The AAMFT Blog

The Ultimate SEO Checklist for Therapists

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

When you’re taking the steps to grow your practice with online marketing, one term you will inevitably come across is 'Search Engine Optimization' or SEO. 

The term ‘Search Engine Optimization’ can be in and of itself overwhelming, let alone learning the specifics of how to understand it.

In this post we’re going to break down the details of what it means to have a website that is optimized for search engines, leaving out the typical ‘tech jargon’ that tends to do nothing but complicate things. 

What the Heck Is SEO, Anyway?

SEO stands for Search Engine Optimization and is essentially the practice of following a series of steps so that Google will show your site in its search results.

You want your website to show up on the first page of Google when a user types in a query that applies to your private practice, right? Of course you do! You work hard at what you do and your practice deserves to be found.

At the end of this post you will find a bonus SEO Checklist that you can print off to help you improve your own web pages one step at a time.

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.

“Therapy of the absurd” – Re-Partnering Play and Family Therapy

Carl Whitaker was known to call his flavor of family therapy “therapy of the absurd.” As I have contemplated this phrase and the work I do in play therapy, I can definitely resonate with that feeling. At times, when I’m rolling on the ground getting attacked by aliens, or tiptoeing in my office to avoid detection from military personnel, I often wonder if parents, families, and fellow therapists look at me as an absurdity! In fact, on more than one occasion I have had colleagues tell me, “I just don’t understand what you enjoy about seeing whole families – isn’t it just too stressful?”

I agree with my colleagues, parents, and Carl Whitaker himself, that family therapy, and its very important partner, play therapy, do look absurd to the untrained on-looker. In fact, many pioneers of family therapy saw family therapy and play therapy as one and the same! Keith and Whitaker (1981) stated, “play therapy has become our model for family therapy.” In the same article they also state, “families need the presence of children in therapy to stay alive. We find again and again that families change less and more slowly when children are not part of the therapy process.”

Join Michael Whitehead, PhD, LMFT, RPT-S, for a webinar introducing play therapy theories and principles to family therapists on June 14, from 3:00-4:40pm EST. This webinar is hosted by the Systemic Perspectives Across the Lifespan Topical Interest Network. Click here to learn more and register. 

Unfortunately for our profession and for our clients, a large number of family therapists trained as MFTs report not wanting to work with children. Korner and Brown (1990) reported that 40% of MFTs never include children in therapy. When asked why, Johnson and Thomas (1999) found that for the most part it was due to a lack of training working with children and not knowing how to include children in therapy.

Most family therapists conduct “Relational Family Therapy,” defined as working with an individual or a subsystem of a family (Breunlin and Jacobsen, 2014). Early family therapy pioneers viewed themselves as practicing “Whole Family Therapy,” defined as including all family members that are able to physically be present in the session (Breunlin and Jacobsen, 2014). This whole family therapy approach requires some comfort working with children, adolescents, marriages, siblings, and grandparents.

Marriage and family therapists have a unique story, with unique skills, that when used properly and fully, can create amazing changes for families and communities. Let’s utilize this rich history in continuing to help families find fun in the absurd!

 

Michael Whitehead, PhD, LMFT, RPT-S, is a clinical fellow of AAMFT and AAMFT Approved Supervisor. As a practicing therapist, he has incorporated children, divorced, and step-parents in his whole family therapy approach. He often uses play therapy with whole families, and encourages the same of his supervisees. 

 

Breunlin, D. C., & Jacobsen, E. (2014). Putting the “Family” Back Into Family Therapy. Family Process, 53(3), 462–475. https://doi.org/10.1111/famp.12083

Keith, D., & Whitaker, C. (1981). Play therapy: A paradigm for work with families. Journal Of Marital And Family Therapy, 7(3), 243–254

Korner, S., & Brown, G. (1990). Exclusion of children from family psychotherapy: Family therapists’ beliefs and practices. Journal of Family Psychology, 3(4), 420–430

Johnson, L., & Thomas, V. (1999). Influences on the Inclusion of Children in Family Therapy. Brief Report. Journal of Marital & Family Therapy, 25(1), 117–123

“Are Your People in Sri Lanka okay?”: After Exposure to Traumatic Violence, Reflecting on the Patterns that affect Families across Space and Place

by Laurie L. Charlés PhD LMFT

AAMFT Approved Supervisor and Clinical Fellow

In Boston, in Light of the Easter Sunday Attacks in Sri Lanka

Danaa walked into my class a few minutes early Tuesday night, breathless: “Are your friends in Sri Lanka okay?” Danaa is a student in my Sociology of the Family class, a seminar with students in Boston who are mid career professionals, re-training or finishing their degrees after having families or after migrating to the U.S. from the Global South. Our conversations about family life and family issues are constantly fascinating for me because of the stories they bring from their world. I did not ever expect that the class would become so keenly sensitive to my stories, however, and to the Easter Sunday bombing that had happened in far and away Sri Lanka only two days earlier. But somehow, they had.

