The AAMFT Blog

All Loss Is Not The Same

While our responses to loss have common features, not all loss is the same nor is all loss recognized in the same way.  For those who struggle with infertility, pregnancy loss, and the unexpected results of genetic testing, grief is layered and complex. It is often unseen or marginalized by others, making the grieving process all the more difficult. Couples who experience these types of losses are mourning multiple events. And clinicians need to be aware of these losses in order to help clients mourn and move toward healing.

The disappointments caused by these losses are often overlooked. When we encounter infertility, for example, we tend to think of the couple’s inability to conceive and do not see other hidden pain they experience. Few people recognize the full impact of the sadness that the infertile couple is going through. The loss of a hoped-for future is one of the complex layers felt by the couple experiencing infertility. It can be very difficult to allow oneself to grieve over something that has not come into full existence, as is the case with the dream of having a life with children.

Couples who have gone through a pregnancy loss or the unexpected results of genetic testing, suffer the loss of the future in a way that is different from the struggle of those experiencing infertility. Every couple has a vision of their baby and the life they are going to have with him or her. And when that is lost, the pain is crushing while the loss is often mourned in silence.  Grief then turns invisible, unacknowledged even by well-meaning others who respond with such comments as “you can have another” or “it’s not your fault.” Or in such cases as multiples where one twin is lost, people might attempt to console with,  “at least you have one baby.”

The number of these experiences is not negligibly small; of course, even if it was, sufferings that are rare are harrowing or isolating in a special way. But most of the invisible losses we have in mind here are common. To take just one type of loss, today as many as 20% of clinically diagnosed pregnancies will end in a miscarriage. Despite this high number, these experiences are not widely announced or shared. Even the tendency of today's social media to share, and even overshare, life events and updates does not usually extend to these kinds of hardships.

What does this mean for our clients who experience invisible losses and are suffering in silence? We need to remember that these clients walk into our office carrying the heartache of days, months and sometimes years of cumulative loss. They are mourning—over and over.  It is our task to witness and help them express the roller coaster of emotions that they are experiencing. Our clients need to feel their way through the losses and over time, fold them into their lives—finding a “new normal” and creating an expanded life narrative.

We need to ask ourselves, how comfortable are we giving a name, a story, and a voice to their pain?  If we, ourselves, can get comfortable with and take seriously the losses of our clients, we can then make the gentle inquiries into the invisible and unspoken worlds of infertility, pregnancy loss, and unexpected genetic diagnosis. Through sharing their heartache with us, with their partners, and with trusted loved ones, our clients will eventually heal and move forward with a “new normal” in place. When we help our clients bring loss out of invisibility and silence, we help them live their lives out of the shadows feeling loved, accepted and supported by those around them. While the human lens toward the world is forever reshaped by a loss, the experience of joy can be recovered and even increased. Their stories have been validated and honored, and they can once again live meaningfully and fully.

Interested in this topic? Find it on Teneo: "Invisible Losses: Working with Couples Coping with Infertility, Pregnancy Loss, and the Unexpected Results of Genetic Testing." 

Vanessa Bradden, LMFT is a staff member at AAMFT, collaborating with the Communications Department as a product development specialist. She has a private practice in Chicago and is an AAMFT Approved Supervisor. Vanessa’s clinical interests and expertise include working with individuals and couples coping with perinatal mood disorders, pregnancy loss as well as grief and other losses.

Michele Weiss, LMFT has a private practice in Chicago.  She completed two years post-masters training at The Chicago Institute of Psychoanalysis and received a certification in Adult Psychoanalytic Psychotherapy. Michele is a member of The American Society for Reproductive Medicine: Mental Health Professionals Group and has developed a special interest and proficiency working with individuals and couples coping with postpartum depression, perinatal mood disorders, and infertility.

Benefits of Being an AAMFT Approved Supervisor Part II

Read a prior blog post about Approved Supervision.

In AAMFT Supervision courses, we focus on the process of supervision from the time of meeting and interviewing potential trainees, to contracting and determining goals, to using multiple roles and skills to ensure client care and trainee professional growth, to working as a colleague and co-professional in the field. We focus on relationships within the supervisory system, and on roles that supervisors engage in for varying purposes and at varying trainee developmental stages. We also focus on the purpose and appropriate goals for supervision, system concepts, the relationship between one’s approach to therapy and approach to supervision, personal and professional experiences that impact supervision, the process of supervision, formats, ethical and legal training and practice, contextual awareness/sensitivity/competency, and evaluating trainees’ progress.

