The AAMFT Blog

The Experiential Process of our Country's Stagnation and Growth

The morning after the election I began processing the results with my colleague and practicum students I train and supervise. Shortly into a dialogue with one supervisee, I recalled an interaction she and I had following a family therapy session we recently co-facilitated. I run a training model grounded in experiential, gestalt-based approaches and we were a few weeks into her first family therapy client. As it generally tends to go—slowly, and then all at once—the experiential nature of the session evoked years' worth of suppressed emotion. Anger, grief, confrontations with mortality, abandonment, and various ambiguous losses that the family had always felt, but desperately tried to move on from and ignore. It quickly filled the therapy space. It was messy. It was ugly. It was raw. But it was authentic.

At the end of the session my supervisee looked at me in distress and said, "That was awful..." Although I wasn't surprised by her response, I was left with a much different impression of what was just experienced. We then discussed how experiential therapies—and the growth process in general—is not always pretty, and often, gets messy. Messy, but not worse. I never liked the phrase that "things get worse before they get better" relative to the therapeutic process. I feel that it fails to honor the courageous work of our clients as they confront the realities of their experience. To me, this has never been a process of things getting worse, but instead, things becoming more. More feeling. More complexity. More weight. More authenticity as clients face the brutal truths that entail their existence. The very experience of authenticity that begins the process of integration and growth. But moving from point A to point B often requires the suppressed rising to the surface in a way that relieves any individual from denying its presence. Whitaker urged that the entire family be present in order for the process to take effect, as it required every member of the system to not only bear witness, but to feel. Once it's in the room with us—all of us—only then can the system collectively begin working through.

To me, this is what I see happening with our country. The very ugly that so many have desperately tried to ignore has now risen to the surface. Looking back to early October I can think of so many individuals in my personal life that would deny the presence of racism, misogyny, and various forms of oppression in contemporary North-American society. Coalitions with the media and various political parties joined to maintain the suppression of the lived experience of countless humans sharing our soil. And just like a family system, the suppressed emotion of a painful truth manifested in various microaggressions, disguised just enough to keep reality buried for a large enough majority. Many were kept distracted, others were pathologized, and too many were scapegoated.

I can now see a homeostasis that was established and maintained over the past several decades. Progress was made, but in so many ways, our country stayed just the same. Racism and oppression were never overcome—they evolved to survive. But those that live it, and the others that grew aware and listened, never stopped fighting. The positive feedback loop of social progress continued to challenge the homeostasis of our country's moral climate. But the more progression tried to pull the homeostasis forward, with just as much might conservative values and beliefs countered with negative feedback. This general functioning of our country's social system continued, pushing each party further away from one another with each passing election. All the while, who felt it the most? Our human system. As the tension between progress and conservatism intensified, so did the system's dysfunction. As we know, a system's ability to maintain homeostasis in the midst of intense positive and negative feedback will eventually tire. And in the earliest morning hours of November 9, 2016, the tension that once stagnated the system snapped.

Much like the experiential process of therapy, the hatred that has always been present, but remained suppressed in so many ways, spiraled to the surface. It is messy. It is ugly. It is raw. But it is authentic. It is something that has always been there, but now, is right in front of our country's eyes. No longer can individuals claim that racism died and equality was achieved. Now, the hatred and divisiveness that is so deeply entwined in the moral fabric of our country has painfully filled the space, and we are all here to bear witness.

Is it too soon to find a silver lining? Did this have to happen in order for our country to be released from the homeostatic forces that stagnated social progress? It's hard to find hope as acts of hatred and violence continue to inflict so many members of our global family, but I also can't deny the parallel to what I've come to know as the human growth process. I won't say that this needed to happen, but since it has, I will remain present and connected as we hold its weight and ambiguity. As challenging as it may be to see, I will remain mindful of the universal pain and yearning that still unites us. I will continue to cultivate hope that, perhaps now, we can begin the healing process of integration and growth. Perhaps now, collectively, we can begin the process of finally making America great—for everyone.

