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:
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.
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.
The Referral Behavior—Why Naming It Clearly Matters (and Why It’s Not the Problem)
Every course of treatment begins with a referral behavior. A youth is aggressive. A child is refusing school. A caregiver is overwhelmed. A system is worried about safety. These behaviors are the reason therapy begins—but in systemic family therapy, they are not the reason therapy works.
Referral behaviors function as signals, not diagnoses of the system. They tell us where distress is concentrated, not where responsibility lives. When therapists mistake the referral behavior for the problem itself, treatment becomes narrow, reactive, and often ineffective. The family may comply temporarily, but the underlying interactional pattern remains unchanged.
Best practice requires that the referral behavior be named clearly and collaboratively. Families deserve transparency about what brought them into care and how the therapist understands that concern. At the same time, systemic therapists must explicitly distinguish between the presenting behavior and the relational context that gives it meaning.
For example, a child’s aggression may appear to be the primary issue. But aggression rarely exists in isolation. It often emerges within systems struggling with inconsistent caregiver leadership, unresolved trauma, or chronic stressors embedded in the family’s social ecology. Without clarifying this distinction early, families may assume therapy is about “fixing the child,” reinforcing blame and undermining engagement.
Agreements for treatment begin here. Therapists must clearly state:
What the referral behavior is
Who noticed the behaviors
How did we get here
This clarity creates safety. It helps caregivers feel less blamed and more capable. It invites collaboration rather than compliance. It also sets realistic expectations: therapy is not about eliminating a behavior in isolation but about restructuring the relationships that sustain it.
When referral behaviors are framed systemically, families can begin to see the problem as shared rather than owned by one individual. This reframing lays the groundwork for all future agreements about participation, dosage, and responsibility for change.
In short, you cannot form an ethical or effective agreement for treatment unless everyone understands what brought them together—and what that behavior truly represents.
Andrew Benesh, PhD, LMFT-Behavioral Health Education and Community Development Professional comments on drafted rule changes.
I know there’s a lot of anxiety floating around regarding upcoming changes to student loan rules, and their anticipated effects on students.
The Department of Education (ED) is moving forward with draft rules that will fundamentally change how graduate students finance their education. Under the rule ED will propose, many healthcare professions are not classified as professional programs, but instead as graduate programs. “Graduate programs” will have a $20,500 annual limit, with a $100,000 total cap, while programs defined as “professional programs” will have a $50,000 annual limit, and $200,000 total cap. This means that many students, including MFT students, would be subject to significantly lower loan limits. This change will take effect on July 1, 2026, and will apply to new borrowers. The ED is expected to open this proposed rule up for public comment early next year, most likely in January.
AAMFT has been actively advocating for the inclusion of MFTs in the professional degree definition throughout the rulemaking process, including joining coalitions of health professionals advocating for a more expansive definition of professional degree. AAMFT and many other healthcare associations will be submitting public comments to ED on this proposed rule. AAMFT will alert members once the public comment period begins.
What can be done before the public comment period begins?
It is important for Members of Congress to hear from their constituents on this important issue, and to ask Members of Congress to make sure that ED includes MFTs and other healthcare professions under the professional degree definition in the final rule. Use this link to contact your Member: https://lnkd.in/eZ6qQmaj
In addition, AAMFT wants to hear how federal graduate student loan program has supported your path to licensure and how these proposed limits would impact future students. Your stories will help show Congress the real-world impacts of these changes on current and future MFT students, as well as how these changes will exacerbate the shortage of behavioral health providers. Share your story here: https://lnkd.in/eBFKMdZh
The above is based Original Message: Sent: 11-24-2025 04:04 PM From: Neal Sombke
Hello Family TEAM members,
Thank you for your comments on this important issue. AAMFT has been actively advocating for the inclusion of MFTs in the professional degree definition throughout the rulemaking process, including joining coalitions of health professionals advocating for a more expansive definition of professional degree.
We have linked here two coalition statements AAMFT has signed on to within the last month that urge the Department of Education to classify MFT degrees and other healthcare degrees under a more inclusive professional degree definition.
The Department of Education (ED) is moving forward with draft rules that will fundamentally change how graduate students finance their education. Under the rule ED will propose, many healthcare professions are not classified as professional programs, but instead as graduate programs. “Graduate programs” will have a $20,500 annual limit, with a $100,000 total cap, while programs defined as “professional programs” will have a $50,000 annual limit, and $200,000 total cap. This means that many students, including MFT students, would be subject to significantly lower loan limits. This change will take effect on July 1, 2026, and will apply to new borrowers.
The ED is expected to open this proposed rule up for public comment early next year, most likely in January. AAMFT and many other healthcare associations will be submitting public comments to ED on this proposed rule. AAMFT will alert members once the public comment period begins.
