ORI GIN AL PA PER

A Perspective on Evolving Family Therapy in Turkey

Eda Arduman

Published online: 21 May 2013� Springer Science+Business Media New York 2013

Abstract This article attempts to summarize the journey of evolving family therapy in

Turkey. It aims to provide an overview of the development and history of family therapy.

Formulations attempting to explain the context of challenges family therapy faces, include

political as well as historical events of the past few decades. The current challenges of

training, regulating and legislations of family therapy are taken into account with a lens

ranging from micro to macro perspectives.

Keywords Turkey � Marital and family therapy � Training � Regulation of family

therapy � Layered trauma � Interdependent families � Change

Turkey is situated between the East and the West; therefore, historically and currently, its

culture has been and is subject to diverse influences, which in turn has resulted in the

development of many family prototypes (Ataca 2006). The functioning and operations of

Turkish families often do not coincide with a Western understanding of a functional

family. For example, unlike in the West, obedience and conformity have traditionally been

important values in Turkish culture. The structure, boundaries, and ways of operating

typical of Turkish families can be misconstrued as dysfunctional by Western family

therapists who are not fluent in cross-cultural contexts.

Kagıtcıbası (1990, 1996) came across two main types of interdependently functioning

families in Turkey: (a) the traditional family of interdependence and (b) the family of

psychological (emotional) interdependence. Kagıtcıbası’s model of family change distin-

guishes three prototypical family patterns. First is the family model of independence,

which is most common in Westernized, industrial, urban settings and is characterized by an

individualistic cultural organization in which both psychological and material dependence

are low. Second, the family model of total interdependence is most common in less

developed, rural, agrarian settings. It is characterized by a ‘‘culture of relatedness,’’ or

collectivism, and involves both psychological and material interdependence in the family

E. Arduman (&)CATED Couple and Family Therapies Association, Istanbul, Turkeye-mail: earduman@gmail.com

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Contemp Fam Ther (2013) 35:364–375DOI 10.1007/s10591-013-9268-0

system. A third pattern, the family model of psychological (emotional) interdependence, is

a synthesis of the first two patterns. It is most common in urban and developed socio-

economic settings and is characterized by a culture of relatedness in which psychological

interdependence continues, but material interdependence is weakened.

Clients who come from interdependently functioning Turkish families often initially

follow any directions given by the therapist, which can be pleasing to the therapist.

However, as the therapist works toward second-order change, rather than comply with any

directions that might make them uncomfortable, clients are likely to drop out of therapy.

Thus, it is important to confront and challenge clients in ways that are comfortable for

them. Teaching people to question openly can be very effective when working with

individuals as well as families. Priming potential clients of therapy to say no or openly

admit their discomfort helps lower the level of drop outs from therapy.

My Journey

I have learned in the course of my own life to appreciate the difficulty of transitioning

between different ways of relating as a family. At the age of 12, following an overseas

move, I went through various second-order changes as my worldview shifted from that of a

1970s Bay Area pre-teen. My family settled in a large city on the West Coast of Turkey,

where the culture was typified by coercive rules that were never openly stated. My peers

knew the code because they had grown up with it. I had to ‘‘wing my way’’ through it. My

new skill set included careful observation, regulation of extended family relationships,

establishment of family coalitions, and a new respect for a culture I previously would have

judged as ‘‘out of date.’’ My teenage years were mainly occupied with deciphering con-

fusing, inconsistent extended family codes, surviving male chauvinism, and maintaining

personal integrity—all at the same time. I became quite skilled in reading between the

lines. I learned peace in the face of the unknown. Looking retrospectively, I believe a

certain amount of dissociation with my cluelessness and hopelessness was at the time a

functional defense. This has been my most treasured capability as a therapist. I think

people often feel so lost and alienated that a therapist who partners with that sense of

aloneness can foster the therapeutic alliance.

I studied psychology at Bogazici University. Dianne Sunar Phd. Guler Fisek Phd. and

Cigdem Kagıtcıbası Phd. inspired us to think about families with respect to an Eastern

perspective. I was exposed to systems theory and systemic thought during my masters in

clinical psychology. I found the mutual impact of micro and macro systems fascinating.

