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! 

 

Loss, Grief, and Resilience: Finding Light Through the Darkness

 

By Froma Walsh, PhD

Professor Emerita, University of Chicago

and Co-Director, Chicago Center for Family Health 

 

National Grief Awareness Day, on August 30th, 2024, is intended to raise awareness and support for the experience of grief.  In these turbulent times, families have suffered devastating losses of loved ones, from the anguish of Covid-related deaths to gun violence, drug overdose, suicide, environmental disasters, and war. More attention is urgently needed in MFT training and practice to help the bereaved to heal and forge pathways ahead to live and love fully beyond loss.   

 

Attending to Death and Loss: The Shared Human Experience 

Of all life experiences, death and loss pose the most painful and far-reaching challenges for surviving loved ones. Yet, in our American cultural aversion to facing death, the profound impact of loss is minimized. Many are isolated in their grief, lacking vital connection, understanding, and support. Recovery is hindered by workplace demands, lack of paid bereavement leave, financial duress, and barriers to resources that disproportionately affect racial/ethnic minorities and other marginalized communities. In our ethos of “the rugged individual” and faulty notions of resilience, the bereaved are often urged to quickly gain “closure,” "bounce back," and move on, and are advised to "keep strong" and count their blessings. Caring spouses, family, and friends who are uncomfortable and unsure of what to say or do may withdraw over time. Too often, grief is unacknowledged or minimized, as in pregnancy loss or the death of a cherished pet. Covid-related losses may be suppressed by the understandable wishes to put the pandemic behind us (Walsh, 2020; 2023).   

Attending to death and loss is challenging for therapists, as well. We may feel uncomfortable, unsure of what to do, or even helpless: death is not a problem to solve. In meeting with a couple after their baby's death, the father said: "I don't know why we're here--what can you do? You can't bring back our child!"    

In our personal lives, we all face painful losses, our own mortality, and family legacies of loss that may constrain our engagement with the bereaved. Yet, by attending to our own losses, our common humanity can enrich our work with those in distress.  

 

Death and Loss:  A Hole in the Heart of the Family 

In the mental health field, most grief treatment models focus narrowly on reducing individual symptoms. The DSM diagnosis of Prolonged Grief Disorder can pathologize diverse experiences. A systemic practice approach is vital to humanize our understanding and expand our attention to influences in family and social contexts in suffering and healing. We address the impact of loss in couple bonds, among siblings, and in the family system, affecting all members, their relationships, and family functioning. Stressful adaptational challenges --as with the loss of a caregiver or breadwinner--compound distress. Rippling through kinship networks, loss touches many lives with immediate and long-term ramifications. Couples and family bonds can be broken, hopes and dreams are shattered. Submerged pain of overwhelming loss can surface years later in problems in life pursuits or other relationships, which may bring people to therapy.    

 

Resilience-Oriented, Systemic Practice with Loss and Grief 

Over my career, from early collaboration with Monica McGoldrick, my specialization in clinical training and practice has been the development of a resilience-oriented systemic approach with complicated loss (Walsh, 2023). At the core is the conviction that distressed couple and family processes can be strengthened to support healing and positive adaptation for all members and their bonds.  

Best practices in understanding and helping bereaved clients are informed by early family systems studies and a growing body of grief research: 

• Mourning and adaptation are varied and complex processes over time. There is no right way to grieve, no timetable, and no fixed sequence of stages to complete resolution. 

• Attention oscillates between grieving and addressing adaptive challenges.  

• We heal through our grief, not by getting over it.  

• People die; relationships don't die. Adaptation is facilitated not by detaching but by transforming attachments into continuing bonds through spiritual connections, rituals, memories, stories, and deeds.  

A resilience-oriented systemic approach applies core principles and methods of strength-based, collaborative practice (Walsh, 2023). Therapists provide a safe haven and compassionate listening and inquiry to understand both the shared and unique experiences of loss. We depathologize and humanize grief processes and support the inherent human capacity for resilience, helping those who are struggling to cope, to adapt, and to thrive. We facilitate--or repair--vital connections and communication to strengthen kin and social support, mobilize community and larger systemic/institutional supports, and tap cultural, and spiritual resources. In complex and traumatic loss situations, we attend to conflictual or estranged relational dynamics and to deep concerns that complicate grief. When working primarily with individuals, we may employ coaching methods or flexibly combine couple or family sessions, group formats, and community rituals and collaborative action in situations of collective trauma and loss. Applying the research-informed Family Resilience Framework (Walsh, 2016), we strengthen key relational processes--shared beliefs and practices-- that facilitate resilience. We highlight the power of connection, meaning-making, hope, and transformation for individuals, families, and their communities to heal from unbearable loss and go forward to thrive.  

