The AAMFT Blog

Post-Election, Holiday Stress and A New Year: A Systemic Look at Using Self-Compassion to Manage Our Anxiety in Stressful Times

Written by: Vanessa Bradden, LMFT

Strengthening family connections during the holiday season and in trying times is essential. Yet, it can become complicated by the pressures of gift buying, election results, and goals for the new year. Additionally, we may be coping with the loss of a loved one or loved ones and other significant life pressures like the loss of a marriage or a job. For many of us, this can cause great distress, made worse by the prospect of having to attend various holiday parties and family gatherings.

While these difficulties are real for many, hope is not lost if we take the time to understand ourselves better and the limitations of being human. As marriage and family therapists, we know that it is possible to overcome some of our stress and build better familial relationships (even if only small gains are made) by using Family Systems Theory alongside self-compassion and compassion for others. This approach helps us better understand our relationships and offers stress management tools. By focusing on kindness to ourselves and others, we can create a supportive environment for everyone during challenging moments.

Family Systems Theory is the foundation of the Marriage and Family Therapy (MFT) profession. When applied correctly, it becomes a valuable tool for therapists and clients, aiding in self-understanding, particularly during stressful situations. By utilizing systems theory, clients can develop a broader sense of compassion for themselves and others. Compassion not only fosters empathy but also encourages positivity toward those around us. Ultimately, it helps us manage the tension and anxiety often accompanying the holiday season.

Let's be honest: holidays can evoke many emotions, especially regarding our family of origin. Regardless of the complexities within your family tree—ranging from playful banter to deep-seated emotional wounds—everyone has triggers that can be activated by family members, irrespective of age or stage in life. Family gatherings can cause us to revert to unhealthy behaviors we prefer to avoid. Murray Bowen, a pioneer of family systems theory, aptly notes that families profoundly influence their members' thoughts, feelings, and actions, often making it seem like individuals live under the same "emotional skin." Family members seek each other's attention, approval, and support while reacting to needs, expectations, and upsets.

Our shared emotional history complicates the process of breaking free from established roles and negative patterns learned during childhood, yet it also connects us through shared experiences. So, what does this mean as we approach an already stressful time of year?

One approach to the season's difficulties is to cultivate self-compassion, which, in turn, allows us to have compassion for others. To do so, we need to understand our role within our family of origin, its influences, and how we contribute to its dynamics. For example, suppose you are the eldest sibling who took on a parental role. In that case, you might find it difficult to view your younger siblings as independent adults, which can lead to infantilizing behavior. Conversely, younger siblings may struggle to appreciate your support, resulting in misunderstandings and unnecessary resentment.

Engaging in sensitive discussions within family dynamics can often trigger anxiety, leading to hurt feelings and a pervasive sense of injustice that is hard to resolve. If political concerns dominate your thoughts this year, this may heighten the family's reactive tendencies. However, if we can take a step back and view these dynamics through a lens of compassion for ourselves and others, we are more likely to respond with empathy rather than contempt. At a minimum, it can prevent escalating something unlikely to be resolved. In the best-case scenario, this approach can facilitate personal growth and enhance our relationships,

Self-compassion can be a powerful tool in managing anxiety. If used properly, it will lessen the intensity of negative feelings that can come up when we are with our families over the holidays and beyond. 

Here are several ways it helps:

1. Reducing Self-Criticism: When feeling anxious, it's common to engage in harsh self-criticism. Practicing self-compassion encourages kindness toward oneself, helping to combat negative self-talk. By treating ourselves with the same understanding we would offer a friend, we can reduce feelings of inadequacy and shame.

2. Normalizing Feelings: Self-compassion allows us to recognize that anxiety is a common human experience. When we understand that others also struggle, we break the isolation that anxiety can create. This normalization can lessen our feelings of being alone in our distress.

3. Encouraging Mindfulness: Self-compassion involves being present with our feelings without judgment. This Mindfulness helps us acknowledge anxiety without becoming overwhelmed by it. Rather than suppressing or avoiding these feelings, we learn to accept them, which can reduce their intensity.

4. Promoting Emotional Resilience: We build resilience when we approach our anxiety with compassion. This resilience allows us to face challenges with greater strength and flexibility rather than feeling defeated by them.

5. Enhancing Coping Skills: Self-compassion encourages us to explore helpful coping strategies when faced with anxiety. Instead of resorting to avoidance or negative behaviors, we're more likely to engage in healthy behaviors such as seeking support, practicing relaxation techniques, or pursuing activities that bring joy.

6. Fostering a Positive Mindset: Practicing self-compassion can help shift our perspective from fear and anxiety to hope and possibility. This shift can lead to a more optimistic outlook, reducing feelings of helplessness.

7. Building Healthy Relationships: When we practice self-compassion, we're often more compassionate toward others, which can strengthen our relationships and create a supportive network, which is vital during anxious times.

In essence, self-compassion provides a powerful antidote to anxiety's harshness. It allows for a gentler, more supportive internal dialogue that fosters healing and growth. By cultivating self-compassion, we can navigate anxious moments with greater ease and grace.

