The AAMFT Blog

Different Stories, One Song!

By: Dr. Michelle Karume, DMFT 

Just like biases we often don’t think we have them until we sometimes find ourselves working with clients from various walks of life and recognizing we have some adverse thoughts or attitudes about them, their practices, their culture, their beliefs etc. it happens to be best of us. In the same vein racial discrimination (RD) does not discriminate; sounds like a double negative but it’s not. The truth of the matter is, the field of MFT is not immune to racial discrimination. One could argue, how can that be, when we are arguably the most competent when it comes to working within a systemic framework? Afterall, we are able to hold spaces for people who are different from us and serve as catalysts for change within their relational issues.  That’s a fair question! We can each point a finger on who should do what better, but the blatant truth is, we each have a critical role to play. One that perhaps will call on us to be vulnerable and transparent for the greater good. I figure if we don’t, then who will.  

     Before going into how we, in the field of MFT can start to have these conversations on racial discrimination, let’s take a brief look at the effects it has on individuals as well as families. Studies have shown that (RD) has adverse effects on individuals and family’s mental health, physical health; if we Use the biopsychosocial-spiritual framework we can see that racial discrimination has its tenets in these various areas. In their study Chen & Mallory (2021) found that individuals who had experienced RD were at higher risk for physical diseases as well as mental health diseases such as depression and anxiety and also substance use disorder. Similarly, a study by Lavner et al., (2023) reported significant correlations between depression in adolescents who have experienced racial discrimination. However; though these negative experiences are still present today, the complexity of racial discrimination also begs to highlight that even though there is still some work to be done; there however has been progress.  

     I’ve heard it said that charity begins at home. If we use the same thought process, we can see the importance of protecting our field from the fault lines that RD can cause. The detriment of these cracks in the field cannot be taken lightly for the negative impact is too costly. Perhaps the first step to this change is a paradigm shift from how we view changing the climate of RD. Due to its historical traumatic experiences and effects, I can see why aims at making changes on the same have also had some aggression towards them. But if we, in the field of MFT saw this as,  

“as advancing the understanding of a psychological phenomenon rather than as something more threatening, such as “pushing an agenda” (Roberson, 2023., p.181) maybe we would approach it less armed or guarded and more open to the need for this change. Once we have this paradigm shift I think we can then be more open to creating safe spaces just like we do for our clients. When the space is safe, people are more amenable to trust us with their stories-it would not be any different for us the clinicians. As an African myself, one of our traditional ways of healing societal challenges was through stories and folk songs. Whereas I am not asking us to sing; although that would be pretty amazing, the power of storytelling is one we can all relate to. Here as a chance for us to re-write this story on racial discrimination in the field of MFT. How do we tell our stories? Perhaps through our written works, through our platforms such as teaching, or during our conferences or simply by sharing it with other MFTs in the field.  These stories would specifically focus on what led us to the beliefs we hold regarding racial discrimination, what were our experiences? Similarly, when we do genograms with our clients the historical view allows the client to see what was but more so it gives them the opportunity to see how to effect change and not repeat the same.  Another suggestion could be having a sense of pride-through their program in working with families to disrupt the negative consequences of racial discrimination, Berkel, C.,. et al. (2024) found a key component in “overcoming discrimination” was this element of ‘Black pride’. It was what parents also used to give their children a sense of belonging and pride in who they were. Could we in the field of MFT embody a similar key factor that bonds us together? I want to believe we are proud to be MFTs but something that unifies us deeper on this very issue so much so that it could start the elimination process of this issue? Something that we would be proud to say that the field of MFT prides itself in implementing this change. I hope we can. 

     Finally, MFT programs-curriculum in the MFT programs could include a course or material on racial discrimination and tribalism specifically, there effects and most importantly how to disrupt them. I think part of the problem is that we are not taught how to best manage and or talk about it. If this is made a requirement then from the collegial level, we learn how to implement the relevant techniques.  I truly believe that we are a more similar than we are different-if so; then let’s make our field an example of this. 

 

 

 

References 

Berkel, C., Murry, V.M., Thomas, N.A. et al. The Strong African American Families Program: Disrupting the Negative Consequences of Racial Discrimination Through Culturally Tailored, Family-Based Prevention. Prev Sci 25, 44–55 (2024). https://doi.org/10.1007/s11121-022-01432-x 

 

Chen S, Mallory AB (2021). The effect of racial discrimination on mental and physical health: A propensity score weighting approach. Soc Sci Med. 2021 Sep;285:114308. doi: 10.1016/j.socscimed.2021.114308. Epub 2021 Aug 8. PMID: 34399293; PMCID: PMC8451383. 

