The AAMFT Blog

AAMFT Makes Progress on MFTs in Medicare in Omnibus Spending Bill

Last week, AAMFT made progress on the goal of adding MFTs as Medicare-eligible providers with the inclusion of an AAMFT-supported provision in a spending bill that supports efforts to expand the behavioral health workforce for the Medicare population. This bill, also known as an omnibus spending bill, has been signed into law by the president, and this bill will fund the federal government through September 30, 2018.  

Due to the successful advocacy efforts by Rep. John Katko (R-NY), the chief sponsor of legislation in the House of Representatives that would include MFTs and mental health counselors as Medicare-eligible providers (HR 3032), this AAMFT-supported provision was included in the explanatory statement for the omnibus bill. The statement supports efforts by the Centers for Medicare and Medicaid Services (CMS) to explore the expansion of behavioral health providers. This language states that Congress is “aware that Medicare beneficiaries have limited access to substance use disorder and mental health services, particularly in rural and underserved areas.” They noted “concern about the shortage of eligible mental health providers for the Medicare population,” and that they support efforts “to explore the expansion of the mental and behavioral health workforce.”

Although this language does not add MFTs as Medicare-eligible providers, this provision advances AAMFT’s goal of Medicare inclusion for MFTs. This language demonstrates intent by Congress to expand the Medicare behavioral health workforce.

AAMFT would like to thank Rep. Katko for his success in advocating for this provision. We would also like to thank the many AAMFT members who have contacted Congress over the last year advocating for MFTs in Medicare. Just this month, Family TEAM and other AAMFT members responded to an AAMFT advocacy action alert by sending over 1,200 messages to their Members of Congress urging the inclusion of LMFTs as Medicare providers in the omnibus bill.   

AAMFT’s Medicare advocacy efforts are continuing. For example, several AAMFT members will be traveling to Washington the week of April 9 to urge their Members of Congress to support the MFTs in Medicare bills, HR 3032 and S 1879. If you have not already done so, please contact your Members of Congress now and urge them to cosponsor legislation that includes MFTs as Medicare providers

Urge your Member of Congress to Support MFTs in Medicare

Medicare Access Coalition: Preventing Suicide in Older Adults

AAMFT, along with the Medicare Access Coalition, partnered with the National Council of Behavioral Health to hold a briefing on March 15 titled Preventing Suicide in Older Adults. This briefing, held on both the House and Senate side, featured esteemed panelists from the National Institutes of Mental Health and Peak Wellness Center of Wyoming, with Chuck Ingoglia of the National Council acting as the moderator. A beneficiary of mental health services also shared her story of success to emphasize the need for older adults to have access to quality mental health care. The presentation focused on one unifying sentiment: allowing MFTs and licensed professional counselors (LPCs) to bill Medicare is a simple solution to a major mental health access problem.

Congressional briefings are held to communicate policy solutions and information to congressional offices by inviting staffers and other important personnel. Typically, light refreshments and meals are provided to audience members, which makes the event more enticing to staffers with busy schedules. A briefing usually consists of a 45-minute presentation, and time allotted for a question-and-answer session after. While congressional staffers are the main target audience, it is not uncommon for other organizations to send individuals to briefings to learn more on a subject. The panelists for this briefing were chosen because they see the direct effect lack of access has on the mental health of older adults.

The first panelist for our briefing was Dr. Jovier Evans, of the National Institutes of Mental Health. He works specifically in geriatrics, and provided background statistics on the mental health of older adults. Dr. Evans discussed how depression and anxiety present differently in older adults, and the intermingling of physical illnesses with mental disorders. His presentation focused on the need for mental health care in the elderly population.

The next panelists included Linda Goodman and Karl Cline, Chief Clinical Officer and Chief Executive Officer respectively, of Peak Wellness Center in Wyoming. Peak Wellness Center, a community mental health care facility, serves a rural population while also facing a severe workforce shortage. According to Ms. Goodman over 45% of the elderly patients are dependent on Medicare and often the only providers (social workers, one psychologist) are too busy. Sometimes the provider that is available may not be the one best suited for the patient’s needs. Both Goodman and Cline see the need for MFTs and LPCs in Medicare to better serve their community.

The final speaker, a beneficiary of mental health services, explained the positive impact accessing quality mental health care had on her life. Including MFTs and LPCs in Medicare will increase access to care, especially in rural areas where providers are scarce. Senator Barrasso, the sponsor of the Seniors Mental Health Access Improvement Act of 2017 (S. 1879) shared these sentiments when he appeared for the Senate side briefing (pictured above).

