1 Introduction

Multi-family therapy (MFT), an integration of family therapy and group therapy (Asen 2002), has been extensively applied in different settings ever since the work of Peter Laqueur and colleagues was published in the 1950s (Laqueur et al. 1969). Comprehensive reviews of empirical studies regarding the applications of MFT to diverse target populations suggest its usefulness for psychiatric disorders (Gelin et al. 2018) and nonpsychiatric problems (Cook-Darzens et al. 2018). Although MFT is increasingly used in specialist psychiatric services and in community settings internationally (Lemmens 2023), the bulk of literature on MFT focuses on examining MFT's effects for specific populations (e.g., Ma et al. 2021a), its specific advantages over other active treatment modalities (e.g., Eisler et al. 2016), and the therapeutic factors and change processes of MFT (e.g., Liu et al. 2015). Meanwhile, only a handful of articles address the clinical training process for MFT (e.g., Saayman et al. 2006). In response to that gap in the literature, this article describes and evaluates a brief MFT training model for helping professionals in China, where applications of MFT remain in their infancy.

1.1 MFT and Its Applications in China

MFT is a systemic approach in which several families facing similar problems come together in the same therapeutic space. The therapeutic space for MFT, characterized by high levels of acceptance and intensity, helps to facilitate enactments between the individuals who manifest symptoms of psychiatric or nonpsychiatric problems and their families and allows the creation of healthier interactions with other group members and their own families. Such changes in family interactions gradually evolve in the therapeutic process by creating opportunities for members to observe and exchange as well as to learn by doing and reflecting (Baudinet et al. 2024). Although the multiple models of MFT developed across the world over the past five decades showcase differences in their theoretical bases and presentation, the models share the same treatment goals, including reducing stigma and isolation, relieving caregivers' stress, mobilizing families' strengths and resources, and strengthening family-based support for individuals who manifest symptoms of psychiatric or nonpsychiatric problems (Asen and Scholz 2010).

MFT has been well-established in mainstream family services in Western countries. In Chinese societies, by contrast, where family therapy has been found to work well with Chinese communities since the 1980s, systemic approaches have not yet been widely disseminated (Wong and Ma 2013), including those involving family psychotherapy group work such as MFT. Ma et al. developed the first indigenous model of MFT for Chinese families of school-age children with attention deficit hyperactivity disorder (ADHD) in Hong Kong (Ma et al. 2018, 2019) and subsequently adapted the model to the broader Chinese population, including families with children placed in out-of-home care (Wong et al. 2019), adult children with high-functioning autism spectrum disorder (ASD) (Lo et al. 2024), parents with depression (Ma et al. 2021a & 2021b), adolescents with mild-grade intellectual disabilities (Lo et al. 2023), and adolescents with ADHD (Lo and Ma 2024). There is another recent application of MFT for first episode psychosis in Singapore (Loh et al. 2021, 2023). Although research continues to be needed to fully understand the treatment process within MFT and support its effectiveness in Chinese contexts, our previous works have indicated MFT's clinical applicability and treatment effectiveness within Chinese families with diverse backgrounds and conditions. By extension, disseminating knowledge of MFT in the mainland of China would allow more family therapists and helping professionals there to develop their own MFT practices and adapt MFT to their clinical settings.

1.2 A Short-Term Training in MFT in China

MFT remains new to most helping professionals in China, and resistance may be common for new methods of intervention. The training protocol presented in this article is designed as a short-term introductory workshop with the overall goal of sparking an interest in MFT among helping professionals in China. In the workshop, we offer trainees a taste of what MFT is and how it works with families in Chinese contexts and create an experience for trainees to explore their own motivations for learning more about MFT and consolidating their MFT-oriented skills. We do not intend to train MFT therapists in this short-term introductory workshop. For those who are interested in further developing their skills and knowledge in MFT after attending this training workshop, they are advised to proceed for intensive clinical supervision on MFT.