Dr. Lucas Volini, DMFT, LMFT, is a Clinical Fellow of AAMFT, an Assistant Professor at Saint Mary's University of Minnesota in the MFT Program, and author of The National Licensing Exam for Marriage and Family Therapy: An Independent Study Guide. He also maintains a private practice in Waconia, MN. Lucas can be reached at [email protected]

The Holidays are Coming…The Holidays are Here! MFT Thoughts on Managing the Financial Stress of the Season

The Pressures of Holiday Spending

The holiday season is swiftly setting upon us. For many of us, this provokes anxiety as demands on our time, energy, and finances escalate. The reciprocity between give-and-take is put to the test this time of year. For some, the act of giving presents is a love language and the joy they get from it is reward enough. But for an unsuspecting recipient, this can cause tremendous pressure to reciprocate. When someone receives an unexpected gift, he or she may feel obligated to return the gesture, subsequently extending his or her pocketbook.  And the stress of finding "the right present" can be daunting, diminishing the joy of the experience. In any event, it almost always—but not always!—takes money to participate in these rituals.

For better or for worse, we live in a consumer-centered culture with easy access to credit. Many of us will blindly put a purchase on credit and worry about it later. Unlike older generations who grew up on the concept of a layaway, it seems we can have whatever we want now.  In this age of immediate access to merchandise, it is easier than ever to engage in frivolous spending. The outcome of such spending has a similar feeling to buyer’s remorse.  In other words, we feel guilty when we realize that we may have blurred the line between needs and wants.

While it is pleasant to give and receive presents, it can easily create a drain on our bank account that may take us months to pay off. In addition to the stress of family politics and the complex emotions that surround the holidays, we may also find ourselves hundreds or even thousands of dollars in debt.  The hangover effect of overspending hardly seems worth it.

As MFT's, we know that relationships are a core part of our well-being and that the health of our relationships is connected to how well we care for ourselves. When we engage in healthy practices, our partners, children, friends, and family benefit. Taking care of our finances is one of many healthy practices. If the holiday season is going to throw you into debt that takes months to reconcile, don't do it!

Here are some suggestions for managing the financial stress of the season.

Set a Budget: Take a closer look at your income and expenses. Use a piece of paper, word document, or excel spreadsheet and set a budget based on what you are comfortable spending. Examine your fixed expenses­ —rent, food, electricity, heat, and transportation – first. Now, look at what is left for holiday spending. If your budget isn't as large as you had hoped, consider how you can cut spending and, if desired, think of ways to build additional savings for next year. Keep in mind that you need to be comfortable with how much or how little you spend during the holidays.

Make a List and Stick to it! Make a list of the people you want to give presents to, as well as the social events you would like to attend. For some, the social aspect of the season adds to their financial stress. While it can be hard to say no, it is perfectly reasonable to set limits on what you can and cannot do during the holidays. If someone unexpectedly gives you something, be gracious and say thank you. If you feel guilty because you didn't get that person a gift, ask yourself "why" you feel that way? Remember that we don't all have to do the same thing in order to care about someone.

Engage in Mindful Spending: Think about the meaning of the gift you are buying. In most cases, there is such a rush to get things done that we spend without thinking about the usefulness of what we are buying.  Sometimes, the smallest and least expensive gift can be the most meaningful. For example, offering childcare to a friend who needs a night out is of great value without spending money to do it.

Use Cash: Another way to engage in mindful spending is by using cash. When we pay for something in cash, we are more likely to stop and think about the purchase we are making. It also reduces the risk of overspending when seduced by the various items that bombard us in the checkout line.

DIY Projects: If money is tight this year, consider do it yourself gifts. Baked goods are thoughtful and likely to be well-received.  This is an opportunity to be creative. Make an ornament; use photos you have in a picture frame you painted. For those that love to knit or crochet, making a cozy scarf or hat is another way to give on a budget.

Give Within Your Means: At the end of the day, you are the one who is left paying the bills of the season. Just as one is more likely to save money by adopting a live-within-your-means approach to life, giving within your means will help you manage the financial stress that comes with the holiday season.

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.