What can be done before the public comment period begins? The federal bureaucracy does listen to Congress. Therefore, it is important for Members of Congress to hear from their constituents on this important issue, and to ask Members of Congress to make sure that ED includes MFTs and other healthcare professions under the professional degree definition in the final rule. AAMFT has developed a grassroots message that you can send to your Members of Congress.
In addition, AAMFT wants to hear how federal graduate student loan program has supported your path to licensure and how these proposed limits would impact future students. Your stories will help us show Congress the real-world impacts of these changes on current and future MFT students, as well as how these changes will exacerbate the shortage of behavioral health providers. Please click here to share your story.
AAMFT continues to monitor the situation and how these changes will affect MFTs. If you would like to read about how these changes will affect MFTs, you can click this article. Please contact AAMFT at FamilyTEAM@aamft.org if you have any questions.
Recording therapy sessions is a powerful tool for promoting professional growth and improving therapeutic outcomes. Without this practice, therapists miss out on valuable opportunities for feedback, self-reflection, and skill enhancement, which are essential for ongoing development.
The Importance of Feedback in Therapy
Feedback is a cornerstone of professional growth in any field, and therapy is no exception. For therapists, receiving feedback on their work is crucial to understanding how their interventions are perceived, identifying areas for improvement, and refining their techniques. Without recording sessions, it becomes challenging to obtain accurate and detailed feedback. Relying solely on memory or subjective impressions can lead to a skewed understanding of the session, missing out on subtle but important nuances in the therapeutic process.
Enhancing Self-Reflection
Recording sessions allows therapists to revisit their work with a critical eye, enabling them to analyze their interventions, communication style, and the overall flow of the session. This practice fosters self-reflection, helping therapists recognize patterns in their behavior that may be hindering or facilitating the therapeutic process. For example, a therapist might notice that they frequently interrupt clients or that they struggle to maintain a non-judgmental stance in certain situations. Identifying these patterns is the first step toward making intentional changes that can enhance the effectiveness of therapy.
Facilitating Supervision and Peer Review
Recorded sessions are invaluable in supervision and peer review processes. Supervisors and colleagues can provide more precise and constructive feedback when they can observe the session directly rather than relying on second-hand accounts. This external feedback is critical for identifying blind spots, challenging assumptions, and exploring alternative approaches. Without recorded sessions, therapists may miss out on these rich learning opportunities, limiting their professional growth.
Improving Client Outcomes
Ultimately, recording sessions and using the feedback to improve therapeutic skills leads to better outcomes for clients. When therapists are more aware of their strengths and weaknesses, they can tailor their approach to meet clients’ needs more effectively. This continuous process of learning and improvement ensures that therapists are providing the highest quality care possible.
Conclusion
If you aren’t recording your therapy sessions, you are likely missing out on key opportunities for growth. By incorporating session recordings into your practice, you can enhance self-reflection, receive valuable feedback from supervisors and peers, and ultimately improve your therapeutic effectiveness.
Dr. Kenneth Hardy’s work offers a profound framework for understanding power, privilege, and oppression within therapeutic relationships and broader social systems. His concepts of the tasks of the privileged and the tasks of the subjugated challenge therapists to examine not only the dynamics within the families they serve, but also the relational forces that exist between therapist and client.
Hardy (2016) explains that privilege and subjugation are relational positions, not fixed identities—both shaped by historical, social, and cultural contexts. Those in positions of privilege have the task of acknowledging, naming, and owning their privilege. This includes developing an awareness of how their position influences interactions, interpretations, and access to resources. Privileged individuals must resist the temptation to minimize or universalize experiences of marginalization and instead cultivate curiosity and humility.
Conversely, the tasks of the subjugated involve reclaiming voice, validating lived experience, and challenging the internalized messages that come from systemic oppression. These tasks are not the responsibility of the oppressed alone, but require environments where it is safe to speak truth and be believed.
In Ecosystemic Structural Family Therapy (ESFT), joining—the process of authentically entering a family’s world—is at the heart of systemic change. Hardy’s framework deepens our understanding of joining by reminding us that power differentials always exist in the therapy room. Therapists, whether aware or not, bring their own privilege into the system—through education, race, class, professional role, or authority. When privilege goes unacknowledged, it can replicate the very hierarchies that perpetuate distress within families.
To join effectively, therapists must intentionally decenter themselves and cultivate empathy through curiosity and transparency. They must ask: “What might it be like for this family to be joined by someone in my position?” and “How might my privilege or my own subjugated experiences be shaping how I join?”
By integrating Hardy’s lens, joining becomes not just a clinical technique, but an act of social justice—a way of restoring balance in relationships fractured by inequity. True joining honors both voices: the courage of the subjugated to speak and the humility of the privileged to listen.