The learning objectives of our training workshop were developed based on Tomm and Wright's (1979) theoretical framework for family therapy training and on the core competencies for practicing marriage and family therapy proposed by Nelson et al. (2007). A core competency model was constructed based on Nelson et al. (2007)'s framework for evaluating the levels of competency of family therapists in a Chinese context (Chao and Lou 2018). This culturally adapted model focuses on the prerequisite competencies that are relevant to the practices of family therapists in Chinese contexts, which provides comprehensive guidelines on Chinese family therapists core competencies in aspects of admission to treatment, assessment and diagnosis, therapeutic interventions, and case management. This model is useful for continuous assessment of the development of family therapists in Chinese contexts, however, it may not be fully applicable for assessing the learning outcomes of trainees in this study. Given the short-term and introductory in nature of our training, the content of our training only covered two specific aspects of core competencies in MFT: assessment and diagnosis, and therapeutic interventions. The core competency in assessing the family problems contextually requires the trainees to be equipped with conceptual knowledge and abilities to understand the problems in light of a systemic perspective. For the core competency in carrying out the therapeutic interventions in MFT, this requires the trainees, first, to be able to plan the therapeutic contexts in an MFT based on their conceptual understanding of the family problems, and then implement in a flexible manner to cultivate a therapeutic process to facilitate changes in the families.

To this end, our training emphasizes a learning process in which trainees acquire the basic conceptual, perceptual, and executive skills needed for MFT. In this context, conceptual skills refer to a conceptual understanding of the systems concepts, theories, and techniques that are foundational to practice in MFT, ranging from family assessment and the conceptualization of family-based problems to the design of treatment principles for MFT (Asen and Scholz 2010). By contrast, perceptual skills refer to the ability of trainees to apply their conceptual understanding of MFT theory and techniques in practice based on their observations of the family's patterns of interactions in MFT sessions, including in here-and-now contexts in MFT, and to adopt a systemic–developmental perspective in their intervention plans. Finally, executive skills refer to the ability of trainees to perform behaviors, actions, and MFT activities that can facilitate the therapeutic processes in MFT, including being able to stay curious about the stories behind each participant, use nonexpert stances to mobilize mutual support in Chinese families and cross-family exchanges (Lo and Ma 2024), and elucidate the problem presented by cultivating an experience-rich, multifaceted group context in MFT.

1.2.1 Training Settings and Approach

Our training workshop lasts 2 days, for a total of 12 training hours. The workshops are usually held on Saturdays and Sundays to accommodate the work schedules of helping professionals in China. They target helping professionals in China with backgrounds in family therapy, social work, psychology, psychiatry, and child and youth care with previous training in individual, group, and family therapy modalities. To reach that target audience, we collaborate with local universities, psychiatric hospitals, or nonprofit organizations in four cities in China: Hong Kong, Hangzhou, Shenzhen, and Kunming. The ideal size for our workshops is 30–50 participants, which is conceived to allow better trainer–trainee interactions and trainee engagement. All training workshops that we examined in our study fell within that range of enrollment size except for the one conducted in Shenzhen, which had 114 trainees. That workshop was organized by a psychiatric hospital in Shenzhen, which is one of the major psychiatric hospitals in China's Guangdong province. Workshops organized by a leading psychiatric hospital is attractive to helping professionals in China, which may explain the above-average enrollment size for the workshop in Shenzhen. To accommodate the large enrollment size of the workshop in Shenzhen, the training was conducted in a big functional room of a hotel, where an ample space was available at the center of the room for activity demonstration and allow the trainers moving around to maintain good interactions with the trainees during the training.

To ensure a positive training dynamic and reduce trainees' feelings of isolation and/or anonymity in our workshops regardless of enrollment size, we have developed an instructional approach based on the principles of team-based learning (TBL), which is an active learning method employed in psychotherapy education with large classes (Kibble et al. 2016; Touchet. 2005). Due to the short duration of our workshops, we do not intend to apply all procedures of the TBL instructional approach; instead, the principles of TBL adopted in our workshop are (1) forming heterogeneous teams, (2) emphasizing trainees' accountability, (3) providing team assignments focused on solving a real-world problem happening in the MFT sessions, and (4) offering immediate feedback to trainees. In each workshop, we divide trainees into groups of 8–12 individuals selected at random to afford them an opportunity to learn on a diverse team of members with different professional experiences and types of expertise in therapy. Trainees remain in their assigned groups for the entire workshop to give them time to practice working as a team.

