The AAMFT Blog

Reflections from a Veteran and MFT

by John Stinebaugh, Chair of the Working with Military Personnel and their Families Topical Interest Network. 

This past Memorial Day, I heard several times how much everyone is looking forward to the long weekend. Camping, family time, and of course barbecuing are the plans for the unofficial start of summertime here in the United States. It is of course coupled with a holiday of remembrance for those who have died in the course of service to others.

As a veteran, the Memorial Day holiday has always been tricky. While it is nice to have those who are well-intentioned thank me for my service, it is a personal reminder that those who I have called brothers and sisters in arms have died and continue to die. I can honestly say that one of the more sobering moments of my life is when the first report of Marines killed in action contained the names of those who had begun their service around the same time as me.

As systemically minded therapists, military culture is one that our mindset uniquely prepares us for. Here is a culture that is voluntarily joined, and deliberately creates new systems and structures around a person. Transitioning out of this system and dealing with the myriad of stresses associated with it can be a real challenge. Those on active duty and veterans alike die by suicide at alarming rates.

This problem has become so difficult that the Commandant of the Marine Corps released a two-page letter on mental wellness to try to stem this tide of loss. Most significantly, he encourages service members to reach out and ask for help. It is after all how we approach other problems in the military, so why not this one?

While I could talk at length about this, and I do hope more conversations follow, I would like to leave you with the following thoughts.

1. If you are active duty or a veteran, please ask for help. There are so many of us who will do whatever we can to help in whatever way we can. There are so many more options than you know and we are striving to create more.
2. On the same token, if you know a veteran or an active duty service member, ask them if they are ok and then listen to what they have to say. We know this is important in our work and as a group we tend not to ask for the help but will answer someone if asked.
3. Consider joining or supporting our Topical Interest Network for Working with Military Personnel and their Families. Our plans for the next two years include competencies for working with this population, webinars on emerging topics like games and their impact on mental wellness, and emerging trends in suicide. We also provide an online forum that includes many veterans or family members of active duty military, all marriage and family therapists. Adding your voice, expertise, and willingness to help will make us a stronger team.

 

John Stinebaugh is a licensed marriage and family therapist in Colorado and Wyoming and has been in community mental health for over 12 years. He has worked extensively with youth and families in his clinical work, and has developed numerous programs including dealing with first episode psychosis, at risk youth and families, telehealth services and supervision in his time as an administrator. He is a recipient of the AAMFT certificate in leadership from its inaugural cohort. John enjoys disc golf, geocaching, reading, anything Star Wars, and spending time with his wife and two cats.

 

Why Pride Matters for Marriage and Family Therapists

June is celebrated by many as Pride month. The first Pride march was established through the courage of Brenda Howard, a bisexual woman reverently known as the "Mother of Pride." This was due to her work coordinating first a rally and then the Christopher Street Liberation Day March to commemorate the first anniversary of the Stonewall Riots, which happened on June 28, 1969. These riots were led by trans feminine people of color-such as Sylvia Rivera and Marsha P. Johnson- tired of being targeted and criminalized by the police because of their race, ethnicity, gender and sexuality. It is important to remember, now more than ever, that Pride was initially rooted in active resistance to pathology, criminalization, racism, transphobia and queerphobia. Pride, at its best, is about celebration of the wonderful and essential diversity of genders and sexualities, it is about community and the family that many of us find with one another when faced with rejection or misunderstanding by our families of origin.

For many trans and queer individual and families, Pride is a time to remember that we are not alone, to celebrate our survival and to come together. Pride is also complicated given that in many places corporations use it as yet another way to push capitalist consumption and many parades often have a police presence, which can make Pride feel unsafe for many trans and queer people, especially Black and Brown members of our communities who are too often impacted by systemic violence. Yet, every year since 1970 in this place we currently call the United States, Pride is celebrated, mostly during the month of June and many trans and queer people find safety, acceptance and community through Pride-related events.