Both briefings went well, and AAMFT plans to hold our own briefing in the future. We hope that the visibility of our issue, and the support of other, sometimes larger, organizations will lead to legislative success. If you have not done so already, urge your Member of Congress to Support MFTs in Medicare.

Core Scholarship Competencies for Family Therapists Working in Healthcare Settings

Click to download your free copy: www.aamft.org/healthcare 

Read Part 1 of this series: Clinical Competencies for Family Therapists Working in Healthcare Settings

In 2013, a team of field leaders in Medical Family Therapy came together to develop competencies for family therapists working in healthcare settings. They initiated these efforts in response to the increasing number of therapists being sought-out for and placed within such settings, alongside a recognition that clear guidelines regarding knowledge, skills, and abilities for effective engagement in such placements were not yet available. Over the next four years, this team worked across small- and large- group formats to identify key domain areas, associated skillsets, and target indicators relevant to this work. For a thorough description of the steps encompassed in this effort, see American Association for Marriage and Family Therapy (AAMFT; 2018). The following is a summary of core competencies related to scholarship for family therapists in healthcare settings

A marked strength of Marriage/Couple and Family Therapy (M/CFT) programs, particularly among those that are accredited by the Commission on Accreditation for Marriage and Family Therapy (COAMFTE), is the rigor placed on clinical training. Without question, M/CFTs are well prepared to engage in relational screenings and interventions. What is greatly needed, building upon this, is a stronger skillset in scholarship for those at the master’s level and beyond. This becomes even more essential when considering collaboration with healthcare teams and in diverse healthcare contexts. This skill will also make family therapists more competitive for jobs, as the current hiring climate in health care continues to evolve. Behavioral health providers, in addition to providing clinical services, administrative duties, and perhaps supervision/teaching, may be asked to design evaluations, analyze findings, and present on or publish the outcomes from program development and process improvement studies. These types of studies are vital to successfully initiating, growing, and sustaining behavioral health services in a healthcare setting.

M/CFTs conventionally take a class during their master’s program that affords an opportunity to learn about commonly used statistics and/or research methods. However, having competencies in scholarship pertaining to family therapy in healthcare settings is what really makes the clinician a desirable team member. Those who have competencies in scholarship as a family therapist in healthcare have learned to navigate research that honors: (a) systems, (b) biological, psychological, social, and spiritual foci, (c) interdisciplinary collaboration, (d) leadership, (e) ethics, and (f) diversity. This erudition spans across scholars who contribute to the fields of family therapy, medical family therapy, and other healthcare disciplines – and the patient/family/community populations that they study.

Those who were influential in constructing these competencies believe that family therapists who work in healthcare contexts can transcend the roles that have historically bound them. As scholars who are savvy in these competencies, well-trained family therapists are able to effectively contribute to diverse research teams, with an ability to publish in a variety of healthcare journals (mental health, biomedical care, healthcare administration and policy, etc.). This opportunity strengthens the reputation of family therapists in our own field, and beyond our typical readership.

Scholarship Competencies related to General Systems

What is true in the broader family therapy research is also true in the relational facets of healthcare research; family therapists must be at the forefront on studies pertaining to the study of relational health.The door stands open for dyadic, triadic, and familial research (target indicator 1.4a; AAMFT, 2018) in relation to experiences with illness, loss, trauma, and wellness. Thus, family therapists should advocate for research that includes the voice of caregivers, siblings, partners, and providers on the health outcomes of participants.

Scholarship Competencies related to Biopsychosocial-spiritual (BPSS) Systems

Any therapist who works in a healthcare context ought to be a competent consumer of both mental and physical care literature in order to best support the families and teams within their practice setting. For some, the role as a researcher may have a prominent presence in the therapist’s life, including competencies in designing and conducting evaluations or research studies that include BPSS dimensions into interventions and protocols (target indicator 2.4b; AAMFT, 2018). Therapists can strengthen their competency by identifying ways to maximize BPSS data through big data analytics, clinical trials, and dissemination and implementation studies.