Walsh, F. (2023) Complex and Traumatic Loss: Fostering healing and resilience. New York: Guilford Press. www.guilford.com/p/walsh6 

Walsh, F. (2020). Loss and resilience in the time of COVID-19: Meaning-making, hope, and transcendence. Family Process, 59(3), 898-911. doi: 10.1111/famp.12588   

Walsh, F. (2016). Strengthening family resilience. New York: Guilford Press. 

 

Top 4 Messaging Mistakes Made by Marriage And Family Therapist Websites

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. 

Your private practice website is a hub for connection with potential clients. The messaging you use on your website and other marketing materials is meant to connect, inform, and motivate people to act for themselves. Your message could be the difference between someone being stuck in their pain and someone finding help to heal their pain.

But when you search for marriage and family therapists online or through a directory, you may find a lot of the messages have made some simple mistakes that we want to show you how to avoid.

Mistake #1: Ask a lot of questions

Imagine if you are meeting with someone you don’t know, naturally, you ask a lot of questions to get to know them. Yet, part of having a solid marketing plan is knowing who you do great work with and being able to speak to the pain of those ideal clients. You should know generally something about their pain. If you start your website asking a lot of questions such as: Do you feel stuck? Do you not feel like yourself? Do you struggle with anxiety or depression? Are you grieving the past or something in the current present moment? You communicate that you aren’t sure who you are speaking to and are unsure of what they might generally be going through.

Instead of asking a lot of questions, peppering them with all the possibilities of what could be going on, speak to the common pain points of your clients. This takes knowing who you want to work with though. You can’t speak to everyone in one message. You need to hone in and speak to the clients you do the best work with.

Imagine moving away from the questions and more into painting a picture of what they might be going through. For example, "you woke up this morning with a tightness in your chest that is all too familiar. You do your best to push down the anxiety and worry, but day in and day out, it creeps up on you rendering you exhausted. You can’t focus at work. You miss appointments or space out in conversations with friends and loved ones. You worry so much about what others think about you, you just never feel like you can let your guard down."

How does that messaging feel compared to questions? It conveys attunement, and an understanding of the client because you know other clients like them. They aren’t alone and you know how to help.

Mistake #2: You aren’t clear about how you help

So many therapist websites speak in generalities about how they help. Many therapists talk about how they hold a safe nonjudgmental space for their clients. I hope they do! That is important, but that is the standard across the board. Besides, does a client really know how a nonjudgmental space being held for them helps? Probably not other than that there is comfort.

Instead, speak to how you show up as a therapist, giving good, informed consent about what to expect from you as a clinician. We aren’t speaking about being competitive and comparative with other clinicians. You never need to put down others to put yourself out there. You simply want to stand out clearly about what is unique about you in this work.

For example, I help anxious, high-achieving adults to simmer their anxiety so they can be comfortable in their own skin. I meet with my clients weekly because that is what gets better outcomes for the way that I work. I’m not a therapist who gives homework, instead, you will learn tools you can use outside of the session to use your body's wisdom to help you integrate more calm states in your day-to-day. Many of my clients love that they get to move their bodies during sessions and that there is a lot of laughter in the process of healing, It doesn’t always have to be so serious as you see on TV.

In this example, you can learn more about how the therapist works and what to expect. This gives the potential client way more information to decide if this is a good fit for themselves. Maybe they decide they don’t like what they read. That’s a good thing because it’s helping them tune into their own wisdom about what they need and it expedites them on the path to finding the right therapist for them.

Chronic Stress Responses in People of the Global Majority: Exploring Somatic Therapy Interventions and Modern Clinical Approaches

 

By Octavia Neal, LMFT 
Treasurer-MFT’s Working In Trauma 

 

Chronic stress is a pervasive issue that affects diverse populations, but people of the global majority—a term used to describe those from historically marginalized racial, ethnic, and socio-economic backgrounds—often experience unique stressors that exacerbate their mental and physical health challenges. Understanding these chronic stress responses and exploring effective interventions, such as somatic therapy and modern clinical approaches, is crucial for improving the well-being of these communities. 