Following graduation, I intended to train with the Mental Research Institute (MRI), based

in Palo Alto, California, I was inspired to do this because I had attended the training

programs given by Emre Konuk Ma. who had returned to Istanbul following his training at

the MRI. The strategic model taught at the MRI, entails ‘‘tricking’’ people into getting

better. This approach disillusioned me. I preferred an approach that involved working to

increase the awareness of couples and families and provide them with choices. As a result,

I later trained as a Gestalt couple and family therapist at the ISRAGIC program in Israel

and The Cape Cod Gestalt International Study Center. I continued to develop as a family

therapist by training with Hedy Schleiffer and Harville Hendrix in Imago couple therapy,

and William Hiebert (current general secretary of IFTA) with a focus on developing

supervisory skills.

In the spirit of the Gestalt approach, I now advocate experiential learning. When

teaching or supervising, I emphasize courage and experimentation. The Gestalt Study

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Center stressed the importance of curiosity and the courage to try new things. I believe

interventions are most effective when simple and clear. Clients forgive mistakes; however,

they do not forgive arrogance or impoliteness. I am continuing to train as a psychoanalyst

(currently an advanced psychoanalyst candidate). Therefore I am invested in unconscious

phenomena and how these play out in the session. When with couples and families, I work

in an experiential, hands-on mode. I engineer enactments for the couple, and they move

around a lot during sessions. I also freely comment about unconscious phenomena as they

emerge.

I am continuing to train with Stan Tatkin, who is the founder of the PACT (Psycho-

biological Approach to Couples Therapy) approach. The PACT approach integrates

attachment theory, Affect Regulation, Psychobiology, and Therapeutic Enactment in work

with couples. This is an approach that I feel most at home with. I embody learning as a life

long experience.

Early Years of Family Therapy in Turkey

During the 1970s in Turkey, the closed economy and closed mindset, coupled with rising

threats of strife between battling political fractions, ended with a military coup. Suddenly

the nation was in a state of dissociation, and many atrocities took place behind closed

doors. We are only now uncovering some of the horrors that occurred during that era.

Paker (2004) borrowed from psychological terminology to describe the multi-layereddissociation that he cited as the cause of many problems within the Turkish society. In fact,

Turkish history and the development of family therapy appear to share many parallels.

Recovering and owning all eras of Turkish history will perhaps constitute the philosopher’s

stone for family therapy in Turkey.

Since the late 1980s, family therapy has been practiced in Turkey as an extension of the

mental heath profession. Universities were owned by the government during the 1980s, and

some offered masters programs in clinical psychology. Some of these programs included

courses on systems theory or family therapy; however, none provided thorough family

therapy training. The earliest form of family therapy was conducted by MRI trained Emre

Konuk who taught solution-focused strategic family therapy, Murat Dokur Md. trained at

the MRI and established the first Family Therapy Association and organized biannual

conferences. This spawned a family therapy training program affiliated with the European

Family Therapy Association (EFTA).

Nusin Sarimurat Baydemir graduated from the Ackerman Institute in New York and set

up a training and supervision program that is EFTA approved. Various family therapists

teach and supervise in this program. Some are graduates of the program who have fur-

thered their studies. I also teach in this program.

Other training programs are taught by visiting or domestically based expatriate MFTs.

The Satir approach is being taught and applied by Sibel Erenel (a licensed marital and

family therapist) along with experienced trainers from the Satir Institute of the North

Pacific. The Gottman approach is taught and practiced in Turkey via an independent

institution. Currently, master programs at some universities as well as certificate programs

provide theoretical as well applied training and supervision. Middle East Technical Uni-

versity in Ankara under the leadership of Hurol Fısıloglu Phd. has also been providing

marital and family therapy training.

By the early 1990s, the concept of family therapy was established in Turkey and mental

heath professionals and aspiring practitioners of psychoanalysis, psychodrama, cognitive

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behavioral therapy, and family therapy were sharing ideas. Cross-disciplinary learning and

teaching were accompanied by warm friendship as practitioners of the different orienta-

tions worked together in close contact. As practitioners became more experienced and

public awareness increased, some individuals—both academically accredited as well non-

accredited teachers—emerged as trainers, mentors, and leaders.

I often have thought that family therapy is going though a period of differentiation akin

to what Bowen (1976) described as ‘‘differentiation of the self.’’ Developmentally, the

individual is originally enmeshed in the family system. This enmeshment has two aspects:

the individual perceives his or her own needs as needs of the other, and the individual takes

indiscriminate ownership of the needs of the other. Undifferentiated families and people

also put more value on emotions than on intellect. This means these people are reactionary

and unable to step out of a family crisis and (at least attempt to) reevaluate situations in an

empathic, objective manner.