As marriage and family therapists we know how important systems of support are, how essential families and relationships, and a sense of belonging to community are to our well-being. As systemic therapists we are uniquely located to support queer and trans families, as well as colleagues, not only during Pride month but all year long. For example, we know from research evidence that family support is a protective factor for trans, nonbinary and queer youth and we can have an instrumental role in this process. In alignment with our code of ethics and our commitment to health across communities, we can disrupt the ongoing systemic dynamics contributing to systemic oppression and violence against trans and queer people, especially trans feminine people of color.

May this Pride season remind us that our communities thrive when we can celebrate the wonderful gender and sexual diversity in our humanity and that we, as marriage and family therapists, have a unique role to play in the ongoing survival, resistance, celebration and support of gender and sexual minorities.

 

Alex Iantaffi, PhD, MS, SEP, CST, LMFT, is a Licensed Marriage and Family Therapist, Clinical Fellow and Approved Supervisor with the American Association for Marriage and Family Therapists, Certified Sex Therapist with the American Association of Sex Educators, Counselors, and Therapists, Somatic ExperiencingⓇ practitioner, writer and independent scholar. Alex co-owns a small group private practice, Edges Wellness Center LLC, and is passionate about healing justice and community-based scholarship. They are adjunct faculty at the University of Wisconsin-Stout, where they teach on the Graduate Certificate in Sex Therapy. They were the Editor-in-Chief for the Journal of Sexual and Relationship Therapy for eleven years and have researched, presented and published extensively on gender, disability, sexuality, bisexuality, polyamory, BDSM, Deafness, education, sexual health, HIV prevention, and transgender issues. Alex is the Chair Elect of the Queer and Trans Advocacy Network.

Remembering Douglas H. Sprenkle

by Fred P. Piercy

Douglas H. Sprenkle died peacefully in his sleep on August 15 after a battle with pancreatic cancer. He was a good man, loving husband, father and grandfather, and a giant in the field of marriage and family therapy. He was also my friend.  

William Wordsworth once said, “The best portion of a good man's life is his little, nameless, unremembered acts of kindness and love.” Doug certainly made a difference to the field, but it was his mentoring—those acts of kindness he gave freely—that have had reverberations throughout the field of family therapy for decades. Many of his students have become leaders themselves, and likewise carry on the generosity of spirit that they experienced from Doug.

I met Doug around 1980. I remember him being hard to read initially. He seemed serious and intense. Our colleague, Wallace Denton, put me straight. Wallace said, “Doug is a prince of a person,” and he was right. Professionally, Doug’s work shaped our field, and I feel so fortunate to be witness to this.  

Doug received his bachelor’s in Government from Wesleyan University (1963), a masters from Princeton Theological Seminary (1967), and a masters (1973) and doctorate (1975) in Family Social Science with a minor in Psychology from the University of Minnesota. Doug spent his entire post-doctoral career of 39 years with the Marriage and Family Therapy program, Department of Human Development and Family Studies, at Purdue University. He was Purdue’s MFT program director from 1985 to 1994 and again from 2003 to 2014. Doug also maintained a small private practice in Lafayette, Indiana.

When Doug visited Virginia Tech, one of my students called him a rock star. That seems fitting since the breadth of his contributions is unprecedented in the history of family therapy. How many leading scholars in the field do you know who have also won two national teaching awards, directed a leading doctoral program, served as a state MFT President; served the American Association for Marriage and Family Therapy (AAMFT) as the Editor of their flagship journal, the Journal of Marital and Family Therapy, for two four-year terms, served as a member of the Commission on Accreditation, as Treasurer and member of the AAMFT Board, and as board member and Treasurer of the International Family Therapy Association?

In 1974, the National Council on Family Relations awarded Doug its Outstanding Student Award—given to the student with the "greatest potential to make an outstanding contribution to the field of family studies."  Well, Doug obviously lived up to his potential since he went on to win seven major national family awards, including most recently, AAMFT’s Outstanding Contributions to Marriage and Family Therapy Award.  