During the 48+hours that had passed since the attacks in Sri Lanka, which, as of this writing, has claimed the lives of hundreds of people and injured more than 500 across three cities on the island, I’d also received messages of concern from loved ones and colleagues across the globe—San Antonio, Beirut, New York City, Istanbul, Washington DC, Santiago, California, and Syria. Essentially, the message was the same: “Are your people okay?” Traumatic incidents truly reach across space and place; the patterns resonate across global barriers, connecting us. Concern for my colleagues in Sri Lanka was also what I saw on my students’ faces Tuesday night—a few minutes before I began the lecture, Andrae walked into class with the same question that Danaa had: “Are your people okay?” Like her, he didn’t wait to sit down before he asked.

I am a family therapist who, through a profound stroke of luck in a life full of good fortune, is deeply embedded in Sri Lanka. My first experience in the country was in 2010 as a Fulbright Scholar; I taught at the University of Colombo, where I am still an affiliated faculty member. Back then, I met many of the colleagues whom I now consider dear friends. Bookend that with a trip the week before Christmas in 2018, when I was there under contract with the United Nations as a “Consultant/International Master Trainer” for the United Nations Family Therapy (UNFT) Program. Our training program in the capital of Colombo was held at the Cinnamon Grand, one of the hotels where a bomb went off on Easter Sunday.

My class last night had at least two spaces and places in it: Boston and Colombo. The effects of traumatic incidents on family life had been our topic of discussion, as the week prior to the Easter Sunday attacks was “Marathon Monday” in Boston. Our class was held the day after the event, but the Marathon Monday joie de vivre was still in the air, that heady spirit of end-of-winter and almost-Spring, of the celebration of sport, endurance, and since 2013, of reflection and commemoration for those we lost and for those who survived the Boston Marathon bombing. With insider knowledge, my class discussed what it was like to be immersed in the exposure to that traumatic incident, and then, graciously, they allowed me to guide them to think viscerally about effects of traumatic incidents on individual, family, and community health, across other spaces and places. I discussed my own work in conflict affected states, including Sri Lanka but also other countries. I talked about Judith Herman’s[1] work, how the severity of traumatic events cannot fit on a linear scale or dimension; there are complex layers of experiences and external events particular to each person, each setting, each intersection of identity and social location. This is a fit for my systemic family work, and I have found her writings invaluable as I work across the globe. Herman goes on to say that in spite of the complexity of experiences, there are common salient characteristics across the severity of traumatic events. In other words, there are patterns: Exposure to extreme violence; Physical violation or injury; Witnessing grotesque death; Sense of helplessness in the face of the event(s); threats to life or bodily integrity; a close personal encounter with violence and death; a feeling of “intense fear, helplessness, loss of control, threat of
annihilation” (p. 33). 


The students, keenly sensitive to and still freshly remembering what had happened in Boston in 2013, seemed to understand the points about how traumatic incidents, while contextual and diverse, share particular patterns. Sri Lanka had been fresh in our class discussions for another reason: I had just returned from a vacation there the week prior. Arriving back at Logan airport a day later than planned, and after being delayed over two hours upon arrival, I had barely made it to class on time. I was jetlagged, ragged, and disoriented. As I tried to do the lecture, one student raised her hand: “Is your hair blue?” I’d forgotten—a stylist I often see at Crescat Mall in Colombo, Ananda, had died some of it blue. I don’t know if it was my lecture on Sri Lanka, or my stories, or my blue hair, or something else altogether, but somehow, the students had become highly sensitized to what had happened there, to traumatic incidents beyond their own geographical home. The Easter Sunday Attacks had confirmed that their insider knowledge had indeed crossed space and place. They understood what exposure to violence could do to a person, a family, and that knowledge had opened a door, viscerally and theoretically.

At the end of Tuesday’s class, Danaa asked me a surprising question: “So, will you go to Sri Lanka?” This was a question I did not expect. I am always going to Sri Lanka! I thought to myself. I have lost count of the number of times I have been there, but it now averages more than once a year.[2] Almost in every case, the projects are brought forward by my Sri Lankan colleagues themselves, and inspired by work we do together. I adapt to what their suggestions are, as they are the best ones to know the needs of the communities in their country, and how I can best support them. Their work also generates new questions for me; I’ve published three books with colleagues in Sri Lanka. Together, we can find so many ways to focus on how to support professionals in their capacity to support families in the context of Sri Lanka.