Scholarship Competencies related to Collaboration

Likely an easier competency for family therapists to engage in is collaboration within their own research/scholarship endeavors. However, what may sometimes cause a therapist to pause is the hierarchy within medical systems and the perception that their skills are “less-than” compared to other providers. An important element of any interdisciplinary collaboration on clinical, financial, and/or financial outcomes (target indicator 3.4b; AAMFT, 2018) is to have team members who are willing to serve as both experts and learners.  Everyone on a team has something to contribute, and this mosaic of different strengths translates into a whole that is more than the sum of its respective parts.

Scholarship Competencies related to Leadership

A skill that requires even more attention among family therapists in healthcare settings is learning how to “serve as a leader in writing, submitting, and implementing grants or contracts on BPSS and relational health and health care” (Knowledge/Abilities/Personal Characteristics 4.4c; AAMFT, 2018). While grant writing may seem like a daunting or intimidating task, many foundations across any state, nation, or providence levels exist that support clinical research aimed at reducing health disparities, increasing best practices, improving healthcare employee productivity, and maximizing value of care services. Both modest- and large- grant sponsors support the systemic and BPSS lenses put forth in proposals led by family therapists.

Scholarship Competencies related to Ethics

Competencies for family therapists in healthcare settings align with the ethics of scholarship that are grounded in AAMFT’s Code of Ethics (2015); these include an awareness of ethics from other disciplines. This understanding is particularly important in healthcare research and grant writing, as the scholar may be accountable to multiple institutional review boards and layers of privacy and protocol requirements. The ethics of family therapy scholars in healthcare contexts must attend to participants, engaging with collaborators, and the role(s) of researchers within the system and/or community. Above all, the researcher must maintain an awareness for the role of sustainability for a program or grant initiated in the healthcare context.

Scholarship Competencies related to Diversity

An area of publishing, presenting, and grant writing that family therapists in healthcare settings must stay especially attuned to is cultural sensitivity, cultural humility, and the ethical implementation of research studies with vulnerable populations and minority groups (target indicators 6.4b and 6.4c; AAMFT, 2018). Upholding these competencies is essential, not just as scholars, but also as professionals whose ethical practice is grounded in interventions that are indicated for a specified family, community, or larger system.

 

Conclusion

The competencies for scholarship among family therapists working in healthcare settings cut across systems-, biopsychosocial/spiritual-, collaboration-, leadership-, ethics-, and diversity-domains. Crossing primary (e.g., family medicine, pediatrics), secondary (e.g., OBGYN, emergency medicine), tertiary (e.g., hospice care, alcohol and drug treatment), and other scholarly environments (e.g., research institutes, federal organizations), these skillsets are essential for strengthening our contributions in both family therapy and other healthcare literature, research, and scholarly productivity.

References

American Association for Marriage and Family Therapy (2018). Competencies for family therapists working in healthcare care settings. Retrieved from www.aamft.org/healthcare

American Association for Marriage and Family Therapy (2015). Code of ethics. Retrieved from https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

 

Authors:

Angela Lamson, Ph.D., LMFT

Tai J. Mendenhall, Ph.D., LMFT

Jennifer L. Hodgson, Ph.D., LMFT

Lisa Tyndall, Ph.D., LMFT

Stephanie Trudeau, Ph.D.

Legislative Success in Virginia

After the problems that arose in Texas, leaders in Virginia carefully reviewed the scope of practice for licensed marriage and family therapists in Virginia. While there has never been a question or a problem, the law governing our practice was, at the very least, ambiguous about our ability to provide diagnoses. In making this review, it was noted that the term of choice was “assessment,” but that there was no definition for “assessment” anywhere in the language of the law. There was, however, a definition for “appraisal” which included providing “objective assessments” and diagnoses.

A freshman legislator in the Virginia House of Delegates, Ms. Debra Rodman, agreed to patron the legislative language change, substituting “appraisal” for “assessment” in the scope of service for MFTs. This was presented as a clarification of the existing ambiguous language and as a reflection of actual practice in the mental health industry as LMFTs have been providing diagnoses since the inception of the license in 1998.

There was no opposition to this change as the Board of Counseling and the Virginia Association of Clinical Counselors were consulted and informed of the proposed change in the Code of Virginia. There were two negative votes on the floor of the Virginia House of Delegates. These votes were cast by persons representing a strong libertarian posture and they routinely vote against any bill that smacks of government regulation! The bill passed by unanimous vote of the Virginia Senate and was signed into law by the Governor.

Written by Arnold Woodruff, LMFT, Executive Director of VAMFT. Pictured above with Delegate Debra Rodman. 