Doug was a prolific author who wrote over 130 refereed journal articles and was cited over 6,000 times. His very first paper, published in Family Relations in 1975 was titled "The Need for the Integration of Theory, Research, and Practice in the Family Field." Doug's career has embodied that integration. As for research, AAMFT awarded Doug its prestigious Cumulative Career Contribution to Family Therapy Research Award, which recognized his many research publications and books, including, with Sidney Moon, his wife, and me, two editions of Family Therapy Research Methods. Doug also edited (with Ron Chenail) Effectiveness Research in Couple and Family Therapy, the second such decade review of family therapy research that he has edited. Doug also teamed up with Joseph Wetchler and me on the Family Therapy Sourcebook. He also taught the first formal course in the nation on family therapy research in 1978.  

Regarding his contributions to theory, Doug had a passionate interest in the integration of family theories since his days as a graduate student, when he co-developed with David Olson and Candyce Russell, the Circumplex Model of Marital and Family Systems—which sought to integrate a potpourri of family concepts into a model that resulted in two and then later three dimensions—cohesion, adaptability, and communication. Similarly, his most recent book, Common Factors in Couple and Family Therapy: The Overlooked Foundation for Effective Practice (with Sean Davis and Jay Lebow) reflects the passion he had for theory integration.  

Doug has my vote as the best editor in the history of the Journal of Marriage and Family Therapy. His editorship helped shape the field. He brought scholars together for special issues, emphasized the need for research on certain topics, and orchestrated unforgettable debates. He had the knack for reaching out to the best people in the field and raising the status of the journal in the process.

Doug’s influence on the field can also be seen in the large number of distinguished graduates who have made major contributions to the field, whether it be as scholars, educators, or dynamic clinicians. Eighteen of Doug’s students are serving or have served as faculty members at COAMFTE-accredited MFT programs, seven are current or former directors of COAMFTE programs, and eight won the AAMFT Research award.  

One might conclude from all of Doug’s accomplishments that there were actually Sprenkle twins or triplets, all busy at work. An alternate hypothesis is that Doug must have been a dull guy who worked too much. Well, he wasn’t dull—lovably idiosyncratic, maybe. I’ll share a few “Doug stories” to let you know what I mean and to humanize him a bit.

There’s the story of Doug in graduate school at the University of Minnesota slipping his shoes off in the library and then, not being able to find them, walking home in the snow in his socks.

And then there was the time when Doug got up in the morning, went to his garage, and his car was missing. It was only after he reported it stolen to the police that he remembered that he’d left it in front of his optometrist’s office the day before and had walked first to his office and then home.  Doug would tell such stories and laugh until he cried.

At the end of each year I was at Purdue, an end-of-the-year party always involved students doing skits that captured the faculties’ most obvious foibles. An anthropologist would call this a leveling ritual because the students pulled no punches and definitely leveled the hierarchy, at least for the evening. More than one skit involved Doug’s idiosyncrasies, from curling up his legs in his chair like a swami, to eating giant carrots, to absent-mindedly nibbling French fries off a stranger’s plate. He was a good sport and clearly one of a kind.     

Finally, let me reflect on Doug as my mentor and friend. I knew Doug for almost 40 years and worked with him for 18 years at Purdue University. Truthfully, nobody has had more of an influence on my professional life than Doug Sprenkle had. When I first came to Purdue, Doug suggested that we meet for lunch once a week, just to chat. We talked about everything—football, politics, our families, and family therapy. Those weekly meetings lasted years. Out of those mentoring chats came a great friendship and a productive professional relationship.   

Along the way, I got to know Doug’s professionalism, high standards, personal integrity, and yes, generosity of spirit. I will miss Doug. We all will.  Thanks, Doug, for all you’ve done, for what you have meant to us, and for who we’ve become in the process of knowing you. You’ve made us all better.

Fred P. Piercy, PhD, is Professor Emeritus at Virginia Tech and is currently a consultant with the Office of Drugs and Crime at the United Nations in Vienna, Austria.