In the early, honeymoon stage of family therapy in Turkey, mental health professionals

were in awe of an approach that contradicted the medical model and harmonized with

common sense. Working with systems focusing on interactions was confusing for some,

yet inspiring for others. Those who were learning and practicing this relational approach

were exalted and eager to share their experiences and learning with kindred spirits.

Everything was melding. However, disagreements about practices, ethics, and personal

lives, and competition between approaches emerged. For those who were emotionally as

well as physically invested, this was exhausting. People remained cordial toward each

other even though underlying discontent was often not openly shared. I believe the

resulting pain and disappointment enticed people to form new groups and take their own

directions. This was the first step toward differentiation, and the seeds for specialization in

orientation were thus planted.

The honeymoon phase for trainers and supervisors of family therapy in Turkey was

followed by a phase dominated by differing views about what was being done and how it

should be done. Different opinions were sometimes a source of conflict. To understand this

phase, we can borrow a concept from Bion (1967), who said the raw, intense experiences

of the infant are projected into the mother’s mind because they are indigestible sensations.

The mother, for her part, has a receptive mind and contains these raw emotions for the

infant. The mother’s ability to mollify the sensations and redeliver them to the infant in a

way it can incorporate is how the baby develops psychologically as well as learns to think.

Perhaps we can say the pioneers of family therapy were collectively unable to contain and

transform all the conflict and raw emotions being churned out at the time. The emotional

container of the therapy community was unable to carry, let alone metabolize, the

increasing conflict-induced tension. Varying opinions were not allowed enough space.

Various therapists who lived through this stage felt misunderstood or unfairly treated. As a

result, they pulled back and continued practicing in ways they felt most comfortable.

During this period, training and supervision programs operated independently and

remained somewhat isolated from each other. This was the marital and family therapy

community’s first attempt to separate in order to embark upon a path of individuation, as

described by Bowen (1976).

In my opinion, the tragic earthquake of 1999 catalyzed the therapy movement in

Turkey. The reported loss was approximately 12,000 lives; however, the actual loss is

believed to exceed 50,000. Ironically, this tragedy drove home to the therapeutic com-

munity how thin the thread between life and death can be. Foreign experts were on the field

working with the survivors, as well as training mental health professionals to work with

them. This effort not only catalyzed the MFT movement but also increased awareness of

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trauma and its impact. Turkey was suddenly aware of its traumatic history and how this

history affected us professionally as well as personally. I am sure that prior to the earth-

quake many were working to build awareness; however, the tragedy added momentum to

this development of all fields of mental health.

During this period, another well-qualified family therapy training program was estab-

lished by Neylan Ozdemir and Nevin Dolek that involved a joint collaboration between

Turkish and Israeli MFT trainers and supervisors who had participated actively in relief

activities for the earthquake victims and their families. The Israeli group functioned as

visiting staff and trained many of the family therapists currently practicing in Turkey. I was

able to witness first hand the movement in trauma studies as well as MFT and psycho-

analysis. Mental health practitioners became more active and visible, and a great hunger

for training and learning was apparent.

The Impact of the IFTA Conference in Slovenia

In 2009, the International Family Therapy Association (IFTA) organized a conference at

Portoroz in Slovenia. During this conference, the current IFTA president Fatma Torun Reid

facilitated a series of discussions between Turkish family therapists and IFTA leadership to

discuss how IFTA could assist Turkish family therapists develop policies to influence the

government around the development and regulation of family therapy in Turkey. Fol-

lowing the conference in the Netherlands 2011 William Nichols (past president of IFTA)

established a committee that would work to develop an exemplary IFTA recognized family

therapy training and regulation manual that would add credibility to the efforts of family

therapists when interacting with government officials in Turkey.

These meetings ignited a desire to collaborate and set the ground for bringing together

independent operating family therapists in Istanbul. The first call was made by the current

IFTA president, Fatma Torun Reid, who is well known and highly respected as a pro-

fessional as well as human being. She organized a training of approved supervisors, which

was given by William Hiebert the IFTA secretary, who guided participants to create a

vision of family therapy in Turkey.

Thus, the seeds for CATED (Couple and Family Therapy Association) were sown. Prior

to establishing CATED as an association, a series of meetings were held in which working

committees were established and areas of interest were shared.

