The AAMFT Blog

Overcoming Your People-Pleaser Part: An MFT Perspective

 

By: Vanessa Bradden

 

As a therapist, I often discuss the complex issue of people-pleasing behavior with clients and colleagues. While others may initially see it as a positive trait—after all, who would dislike you for agreeing with them? —it comes at a significant personal cost. People-pleasers often mask their needs in their quest to be liked by others, a struggle that can be deeply challenging.  

 

People-pleasing is a learned behavior originating from childhood experiences and social conditioning. For example, children who receive praise and positive reinforcement for being helpful and obedient may learn that pleasing others is desirable behavior. In the right circumstances, going along with something is good; it is valid and leads to simplicity. However, it has poor outcomes for everyone when it becomes a chronic behavior.  

 

When we constantly go along to get along or say “yes” to keep the peace, we inadvertently dismiss an essential part of ourselves, resulting in what is known as an 'arrested development.’ When a young part of self cannot develop the skills to set healthy relationship boundaries, we carry it into adulthood. It can impair one's ability to navigate simple conversations for fear of being disliked and ultimately lead to lost opportunities and unrealized potential.  

 

Our people-pleaser part is a young self that internalizes the positive feeling of being praised by others. And when positive feelings are present, they make less desirable ones hard to tolerate. And if no one teaches us how to say "no" and still feel loved and cared for, we will take the path of least resistance every time. Think about the "carrot and stick" metaphor. When it comes to people-pleasing behaviors, the carrot represents an avoidance of anxiety at all costs because the stick is anxiety on steroids.  

 

People-pleasing behavior can also be a symptom of internalized trauma, a coping mechanism that forms in childhood. For example, when parents cannot manage relational tension or conflict, a child often acts as the mediator or soothing mechanism. This child, in turn, becomes wired to prioritize peacekeeping, as it provides temporary relief from tension and discomfort. The initial rewards of this behavior seem promising. However, they can lead to long-term consequences that are not immediately apparent, potentially significantly impairing our relationships and sense of self.  

 

With a unique perspective, systemic therapists, like marriage and family therapists, illuminate the issue of people-pleasing behavior through a holistic lens. They view it as part of a larger, more intricate picture that often remains unseen until it affects essential relationships in a client's personal or professional life. By looking at how the behavior came to dominate, we can help our clients develop skills that better protect them from the slippery slope of going along with things to make others happy and avoid discomfort by saying “no.”  

 

When a young part of self cannot develop the skills needed to set healthy boundaries in relationships, it continues to operate this way into adulthood. The lack of healthy boundary development can impair one's ability to navigate simple conversations for fear of being disliked, leading to lost opportunities and unrealized potential.  

 

Saying "yes" to something when you want to say "no" or being agreeable with opinions that make you bristle is a disservice to yourself and puts you at risk of burnout, anxiety, and depression. The people-pleasing part is not protecting us from the discomfort of anxiety; it just kicks the can down the road by allowing us to stockpile our unspoken "nos" until we either implode, causing self-destruction, or explode and project our stored resentments onto the wrong people.  

 

To overcome your people-pleaser, you must understand the narrative that created this part of you while remembering it is just one part, a young part prevented from getting the traction needed to set boundaries. Still, you can learn new skills by working with a marriage and family therapist. Here are some tips to consider when the inner people-pleaser takes over.  

 

1. Learning to Let People Down and Be Okay with the Outcome 

Imagine this: your friend asks you to help move this weekend. You've already planned a self-care day. Your inner people-pleaser wants to cancel on yourself for fear of letting your friend down. Instead, offer an alternative solution that does not involve canceling your self-care day. For example, you can say: "I've got plans this weekend, but here's the number of a great moving company." You've said “no,” offered a solution, and kept your self-care intact. It is okay to say “no” to protect your self-care needs. Other people’s expectations belong to them. We are not required to fulfill them. Remember what Murray Bowen taught us about differentiation. “We are responsible “to” others, not “for” them.”  