 

Lavner, J. A., Ong, M. L., Carter, S. E., Hart, A. R., & Beach, S. R. H. (2023). Racial discrimination predicts depressive symptoms throughout adolescence among Black youth. Developmental Psychology, 59(1), 7–14. https://doi.org/10.1037/dev0001456 

 

Roberson, Q. (2023). Understanding racism in the workplace. Journal of Applied Psychology, 108(2), 179–182. https://doi.org/10.1037/apl0001079 

AAMFT Statement: Regarding Change Healthcare Cyberattack

 

Last month, Change Healthcare was the target of a major cyberattack that has impacted many marriage and family therapists (MFTs) and other healthcare providers. Owned by UnitedHealth Group (UHG), Change Healthcare processes up to 15 billion healthcare transactions annually. Due to this cyberattack, MFTs, other individual healthcare providers, hospitals, and clinics are not receiving payments for services recently provided to clients. This disruption significantly impacts the finances of MFTs and other providers, especially smaller providers. 

AAMFT recognizes the impact of this cyberattack on MFTs who process payments through Change Healthcare and has reached out to share these concerns with Change and UHG. Change Healthcare shared that they will not resume electronic payments until March 15 at the earliest. 

AAMFT fully supports the statement by the U.S. Department of Health and Human Services encouraging insurers to make interim payments to impacted providers. We applaud the Centers for Medicare & Medicaid Services for making accelerated payments available to Medicare Part B providers. We urge other payers to make advanced payments to MFTs impacted by this cyberattack.

Providers can learn more here: https://www.hhs.gov/about/news/2024/03/10/letter-to-health-care-leaders-on-cyberattack-on-change-healthcare.html

https://www.unitedhealthgroup.com/changehealthcarecyberresponse

Medicare Providers can learn more here: https://www.cms.gov/newsroom/fact-sheets/change-healthcare/optum-payment-disruption-chopd-accelerated-payments-part-providers-and-advance

Why You Don't Want to Be a Therapist Anymore

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy. 

I stared at a stack of yellow files, all waiting for my review to be sent to Medicare for payment. Piles of notes and treatment plans made my soul sink. I didn’t go to school for this, pushing paper and unrealistic expectations and quotas on other therapists. I was worn out, irritable, tired and no longer finding joy in the work that I once had loved so much.

That’s when the thought hit me, “I don’t want to be a therapist.”

But I had invested so much time and energy to get here. Even after looking into other grad programs for a medical career, I decided to try shifting how I was doing the work and began a business on my own. 

Private practice was my last-ditch effort to fall back in love with my career.

Maybe you’ve felt it before, that inkling that something isn’t right or is creating a level of discomfort that you aren’t sure how much longer you can tolerate. Truth is, we have more people leaving our field than entering it. But why? Why do we really not want to be therapists anymore and is there anything we can do to change the course?

Reason #1 You Don’t Want to be a therapist: The mental health system is set up for burnout.

For all of us in this mental health field, we were born out of systems that do not serve us. Working for unpaid internships and practicums, and acquiring high student loan debt. All while the powers at be KNOW we are in fact some of the worst paid masters degrees. We come out of graduate school already set up for stress and overwhelm.

Add to that the weight of people’s lives that we serve, being told we are responsible for the outcomes when the resources of the system are so limited. The system is the cause of a lot of their mental distress, much of which we can’t do anything about.

When we wrote the book on Therapist Burnout, we realized that many people thought burnout came from just feeling stressed about work. Burnout in the mental health system is almost always  seen as a personal weakness, instead of a normal response to a broken system. In order to heal burnout one of two things needs to happen. One,  the system has to change or, two, we have to change how we interact with the system.

For example, I left my government job because it was causing burnout. I created a practice from there that supported my needs as well as for my clients. Changing the setting made all the difference in me continuing on my path as a therapist. Suddenly I truly loved being a therapist again, and I felt inspired to help other therapists find their love again too. It was like a switch flipped.

I know private practice isn’t the path for everyone, and that is ok. For those who don’t want to take the entrepreneurial route, can you change the system from within? it’s going to take push back, setting new boundaries and speaking up all in the name of self care to heal the burnout. The truth is, your labor is incredibly valuable! We are taught often that we are expendable, but truly our work is invaluable.

Reason #2 You Don’t Want to be a therapist: Private practice is failing you.

But what if you are already in private practice and you don’t want to be a therapist anymore? Private practice is the dream for a lot of therapists. It signifies independence and freedom. Often that freedom is sucked away by fears around marketing, low paying insurance companies with horrendous clawbacks, tech companies that take advantage of therapists and their clients and overwhelm with learning how to be a business owner. It is a lot and nobody learns these skills in grad school.

Many therapists go into their private practice with the same mindset they had in their agency work and replicate processes and ways of doing/being that often continue the harm they were trying to leave, such as unrealistic sliding scale fees, overworking, documentation that is over and above what is needed, and accepting any potential client who calls. Any chance to deviate from those norms has often led to being shamed by peers who tell them that what they are doing can’t be done or is unethical, such as charging a rate for therapy that allows them to live beyond the poverty line.

