The AAMFT Blog

The Journal of Martial and Family Therapy Celebrates 50 Years

 

2024 marks the 50th volume of the Journal of Marital and Family Therapy. It’s hard to believe it’s been half a century since the very first issue of JMFT rolled off the printing press.  

Some of you may be aware that the first article in Volume 1 in 1975 was Jay Haley’s “Why a Mental Health Clinic Should Avoid Family Therapy.” Haley’s tongue-in-cheek jab was fitting for the founders of the day, who often used humor to bring home a point. The piece begins with an editorial note suggesting that adding family therapy procedures to a health clinic might include consequences that are “likely to include disorientation of the staff, radically changed administrative procedures, and others, including service to larger numbers of people and better treatment outcome.” How appropriate for the journal to begin its life cycle with a wink and a nudge to incorporate systemic therapy into the realm of general healthcare; a reminder that so much progress has been made, but there is much left to do! 

The second article to appear in Volume 1 was written by another founder, James Framo. His “Personal Reflections of a Family Therapist” reads like a literary time capsule, painting a picture of life as an early family therapist in the 70s: covering his reflections on the politics of a systems approach in conventional settings, resistances to family and marital therapy by other professionals, whether family or marital therapy works, the satisfactions, frustrations, and stresses of being a family therapist, and how one's own personal family relationships impact and are impacted by this work. It is as much a look back in history as it is a reflection of challenges MFTs still face today. 

In the spirit of reflecting on the rich history of the journal, JMFT is pleased to offer a special 50th anniversary virtual issue. This curation highlights nearly 40 noteworthy and milestone articles from the past 50 years. Articles were selected based on the impact on the practice of family therapy, the advancement of the profession, and those that created a positive “buzz” for the practice and profession. 

JMFT editor Lenore McWey, PhD, of Florida State University commented:  

When we asked colleagues to share suggestions for papers that help shape our field, I wasn’t fully prepared for the volume, depth, and range of articles nominated for the JMFT 50th anniversary special virtual issue. The collection features early theoretical works, research that helped substantiate the legitimacy of systemic family therapy, measurement development, ideas about common factors, considerations for cultural humility, and evidence on the current state of the field. For some, this collection might feel like a walk down memory lane. For others, it may spur ideas for continued progress. Regardless, I hope this collection evokes inspiration. We hope you enjoy!  

The issue is broken into sections like Seminal Works Demonstrating the Significance of Systemic Family Therapy, featuring works including the 1995 “The Efficacy and Effectiveness of Marital and Family Therapy: A Perspective From Meta-Analysis,” by William R. Shadish, Kevin Ragsdale, Renita R. Glaser, and Linda M. Montgomery. 

The section on Historical Hot Takes: Manuscripts that Generated a Systemic Buzz, includes the 1980 article “Prescribing the Families’ Own Dysfunctional Rules as a Therapeutic Strategy” by Maurizio Andolfi. 
 
In the category of Assessment in Systemic Family Therapy: Works that Moved the Field Forward, the 1981 article “Assessing Intimacy: The Pair Inventory” by Mark T. Schaefer and David H. Olson is featured. 
 
The section covering Diversity, Equity, and Inclusion and Systemic Family Therapy includes “Different and Same: Family Therapy with Asian-American Families” by Insoo Kim Berg and Ajakai Jaya, published in 1993. 

And the final section, The Current State of the Field: Research and Clinical Implications, includes “Reducing Mental Health Disparities Among Racially and Ethnically Diverse Populations: A Review of Couple and Family Intervention Research Methods (2010–2019), published in 2022 by Lekie Dwanyen, Kendal Holtrop, and Ruben Parra-Cardona. 

The JMFT advisory council is excited to invite you to join us in celebrating the many years of high-quality content focusing on systemic therapy. All articles in the special issue are open to the public until July 2024. Please feel free to share with peers and others interested in mental health research. 
 
We hope you enjoy the selections! 