1. Learn to Say “No”  

"No" can be gentle yet firm, and for people-pleasers, it comes with anxiety and guilt. However, you can harness this skill by reminding yourself that saying “no" is setting a limit intended to protect you from over-extending yourself for the sake of others. For instance, when your boss asks you to work late for the umpteenth time this month, instead of the knee-jerk "yes," try, "I understand the urgency, but I've committed to work-life balance. Can we find a solution that respects our time outside work?" This approach respects both parties and sets a precedent for future interactions.  

1. Boundary Setting in Action 

Boundaries are like your personal force field. Their purpose is to protect your emotional energy. However, they are invisible and can be hard to implement for those who find it hard to say “no” to others. Here is what it looks like in action. Let's say a relative has a habit of calling late at night to vent. You value your sleep, so you say, "I care about you and want to support you, but I can't take calls after 9 PM. Let's find a time earlier in the day to connect." This way, you're not just setting a boundary but also offering an alternative that respects your well-being.  

1. Communicated Your Needs Clearly  

The silent treatment never works. In fact, it breeds negativity that leads to contempt and resentment. Being clear and specific with others about your needs will help you avoid these adverse outcomes. For example, if you're always picking up extra shifts at work, and it's burning you out, sit down with your manager. Use "I" statements to communicate your need from a place of non-defensiveness. You can say, "I've noticed I'm often the go-to for extra shifts, which I'm happy to help occasionally. However, I need this to be more balanced with the team for my well-being." This conversation opens the door to change and shows you're proactive about finding solutions. 

1. Practice Self-Care  

Self-care is also setting boundaries with yourself. Say you're a chronic over-committer. The next time you're about to say "yes" to yet another commitment, pause. Ask yourself, "Is this something I genuinely want to do, or am I afraid of disappointing someone?" If it is the latter, it's time to practice self-care by declining. Leading with “no” will help you save your “yes” for something that meets your needs rather than the needs of others, which is a new skill for people-pleasers.   

1. Celebrating the "No" 

When you notice yourself saying "no" to something that you would typically say “yes” to, do something to celebrate – it can be as simple as treating yourself to a coffee or taking yourself out for lunch. These celebrations reinforce positive behavior, making it easier to say "no" in the future. 

 

Remember, you're not responsible for how others react to your newfound "no." If someone is upset because you're taking care of yourself, that belongs to them, not you. Your responsibility is to your well-being. Lasting change takes time, and talking to a marriage and family therapist can help you further clarify and define the changes you want to make to heal and overcome the people-pleaser part that keeps you from setting healthy limits with yourself and others. 

Multiple Streams of Income or Multiple Streams of Distraction?

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. 

It seems like every other podcast and training for therapists is focused on multiple streams of income. Write a book, start a podcast, launch a course, start doing retreats, what about integrating plant medicine? 

The truth is, you DO have a lot of options as a Marriage and Family Therapist! But the grass is NOT always greener. Today we want to dive into how multiple streams of income can lead to more distraction, less profits, and more burnout so you can get clear about whether multiple streams of income really the right next step for you in your career is.

A Shaky Foundation

Many therapists get little to no training on how to run a business. In fact, many only have to take statistics in grad school- which is NOT helpful in developing a business plan! In fact, for many of us basic financial math was not taught or shared with us.

Colleges and universities would be doing themselves a disservice if they taught us financial math in many cases. Why? Because master’s degrees related to counseling and therapy continue to be among the top worst-paid master’s degrees. Showing a student the numbers in terms of income while they are investing sometimes over $100,000 in getting a degree is just bad math!

As we start to move into seeing clients during practicums and internships, we are often unpaid or severely underpaid. I was lucky enough in California as an MFT Trainee to have a job paying $15/hr where I could also gather hours. People were jealous of my income. And yes, I had to take a pay cut to do this work because I had been supporting myself working in corporate America previously.