MFTs are uniquely trained to work with family dynamics and are an excellent resource for those struggling with complex familial relationships. AAMFTs therapist locator is a great place to find an LMFT in your area.

Be kind to yourself this holiday season, and remember that everyone has anxious thoughts and feelings, even if we can't see them.

Sliding Scales and Accessibility in Private Practice

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.

Therapists are helpers at heart. We got into this work because we genuinely care about people and want to make a difference. We all believe in the power of therapy and its impact on not just the individual but also the family and the legacy left by each person we work with. Therapy is something that we want everyone to have access to, but how do we do that within the current context of our healthcare system?

The Truth No One Wants to Admit: Being Underpaid Can Impact Clinical Outcomes

Fees that don’t lead to a livable wage, inconsistent income, and the creeping dread of burnout don’t exactly make for a thriving private practice—or a happy, healthy therapist. And a burnt-out therapist does NOT lead to great clinical outcomes. Therapists who are struggling to live on an unlivable wage also often do not have access to consultation, training, rest, or sustainable caseloads. And yes, all of these impact clinical outcomes.

Bridging the Gap in the Healthcare System

The current landscape of mental health care in the United States is a challenging one for therapists and clients alike. Insurance companies, which are supposed to bridge the gap between care and affordability, often make it harder for both parties. Therapists are grappling with clawbacks—where insurers retroactively recoup payments for services already provided—and steadily declining reimbursement rates. These practices not only undervalue the work of mental health professionals but also discourage many from accepting insurance altogether. As a result, clients seeking affordable care are left navigating a shrinking pool of in-network providers, while therapists face increased pressure to balance accessibility with their financial and professional sustainability. This cycle perpetuates a broken system where both clients and clinicians pay the price.

For years, mental health has been underfunded and overlooked, leaving therapists to play the role of superhero—minus the cape, plus the student loans. The truth is individual therapists can’t fix systemic problems like inadequate funding or insurance barriers. Yet we’re often left holding the bag.

What’s the takeaway? We shouldn’t be the only ones patching the holes in a broken system. Advocacy and systemic change are where the real magic happens.

But what do we do at an individual level? How do we keep helping without helping ourselves into exhaustion? Let’s dig in.

Sliding Scale Fees in Private Practice

Ah, the sliding scale: the DIY solution therapists often turn to when we want to make therapy more affordable. Essentially, it’s a fee structure where clients pay based on what they can afford. Seems simple, right?

Sliding scale fees might seem like the hero we need, but they can come with some sneaky ethical dilemmas. For starters, charging different client's different rates for the same service can make things feel a little… wobbly. Imagine a client paying full price finding out someone else gets the same care for less—awkward, right? It could create feelings of unfairness or even erode trust in the therapeutic relationship.

Plus, therapists are human, and let’s be real—there’s a chance you might subconsciously invest differently in someone paying less versus someone paying your full rate (even if you don’t mean to!). Could resentment arise in the therapeutic relationship if you hear about something that infers to you that the client could pay the fee for therapy? We think it could.

This variability can conflict with the ethical principles of fairness, transparency, and maintaining the value of therapy. The result? Sliding scales can unintentionally slide right into murky territory, making it essential for therapists to tread carefully and consider alternatives that feel fair and aligned with their values. Sliding scales are not always the knight in shining armor they appear to be.

The Ethics of Using a Sliding Scale

AAMFT emphasizes fairness and transparency. If you’re using a sliding scale, it better be clear, consistent, and above all, ethical. This means that if you choose to use a sliding scale you need to remove bias from your process, so that every person that comes through your door gets the same access based on the same factors.

In a CPH Insurance Avoiding Liability Bulletin it was mentioned by Richard Leslie, “My view is that a "sliding fee scale” is unnecessary, unwise and problematic." Most sliding fee scales used by nonprofits and other entities base the fee on the financial condition of the patient. In order to properly implement such a policy, entities must ask for certain information and perhaps supporting documentation, like tax returns. Most private practitioners do not want to get into that kind of detail in their practices. Psychotherapists usually establish fees that they are comfortable charging and stay with those fees until they decide to raise their fees. Physicians and other practitioners likewise establish a “usual and customary fee” and typically do not change their fee for different patients. If the patient can’t afford the fee, he or she can be referred elsewhere."

Sliding scales aren’t a no-no, but they’re not exactly a “yes-yes” either.

Let’s think outside the sliding-scale box and explore some fresh alternatives that keep therapy accessible without leaving therapists feeling like overworked superheroes.

First up, there’s the Privilege-Based Sliding Scale. An example of this would be the Green Bottle Method created by Alex J. Cunningfolk. This spin on the traditional sliding scale puts the power in your clients’ hands. Instead of awkward financial disclosures, clients self-select their fee based on their resources, privilege, and ability to pay. It’s judgment-free, transparent, and as a bonus—way less paperwork for you! This approach empowers clients while taking the emotional and administrative weight off your shoulders. Yet, what will you do if you find that this process doesn’t lead to a sustainable wage? Or, if clients that appear to have more financial privilege are consistently self-selecting for a sliding scale, while clients who are struggling do not?

