Family therapy in Romania
Context. The magazine for family therapy and systemic practice in the UK, August 2007
Zoltán and Ágnes Kónya
Family therapy began to develop in Romania after the fall of the Ceauşescu regime, in the early-mid-nineties, with the organisation of the first family therapy training courses in the cities of Cluj, Târgu-Mureş and Timişoara. As there were no Romanian trainers at that stage, these courses were conducted by teachers invited from Ireland, France and Yugoslavia. Later on several other training courses were involved, with teachers from Hungary, England, Norway, Holland, Greece and Israel.
In 1993 two Irish family therapists, Patrick Sweeney and Colette Richardson attended a conference in Romania and presented a workshop on the nature of change in families. One of us (Á.K.) happenned to be at the workshop and volunteered to do the translation. Following this successful collaboration the plan of organizing a family therapy training course emerged. Patrick and Colette accepted the invitation to deliver an introductory course for 18 Romanian professionals in the city of Cluj, Transylvania.
The introductory course proved to be a success and the next objective was to build a full training programme that would meet British and Irish standards. The biggest challenge in this respect was providing the necessary number of hours dedicated to live supervision. In September 1997 a group of 12 intermediate students participated in a two-week intensive clinical practicum led by Nollaig Byrne and Jim Sheehan at the Mater Hospital in Dublin. This was an excellent opportunity for experiencing teamwork, receiving live supervision and seeing experienced therapists at work with families presenting a wide range of problems. The visit to Dublin was a big leap on our journey towards becoming family therapists. It was only after the Dublin experience that we began to see families in Cluj. Another outstanding event was Jim Wilson’s visit in August 2000, offering live supervision and introducing us to child focused practice.
Language was a special challenge for everyone involved in the process. As Transylvania is a historically multiethnic area, some trainees had Romanian, others Hungarian as their first language. All of them spoke English well enough to participate in the course which was taught in English. As families seen in Cluj spoke either Romanian or Hungarian and live supervision was provided by English-speaking supervisors, one member of the team had to do simultaneous translation. This slowed down teamwork and sometimes the interview itself. Some families spoke English well enough and the session could partly be conducted in this language. On the other hand, understanding some Irish families seen in the Mater Hospital proved to be a challenge for the Romanian group. Language was crucial also because the recommended readings were only available in English and the assignments had to be written in English. Trainees who were less fluent were also less likely to complete the training.
Geographical distance between trainees and trainers made the training last longer than usual so that the necessary number of hours of supervision could be completed. Trainees were seeing families in their own work contexts including a psychotherapy centre, a psychiatry hospital, a centre for victims of domestic violence and a family planning centre. Patrick and Colette visited Romania once or twice a year providing live and retrospective supervision. The final examination took place in Dublin in January 2004, with Jim Sheehan and Jim Wilson as examiners. It included the presentation of case studies, videotapes of work with families, logbook of systemic work done and a number of essays. The purpose of the assessment was to judge if graduates of this training were on a par with students completing an advanced training programme in Ireland or the U.K.
Four trainees of the original group of 18 applied for this exam and all four passed successfully.
In time, the newly trained family therapists have organized themselves in professional organisations. At this moment there are seven family therapy associations in Romania:
- Systemic Family Therapy Association in Cluj
- Association of Family Therapy in Bucharest
- Romanian Association for Family and Systemic Therapy in Timişoara
- Association Crisdu Areopagus in Timişoara
- Pro Familia - Family Therapy Association in Miercurea-Ciuc
- Association for Couple and Family Psychotherapy in Iaşi
- Association for Family Counselling and Therapy in Iaşi
To make sense of the unusually high number of associations one needs to appreciate the fact that each association emerged as a result of family therapy training courses happening at different times, in different places, with trainers invited from different countries, each trainer conveying different ideas about what family therapy was or what the word “systemic” meant. As trainers were highly respected by trainees, their ideas became the strongly held ideas of their trainees. While, for example, our training was strongly influenced by the Milan / Post-Milan approaches and social constructionism, some of our colleagues were exposed to more psychodynamic ideas and their training put an emphasis on the personal therapy of the trainee. Some of the teachers invited to Romania favoured the term “family psychotherapy”, while others told their trainees that family therapy was not psychotherapy at all as it did not use the instrument of psychological diagnosis. Some trainers identified the word “systemic” with the Milan approach and thus conveyed the idea that family therapy was more than the systemic orientation itself and included the structural, strategic, etc. approaches; others believed systemic thinking was more than the family approach, being an all-encompassing epistemological frame for consultation with individuals, families, organizations and other humans systems; still others did not attach much importance to the term systemic at all. We believe this situation might be a reflection of the diversity and richness, also of some degree of confusion, in the family therapy field in general.