 

Celebrating Pioneers - LGBTQ+ Advocates in Family Therapy

Written by Ivonne Harting (She/Her) LAC, LPCC, MFTC, NCC

Diversity has always existed; it’s an intrinsic part of the human condition. Why is understanding diversity crucial in today's society? There isn’t a single person on Earth who is exactly like another. Yet, we often choose to rival our differences instead of rejoicing in them. Although we recognize the importance of support and acceptance as a society, hesitation still exists. Fortunately, we have made significant strides in celebrating diversity, particularly within the LGBTQIA+ community, which has relied on brave pioneers to advocate for our rights and illuminate the battles we face.

In honor of LGBTQIA+ History Month, I want to highlight one such pioneer: Dr. Deborah Coolhart. She is a prominent voice in family therapy, especially known for her work with trans and gender-expansive youth. Dr. Coolhart has made significant contributions to gender-affirmative therapy, centering the needs and voices of LGBTQIA+ youth in family therapy practices.

Dr. Coolhart emphasizes the critical importance of support—especially family support—in fostering positive mental health outcomes for LGBTQIA+ individuals. In her work, she discusses how dysphoria affects not just the mental health of trans masculine individuals, but also their physical and relational well-being. She states, “Because your dysphoria gets in the way of you…it affects everything.” This highlights the profound impact body dysphoria can have on a person’s identity and daily functioning. Addressing dysphoria through gender-affirming practices in therapy is essential, as it not only validates the experiences of trans individuals but also creates an environment where families can learn to support their loved ones effectively.

Dr. Coolhart’s work resonates deeply with me, especially as I reflect on my own experiences as a queer therapist. I remember the fear I felt when contemplating coming out to my family. Growing up in Venezuela—a society that lacks inclusivity regarding anything outside of heteronormativity—having a safe space that normalized discussions about gender and sexuality would have been life-changing. Such an environment would have allowed my family to understand my experiences from a different perspective and receive psychoeducation on how to support and accept me. This is what I believe our current society needs more of: education—not just about tolerance and acceptance, but about love and empathy. Community workshops and educational programs can play a vital role in fostering this understanding.

The progress we have seen in our field is monumental! We have transitioned from homosexuality being classified as a disorder in the DSM-I in 1952, to professionals like Dr. Coolhart advocating for and researching gender-affirming care, driving positive change in family therapy. It is clear that there is nothing we need to change about gender-diverse individuals. Conversion therapy is not the answer. Inclusion is. Let history be a reminder of how far we’ve come and where we are yet to go. Let’s continue to find ways to contribute as professionals, fostering environments that celebrate diversity and support all individuals in their journeys.

With love and pride,

Ivonne

Disaster Resources

Millions of people are reeling from the heartbreak left behind by Hurricanes Helene and Milton. In the Carolinas, Helene left entire communities submerged by floodwaters and cut off from aid with people waiting to be rescued with no access to food, power, or fuel. In Georgia and Tennessee, damage from downed trees and flooding have left neighborhoods unrecognizable. In Florida, cars are buried in sand and homes have been gutted by the massive storm surge. Rescues are underway in Florida as the extent of damage and deaths from Milton are still unfolding. Hurricane Milton knocked out power to more than 3 million customers, flooded barrier islands, tore the roof off a baseball stadium and toppled a construction crane. Many are missing, possibly unable to leave their location or unable to contact family where communications infrastructure is inoperable. AAMFT will shortly release information on its partnership with the Red Cross letting AAMFT members know how they can help by volunteering in the impacted areas.

Following are ways for you to donate, volunteer, or get resources on helping families navigate this challenging and life-changing time.

• Make a donation to the Red Cross here for hurricane relief.

Resources and Information

Disastershock: How to Cope with the Emotional Stress of a Major Disaster has a systemic, trauma-informed, and evidence-based foundation, making the manual an excellent resource for MFTs. This resource was produced by AAMFT members who serve on the board for the Institute for School-based Family Counseling and are part of the Disastershock Global Volunteer Team, which has members from 16 countries.