I answered Danaa as thoughtfully as I could: “Sri Lanka is well resourced; there are many trained people who do what I do, they are incredibly innovative and sharp and creative. So, no, I don’t expect to go.” It’s true. Most low and middle income countries face a shortage of professionals in mental health, and Sri Lanka faces that challenge as well, but they also have a robust segment of professionals working to meet that challenge head on, and they are already inside the country. Sri Lanka is a fragile state, a post conflict state, and in fragile, conflict-affected states, the government is challenged to provide direct security to its citizens and is limited in its ability to deliver basic services. However, the sophistication of the professionals who do what I do in spite of limited state capacity is incredible. It’s inspiring. Sometimes, psychosocial innovation comes from the need to be at high capacity. Sri Lankans know this intimately after the Boxing Day Tsunami, after three decades of war, and other key critical incidents of violence throughout the nation’s recent history. In fact, it has made them even more expert. As Richard Mollica put it, we can become higher in our awareness after a severe traumatic event, exquisitely sensitive to what needs to be done to reconnect the “before” and “after”, precisely because of our exposure to it.[3]

However, I understand the meta message that is part of Danaa’s question. It is a very natural human impulse to want to intervene, to do something. This impulse is particularly powerful amongst those of us in the helping professions; I have felt it before, many times. But I don’t experience that impulse when it comes to Sri Lanka—I’ve been there too often and I’m too keenly aware of its assets, its internal and often hidden set of strengths. Although I have certainly delivered my share of trainings in Sri Lanka, I am just as likely to be the one observing, learning, while Sri Lankans are busy on the ground, as they are right now, focusing on how to support families within their context. Two days ago, I was added to a WhatsApp group for MHPSS response to the emergency; the group originates inside Sri Lanka, and its activities are managed and conducted by local people for local people. (The foreigners who were affected by the bombings in Sri Lanka seem to be supported primarily by their embassies). It is an honor to be witness to the sensitivity of our Sri Lankan colleagues, beginning the hard work to support families exposed to this traumatic violence. We experienced that in Boston, too, during the Marathon bombing, when my colleague Richard Mollica offered our clinical team a guide and set of recommendations. For everyday Sri Lankans, who have already lived through three decades of war, this current situation is painful in a new but also familiar way. Of course, I will support them any way I can. But most of all, I am proud to stand alongside them, across all of the spaces and places, as they teach me and others the way forward.

 

Laurie L Charlés, Ph.D., L.M.F.T., implements systemic family therapy practice in international humanitarian relief contexts, in low- and middle-income countries, and with vulnerable populations in conflict-affected states. She is the author and co-editor of several books in family therapy and qualitative research, including Family Systems and Global Humanitarian Mental Health: Approaches in the Field (2019) and Family Therapy in Global Humanitarian Contexts: Voices and Issues from the Field (2016), both with Dr. Gameela Samarasinghe, as well as the forthcoming Family Therapy Supervision in Extraordinary Settings, with Dr. Thorana Nelson. She is an AAMFT Approved Supervisor and Clinical Fellow.

 

[1] Herman, J. (1997) Trauma  & Recovery: The aftermath of violence—from Domestic Abuse to Political Terror. NY: Basic Books.

[2] For example, from April to September, 2018, I was consultant to an international NGO in Colombo, contracted to help write and develop a grassroots toolkit to be used by practitioners engaged in transitional justice work, increasing their knowledge on how/what impacts can be expected following a traumatic experience and guide them on how to engage people in storytelling and memorialization in a psychosocially sensitive manner. I’ve conducted trainings and workshops for NGOs in Sri Lanka across the years 2011-2018, in “Group Methods/Counselling” training for psychosocial workers based in north and eastern regions of post-conflict Sri Lanka; to introduce the concept of self-reflection in psychosocial work; in using Appreciative Inquiry and Richard Mollica’s “The Trauma Story” in psychosocial work with war affected communities. I’ve taught family therapy methods, interventions, and interviewing at the University of Colombo Faculty of Graduate Studies, as a Visiting Professor and a Guest Lecturer; conducted focus groups with psychosocial workers in research projects that resulted in manuals published in Tamil, Sinhala and English. I’ve been a Fulbright Scholar there twice, first in 2010 and again in 2017/2018, as a Fulbright Global Scholar in two conflict affected regions of the globe, including in Sri Lanka, where I focused on the challenges of family-focused mental health and psychosocial support (MHPSS) project delivery in the context of each country’s state structures and international partnerships.

[3] Mollica, R. (2006). Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. Harcourt: NY

photos courtesy of Laurie Charlés

How Do You Know It’s Time to See A Therapist?

