Journal of Family Psychotherapy, 20:6071, 2009 Copyright Taylor & Francis Group, LLC ISSN: 0897-5353 print/1540-4080 online

e DOI: 10.1080/08975350802716517

1540-4080 0897-5353 WJFP Journal of Family Psychotherapy, Psychotherapy Vol. 20, No. 1, January 2009: pp. 119

Countering the Isomorphic Study of Isomorphism: Coercive, Mimetic, and Normative Isomorphic Trends in the Training, Supervision, and Industry of Marriage and Family Therapy
KYLE N. WEIR
Department of Counseling, Special Education, & Rehabilitation, California State University-Fresno, Fresno, California, USA

Countering K. N. Weir the Isomorphic Study of Isomorphism

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This theoretical piece explores the ways in which the study of isomorphism by the marriage and family therapy (MFT) field has taken on a narrow or isomorphic form. It also outlines discussion points for addressing isomorphic structures in clinical supervision from an interdisciplinary perspective. This study examines the MFT field as an industry and draws upon sociological theory to explore three differing types of isomorphic structures in the MFT field: coercive, mimetic, and normative isomorphism. The author outlines his supervisory experience employing the three forms of isomorphic trends during supervision of 65 practicum/field placement students over a seven-year period (20002007). KEYWORDS isomorphism, theory, supervision, training, marriage & family therapy

LITERATURE
Isomorphism has emerged as a vital topic of study in the marriage and family therapy (MFT) field literature, particularly as it relates to the training and supervision of clinicians. Simply defined, isomorphism describes when things take on the same or similar form. Interestingly, the study of isomorphism in

Address correspondence to Kyle N. Weir, Department of Counseling, Special Education, & Rehabilitation, California State UniversityFresno, 5005 N. Maple Ave., M/S ED3, Fresno, CA 93740-8025, USA. E-mail: kweir@csufresno.edu 60

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the MFT literature has taken on one form because it has focused on the systems and subsystems of the client/family, therapist/trainee, and supervisor rather than expanding its view to incorporate how the client-therapist-supervisor systems are affected by isomorphic trends in the industry or field of marriage and family therapy, as a whole. Using a sociological understanding of isomorphism helps to address several contextual issues that are external to the client-therapist-supervisor clinical training system. Isomorphism has sometimes been termed the parallel process (Everett & Koerpel, 1986) between the trainee and supervisor. Systemically, isomorphism in clinical training and supervision also incorporates the similarity of structure and process at the client/family level, therapist/trainee level, and supervisory level in both directions (Getz & Protinsky, 1994). Deveaux and Lubell (1994, p. 297) define the isomorphic process in supervision with the following: The pattern of the relationship between the family therapist and the family in treatment is often reflected in the pattern of the relationship between the supervisor and family therapist. For example, a family may come for therapy around parenting issues with their children. If the supervisors typical supervisory posture emphasizes hierarchy with his or her trainee, it is common for the trainees posture in session to also be hierarchical and model hierarchical approaches to parenting to the family. The family may take this same form or stance with their children, which may or may not be helpful depending on the existing familys need for more or less hierarchy to increase health and functionality. Conversely, a familys operating style may have influence up the hierarchical clinical training chain, where trainees and supervisors are influenced by the familys dynamics. Liddle (1988, p. 155) suggests that the isomorphic nature of training and therapy not only refers to this pattern of sequence replicability across subsystem boundaries but can be used by supervisors to transform this replication into an intervention, redirecting a therapists behavior and thereby influencing interactions at various levels of the system. Liddle (1988, p. 155) calls this the domain of supervisory intervention. This implies that as supervisors become more aware of isomorphic trends in their work, supervisors can (and ought) to consciously utilize isomorphism appropriately in their field. Because families in treatment elicit transference/countertransference processes with therapists and supervisors, it is critical to review two important studies that have shown how supervisory awareness of isomorphism can address these issues. Lee (1997) provides an excellent clinical example of isomorphic training demonstrating how he and a trainee were caught with isomorphic blinders with a family in treatment. Some of the issues stemmed around the religious persuasion of the agency and clients where his supervisee was doing her clinical work. The supervisor and trainee were both somewhat dismissive of the agency and clients perspectives. The trainees own personal background was fairly similar to the concerns of the clients, and