Then there’s Group Therapy, the ultimate win-win solution. Group therapy gives clients a built-in support system, reducing feelings of isolation while being budget friendly. For therapists, it’s a great way to maximize impact without burning out. Pro tip? Market it as a unique, collaborative feature of your practice—because group therapy is seriously underrated and underutilized.

Another option is Tiered Service Models, which are like a buffet of therapy offerings. You can create a range of options: lower-cost services such as workshops, self-guided programs, or one-off consultations for budget-conscious clients, while reserving your one-on-one sessions for full-fee clients. This approach not only protects your time and energy but also gives clients more ways to access your expertise.

You can also choose to Give Back, as our AAMFT ethics mention, and improve accessibility, changing the system from within through lobbying, advocacy and volunteering at a government level to affect change.

And sometimes, you just have to pass the baton. Build Advocacy and Referral Networks by connecting with nonprofits or other clinicians who offer sliding scale or low-cost options. It’s okay to acknowledge when a client’s needs fall outside your financial or professional capacity. Bonus points for getting involved in advocacy efforts to push for systemic changes like better insurance reimbursements and increased mental health funding—because real change happens when we shift the system, not just our individual practices.

Finally, there’s the all-in strategy of Lower Fees Across the Board. While it might sound like an easy fix, it comes with a big red flag: burnout. If you decide to reduce rates for all clients, make sure you’ve got a rock-solid self-care plan and a realistic client load. Remember, being a therapist isn’t about self-sacrifice—it’s about sustainable care for both you and your clients.

Redefining Accessibility and Sustainability

Sliding scales aren’t inherently bad, but they’re not the only (or always the best) solution. Whether it’s privilege-based models, group therapy, or tiered services, there are plenty of creative ways to balance accessibility with sustainability.

And let’s not forget the bigger picture: systemic change is the real game-changer. So, while you’re doing the amazing work of supporting your clients, don’t forget to advocate for a system that supports you, too.

because at the end of the day, the best therapy happens when both client and therapist are thriving.

National Hispanic Heritage Month: Embracing Diversity in Marriage and Family Therapy

Written By Julian Crespo, Ph.D., LMFT. 

As we celebrate National Hispanic Heritage Month from September 15 to October 15, it's impossible not to reflect on the rich multiplicity of Hispanic cultures. This annual observance provides marriage and family therapists an opportunity to consider the profound influence of Hispanic heritage on our field and society as a whole.

The Hispanic community defies simple categorization. It's a composite of cultures, traditions, and identities shaped by centuries of mestizaje – the blending of Indigenous, European, African, and other ancestries. This intricate history has fostered a wide array of perspectives on individual and family identity formation. Some Hispanic families celebrate their indigenous roots as a cornerstone of their identity, while others may emphasize their European heritage. Many embrace a fluid, multifaceted identity that honors all aspects of their lineage.

For marriage and family therapists, this diversity within Hispanic cultures is a wellspring of insight. It underscores the need for tailored approaches to therapy, even among seemingly similar cultural groups. Each family brings to the therapeutic space its unique historical narrative, cultural values, and identity constructs. Additionally, the multifaceted nature of Hispanic populations can significantly enrich and foster inclusivity in the United States. As therapists, we can draw valuable lessons from how Hispanic cultures have navigated complex identities and histories. This knowledge can shape our approach to working with all clients, helping us develop more inclusive and culturally responsive therapeutic practices.

Many Hispanic cultures, for instance, place great importance on strong family bonds, respect for elders, and collective decision-making. These values offer fresh perspectives that contrast with more individualistic approaches. By integrating these diverse worldviews, we can broaden our therapeutic toolkit and better serve a wider spectrum of clients.

Furthermore, the richness and complexities of Hispanic cultures can inform and nurture marriage and family therapy practices to adopt a critical stance. They push us to examine our assumptions and biases, encouraging us to create epistemological spaces where the profession can grow in multiple directions.

Take, for example, the concept of familismo – the strong identification and attachment to nuclear and extended family – prevalent in many Hispanic cultures. This concept prompts us to reconsider our understanding of family systems, encouraging us to look beyond the nuclear family and consider the roles of extended family members and close friends who may be considered family.

Similarly, the diverse spiritual and religious practices within Hispanic cultures can expand our approach to addressing spirituality in therapy. From indigenous spiritual practices to syncretic religions like Santería, these varied belief systems remind us of the many paths people take to find meaning and healing.

The linguistic diversity within Hispanic communities offers another valuable lesson. It highlights the importance of not just literal translation, but cultural interpretation in therapy. This insight can inspire us to be more attentive to the nuances of language and communication in all our therapeutic interactions. 

As we mark National Hispanic Heritage Month, let's embrace these lessons from Hispanic cultures. Let's use this richness and complexity to foster more inclusive, culturally responsive, and critically reflective marriage and family therapy practices. In doing so, we not only better serve our Hispanic clients but also enrich our field as a whole, creating space for multiple perspectives and approaches.

