On Teamwork

In the latest post for a blog titled "In Our Humble Opinion” with content by Family-Based Recovery (FBR) Model Development and Operations (MDO) team members, Michelle St. Pierre, LCSW, addresses the important roles of teamwork and supervision in the implementation of FBR. The FBR MDO blog was launched in February 2025 to provide information and resources for professionals related to the experiences of FBR providers. Approximately quarterly throughout the year, team members share insights learned from their work providing home-based substance use treatment and attachment-based therapy to parents of young children. Any opinions or views expressed in this blog are those of the authors and are not intended to represent Yale University.

Much of the focus in providing effective and comprehensive psychotherapy is the ability to develop collaborative, supportive relationships with clients. But what happens when an intervention is provided by a team?

In team-centered models such as FBR, not only is the development of an effective team-client relationship vital, so too is that among team members. Attending to all relationships within the work is necessary for the best possible outcomes, yet the collaborative focus can sometimes get lost in the busy, day-to-day needs of service delivery.

In my role as a team supervisor and model consultant over the past ten years, I have had the opportunity to witness clinical teams form, grow, shift, and renew. There are many factors that I have observed and experienced that have helped and hindered team growth, and these observations are shared in this blog post.

FBR is an intensive, in-home treatment model focused on providing substance use treatment and parent-child dyadic therapy while also supporting connection to basic needs to build recovery capital. Each FBR team consists of two master’s-prepared clinicians, a bachelor’s-prepared family support specialist, and a supervisor—all of whom provide care to the same families. The FBR model sets relationships as the foundation from which all interventions grow. Supportive relationships are essential, between the team and the family, as well as among teammates.

While clinical staff join FBR equipped with the knowledge, experience, and interest necessary to treat FBR families, many have never worked in a service delivery team of three. Someone new to their role on an FBR team joins colleagues who have more experience and who share in all aspects of clinical intervention, team supervision, program meetings, and consultation. Being observed by both families and teammates can feel exposing, especially when someone is still learning the model or building confidence in their clinical skillset.

Working as a team often means that others will witness or learn about your mistakes, missteps, and clinical ruptures. Further, as relationships are being built with families, it is natural that some may gravitate to one clinical staff member more than another. A desire to be effective and liked by clients can unintentionally cause splits and conflict among team members. For all new to a team, trust in teammates and the collaborative process is not a guarantee, but something that is built over time and can prove challenging if given and broken.

On a team, connection is palpable and noticed when missing. Individuals who are not yet working cohesively show clear signs. Discussion about the intervention, collaboration, and even scheduling of clients leads with the terms “I/me” rather than “we.” In case discussions, some may be hesitant to share differing viewpoints, be unaware of current case material, or have not collaboratively built a case formulation. Individuals may be working at different intensities or against each other, rather than displaying a sense of shared work. Splits and ruptures with clients and among team members are not addressed or are further reinforced. Even when communication strategies exist, they are not always utilized or implemented effectively. Most notably, when a team is not working in a unified manner, it is evident to the families they are treating and providers with whom they are collaborating. Ultimately, without focusing on relationship building in all aspects of the work, strain and burnout increase, longevity in the model is shortened, and the success of the intervention may be impacted.

Partnership in teams comes from a similar skillset used to build connection between clinical staff and a client. Partnerships do not form by an expectation that they exist, but from an understanding that over time and with intentional focus, individuals can find ways to join together. Staff build relationships with clients by showing that they are accepted, valued, and important. Clients know that their clinical staff have their backs, and when disagreements occur, they will be met with respect and humility.

While this process is expected in relationships with families, it is not always at the forefront of teamwork. Staff build similar relationships, through mutual support, effective communication, an openness to trust, an acknowledgement of differences, and acceptance that mistakes will be made. Enduring shared experiences, even the most challenging, seem to further support team formation.

Instability in teamwork often grows from a lack of intentionality around the formation of team relationships. A focus on team cohesion starts even before hiring team members. Teams reshape and reform each time a new colleague joins. Agency culture and onboarding practices can bring necessary support. In anticipation of new teammates, existing colleagues benefit from the opportunity to interview or provide recommendations about ideal qualities for their team. With colleagues’ buy-in during the hiring process, they are more likely to support a new teammate’s integration.

Safe spaces within agencies, in addition to dedicated time and patience, normalize the goal for connection. Agencies that provide a home base for their teams encourage and support team members to meet both formally and informally, and in-person. In a world of video conferencing and texting, communication does not equal connection and teams that meet in person, especially in the early stages, make great strides in effective team building.

Team supervision involves many tasks, and the focus on teamwork may be one of its most challenging. Skills needed for team supervision differ from those for individual supervision. A team supervisor is juggling many personalities and perspectives while navigating each to more largely support the intervention and the group as a whole. Tasks that appear to benefit team supervision include validating unique perspectives and roles, highlighting connections where they happen, and building in time to reflect on strategies for and the benefits of working together.

Team supervisors normalize that mistakes will be made and that some families will connect more with one teammate than another. They also help recognize when colleagues are operating individually and help teams to find mutual ground. Effective team supervisors provide a foundation, and once established, teams appear more equipped to navigate challenges directly with one another. Teams can address ruptures when they happen, and embark on difficult conversations together, and with families.

Individual supervision is a vital place to work through new staff jitters, build confidence, process strain in connecting, and understand biases and countertransference. Individual supervision is also a place for finding one’s own clinical voice, and learning to accept that of others, even when different. Some team dynamics require individual support, before being addressed by a team. Having a safe individual space for reflection allows teamwork to flourish.

Team building requires time and focus, and the process of getting there can be daunting and exposing. Some individuals may ultimately decide that being a solo practitioner is a better fit as they progress in their careers. But for those who embrace team-based work, the benefits are substantial. FBR provides an intensive intervention that supports families in many psychosocial areas, and having a team divides the work and balances the focus. The intervention, like many in the human service field, can be stressful and overwhelming at times. The ability to lean on teammates while bearing witness to the experiences of families together is powerful and may lessen burnout.

Clinical staff who can navigate the challenges of relationship building within teams are honing their skillsets to be more effective clinical partners with families. Supportive relationships and trust are hard to achieve and incredibly meaningful once established. Teams that are well formed tend to last in the work much longer than teams with more instability. Families, too, benefit from an effective team. They can experience relationships where mistakes can be made, trust rebuilt, differences accepted, and where respect and humility prevail. This blueprint can be internalized and drawn upon even after the intervention ends.

By exploring the topic of teamwork, I found myself considering my own professional teammates and partnerships. I can recall the excitement and hesitation when faced with a new teammate joining, and the relief and ease once the relationship was established. What a gift a teammate can be—someone that I can say “help!” to when I need it, someone with whom I can be vulnerable and still be okay, and someone that knows me well enough to tell when I’m on point or having an off day.

Blog writing has forced me to approach a new place of vulnerability, in writing and sharing my thoughts publicly. It also allowed me the space to reflect on the many teams I’ve worked in historically and recognize the ingredients that support our connection. I did not hesitate to share my many drafts with teammates and lean on them when I was stuck. I knew there would be mistakes, and that vulnerability was something I could manage because my team would support me. For my team, and all the teams I have learned from, I am truly grateful.