 

Minority Fellowship Program Volunteers Needed

The AAMFT Research & Education Foundation is excited to announce that the Minority Fellowship Program Volunteer Applications for the 2018-19 year are now open! The MFP is funded by grants from the Substance Abuse and Mental Health Services Administration (SAMHSA), focused on training of doctoral and master’s level practitioners and researchers in culturally competent mental health and substance abuse services, treatment, and prevention. The MFP has supported the training of over 1,700 Fellows from various mental health disciplines including marriage and family therapy.

There are many ways that you can contribute to the efforts of the MFP in shaping the marriage and family therapy workforce and enhancing the field of mental health.

Positions include:

Advisory Committee Member (Professional and Public Member)

MFP Mentors

Ad-hoc members/ Initial Reviewers

Volunteering for the MFP is an amazing opportunity to further the mission of expanding culturally competent mental health services to underserved populations, contribute to the growth and development of the behavioral health workforce, and gain access to members with similar interests and professional goals.

Review the volunteer position you wish to apply for on the MFP Volunteer Application Information Page.

 

To learn more about this opportunity please attend one of our free volunteer webinars:

Thursday March 29, 2018, 2:30 PM -3:30PM ET Click here to Join

Thursday April 19, 2018, 2:30PM -3:30PM ET Click here to join  

Volunteer Applications are due Friday June 29, 2018

Why We Love Ethics (and You Should Too!)

Register for the Student Ethics Competition here (last day to register is March 16, 2018, at 11:59 p.m. ET)

It was this time last year, my fellow classmate and I made the decision to enter the 2017 AAMFT Ethics Competition. Participating in the ethics competition, winning first place, and attending the 2017 AAMFT Annual Conference in Atlanta, GA were incredible experiences for us both. It was fascinating to meet and hear professionals discuss their ideas and perspectives at the AAMFT conference.

Amanda Ortega shares......

“The experience and resources available to me at the AAMFT annual conference are among the things I value most from my participation in last year's ethics competition. There were countless opportunities and activities at the conference to further my education, such as workshops on moral injury and traumatic brain injuries. Although I have not yet started the clinical component of my master’s program, I feel more confident in making ethical considerations with the tools that I acquired as a result of having made the decision to compete.”

The 2017 AAMFT Ethics Competition stands out as a pivotal and defining moment of our graduate experience thus far. It was a phenomenal opportunity to integrate the conceptual classwork lessons into a true to life scenario. As teammates in the Master’s/PDI category, we were charged with the specific task of analyzing a hypothetical ethical situation. We first began by identifying ethical codes that were adhered to, and ones that were violated. Then, through the use of an empirically supported ethical decision making model, we were able to implement our analytical skills by formulating a comprehensive essay response to the case scenario.

Heather Frostman shares.....

"Since participating in the ethics competition, I continue to benefit from the experience. During the subsequent semester, I was jump-started into my internship within a mixed group of professionals, to include fellow interns and seasoned therapists. I have felt comfortable and confident in my abilities, interpretations, and presentation skills. I can trace much of my success at my internship site to the technical, teamwork, and networking skills that I developed over the course of my time at Regis University, to include my experience with AAMFT, and the recent ethics competition.”

Competing in the AAMFT Ethics Competition was such a uniquely challenging and exciting experience. We would encourage anyone who is considering a career in the counseling profession to pursue this opportunity. We truly feel that this experience helped prepare us for the responsibilities that will soon be placed on us as future licensed therapists, most importantly being that of maintaining a high degree of professional integrity.

We would like to thank Regis University Professor, and Licensed Marriage and Family Therapist, Dr. Roxanne Bamond, for encouraging us to compete; and for the valuable opportunity offered by the American Association for Marriage and Family Therapy.

Amanda Ortega is approaching her clinical component of the Marriage and Family Therapy program at Regis University, in Denver, CO. Her passion is working with service members, veterans and their families. In addition to a Master of Arts in Marriage and Family Therapy, Amanda is also pursuing the post-master’s certification in Counseling Military Families. Amanda is currently President-Elect for the Kappa Chapter of Delta Kappa Honor Society, and is an active member of the American Association for Marriage and Family Therapy.

 

Heather Frostman is a Psychotherapist Intern at People House in Denver, CO, where she provides individual, couples, and family therapy, in combination with mind-body medicine practices. Her passion is working with adolescents and their parents, navigating the challenges of the teenage years. Heather currently holds a Master of Arts in Applied Psychology (2010) and is in the process of completing her Master of Arts in Marriage and Family Therapy at Regis University, in Denver, CO (expected August, 2018). She is an active member of both Chi Sigma Iota, and Delta Kappa Honor Societies, and the American Association for Marriage and Family Therapy; and was recently admitted to the Ph.D. Mind-Body Medicine program at Saybrook University.

