Category: Resource

Looking Beyond the Individual

In clinical practice, it is common for families to enter treatment with a clearly identified concern—“fix my child.” The referral behaviors consist of “defiance, tantruming, hurting self and others…and not listening to me…” The family will report, the child is diagnosed with ADHD.

Now folks, ADHD is a constellation of symptoms, these are the measurable constructs that signal how this child’s brain navigates the day to day. However, the focus quickly narrows to how those symptoms show up: impulsivity, inattention, difficulty regulating behavior.

But from an Ecosystemic Structural Family Therapy (ESFT) perspective, this is only the starting point—not the full picture.

A systemic family therapist is always asking a broader question:

Is the referral behavior an individual-based challenge, or is it organized within the family system?

The Individual Within the System

Systems theory reminds us that individuals do not exist in isolation. Every person is embedded within a biological network of relationships, environments, and experiences that shape how behaviors are developed and maintained.

So while a diagnosis like ADHD may accurately describe a constellation of symptoms, ESFT invites us to look beyond the individual and ask:

• Who is involved in this pattern?
• What interactions are maintaining it?
• Where is this behavior occurring—and where is it not?

This shift moves us from a symptom-focused lens to a contextual, developmental, relational and trauma informed understanding.

Expanding the Assessment: The Role of Social Ecology

In ESFT, understanding the family system means understanding the social ecology surrounding it. The therapist is not only observing behavior but also gathering information about the conditions that shape the family’s functioning.

We begin to ask:

• Is there food insecurity or housing instability impacting daily routines?
• Are there challenges related to income instability or access to resources?
• What adverse childhood experiences (ACEs) are present across generations?
• Is the family navigating acute stress, medical concerns, or trauma exposure?
• Are there generational patterns of mental health needs that resulted in developmental trauma and inform current functioning?

These factors are not secondary—they are central to understanding how the family “got here.” BOTH their story of dislocation and their story of resiliency and strengths.

Community and Cultural Context Matter

ESFT also widens the lens beyond the household to include the community and cultural environment.

• What are the beliefs within the family’s community about behavioral or mental health challenges? How does this influence who this family turns to?
• How do schools, healthcare providers, and other systems respond to this family?
• Are supports experienced as helpful, judgmental, or inaccessible?
• Generationally what are the experiences of formal and informal supports?

The way a community interprets and responds to behavior can either reinforce distress or support change.

For example, if a child’s behavior is consistently labeled as “defiant” without consideration of context, the family may feel blamed or misunderstood. This can increase stress, reduce engagement with supports, and intensify the pattern.

From Blame to Understanding

When we focus only on the identified client, we will place pressure on one individual to “fix” the problem. ESFT challenges this by reframing behavior as part of a larger interactional system.

This does not dismiss individual needs—it situates them within context.

A child’s difficulty with attention and regulation may be influenced by:

• Environmental instability
• Caregiver stress or overwhelm
• Inconsistent routines shaped by external pressures
• Limited access to supportive resources

Understanding these factors allows the therapist to move from blame to curiosity, and from symptom management to systemic intervention.

Why This Matters for Change

When we understand referral behavior systemically, the pathway for intervention expands.

Instead of asking, “How do we fix this child?”, we begin asking:

• What strengths do we already have we can use to support this child?
• How do we strengthen the system around this child?
• How do we increase stability, support, and connection?
• Can we practice right now to shift patterns that maintain the behavior?

This is where meaningful, sustainable change occurs.

Final Thought

In ESFT, the identified client is never the whole story.

The client serves as the entry point into a system that is doing its best to adapt to a complex set of circumstances. When we take the time to understand the “who, what, and where” of that system, we move closer to interventions that are not only effective—but also compassionate, contextual, and lasting.

Because when we change the system, we change what is possible for every individual within it.

Put yourself in someone else’s shoes…

(PCFTTC does not have any religious affiliation with the recording entity, nor do they have any conflict of interest, or financial disclosures to make.)

“Am I joining with the family—or am I joining in on the pattern?”