There are many misconceptions about therapy and—let’s face it— asking for help can be difficult, especially when it comes to matters of mental health. We may ignore or suppress negative feelings to maintain an image of being able to handle our problems. Or we may believe that our difficulties are not that serious compared to those of others. Often that is why we put off seeking help and why, for most, it can be hard to know when it’s time to see a therapist. Here are some insights from marriage and family therapists on when to reach out for help. 

Sometimes our best efforts to resolve a problem leave us feeling confused, hopeless, frustrated and asking, "Why does this keep happening to me?" This is a great time to consider seeing a therapist. Another great time to seek professional help? Usually when a friend or family member suggests it (if you believe generally that the person has your best interests at heart). We can become so tangled in our own life that we forget to pay attention to our mental health needs, and sometimes others notice first. Heather Holmgren, MFT, Salt Lake City, UT

We are constantly responding to problems that show up in our lives (problems at work, relationship difficulties, mounting pressures) and are often able to work through or alleviate the influence of these problems by ourselves or with the help of friends and family. However, especially in times of greater vulnerability (compounding stressors, after a loss, major life transitions), even little problems can start to show up more often and at times when we do not want them to. Whatever the problems may be, when they interfere in your daily life (influencing your thoughts, emotions & behaviors) and potentially disrupt your relationships (partner, family, friends, coworkers) then seeking out a therapist might be an important step in returning to life as you want it to be. Eugene Hall, LAMFT, Minneapolis, MN

When you and your partner become gridlocked on an issue. Many couples have issues to deal with in their relationship. Some issues that never get resolved. It's how a couple handles this that can really make or break a relationship. If a couple is in gridlock, essentially the problem comes up often and they each get defensive about it. It becomes a devastating elephant in the room. They never find a resolution or even a happy middle ground for how tolerate the issue better. If you and your partner are gridlocked on an issue, it is good to seek some help from an outside party.

You can also come in to therapy for preventive matters. Before getting married or before having a baby is a great time to come into therapy for a relationship checkup and to explore different issues that are likely to arise as a part of the transition. I have noticed that couples that spend time exploring potential issues tend to make transitions better. Come into therapy to talk about what it will be like as a new parent. What challenges do couples face with a new baby? How will our sex life change after baby? What will be our plan for discipline and teaching our child new behaviors? etc. Angela Skurtu, M.Ed. LMFT, St. Louis, MO

If you know that it is time to seek therapy, we can help. Marriage and family therapists (MFTs) are trained in psychotherapy and family systems, and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples and family systems. The unique feature you will find during treatment with an MFT is the therapist will focus on understanding your symptoms and diagnoses within interactions and relationships. The existing environment and context is given careful examination paying particular attention to the family system – as defined by you. MFTs treat predominantly individuals but always from the perspective that “relationships matter.” Find a therapist here. 

The American Association for Marriage and Family Therapy represents over 50,000 marriage and family therapists worldwide. 

 

The Experiential Process of our Country's Stagnation and Growth

The morning after the election I began processing the results with my colleague and practicum students I train and supervise. Shortly into a dialogue with one supervisee, I recalled an interaction she and I had following a family therapy session we recently co-facilitated. I run a training model grounded in experiential, gestalt-based approaches and we were a few weeks into her first family therapy client. As it generally tends to go—slowly, and then all at once—the experiential nature of the session evoked years' worth of suppressed emotion. Anger, grief, confrontations with mortality, abandonment, and various ambiguous losses that the family had always felt, but desperately tried to move on from and ignore. It quickly filled the therapy space. It was messy. It was ugly. It was raw. But it was authentic.

At the end of the session my supervisee looked at me in distress and said, "That was awful..." Although I wasn't surprised by her response, I was left with a much different impression of what was just experienced. We then discussed how experiential therapies—and the growth process in general—is not always pretty, and often, gets messy. Messy, but not worse. I never liked the phrase that "things get worse before they get better" relative to the therapeutic process. I feel that it fails to honor the courageous work of our clients as they confront the realities of their experience. To me, this has never been a process of things getting worse, but instead, things becoming more. More feeling. More complexity. More weight. More authenticity as clients face the brutal truths that entail their existence. The very experience of authenticity that begins the process of integration and growth. But moving from point A to point B often requires the suppressed rising to the surface in a way that relieves any individual from denying its presence. Whitaker urged that the entire family be present in order for the process to take effect, as it required every member of the system to not only bear witness, but to feel. Once it's in the room with us—all of us—only then can the system collectively begin working through.

To me, this is what I see happening with our country. The very ugly that so many have desperately tried to ignore has now risen to the surface. Looking back to early October I can think of so many individuals in my personal life that would deny the presence of racism, misogyny, and various forms of oppression in contemporary North-American society. Coalitions with the media and various political parties joined to maintain the suppression of the lived experience of countless humans sharing our soil. And just like a family system, the suppressed emotion of a painful truth manifested in various microaggressions, disguised just enough to keep reality buried for a large enough majority. Many were kept distracted, others were pathologized, and too many were scapegoated.