Navigating Relationships and Commitment in the Millennial Generation

It may sound idealistic to the layman’s ears, but when I ask couples what they are hoping to experience in their relationship, the answers I hear are sometimes harrowing. 

“I just want to be in love.”

“I want a soul mate.”

“All I know is that I don’t want to end up like my parents’ marriage.”

“I want a partner who is my best friend and lover.”

“I just want to know they will never leave me.”

“I’m a person of very few needs. I just want to be happy.”

Beautiful statements, to be sure. But what actually makes love last? How do we know when we’ve found “The One”, and what certainty can we rely on to know they will never stray? How can a couple make sure they don’t repeat the patterns of the past and create a relational environment where they both feel nurtured, supported, autonomous, yet a deep and vulnerable intimacy?

Couples in the millennial generation have the hope and belief that such a relationship exists, yet many lack the skills, understanding, and personal development to actually attain it. 

Being in a successful, long term relationship is not easy in today’s world. In fact, it never was. As therapists, helping couples rise above the challenges of growing apart, falling out of infatuation, losing jobs, dealing with death or caretaking ill parents, feeling imprisoned to financial debt, experiencing a plummet in sexual satisfaction, or navigating the impact of social media and technology on intimacy and trust will take an understanding of how our culture functions.

Due to the advancements of today’s dating culture, we are forgetting- or never really learned- how to commit. The reality that a person has infinite partner options in the palm of their hand (or smart phone) has led to a rampant plague of choice paradox, and an anxiety defined by self-doubt and fear of regret. Monogamous couples are up against great challenges in today’s consumer culture, where the belief of the grass being greener on the other side can often run individuals out of relationships as quickly as they ran in.

If you are a clinician who sees couples in your practice today, you are working with a couple impacted by the trends and advances of the Information Age. Do you know what it means when your client “swipes left”, “Netflix and chills”, or gets “catfished”? As therapists, it is our due diligence to understand the framework of our clients’ lives. Even more refined should our awareness be when it comes to couples. Relationship dynamics are constantly changing and reforming as our culture and generation grows. The expectations that individuals and couples have of themselves and of their intimate relationships are greater today than ever before.

Join us for a webinar presentation on millennial couples and relationships with Liz Higgins, LMFT. The webinar will focus on the unique implications to consider when working with couples in today’s culture, and will explore clinical considerations while working with these clients in your practice. Whether you work with engaged, newlywed, or long-term couples, there will be something to gain from this presentation. Register here.

Liz Higgins is a Licensed Marriage and Family Therapist in Dallas, TX. She is the creator of Millennial Life Counseling, a practice focused on helping couples and individuals with the challenges of dating, engagement, and marriage in the context of the millennial age. Liz’s relationship blogs have been featured on The Huffington Post, Today, The Gottman Institute Blog, Prepare-Enrich, and more. Liz has a publication in the AAMFT Magazine, and continues to write and speak on millennial trends related to couple dynamics.

Effective Communication and Alzheimer's Disease: Working with the Family

Marriage and family therapists face various roadblocks in their professional concentrations. When working with people with Alzheimer's Disease, as well as their caregivers, family therapists have to create an ongoing and wavering form of communication. Our skills regarding listening, acting, reacting, and verbal and non-verbal communication, test our capabilities and patience.

Communication is about understanding the emotional intentions behind relayed information. Therefore, often the memory impaired individual, whose complex emotions don't align with his or her responses, makes it appear impossible to interact.

Family therapists who specialize in this work are aware that the earlier stages of the disease present quite differently than the later and final stages. Initially, activities of daily functioning and executive functioning appear in line with your observations.

As the disease progresses, family therapists find themselves learning a new form of communication. In addition, we must include their caregivers' concerns. Non-verbal communication such as, smiles, attitudes, tones, and touch will strengthen verbal communication where and when applicable. Relaying our observations to caregivers, and how family therapists apply dialogue with the care-recipient, gives the caregiver tools and support.

Over the years my personal and professional interactions with the Alzheimer's population have helped me learn how to speak, when to speak, and not to take things said or done personally, however difficult this may be.

