The AAMFT Blog

Why So Many Changes?

Numerous times I have been asked, “Why is AAMFT making so many changes?”

When I became CEO, one of my first tasks was to assess the health of AAMFT with staff and consultants (financial, association management, and legal). While overall AAMFT’s health was very good, there were areas that suggested action was needed to assist in our continued long- term health. For example, our dues dependency was extremely high at 72%; the benchmark for associations similar in size to AAMFT was at the time 35%. Knowing that AAMFT was sitting on a very large retirement bubble, having such a high dues dependency was understandably alarming. Changes needed to be made to decrease dues dependency. Since these efforts were initiated, AAMFT has lowered our dues dependency to 57%; while we are still facing a retirement bubble burst, and I would like to see this dependency even lower, the progress is vital to our future stability.

Another necessary change to continue the positive health of AAMFT was creating mechanisms to access member expertise while also addressing the challenges identified in the preceding years related to our less than optimal geographic structure. Associations had already began making a gradual organizing structural shift from geography to content. To remain relevant, and give us the ability to access member expertise, AAMFT needed to embrace this trend towards a structure based on content – Interest Networks. For example, Integrated Health or Military Personnel and Families are areas that AAMFT needed content for advocacy work. Combining this need with the alarming rate at which the divisions were experiencing managerial challenges and volunteer burnout, precipitated the need for changes in our structure – a bylaws change. Already we have over 10,000 members participating in engagement programs including our nine new content driven networks to feature along with our geographic networks and Family TEAM.

Moving on to membership categories. AAMFT’s Clinical Fellow membership category is coupled to licensure which makes it very USA-centric, places a ceiling on the potential membership numbers, and acts as a barrier to those seeking membership outside of the USA. As our COAMFTE programs continue to graduate students that move out of the USA and often return to a country of origin, AAMFT had little ability to provide a membership path. Additionally, having five membership categories was complicated and appeared that AAMFT was trying to “keep others out” through this complexity. Simplifying our membership categories provides AAMFT opportunity to create a much more inclusive organization. Again however, these changes necessitate a Bylaws vote.

To try to identify how to stay relevant and current in today’s association landscape, and why so many of our changes necessitated taking action on changing Bylaws, we met with a number of association parliamentarians and consultants.  We learned that other associations were experiencing the same challenges. To address the challenges associations were working towards simplifying bylaws to make them more evergreen - providing their association with the ability to meet the rapidly changing business landscape. AAMFT had the choice of making a wholesale change to the bylaws (without context) with a single change or to proceed in a methodical manner that provided members the ability to walk in step with these important changes as they are being introduced and executed. We opted for the latter using these changes as an opportunity to have important conversations with members about the challenges our association was facing and utilizing task forces and steering committees of members to help generate solutions that kept our systemic perspective and profession first and foremost.

In short, for AAMFT’s long-term sustainability, and to be positioned for growth, AAMFT needs to make changes that capitalize on the changing association demographics, stakeholders, and needs. The roll-out of these changes has been thoughtful, purposeful, and done with a very close eye on unintended consequences as well as capitalizing on new opportunities. For these reasons, and more, the AAMFT Board is seeking member support for the proposed bylaws change. If you have not yet voted, please check your email (or spam email) for the link or visit our voting website here and express your leadership voice by voting in support of the bylaws.

Tracy Todd

CEO, AAMFT

The Big Tent is Still Big, Again

The President's Column below, written by AAMFT President Timothy Dwyer, is excerpted from the May/June 2019 issue of AAMFT's Family Therapy Magazine. Eligible members of AAMFT can cast their votes in the current election at this link through 5:00 p.m eastern on August 15, 2019. 