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the trainee had triangulated the supervisor into her own undifferentiated family-of-origin issues (and the agencys metaphorical representations of the trainees family of origin). This type of isomorphic structure continued unexamined by the supervisor, trainee, and clients until a conversation between the supervisor and colleague led the colleague to challenge some of the supervisors and trainees assumptions about the agency and clients in treatment. As the supervisor became more differentiated, the supervisory/trainee system isomorphically shifted its perspective about the clients. Particularly, as Lee (1997) became aware of the isomorphic trends he determined to use this isomorphism as an intervention rather than a replication. He asked different (more insightful) questions and gained new understanding about the family in treatment, he challenged the trainees assumption (much like his colleague challenged him), and he was able to direct the trainees work toward a different, healthier outcome for the family system. Both Lee (1997) and Deveaux and Lubell (1994) link the concept of isomorphism with a Bowenian perspective regarding the lack of differentiation of self, suggesting that as supervisors consciously focus on being more differentiated they will avoid isomorphic supervision errors. Most of the MFT literature about isomorphism really focuses on a particular kind of isomorphism, namely mimetic isomorphism. As students learn theoretical models from their supervisors, supervisors tend to model a theoretical approach and expect trainees to mimic their work (hence the term mimetic isomorphism). For example, Behan (2003) discusses how to incorporate isomorphism into a narrative approach to therapy and supervision. Like Deveaux and Lubell (1994) and Lee (1997), Getz and Protinsky (1994) represents another study illustrating how isomorphism operates within a Bowenian/family-of-origin theoretical framework. Rothberg (1997) is an excellent study examining isomorphism from a structural theory perspective, and heavily emphasizes the ways that a supervisor models structural approaches and how trainees mimic their supervisors clinical work leads to isomorphic trends. These studies exemplify how students training in MFT learn theoretical models through replicating or mimicking supervisory examples. White and Russell (1997) is one of the only studies to be found in the literature that does not take a narrow or isomorphic approach to the study of isomorphism. Their study used a sophisticated research methodology to explore American Association for Marriage and Family Therapy (AAMFT) Approved Supervisors notions of isomorphism and its role in the supervisory process. White and Russell (1997) report five specific facets of isomorphism in supervision: identifying repetition of similar patterns, translation of therapeutic models and principles in supervision, the structure and process of therapy and supervision are identical, isomorphism as an interventive stance, and isomorphic transactions occur in multidirectional patterns. Although their article elucidates greater conceptual clarity concerning what AAMFT supervisors think about isomorphism, White and Russell (1997,

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p. 327) indicate that their research does not examine the impact of contextrelated variables on supervisory outcomes, nor does it include variables such as the settings financial and physical resources, the theoretical orientation(s) of the practitioners, clientele, and administrative support for the training program . . . In the discussion points listed in this article, inclusion of such contextual variables is afforded the opportunity to be incorporated (or at least discussed between the supervisor and trainee). Rather than examining isomorphism as being a singular concept with multiple facets as suggested by White and Russell (1997), this new approach recommends examining three specific, different isomorphic types or trendsthree different isomorphisms. Such broadening is required to understand the differing causes of isomorphic outcomes. Surprisingly, Sprenkles (1999) examination of the literature regarding isomorphism argues for a more precisely, narrowly defined conceptualization of isomorphism (because, he astutely argues that isomorphism means different things in the literature). This article suggests that more precisely defining isomorphism requires broadening our definitions of isomorphism (including the differing causes that create isomorphic outcomes) and delineating the multiple isomorphic trends impacting the MFT industry according to DiMaggio and Powells (1991) model rather than taking the narrowing stance suggested by Sprenkle (1999). The predominate vision within the literature of the role isomorphism plays in training and supervising therapists is limited and has taken on a narrow form. The study of isomorphism in the MFT field has ironically been relatively isomorphic in nature. It primarily examines what DiMaggio and Powell (1991) call mimetic isomorphismhow trainees mimic or replicate the thoughts, perspectives, and theories or models of their supervisors. The currently held perspective regarding isomorphism in the field devotes little attention to the broader social context that causes mimetic isomorphism nor does it address other forms of isomorphism (the notable exception to a one-dimensional study of isomorphism is White & Russell, 1997). The sociology of organizations is a field where isomorphism has been thoroughly examined. Powell and DiMaggio (1991) are neoinstitutionalists within that field. They explore how and why institutions and organizations in an industry take several forms, including why organizations within an industry take on isomorphic forms. Their work provides a careful analysis of the role isomorphism plays in institutions throughout a variety of industries. The cross-fertilization of interdisciplinary approaches can increase our understanding of the role isomorphism plays in training and supervision if we take the perspective of examining the MFT field as an industry. This broader perspective allows us to examine the coercive, mimetic, and normative forms of isomorphism operative in MFT training and supervision. DiMaggio and Powell (1991) delineate three types of isomorphism: coercive, mimetic, and normative. Coercive isomorphism stems from political