 

Key Definition: People of the Global Majority 

People of the Global Majority refers to those racial and ethnic groups that are numerically dominant worldwide but are often marginalized in societies where they represent a minority. This term emphasizes that, globally, people of color form the majority, challenging the notion that they are outliers or minorities. The concept seeks to shift the perspective from a deficit-based to a majority-based framework, recognizing the systemic challenges faced by these groups as a result of historical and ongoing inequities (Sims, 2020). 

 

Chronic Stress in People of the Global Majority 

Chronic stress is the continuous activation of the body's stress response system due to persistent external or internal stressors, which can lead to long-term health consequences such as cardiovascular disease, weakened immune function, and mental health disorders (American Psychological Association, 2021). 

Causes and Examples: 

• Socioeconomic Inequality: Persistent economic disparities often impact People of the Global Majority, leading to chronic stress from financial instability, job insecurity, and lack of access to quality healthcare and education (Williams & Mohammed, 2009). 

 

• Racism and Discrimination: Systemic racism and everyday microaggressions contribute to ongoing stress by creating hostile environments and undermining opportunities for advancement (Sue et al., 2012). 

 

• Historical Trauma: The collective memory of colonialism, slavery, and other forms of oppression continues to affect communities through intergenerational stress and trauma (Brave Heart, 1998). 

 

Somatic Therapy Interventions 

Somatic therapies offer a promising approach for addressing chronic stress, especially for individuals from the global majority. These therapies focus on the connection between the mind and body, emphasizing the role of physical sensations in processing and managing stress. Several somatic therapy techniques are particularly relevant for addressing chronic stress responses: 

1. Somatic Experiencing (SE): Developed by Peter Levine, SE aims to help individuals process traumatic experiences and reduce stress by focusing on bodily sensations. SE involves guiding clients to become aware of their physical responses to stress, helping them process and release stored trauma. This approach is beneficial for people of the global majority who may have experienced historical and personal traumas (Levine, 1997). It is important to note that these principles resonate deeply with historical and traditional practices used by Indigenous peoples around the world. Indigenous cultures have long understood and utilized the connection between the body and working through the physical sensations linked to past traumas. (Ex. Native American tribes such as the Lakota and Hopi that used the practice of sacred circle ceremonies to connect to physical sensations and the natural world. Often involving drumming, dancing, and storytelling (Deloria, 1995). 

 

2. Body-Oriented Psychotherapy: Techniques such as Sensorimotor Psychotherapy integrate body awareness into therapeutic practice. By focusing on physical experiences, therapists help clients access and process unresolved emotions and stress (Ogden, Minton, & Pain, 2006). For people of the global majority dealing with the cumulative effects of discrimination and trauma, these methods offer a holistic approach to healing.

 

3. Trauma-Sensitive Yoga: This practice combines traditional yoga techniques with trauma-informed principles to address both physical and emotional stress. Trauma-sensitive yoga helps individuals reconnect with their bodies in a safe and supportive environment, which is particularly beneficial for those experiencing chronic stress due to trauma or discrimination (Van der Kolk, 2014).

 

Benefits of Somatic Therapies: 

1. Holistic Approach: Somatic therapies address the physiological aspects of stress, helping individuals manage their stress responses in a more integrated way.
2. Empowerment and Agency: These therapies promote self-awareness and personal empowerment, enabling individuals to take an active role in their healing process.
3. Creation and Maintenance of Safe Therapeutic Environment: Many treatments can often trigger destabilization via re-experiencing of traumatic events through disclosure. Focusing on somatic interventions can give concrete skills to use to mitigate the physical symptoms of trauma/chronic stress response instead of feeling overwhelmed by them. 

 

Modern Clinical Approaches 

Modern clinical approaches to chronic stress in people of the global majority are evolving to address both the psychological and systemic factors contributing to stress. Some effective methods include: 

Culturally Competent Therapy: This involves understanding and respecting clients' cultural backgrounds and incorporating this knowledge into therapeutic practice. Culturally competent therapists are trained to recognize the impact of systemic inequalities and address them in therapy sessions (Sue et al., 2012). For people of the global majority, this approach can help bridge gaps in understanding and support healing in a culturally sensitive manner. This should also be a part of continuous education for any provider who is connecting with any who identifies as part of the global majority.  