University-Based Training Programs

Couple and Family Therapy Association meetings spawned Turkey’s first university-based

family therapy training certificate and master programs. Members of CATED collaborate

to generate programs that promote public as well as governmental and political awareness.

The first university-certified couple and family therapy program was established in Istanbul

at Bilgi University. The program is a group effort of independent practitioners and aca-

demics who have been practicing and teaching family therapy. The Bilgi University

Couple and Family Therapy certificate program is a 2-year program that provides theo-

retical and applied marital and family therapy training for its participants. Its mission is to

train practitioners of marital and family therapy.

The Dogus University Couple and Family Therapy masters program was founded by

three licensed MFTs. The founder and former coordinator, Nilufer Kafescioglu, holds a

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PhD in marital and family therapy. Upon completion of her doctorate, she returned to

Turkey to set up the Marital Family Therapy program. During this period she became an

active member of CATED. She has resigned from Dogus University and is now setting up

a marital and family therapy training and master program at Ozyegin University.

Yasar University in Izmir also developed a marital family therapy training program.

This program was chiefly supported by William Hiebert, the former president and current

general secretary of IFTA, who works as visiting staff.

Additional programs are being initiated elsewhere in Turkey. One issue of concern is

that regulations have not yet been established to guide what is being taught or to determine

the credentials of those who teach and supervise. Because no licensing is provided by the

government, practitioners want certificates from the programs they attend. This has created

a climate open to deceit. For example, many ‘‘pop up’’ programs claim to be IFTA

accredited in their advertisements, when in fact they are not. IFTA is a body that works to

broaden family therapy throughout the world, and does not provide accreditation.

When preparing the Bilgi certification program, we examined various accredited MFT

certificate programs as well as educational standards of associations such as EFTA and

AAMFT, with the intention of launching a competence-based program. We are a small

group of like-minded individuals. From time to time we have different perspectives, yet we

were able to discuss and reach compromise. The family therapy community in Turkey is

still in the process of hatching from its shell. The community encompasses many MFT

practitioners with varying perspectives. To gather diverse opinions under a common

umbrella is a challenge.

Political Shifts and Family Therapy

In August 2011, the Ministry of Social Welfare was replaced with the Ministry of Family

and Social Policy. The branch for family and social services was assigned the mission to

determine, define, and cultivate solutions for social and familial issues. The intention is to

strengthen the family institution and to develop projects, trainings, literature, and solutions

that will solve social and family-related issues. The ministry has been busy setting up pre-

marriage training projects and consensus-seeking trainings for couples who seek divorce.

These projects have had an impact on improving the quality of the relationship of the

family.

Turkey is a democracy, currently led by right wing leadership. The family and its

fortitude carry the utmost importance for the government. The ministry is now focused on

strengthening the family. This has both advantages and disadvantages because strength-

ening the family does not always result in support for female members of the family, who

are subject to violence. CATED and other associations are trying to build awareness

around the concept that when any individual is suffering on behalf of another, that family

cannot be seen as a strong family unit.

It is interesting to note that historically the field of therapy has been dominated by

psychiatry and was under the auspice of the Ministry of Health. Officially, clinical psy-

chologists, counselors, social workers, and other related professionals are not eligible to do

therapy unless under the control of a psychiatrist (regardless of whether the psychiatrist has

had extensive training in psychotherapy). There is a conflict over the use of the term

therapy, which in the view of the Ministry of Health only can be conducted by medical

doctors. This is a heated political topic. However, it now appears family counselors (as

they are called) will be awarded professional identity. A family summit of academics and

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representatives from relevant associations was organized by the ministry in January 2013

to clearly define the professional identity of family therapists. Recently, I received news

from representatives of CATED who (at the time I am writing this article) are participating

in the family summit taking place in Ankara at the Ministry of Family and Social Policies.

CATED representatives have conveyed some key concepts of marital and family therapy to

the ministry. Representatives of the ministry have agreed with the importance of stan-

dardized training and supervision, as well as using core competencies as a benchmark for

evaluation. Legal recognition of these procedures will take time due to red tape, however

building momentum is very important at this point.

It is an exciting time for family therapy. One hurdle to overcome is the reactive rather

than proactive nature of the ministry. Rather than think and plan proactively, the ministry

tends to focus on putting out fires. Violence toward woman has been an enormous threat to

the community. Murder of women as a result of marital strife or jealousy has been daily

news. Family blood feuds based on the concept of family honor has often resulted in the

murder of the woman as a scapegoat. The ministry is pushing hard to institute laws that

will work in favor of the protection and sanctity of the family. Providing law enforcement

officers knowledge and training regarding coping with domestic violence and setting up

help lines are some of the measures being taken.