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influence and the problem of legitimacy (p. 67). Industries often take on similar forms or structures to accommodate powerful governing or controlling entities and will often respond to formal and informal pressures . . . upon which they are dependent (DiMaggio & Powell, 1991, p. 67). Mimetic isomorphism results from standard responses to uncertainty (DiMaggio & Powell, 1991, p. 67). In such circumstances, organizations (and we could extrapolate this to other entities, such as trainees) will model their efforts after others who have successfully navigated the uncertainty within the field. Mimicking or following standard models provided by successful organizations (or supervisors) explains why similar forms (isomorphism) occur. Normative isomorphism refers to the role of professionalization leading to similar forms. DiMaggio and Powell (1991, pp. 7172) discuss how universities, training institutions, and trade associations promulgate normative rules about organizational and professional behavior and encourage normative isomorphism in filtering personnel that are drawn from the same universities and filtered on a common set of attributes that will cause a tendency to view problems in a similar fashion, see the same policies, procedures, and structures as normatively sanctioned and legitimated, and approach decisions in much the same way. DiMaggio and Powell (1991, p. 72) also suggest that normative isomorphic processes also involve pervasive on-the-job socialization and training.

COERCIVE, MIMETIC, AND NORMATIVE ISOMORPHISM IN MFT

By examining the MFT field as an industry and viewing the training process of MFTs in the field through the lens of DiMaggio and Powells (1991) neoinstitutionalist perspective (as a school of thought within the sociology of organizations), several key tendencies are illuminated as to how and why isomorphism occurs in the training and supervision of MFT trainees.

Coercive Isomorphism
First, therapy is a business and involves money and other resources. Because of the economic nature of therapeutic practice, parties outside the MFT industrial system (i.e. insurance/managed care industries and other mental health professional associations) have an interest in regulating, engaging, and influencing the MFT industry. As a body of systemic thinkers, the field of MFT must respond to the other interested parties from an institutional, industrial approach. From an industrial perspective, MFTs (particularly governing trade associations within the MFT field) need to respond to market forces as a rational-actor as an institutionally-savvy state of awareness. Recognizing the coercive forces that shape our industry can elucidate our understanding of how isomorphic trends occur in our field. For example, as a professor training students in MFT theoretical