From AAMFT’s Family Therapy Magazine

Helping Families Cope with Disasters

An Overview of the Red Cross and Disaster Mental Health

Systemic Therapists on the Frontlines of Climate Change

Attending to the Whole System: Eco-Informed Family Therapy

Tips for Parenting During Times of Crisis

• Model calm and control. Reassure children that they are safe and so are the other important adults in their lives.
• Talk with your children about crisis events. Take some time and determine what you wish to say. This is especially true since new information will unfold each day. Provide brief, accurate, and age-appropriate information. Don’t dwell on the scale or scope of the tragedy, particularly with young children.
• Keep your explanations developmentally appropriate. Early elementary school children need brief, simple information that should be balanced with reassurances that their lives will not change. Upper elementary school children will be more vocal in asking questions about their safety and what is being done. They may need assistance separating reality from fantasy.
• Understand what your child is asking. Difficult questions that children ask may be spurred by curiosity or feelings. Rather than plunging into an immediate answer, learn what motivates the question. Ask, “What made you think of that?” or “What ideas do you have?” Once the meaning of a question is known, it is easier to answer effectively.
• There may be questions we cannot answer. Rather than invent a response, it is more helpful to say, “I don’t know,” or “I’ll try to find out.”
• Acknowledge, validate, and accept your child’s feelings. He or she may be feeling confused, frightened, or even excited. Listen calmly and reassuringly as they express their thoughts and feelings.
• Limit the amount of your child’s television viewing of these events. If they must watch, watch with them for a brief time; then turn the set off. Young children should not be allowed to watch TV coverage of the event, as they are too young to process what they are seeing and hearing.
• Maintain a “normal” routine. To the extent possible, stick to your family’s normal routine for dinner, homework, chores, bedtime, etc. Children feel secure when routines are calmly followed.
• Spend extra time reading or playing quiet games with your children before bed without the television or news radio on. These activities are calming, foster a sense of closeness and security, and reinforce a sense of normalcy.

First Responder Toolkit: A free app for those deployed to emergency response events

Red Cross Disaster Mental Health Volunteers

From AAMFT: MFT Volunteer Opportunities with the American Red Cross

Red Cross Volunteers

Trauma Informed Care: A downloadable, comprehensive, and free guide to TIC

Psychological First Aid: A downloadable, comprehensive, and free guide to PFA

SAMHSA Resources by Disaster Type

SAMHSA Disaster Response Helpline (call or text): 1-800-985-5990

SAMHSA Disaster Response Overview

Doing What Matters in Times of Stress: An Illustrated Guide (from the World Health Organization). A stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. A few minutes each day is enough to practice the self-help techniques. Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances.

Pan American Health Organization: Mental Health and Psychosocial Support in Emergencies (MHPSS). Health emergencies, natural and socio-environmental disasters, armed conflicts, and various migratory phenomena may cause severe suffering in affected populations. The psychological and social effects of emergencies can be severe in the short term, but they can also affect people in the long term. Protecting and improving people's mental health and psychosocial well-being is therefore a priority in emergencies.

Disaster Preparation

AARP offers tips on how to protect your important papers and property:

Protect Your Important Papers and Property

Information on preparing your office for an emergency:

8 Tips on Preparing your Office for an Emergency

Be prepared before the next storm. The Red Cross offers tips on “How to Prepare for a Hurricane”

Tips for a flooded office

Ways to donate and help

How to help those impacted by Hurricane Helene: Charities, organizations to support relief efforts

Pet Rescue

For those interested in helping pets impacted by the hurricane, a Virginia-based pet rescue organization is receiving cats and dogs from flood-impacted states and is in need of donations to care for the influx of arriving pets. Learn more in “Cats and dogs from flood-ravaged North Carolina find hope in Fairfax”

Homeward Trails: Donate

Hiring for Group Practice

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy.

