The AAMFT Blog

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 

 

90 Day Business Plan for Private Practice Therapists

Guest Blog: by AAMFT affinity partner zynnyme

As a private practice therapist, you need a business plan.

But not just any plan. You want to create one that grows with your business and reconnects with those deep parts of you that give you the energy to make your plan a reality. Because private practice success looks different for everyone, and you want to be in genuine alignment with who you currently are — NOT the “you” from months (or even years) ago who had different goals.

Many therapists in private practice who develop an initial business plan, focus on a business plan that outlines broadly what they’ll do over the next 3-5 years. Then, that business plan collects physical or virtual dust as they start actually running their business. Often, the business plan and the day-to-day operations are completely disconnected from each other.

That is why we recommend starting with a 90-day business plan. It keeps things focused on things you can achieve and implement over the next 3 months. It helps reduce the overwhelm. And finally, it turns it from a dusty document to a game plan, so you know what you’re doing and WHY -- week by week and month by month. 

An effective 90-day business plan involves eight key elements:

• Your vision for life and practice.
• Your schedule and organization.
• Your documentation.
• Your processes.
• Your financial plan.
• Your niche and messaging.
• Your private practice website.
• And your marketing plan.

Let’s cover each of these areas in more detail…

Private Practice Vision

This is the foundation of your business.

As a reminder, it’s okay to change. In fact, depending on how long you’ve been in solo or group private practice, that might be exactly what your business needs to reach that next level!

When you’re creating your ideal vision, you want to include not just time for your practice but also time for your life. Journal about your one-of-a-kind strengths as a therapist — or, if you have some people in your life you can ask, share a survey with them (even if it’s anonymous).

It’s all about identifying (or reconnecting) with your core values.

Schedule and Organization

Just like your vision — you’ll notice a trend here! — you want to create a schedule that includes time for the impactful work you do AND your personal life. Figure out a way to organize your plan and tasks that works for YOUR brain and learning style. This isn’t one-size-fits-all!

And don’t forget to get your calendar organized. If you have multiple calendars, ensure they’re all in sync with each other. We personally recommend software like Google Calendar where you can have a virtual record of everything you need (and want) to do and easily make updates.

Private Practice Documentation

Do you have a way of doing your notes that allows you to finish in 5 minutes or less? Do you have a clear informed consent with a clear cancellation policy?

We recommend a 48-hour cancellation policy at minimum, but feel free to set up something like 72 hours in advance if that works better for you. The goal here, like with all the other parts of your 90-day business plan for private practice, is to create something sustainable.

And speaking of sustainable… we recommend a paperless office.

The less you have to lock away in filing cabinets, the more ease of access (and, for many private practice therapists, peace of mind) to your business and clinical documents.

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 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.