National Hispanic Heritage Month serves as a powerful reminder of the invaluable contributions Hispanic cultures make to our society and our field. It challenges us to continuously expand our understanding, question our assumptions, and strive for truly inclusive and effective therapeutic practices. In honoring Hispanic heritage, we also honor the diversity of human experience and the myriad ways families and individuals construct their identities and relationships.

World Alzheimer's Awareness Day: Understanding and Reducing Stigma

By Vanessa Bradden, LMFT,

Founder and Clinical Director at Lakeview Therapy Group

Did you know that September 21st is World Alzheimer's Day? It is a day intended to increase our understanding of Alzheimer's and other forms of dementia and diminish the stigma associated with it. Globally, more than 55 million people are living with dementia, and it is estimated that 10 million new cases are diagnosed each year. The number of people with dementia is expected to increase to 139 million by 2050.

Most of us have been affected directly or indirectly by dementia and know that it is a painful, often lonely journey. Receiving and processing a dementia diagnosis is a significant life transition that needs more attention. It is grief work for the patient and the loved ones around them. And like any loss, it is not a linear process. There is denial, anger, bargaining, depression, and acceptance, which oscillate depending on the day. The feelings associated with such a loss can be paralyzing, overwhelming our ability to cope well.

As marriage and family therapists, we understand that the patient is part of a more extensive system – family, friends, and co-workers. We also know that stigma is an obstacle, imposing shame and making it harder to focus on what needs to happen to adapt and keep a good quality of life. The stigma around dementia can result in premature outcomes if we decide that patients cannot do anything on their own because they have dementia. We all benefit when we encourage diagnosed individuals to use as many capabilities as possible, if they are safe.

Stigma and Its Impact 

 For those directly affected by Alzheimer's and other forms of dementia, life changes in ways that are scary and unpredictable. The progressive nature of the disease can alter parts of our loved ones who were once vibrant and productive members of their families and communities. It is a startling moment when you realize someone you know and love is struggling with pieces of their ability to remember things you experienced together or, even more alarmingly, your name and who you are to them.  

Fear of the unknown is difficult for all of us. However, if left unchallenged, it perpetuates stigma around the disease, making it hard for everyone to get proper care and support. Raising our awareness about Alzheimer's disease is one of the best ways to deflate the stigma that negatively affects patients and their families. 

Stigma is a significant concern facing patients and families living with dementia. Many report feelings of abandonment, isolation, and infantilization. Our fear of dementia can cause us to back away from someone when they need us the most. For some, it is a fear of not knowing what to say or do, or more selfishly, an inability to cope with the changes that will happen over time. Either way, it further worsens feelings of loss.

Reducing Stigma 

Marriage and Family Therapists are the pioneers and leaders of systemic therapy. We think that the individual is more than the sum of their parts, and we value finding strength-based solutions rather than those that enforce stigma and isolation. We believe nothing happens in a vacuum, and effective treatment comes from looking at the broader context of what is happening with the individual and those closest to that person. With staggering numbers projected for the future of Alzheimer's, it is crucial to reduce and even end its stigma.  

Educating yourself and those around you about dementia is one of the most effective ways to reduce stigma. Be direct and factual about what is happening. Being direct can help set expectations for others while also empowering ourselves as advocates of our lives. Being open and honest with others can help people better understand what you are facing and take the pressure off them not knowing what to say or do to help you.  

How Marriage and Family Therapists (MFTs) Can Help  

Marriage and family therapists (MFT) have a unique skill set and know how to work with individuals, couples, and families. They support everyone in the family system, making processing loss more manageable. Grief work is complex, and there is no easy solution. Each person's experience is essential; tensions can run high in the family, and old wounds can get triggered. Working with an MFT provides an added level of support for everyone. 

Medical Advances Give Us Hope 

While we search for a cure for Alzheimer's disease, we must hold onto hope. The National Institute on Aging (NIA) is the leading agency supporting and conducting Alzheimer's disease research, and their unyielding support continues to push researchers toward more effective prevention and treatment protocols for dementia. 

September is National Suicide Prevention Month

Join AAMFT for a conversation on suicide prevention

Each September, the United States observes suicide awareness and prevention. The nationwide observance aims to raise awareness about suicide, identify ways to prevent suicide, and remember the lives lost to suicide.

In the U.S., someone dies by suicide every 11 minutes. Suicide can impact anyone—people of all ages and backgrounds. The White House World Suicide Prevention Day proclamation underscores this, noting that in 2023, nearly 50,000 Americans died by suicide, and in 2022, over 10 million seriously considered suicide. In 2022, suicide was the second leading cause of death for young people aged 10 to 14 and 25 to 34, and the suicide rate for veterans was 50 percent higher than for anyone else.

On September 24 at 12:00 p.m. Eastern, we invite you to a special LinkedIn live panel discussion titled “Understanding Suicide Prevention: Community, Signs, and Support.”