Sheryl Stern is a Licensed Creative Arts Therapist, Licensed Marriage and Family Therapist in private practice, and an Adjunct Professor at Hofstra University in New York. She specializes in working with clients and families facing the difficulties of communication with the Alzheimer's Disease population. She can be reached at 516-662-3362, and is the author of AAMFT's therapy topic on Alzheimer's Disease. 

Legislative Victory for MFTs in South Carolina

In March of this year, South Carolina MFTs used the power of grassroots effort for a big legislative win! Marriage and Family Therapists in South Carolina have been a small but mighty force in our state from the beginning, and we have every intention of carrying on the legacy of our founders. Advocacy can seem like an overwhelming task, especially when you don’t have professional training or experience, but as the following story shows, one small connection can create mighty impact.

On January 10th, a bill was introduced in the South Carolina House of Representatives which, if passed, would have hurt Marriage and Family Therapists in the state. It sought to reduce the number of MFT representatives on our state’s licensing board by replacing one MFT representative with a licensed addictions counselor.

When the South Carolina Association of Marriage and Family Therapists (SCAMFT) found out from AAMFT that this bill had been proposed, we did several things: First, we had discussions with Laura Evans, AAMFT’s State Government Affairs Manager, about how to proceed for the best chances of success. (Laura proved to be an invaluable help during this process.) Second, we drafted a form letter on the issue to distribute to members and post on our website. Lastly, we leveraged our network using social media and an email blast to request grassroot MFT support by asking members to contact their local representatives about the bill – which many members did.

One SCAMFT member, Allen Lollis, who has a particular interest in legislative advocacy, reached out to several of his connections in the statehouse to begin the conversation about how and why this bill would be detrimental to our field.

Another member, Elizabeth Brady, e-mailed her representative, Marvin Pendarvis, with a request for a phone call or coffee. Representative Pendarvis happened to be on the committee which proposed this bill, so he agreed to meet, and Laura assisted Elizabeth in honing her message. During their conversation, Rep. Pendarvis valued what Elizabeth had to say on the issue and committed to offering an amendment which would increase the Board size, maintaining the current representation of MFTs and creating new seats for the licensed addictions counselors. Based on sharing Elizabeth’s talking points with other representatives, Rep. Pendarvis’s amendment passed unanimously!

Through this experience, SCAMFT has been reminded what we as MFTs already know – systems are only as strong as the relationships which exist within them. Having MFTs who are civically engaged enhances the profession’s ability to advocate for itself when necessary and sets a foundation to be as proactive as possible. It is easy to get caught up in the day to day business of being a therapist and to wonder how one voice (that knows very little about politics) can make a difference, but it often takes just one connection to create lasting positive results. We encourage all states to leverage the power of their membership and to train and equip their members for advocacy. It is through this collective force that we believe MFTs will establish their staying power in the greater scope of the mental health field.

 Elizabeth Martin, LMFT, is a Clinical Fellow from South Carolina. 

Hill Week and Why It Matters – From a Student MFT

Whether you’re studying to become a marriage and family therapist like myself, or are a seasoned MFT, it’s probably safe to say you know a bit about the term “imposter syndrome.” I recall sitting in the very first class of my graduate program and wondering if I had bit off more than I could chew! It wasn’t that I was unsure of my own potential; but more so that I was greatly impressed (and slightly intimidated, if we’re being honest) by the vast amount of talent and wisdom that filled the room. If you can recall an experience like this in your own life you’ll understand the similar feeling I had when traveling to Washington, D.C. as part of the AAMFT Family TEAM.

What is the AAMFT Family TEAM?