Given the large differences in enrollment size between Shenzhen and the other three workshops, investigation is warranted to see whether there are any differences in the competence of the trainees in Shenzhen as compared with those in other workshops.

1.2.2 Metacognitive Skills as the Focus of Training

Traditional training in psychotherapy that emphasizes didactic teaching methods and adherence to manual-guided techniques has been called into question regarding its effects on enhancing the competence of therapists beyond the training itself (Bein et al. 2000). It has been suggested that psychotherapy training should instead focus on developing the metacognitive skills of trainees via experiential learning and attend more closely to the organizational context in which training occurs (Fauth et al. 2007). Metacognitive skills, defined as an individual's knowledge and regulation over their cognitive process that is, thinking about one's own thinking (Flavell 1979)—play a fundamental role in informing and rethinking decisions and actions through the continuous ongoing monitoring of one's progress and identification of one's own strengths and weaknesses (Scandurra et al. 2018). A reflective ability has been identified as a key metacognitive skill that is central to developing therapists' expertise, one that enables them to discern which intervention strategies may be useful in what context, with whom, and under what conditions (Bennett-Levy 2006). Through the metacognitive process of observing, interpreting, and evaluating one's own experience and that of families, it is thought that therapists can learn and build on their conceptual and perceptual skills as a means to plan procedures for a therapy session (Bennett-Levy 2006).

Because MFT is not a manualized intervention, MFT leaders should observe the interaction between group members, assess the needs of the families involved, and formulate plans to address those needs from time to time during MFT. They should also be process-oriented in organizing activities and adjust the program's plan flexibly to optimize the learning of family members. Thus, our training workshops encompass theoretical and experiential components to enhance the metacognitive skills of trainees, especially their learning of the program logic behind MFT (Table 1). For the theoretical components, essential conceptual knowledge of MFT is introduced, including foundational concepts in family and group therapy, the theoretical framework of MFT, processes of change in MFT, and the design of activities and leadership for MFT. For the experiential components, by contrast, various MFT-oriented activities are facilitated via simulated role-play, including a group-building activity, intra- and interfamilial activities, and a problem-focused activity. Instead of teaching a particular MFT model and drilling skills, our workshops focus on guiding trainees in applying conceptual knowledge as the building block for planning MFT suitable for the organizational and sociocultural contexts surrounding trainees and families. The typical organization and programming of an MFT model are explained at the outset of each workshop as a means to provide a general picture of MFT to trainees—that is, psychoeducation talks for family recruitment and engagement, family interviews and assessment before MFT, the core program of MFT, and a family reunion to consolidate the experience. The flow of the workshop follows that typical organization so that trainees can contemplate the thinking processes involved in planning MFT.

1.2.3 Applying Theories to Practice Through Experiential Learning

Experiential components have been highlighted as being necessary for training in family therapy (Kane 1996). Along with helping psychotherapy trainees to cultivate their therapeutic skills, including empathy and sensitivity to others' perspectives and experiences, experiential exercises provide trainees with a different level of comprehension of their preconceptions about different clientele (Helmeke and Prouty 2001). From this perspective, when designing team-based assignments, we also integrate the work of Raasoch and Laqueur (1979), who used simulated workshops to teach MFT such that each trainee on a team is responsible for contributing to either family-based role-play or for playing a role as a clinical team member in a simulated MFT session. Often, these simulated sessions touch on numerous real-life issues that are common in MFT processes, and trainers open the floor to the team to respond. As a result, trainees can expand their perceptual skills in labeling, for example, the family's pattern of interactions and group transactions by observing role-play in the simulated activity. The process can also reinforce trainees' conceptual understanding of theories and techniques related to MFT.