Side note: The sliding scale fee structures that we bring from non-profit organizations are often based on millions of dollars worth of grants that allow for pro bono or sliding scale spots. Those sliding scales aren’t appropriate, or sustainable for most for profit models without extensive grants. In fact, mental health attorneys advise AGAINST sliding scales in private practice for legal and ethical reasons. You can learn more about the law, ethics, and legal advice in free How to set fees training.

Before you end your career as a therapist, first look at what you created with this private practice and ask yourself:

• Is this really working for me? It is so easy as therapists to stay checked out focusing on everyone else. What is your body, mind, heart, and spirit saying about your life right now? Is work and personal life in balance and truly aligning with your values?
• Am I making a livable private practice salary? You may need to relook at your financial plan to ensure you have a fee that is viable for your needs to live in your community with balance and health.
• Am I doing things that don’t make sense and drain me? Whether it be your documentation processes or billing, look at how you have been running your process and see what you can streamline, eliminate or delegate.
• Do I have support in private practice? Private practice can be isolating. We have seen many therapists go back to employment simply because they felt so alone in private practice. You want community in your personal life and in your business. For your private practice, that might mean getting involved in a local AAMFT chapter, inviting colleagues out to get together, signing up for group case consultation and more. You may need some direct guidance and support from an expert, whether that is clinical or in the realm of running a business. You don’t have to do everything on your own.

Once you look at these questions you can either choose to make adjustments or you may decide that private practice isn’t for you. That is all ok. The goal is to create a way of working that really lights you up, not sucks you dry. Private practice may not be for you or your private practice may simply need some adjustments.

Reason #3 You Don’t Want to be a therapist: Obligation is dictating the focus.

The style of working or the way you offer your services might be coming from a place of obligation and not conscious creation. You do what you have been taught to do or feel you must do. You know when you were taught that a 45-50 minute session is the standard of care. Sure, for billing insurance companies it is, but that doesn’t mean that is proven to be what is needed for great clinical outcomes with the clients you like to work with and how you like to work.

Many therapists who don’t want to do this work anymore are really no longer wanting to do the work in a way that doesn’t fit them. Yet, we are raised to fear losing our license so heavily that we become paralyzed with our innovation and creativity.

We have helped many therapists engineer clinically outcome focused services that break the mold of traditional therapy. From walk and talk therapy, intensives, retreats, longer sessions, shorter sessions, it’s all a perfect opportunity to really evaluate if the service you are providing is one that you believe in and do good work in.

Reason #4 You Don’t Want to be a therapist: Clients are draining.

Another reason you may want to quit being a therapist is because of who you are doing therapy with. This is not to blame or shame the client. This is to simply explore that you may have said ‘Yes” to working with people who are not a good fit. Or, something for you has shifted and who you once loved to work with, is no longer the case.

How does this happen? There is often an unspoken code that if you are a helper and a healer, you do not discriminate or turn people away from healing. That would be cruel! You can’t be a good therapist unless you are truly willing to help anyone that comes through your door.

It could be argued that it is quite the opposite, the more clarity you have leads to better clinical outcomes and is better for the clients for you to refer out than to work with them from a half hearted or burned out place. People get better clinical outcomes when they have a focus, speciality or passion behind who they are serving.

Take Sam for example. They loved doing couples work but after their own recent divorce, they find working with couples to be absolutely challenging. We would never suggest that Sam just suck it up and work through it. Instead, we recommend Sam to honor the challenges and changes in their own life and to see where else there might be passion for them to see clients - such as with individuals. Ask yourself if the clients you are working with are ideal for you and make a commitment to only working with those who you feel drawn to support out of ease and confidence, not fear or scarcity.

Reason #5 You Don’t Want to be a therapist: Avoiding the feeling and projecting the solution.

You might be blaming the work of therapy for dissatisfaction in your life that is sourced from elsewhere. Instead of giving ourselves space to feel our feelings and understand the sadness, yuck and muck we can tend to look at our work as what is wrong and what needs to be fixed.

“I went to work today and I just didn’t want to hear another person talk about their pain.”

You can’t address an internal issue from the outside. It has to come from within.

Sure, this could be because you don’t want to do therapy, or it could be that you aren’t well resourced in your own life due to stress and other circumstances. But then it can quickly turn into “the solution could be a career change”.

I can’t count how many times people have come to me wanting to quit, and then with time and feeling they realize what is really going on are things in their personal life - all very valid and real stressors.

Before you jump ship, look at your life and what it is asking of you. Does it need more time and attention, compassion and love so you can then make a decision about your work from a place of grounded confidence and not exhaustion from your daily struggles?

Please don’t go.

Or at least, before you do consider whether your environment or system needs a shift. If you still feel a change is necessary, know that the lessons learned will enrich your next journey. Creating a fulfilling career is about discovering or even inventing paths that bring joy to your life.

Need assistance? Our Business School for Therapists, operational since 2010, has aided thousands of therapists in finding their passion and navigating the financial aspects of their practice. We're here to support you in this journey.