One of the core elements of the AAMFT is to actively advocate for the profession of marriage and family therapy. This includes acting to protect the recognition and respectability of marriage and family therapy as a mental health profession. AAMFT is actively involved in many federal (and state) initiatives in order to protect and advance the profession as a whole. The role of the AAMFT Family TEAM (Family Therapist Education and Advocacy Movement) is to:

1. Provide interested members with the latest developments in our federal advocacy efforts,
2. Organize members to take action with their Congresspeople when our issues reach a critical point in the federal legislative process

2018 Family Team Visit to Capitol Hill

I was invited to attend Capitol Hill as a representative of the AAMFT Family Advocacy Team on April 10-11, 2018. The purpose of this visit was to continue ongoing advocacy for the inclusion of both marriage and family therapist and mental health counselors to be recognized as mental health care providers in Medicare programs. The two key congressional bills focused on during this visit were S 1879 and HR 3032.

As a member of a key congressional district, I was paired with AAMFT contracted Federal Lobbyist David Connolly. Mr. Connolly works closely with the AAMFT as well as the CAMFT (California Association of Marriage and Family Therapy), as a trusted liaison between the organization(s) and congress. His knowledge in law and congressional matters is a key factor in the success of these visits, and I had the privilege of benefiting from the ample time he spent educating myself and other Family TEAM members on the congressional implications and the process of these bills.

During our visit, I quickly learned that a key area of focus in Congress currently is enacting measures that will help decrease the current rate of opioid addiction in the United States. In my meeting with the staff person of Senator Roy Blunt, I was able to speak to how allowing MFTs and MHCs to be included in Medicare programs would directly benefit this initiative. I explained the systemic nature of our profession, and the role that plays in facilitating change within mental health diagnoses such as addiction.

A Life-changing Story

One very memorable portion of my visit occurred before I stepped foot on Capitol Hill. David Connolly met me in the lobby of my hotel to accompany me to my scheduled meeting with Congress. As we rode towards our destination in our Uber, he explained to me the legislative background of the opioid addiction. I excitedly shared how crucial of a role the training I’m receiving as an MFT student plays in helping individuals that struggle with this.

In the midst of our conversation our Uber driver spoke up, apologizing for “eaves-dropping” on our conversation. We chuckled a bit and joked about how he didn’t really have much of choice but to overhear, considering our close quarters.

Our driver went on to tell us a very personal story about his own struggle with opioid addiction. I must admit, as an MFT graduate student with an Ethics class still fresh on my brain, my first thought was to make sure it was clear that I am NOT a licensed therapist… unsure of what route his abrupt disclosure might take.

He assured us that he was sharing information he thought might be important to let Congress know, and continued to divulge. As we arrived at our destination, I shared with him my appreciation for sharing such a vulnerable story, and walked away preparing to shift mental gears and ready myself for my meeting. Mr. Connolly, on the other hand, was in awe. He expressed how much he’d learned by simply hearing the manner I spoke with the driver and encouraged me to share his story in my meeting.

In that moment it dawned on me… in such a little time training as an MFT, the way I’d interacted with the driver had become normal to me! It’s engrained in who I am, and how I think. I am a systemic thinker who, as a default of the skill, is able to help change and encourage people simply by speaking to them! Despite me not being a licensed therapist, our driver felt he could be vulnerable in the moment. He, in essence, was saying to me, "Please take my voice with you, beyond the doors that I’m unable to accompany you through.”

In that humbling moment I was overcome with such an overwhelming sense of duty. Duty both to those in my profession; but to the future clients that I may be able to reach due to changes to current Medicare legislation. In that moment I realized that a marriage and family therapist is never something you do, it’s who you become. We facilitate change, and owe it to the communities we serve to make our services more accessible and affordable to all that choose to utilize them.

Join the Movement

Please let my visit be a confirmation that you are never too new to the profession or unversed in politics to be an advocate on the TEAM. The Family TEAM is a grassroots initiative of the AAMFT that could always use more hands on deck. Ideally, we could (and should) all play out roles to advocate for our profession. As systemic thinkers we know that a change anywhere in the system, affects the system overall. As is frequently stated in my own graduate program; “the whole is bigger than the sum of it’s parts.” Be a part of the movement! Learn more about the AAMFT Family TEAM and how you can make a difference.