Hosted by AAMFT Board President Silvia Kaminsky, this critical session will feature insights from AAMFT members Dr. Marie-Nathalie Beaudoin and Dr. Katherine M. Hertlein, along with Dr. Lisa M. Horowitz of the National Institute of Mental Health. Together, they will explore the significant impact of family dynamics on mental health and discuss practical strategies for suicide prevention.

This session will provide expert insights into the warning signs of suicide; help you understand the support systems that can prevent crises; and insights from top professionals about the role of marriage and family therapists in mental health advocacy.

This event is essential for anyone interested in the latest approaches to mental health and wellness, especially in recognizing the crucial role families play in prevention. Whether you're a professional in the field, a student, or simply an advocate for better mental health practices, your participation is valuable.

Save the date and join the conversation that matters. Let's empower our communities with the knowledge to support and save lives.

REGISTER FOR THIS LIVE EVENT HERE

Top 4 Messaging Mistakes Made by Marriage And Family Therapist Websites

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. 

Your private practice website is a hub for connection with potential clients. The messaging you use on your website and other marketing materials is meant to connect, inform, and motivate people to act for themselves. Your message could be the difference between someone being stuck in their pain and someone finding help to heal their pain.

But when you search for marriage and family therapists online or through a directory, you may find a lot of the messages have made some simple mistakes that we want to show you how to avoid.

Mistake #1: Ask a lot of questions

Imagine if you are meeting with someone you don’t know, naturally, you ask a lot of questions to get to know them. Yet, part of having a solid marketing plan is knowing who you do great work with and being able to speak to the pain of those ideal clients. You should know generally something about their pain. If you start your website asking a lot of questions such as: Do you feel stuck? Do you not feel like yourself? Do you struggle with anxiety or depression? Are you grieving the past or something in the current present moment? You communicate that you aren’t sure who you are speaking to and are unsure of what they might generally be going through.

Instead of asking a lot of questions, peppering them with all the possibilities of what could be going on, speak to the common pain points of your clients. This takes knowing who you want to work with though. You can’t speak to everyone in one message. You need to hone in and speak to the clients you do the best work with.

Imagine moving away from the questions and more into painting a picture of what they might be going through. For example, "you woke up this morning with a tightness in your chest that is all too familiar. You do your best to push down the anxiety and worry, but day in and day out, it creeps up on you rendering you exhausted. You can’t focus at work. You miss appointments or space out in conversations with friends and loved ones. You worry so much about what others think about you, you just never feel like you can let your guard down."

How does that messaging feel compared to questions? It conveys attunement, and an understanding of the client because you know other clients like them. They aren’t alone and you know how to help.

Mistake #2: You aren’t clear about how you help

So many therapist websites speak in generalities about how they help. Many therapists talk about how they hold a safe nonjudgmental space for their clients. I hope they do! That is important, but that is the standard across the board. Besides, does a client really know how a nonjudgmental space being held for them helps? Probably not other than that there is comfort.

Instead, speak to how you show up as a therapist, giving good, informed consent about what to expect from you as a clinician. We aren’t speaking about being competitive and comparative with other clinicians. You never need to put down others to put yourself out there. You simply want to stand out clearly about what is unique about you in this work.

For example, I help anxious, high-achieving adults to simmer their anxiety so they can be comfortable in their own skin. I meet with my clients weekly because that is what gets better outcomes for the way that I work. I’m not a therapist who gives homework, instead, you will learn tools you can use outside of the session to use your body's wisdom to help you integrate more calm states in your day-to-day. Many of my clients love that they get to move their bodies during sessions and that there is a lot of laughter in the process of healing, It doesn’t always have to be so serious as you see on TV.

In this example, you can learn more about how the therapist works and what to expect. This gives the potential client way more information to decide if this is a good fit for themselves. Maybe they decide they don’t like what they read. That’s a good thing because it’s helping them tune into their own wisdom about what they need and it expedites them on the path to finding the right therapist for them.

Costs for Starting a Marriage and Family Therapist Practice

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. 

You have your degree, supervision hours, training experience, and licensure… but what about a Marriage and Family Therapy private practice? Even though you’ve already invested a LOT of money into your education to become the kind of therapist who makes a real impact on clients, you feel completely out of your element when it comes to the business side of things.

And then there’s the dreaded question:

How much is a Marriage and Family Therapy practice actually going to cost!?

The good news: Much less than you might expect. In fact, all of the money spent on getting you to where you are today in your profession is the greatest expense you’ll need as a therapist. Yes, it’s true that you’ll need to invest some money into private practice, but it’s totally doable.

In fact…

Your Marriage and Family Therapist practice costs LESS than most businesses.

That’s right — you don’t need hundreds (or even tens) of thousands of dollars to start a successful, values-aligned private practice. It’s all about starting for a low cost and growing as you build a steady caseload of ideal clients to learn from and serve.

So, let’s get right to it!