The staffing needed for MFT depends on the work context and the specific issues that the specific MFT program is meant to address (Asen and Scholz 2010). Based on our clinical experience, it is impossible for only one therapist to manage a group of six to eight families, no matter how experienced the therapist is in family or group therapy. MFT requires a team of three to four therapists with different but related forms of expertise to colead a group. Following that team-leading approach, we usually have one or two therapists lead the entire program; they deliver instructions for the activity, promote fun and joy in the group, monitor the activity's progress, connect families, and create group contexts able to facilitate alternative interactions in each family. Meanwhile, the other one or two therapists stand apart from the main stage to observe the processes happening in the group with a bird's-eye view and step in whenever critical issues happen in the group. Through simulated role-play in our workshops, trainees can observe how the two trainers share and communicate their views of working together as a team to create a respectful, engaging platform in which families feel safe disclosing their concerns and that at once connects families to promote exchanges in the simulated group process.

We have observed that the simulated role-play and TBL approach can be useful to demonstrate teamwork between the MFT leaders in designing, planning, and leading an MFT program. We first lead a discussion among all teams to identify a specific target clientele that they would like to work with in the simulated MFT session. Each team role-plays a family of the targeted clientele to enact the issues and problems that the family is facing. The trainers then lead an open discussion to decide whether the family, considering the nature and severity of the problem that the family is facing, is suitable for participation in MFT. Very often, due to their diverse backgrounds in terms of their work experience and clinical expertise, the trainees have very different opinions about what to implement for the positive development of the family and MFT. Conversations among trainees may get heated in the discussion process, which vividly provides trainees with an experiential learning opportunity to embrace the multiple perspectives of team members regardless of their seniority. For some trainees who are the leaders or senior staff in their work settings, participating in such discussions contributes to their learning, particularly in relation to their self-awareness in their roles as clinical leaders.

1.3 Study Objective and Hypotheses

In our study, by adopting a single group pre-and-posttest design, we aimed to evaluate short-term clinical competency training in MFT for helping professionals in China and to examine its effects on enhancing trainees' basic conceptual, perceptual, and executive skills in MFT.

Our short-term training workshops offer theoretical inputs and experiential learning in the training process, which may be helpful to enhance the conceptual and perceptual competencies in MFT of the trainees. However, due to the short duration in length of our training, the trainees did not have the opportunities to apply the knowledge in real life situations, and may be unable to acquire the executive competencies in MFT. Therefore, we hypothesize that the trainees will have their conceptual and perceptual competencies in MFT to be significantly increased after completing our short-term training, but their executive competencies in MFT will not show a statistically significant change after our training.

We delivered our training workshops in different cities in China. Although all the trainees who attended our training were helping professionals, their personal characteristics varied (e.g., length in experience, professional posts, educational levels and gender) which may influence their learning outcomes. For example, therapists' work experience and educational background were found to be significantly positively correlated with their self-competencies in therapy (Gordillo 2015). Mixed results have been reported in previous research on the influence of therapists' gender on their self-efficacy in delivering therapy sessions. For example, female therapists tended to have significantly higher counselling self-efficacy than male therapists (Bodenhorn and Skaggs 2005), but this gender influence diminished when it came to therapists with higher levels of education (Holcomb-McCoy et al. 2008). In our training, trainees with more work experience in family therapy and with higher level of education may have higher degree of self-competencies in therapy before joining our training than those with less work experience and lower educational level. Therefore, we hypothesize that trainees with less work experience in family therapy and lower educational level will have significantly increment in their competencies in MFT than more experienced and educated trainees after completing our training. Regarding the gender influence, we hypothesize that there will be no significant differences in the learning outcomes between female and male participants in our training.

Last, the enrollment size in the Shenzhen workshop was much larger than the other three workshops, which may inevitably affect the trainer-trainee interactions in the training process despite the accommodations made to this large class. We hypothesize that trainees who attended the Shenzhen workshop will have significantly less increment in their competencies in MFT than trainees attended the other workshops.

