedly falls into the hole, feeling confused, helpless, and ashamed. This mirrors what families experience when a child’s behavior becomes the focus of concern. The system reacts to the symptom—often with urgency, fear, or blame—without fully understanding how everyone’s responses contribute to the pattern. The problem feels external, inevitable, and overwhelming.
As the poem progresses, the narrator becomes aware of the hole and learns how to cope with falling in. This stage reflects first-order change: the system adapts without restructuring. Families may implement behavior plans, crisis interventions, or short-term supports that help manage the distress. While these efforts can bring temporary relief, the underlying interactional pattern remains intact. The hole is still there.
True transformation begins when the narrator walks around the hole. In ESFT terms, this is second-order change. Caregivers begin to see behavior in context. Leadership shifts. Interactions change. The family no longer responds automatically to distress but instead engages differently—using strengths, co-regulation, and collaboration. The symptom loses its power because the system no longer requires it.
The final chapter of the poem—choosing a different sidewalk altogether—captures the essence of sustainable systemic change, restructuring. ESFT aims to help families build new relational pathways. Through joining, reframing, enactment, and anchoring, families practice and solidify healthier ways of connecting, responding, and problem-solving.
Ultimately, There’s a Hole in My Sidewalk reminds us that healing is not about avoiding mistakes or fixing individuals. It’s about recognizing patterns, understanding their origins, and choosing—together—to walk a different path. That is the heart of ESFT: changing the system so that growth becomes possible.
Writing the Treatment Plan Together—When Collaboration Is the Intervention
In systemic family therapy, treatment planning is often misunderstood as an administrative requirement—something completed to satisfy documentation standards, payer expectations, or agency policy. In reality, treatment planning is a clinical intervention. How the plan is created, who participates, and how it is revisited over time directly shape engagement, accountability, and outcomes.
When treatment plans are written with families rather than for them, they function as a roadmap for shared work rather than a list of tasks imposed from the outside.
Collaboration Builds Ownership
Collaborative treatment planning reinforces a core systemic principle: change happens through relationships, not compliance. When families participate in naming goals, identifying priorities, and defining what progress will look like, they are more likely to remain engaged and invested.
This process also helps clarify expectations early. Families deserve to understand:
What the therapist believes needs to change
Why those targets matter
What each person’s role will be
How progress will be measured
Rather than overwhelming families with clinical language, effective treatment planning translates the model into accessible, relational terms. It aligns professional expertise with the family’s lived experience.
The Treatment Plan is a Living Document!
Ethical practice does not end once a treatment plan is written. In systemic work, re-evaluation is not optional—it is a responsibility. Families change, circumstances shift, and interventions may or may not produce the intended effects. A treatment plan that is never revisited becomes disconnected from the reality of care. Ongoing evaluation allows the therapist and family to ask:
Are we seeing movement in the primary targets?
What has improved—and what has not?
What barriers are emerging in the system?
Do goals need to be refined, expanded, or redirected?
When progress stalls, the response should be curiosity, not persistence with ineffective strategies.
Protecting Families and Clinicians
Collaborative treatment planning also serves an ethical safeguard. Families are protected from drifting through therapy without clear direction, while clinicians are protected from practicing outside their scope or continuing interventions that are no longer clinically justified.
Documenting shared goals, agreed-upon interventions, and timelines for review ensures that care remains intentional and defensible—regardless of payer source.
Collaboration, a Change Mechanism
Ultimately, writing the treatment plan together is not just good practice—it is the practice. The act of collaborating, clarifying, and revising mirrors the relational work families are being asked to do in their own systems.
The Philadelphia Child and Family Therapy Training Center is proud to announce the 3rd Annual Marion Lindblad-Goldberg (MLG) Awards, honoring outstanding professionals within the Family Based Mental Health Services (FBMHS) community.
Beginning January 26, 2026, nominations will be accepted for staff, supervisors, and trainers who exemplify the heart of Dr. Marion Lindblad-Goldberg’s legacy—using systemic, relational, and trauma-informed practice to make the world a better, brighter, and more connected place, one family at a time.
Many therapists hesitate to set clear expectations at the beginning of treatment. The fear is understandable: I don’t want to overwhelm the family.I don’t want to seem rigid.I need to build rapport first. While well intentioned, this delay often creates more harm than protection.
In systemic family therapy, clarity is not the opposite of compassion—it is an expression of it.
From the very first session, therapists have an ethical responsibility to clearly articulate what they need in order to provide effective treatment. This is not about control or authority; it is about transparency, competence, and respect for the family’s time, energy, and investment in care.
Why Early Clarity Matters
Families typically enter treatment during moments of crisis, confusion, or exhaustion. They are often navigating multiple systems—schools, child welfare, juvenile justice, medical providers—each with its own expectations and demands. When therapy adds implicit or unspoken expectations, families may feel blamed, confused, or set up to fail.
Early clarity answers critical questions families are already asking internally:
What will therapy actually require of us?
Who needs to be involved?
How often do we need to meet?
What happens if things escalate?
What does the therapist believe creates change?
When these questions remain unanswered, families often fill in the gaps with assumptions—many of which are shaped by past experiences of “non family therapy” and of being judged, blamed, or pathologized.
Clarity Is an Ethical Obligation
Ethically, therapists are responsible for practicing within their scope of competence. That means being honest about the conditions under which their model is effective. In ESFT, for example, meaningful change depends on caregiver involvement, relational work, and attention to the family’s broader social ecology.
From day one, therapists should clearly state expectations related to:
Who needs to attend sessions (e.g., caregivers, co-caregivers, siblings)
Frequency and consistency of sessions
The role of caregivers in treatment
Use of collateral contacts (schools, caseworkers, probation, etc.)
Crisis planning and safety expectations
Participation in between-session practice
These are not demands placed on families. They are professional responsibilities owned by the therapist. When framed appropriately, they communicate: “This is what I need in order to help you in the way I believe is effective.”
The Cost of Avoiding Early Agreements
When expectations are delayed or softened to avoid discomfort, problems often emerge later:
Caregivers feel blindsided when asked to attend more sessions
Therapists feel frustrated by lack of follow-through
Importantly, these ruptures are rarely about the expectations themselves. They arise because expectations were never made explicit, negotiated, or revisited.
Avoiding clarity does not preserve the alliance—it weakens it.
Therapist’s Leadership
In systemic work, how we practice is as important as what we do. When therapists lead with clarity, consistency, and calm authority, they model the very leadership many families are struggling to establish at home.
Reduce power struggles by making roles explicit
Normalize structure as supportive rather than punitive
Increase predictability, which enhances safety
Support caregivers in stepping into leadership roles themselves
Rather than overwhelming families, clarity often brings relief. Families may not like every recommendation, but they appreciate knowing what is expected and why.
Clarity as an Act of Respect
Entering session from day one with clear agreements communicates respect for the family’s autonomy. It allows families to make informed decisions about their participation in treatment. It also protects clinicians from practicing outside their scope or delivering care that is unlikely to be effective.
Ecomaps allow the therapist to create a snapshot of the social ecology; where the client and family are dislocated. This guides the therapist to understand the impact of intergenerational trauma on belonging, relating, and engaging with people, places, and things in the community. Ultimately, the therapist is to guide the healing to occur within the culture of the family. How can we do this if we don’t understand the context? Therefore, the therapist isn’t the most important resource for the family, they are and their ecosystem is. Elevate the caregivers’ leadership by helping them discover who and what has their back when the emotions get big. Have them decide where they will turn on purpose. Engage the strengths into treatment. Embed the resources into the crisis plan. Work smarter not harder, as a therapist!