Here’s how much starting a Marriage and Family Therapist practice really costs…

Checklist: Cost of Starting a Marriage and Family Therapist Private Practice

To make this easy for you, we’re going to cover things one at a time. You’ll be able to check off each of these items once you have what you need, so you can avoid confusion and overwhelm.

Alright, here we go…

1. A Physical or Virtual Marriage and Family Therapist Office

Whether you prefer to see clients in person or with secure, HIPAA-compliant telehealth software for online sessions, you need some kind of private space to practice therapy.

If you choose to go the in-office (or hybrid) route, look into subletting an office for $100-200 or less per month. The specific number depends on the area you’re practicing in, of course, but you’ll likely find it’s a lot more affordable than you might’ve expected!

Plus, you won’t have to pay for expensive furniture and may even negotiate a deal where you only start paying for office space after you start seeing clients. My personal experience as a Marriage and Family Therapist was that I only paid for the space when I had clients, and there was an hourly fee that only went up to a max of $75 for a couple night’s worth of rent per month.

Investment: $200/month
> Download our free Office Space Checklist for your private practice 

 

Imposter Syndrome: An MFT Perspective

What Is It?

As a marriage and family therapist and AAMFT-approved supervisor, I often discuss imposter syndrome with clients and students who experience feelings of doubt about themselves and their abilities around achievement. Initially, it presents as anxiety, which is an accurate assessment of the physiological response to feeling out of sorts with something. Our mind tells us a story in which we question our skills and abilities to succeed at something.  For example, we may tell ourselves that our boss made a serious mistake giving us a promotion, even though it is the consequence of our competence. 

A significant gap exists between our inner and outer selves, making it difficult to assess and connect with our accomplishments properly. Imposter syndrome is a psychological phenomenon in which our internal feelings do not align with the external narrative, and it can cause great distress to one’s ability to feel confident and calm.

 

How Does it Show Up?

When our clients are grappling with perfectionism, procrastination, people-pleasing, self-doubt and self-sabotage, they are experiencing imposter syndrome. As systemic therapists, we know that problems do not happen in a vacuum. The perfectionist for example is also a procrastinator and vice versa. These behaviors share a relationship with one another and here is how these behaviors show up as imposter syndrome.

1. Perfectionism: Striving for perfection is a slippery slope precisely because it is not fully attainable. Perfectionistic traits like “all or nothing” thinking or focusing only on the outcome and not the process, create roadblocks that will keep us questioning our self-worth. The belief that “it has to be perfect” perpetuates chronic doubt and dissatisfaction with one’s accomplishments, and our imposter will always feel like a fraud.

2. Procrastination: Ah, our old friend procrastination. Also known as the thief of time. Our imposter syndrome gets amplified when we delay doing what we know will get us to the finish line. It is paralytic. Our inner critic unconsciously tells us we can’t do it or that it won’t be perfect, and such thoughts create a never-ending feedback loop that supports our belief that we are incompetent in a particular area.

3. People Pleasing: Typically, people-pleasing develops in childhood when the reward for being a helper gets positive reinforcement. But the people pleaser grows up not knowing how to say no to others. After all, they are constantly rewarded with positive feedback about how reliable or generous they are when really, they may be harboring resentment toward others who lean on them too hard.

4. Self-Doubt and Self-Sabotage: The doubter part of the self is an inner critic, who has low self-esteem when it comes to knowing their worth. When we don’t know our value, we can easily shrink ourselves to make others happy. And in doing so, we do ourselves a disservice. Our fear of not feeling competent undermines our ability to achieve our goals.

 

Coping Strategies

If this resonates with you, know that you are not alone. It is estimated that 70% of us will experience at least one episode of imposter syndrome at some point in our lives. With that in mind, many of us will suffer more than one episode of it. So, how do you do to overcome the negative effects of imposter syndrome?

To begin with, you need to understand the story your mind tells you while also realizing your body provides important clues. When we feel anxious or stressed, which we do when the imposter is alive and well, our body produces more cortisol. When that happens, positive self-talk will only provide you with a band-aid solution. Our core beliefs are often unconscious and need a deeper evaluation before making a lasting change.

Here are some tips for coping with Imposter Syndrome:

1. Know Your Story: It is essential to understand the story that feeds your imposter Somewhere along the way, we created a story about ourselves that stuck with us, and it is no longer helping us. As children, we absorb our environment like a sponge and can easily internalize a false narrative about who we are and what we can do. With a deeper understanding of what we internalize about ourselves, we can work to rewire it.

2. Take a Neutral Stance with your Imposter Part: Consider what it would be like to engage in a neutral stance while navigating and recreating your narrative. By adopting a neutral position you can give yourself space to pause without judgment. To make sustainable changes to the thoughts and feelings that we hold about ourselves, we need to ensure that we do not overwhelm ourselves with uncomfortable emotions. Letting ourselves take a neutral stance provides a platform to stand on while we work to rewire our negative thoughts about ourselves.