I can now see a homeostasis that was established and maintained over the past several decades. Progress was made, but in so many ways, our country stayed just the same. Racism and oppression were never overcome—they evolved to survive. But those that live it, and the others that grew aware and listened, never stopped fighting. The positive feedback loop of social progress continued to challenge the homeostasis of our country's moral climate. But the more progression tried to pull the homeostasis forward, with just as much might conservative values and beliefs countered with negative feedback. This general functioning of our country's social system continued, pushing each party further away from one another with each passing election. All the while, who felt it the most? Our human system. As the tension between progress and conservatism intensified, so did the system's dysfunction. As we know, a system's ability to maintain homeostasis in the midst of intense positive and negative feedback will eventually tire. And in the earliest morning hours of November 9, 2016, the tension that once stagnated the system snapped.

Much like the experiential process of therapy, the hatred that has always been present, but remained suppressed in so many ways, spiraled to the surface. It is messy. It is ugly. It is raw. But it is authentic. It is something that has always been there, but now, is right in front of our country's eyes. No longer can individuals claim that racism died and equality was achieved. Now, the hatred and divisiveness that is so deeply entwined in the moral fabric of our country has painfully filled the space, and we are all here to bear witness.

Is it too soon to find a silver lining? Did this have to happen in order for our country to be released from the homeostatic forces that stagnated social progress? It's hard to find hope as acts of hatred and violence continue to inflict so many members of our global family, but I also can't deny the parallel to what I've come to know as the human growth process. I won't say that this needed to happen, but since it has, I will remain present and connected as we hold its weight and ambiguity. As challenging as it may be to see, I will remain mindful of the universal pain and yearning that still unites us. I will continue to cultivate hope that, perhaps now, we can begin the healing process of integration and growth. Perhaps now, collectively, we can begin the process of finally making America great—for everyone.

Dr. Lucas Volini, DMFT, LMFT, is a Clinical Fellow of AAMFT, an Assistant Professor at Saint Mary's University of Minnesota in the MFT Program, and author of The National Licensing Exam for Marriage and Family Therapy: An Independent Study Guide. He also maintains a private practice in Waconia, MN. Lucas can be reached at [email protected]

MFTs in Schools

Schools are where children spend the majority of their time outside of the home. Schools are also the only place where some children have access to services that promote and maintain health. Educational systems are making increasing use of mental health services to support academic achievement. Early intervention by collaborative health teams is aimed at preventing problems that can escalate into behavior dyscontrol and violence.

In recent years, schools have begun to employ system-wide programs and services to improve school climate and address the social and emotional variables that are precursors to learning. It is an auspicious time for systems-trained marriage and family therapists to join school teams. As the MFT profession matures and obtains such specialized credentials as school certification along with licensure, clinicians need to understand the culture of school systems and multidisciplinary teams in order to practice effectively on in schools.

MFTs who practice and/or consult to schools need to appreciate the unique culture of school systems and our initial “guest” role in order to engage comprehensively. We also need to appreciate the history of special education in America schools, as well as the more recent systemic initiatives such as Response to Intervention, Multitiered Systems of Support, and Positive Behavioral Intervention and Support, in order to have a fuller appreciation of the shift from linear to systemic thinking in education. 

Such orientation is necessary in order to appreciate how timely school certification for MFTs is and how relevant MFTs are to school teams. The profession of marriage and family therapy has a strong multidisciplinary history, and we are in a unique need position to appreciate the “necessary redundancies” that all mental health professionals share, as well as the singular contributions of each profession. Multidisciplinary collaboration is necessary in order to navigate the health and educational needs of all students, as well as to advocate collectively for the health needs of students and their families in in education.

Childhood trauma can profoundly affect a child’s readiness to learn, although the effects may be difficult to observe. “Squeaky wheels” most often get the grease, and often children who struggle with numbing violence at home or in their communities may experience more “invisible” symptoms of anxiety and depression that are not readily observed in an educational setting. Mental health teams who can screen and advocate for students with trauma histories can help prevent undue strife and possible violence later. 

Health care systems across the U.S. are beginning to develop a Medical Home framework, where patient and family-centered mental health services are provided in primary care settings. Likewise, health care teams in schools can provide an Educational Home in schools to promote the health and resilience of all students, particularly those in need of special services to help them achieve.

Join Kathleen for a three-part webinar series on MFTs in Schools. Learn more and register here.