Reference: Hardy, K. V. (2016). The View from Black America: Reflections on My Work and Journey. In D. Combs et al. (Eds.), Family Therapy Review: Contrasting Contemporary Models. Routledge.
An important distinctions we make in Ecosystemic Structural Family Therapy (ESFT) is the difference between first-order change and second-order change. Understanding this difference is crucial for therapists committed to creating meaningful, sustainable outcomes for families.
First-Order Change: Behavior Changes in Interactions (Linear, External, and Compliance-Driven)
First-order change focuses on surface-level behavioral shifts. It’s linear, cause-and-effect in nature, and often driven by external factors like rewards, consequences, or direct instructions. The goal is to stop or start a behavior, and the motivation is frequently tied to the fear of punishment or the promise of a short-term incentive.
While first-order change can offer temporary relief, it rarely addresses the deeper relational dynamics that sustain the behavior over time. In many cases, the family’s underlying patterns remain intact because the structure is still the same. The change is often fragile—likely to regress the moment the external motivator is removed.
For example, a child might stop yelling because they’ve been threatened with the loss of screen time. But without addressing the relational patterns driving the behavior—like poor emotion regulation or lack of parental leadership—the change won’t last.
Or the professional may step in and redirect the child. This makes the therapist part of the structure. So of course the behavior changes. When the therapist leaves the unwanted behaviors signaling distress come racing back!
Second-Order Change: Relational Changes in Interactions (Internal and Transformative)
Second-order change, in contrast, happens at the level of structure, meaning, and relationship. It’s not just about doing something different—it’s about thinking, feeling, and relating differently. The structure (hierarchy, boundaries, and family culture) requires a collaborative change and active in deliberating practicing shift in roles, and new patterns/ emotional responses.
Second-order change is: ✅ Internal – driven by insight, motivation, and relational shifts ✅ Dynamic – involving multiple members of the family system ✅ Sustainable – changes are maintained because they’re meaningful and integrated into daily life ✅ Collaborative – both caregivers and children participate in creating and maintaining new patterns
In ESFT, we guide families toward second-order change by focusing on co-regulation, attachment, co parenting, alliance building, and caregiver leadership. We help families see their patterns, understand their emotional processes, and take ownership of creating new interactional cycles that are healing, not harmful.
For instance, instead of a caregiver demanding a child “just calm down,” the family works together on building emotional safety and regulation strategies that change how stress is handled systemically.
Why the Difference Matters
First-order change may help in the short term—but second-order change transforms the family system. It’s the difference between managing symptoms and reshaping the emotional environment that sustains wellness over time. At PCFTTC, our focus is always on helping therapists and families work toward deep, relational, and lasting change—the kind of change that doesn’t rely on external control but grows from within.
Example of First-Order Change (External, Linear, Compliance-Based)
Scenario: A teenager is refusing to complete homework and is spending excessive time on video games.
Therapist Intervention (First-Order): The therapist coaches the caregiver to implement a behavioral consequence plan:
The caregiver tells the teen, “If you don’t complete your homework by 7 PM, you lose access to video games for the rest of the night.”
The teen complies with the homework expectation—but only because of the fear of losing privileges.
What makes this First-Order Change?
It’s linear: If you don’t do X, Y will happen.
It’s externally motivated: The change happens due to fear of consequence, not internal motivation.
It’s compliance-focused and likely temporary: If the caregiver stops enforcing consequences, the old pattern will likely return.
Example of Second-Order Change (Internal, Relational, Sustainable)
Scenario: Same teenager, same homework avoidance.
Therapist Intervention (Second-Order): The therapist works with the entire family system to explore the relational and emotional dynamics driving the avoidance through the family assessment tools. Therapist discovers:
The teen feels disconnected and overwhelmed but doesn’t know how to express this.
The caregiver tends to escalate quickly into frustration and yelling, which increases the teen’s avoidance and emotional shutdown.
The therapist guides the family to deliberately practice in session:
Improve caregiver leadership and co-regulation:
The caregiver practices giving clear, emotionally regulated instructions and checks in with the teen about emotional needs before setting expectations.
Build emotional safety:
The teen is helped to voice feelings of anxiety around schoolwork.
Develop a new relational pattern and anchor it:
Together, the family creates a homework plan that includes built-in support, positive connection time afterward, and space for emotional check-ins.
What makes this Second-Order Change?
This change is caregiver lead and therapist facilitated.
The family shifts relational dynamics and emotional responses—not just behaviors.
Motivation becomes internal and relational, not driven by fear or reward.
Caregiver leadership is strengthened, and the teen feels emotionally safer and more engaged, making the change sustainable over time.
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