Someone asked me earlier this year, “What is the theme of your presidency going to be—or is it too early to know?” I appreciated the question, as I’d been thinking about that quite a lot. In a word, the theme for my term as president is
inclusivity. This theme does not begin on my watch, though I am happy and excited to advance it. This time last year, I had the privilege to serve as chair of the Diversity and Inclusivity Steering Committee. The charge of our committee was to operationally define diversity and inclusivity relative to AAMFT corporate expectations; identify existing barriers to meeting diversity and inclusion expectations in AAMFT governance units, and; to make specific board recommendations and steps to effectively eliminate barriers to diversity and inclusivity within AAMFT governance structures. The good work of that committee reflects a vital commitment to intentionally advance a more inclusive culture of belonging at all levels within AAMFT. The board and staff aim to create systems of inclusivity as both an ethical imperative and as association best practices.

I used to take a special pride in the very selective nature of AAMFT membership and her history. It felt inherently special to have graduated from a COAMFTE-accredited program and earned the keys to membership. I saw our association as the only one holding the banner and carrying the torch for systemic clinical practice. I was socialized to see marriage and family therapy as distinct and special, with a professional identity differentiated from other paths in the mental health field. Of course, I still see it that way, but through a more evolved and inclusive lens. Yes, I am proud to be a licensed marriage and family therapist. I value the special theoretical knowledge, clinical skill, supervised experience and training it took to achieve that title. I have always prized the rigorous path of my training, but I appreciate there are many ways in which to get there.

I became a Clinical Member (now Fellow) of AAMFT at the point of graduation from Purdue University’s doctoral program. It was a “one-two punch” as I was eligible for licensure at the same time. I worked my way up the ladder from student—skipping the Associate Member level—to Clinical Member. The first time I heard about clinical membership was long before we had licensure in very many of the states. It was a path of professional destiny for me. I was committed to the movement to advance recognition of the profession, lobbying for certification while in graduate school, and later to win licensure in my home state. I remember the caution members voiced about the grandfathering period for other licensed mental health providers (social work, counseling, psychology), and the concern about qualifications, standards, and the so-called dilution of the field if we let everyone in who wanted to become a licensed marriage and family therapist. We soon discovered however that the tent got bigger and more vibrant in the professional community, and those with systemic inclinations include more than MFTs.  

I must admit my necessary humbling along the way. Equifinality informs us that in open systems there are many ways to arrive at a desired state. While we have heroically championed, codified, and advanced the clinical standards for marriage and family therapy, we did not create the big idea of systemic family therapy. It took many thinkers, scholars, clinicians and the committed systemic practice of many leaders over decades to do that. I’m not sure how we can continue that growth and advance the field by holding parochially to a narrow gate for the top tier of membership.

Reading the Nichols (1992) history of our association, it is easy to see that from our inception, we were unapologetically exclusive and elitist. From the beginning, there were intense rigorous debates about who should be eligible to become members. There were a variety of litmus tests to make sure that qualified applicants were systemically and professionally worthy of membership.  Members needed to have the right subject base and theoretical pedigree. Applicants needed to provide clinical demonstration of their work, be recommended, submit to the standards of specified content areas, specific clinical experiences and supervision requirements, etc. And if this sounds familiar, well it’s because we still operate with many of these standards, which of course remain strongly held and highly prized.

The rich developmental history of our association illustrates that the innovators and leaders of our field emanated from disparate paths of training and inquiry, yet they banded together to form an organization that embodied that most fundamental of systemic truths. We are a more than a sum of our parts. Those historic tensions in our association relating to how distinct, exclusive, and special we are no doubt helped to launch us as a field and a profession. But as a professional organization with a mission to protect and advance the profession and practice of marriage and family therapy, those old tensions and barriers are impediments to meaning and relevance and more importantly carry historic inequities which need acknowledgement. Barriers to membership will not help us evolve and remain vital in the field. The current membership categories are confusing and exclusionary. Those hurdles to a sense of full belonging and access don’t serve an increasingly nimble, diverse, global, and inclusive association.  