Trauma-Informed Care: Trauma-informed care is a framework that recognizes the prevalence of trauma in individuals’ lives and seeks to create a safe and supportive therapeutic environment. This approach emphasizes safety, trustworthiness, and empowerment, making it particularly effective for individuals dealing with chronic stress from trauma or discrimination (Substance Abuse and Mental Health Services Administration, 2014). Active practice and observation of this framework often has difficulty being implemented in large systems or inundated systems of care.  

 

Mindfulness-Based Stress Reduction (MBSR): Developed by Jon Kabat-Zinn, MBSR is a structured program that teaches mindfulness meditation techniques to manage stress. MBSR has been shown to reduce stress, improve mood, and enhance overall well-being, making it a valuable tool for those experiencing chronic stress (Kabat-Zinn, 1990). 

 

Combining Somatic Therapies with Modern Approaches 

Combining somatic therapies with modern clinical approaches, such as somatic experiencing techniques with trauma-informed care, can address both the physiological and emotional aspects of stress. Similarly, incorporating mindfulness practices into culturally competent therapy sessions can enhance clients’ stress management skills while respecting their cultural contexts. 

There has been success in using these integrative, collective approaches. A community mental health clinic serving a diverse urban population implemented a combined approach using somatic therapies and trauma-informed care. Clients participated in somatic experiencing sessions to address their stress responses and engaged in culturally competent therapy to explore and resolve underlying issues related to systemic discrimination. The clinic also offered mindfulness workshops as part of their stress management programs. This integrated approach resulted in significant improvements in clients' mental health and well-being, demonstrating the effectiveness of combining these methods (Rothschild, 2000). 

Chronic stress for people of the global majority is a multifaceted issue that requires a nuanced approach to treatment. By integrating somatic therapies with modern clinical practices, mental health professionals can offer effective interventions that address both the physiological and emotional components of stress. Somatic therapies, such as somatic experiencing and trauma-sensitive yoga, provide valuable tools for helping individuals manage their stress responses. When combined with modern clinical approaches like culturally competent therapy and mindfulness practices, these therapies offer a holistic framework for improving mental health outcomes for people of the global majority. As we continue to develop and refine these methods, a focus on both individual and systemic factors will be essential for creating supportive and effective mental health care for all communities. 

 

 

 

References 

-American Psychological Association. (2021). Stress: The Different Types of Stress. Retrieved from APA 

-Brave Heart, M. Y. H. (1998). The Return to the Sacred Path: Healing the Historical Trauma of the Lakota. Journal of Human Behavior in the Social Environment, 1(1), 1-21. 

- Deloria, V. (1995). Red Earth, White Lies: Native Americans and the Myth of Scientific Fact. Scribner. 

-Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Dell. 

- Levine, P. A. (1997). Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. North Atlantic Books. 

- Marmot, M. (2004). Status Syndrome: How Your Social Standing Directly Affects Your Health and Life Expectancy. Bloomsbury Publishing. 

- Ogden, P., Minton, K., & Pain, C. (2006). Sensorimotor Psychotherapy: Interventions for Trauma and Attachment.  Norton & Company. 

- Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. Norton & Company. 

- Sims, D. (2020). The Global Majority: A Radical Reimagining of Diversity. Journal of Critical Race Theory, 3(2), 12-24. 

- Substance Abuse and Mental Health Services Administration. (2014). Trauma-Informed Care in Behavioral Health Services. SAMHSA. 

- Sue, S., Cheng, J. K. Y., Saad, L., & Rivera, D. P. (2012). Racial Microaggressions and the Stress Process: Theory, Research, and Clinical Implications. American Psychologist. 67(7), 532–544. 

- Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking. 

- Williams, D. R., & Mohammed, S. A. (2009). Discrimination and Health Inequities. Journal of Behavioral Medicine, 32(1), 20–47. 

-Williams, D. R., & Mohammed, S. A. (2009). Discrimination and Health Inequities. Journal of Behavioral Medicine, 32(1), 20-47. 

Co-Creating Improved Clinical Outcomes for Marriage and Family Therapists

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. 

Creating a Successful Private Practice

What makes for a successful private practice as a Marriage and Family Therapist? Success in business is more than the cash in a bank account. This is about impacting lives. Our work has a ripple effect. As marriage and family therapists we know that by the shifts and transformation of the person on the couch or in the therapy room, that transformation becomes multiplied through the lives that the client touches. One change can upend an entire system whether that be familial relationships or beyond. That shift also transcends generations. You see it when people get sober, embrace their identities, heal traumas, and stop abuse cycles.