3. Develop Your Compassion: Being curious with or about yourself is one of the most effective ways to develop your compassion. Curiosity removes judgment which opens the door to compassionate thinking. Self-compassion asks us to be kind to ourselves and when we engage in the practice of compassion, we change our neuroplasticity for the better. Being kind to ourselves can tame and rewire negative thoughts that keep us from connecting to our competencies.

4. Seek Therapy: One of the best ways to cope with imposter syndrome is through therapy. A marriage and family therapist can be a wonderful resource to you by providing a safe and holistic approach to unpacking, processing, and reorganizing your story to better support a narrative that keeps our imposter part from taking over. AAMFT’s therapist locator is a wonderful way to find a systemic therapist.

Working with “Resistant” Clients: An MFT Perspective

As therapists, we are natural healers and helpers. We build a strong alliance, set goals, implement interventions, and achieve positive outcomes. More than anything, we want our clients to make consistent gains toward their therapeutic goals. Marriage and family therapists (MFTs) are acutely skilled and interested in shifting negative patterns in their lives and relationships. We are holistic in our approach and want our clients to connect with their strengths and make desired changes in their lives.

MFTs treat individuals, couples, and families and view problems in the context of relationships. We meet a range of clients in our practice and face various issues. One of the most challenging therapeutic presentations is resistance. When a client resists therapy, it leaves the therapist feeling discouraged. Even a seasoned therapist will tell you that resistance can make them feel deskilled, stuck, and unsure of what to do next.

There are, however, other ways to frame this experience. While uncomfortable, resistance provides essential information about what is happening in the client system. As MFTs, our training tells us that this is an isomorphic moment. Resistance is a standard defense mechanism activated in response to fear. It may serve an adaptive purpose to the client but feels like a barrier to the therapist.

Therapeutic resistance can be covert or overt, showing up in several different ways. Clients may come in for therapy with their spouse and announce that they don’t believe treatment works. In this instance, the resistance is manifest. Another client may resist therapy due to a cultural norm according to which accepting outside help cannot solve personal problems, or at any rate is embarrassing. Yet for others, resistance may be a symptom of another problem. It may be the discouraged or fearful surface response of someone who is feeling depressed or anxious. Either way, we need to have some strategies for recognizing and handling resistance so that we don’t miss the opportunity to connect clinically with our clients.

Here are some ways to work with resistant clients:

1. Use it as an opportunity to join and build trust with the client: If a client announces that therapy is not for them, do not try to convince them otherwise. Instead of making a sound argument for the benefits of therapy, be agreeable and curious. Our job is not to persuade anyone to believe in therapy but rather to validate their perspective and gain more understanding of their narrative about therapy.

2. Check-in and ask for feedback: It is important, in the first place, to notice the resistance which may be masked by broader cultural beliefs. You may think your alliance is strong and your connection with your client is close. However, the client may still be harboring resistance and concealing it from you. Therefore, check-in and ask specific questions and invite direct feedback. For example, you may let your client know upfront that the therapeutic process takes time, and the therapist might miss something important to the client. Encourage the client to ask clarifying questions and to give candid feedback about what is and is not working for them.

3. Keep an eye out for underlying causes of apparent resistance: If your client is in a cycle of “help-rejecting complaining,” remind yourself that it is not personal, but it may be a symptom of underlying depression or anxiety. Clients who present themselves as high functioning may appear to be resistant when in fact, they are experiencing inner turmoil. We need to be sure that we check-in and are screening for any underlying conditions before concluding that the client is being “difficult” or not open to help.

Our work as therapists can be rewarding and challenging. When you find yourself overwhelmed or puzzled by resistance, seek professional supervision. The objective feedback of another MFT can relieve the stress of working with resistance.

Setting Your Therapy Private Practice Salary

Guest blog post by: Miranda Palmer at zynnyme

Let’s face it, you were called to do this work. You believe in the power of relationships and systems, and you’ve invested years and tens (or hundreds) of thousands of dollars into your training to deeply help heal systems and families.

But what happens when you sit down and do the math and realize what you’ve trained and worked so hard for won’t actually pay the bills (much less give you an option for retirement or reducing your hours at some point)? The truth is, most of us haven’t done that math. In fact, some of you chose this career so you could AVOID all that math. And yet, here we are. You’re noticing that your paychecks aren’t stretching as far, and your savings account is dwindling.

If that’s you, you aren’t alone. Marriage and Family Therapy and other counseling degrees are among the worst paid Master’s degrees in the United States. But, it does NOT have to be this way. In fact, many therapists make a sustainable income with their degree in private practice as either private-pay or an insurance-based practice.

So, what’s the big difference between therapists who are paid well and ones that aren’t? Is it their value as humans? As therapists? Their outcomes? Their location? I’m going to go out on a limb and say no. While location and other factors may impact insurance reimbursements, cost of living, etc., the biggest impact is therapists’ understanding of finances and making conscious choices about what they say “yes” and “no” to.

Therapy is priceless. Each one of you is priceless. However, when the bulk of therapists say “yes” to insurance reimbursements that fall below the poverty line, then insurance companies have no reason to increase reimbursements. When therapists shame other therapists who’ve done their math and charge a sustainable fee, then we lose as a profession both in connection and in our ability to do the work if those therapists feel shamed out of the profession.