We recently received a question from a group practice owner in practice since 2013. They are known in their community as one of the top private practices in their county and in the past never had an issue with finding and retaining great clinicians. Yet recently they have noticed a change in the landscape for employment options for therapists and they asked “Since you are in the of the ‘business’ of mental health, am I the only one seeing this or are other brick and mortar therapy offices struggling as well? I fear that if places like mine go out of business what will there be for therapists to return to if they tire of the online platforms?”

Many years ago, therapists who wanted to work in private practice settings had the option of either starting a private practice themselves or joining one. Fast forward to today where therapists can now work for online mental health tech companies, creating a work-from-home option usually as a contractor but sometimes as a W2 employee. To acquire therapist labor, they offer sign-on bonuses, promises of providing clients and working as little or as much as you would like, and do some of the administrative work of being on insurance panels.

So now that there are more options than ever before, how do you as a group practice owner stand out, hire and retain great staff so you can continue to provide great clinical outcomes to your clients?

First, we want to say that this group practice owner is not alone. Many group practice owners have found hiring to be more challenging because of the landscape of multiple options for clinicians. We want you, the group practice owner to be more agile so you can continue serving your community, clients, and staff. Being a group practice that offers clients to a clinician is no longer enough of a draw for hiring. Let’s look at what you want to be clear about when showing what you offer to potential new hires so you can create a private practice that truly thrives.

Stand out In WHO you serve

Many tech companies take a serve-all approach. We believe that group practices that serve within their scope and expertise, will find they get better clinical outcomes, reduce the burnout of their staff, and be known for the good work they do. Group practices that stand out in who they serve have not only a great benefit to the client but also to the clinician.

The focus on who you serve will influence trainings, supervision, and overall culture of the group practice. For example, one of our coaching clients is highly specialized in divorce and mediation. They focus on hiring therapists interested in working with couples and those who want to gain special training in divorce and mediation. Their therapists benefit from the specialization and can really hone their skills in this area.

Stand out in HOW you serve

Some group practices choose to stand out in how they serve their communities. Again, this is a benefit to the clinicians they hire because the clinicians get a more specialized approach in their supervision and trainings. We know of practices that focus exclusively on IFS or EMDR. You appeal to clinicians who want to really develop their skills with the modalities that are of focus in the group practice. Other options for clinicians don’t typically offer this kind of focus. They provide the clients, but not necessarily expert case consultation or training.

Stand out in WHAT you offer to your staff

To run a group practice, you need to pay your staff well. As one of the lowest-paid master's degrees, group practice owners have an opportunity to shift the narrative and value their staff’s well-being. When you take care of your clinicians, you are also taking care of their clients. We would much rather see a well-rested, low-stressed therapist than one that is overrun with clients and burning out.

So, what are some things to consider offering clinicians who you want to hire beyond just paying them? Let us help you stand out even more as the best option for therapists when it comes to choosing their private practice setting options.

Health Insurance - This is beyond what many tech employers offer clinicians, but it is necessary for your clinician’s well-being that they have access to health care.

W2 vs 1099 - By the federal definition of what constitutes a 1099, it is very rare that group practices can hire a 1099. If you do hire a 1099 contractor, you are outsourcing your business to another business. What does this mean for you? It means you have no say in how the therapist provides treatment. You cannot provide anything for them to do their job either, think about laptops or office space. As a 1099 contractor, the therapist is responsible for using their own resources to take on the work you provide. But with a W2 you do have more control, and not in a sense of abusing power, but to work together to create better clinical outcomes for clients. W2 status protects the therapist with labor laws and is in that therapist’s best interest.

Vacation & PTO - We all need breaks, but often if you are a therapist, taking a break means you don’t get paid. If you aren’t saving up for vacation or sick leave, it can be financially disastrous for many. This is why so many therapists never take time off even though that leads to massive burnout. As the group practice owner, you can support your staff by setting aside part of their pay for vacation and sick leave. It can be such a relief for clinicians to not have to worry about how they will cover this expense. This means your clinicians are more likely to take time off and your clients benefit too, because again, we love a well-rested therapist.