From a position of equity, how might we lift the barriers to membership for highly qualified systemic professionals, and not exclude them simply because they arrived on a different track in their training? I’m certain we all know highly qualified clinicians who practice with stellar systemic ability but who hold a license other than MFT. Some members may hold tightly to the paradigm of our uniqueness and ask how can AAMFT become inclusive without abandoning her standards? I might reframe the question as, how do our current member categories hinder us from advancing those standards and competencies more broadly and inclusively to the wider field?

In the upcoming election cycle, there is a ballot proposal to modify the bylaws and simplify the membership categories. The current membership system with its six (6) distinct categories is not only confusing, but clearly privileges the license and the geographic boundaries of the U.S. This poses an exclusive and geocentric system for which the unintended consequence is it limits those highly qualified applicants who can be “full members.” While Groucho Marx might assert he would not join a club that would have him as a member, most of us would not join an association if we couldn’t enjoy the benefits of full and equal membership or could acknowledge that our organization endures such obvious exclusion in admission. Our current membership system poses distinct barriers to those from other clinical training programs, other geographic areas, and prohibits them from striving for our most prized designation: Approved Supervisor. The new bylaws propose two (2) categories: Professional and Student. It also offers equitable and reachable aspirational goals for those who wish to develop and advance their unique systemic family therapy skills: Approved Supervisor (AS) and a new Clinical Fellow (CF) designation.

The key difference in the newly conceived designations is that any AAMFT member can pursue attainment—regardless of degree—as neither the AS nor CF designation will be tethered to license title. The effect of this bylaw change is greater equity and inclusion in AAMFT. It will level the member playing field. Some may argue that it jeopardizes the license and accredited programs. However, it still affords those electing to train in premiere COAMFTE-accredited programs and pursue the license as a marriage and family therapist a clear, bright path to those highly respected and meaningful designations.

I wanted to title this column “The big tent is still big, again.” For me, that first part acknowledges our historic roots, while signaling an emerging and renewed openness. We can certainly argue how big that tent was back in the days before licensing and regulation. But the origins of our association drew together a wide variety of systemically-minded individuals who helped champion a relational paradigm for understanding couple and family development and health, and new ways to understand and address the problems of living. That big tent attracted individuals from a broad spectrum of clinical training origins—medicine, social work, nursing, psychology, ministry or pastoral care, and others from diverse areas of study who steered their epistemological leanings to emerging systemic clinical lenses. In the early days, our membership was small but ever growing—expanding from 700 to 7,000 members between 1969-1979, and then doubling from 9,000 in 1982 to 18,000 by 1992 (Nichols, 1992). Today, our membership hovers around 25,000, but has not changed substantially in the past two decades. The structural impediments of our current member categories impose severe limits on further penetration. The imminent retirement bubble guarantees significant member loss in the very near future. While I could strenuously stake my position for change on the case of equity and inclusion, there are other compelling trends that argue in favor of your support of the bylaws vote, as well.

Please join me and the Board of Directors in our unanimous support of the bylaws revision for a more vital, vibrant and inclusive AAMFT. Thank you.

Timothy F. Dwyer, PhD

 

Reference

Nichols, W. C. (1992). The AAMFT: Fifty years of marriage and family therapy. Alexandria, VA: AAMFT.

 

Family TEAM Leader Attends Bipartisan Policy Center Rural Health Task Force Event

While in D.C. to advocate for MFTs in Medicare, Hollyn Smith (Family TEAM Leader-Kansas), had the opportunity to attend a policy event by the Bipartisan Policy Center on rural health. Typically, these events are attended by other policy think-tanks, congressional staffers, and other corporations with invested interest. In this post, Hollyn offers her unique perspective of attending the event as a grassroots advocate.