One of the most essential—and most misunderstood—skills in Ecosystemic Structural Family Therapy (ESFT) is the art of joining.

Joining is not simply about being warm, agreeable, or likable. It is not about aligning with one person’s perspective or “taking sides.” In fact, when joining slips into blind agreement, secret keeping, or following the maladaptive rules of the family system, it stops being joining altogether.

It becomes collusion.

And in systemic work, collusion can quietly undermine the very change we are trying to create.

What Is Joining in ESFT?

In ESFT, joining is a deliberate clinical stance. It is the process of entering into the family system in a way that communicates:

• I see you
• I understand your experience
• The client’s/caregiver’s behavior makes sense in context

This is only accomplished through the use of family assessment tools. Joining allows the therapist to build responses to the narrow, negative narrative, creating relational safety. This is necessary for any meaningful intervention. Without it, families cannot tolerate the discomfort required for change.

Colluding

“oh I don’t think we can talk about that with the children…” claims the caregiver as the therapist suggests the presence of addiction has taken over everyone in the family. The therapist has a decision to make. Do they say, “okay…I don’t want to do anything without your permission…” Or, do they say, “I hear you, it makes sense that you are terrified about saying this out loud, and I have to tell you that everyone has talked about it to me, just not to each other… How we are managing the impact of addiction has literally almost killed your child. They tried to kill themselves. I think this lagging skills of talking about emotional pain means everyone is suffering alone…”

Collusion happens when the therapist:

• Aligns too strongly with one family member’s perspective
• Reinforces a problem-saturated narrative
• Avoids challenging harmful, abusive, and coercive ways of relating
• Over-identifies with a client’s emotional experience and doesn’t seek supervision to develop an intention plan to use this insight in service of the family.

For example, a therapist might believe they are joining with a caregiver’s frustration by saying:

“It makes sense that you’re overwhelmed—your child is completely out of control.”

While this may feel validating, it will unintentionally:

• Solidify blame toward the child
• Reduce curiosity about the system
• Strengthen the very pattern maintaining the problem

In this moment, the therapist has moved from joining the experience to colluding with the narrative.

Joining around the “interaction between people”

In ESFT, we are not joining the content of what is being said—we are speaking to the interaction between family members. Because we believe the referral behaviors are a family based challenge, not an individual based challenge.

This is a critical distinction. Instead of agreeing with the single narrative, we look deeper:

• How did they get here?
• What are the strengths?
• How does the way people relate organize in the family?
• How does this structure maintain the current pattern?

A more systemic response might sound like:

“It makes sense that you’re feeling overwhelmed—and I wonder if your child’s behavior might also be a way of signaling how hard things have been for them lately…I don’t think anything has felt the same since your mother passed away…She was such an important member of this family and meant so much to all of you…”

Now, the therapist is:

• Validating the caregiver
• Expanding the meaning of the child’s behavior
• Opening space for a new interaction

This is joining without colluding.

Why This Balance Matters

Families often come to therapy with rigid, polarized narratives that are points of induction for the therapist:

• “The child is the problem”
• “The parent doesn’t care”
• “Nothing ever changes”

If the therapist joins one side of the narrative, the system becomes more entrenched. But if the therapist avoids joining altogether, the family experiences the therapist as distant or invalidating.

The work, then, is to hold both connection and clinical direction at the same time.

Joining without colluding allows the therapist to:

• Maintain simplicity in the face of complexity
• Preserve curiosity and complexity
• Create space for new patterns to emerge

Final Thought

Joining is not passive. It is an active, moment-to-moment clinical decision.

It requires therapists to stay grounded, curious, and aware of their own pull towards. It asks us to tolerate complexity, and remain connected to every member of the system—especially when the system itself is asking us to choose a side.

Because in ESFT, healing happens through connection, clarity, and the courage to see the system differently.

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.

Subscribe to the blog to access the newsletter!

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.

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.

Entering Session From Day One with Clarity

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
• Ruptures occur when boundaries are finally named
• Families disengage, believing therapy “isn’t working”

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.