Kathleen Laundy, PsyD, LMFT, MSW, is a Past President of the Connecticut Division of AAMFT and she helped pass the first legislation certifying MFTs for school-based practice in the U.S. in 2007. She is an AAMFT Approved Supervisor and Trainer, and she is on the clinical faculty of Central Connecticut State University, where she teaches preparatory courses for school certification. She is the author of Building School-Based Collaborative Mental Health Teams:  A Systems Approach to Student Achievement.

Using the MFT Lens to Venture into Uncharted Waters

When speaking publicly about the topic of my most recent book I am often asked what could have possibly been my motivation for developing such a strange specialty as working with those with pituitary tumors and other neuroendocrine and endocrine disorders? I completely agree that upon first glance, the fields of endocrinology and neurosurgery have no relevance to Marriage and Family Therapy. However, when I tell the story of how I became interested in this there is a direct, logical connection. First, I not only met someone who had a pituitary disorder, but someone who strongly felt there was a mental health component (that was largely ignored by the medical community). So, a personal connection/relationship began to spark my interest.

As MFTs we are keenly attuned to the importance of human to human connections. When I decided to explore the topic further I discovered that hormones are part of a “system” within the body that connects to virtually all parts of the body, and this system is closely connected to areas of the brain affecting emotions. Next, I was horrified to learn that even today it often takes patients months to years (if they are lucky to find the right physician) to get proper medical diagnosis and even longer to find qualified specialists for treatment. The idea that patients and their families are so intensely impacted by these disorders and yet cannot find help seems impossible in a modern age. Lastly, after talking to hundreds of patients and their family members worldwide I was struck, as a therapist, by the impact that disorders of the endocrine system have on the external family and social system. It was this internal/biological system’s impact on the external family/social system that gave me the impetus to delve into learning about such a highly specialized medical world.

Students of Marriage and Family Therapy are taught to stay within the boundaries of their license and not to practice outside their expertise. But, how is one to gain expertise if not to stretch beyond the zone of comfort? In this brief missive I am not going to attempt to answer this important question but will say it is something I had to face in the early years of developing my unique area of specialty. After practicing over thirty years now I have witnessed an overall growth in the depth of the MFT profession that includes a wider array of options for use of systemic theory and concepts. This also includes opportunities to bring a systemic and family therapy understanding to those who would never have previously thought it could apply or be helpful.

When I first began my work with pituitary/endocrine disorder patients and their families, the physicians I came to know would refer to me as a psychiatrist or psychologist. Rather than let this lie, I gently and briefly began to let them know the differences among the mental health professions. I have also had wonderful opportunities to reach a wide audience through writing/editing books (with contributions from world-renown physicians, patient advocates, medical family therapists, and patients) as well as online newsletters, blogs etc. Not only have I used such opportunities to provide education/support about a wide array of endocrine disorders, but conversely to inform readers about MFT and systemic thinking as it may apply to family and social dynamics of serious and/or chronic medical illnesses. I encourage MFT students as well as seasoned professionals to seek-out potential opportunities to use and teach MFT concepts to those outside the walls of a psychotherapy practice or graduate program specific to MFT.

Read Linda's article, The Family System and Chronic/Severe Illness, here. MFTs, in what unique ways have you integrated your training? Tell us!

Linda M. Rio, MA, MFT co-authored a book with her daughter, Tara, on eating disorders and her most recent book, The Hormone Factor in Mental Health: Bridging the Mind-body Gap, includes contributions from some of the world’s top experts in endocrinology, medical family therapy, nutrition, case studies and accounts from patients and their family members. She has served AAMFT in a variety of roles in her division and nationally. She has been married for 47 years, has two children and 3 granddaughters who are now in college. Find her at www.lindamrio.com.

 

Rabbit/Duck Season

 

The "rabbit season/duck season" argument occurs often among couples. They go back and forth and back and forth and back and forth, usually with someone getting "blown up." This ping pong match features lots of conflict which goes nowhere.  Just like rabbit and duck season, nothing is solved, there is no resolution of the conflict, and there are no negotiations. Things just go boom!

What is the cost of that boom? More conflict, less communication, holding grudges and resentment, less intimacy, and further distance between partners— a loud boom indeed for a relationship. The ironic part of this conflict is that many of the topics in the argument are pretty worthless. It is conflict for the sake of conflict and conflict in order to win. Please pause from reading this and think about the last five fights that you and your partner have had...

How many of these involved “big ticket items”— addiction, mental illness, infidelity, domestic violence?

How many of these involved a misunderstanding/misperception of who was going to do what /when?

If you have big ticket item fights you should be attending regular couples and individual therapy – Schedule that now.