2 Methods

2.1 Participants

Four workshops were conducted in four cities (i.e., Hong Kong, Hangzhou in Zhejiang province, Shenzhen in Guangdong province, and Kunming in Yunnan province) between April 2023 and September 2024. The workshops attracted 232 participants in total, 203 of whom completed the pretraining questionnaire and 179 of whom completed the posttraining questionnaire, for a response rate of 77.2%.

The valid sample included 162 participants who completed both the pretest and posttest. As Table 2 shows, most trainees were women (n = 141, 87%) with at least a bachelor's degree. Approximately one-third of the participants (30.9%) had less than 5 years of experience working in social services, another one-third (28.4%) had 5–10 years of experience, and the rest (38.9%) had more than 10 years of experience. As for their professional positions, most were clinical psychologists (37.7%), followed by social workers (32.1%), while the remaining 30% were care workers, psychiatrists, special education teachers, and social work academics.

2.2 Trainers

All four workshops were conducted by the training team, comprising of the first and the last authors of this study. The last author possesses a PhD in social work, and is a family therapy supervisor with 30 years of experience in family therapy. She has over 10 years of experience in MFT, particularly on using MFT to work with families with parental depression and families with children with neurodevelopmental disorders such as ADHD, autism, and intellectual disabilities. The first author possesses a PhD in social work, and is a family therapist trained by the last author. The first author has 10 years of experience in leading MFT for families with children with ADHD, autism, intellectual disabilities, and anxiety symptoms.

2.3 Measure: A Self-Evaluation Form for Perceived Competency (SEF-PC)

With reference to Tomm and Wright's (1979) framework on family therapy, we developed the SEF-PC to assess the participating trainees' perceived competency in MFT. The nine-item scale comprises two subscales: (a) the Perceptual/Conceptual subscale, with five items (e.g., “I have a conceptual competency in applying family treatment principles”), and (b) the Executive subscale, with four items (e.g., “I feel capable of executing multiple family therapy skills and techniques”). The items are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), and higher scores denote a higher level of perceived competency in MFT. The scale showed high reliability in our study, with Cronbach's αs of 0.86 for the pre-training test and 0.74 for the post-training test.

2.4 Demographics

Basic demographic information of participants was collected, including their gender, level of education, professional positions, and length of work experience in social service settings.

2.5 Procedures

Data were collected using a self-administered anonymous online questionnaire. Participants were invited to respond to the same questionnaire before and after the training. The study was approved by the research ethical committee of the first author's institution. Participants joined the study voluntarily and were free to withdraw from the study at any time for any reason. Participants indicated their informed consent before the pretraining questionnaire.

2.6 Data Analysis

A paired-sample t-test was conducted to examine the effectiveness of the training workshops in enhancing the participants’ professional competency by comparing their pretest and posttest scores and calculating the effect size (Cohen's d). To explore potential differences in outcomes based on demographic characteristics, including gender, length of professional experience, level of education, and professional position, a repeated one-way analysis of variance (ANOVA) was employed to examine the changes between posttest and pretest scores. Post hoc tests were applied to identify specific between-group differences according to the ANOVA's results. Statistical analyses were conducted using SPSS version 28.0, with a significance level set at p < 0.05.

3 Results

The descriptive results indicated a relative perceived competency in MFT, with the average total score as well as the two domains exceeding 3.2 out of 5 points (Table 3). The participants were most confident about their competency in relation to the item “I am curious to learn about family stories” (Q7, M = 4.17, SD = 0.71) but least confident about their actual performance (Q8, M = 2.72, SD = 0.90) while conducting family interventions.

The paired-sample t-test showed a significant improvement of participants' overall perceived competency from pre-training (M = 3.29, SD = 0.65) to post-training (M = 3.94, SD = 0.38), t = −13.731, p < 0.001 and Cohen's d = 1.22. Improvement on both the Conceptual/Perceptual and Executive subscales was also statistically significant, and a prominent increase in scores was found for each item on the scale except “I often worry about my performance during family intervention” (Q8). The results suggest that participants remained somewhat worried about their performance in applying the knowledge and skills of MFT in family interventions. The workshop slightly alleviated their worries and boosted their confidence (t = 0.782, p > 0.05) but not to a statistically significant degree (Table 3).