Applied Family Therapy in Turkey

Traditionally the Turkish family was an extended system. Grandmothers assisted in

childcare, and grandfathers had the final word. Parents were expected to transmit family

values to their children. Children were expected to obey. By and large, this model is still

applicable in most rural areas of Turkey, as well as in urban metropolises. However, in the

cities, a shift to the nuclear family model has occurred in the past 15 years. As a result

family therapists now encounter an increasing number of families who fall between the

model of independence and the model of interdependence. In the pursuit of Kagıtcıbası’smodel of interdependence, people oscillate between cherishing the closeness and reliability

tradition provides and longing for liberation and freedom of choice. They can border on

being overly lenient, or on being overly chaotic. In both situations, the families are

polarized. On the one hand, a rigid authoritarian structure can hinder the development of

tolerance; on the other hand, an avoidance of authoritarianism at all costs can lead to

disarray. Both situations represent opposite sides of the same coin, and families can

fluctuate between them. Unresolved issues with authority often are reflected in family

therapy sessions.

Having been steeped in Bowenian concepts (e.g., individuation) as a goal for therapy,

we as therapists often feel pressure to push individuals toward a relational model that is

individualistic. The challenge is to clarify how people can be autonomous as well as

connected. We are still trying to define what we understand by family in the context of a

pluralistic culture.

Fatma Torun Reid current president of the International Family Therapy Association

shared that ‘‘in urban areas we come across communication problems, systemic problems

stemming from extended families, and child focused issues. Often families will apply for

therapy with child based complaints. This is often followed with the need for couple

therapy’’ (personal communication). Emre Konuk Ma. founder of The Institute of

Behavioral Sciences (Davranıs Bilimleri Enstitusu) in Istanbul, shared his observation that

the mindset of family therapy clients is not yet systemic (personal communication). Parents

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bring their children to therapy expecting the therapist to ‘‘fix’’ the child. Such parents

overlook the recursive loop that takes place in all families. They are often unaware of how

they personally contribute to the symptom. It is often the job of the therapist to transmit

this perspective to clients.

Kemal Kuscu Md. Professor at Marmara University in Istanbul is a Tavistock-trained

family therapist, claimed that in the early 2000s, family therapy was dominated by the

medical model for diagnosing individuals. The medical model implies that the source of

the problem lies within the individual. Therefore, interventions are designed to focus

beneath the skin of the individual. In contrast, family therapy is context based and rela-

tional. The beliefs, behaviors, feelings, sensations, values, and so on that characterize the

family system are what allows change to take place. The family therapist provides the

family both a perspective from which to view their context as well as a new way of

speaking and relating. Since 2005, shifts in the hierarchy of families, as well as the

incapacity of the nuclear family to contain and process family issues, have resulted in a

group of families populated with belligerent adolescents who are discontent. Whereas in

earlier years therapy was seen as something for the so-called mentally ill, many of these

families currently view family therapy as a method for solving problems. The shift in

family values, however, has taken its toll on the dyadic relationship. Expectations have

changed and people are demanding more from their marriages. Shifts in expectations are a

critical reason that bring people to therapy. Sibel Erenel Ma., the founder of Satir Training

Institute in Turkey and a licensed MFT in the state of California, said most couples apply

for therapy as a result of inability to resolve conflict as well as issues of trust and

breakdown of intimacy. There is a significant increase in the number of couples who come

to therapy to facilitate the divorce process. Ozkan et al. (2006) [cited in Guney (2011)]

indicated that in many rural areas of the country multiple-spouse marriages are somewhat

common. Although in urban areas there are fewer cases, many marriages are still arranged

throughout Turkey. It is widely believed that arranged marriages last longer.

Murat Dokur Md. who founded the first family therapy association in Turkey, claimed

most families come to family therapy for child-related problems, or conflict between

adolescents and their parents. Such problems are usually school based or stem from conflict

between teenagers and parents. Most couples complain of infidelity or dysfunctional

partners. NAME, who teaches family therapy at two universities, stated that she works with

couples who find that one of the spouses has lost interest in the relationship and is moving

in another direction. Fısıloglu (2001), one of the pioneers of family therapy in Turkey,

wrote that parenting issues and child management questions are the chief reasons families

request therapy. Couples often come to therapy as a last resort following intense conflict

and strife. Many couples need to develop the skills to deal with confrontation and conflict.