Supervision and Training - In other private practice settings you will not find this offered to clinicians. Clinicians are expected to seek out these things on their own. Value your knowledge and the collective knowledge of your team by offering supervision and training. Not only does this improve clinical outcomes, but it can improve group practice culture, clinician confidence, and satisfaction as well.

As a group practice owner, you aren’t here to create a practice that just churns people through the therapy door. You genuinely care about the outcomes of the clients and the satisfaction and joy of your clinicians. It may take some financial planning and support, but standing out from other options is your best bet to attract the right kind of clinicians who value the work that you do.

Need more support on your group practice? Check out our free training library where we have training exclusively on group practice financials.

National Hispanic Heritage Month: Embracing Diversity in Marriage and Family Therapy

Written By Julian Crespo, Ph.D., LMFT. 

As we celebrate National Hispanic Heritage Month from September 15 to October 15, it's impossible not to reflect on the rich multiplicity of Hispanic cultures. This annual observance provides marriage and family therapists an opportunity to consider the profound influence of Hispanic heritage on our field and society as a whole.

The Hispanic community defies simple categorization. It's a composite of cultures, traditions, and identities shaped by centuries of mestizaje – the blending of Indigenous, European, African, and other ancestries. This intricate history has fostered a wide array of perspectives on individual and family identity formation. Some Hispanic families celebrate their indigenous roots as a cornerstone of their identity, while others may emphasize their European heritage. Many embrace a fluid, multifaceted identity that honors all aspects of their lineage.

For marriage and family therapists, this diversity within Hispanic cultures is a wellspring of insight. It underscores the need for tailored approaches to therapy, even among seemingly similar cultural groups. Each family brings to the therapeutic space its unique historical narrative, cultural values, and identity constructs. Additionally, the multifaceted nature of Hispanic populations can significantly enrich and foster inclusivity in the United States. As therapists, we can draw valuable lessons from how Hispanic cultures have navigated complex identities and histories. This knowledge can shape our approach to working with all clients, helping us develop more inclusive and culturally responsive therapeutic practices.

Many Hispanic cultures, for instance, place great importance on strong family bonds, respect for elders, and collective decision-making. These values offer fresh perspectives that contrast with more individualistic approaches. By integrating these diverse worldviews, we can broaden our therapeutic toolkit and better serve a wider spectrum of clients.

Furthermore, the richness and complexities of Hispanic cultures can inform and nurture marriage and family therapy practices to adopt a critical stance. They push us to examine our assumptions and biases, encouraging us to create epistemological spaces where the profession can grow in multiple directions.

Take, for example, the concept of familismo – the strong identification and attachment to nuclear and extended family – prevalent in many Hispanic cultures. This concept prompts us to reconsider our understanding of family systems, encouraging us to look beyond the nuclear family and consider the roles of extended family members and close friends who may be considered family.

Similarly, the diverse spiritual and religious practices within Hispanic cultures can expand our approach to addressing spirituality in therapy. From indigenous spiritual practices to syncretic religions like Santería, these varied belief systems remind us of the many paths people take to find meaning and healing.

The linguistic diversity within Hispanic communities offers another valuable lesson. It highlights the importance of not just literal translation, but cultural interpretation in therapy. This insight can inspire us to be more attentive to the nuances of language and communication in all our therapeutic interactions. 

As we mark National Hispanic Heritage Month, let's embrace these lessons from Hispanic cultures. Let's use this richness and complexity to foster more inclusive, culturally responsive, and critically reflective marriage and family therapy practices. In doing so, we not only better serve our Hispanic clients but also enrich our field as a whole, creating space for multiple perspectives and approaches.