As marriage and family therapists we are most successful when we facilitate those transformative outcomes for our clients. But we don’t do this on our own efforts alone. Improving clinical outcomes is a co-creative process for both the clinician and the client.

Defining Positive Clinical Outcomes

For the purposes of this article, it’s important to establish the definition of a positive clinical outcome in therapeutic practice. Good outcomes are about your client’s experience. There needs to be an observed and felt transformational value of therapy by the client and that the client is able to verbalize or express the positive changes in their life. Yes, you could go with a score on the SRS or ORS but ultimately what matters most is the client's experience and reflection.

Clinical Outcomes Research

Clinical outcomes require the feedback from our clients. Miller & Duncan* found that "providing therapists with real-time feedback improved outcomes nearly 65%. No downside exists to determining your baseline effectiveness. One either is proven effective or becomes more effective in the process."

Scott Miller who has been studying what puts some therapists consistently getting the top 25% of outcomes across all kinds of different settings and with different types of clients found the following: “Super shrinks, our research shows, are exquisitely attuned to the vicissitudes of client engagement. In what amounts to a quantum difference between themselves and average therapists, they’re much more likely to ask for and receive negative feedback about the quality of the work and their contribution to the alliance."

"We have now confirmed this finding in numerous independent samples of practitioners working in diverse settings with a wide range of presenting problems. The best clinicians, those falling in the top 25 percent of treatment outcomes, consistently achieve lower scores on standardized alliance measures at the outset of therapy—perhaps because they’re more persistent or are more believable when assuring clients that they want honest answers—enabling them to address potential problems in the working relationship. Median therapists, by contrast, commonly receive negative feedback later in treatment, at a time when clients have already disengaged and are at heightened risk for dropping out.”

Based on decades of research about what makes some therapists great and get consistently better outcomes Scott Millers teaches the following

“(1) determining your baseline of effectiveness, (2) engaging in deliberate practice, and (3) getting feedback—depends on and is informed by the others, working in tandem to create a “cycle of excellence.”

Not to oversimplify, but just by being intentional and asking your clients how they are doing in therapy and making it truly SAFE for them to respond honestly, your outcomes overall will improve even if initially that feedback is negative.

Clinical Outcomes Conversations

 

You can find a script to use in our training that covers this in detail on The Outcome Driven Practice, where we list questions to ask your clients. Our clients report that these are often some of the most transformational conversations they have with their clients, deepening the therapeutic relationship and also improving future outcomes.

You would use a session for inquiry and shared dialogue. Asking questions such as

• Share what you remember about how life was immediately before you started therapy.
• What was the last straw when you decided to reach out to find a therapist?
• Do you remember what it felt like to call a therapist?
• Do you remember what in particular you were expecting and hoping for when you found me and came into your first session?
• What do you recall feeling during and immediately after that first session?
• Who do you have for support right now?
• What are your biggest world-related concerns right now?
• Is there something you wish we could change about your therapy?
• Has there been a time when you’ve tried to tell me something and I missed it or you didn’t feel fully heard?

It is important that in your initial consult and in your first session you stress that you will be checking in on outcomes on a regular basis, after each session but in depth quarterly or every 6 months depending on your treatment pacing. Set the tone from the beginning of the relationship that you are open to feedback, positive, negative, and neutral and that you will be asking for it, even persistently because outcomes matter to you and are important for the client.

Negative Feedback

Sometimes the feedback is negative. Negative feedback is a good sign! It is a sign that there is enough trust to share. Often, there also won't be as much negative as you think it will and we find most therapists have a more negative view of their work than their clients do. These conversations can help you see yourself more clearly, including the positives and where you can really improve vs where you think you need to improve.

The ability to have this conversation and receive any kind of feedback is a tool to help the client pattern how to have conversations where feedback may be negative, giving them a safe space to practice navigating the emotions and tension that might arise.

Creating a Feedback Loop

While the responses are documented as part of the clinical note, you want to take the feedback and make adjustments accordingly. You can use the feedback to improve clinical intervention - there may be a different methodology, a referral to another provider for adjunctive services, or a change in frequency or length of session, for example. You can also use the feedback to get clarity on how you best do your work and with whom. You may discover that you prefer working with a niche, providing a different approach or level of service. You will learn not only about the client but about yourself as well so that you can speak more clearly to future clients in your informed consent and marketing. This is how the feedback creates a loop of excellence. Outcomes inform improvements that improve future outcomes.