If you are having the “rabbit season/ duck season” fights—explain to YOURSELF why you are doing this. Please do not rationalize, justify and blame your partner for HIS/HER actions.  Please ask yourself……Why am I doing this? What is MY part in the fight? What is MY ISSUE that keeps coming up? Why do I want to engage in this conflict? Do you want to know? (Do you need to know?)

YOU have the power to change YOUR behavior! If you do that, you can change the relationship! If you change one part of a relationship, that changes other parts of the relationship -- a lengthy conversation for another time.

At this point, you may be feeling defensive and wondering why YOU have to do all the work? What about your partner? Shouldn’t s/he be doing some of this SELF examination? You may want your partner to do this, but is your partner open to this inquiry? If s/he is willing, communicate your desire for him/her to change in a loving, soft, gentle way. No need for another boom. If your partner is not open to change, then you have two choices— keep having booms over small ticket items or change YOURSELF. Start with the questions from the previous paragraph. Identify that issue. Work on making it better. Since you are looking at yourself, ask the hard question— is there any truth to what my partner is saying about me? If I’m accused of being loud and obnoxious and insensitive, is there truth in that? If so, how can I change that? Can I be warmer, more caring, and more empathetic? Can I be a better listener? Do I have to win every round of every fight? (You don’t.)

If you work on changing yourself, then something magical is going to happen— you will feel better. You will feel better about the world, you will feel better about your partner, and you will feel better about the relationship. You will see how worthless the "rabbit season/duck season” argument is and how it is much better to appreciate the positives that your partner brings to the table, not his/her deficiencies. You can also acknowledge those positives, and validate his/her behaviors that you appreciate (instead of criticizing your partner repeatedly).

What do you have to lose? Many pointless hours of frustration, stress, agitation.

What do you have to gain?  Peace, change and love.

Seems like a simple decision.

Change is possible.

 

Jeffrey M. Brandler, EdS, CAS, SAP, has been in private practice for individuals, couples, and families in Mountain Lakes, NJ, for 31 years. He is a requested speaker and trainer for industry, schools, and self-help groups. He is the chapter advisor for the Depression Bipolar Support Alliance (DBSA) in Morristown NJ, and has been published on several occasions for the NJ chapter of the AAMFT. Visit his website at www.changeispossible.org. 

Forgiveness: The Benefits of Letting Go

As a marriage and family therapist, I have worked with various presentations of injured relationships (often related to infidelity) and the most productive and positive results come with forgiveness. When anger and bitterness are directed toward anyone, including ourselves, the result fuels further vulnerability. Infidelity, for example, injures the foundation of relationships, leaving both parties with a difficult choice—hold on to negative feelings or let go and move forward. In my work, I often talk about forgiveness, and while it is easy for me to talk about it, putting it into action can be, and often is, challenging for clients trying to cope with an emotional injury.   

Nearly everyone has been on the receiving end of a comment or action that is hurtful. Maybe your spouse had an affair or your best friend lied to you, intending to “protect you.” When we feel betrayed by someone we trust and love, it can be excruciatingly difficult to understand how that person hurt us, intentionally or not. And there is a host of negative emotions that keep us imprisoned in our anger or sadness, unless we forgive and move forward. Forgiveness shares a border with betrayal and is necessary for us to heal.

Human forgiveness may be understood as the act of letting go of negative emotions, and the challenge for most, if not all of us, is how to do that.  It can be difficult to find compassion for someone who has wronged us in some way; depending on the offence, it can be nearly impossible. There are shades of grey when it comes to forgiving, yet succeeding in doing so brings great benefits to the sufferer.

Why is it so important to practice forgiveness, or at the very least, engage in its possibilities?  Engaging in forgiveness frees us from the toxic emotions that accompany grudges and bitterness. In fact, it is in our own interest—our happiness and inner peace—that we forgive. Holding an intense grudge mimics the notion that “resentment is like drinking poison and expecting someone else to die from it.” We end up hurting ourselves when we don’t practice forgiveness. And yet, we walk a fine line between being oblivious to the infraction that caused us pain and stewing in resentment.

While it is clear that forgiveness yields benefits, making peace with actions or events that feel unfair is hard work! It requires self-awareness and understanding of our own need for forgiveness, without hubris. Has the sufferer never intentionally or unintentionally hurt someone else? One needs to access difficult and painful emotions that often resemble grief. The injured party has to look deep inside and ask how productive it will be to hold onto their anger and possible vengeance for the wrongdoer. It becomes a tug of war between intellect and emotion. Logic says let go, while the emotional self wants to even the score somehow.

Forgiveness, like grief, is a process. The initial discovery that someone we love hurt us or has been taken from us in some unjust way is met with shock—protecting us from plunging into despair.  And as it lifts, we move through stages of denial, anger, depression—vacillating between them —until we finally reach acceptance. Just as grief is a process that changes us in ways we never imagined, forgiveness is transformative and freeing in ways that release us from our suffering.