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approaches, it is essential to, with foresight, address their desire to be economically viable once the students eventually become licensed and engage in the practice of MFT as a component of the curriculum. It is reasonable to teach students theories and intervention strategies that are fiscally feasible and desirable in a managed care/insurance driven context as part of the curriculum. This process is replicated by the many training programs in MFT and illustrates the coercive isomorphic trend in MFT training and supervision. The facts that governments, insurance companies, and other interested parties legitimately influence the practice of MFT shapes the way MFT students are trained. The fact that MFT students are then trained somewhat isomorphically toward theories that are insurance friendly (e.g., solution-oriented or Cognitive Behavioral Therapy [CBT] approaches) is not coincidence. Rather it reflects a systemic, industrialsavvy awareness of the coercive isomorphic forces that impact the MFT industry. When politicians, state licensing boards, state educational boards, and other similar entities issue directives that dictate curriculum, funds, grant opportunities, or mandates pertaining to the mental health profession, faculty training students naturally respond to the coercive forces and tailor their training to meet the designated criteria (e.g., state directives about curriculum requirements from licensing boards shape training curriculum into a similar fashion across universities within that state and state directives about funding of agencies dealing with domestic violence typically shapes the training of MFT students away from traditional systemic perspectives toward feminist approaches). Such responses to coercive directives represent industrial-savvy faculty who can read the field and prepare students for the realities of the field in an isomorphic way. By incorporating an awareness of the coercive forces that cause isomorphic trends in the field, supervisors must pay attention to the contextual variables proposed by White and Russell (1997). They must address organizational factors such as fiscal and physical resources, legal requirements, and administrative expectations while balancing these realities with the clinical needs of their clients. Such supervision of MFT trainees prepares the students for their career but also accounts for the isomorphic trends seen in the field.

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Mimetic Isomorphism
Mimetic isomorphism is the most commonly explored type of isomorphism in the literature regarding isomorphism in clinical training and supervision. The parallel process of replication of sequences between the three systemic levels (family in treatment, therapist, and supervisor) involve modeling or mimicking similar forms or patterns (in both directionsfrom the family in treatment up through the therapist to the supervisor and down from the

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supervisor in reverse fashion). This mimetic isomorphic process seems to be particularly evident when trainees are being trained in a specific theoretical school. The key addition DiMaggio and Powells (1991) model brings to understanding mimetic isomorphic processes is answering the question of why mimetic isomorphism happens in the first place. Mimetic isomorphism happens as a standardized response to uncertainty. When families and therapists are uncertain how to proceed clinically, it is natural for them to turn to the supervisor, follow the supervisors model or approach to clinical work, and mimic their techniques (both theoretical orientations and practical strategic interventions). A key role for supervisors, then, is to recognize moments of uncertainty, and provide models for students to mimic when needed. But equally important regarding isomorphic awareness, supervisors must also not rescue students at every moment of uncertainty and encourage the students to think for themselves, strive for personal and professional growth, and challenge shared assumptions that lead to isomorphic views. The determination regarding when to take which approach depends on the students levels of experience, the seriousness of the client(s) issues, ethics and legality issues, the intuition of the supervisor, and a host of other factors outlined in Mead (1990).

Normative Isomorphism
Accreditation is a normative isomorphic pressure on the MFT field. Though it may also fit into the coercive isomorphic trend (by issuing standards directives that in effect dictate curriculum as discussed previously), it more appropriately fits into the normative isomorphic category because of the emphasis on professionalization. Accrediting bodies within the mental health professions set standards, direct curriculum expectations, encourage development of a professional identity, and delineate ethical and unethical behavior. The MFT industry similarly has accrediting institutions that promote these endeavors (even the major accrediting bodies in the field such as Council for Accreditation of Counseling and Related Educational Programs (CACREP) and Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) are responding isomorphically to changes in the directives from the U.S. Department of Education to retain their ability to accredit programs). Thus, when training institutions (usually colleges, universities, and postgraduate training institutions) take similar forms in terms of these aspects, it should come as no surprise. Furthermore, as personnel filters it is not surprising that graduates of accredited programs isomorphically embody similar views regarding clinical work, ethics, and professional identity. In part, this occurs through the pervasive on-the-job socialization MFT trainees experience through practicum and internship experiences.