 

Advocacy Alert: Oppose HB 465 in Kentucky

Members in Kentucky are encouraged to email their Representative and urge them to oppose HB 465. Find email addresses HERE or call the legislative hotline at 1-800-372-7181 and leave a message - NO TO HB 465!

AAMFT's statement: 

The American Association for Marriage and Family Therapy (AAMFT), a non-profit organization representing the professional interests of Marriage and Family Therapists (MFTs), expresses our serious concern regarding Kentucky House Bill 465. This legislation would place the Kentucky Board of Licensure for Marriage and Family Therapists (Board) under the authority of a general licensing entity. AAMFT opposes HB 465 and any attempt to reduce the Board’s ability to protect the public by providing appropriate oversight of MFT professionals.

Regulatory boards are tasked with protecting the public from incompetent and unethical practitioners and the Kentucky Board of Licensure for Marriage and Family Therapists is no different. The Board members and staff are knowledgeable in issues surrounding licensing, the practice of marriage and family therapy, and ethical boundaries. The Board establishes and maintains standards of qualifications and performance for over 650 MFTs. The Board also has the authority to discipline licensees for violations of the licensure law, offering an additional protection for members of the public. Under HB 465, the administration of the Board functions may be overseen by individuals without sufficient knowledge of the profession to provide proper oversight and recourse. This is especially true given that HB 465 places MFTs under a general licensing authority, separate from the proposed Health and Restoration entity that is composed of mental health professions such as psychology and social work.

HB 465 would negatively impact the Kentucky residents seeking mental and behavioral health services. Without an independent board to provide oversight of MFTs, members of the public may face barriers to care, or lack recourse to timely file complaints. HB 465 is also unlikely to result in cost savings to the state as the Board is self-supporting and does not receive Kentucky general funds for operation. AAMFT believes that the Kentucky Board of Licensure of Marriage and Family Therapists should remain as currently structured or fit within the mental health profession structure.

AAMFT Signs Letters to Implement Recommendations for MFTs

AAMFT and 35 national organizations signed and submitted letters to federal agencies to follow-up on the steps that are being taken to implement the 45 recommendations, including MFTs in Medicare, outlined in the Interdepartmental Serious Mental Illness Coordinating Committee’s report to Congress. Read the letter MHLG ISMICC Letter to HHS, and the original ISMICC report here.

 

An Advanced Look at Polyamory and Kink Lifestyles in Therapy

Interested in this topic? Join us for a webinar on April 6, 2018 from 3:00 - 4:30 PM ET. Register here.  Catch up on part 1 of this series here.

While the typical American couple would identify themselves as monogamous and/or vanilla, more and more couples are looking for alternative ways to explore their sexuality. What is out there? In the image below, you can learn about a variety of styles of non-monogamy. Some of the types include swinging, casual sex, polyamory, BDSM play and Dominant/Submissive non-monogamy, open relationships and relationship anarchy, and many more.

As therapists, we need to take a sex positive approach with our clients regardless of whether or not we are comfortable with their life choices. What this means is that we respect the lifestyle and encourage people to take a positive and educated approach to sex. We are avoiding attaching shame to sex or sexual expression. How do we do this without knowing much about what is out there? How do we do this if our own values are vastly different from the clients we work with?

I often teach a model of sexual health first created by Michael Vigorito and Doug Braun-Harvey. In their 2015 book, “Treating Out of Control Sexual Behaviors,” they developed a great tool to teach individuals to make sexually ethical choices. These ethical rules include: consent, non-exploitation, honesty, mutual pleasure, shared values, and protection against unwanted STIs/HIV and unwanted pregnancy. This sexual health model is a helpful reference for clients across the spectrum.

Let's look at each part. The first and most important rule is consent of all parties. With the recent #metoo movement, it is becoming clear that people all across the country need education in consent.

In relationships where couples are exploring sex outside their marriage, they need to have direct conversations about consent. In kinky communities, they will talk in depth about sexual acts they like, sexual acts that are not okay with, and sexual acts that are somewhere in the middle—it depends on the context. In some lifestyle communities such as Sex Positive St. Louis, they are even educating their participants about both verbal and non-verbal consent-that someone may hesitantly say yes to something, but their body language may be showing hesitation. As clinicians, we can educate our clients about how to read non-verbal communication and build a deeper trust through consent even in monogamous relationships.