As is common in extended families, where obedience is valued, people cope with different

opinions by either avoiding each other or fighting aggressively. Therapy teaches people

how to listen to each other without getting triggered. Holding on to their own perspective

and communicating it effectively are skills most couples need.

Fısıloglu (2001) emphasizes the importance of the family therapists exercising caution

when it comes to giving families advice. There is a fine line between benign suggestions

and meddling. I have heard couples say they were told by their former mental health

professional that they were not well matched and should divorce. I cannot be sure if

couples say this because they wish to have a scapegoat mental health professional to

blame; however, I have come across this phenomena myself. Family cohesion is perceived

as a value added goal. Keeping the family together is a shared mission. Fısıloglu stated that

people have difficulty forming boundaries between themselves and the family subsystems.

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Marriage between relatives is another issue. Often an aunt becomes the new mother-in-law,

which leads to role as well as boundary confusion.

The problems systemic-oriented therapists encounter in Turkey can be summarized as

follows.

Developmental Problems

Families have different stages of development, and each stage includes its own crises.

Normalizing symptoms that flare up as a result of the developmental stage is an important

first step. People need information about the situation they are in and some guidance and

reassurance. They also need to develop skills to cope. Sometimes they have to restructure

their relationships, prioritize, delegate, communicate, and take time for rest and together

time.

Triangulation

The individual is born into a relationship of two: a caregiver (mother) and an infant. After

the toddler is up and running and becomes curious about the world around, thirds become

an area of interest. Suddenly there are others to love or hate, to see as rivals or to identify

with. The oedipal stage is vital in development of the child. Successful resolution of the

oedipal conflict allows the child to compete and win but also to lose graciously. Couples

need time to move away from an enmeshed relationship of two people and toward an

intimacy that allows space as well. Hobbies, children, careers, interests, in-laws, and

friends are all thirds that allow ventilation in the relationship.

Boundaries

Many families suffer from structural issues due to the transition of authority figures. In

rural families, the oldest son often follows his father to become the next authority figure.

This can result in much frustration for the young man, who may still need authority

himself. The younger generation is often abused and intimidated. If the mother forms an

alliance with her older son and submits her authority to him, she becomes a disempowered

mother figure. Though this model is not without merits, it has its consequences. I find that

women coming from this sort of environment are predisposed to depression and anxiety

disorders. Young men tend to be inflexible and harsh and punitive in their interactions with

siblings. Sisters are expected to take part in child raising; although some sisters are nur-

turing, this can rob them of their need to be taken care of as children. The consequence is

often abused younger siblings.

Authoritarian Leadership

Historically, the Turkish people are skilled at following orders. We have a history that is

founded on dedication toward the parent, sultan, government, or other authority. Move-

ment toward the freedom to question and criticize is still in its infancy. This is so at a

macro level as well as a micro and individual level. The skills of negotiation and dialogue

are not yet part of the culture. People are familiar with two options: staying quiet or

exploding in displaced anger at irrelevant things. I believe that as therapists it is vital for us

to model constructively confrontational behavior.

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Theory of Change

There are similarities as well as variations in the ways therapists formulate and catalyze

change. Sibel Erenel Ma. believes change is always possible and resources to change lie

dormant within the family or individual. This therapist works in a positive direction, with a

strength-based approach and works to instill hope in the family. Change is possible when it

is experienced, preferably in the session. Experience in the session leads the way to first-

order change.

Yudum Akyıl Phd. and Nilufer Kafescioglu Phd. state that in Turkey, many couples

have difficulty with conflict. They either avoid it or conflict explodes in the middle of the

relationship. Both emphasize the importance of attachment issues and ensure that a secure

base is established in the session room. Forming a trustworthy, safe environment is the key

to effective therapy.

Emre Konuk Ma. and Murat Dokur Md. agreed that the effort a family makes to rid

themselves of the problem can itself be the chief problem. So working paradoxically and

prescribing the problem is an effective means for change.

The new generation of therapists tend to works emotionally and aim for experiential

corrective experiences that take place in ‘‘the here and now’’ of the session. Affect reg-

ulation theory and its applications are also critical in this work. Reciprocal perspective

taking and bypassing the encoded pattern of interaction are also important.