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USING COERCIVE, MIMETIC, AND NORMATIVE ISOMORPHISM DISCUSSION POINTS IN MFT SUPERVISION: A SUPERVISORS EXPERIENCES
These three isomorphic trends were incorporated into discussion points in providing supervision to practicum students and field placement students in two different university settings over the past 7 years. At one university, the practicum course represented the students first clinical training experiences in the training program where they began to work with live clients (as opposed to role plays in previous courses). Students were placed in agencies throughout the community with an on-site supervisor directly supervising the students work. As the faculty supervisor, I reviewed audio and video tapes of the students clinical work. Practicum supervision consisted of 2 hours of group supervision and 1 hour of individual supervision each week with their faculty supervisor (the author of this article) and 1 hour of individual supervision with their on-site supervisor. Class size averaged 5 trainees per class each semester totally 30 practicum students over the 5-year period (I was not assigned to teach practicum every semester). At the second university, the field placement experience represented the students last clinical graduate work prior to graduation. Like the practicum experience, students would be placed in agencies throughout the community with an on-site supervisor directly supervising the students work. I represented the faculty supervisor who ensured that students experiences met accreditation standards, and reviewed the students clinical work. This was done through review of some digital recordings of sessions, but primarily through case reporting and oral presentations by the students. In the 2 years I have been a supervisor of the field placement experience, I have supervised 35 students utilizing these discussion points. During group supervision in both settings, I customarily took 30 minutes at the beginning of each session to discuss issues pertinent to the training and development of trainees. Although a variety of issues were discussed, I interwove discussion points stemming from a conceptual awareness of coercive, mimetic, and normative isomorphism. I believe this is an example of the use of isomorphism as a domain of supervisory intervention as suggested by Liddle (1988, p. 155).

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Coercive Isomorphism Discussion Points

As we discussed theoretical orientations toward clinical work, diagnosis, and number of clinical sessions, I was careful to incorporate discussion of the impact of managed care and other insurance trends on these factors. Although I encouraged the students to develop theoretical orientations that were congruent with the personalities and populations they were serving, I also

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encouraged them to consider integrating theories that were desirable for the contextual variables of their situations (e.g., solution-oriented approaches for students in health maintenance organization (HMO) hospital settings and CBT for students in substance-abuse rehabilitation centers). Students invariably were interested in private practice and the fiscal realities of such an endeavor. I provided readings from Kottler and Hazler (1997) about financial realities of private practice and discussed what students were observing in their agencies about billing practices. Furthermore, in every practicum or field placement course I presented an ethical dilemma vignette from a foster family agency that pitted the financial needs of the organization against the clinical needs of two foster children in the agency. In short, it involved the premature termination of services for two foster children in exchange for the addition of four new foster children (thus bringing in the net financial gain to the agency from payments for two additional children) at a time when the agency was in financial crisis. As students grappled with the multiple ethical dilemmas involved, they became aware of the coercive forces that impact clinical work. Finally, discussion of the standards and directives from state licensing boards and other governing entities was included in the course. This afforded students the opportunity to ask questions and prepare for the legal realities awaiting them upon graduation. I noticed that in individual supervision sessions that many students became more organizationally aware and would discuss with me their deeper understanding of how their agency struggled to exist within a context of coercive forces. They would note how funding and billing policies impacted their clinical work, how political and legal directives had to be accommodated in their therapy process, and how administrative constraints determined aspects of their clinical approach. An ongoing discussion of coercive isomorphic trends deepened their ability to function as responsible therapists in the context of their agency settings.

Normative Isomorphism Discussion Points

Professional identity development, accreditation standards, and ethics are some critical areas in the supervisory domain of clinical training that fall under the purview of the normative isomorphic trend. In each practicum or field placement course I discussed with students their professional goals, their association with trade associations (mostly AAMFT and the American Counseling Association [ACA]), and their opportunities as students to develop a professional identity. Questions such as What makes a great therapist? and What resources are available through AAMFT/ACA? were frequently asked. As a component of professional identity development, we discussed whether therapy was a calling or a craftsomething you do or something you live, and how to balance therapy with other interests to avoid burnout.

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Another integral component of professional identity development involved acquainting students with the professional trade associations that accredit the profession (in this case ACA and AAMFT). Helping students gain a clear understanding of the accreditation process, what accreditation means for them in terms of licensing after they graduate, and why procedures we followed fit accreditation standards and had logical purposes was important for their development as a therapist. The most critical contribution from the normative isomorphic trend was a thorough review of ethics and ethical guidelines outlined by accrediting bodies. Although students had previously taken coursework in ethics, at the practicum and field placement points of the curriculum, ethics and ethical decisionmaking gained considerably more application relevance for the students. Now that they had to apply ethics to real-life people and situations, their interest in ethics peaked and took on more vivid meaning. Helping students to conform to ethical standards was a beneficial normative isomorphic process. We also discussed the filtering process of clinical training, the need for their own ongoing personal therapeutic work, and the role of the training program as gatekeepers to the profession. Although these activities do lead to normative isomorphic trends, professionalization does not necessarily mean graduates become automatons. We discussed balancing professional standards and professional identity with individuality and creative expression within their work.