For the next rule, non-exploitation, you may need to describe what an exploitative relationship is with your clients. The easiest way for me to describe it is a one-down relationship. We discuss this in systems theory. As therapists, our clients are in a one-down relationship with us. We have some power in our position which is why it is important for us to have ethical codes to protect our clients.

In our own AAMFT ethical codes 1.4 and 1.5, it states that clinicians are not supposed to engage in a romantic relationship with our clients. That is because the relationship would be exploitative in nature. Other relationships that have a similar one-down situation include adult/child, manager/employee, prison guard/prisoner, and doctor/patient. In each of these relationships, the person in the higher position has more rights, more privileges, and/or more power. Clients need to be aware of this dynamic and try to find relationships that are on more equal footing. In actual dominant/submissive relationships, the couple is typically on equal footing and has consensually created this power dynamic for the purpose of mutual pleasure.

The next rule is honesty. Since sex can be a shameful topic, it can be difficult for clients to share honest feelings about sex, sexual desires, and even kinks. As a sex therapist, I have found increasingly that people are more similar than different. A lot of our shame comes from society and the way we were raised. If as a culture, we could encourage sex positivism, it might be easier for clients to be direct about their needs and desires with their partners.

In the case of my clients, I always try to help them express their honest feelings about sex. I also encourage clients to take a curious, non-judgmental approach to their partner's sharing so that people can build trust. Remind your clients that talking about sexual fantasies does not necessarily mean acting on them. There are many people who like the fantasy of a threesome but would not be comfortable with the actuality. If we can encourage honesty up front, then couples can make conscious decisions about who to couple with and who to break up with if their sexual interests are too different.

Another helpful rule is to make sure there is mutual pleasure (among all participants involved). Pain can be involved in pleasure. For people who have never explored sadism or masochism, it can be difficult to understand why getting a serious spanking could be pleasurable. When I speak with clients who explore this, they state they get a lot of pleasure out of the experience. To be helpful to clients, clinicians need to develop a non-judgmental approach to what it can mean to have mutual pleasure.

Many vanilla couples aren't paying attention to the mutual pleasure rule. Sex can become all about male pleasure while women are having sex “just for him.” As a sex therapist, I try to make it a point to ensure that both partners (or more), are getting something pleasurable out of the situation for themselves. Even in a situation of polyamorous lovers, all parties often describe the feeling of compersion, which is defined as getting pleasure from a partner's romantic relationship with another person. This suggests that even in cases where partners are having sex outside of their primary relationship, they are still getting mutual pleasure out of the situation.

Another important rule is for the partners to have shared values. People involved in swinging communities have similar values. They may have their primary partners, husbands or wives, and then they share and act on sexual fantasies with the bigger group. If all parties involved have a similar value of, “Couples who play together stay together,” then the group can have a great time and enjoy various sexual encounters.

Problems can occur when one person in a relationship wants these things and is trying to strong-arm the other person into situations counter to their values. Going back to the previous rule, if we can help couples be honest, we can help them decide how to incorporate alternative sexual expression safely or guide them in how to respect each other’s differences without harming the relationship.

The final suggestion in the model is that all parties be protected against unwanted STIs and unwanted pregnancy. This is a great rule for all individuals to have with new partners. Recently, I have had a great number of divorcees who are newly dating and concerned about this conversation. The reality is that many people do not have great sex education, so the idea of asking a partner if they have an STI or if they could use a condom may be terrifying.

I have interviewed people in the polyamory community about safe sex practices who state that they get regular STI checks and have very upfront conversations about STIs with potential partners. In fact, in one interview with Kevin Patterson, author of the book, “Poly Role Models,” he stated that the STI conversation is sexy because you know if you are talking about this, you are about to get busy! I find this both hilarious and deeply respectful. As long as your clients are having similar conversations and protecting themselves, they may be in a better spot than some of our clients whose spouses are cheating on them non-consensually.

As long your clients are following these guidelines, then they should be free to explore whatever sexual interests they desire no matter how wild or out of our comfort zones as their clinicians. I hope you will join me for my upcoming webinar An Advanced Look at Polygamous and Kink Lifestyles, in which we will go into a more in depth discussion of various non-monogamous and kinky sexual lifestyles and how we can be helpful as their clinicians.