The benefits of forgiveness often outweigh the consequences of nursing the sentiment of being wronged or attempting forms of revenge.  As systemic therapists, one can easily connect forgiveness to relationships, and when we are able to forgive ­—ourselves and/or others— the outcomes are positive for everyone. Forgiveness can lead to benefits such as:

• healthier relationships
• increased self-awareness and self-esteem
• reduced anxiety, stress, and hostility
• greater spiritual and psychological well-being
• improved heart health and lower blood pressure
• fewer symptoms of depression

When we are able to have compassion for the humanness we all possess, we are able to engage in forgiveness. Be patient and kind to yourself along the way. As with anything that requires great strength and tenacity, it takes time and some days will be harder than others.

Vanessa Bradden, LMFT is a staff member at AAMFT, collaborating with the Communications Department as a product development specialist. She has a private practice in Chicago and is an AAMFT Approved Supervisor. Vanessa’s clinical interests and expertise include working with individuals and couples coping with perinatal mood disorders, pregnancy loss as well as grief and other losses.

Sexual Desire Issues in Couple’s Therapy

On Monday I meet with Julian and Ken who are describing a typical weeknight in which they come home from work and have 2 hours together, exhausted in front of the TV, and then drop in to bed with only a fleeting thought, “We haven’t had sex in awhile”.

The next day I sit with Karen talking about her ADHD diagnosis and how her symptoms may be related to her difficulty switching into sexual energy or enjoying sex when she is having it.

Tom and Aamani cry together as they share that they stopped feeling sexual desire for each other long ago and have decided they don’t want to work towards reestablishing their sex life. They wonder what this will mean for them now?

Julio shares with me a deep resentment from the near constant bickering with his wife and admits he does crave sex, just not when they feel so disconnected and hostile all the time.

Sarah angrily tells her partner, “I might have sexual desire if you weren’t pestering me for sex all the time! And besides it’s over so fast, why bother?!”

All of these clients may present in your practice for issues of low sexual desire. But their needs for support are incredibly different. Assessing what the issues really are and how they play out for each unique client is a complex process, requiring us to take in to account lifestyle, health, diagnoses, relationship patterns, social expectations, beliefs, myths, and more. There is no one size fits all definition or solution for low sexual desire.

Our sexuality is entwined with all aspects of self and our lives in each new phase. Issues and questions of low desire open deep conversation and exploration into the walls and barriers that clients or others in their lives have put up to keep sexual energy at bay. The consequences for clients with low desire are real, relationships end or can lose vitality, self esteem can be hurt, and an integral part of the self feels lost.

These are tender areas, and clients often tell me that this is the topic they left unspoken for years, until it felt too hard to endure. Sadly, I also often have clients tell me that they did bring this up with a past therapist and felt shut down by discomfort in the therapist, dismissed as though sex is not important enough to focus on, or in one recent case, told to just drink a glass of wine and that would take care of it.

Why is desire so hard to talk about? We have been trained over time to see sexuality as compartmentalized; its own set of private issues. We certainly have been exposed to an unrealistic view of sex based on the desires and abilities of 18 year olds. We have been encouraged to believe that love will automatically be linked to sexual desire and that this energy will take care of itself if we just have enough intimacy. And we have fears and hesitations to talk about sex at all. I use “we” consciously here – we as therapists often share these limiting perspectives with our clients, making it even harder to support them in navigating the intricacies and vulnerabilities of repairing sexual connection. We can do better.

As we think more deeply about what healthy sexuality really looks like in this diverse world, we open new possibilities for healthy expression of sexuality. As we expand our understanding of the holistic aspect of sexuality, we can help clients find their way to a sex life that works for them in their changing and evolving lives and relationships. And as we honor sexuality as a valuable and complex part of who we are, we all benefit.

Explore this topic in-depth with Melissa Fritchle, LMFT, Sex Therapist & Educator during a webinar on 02/19, titled "Sexual Desire Issues in Couple’s Therapy." Click here for details.

Melissa Fritchle is a licensed marriage and family therapist, sex therapist and sex educator in Santa Cruz, CA. She is the author of The Conscious Sexual Self Workbook and writes an ongoing blog on sex and relationships. She is adjunct faculty for two Bay Area graduate programs in Counseling Psychology and travels in the US & internationally to provide workshops and trainings. In 2011, she was awarded the Sexual Intelligence award for her groundbreaking work providing sex positive training for counselors and caregivers in Uganda. In 2014 she worked in Kenya with a group of priests and nuns addressing sex positive approaches to sexual issues within the clergy.