As for the variance in improvements according to demographic characteristics, results of the repeated ANOVA show that participants made similar significant improvement in their conceptual/perceptual, executive, and overall competencies after the training regardless of their gender, level of education, professional position, or the training site (Table 4). No significant difference was found in the competencies between trainees who attended the Shenzhen workshop and those who attended the other workshops. However, participants' length of work experience in social services was found to be a differentiating factor for their overall benefits from training (p = 3.081, p < 0.05) as well as on the two subscales (conceptual/perceptual: p = 2.582, p < 0.05; executive: p = 2.754, p < 0.05).

Results of the post hoc analysis for length of work experience in social services (Table 5) show that, overall, participants with less than 5 years of experience made significantly more improvements than participants with more than 10 years of experience (M_difference = 0.38, SD = 0.11, p < 0.05). As for conceptual/perceptual skills, participants with less than 5 years of experience (M_difference = 0.40, SD = 0.13, p < 0.05) and 5–10 years of experience (M_difference = 0.32, SD = 0.14, p < 0.05) had significantly more improvement than people with more than 10 years of experience. As for executive skills, participants with less than 5 years of experience showed significantly more improvement than the other two groups, while no significant difference emerged between the two other groups.

4 Discussion

Our study was the first attempt to evaluate the effectiveness of clinical competency training in MFT. Overall, our results suggest that short-term training may be helpful to trainees who are new to the intervention modality, particularly those with less work experience in a social service setting (i.e., less than 5 years).

Aligned with Raasoch and Laqueur's (1979) suggestion that the ideal duration of an MFT-simulating workshop is 2–3 days, our findings also indicate that short-term intensive training comprising theoretical and experiential learning may be helpful to enable helping professionals in China to feel capable of applying the conceptual knowledge of MFT in their work settings. In previous works, Saayman et al. (2006) and Xia et al. (2022) have outlined a systematized method for training mental health professionals in conducting process-oriented MFT in children's psychiatric hospitals or mental health rehabilitation service centers. Their training models comprise the apprenticeship model that include timely mentoring and the supervision of clinical practices in MFT, which could be helpful to promote MFT's implementation in one service setting. Unlike their models, our training model can be helpful in promoting the enthusiasm and self-motivation of helping professionals and encouraging them to further explore MFT in their own practices. Our training model may be particularly useful to implement in places where MFT-focused research and applications remain in their infancy, including China and other Chinese contexts, and to help with training enthusiastic salesmen in MFT to promote its benefits.

Our findings additionally suggest that helping professionals with less work experience in social services benefited more from our training model. That finding corroborates results in the literature (e.g., Green and Kirby-Turner 1990; Nel 2006), thereby indicating that the process of learning family therapy would amount to a complex integration of a new framework into an already well-consolidated therapeutic construct system for experienced helping professionals. For instance, our training model emphasizes decentralization and the nonexpert stance of MFT therapists in cultivating mutual support among families to facilitate processes of change in group contexts. The nonexpert stance can be a challenging learning process, one that creates an experience of de-skilling (Nel 2006), puzzlement, and discomfort (Givropoulou and Tseliou 2021) for experienced professionals, especially in Chinese contexts. Chinese cultures tend to greatly respect hierarchy and authoritative leadership, and Chinese families tend to seek out solutions and direct information from authoritative therapists (Ma 2000). Experienced professionals, who are usually knowledgeable and resourceful, are therefore often the people whom Chinese families seek out. This trend could lead to a challenging learning process for experienced professionals seeking to integrate the new perspective of the nonexpert stance into their well-established professional identities. Nevertheless, in our study, changes in the perceived competency of the experienced professionals were significant but not as significant as those of less experienced groups. The process of mutual enquiry between trainers and trainees may help to create a learning environment that effectively acknowledges and builds on trainees' pre-existing knowledge and skills (Nel 2006), all to generate positive training effects on the experienced professionals.