Angela Skurtu is a Licensed Marriage and Family Therapist in the state of Missouri and an AASECT Certified Sex Therapist. She is also a speaker and author of two books, Helping Couples Overcome Infidelity: A Therapist's Manual, and Pre-Marital Counseling: A Guide for Clinicians. She runs a YouTube channel and is cohost of the About Sex Podcast. 

Core Clinical Competencies for Family Therapists Working in Healthcare Settings

Click to download your free copy: Click to download your free copy: www.aamft.org/healthcare 

Family therapists are well equipped to work in healthcare settings across clinical, training/supervision, management/policy, and scholarship efforts. This blog post is the first in a series (of four) that highlights core competencies across these respective foci. It begins by describing how field leaders worked with AAMFT to identify said competencies, and then highlights those specific to clinical efforts. These efforts are anchored within systems-, biopsychosocial/spiritual-, collaboration-, leadership-, ethics-, and diversity- domains.

Core Clinical Competencies for Family Therapists Working in Healthcare Settings

In 2013, a team of field leaders in Medical Family Therapy came together to develop competencies for family therapists working in healthcare settings. They initiated these efforts in response to the increasing numbers of therapists being sought-out for and placed within such settings, alongside a recognition that clear guidelines regarding knowledge, skills, and abilities for effective engagement in such placements were not yet available. Over the next four years, this team worked across small- and large- group formats to identify key domain areas, associated skillsets, and target indicators relevant to this work. For a thorough description of the steps encompassed in this effort, see American Association for Marriage and Family Therapy [AAMFT] (2018).

Core competencies for family therapists working in healthcare settings are situated in four principal areas: (a) clinical skills; (b) training and supervision; (c) healthcare management and policy; and (d) scholarship. Each of these domains are further anchored in six domains (systems, biopsychosocial/spiritual, collaboration, leadership, ethics, and diversity).

The following is a summary of core competencies related to clinical skills; ensuing blogs on this website will highlight competencies in training and supervision, healthcare management and policy, and scholarship.

Clinical Competencies

As clinicians who are excited about our own work in healthcare contexts, we have been energized by the opportunity to present at AAMFT conferences and publish on our experiences in a variety of healthcare settings. Over the years, a number of family therapists would ask what they need to know in order to work in a healthcare context. First and foremost, we believe that clinical competencies for family therapists in healthcare settings must be grounded in the AAMFT’s Code of Ethics (2015) and MFT Core Competencies (2004). A team of family therapists then united to offer additional competencies uniquely constructed for family therapists in healthcare settings. Leaders in the field agreed that there was a need for additional specialized training and skills in order to maximize employment in and collaboration with healthcare settings and systems. Below is a sample of the clinical competencies via the six domains:

Clinical competencies related to general systems. Family therapists working in healthcare settings must advance clinical efforts in a manner that recognizes and honors multi-level and multi-directional influences between family members (e.g., patients, spouses, parents, children), between healthcare providers (e.g., behavioral, biomedical, pastoral), and between families and healthcare providers (as active participants in team-based care). They are thereby able to engage patients and families in support regarding, processing of, coping with, and effectively managing health crises/conditions/challenges, while at the same time facilitating valuable communication and collaboration between multiple providers involved in their care.

Family therapists in healthcare contexts balance conversations across the continuum from illness to well-being, deficits to resilience, strengths to weaknesses, hope to despair, and acceptance to agency toward change. They maintain competence in explaining literature and implementing practice through best- and systemic- interventions across multiple fields (e.g., Family Therapy, Medicine, Nursing), and through a variety of theories and models as they interface with systemic health concerns (e.g., motivational interviewing with patients who wish to stop smoking, structural family therapy + psychoeducation for adolescents living with diabetes).

Clinical competencies related to biopsychosocial-spiritual (BPSS) systems. Family therapists in healthcare settings consistently work to advance clinical care with clear knowledge regarding the biological components of – and biomedical interventions for – diseases that are customary to the care sites within which they are positioned and how those components interface with psychosocial and spiritual health and beliefs. For example, those working in endocrinology are familiar with metabolic processes, disease management strategies, and medications core to diabetes care as they interface with health behaviors and spiritual practices; those working in oncology are similarly conversant with physiological processes, testing sequences, and care-strategies common in cancer care – particularly as they intersect with relational decision making and mental health comorbidities. They are up-to-date in psychopharmacology (e.g., medication classes, common uses, common side effects), especially regarding drugs most frequently prescribed in their sites. They communicate in manners that demonstrate healthcare literacy across multiple disciplines (e.g., medical- and psychological/psychiatric- terminology, disease- and/or diagnosis- specific nomenclatures), and regularly articulate the manners in which multiple BPSS dimensions interact with each other in the present, across the lifespan, and with consideration of cultural / spiritual beliefs and practices.