Getting paid ANYTHING feels like a luxury. Most people around us aren’t getting paid much. So, being overworked and underpaid feels normal. It is normal… in this profession. We often replicate this when we start our private practices. Of course, we end up with practices that leave us living paycheck to paycheck, client to client, or without any retirement. You are NOT alone if you need more income as a therapist. You didn’t do anything wrong if you replicated and emulated what you learned and saw and are realizing it doesn’t work for you.

So, isn’t another stream of income, passive income, or a side hustle the obvious solution to this problem? In our experience, having coached therapists for almost two decades, in 90% of cases, it is a distraction from the real issue, and it will actually exacerbate the lack of income and overworking versus solve the problem.

Why are multiple streams of income a distraction for most MFTs?

The truth is, you likely don’t have additional time or energy as it is. You’ve been overworked and underpaid for so long. There are so many hours in the day. Many MFTs today are literally living and working with poverty wages, even with a master’s degree (or higher) and a professional license and it is NOT ok. The first step is not to create another stream of income and replicate being underpaid in a new way.

The first step is to get to the bottom of why your current business or full-time income is not fully supporting you. You should be able to live comfortably, have a savings account, go on vacations, pay down debt, and yes even do a bit towards retirement with one stream of income. If you living paycheck to paycheck, on income repayment for your student loans, etc. something is out of alignment. So, let’s start there.

Are you charging a fee that is truly sustainable?

We know you want therapy to be accessible to as many people as possible. But, if you are struggling to pay your bills, or even losing your love for the work because of the financial struggles that is not going to make therapy more accessible. In fact, more people are leaving the mental health field than entering it right now. We need as many MFTs to stay in this work as possible to make it accessible. So, can we get honest about what it takes to do this work? Here is a link to our free how to set fees training for therapists where we will dig into ethics and give you a clear formula for setting a sustainable fee.

Are you accepting sustainable reimbursements from insurance companies?

Why are therapists in Conway, AR getting reimbursed 40% more for the same CPT code as a therapist living in Los Angeles, CA? We can tell you it is not related to the cost of living. The truth is, insurance companies decide their reasonable and customary rate based on what therapists will agree to and based on making profits. In fact, according to Becker’s Payer Issues the top 5 insurance companies had profits of more than 40 billion dollars after paying their providers. Have you gotten clear on what your average fee or reimbursement rate needs to be in order to sustain. The truth is, the insurance companies are required to have available providers. They are not required to pay well. But, of course, in places where there are fewer therapists willing to say yes to low reimbursement rates, the rates will shift.

Are You Undervaluing Your Labor?

 Over the last several years we have seen online mental health tech companies come in and disrupt the mental health space in some good and bad ways. They helped normalize therapy. They helped normalize online therapy. But, in many cases they normalized very low contract rates for independent contractors, as well as putting advertising over quality of care. If you feel angry at what online mental health tech companies are doing there is only one solution. Do not give them your labor. Without access to boundless, cheap labor these companies cannot continue to underpay therapists.

While we believe multiple streams of income can be great- it is SO important that you focus on having one solid, sustainable source of income first. Often even additional sources of income come out of a balanced life and some stability. Otherwise, we will just keep replicating the therapist’s way of being overworked and underpaid.

As a member of AAMFT, you get special discounts for Business building help from zynnyme. You can learn more about how we help and your discount here.

AAMFT Celebrates World Health Day

 

By Mary Hotvedt, PhD

World Health Day is celebrated on April 7 annually each year and draws attention to a specific health topic of concern to people all over the world. The date of April 7 marks the anniversary of the founding of WHO in 1948.

For marriage and family therapists, nothing could be more central to our core than focusing on systemic mental health—in the US and abroad. With this in mind, AAMFT is pleased to announce that we will be publishing in the May/June issue of Family Therapy Magazine, The Assisi Manifesto, a document originating from a 2023 conference held in Assisi, Italy, where over 1,000 psychotherapists from various countries convened to discuss family therapy and its role in contemporary society. The manifesto, by Maurizio Andolfi, outlines key points regarding the importance of family therapy amidst new challenges facing mental health treatment globally.