National Hispanic Heritage Month serves as a powerful reminder of the invaluable contributions Hispanic cultures make to our society and our field. It challenges us to continuously expand our understanding, question our assumptions, and strive for truly inclusive and effective therapeutic practices. In honoring Hispanic heritage, we also honor the diversity of human experience and the myriad ways families and individuals construct their identities and relationships.

World Alzheimer's Awareness Day: Understanding and Reducing Stigma

By Vanessa Bradden, LMFT,

Founder and Clinical Director at Lakeview Therapy Group

Did you know that September 21st is World Alzheimer's Day? It is a day intended to increase our understanding of Alzheimer's and other forms of dementia and diminish the stigma associated with it. Globally, more than 55 million people are living with dementia, and it is estimated that 10 million new cases are diagnosed each year. The number of people with dementia is expected to increase to 139 million by 2050.

Most of us have been affected directly or indirectly by dementia and know that it is a painful, often lonely journey. Receiving and processing a dementia diagnosis is a significant life transition that needs more attention. It is grief work for the patient and the loved ones around them. And like any loss, it is not a linear process. There is denial, anger, bargaining, depression, and acceptance, which oscillate depending on the day. The feelings associated with such a loss can be paralyzing, overwhelming our ability to cope well.

As marriage and family therapists, we understand that the patient is part of a more extensive system – family, friends, and co-workers. We also know that stigma is an obstacle, imposing shame and making it harder to focus on what needs to happen to adapt and keep a good quality of life. The stigma around dementia can result in premature outcomes if we decide that patients cannot do anything on their own because they have dementia. We all benefit when we encourage diagnosed individuals to use as many capabilities as possible, if they are safe.

Stigma and Its Impact 

 For those directly affected by Alzheimer's and other forms of dementia, life changes in ways that are scary and unpredictable. The progressive nature of the disease can alter parts of our loved ones who were once vibrant and productive members of their families and communities. It is a startling moment when you realize someone you know and love is struggling with pieces of their ability to remember things you experienced together or, even more alarmingly, your name and who you are to them.  

Fear of the unknown is difficult for all of us. However, if left unchallenged, it perpetuates stigma around the disease, making it hard for everyone to get proper care and support. Raising our awareness about Alzheimer's disease is one of the best ways to deflate the stigma that negatively affects patients and their families. 

Stigma is a significant concern facing patients and families living with dementia. Many report feelings of abandonment, isolation, and infantilization. Our fear of dementia can cause us to back away from someone when they need us the most. For some, it is a fear of not knowing what to say or do, or more selfishly, an inability to cope with the changes that will happen over time. Either way, it further worsens feelings of loss.

Reducing Stigma 

Marriage and Family Therapists are the pioneers and leaders of systemic therapy. We think that the individual is more than the sum of their parts, and we value finding strength-based solutions rather than those that enforce stigma and isolation. We believe nothing happens in a vacuum, and effective treatment comes from looking at the broader context of what is happening with the individual and those closest to that person. With staggering numbers projected for the future of Alzheimer's, it is crucial to reduce and even end its stigma.  

Educating yourself and those around you about dementia is one of the most effective ways to reduce stigma. Be direct and factual about what is happening. Being direct can help set expectations for others while also empowering ourselves as advocates of our lives. Being open and honest with others can help people better understand what you are facing and take the pressure off them not knowing what to say or do to help you.  

How Marriage and Family Therapists (MFTs) Can Help  

Marriage and family therapists (MFT) have a unique skill set and know how to work with individuals, couples, and families. They support everyone in the family system, making processing loss more manageable. Grief work is complex, and there is no easy solution. Each person's experience is essential; tensions can run high in the family, and old wounds can get triggered. Working with an MFT provides an added level of support for everyone. 

Medical Advances Give Us Hope 

While we search for a cure for Alzheimer's disease, we must hold onto hope. The National Institute on Aging (NIA) is the leading agency supporting and conducting Alzheimer's disease research, and their unyielding support continues to push researchers toward more effective prevention and treatment protocols for dementia.