As I scanned the room, I saw badges from various political organizations from around the District being worn by individuals who were most likely assigned to cover this event by an executive with spiked curiosity. There was a wide variety in demographics of attendees ranging in, but not limited to, age, gender, race, political views, and healthcare profession. It is out of character for me to feel out of place in a room full of strangers, and in this very moment there was something different in the air. Everyone there, including myself, had an agenda to push; a need for their healthcare profession of choice to be heard. I could not quite put my finger on what it was that had me feeling “off.”

The former Congressmembers who were launching the Rural Health Task Force, through the Bipartisan Policy Center, began sharing their policy initiatives with the crowd; using healthcare statistics that I am sure struck a cord with more attendees than me. “40% higher suicide rates in rural America, and often times no emergency room or mental health professionals,” one panel member stated. I am originally from the middle of Kansas, and much of my family still resides in rural parts of the state. I understand the challenge of a town no longer feeling like a town as schools, grocery stores, medical centers, etc., begin to shut down or move to the next town over. As financial challenges increase for the providers of services, particularly in the health profession, a community becomes unsustainable, thus creating a decrease in the economic stability of the community. It is my shared opinion with this task force, that we in the mental health profession need to be looking for long term health solutions for constituents and providers. I went into the helping profession to assist in the growth of safety and strength within a community, in hopes that individuals would not have to go far looking for their needs to be met. I continue to have that mission, and recognize that something must change as business owners in my profession find themselves constrained by the financial challenges we face in rural and urban America.

A solution that was discussed is one that is a hot topic in the mental health profession right now: telehealth. It was suggested that access to telehealth would potentially help decrease the high burn out rate of clinicians and encourage younger clinicians to practice in rural areas, and I do not disagree. I would love to give back to my rural hometown communities, and with the privileges and opportunities that my current urban community provides me, I am choosing not to. A choice that increasingly weighs heavy on me. From family experience, they have had to be on waiting lists for months due to only one clinician in town, if any at all. When there hasn’t been a specialist in town, my family has had to drive hours for the services needed. I believe that increasing telehealth capabilities for all mental health professionals will not only grow the health profession in rural Kansas, but urban areas as well, as connecting providers and clients via the web will decrease the mental health shortage across the board and limited access in rural America.

During this event, mental health issues presenting as, or leading to, other health issues was discussed. We as MFTs know that there is a reason why we got to where we are mentally and physically, and by thinking holistically past the presenting problem, we are able to consider what else could be our clients’ health issue aside from the symptoms we see in front of us. Through the idea of integrative care with all health care providers, a model is created where working together creates overall healthier people which leads to more prosperous communities. Our rural communities need medical and mental healthcare professionals to broaden our lens that we view the needs of our clients through. In order for professions to stay alive, we as providers need to continue to be innovative with how we deliver our services to those in need, be flexible with the needs of the community we serve in, and continue to update the education we give the next generation of providers.

There it was- I felt a call to be at this task force event as a panel member stated, “Change won’t happen without grassroots efforts. We need people at the local level with a mission to improve their community.” That is me; I am the grassroots mission! Not that the initiatives that anyone there had were any less important than those of the MFT profession, it was the fact that our profession is unique in that we are still, in so much of the United States, in the grassroots phase of growth. We, as a profession, work hard every day to be recognized as legitimately qualified and equally educated mental health professional. To be no longer questioned of our abilities, and instead be turned to for expertise across any mental health initiative. The majority of us joined this helping profession with the intention to assist communities in becoming healthier, to be survivors, to thrive from the increase in mental health access; and so I raised my hand to ask the panel of former congress members a question. “Can your Task Force consider having a focus on the advancement of the Marriage and Family Therapy Profession? Can you help us receive equal rights and opportunities as all other mental health professionals at the same level of licensure?” This opportunity was one I will never forget, and further empowered me to continue fighting for what I believe in through my grassroots efforts within AAMFT’s Family TEAM.

