Author: Jennifer Benjamin

Dear Alliance, 

We’re excited to bring you the latest from the Philadelphia Child and Family Therapy Training Center! This month’s newsletter is packed with updates, insights, and opportunities for professional growth:

• Malibu Bound: PCFTTC is heading to the Society for the Exploration of Psychotherapy Integration (SEPI) conference—discover what we’ll be sharing!
• Nominees for the 2026 MLG Award: Meet the inspiring professionals recognized for excellence in systemic family therapy.
• Pinky & Jen Wraparound the World: Learn how our directors are spreading systemic family therapy practices as podcast guests. 
• Couples Therapy: Explore practical strategies and insights from our featured expert, faculty, Dr. Amber Berkoski on couples therapy.
• Free CE Programs: Enhance your skills with our Free continuing education opportunities.

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For a copy of this month’s newsletter email training @pcfttc.com

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.

What Joining Is Not

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:

• Stay engaged
• Take risks
• Try something new
• Accept guidance and leadership

Understanding creates safety. Safety creates movement.

True joining communicates: “I see you, I understand why this makes sense, and I can help.”

The client and family will experience they are understood, and can accept your influence to collaborate with them to resolve the relational challenge.

From Resistance to Relationship

What is often labeled as “resistance” is usually a sign that joining has not yet occurred at the right level. Families resist when they feel:

• Judged
• Misunderstood
• Blamed
• Rushed toward change

It helps the therapist ask:

• What am I missing?
• Who am I not joined with yet?
• What is happening that makes this pattern protective or necessary right now?

Joining Is Contextual and Cultural

Joining means adapting the therapist’s stance—not asking the family to adapt to the therapist. Effective joining accounts for the family’s:

• Family culture and values
• Social location and lived experience
• Historical trauma and adversity
• Power, privilege, and marginalization

Joining is the foundation that makes direction possible.

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.