As you take the feedback and implement changes it will impact your joy, making you more burnout resistant as you now KNOW you are doing good work and have language for that when you question yourself.  You will increase your commitment to refer people out that aren’t progressing and that drain your energy and it allows you to focus your energy, time, and investments into what really works for you and your clients.

Co-Creation with Clients

We cannot build our practices without our clients. By integrating clinical outcomes conversations, we co-create a better practice and improved transformation for our clients. To learn more about having these conversations, access the free training here.

*Miller, S.D., Duncan, B.L., Brown, J., Sorrell, R., & Chalk, M.B. (2006). Using Formal Client Feedback to Improve Retention and Outcome: Making Ongoing, Real-time Assessment Feasible.

Miller, Scott & Hubble, M. & Duncan, Barry. (2008). Supershrinks: What's the secret of their success?. Psychotherapy in Australia. 14. 14-22.

Juneteenth

 

By: Racine R. Henry, PhD, LMFT, CCTP

Juneteenth is a holiday that recognizes and celebrates enslaved Black people in Texas learning of the Emancipation Proclamation and their legal freedom on June 19, 1865. Despite slavery being abolished two years prior and the Emancipation Proclamation being signed in 1863, slavery continued in many southern states until December of 1865. Independence Day is widely known as July 4th and taught in schools as the day of our country’s freedom, yet Juneteenth is a holiday that many people don’t learn about until adulthood. While it has been a day of celebration hallmarked by gatherings and parades since 1866, Juneteenth only became a federal holiday in 2021. For Black people in this country across the diaspora, the seemingly reluctant acknowledgment of a significant day in U.S. History reflects the reality of our experience in two Americas: one that we continuously co-create with our ancestors and communities and the other that we have to navigate while remaining both unseen and misunderstood.  

As a Black therapist, I’m often asked about best practices to treat Black clients and/or considerations for working with couples and families in the Black community. I tend to oscillate between feeling excited and irritated by this question. It makes me happy that my colleagues want to provide the best possible care for those who look like me, but it is also frustrating that the Black experience is seen as “a thing” rather than a highly nuanced existence that is multifaceted and impossible to capture in a formulaic manner. There is no big answer to treating Black people as we are not a monolith or a foreign entity. To begin to understand what it means to live in the U.S. and identify as a Black person involves learning about the marred history of this country and how institutional racism, white supremacy, and racial/ethnic marginalization show up in every facet of life. This does not mean that Black people should be pathologized but rather that life for Black people, in my opinion, involves an ever-present awareness of our Black identity and what that could mean for those we encounter.  

Marriage and Family Therapy, as a profession, encourages clinicians to embrace a client’s reality, take on their multiverse, and hold their truths as our own. As a field, we can support the Black community by acknowledging that our beloved models and approaches were not designed with this population in mind. We can think critically about how racism and white supremacy show up in the way Black populations are represented in research and discussed in peer-reviewed journals and texts. We can create more explicit standards in our MFT training programs around how students are taught to clinically treat Black people, rather than promoting vague concepts like cultural competency or colorblindness. We can hold each other accountable for the lack of congruency between what we do as clinicians and how we treat one another as people and colleagues. We often talk about Self Of The Therapist or Person Of The Therapist as crucial to doing efficacious work yet neglect to be as introspective about how Black MFTs are regarded. 

Juneteenth, as a holiday, should remind us that the legal enslavement of Black people is part of the not-so-distant history of this country and that the concept of freedom can be a façade when considering the continued demonization and disenfranchisement of Black people in our very current society. Beyond the therapy room, conference halls, and pages of literature, every MFT, whether in training or enjoying tenure, should strive for alignment between how they approach clients being cared for and how they treat those in the larger community. As written on the Smithsonian’s National Museum of African American History & Culture website, “The historical legacy of Juneteenth shows the value of never giving up hope in uncertain times”. Juneteenth is about celebrating freedom from being treated and seen as three-fifths of a person without identity, community, or value. There is very little to be certain of both in this country and globally, but it is important that we, as MFTs, instill hope in our Black clients for a future full of promise, positivity, and alleviation of what is causing them pain. My personal hope is that we begin to set the standard across mental health professions of what it looks like to be congruent in both practice and personhood.