The interactive portion of the Fundamentals course, whether online or in person, also focuses on the elements mentioned above within a context of discussion among an instructor and other supervisor candidates. These discussions have become quite popular and involve participants from around the country, continent, and globe. Instructors lead discussion on topics assigned each week that complement the Units in the didactic portion of the course (5 in all), topics introduced by participants, and exercises aimed at enhancing learning and practice. Many participants continue interacting with each other after the formal sessions have ended.

The combined course culminates in a personal philosophy of supervision paper, which often seems daunting but, when worked on throughout the course, results in clear thinking about what one thinks about relational supervision as well as how one practices as a supervisor.  I have enjoyed reading these papers and nurturing future AAMFT designated supervisors in this part of their journey. Working on these courses has been stimulating, fun, challenging, and quite rewarding for me.

The AS Refresher course is specially designed for AAMFT Approved Supervisors who wish to renew their designations. It satisfies the requirement of a Refresher course for each 5-year cycle for renewal. In this course, we have a didactic, online portion that focuses on readings and assignments in preparation for the online interactive portion, which is 3 hours, offered many times each month. The didactic portion can be completed whenever one wants, which makes it accessible for busy clinicians and supervisors.

I encourage any of you reading this to consider further training as a relational supervisor. If you have any questions, please consult the AAMFT Approved Supervisor Designation: Standards handbook or contact me at [email protected]. If you are currently an Approved Supervisor, and will be renewing your designation soon, I hope you find the AS Refresher course timely, accessible, friendly, challenging, and useful. 

Learn more about the Approved Supervision courses here.

Thorana S. Nelson, Ph.D. is emerita professor of family therapy at Utah State University. She enjoys training and supervision in marriage and family therapy and Solution-Focused Brief Therapy, and has taught AAMFT courses on the Fundamentals of Supervision, the Approved Supervisor Refresher course, and A Crash Course in Marriage and Family Therapy. She currently teaches the online supervision courses for AAMFT and is a co-author, with Robert E. Lee, of The Contemporary Relational Supervisor, published by Routledge. 

Benefits of Being an AAMFT Approved Supervisor

Find Info about AAMFT Approved Supervision

In the field of marriage and family therapy (MFT), we believe that supervision is a different activity from therapy. Yes, we’re systemic/relational therapists and know about focusing on process over content, but there are some important differences that most supervisors have found to be important to attend to.

I teach the AAMFT online Fundamentals of Supervision and Approved Supervisor (AS) Refresher courses. I have supervised MFTs for nearly 30 years and taught supervision courses for over 20 years. Each time I have taught, I have learned something new or seen a different angle on something that I believe has improved my supervision. You’d have to ask my students and post-graduate trainees about that to be certain, but I know that looking back, I wish I could do some things differently.

The AAMFT AS courses were developed using revised guidelines in 2013. After surveying Approved Supervisors and a few supervisor candidates (those in training to be Approved Supervisors, supervising training therapists under their own supervision or mentoring), we determined a number of things about the AS designation that needed tweaking, including the courses’ content and process. You can find those requirements in the 2014 Approved Supervisor Designation: Standards Handbook. Although daunting, the course requirements help to provide the most recent resources and research to those who wish to achieve and maintain the very high standards that AAMFT has of its designated Approved Supervisors.

I don’t know that this ensures better client care or more competent therapists and therapy, but I believe this is true. Years later, students and training therapists contact me about their appreciation for the supervision provided, and seek to become Approved Supervisors themselves. I don’t claim to be the best supervisor in the field – far from it! – but I do think that what I learned about focusing on trainee development rather than doing therapy through them helped them to develop clarity about their own approaches to therapy and an ability to attend to making their practices better over time.

A number of people have asked why one would want to become an AAMFT Approved Supervisor rather than simply meeting the requirements of the states/provinces in which they practice. The answer is simple: because AAMFT holds designated supervisors to the highest standard of supervision, and trainees will always want quality supervision, even when not required. I live in New Mexico, where supervision by an AAMFT Approved Supervisor is not required, and receive calls from people who want supervision by a designated AS because they believe it will better help them become competent therapists.

Supervision means a number of things that are sometimes challenging: ensuring client care, helping trainees develop confidence and competence, sorting through ethical dilemmas and legal conundrums, and gatekeeping for the field. Some have said in the trainings that they are afraid to continue as supervisors because of the heavy responsibilities and legal liabilities. I believe that AAMFT training as a supervisor helps prevent such liabilities by preparing and providing continuing education and resources, as well as a community of supervisors with whom to interact around common things.

But supervision is more than just challenging and fearing for clients or one’s own license: it’s interesting, keeps us sharp, and contributes greatly to our field. In addition, it’s just plain fun! Some of my best memories as a clinician/supervisor/educator are when working with training therapists and watching them grow, becoming confident and competent colleagues. 