Minority Fellowship Program Applications are Open

The AAMFT Research and Education Foundation's Minority Fellowship Program offers three Fellowships. The MFP is one of the longest running behavioral health workforce development grants funded by the federal government – funding provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). These Fellowships are:

1. Dissertation Completion Fellowship (DCF)-For doctoral students at the dissertation stage of their curriculum;
2. Doctoral Fellowship (DF)-For doctoral students still in the process of completing pre dissertation core curriculum;
3. Now Is The Time: Minority Fellowship Program- Youth (NITT-MFP-Y)-For masters students interested in service provision to the nation’s youth.

Find more information here.

Join MFP staff for an informational webinar on applying for a Fellowship. Choose a time that works for you (all webinars are from 11 am - 12 pm eastern):

Wednesday, December, 14, 2016. Click here to join 

Monday, January, 9, 2017. Click here to join 

Tuesday, January, 24, 2017  Click here to join

Multiple Relationships in the Student/Teacher and Supervisory Relationship

In an earlier post, we discussed Standard 1.3 in the AAMFT Code of Ethics and dual roles/multiple relationships, in general. In today’s post, we’ll explore dual roles/multiple relationships in a specific context, namely the student/teacher and supervisory relationship context.

While Standard 1.3 provides guidance on dual roles/multiple relationships with clients, Standards 4.1 and 4.6 are intended to provide guidance on dual roles/multiple relationships in the context of the student/teacher and supervisory relationship. Examples of situations that have prompted calls to AAMFT’s legal and ethics consultation service include questions about former clients enrolling in a graduate program, taking on former clients as supervisees, and entering into social relationships or platonic friendships with students or supervisees.

Standard 4.1 states:

Marriage and family therapists who are in a supervisory role are aware of their influential positions with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships that could impair professional objectivity or increase the risk of exploitation. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions.

Standard 4.6 states:

Marriage and family therapists are aware of their influential positions with respect to supervisees, and they avoid exploiting the trust and dependency of such persons.  Supervisors, therefore, make every effort to avoid conditions and multiple relationships with supervisees that could impair professional judgment or increase the risk of exploitation.  Examples of such relationships include, but are not limited to, business or close personal relationships with supervisees or the supervisee’s immediate family.  When the risk of impairment or exploitation exists due to conditions or multiple roles, supervisors document the appropriate precautions taken.

Standards 4.1 and 4.6 appear very similar in nature. Standard 4.1 is titled “Exploitation” and Standard 4.6 is titled “Existing Relationship with Students or Supervisees.” While Standard 4.1 might apply to dual role/multiple relationship concerns in general, Standard 4.6 may be read to apply specifically to situations where there is an existing relationship with a supervisee or the supervisee’s immediate family.

As explained in our discussion of Standard 1.3, these situations are nuanced and require careful considerations of the facts of the specific scenario, the AAMFT Code of Ethics, and applicable statutes and regulations that govern the therapist’s practice.

The approach to assessing these situations is similar to the approach discussed in the earlier post about Standard 1.3. Generally speaking, when confronted with these scenarios, the Code calls on therapists to assess for increased risks of exploitation of students or supervisees, while also assessing for any increased risks of impaired professional judgment on the part of the therapist/teacher/supervisor. You can refer back to the earlier post for more discussion of what this assessment might look like.

Leaving aside Standard 4.3, which addresses sexual relationships with students and supervisees, there are two more Code standards that offer guidance on specific situations involving students and supervisees that may give rise to concerns about dual roles/multiple relationships or exploitation.

Standard 4.2 addresses situations where MFTs may be called upon to provide therapy to current students or supervisees. Standard 4.2 states:

Marriage and family therapists do not provide therapy to current students or supervisees.

Standard 4.8 addresses financial arrangements between supervisors and supervisees. Standard 4.8 states:

Marriage and family therapists providing clinical supervision shall not enter into financial arrangements with supervisees through deceptive or exploitative practices, nor shall marriage and family therapists providing clinical supervision exert undue influence over supervisees when establishing supervision fees. Marriage and family therapists shall also not engage in other exploitative practices of supervisees.

Standard 4.2 does not necessarily call for assessment of the situation, but rather clearly states that MFTs do not provide therapy to current students or supervisees. Standard 4.8 may call for more assessment of the specific facts of a situation, but overall, these Code standards are relatively straightforward.