Unlike work at nonprofits, it’s the responsibility of the owner of the practice to set the salary and benefits in their private practice. Unfortunately, many private practice owners set the salary without accounting for expenses, time off, time required to work on the business, retirement, or other benefits that are built into W-2 employment for other agencies or businesses.

So, a therapist who sets their income goal at $100k annually, for example, might consider that their salary. But, in a business, gross income and net income are VERY different. Many therapists average close to 40% in expenses, which drops that quickly down to $60k in a salary. However, that $60k salary in private practice is NOT the same as $60k in W-2 Income. You’re taxed at a higher rate for that income AND that $60k needs to include benefits.

Therapists often also set their available hours to work with clients based on their responsibilities while working for another organization. In most organizations, billing, scheduling, cleaning, bookkeeping, marketing, etc. are outsourced to others. In a private practice, however, it may initially be just one person who’s responsible for all aspects of running the business. A therapist who easily saw 30 clients a week at an agency and worked a total of 35 hours may find that even 25 clients a week translates to 50-60 work hours per week.

So, how do you set your salary in private practice?

You need to get clear on the number of hours you want to work per week both in the chair and out of the chair. If you want to work 32 hours per week, for example, I’d recommend starting with a clinical goal of no more than 60% of those hours. So, in this case, a max of 19 clients a week.

You need to explore the weeks you’ll work per year. How many weeks do you need to plan on being out due to illness, vacation, taking care of loved ones, attending clinical trainings? Setting your fee based on this can have a HUGE impact on your bottom line. If you work with families or children who take summers off or you find you have a summer slump, you might also work this number into your total weeks worked per year.

You need to get clear on the costs of starting a business and expenses, including your need for a salary and benefits. Technology, internet, office space, malpractice insurance, retirement, clinical training, etc. There’s a LOT to starting a private practice – it’s a business, after all. Simply setting a random fee without understanding what’s involved is not going to have the impact you hope for! Take some real time putting costs together for your unique situation and practice to develop your gross income goal.

You need to understand the tax implications of being a business owner so you don’t end up with 15% less than you thought you would after accounting for self-employment taxes!

As a VERY rough starting point, you need to look at your gross income and divide that by the number of weeks worked per year. That lets you know what income you need to bring in weekly on the weeks you work on average. After that, you take the weekly average and divide it by the number of clinical hours you want to work.

Feeling a little overwhelmed? You’re completely normal! We believe this is something best done with support and as part of a community. Our next AAMFT-sponsored training, we’ll dive into this for an hour in more detail with lists of expenses to plan for and answering your burning questions about insurance, sliding scale, and more! Click here to register today.

The Respect for Marriage Act – The MFT Perspective

Just last week, the Respect for Marriage Act passed in the House 258-169, marking an incredibly historic moment for not only the country, but also for marriage and family therapists. The first version of this bill was originally introduced back in 2009 and was reintroduced into Congress this past summer. The revised version still included protections for same-sex marriages, but now extends protections to interracial couples. The Senate previously passed the bill in November. 

The bill is on its way to Biden’s desk, which he says upon House passage of the bill, President Biden said he “looks forward to signing into law” this landmark legislation. Biden writes, “The House’s bipartisan passage of the Respect for Marriage Act—by a significant margin—will give peace of mind to millions of LGBTQI+ and interracial couples who are now guaranteed the rights and protections to which they and their children are entitled.” Biden signed the bill yesterday afternoon during a large celebration at the White House, marking a huge step forward for the field of marriage and family therapy.  

This past year, the Journal of Marital and Family Therapy (JMFT) released its Decade In Review– a special issue released every ten years that reviews what the past 10 years of systemic therapy research has to say about various topics within the field. This review included a special article on how couple and family therapy research can reduce mental health disparities for racially and ethnically diverse populations. The article reviewed research surrounding minority, interracial and LGBTQI+ couples, advocating for their inclusion in systemic therapy research and studies in order to advance the field.  

LGBTQI+ individuals are already more likely to struggle with issues like depression and anxiety, due to the stigmas and discrimination they face. Similarly, interracial couples face issues with stereotyping, isolation, negative comments, and rejection, which can often lead and contribute to mental health issues. These mental health concerns impact more than just the individual– they affect the entire family, marriage, and relationship structure. Thus, marriage and family therapy can help address and resolve these issues from a systemic perspective, mitigating any stressors or implications they may cause in marriages.  

JMFT’s Decade in Review article on mental health disparities noted that only 68 of the 271 (25%) articles they examined included predominantly racial/ethnic minority samples or globally underserved populations. Among the 60 relevant articles examined, there was a pattern of inattention to methodological considerations relevant to diverse populations. LGBTQI+ and interracial couples deserve to have the mental health and marriage therapy resources they need to maintain healthy relationships. The passing of this bill is just the first step towards including, accepting, and appreciating LGBTQI and interracial couples, both inside and outside the therapy room.