Mimetic Isomorphism Discussion Points and Processes

Mimetic isomorphism was briefly discussed in group supervision. We discussed that as the students were new to clinical work and would face moments of uncertainty in session, they would likely want to use phrases, questions, and approaches that I use in my own clinical practice. I would tell stories and give examples from my own practice demonstrating how I handled situations. I clearly delineated my own theoretical approach to clinical work but encouraged them to seek a theory that was congruent with their level of development, personality, and style. More often mimetic isomorphism came into play as I modeled my clinical approach during the review of tapes in group and individual supervision. It was not uncommon for students to play tapes in supervision where they specifically used phrases or techniques I had suggested to them based on the successful use of those techniques in my own clinical work. I took the approach that I would be happy to provide models for them to mimic (and often did), but I did not want them to feel constrained to do things my way unless I felt some specific legal or ethical need to direct them to do so (e.g., mandated reporting). I was open to their trying different approaches. Most students, as beginning trainees wanted models, words, techniques, and suggestions to implement due to their uncertainty. Although being careful not to rescue them and stifle their opportunities for growth, I mostly provided models in the review of tapes. I was also careful

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to avoid the blinders of mimetic isomorphism through asking and challenging them to bring in their ideas, theories, and strategies, as well as asking what their on-site supervisor suggested (this gave differing perspectives to our review of their work). Despite these efforts to be consciously aware of mimetic isomorphism trends and be open to diversity of ideas and styles from the students, I found that the newest students just beginning their practicum experiences for the first time were more apt to rely on mimetic isomorphism and mirror my own clinical approach because it was comfortable to them given their lack of clinical experience amidst uncertainty. As students developed their clinical skills, they became less reliant on mimetic isomorphism. I have found that type of theoretical blossoming and differentiation by my more advanced students to be one of my most rewarding experiences as a supervisor.
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CONCLUSION
The study of isomorphism in the MFT fields literature has been relatively isomorphic. Using DiMaggio and Powells (1991) sociological model of examining the MFT industry through the lens of coercive, mimetic, and normative isomorphic forces helps us understand how and why isomorphism occurs in clinical training and supervision. This awareness led me to develop discussion points to be used within practicum and field placement courses I taught over the past 7 years. By exploring the notion of the MFT as an industry and taking a sociological, neoinstitutionalist perspective, it became clear that isomorphism occurs in clinical training and supervision for three reasons. The context of the industry acts as a coercive force. Insurance and other fiscal impacts on the industry, political forces, administrative realities, and competition with other mental health professional trade associations has created a context whereby the training of MFT students requires teaching, training, and supervision to accommodate these coercive realities leading to isomorphism in such training. Because interested parties and coercive forces will likely increase their efforts to influence the MFT industry, it is likely that increased coercive isomorphism in clinical training and supervision will be a response from the MFT field. Normative isomorphism stems from the professionalization of the field. Increasing accreditation standards, licensing requirements, ethics emphasis, professional identity development, and the filtering processes through on-thejob training create a context whereby graduates of MFT training programs will increasingly be likely take similar or isomorphic approaches to clinical situations. Traditionally, the MFT field has focused on the mimetic component of isomorphism. DiMaggio and Powells (1991) approach teaches us that mimetic isomorphism stems from uncertainty. As uncertainty within the field

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is likely to increase, it is reasonable to expect that mimetic isomorphism, as a response to field uncertainties, will also likely increase. Therefore, it is important to recognize these isomorphic trends in the MFT industry and counter the isomorphic study of isomorphism with a more comprehensive approach. By helping students to recognize the isomorphic trends in clinical training and supervision, as well as the contextual variables that compel training and supervision into isomorphic structures, students will be better equipped to face the realities influencing the MFT industry.

REFERENCES
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