Just as MFTs are called upon to attend to concerns about dual roles/multiple relationships within the therapist/client relationship, so too are MFTs called upon to attend to these concerns in the context of the student/teacher and supervisory relationship. Referring to the Code sections discussed in this post is a great starting point.

Multiple Relationships

AAMFT’s legal and ethics consultation service frequently fields calls from members confronted with situations involving concerns about dual roles/multiple relationships. Over the years, various scenarios have been presented including questions about buying or selling items to or from clients, hiring clients, entering into platonic friendships with clients, and entering into some kind of business relationship with clients. You’ll notice the word “clients” was used in the previous examples—later in the post we’ll discuss matters of timing (e.g. current client vs. former client).

Regardless of the scenario presented, these situations are nuanced and require careful considerations of the facts of the specific scenario, the AAMFT Code of Ethics, and applicable statutes and regulations that govern the therapist’s practice. This post, of course, will focus on the AAMFT Code of Ethics.

In these situations, members are guided to Standard 1.3 in the AAMFT Code of Ethics, which states:

Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists document the appropriate precautions taken. 

Taking guidance from Standard 1.3, therapists presented with the possibility of a dual role or multiple relationship are called upon to make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. This portion of Standard 1.3 is consistent with the risk management approach to dual roles/multiple relationships, which generally states that therapists should avoid scenarios that give rise to concerns about dual roles and multiple relationships, whenever possible.

If a therapist makes the decision to move forward in the face of concerns about dual roles and multiple relationships, therapists are called upon to assess the situation in question for any increased risk of exploitation of the client, as well as any increased risk of impaired professional judgment on the part of the therapist. When assessing for an increased risk of exploitation, it may be helpful to turn to a dictionary definition of “exploit.” Merriam-Webster defines “exploit” as “[making use] of meanly or unfairly for one’s own advantage.” Assessing for an increased risk of impaired professional judgment should be relatively straightforward, but therapists would likely benefit from consultation so as to achieve an objective perspective of the situation.

The last sentence of Standard 1.3 hints that there may be appropriate precautions that could be taken if the risk of impairment or exploitation exists. If, after assessing the risks and all relevant factors, a therapist chose to move forward in a situation presenting the possibility of dual roles/multiple relationships, Standard 1.3 advises the therapist to document the appropriate precautions taken. Examples of appropriate precautions may include, but are not limited to, discussing the risks with the client and planning for how to handle issues that may arise, seeking peer consultation or supervision, and being prepared to assess and reassess the situation as it evolves.

Standard 1.3 also provides a non-exhaustive list of examples of relationships that could impair professional judgment or increase the risk of exploitation. That non-exhaustive list includes business or close personal relationships with a client or the client’s immediate family.

Dual roles/multiple relationships can be thought of as landing somewhere on a spectrum of possibly workable to more clearly problematic. On the possibly workable side you’d find situations that may be objectively and reasonably managed (e.g. therapist and client have children that attend the same school and may see each other at school events from time to time). On the more clearly problematic side of the spectrum you’d find situations that are more objectively risky and likely to be problematic (e.g. therapist borrows money from client).

Many members ask about how much time needs to pass between the end of the therapeutic relationship and the beginning of the new relationship in question. Standard 1.3 does not mention a specific time frame. Rather, any questions of timing would simply be one of many factors to consider when assessing the situation for risk. If the therapist/client relationship is current and active, the risk levels may be higher. If the therapist/client relationship has ended, the risk levels may be lower. The greater amount of time that has passed since the end of the therapeutic relationship, the lower the risk levels may drop.

So, while not all dual roles/multiple relationships are automatically problematic, these are not risk free scenarios. Peer consultation, consultation with AAMFT’s legal and ethics staff, and consultation with your professional liability insurer may be helpful resources. And, remember, from a risk management standpoint, the advice given tends to be to avoid scenarios that give rise to concerns about dual roles and multiple relationships, whenever possible.

For further discussion on dual roles/multiple relationships, you can look to the September/October 2016 issue of FTM, which includes an informative article on managing multiple relationships.

References

Exploit [Def. 2]. (n.d.) In Merriam Webster Online, Retrieved November 23, 2016, from http://www.merriam-webster.com/dictionary/exploit.