The manifesto emphasizes:

• Listening to Youth Voices: It highlights the rise in adolescent mental health issues exacerbated by societal factors such as family disintegration and social media. The manifesto stresses the need to listen to the voices of young people and incorporate their perspectives into therapy without resorting to prejudiced labeling.
• Addressing Couple Crises and Divorce: Couple crises are recognized as not just private issues, but as affecting the broader family system, including children and extended family. The manifesto advocates for a multigenerational approach to healing and resilience within families experiencing such crises.
• Navigating Loss, Trauma, and Resilience: The manifesto acknowledges the inevitability of loss and suffering and calls for a culturally sensitive approach to mourning. Family therapists are encouraged to facilitate processes that strengthen families coping with trauma and loss, including those stemming from global crises such as wars and forced migrations.
• Confronting Social and Cultural Discrimination: The manifesto addresses social injustices such as discrimination, economic disparities, and political repression, recognizing both the vulnerability and resilience of families caught in these circumstances. It advocates for therapists to engage not only in therapy rooms but also in broader social contexts to promote empowerment and inclusivity.
• Advocating for Professional Training: The manifesto stresses the importance of intensive training for therapists working with families and communities, emphasizing ongoing education and understanding of both client and therapist traumas and resilience.
• Recognizing the Family as the Foundation of Society: In light of global political divisions and crises, the manifesto underscores the need to strengthen families as the cornerstone of society and a vital source of healing.

Overall, the Assisi Manifesto calls for a renewed focus on family therapy as a means of addressing contemporary mental health challenges within the broader social and cultural contexts in which families exist.

I am also pleased to announce that I have authored a companion piece to accompany The Manifesto which looks at the text from an American lens.

In my piece, I note that The Manifesto responds to the perceived decline in the prominence of family therapy, emphasizing a return to fundamental principles. It invokes the spirit of early pioneers in the field, such as Minuchin, Satir, and Whitaker, who passionately championed family-centric approaches. The document serves not only as a statement of principles but as a call to action, urging practitioners to integrate these principles into their work.

My key takeaways from the Manifesto include:

• Emphasizing the importance of the family unit and community support.
• Embracing inclusivity in practice, considering diverse cultural and familial contexts.
• Recognizing training as a continual process and encouraging therapists to confront personal and professional challenges.
• Advocating for social justice and community involvement.
• Encouraging boldness in practice, akin to the pioneering spirit of early family therapists.

Ultimately, the Manifesto is seen as a revitalization of the foundational spirit of family therapy, calling practitioners to recommit to its core principles and advocate for families' well-being. It challenges therapists to transcend mere professionalization and embrace the interconnectedness of human existence within families and communities.

Coming soon, AAMFT will be holding a new At Home webinar on Thursday, May 23, at 1:00 pm ET, titled Listening to Teen Voices in Family Therapy, with Maurizio Andolfi.

In this webinar, Maurizio Andolfi will outline the essential need to listen to youth voices in therapy without prejudice and labeling. Their voices, sometimes arrogant or bizarre, angry or provocative, are often a despaired cry for love and care. By showing a video of a family session from the Academia Multimedia Collection, Andolfi will illustrate how to build an alliance with a withdrawn teenager with the use of relational questions in the presence of his mother and maternal grandparents. Registration will be announced soon!

And one final note, the Journal of Marital and Family Therapy has opened a Call for Papers on Emerging Trends in Systemic Family Therapy Around the World. Please see the full details at the link below.

Please join us in celebrating global systemic mental health this April 7 on World Health Day, and look for the upcoming May/June issue of FTM where you can read the full pieces described above.

Download JMFT.special.call.

Mary E. Hotvedt, PhD, is an anthropologist and an MFT. Mary served as President of AAMFT. She has worked with Dr. Maurizio Andolfi for over 35 years. She is currently Chair of the Board of Regents for Western New Mexico University.