Thorana S. Nelson, Ph.D. is emerita professor of family therapy at Utah State University. She enjoys training and supervision in marriage and family therapy and Solution-Focused Brief Therapy, and has taught AAMFT courses on the Fundamentals of Supervision, the Approved Supervisor Refresher course, and A Crash Course in Marriage and Family Therapy. She currently teaches the online supervision courses for AAMFT and is a co-author, with Robert E. Lee, of The Contemporary Relational Supervisor, published by Routledge. 

 

MFT as a Profession, Not a Skill Set

During AAMFT's monthly Twitter chats, Tracy Todd discusses a topic of interest with other tweeters, offering his insight as an MFT and Executive Director of AAMFT. In the past, he's talked about stuck cases, developing a clinical specialty, social responsibility, and more. Explore the past twitter chats here!

 

This month, Tracy talked about a topic he's passionate about- the diminishment of MFT as a profession. Scroll through the tweets to learn how you can help advance your profession. Have thoughts to share? You can reply, retweet, or favorite right from here. We hope you will join us on twitter next month, November 2 at 3 PM ET.

 

 

Family Therapy: Human Kindness at Its Finest

This post is written by Pre-Clinical Fellow Anne Totero, originally posted on Linked In. Anne works as a Marriage and Family Therapist in Madison, WI. She finds her clinical passion is creating new and creative ways to work with individuals, couples, and families.

What was one of the skills that Satir, Minuchin, Whitaker, and the greats of Marriage and Family Therapy have that set them apart? Yes, they were forward thinking and new, bold, intuitive, and skilled. What else?

They had the ability to join with humans on a basic human level. They created genuine connection and an honest relationship. They did not have to disclose their lives, their experiences, or mistakes like leaders often do in order to see sustainable change. They made sure they created a relationship with every family member. Everybody had a voice and they did not just tell the family that; they created a safe environment where that could thrive and exist. Modeling through human connection.

Research shows us after years that the modality of treatment is not what creates efficacy within a psychotherapy setting. Those same research articles are telling us that the relationship and joining on a human level is what is showing results and reduced risk of recidivism.

This brings me back to my Social Psychology professor in college. I was taught about altruism. There are research articles that say that altruism does not exist because even desiring a mere smile or wave as a "thank you," is receiving something in return for your kind act. It's the concept that it does not exist because if someone was to feel slightly hurt, rejected, or even notice that they did not receive some sort of response in return; that alone shows altruism does not exist. This same Psychology professor also introduced me to a book by Aronson titled the Social Animal. Aronson highlighted that humans have an innate desire to be liked and understood. Research is now showing us what we know to be true within our heart of hearts. Being liked and understood.

So I revert back to altruism and the opposing views that it cannot exist. Regardless if it does or does not exist; regardless if it has circumstances of which it exists or what those constraints look like. The human race is meant to find exceptions to rules. It's a safety mechanism and how we have survived and thrived. The complexity of thought and learning how to keep ourselves safe is critical thinking at its finest. I can respect that. Instead of using the complexity of thought to look at what does not work for a few seconds; I invite therapists and mental health professionals to step back. Recognize where our hearts and beliefs are and implement genuine connect and kindness into our work every day. Nope, I am not trying to say we can't be burnt out sometimes or have off days. We can however make an active effort to move towards being kinder people and our clients deserve to see that side.

What is one thing we know to be true from psychotherapists who paved the way for effective intervention, researchers, and from culture across the ages? We are driven by that innate desire to be liked and understood. And guess what? It is no different in our families that we work with every day.

I end this therapeutic reflection with intervention suggestions for hints on initial session highlights for family work:

• Create rules that every one has a voice, this is a safe space, and no one will talk over anyone or else they will be redirected. If it persist, they will be asked to leave. This will give you insight on family member investment.
• Every family member has to be present!
• At intake, ask every client in that room (i.e., I don't care if they are verbal, nonverbal, age, etc.); find a way to ask every client what they feel is going on in the home to get them to this point (i.e., in therapy). Be creative. Use art, movement, sand tray, stuffed animals, sign language. Speak their language.
• Give everyone an equal amount of time to speak. Make the structure very clear in the beginning and follow through. You can tell them they may use less if they choose yet they have that full time. They may not have more.
• Be aware of your "gatekeeper" or the person who holds the key to the family. Don't be tricked by this! This is an art all in itself to join with this individual and not forget about the others' voices. This is also a whole article in itself.
• Set structure and follow through. I will say it again.
• Focus on the connection as much as the follow through. Your kindness and genuine care for the family will go a LONG WAY!
• Instill hope. AND BELIEVE IT! Not false hope or puke too much sunshine. Fake presentations are not entertaining for anyone but you and that one cynical family member that didn't think this was worth while.
• Feel something. No, not break down and cry and say how amazing this family is and how you want to save them. Please don't do that. Allow yourself to be there in the pain. Regardless of how big, small, etc. you may feel the toxicity is within the family setting; accept what emotion they are portraying and take them for what they say. Don't overthink.
• Be honest and transparent (i.e., if that is your style!). Do not self-disclose or start getting too deep. Just be honest about the strengths, improvements, etc.
• Talk minimally and end the session with highlighting a common ground. Which brings me back to above; everyone just wants to be liked and understood. It may look different. Yet it's a core desire.
• Give them something to walk away with after the first session. What that means is the best gift you as a therapist can give to a family when they walk away from that session is: highlighting the common ground (i.e., everyone is not as different as we thought), hope for change (i.e., and even give them some interventions that you can try!), human connection and kindness, and providing a safe place of structure and follow through.

People often ask about my success rates with families and the above are my secrets. The first session sets the rest of their experiences apart. Does that just mean that I gave away my secret ingredient? I feel like it's for a good cause and if I can activate something in other clinicians to treat their consumers with kindness and feeling? I'd say that's a win for the human race.

Legal and Ethics FAQ: Record Retention

Record Retention Periods

This post is the first substantive post in the Legal and Ethics FAQ Blog Series. As mentioned in that post, AAMFT’s legal and ethics consultation service frequently receives questions about record keeping issues. The service receives a range of questions related to records and record keeping, but one of the most frequently asked questions is:

How long are MFTs required to keep records?

Some members are surprised to learn that AAMFT does not set record retention periods. Rather, MFTs should look to their local jurisdictions to determine record retention periods. In addition, MFTs can take guidance from Standard 2.5 in the AAMFT Code of Ethics. Standard 2.5 states that MFTs store, safeguard, and dispose of client records in ways that maintain confidentiality and in accord with applicable laws and professional standards.

If your jurisdiction does not specify a record retention period, there are a few other places you can look for guidance. If you work in an agency setting you would want to consult agency policies and procedures on this issue. If you are on an insurance panel, the third-party payor may have specific retention requirements. You can also look to local law governing the retention of records for similar professions. For example, in some cases taking guidance from the record retention requirements set forth by hospitals may be helpful (hospitals tend to have the longest record retention period). You can also take guidance from the statutes of limitations for common claims that can be brought against mental health providers (e.g. breach of contract, malpractice, licensing board complaint). It may also be helpful to consult with colleagues about their record retention policies. 

Some recommend retaining records indefinitely since the record would serve as the primary source of defense against allegations of wrongdoing. The record retention period set by any applicable law should be viewed as the minimum length of time to retain records. In addition to considering statutes of limitations for certain types of claims that could be brought against a provider, other considerations include the likelihood that the records would be needed in the future, whether the client was a minor at the time of service, and so on. 

For those jurisdictions that do set minimum record retention periods, it is common for there to be separate requirements that may require a provider to retain a minor’s record for a certain amount of time after the minor reaches the age of majority. 

To find out what the requirements are in your jurisdiction, you can contact your licensing board or other applicable regulatory body, or a local attorney.  

Strengthening Families Together

During the 2015 Annual Conference, The AAMFT Research and Education Foundation sponsored the keynote address from a recipient of the 2004 Minority Scholarship, Nelba Márquez-Greene. She shared the story of her daughter, Ana, whose life tragically ended on December 14, 2012 at Sandy Hook Elementary School. Ms. Márquez-Greene’s journey since her daughter’s death has led her to every level of government, media, and the public to increase understanding and awareness to prevent violence and promote her family’s motto: “Love Wins.” As a sponsor of the keynote and a Reception Luncheon, Foundation supporters were able to meet Ms. Márquez-Greene and network with other supporters. AAMFT Past President Mary Hotvedt spoke about the importance of supporting the AAMFT Research & Education Foundation in providing impactful research for the field of marriage and family therapy.

The AAMFT Research & Education Foundation is proud to provide a forum for MFTs to discuss these important issues that significantly impact the marriage and family therapy profession.

The Foundation also brought together the new cohort of MFP-D Fellows and Fellows from the MFP-Y program. This provided a great atmosphere for the Fellows to meet and network with each other. 

Finally, President Elect Christopher Habben introduced the 2015 "Strengthening Families Together" during Conference, which offers AAMFT members the opportunity to give back to the profession to expand the Foundation’s support in the areas of research, education, and outreach. 

Learn more about the AAMFT Research & Education Foundation.