Digital Intimacy: Attachment and Sexuality in the Technological Age

 

Join the Queer and Trans Advocacy Network for a webinar

July 19, 2019 from 3:00 PM to 4:30 PM (ET) 

Register here

In this webinar digital intimate connections between people and their technologies are explored. This presentation opens with a brief overview of intimacy, followed by a description of the predominant waves of the modern technological age. The presenter then discusses two types of intimacy—attachment and sexuality—in a digital context, which includes digital attachment (digiattachment) and digital sexuality (digisexuality). The presentation concludes with a brief overview of how to begin to attend to digital intimacy in clinical practice, including digiidentity development, digistigma, digiphobia, and erotocentrism.

Presenter: Markie Louise Christianson (L. C.) Twist, Ph.D., a licensed marriage and family therapist and mental health counselor, as well as a Clinical Fellow and Approved Supervisor of the American Association for Marriage and Family Therapy, and certified sexuality educator and sexuality educated supervisor through the American Association for Sexuality Educators, Counselors, and Therapists. Dr. Twist is the Program Coordinator of the Graduate Certificate in Sex Therapy Program, and Professor in the Human Development and Family Studies Department and Marriage and Family Therapy Program at the University of Wisconsin-Stout. Dr. Twist is co-author of the book, The Internet Family: Technology in Couple and Family Relationships, and co-editor of the book, Eco-Informed Practice: Family Therapy in an Age of Ecological Peril. Dr. Twist also serves as Editor-in-Chief of the Journal of Sexual and Relationship Therapy. To learn more visit: drmarkie.com.

Reflections from a Veteran and MFT

by John Stinebaugh, Chair of the Working with Military Personnel and their Families Topical Interest Network. 

This past Memorial Day, I heard several times how much everyone is looking forward to the long weekend. Camping, family time, and of course barbecuing are the plans for the unofficial start of summertime here in the United States. It is of course coupled with a holiday of remembrance for those who have died in the course of service to others.

As a veteran, the Memorial Day holiday has always been tricky. While it is nice to have those who are well-intentioned thank me for my service, it is a personal reminder that those who I have called brothers and sisters in arms have died and continue to die. I can honestly say that one of the more sobering moments of my life is when the first report of Marines killed in action contained the names of those who had begun their service around the same time as me.

As systemically minded therapists, military culture is one that our mindset uniquely prepares us for. Here is a culture that is voluntarily joined, and deliberately creates new systems and structures around a person. Transitioning out of this system and dealing with the myriad of stresses associated with it can be a real challenge. Those on active duty and veterans alike die by suicide at alarming rates.

This problem has become so difficult that the Commandant of the Marine Corps released a two-page letter on mental wellness to try to stem this tide of loss. Most significantly, he encourages service members to reach out and ask for help. It is after all how we approach other problems in the military, so why not this one?

While I could talk at length about this, and I do hope more conversations follow, I would like to leave you with the following thoughts.

1. If you are active duty or a veteran, please ask for help. There are so many of us who will do whatever we can to help in whatever way we can. There are so many more options than you know and we are striving to create more.
2. On the same token, if you know a veteran or an active duty service member, ask them if they are ok and then listen to what they have to say. We know this is important in our work and as a group we tend not to ask for the help but will answer someone if asked.
3. Consider joining or supporting our Topical Interest Network for Working with Military Personnel and their Families. Our plans for the next two years include competencies for working with this population, webinars on emerging topics like games and their impact on mental wellness, and emerging trends in suicide. We also provide an online forum that includes many veterans or family members of active duty military, all marriage and family therapists. Adding your voice, expertise, and willingness to help will make us a stronger team.

 

John Stinebaugh is a licensed marriage and family therapist in Colorado and Wyoming and has been in community mental health for over 12 years. He has worked extensively with youth and families in his clinical work, and has developed numerous programs including dealing with first episode psychosis, at risk youth and families, telehealth services and supervision in his time as an administrator. He is a recipient of the AAMFT certificate in leadership from its inaugural cohort. John enjoys disc golf, geocaching, reading, anything Star Wars, and spending time with his wife and two cats.