Another explanation could be the lack of a culture for collaborative relationships in our country, pointed out by different visitors at different occasions. This was one of the relatively few criticisms our Western visitors had about Romania. They hypothesized this was connected with the fact that for fifty years communism actively destroyed human communities, discouraged collaborative endeavours of any kind and used the withholding of information to maintain its own power. On the other hand, many of us in Romania felt that communism actually forced a kind of cooperation among people, like the forced introduction of cooperative farming. Well-meaning outside attempts to promote cooperation between individuals or groups can still be met with resistance. From this perspective the expectation of EFTA-NFTO that the different family therapy organizations in one country cooperate among them and be represented by one organization or a federation in EFTA-NFTO poses a challenging task.
Also, there are important cultural differences between the various regions in Romania, each historical region having difficulty recognizing the authority of the others. With regard to family therapy, these pre-existing cultural differences have been intensified by the fact that each training group represented a different culture and seemed to speak their own language. In addition, Romania is a big country and though the use of the internet has made communication much easier today, one may still have to spend twelve hours on a train in order to meet colleagues in more distant centres.
Psychotherapy is not yet on the list of the officially recognized professions in Romania. There is no law regulating the practice of psychotherapy, though there is already a law for psychology and a proposal for the law of psychotherapy. The question of official recognition has been an often raised and worrisome question during training courses.
However, the process of becoming a registered psychotherapist is clearer today than it was ten years ago. There are two national accrediting bodies: the Romanian Federation for Psychotherapy founded in 1993 registering psychotherapists and the College of Psychologists established more recently and providing accreditation for psychologists. The Romanian Federation for Psychotherapy is a member of the European Association for Psychotherapy. Family therapy has a particularly strong representation in this Federation as 6 of its 25 member associations are family therapy associations, with a total of 50 certified family therapists of whom 39 are also accredited as trainers. Of the 28 Romanian holders of the European Certificate for Psychotherapy three are systemic family therapists.
Practice and culture
The fit between systemic therapy and Romanian culture has been a concern of ours since the beginning of our training (Kónya & Kónya, 2003). There had been no tradition of people seeing psychotherapists in times of distress. Also, the vast majority of health care professionals had not even heard about family therapy. Would families come to therapy?
We began to see families ten years ago and in retrospect we can give an affirmative answer to this question. Also, we admire our clients’ courage in facing a series of challenges involved in the therapy process: consulting an outsider for a family problem, participating in sessions as a family, being asked unusual questions, being videotaped and, sometimes, being observed by a team and/or supervisors from abroad.
We have encountered difficulties connected with the use of specific words and phrases used in systemic therapy. For example, the Batesonian phrase “a difference that makes a difference” is very difficult, if not impossible to properly translate into Romanian - of course this may only be a problem in a training context, not in therapy. In response to the Romanian or Hungarian translation of the question “And how has this been a problem for you?” clients almost invariably demonstrate a lack of comprehension - “Would you please say that again? I didn’t understand”. The difficulty here is not that the question makes no sense, but that it is culturally unusual - and therefore potentially therapeutic. Also, certain words that may sound neutral in the West sometimes trigger strong emotions in our country. For example, monitoring progress on a 1 to 10 scale may recall painful experiences connected with school, as in Romania marks are from 1 to 10. Also, talking about “systems” may trigger discomfort, as this is the word people used during communism to describe the oppressive dictatorial regime. People who challenged the dominant ideas used to be called “the enemies of the system”.
For the last 17 years Romania has been the scene of complex changes – the transition from dictatorship to democracy. Joining the EU will add new complexity to this process, the extent of which we can only suspect at the time of writing this text. Changes in society are reflected in changes in the nature of the problems people bring to the therapist and in changes in their attitude toward therapy. For example, according to statistics over two million Romanians are currently working abroad, mainly in Spain, Italy, France and Germany. It is our experience that people familiarized with Western culture find it more natural to seek professional help in times of emotional or relational crisis.
A constant challenge we face is staying systemic in a rather linear environment. This requires a continuous exchange of ideas and experiences with systemic practitioners from other countries. Visitors to our centre, meetings with our supervisors, reading newly published books, participating in the EFTA meetings and, last but not least, regularly receiving Context thanks to AFT, have all helped in maintaining a stance of curiosity, positive connotation and irreverence.
Kónya, Á., Kónya, Z. (2003). Getting from five to six... in the Ireland-Romania Family Therapy Training Project. Feedback, Summer 2003, Vol. 9, No. 3. pp. 26-28.
Sweeney, P., (2003). The Ireland/Romania Family Therapy Traning Project. Feedback, Summer 2003, Vol. 9, No. 3. pp. 23-25.
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Context. The magazine for family therapy and systemic practice in the UK, August 2007
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