Our findings did not show significant differences in the trainees' perceived competencies by their gender, professional posts, or educational levels. We believe that this absence of differences may be attributed to the fact that MFT is still a new intervention approach in China, such that most of the trainees were at the novice stage of learning in MFT, regardless of their gender, professional posts, and educational levels. Our findings also found no significant difference in the perceived competencies between the Shenzhen workshop (large class size) and the other workshops (regular class size). We believe that the team-based learning approach in our training helped increase the trainee-trainee interactions through intensive in-group exchanges, which may therefore compensate the effect of the reduced trainer-trainee interactions in the large class.

In our experience in training workshops for MFT for helping professionals in China, we have observed the importance of promoting exchanges among trainees and the value of experiential components in facilitating learning processes. Given that the importance of teamwork in clinical settings has become more prominent in the mental health service environment (Jenkinson et al. 2013), creating a learning environment that values open communication and mutual exchange among trainees would favor the development of multiple perspectives on each family's situation and multiple possibilities in designing the content of MFT. Adding to the advantages of role-play in simulated MFT workshops identified by Raasoch and Laqueur (1979), we observed that incorporating experiential activities in training for MFT can create a learning process for trainees to appreciate the strengths and internal resources of families and experience how the processes of change evolve within MFT.

4.1 Limitations and Recommendations

Several limitations of our findings bear mentioning. First, although we conducted a multisite study, it nevertheless adopted a single-group pre–posttest research design that may have been threatened by selection bias because participants enrolled in the training workshops voluntarily, thereby indicating their high motivation to receive training and their expectations of it. Participants reported their perceived competency before and after the workshop, which could have also resulted in social desirability bias. The changes observed in the perceived competence of participants could be due to the regression to the mean phenomenon and not the training workshop per se. Second, findings in our study may be influenced by measurement errors. Each training workshop was evaluated using a scale that we developed, which may have jeopardized the validity of our findings. It has been criticized that therapist's perceived competence plays little role in determining treatment outcomes in psychotherapy (e.g., Webb et al. 2010). Discrepancy was reported between perceived and measured outcomes of psychotherapy treatments (Pekarik 1994), suggesting the need to include direct measures of client outcomes and the learning outcomes of the trainees in future studies. There is also a lack of follow-up studies to assess whether the positive effects of our training on the trainees are sustainable. Third, 22.8% of trainees did not respond to the questionnaire, and their experiences may have differed from trainees who responded and remained in the study. Thus, our findings should be interpreted with caution.

Future studies that evaluate the effectiveness of training in MFT should include a control group. Qualitative studies would also be helpful to gain insights into the trainees' learning process following the short-term training model. Beyond that, multi-informant data, including feedback from clients, would be helpful to illuminate the extent to which the knowledge and skills taught are implemented in MFT practice. Future studies should include some direct assessment measures (e.g., a pre-post quiz about MFT knowledge and skills) to evaluate the learning progress of trainees after joining the training workshop. It would be helpful to understand the actual knowledge that the trainees acquired at the conclusion of our short-term training workshop, and which aspects of knowledge in MFT needed to be strengthened in our training. As recommended by the therapist training evaluation outcomes framework (TTEOF) (Decker et al. 2011), future studies on evaluating MFT training should evaluate both short-term training outcomes (i.e., trainee's reactions to training, attitudes, knowledge, and skills) and long-term training outcomes (i.e., trainee's behavior change in practice, and client outcomes).

5 Conclusion

The short-term clinical competency training in MFT in our study helped to enhance the conceptual, perceptual, and executive competencies of helping professionals in China, particularly ones with less work experience in social service settings. Such simulated workshops can be a promising strategy to teach helping professionals who are new to MFT. Finally, creating a learning environment with open communication and mutual exchange between trainees is important for promoting teamwork in leading MFTs. Further development of intensive MFT training and clinical supervision for Chinese helping professionals is needed.