Clinical competencies related to collaboration. Connecting the multiple and complex-overlapping dots of systems- and BPSS- sensitive care, family therapists in healthcare settings work hard to employ evidence-based models that promote interdisciplinary collaboration and relational care. They do this in a manner driven by respectful working alliances with patients, families, and other involved professionals working together en route to shared treatment goals. Family therapists in healthcare contexts must know how to navigate collaborative relationships through careful, purposeful, and flexible attention to collaborative efforts that span across workflow time (before, during, and after care encounters) and mediums (verbal, written, electronic, etc.).

Clinical competencies related to leadership. Family therapists in healthcare settings work hard to create and/or promote evidence-based models of integrated behavioral health care in collaboration with patients, families, healthcare team members, supervisees, administrators, community partners, researchers, and policy-makers. They do this through providing education about, modeling, and/or advancing clinical practices that maximize care outcomes, cost efficiency, and/or training and mentoring development. Given the systemic and BPSS training of family therapists in health care contexts, it is not uncommon to be asked to serve in leadership roles such as behavioral health director. Many also secure advanced credentialing and/or certification in leadership and supervision, which further-establishes their integrity as advocates for (and others’ receptivity of) the content and practices that they espouse.

Clinical competencies related to ethics. Family therapists in healthcare settings must demonstrate adherence to ethical practice in all that they do. This is a complex undertaking, however, because it requires practicing with informed knowledge regarding one’s own and other providers’ overlapping and distinct disciplinary guidelines that regulate foci like scope of practice, confidentiality, and billing – alongside appropriate and purposeful problem-solving vis-à-vis commonplace ethical dilemmas. Combined with these baseline knowledge areas and skillsets, these therapists must function in a manner that is consistently receptive to (and seeking of) input and support from colleagues, supervisors, site administrators, and legal counsel.

Clinical competencies related to diversity. Family therapists in healthcare settings must show awareness of, curiosity about, and respect for different biopsychosocial/spiritual beliefs, practices, and traditions across the intersection of social locations (e.g., ability, age, sexual orientation, gender identity). Furthermore, family therapists must be informed of historical marginalization and be aware of how to honor preferred treatment options for diverse populations. These understandings enable unique and/or sacredly-held viewpoints and customs to be effectively carried out, accommodated, and/or integrated into care provision (inside- and outside- of the clinic/hospital). These therapists also regard “diversity” as encompassing attention to social locations, and they work to incorporate sensitivity to these foci across the purposeful design, implementation, and evaluation of treatment plans. They do this with explicit recognition of their own personal biases and beliefs, and openly seek support/training/supervision to process and/or improve their efforts as indicated.

Conclusion

Core clinical competencies for family therapists working in healthcare settings cut across systems-, biopsychosocial/spiritual-, collaboration-, leadership-, ethics-, and diversity- domains. Crossing primary (e.g., family medicine, pediatrics), secondary (e.g., OBGYN, emergency medicine), tertiary (e.g., hospice care, alcohol and drug treatment), and other care environments (e.g., employee assistance programs, military care systems), these skillsets are essential for the effective integration of family therapists into medically-oriented treatment and interdisciplinary care teams.

Note: As outlined in this blog’s introductory text, ensuing installments will highlight other core competencies for family therapists in healthcare settings. These will include attention toward training and supervision, healthcare management and policy, and scholarship.

References

American Association for Marriage and Family Therapy (2018). Competencies for family therapists working in healthcare care settings. Retrieved from www.aamft.org/healthcare

American Association for Marriage and Family Therapy (2015). Code of ethics. Retrieved from http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx

American Association for Marriage and Family Therapy (2004). Marriage and family therapy core competencies. 

 

Authors

Tai Mendenhall, Ph.D., LMFT

Angela Lamson, Ph.D., LMFT

Jennifer Hodgson, Ph.D., LMFT

Lisa Tyndall, Ph.D., LMFT

Jackie Williams-Reade, Ph.D., LMFT

Stephanie Trudeau, Ph.D.