I emphasize the ability to apply a systemic perspective as the first and most important

step toward effective family therapy. The therapist must engage with the couple at many

levels. This requires teaching, encouraging, comforting, and modeling, as well as con-

fronting and challenging constructively. Getting couples to move and experience different

ways of being is vital for change.

Therapist’s Role in the Therapy Room

Ten years ago I would have said the therapist’s role is to be collaborative. Now that I

have more experience, I think that as long as we have an empathic, curious presence, the

clients will construct us in their mind to meet their own needs. So no matter what I claim

my position to be, the client will make the ultimate decision. However, I am most

comfortable defining my stance as curious. I used to say the client and I are equal and

we must decide together. Now I am not so insistent. Some people regress during family

therapy and need the therapist to fulfill what they did not have at earlier ages. It is

impossible for the therapist to meet all a client’s needs; however, noticing and com-

menting on these needs facilitates the process. A therapist has to be aware and respectful

of the client’s needs and desires, which are often not the same thing. They often have

misconceptions about what their problems are. It is important to be sensitive, empathic,

and respectful.

An MFT therapist needs to be interested in relationships and how they systemically

evolve and be willing to experiment. Humbleness and the tolerance to ‘‘not know’’ are also

important. Supervision is especially important. All therapists need to have extensive

supervision. Newly trained therapists need to know how to self-regulate their own states of

anxiety. They need to be willing to say less and not direct the couple. it is also critical that

they own their power and be willing to guide the family when necessary. Learning to

discern when to navigate and when to follow takes effort. It is important to act as a host for

the family. Undergoing therapy is a good way to achieve this skill.

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Working as a couple therapist should be energizing. When one enjoys couple work, it

has an impact on the couple and the progress of therapy. The couple should leaves the

experience with greater awareness and self-knowledge.

Problems never end in people’s lives. They simply need to learn how they can use their

own resources to solve their problems. Change is possible when one becomes fully aware

of his or her position at an interpersonal level, as well as intrapersonal level. We live in a

context, and having an understanding of that internal as well as external context is critical.

Training Family Therapists

Currently, family therapy trainings in Turkey provide theoretical and practical training as

well as supervision. Some university programs provide marital and family therapy training.

Working as practitioners as well instructors and supervisors, marital and family therapy

candidates struggle with shifting from an individualistic or medical model of therapy to a

collective, systemic approach. Until recent times it was common to be called a family

therapist and to conduct parallel individual therapy to individuals partners in a couple

under the name of family therapy. The ethical stance regarding this mode of work is

arguable; however, saying that long-term individual parallel therapy equates with family

therapy is, in my mind, misleading. This mode can be considered a stepping stone on the

journey of developing family therapy in Turkey.

During training, practitioners should have reflected on a model of family, and regardless

of chosen orientation, should have an understanding of functional and dysfunctional issues.

Family therapists should have been exposed to therapy and have first-hand experience with

it. Trauma is commonplace in any population with which you work, and especially among

those who seek family therapy. Thus, diagnosing trauma and having some experience in

treating it is necessary.

Conclusion

Family therapy is still in its early stages of development in Turkey. Taking a develop-

mental perspective, we can borrow from Margaret Mahler’s (1974) stage of rapproche-ment. During rapprochement, the young child is once again close to his or her mother, but

begins to differentiate from the mother. The child realizes his or her physical mobility

demonstrates psychic separateness from the mother. The toddler may become tentative at

this point, wanting the mother to be in sight so he or she can explore the world through eye

contact and action. Currently, family therapists in Turkey yearn for greater independence,

yet we are still very much in need of guidance. Establishments such as EFTA and IFTA

will continue to provide us with this parental guidance until we can stand unsupported on

our own feet.

It is vital that current practitioners, teachers, supervisors, and researchers of marital and

family therapy in Turkey move with the family therapy movement to create the leadership

much needed to move ahead as a community of family therapists. Unfortunately, devel-

opmental attempts at differentiation have caused some in the field of family therapy to

view others in the field with suspicion. The resulting paranoia and suspicion must be

overcome. This is possible only through engagement and dialogue. The CFTA and a

chapter of IFTA were founded in this spirit. It is important that all practitioners of family

therapy shift into a mode of thinking appropriate and optimal for working with families and

374 Contemp Fam Ther (2013) 35:364–375

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couples; this involves engaging with families as a system and overcoming the tendency to

manipulate symptoms and instead to be open to whatever creative solution orginates from

within the family.

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