Join the Family TEAM

If you would, please also take a moment to utilize this quick contact form to express to your Congressperson the importance of including MFTs in Medicare. Be sure to share on social media and via email as well. Use hashtags #MFTsInMedicare to help gain visual traction for this very impactful legislation.

Take Action on MFTs in Medicare

Cynthia Wright is a student AAMFT member, and member of the AAMFT Family Team. She attends the Family Therapy Masters Program at Friends University – Kansas City, where she is currently entering the clinical phase and working as student therapist intern within her community. In her free time, Cynthia enjoys writing about the topics of faith, family, and career on her website.

Why I Practice Gratitude

 The Power of Gratitude

When I first started working with young clients as a therapist at the Boys and Girls Club I would often begin our sessions by reading a storybook. My youngest clients were five years old and enjoyed the stories, characters, and colorful illustrations. Their anticipation and joy was palatable. I would carefully select each book and was amazed at the plethora of available storybooks covering important topics like empathy, being present, feelings, and gratitude. One day I accidently discovered the power of gratitude when I read Ladybug Girl Gives Thanks by Jacky Davis (2016). My clients’ interest in talking about gratitude was immediate and ongoing. Simply put, it made them happier. I found this positive response repeated with my adolescent clients. I soon came to realize that gratitude had a healing power that was hard to ignore.

What is gratitude? It’s about acknowledging something good in your life and appreciating that it was given. It’s the realization that we have a profound connection to others. It’s understanding that we are not alone in the world no matter how difficult life seems. I also found that gratitude interventions could be used with a variety of therapeutic modalities and is equally effective when working with individual clients, groups, or families. There are many methods of gratitude induction including making lists and sharing them. My clients often expressed their feelings of gratitude through art, drama, and games.

Gratitude and Well-Being

According to a study in Applied Psychology: Health And Well-Being gratitude interventions have positive outcomes on well-being. The study concludes that grateful contemplation has a lasting positive impact on our outlook on life (Rash, Matsuba, and Prkachin, 2011). Research described in the Clinical Psychology Review also supports the use of gratitude interventions citing improvement in many areas including personal growth, resistance to trauma, and day-to-day functioning (Wood, Frosh, and Geraghty, 2010).  

Neuropsychologist Rick Hanson believes gratitude helps shape the brain in both positive and lasting ways. He describes how new mental activity changes the structure of the brain allowing us to modify our behavior. “As a result, even fleeting thoughts and feelings can leave lasting marks on your brain, much like a spring shower can leave little trails on a hillside” (2009, p. 5). Dr. Robert A. Emmons states, “By measuring brain activity of participants researchers found that gratitude, like other complex emotions, causes synchronized activation in multiple brain regions, involving social concepts, emotional responses, logic, and sensory processing. But gratitude also lights up parts of the brain’s reward pathway and the hypothalamus, which controls the release of hormones that regulate bodily processes” (2016, p. 24). In other words gratitude amplifies a positive outlook on life helping clients see a path to improved health and emotional fitness. Gratitude helps shift the emotional shadings of our psyche both consciously and unconsciously.

Gratitude and Joy

I have had many conversations with children about gratitude and each time smiles and joy appeared on their faces and in their body language. According to Brother David Steindl-Rast the appreciation of what is given is what makes us joyful. “Those are the important elements of what gratefulness is. It is the appreciation of the gratuitously given opportunity. Mostly – I stress that – it is the opportunity to enjoy, but always it is the opportunity to do something with the opportunity given to us, to at least learn something and be creative and expect that there is something helpful coming, and then our openness will show us what this opportunity entails for us” (2013, p. 18). I wholeheartedly agree with him. I also agree with Brene Brown when she makes a connection between joy, gratitude, and human connectedness," It wasn’t just the relationship between joy and gratitude that took me by surprise. I was also startled by the fact that research participants consistently described both joyfulness and gratitude as spiritual practices that were bound to a belief in human connectedness and a power greater than us” (2012, p. 123).

In the middle of sorrow and darkness my clients were often able to be thankful for what they had. I often found myself humbled be their sensitivity and honesty. When they honored what they had it allowed them to better understand and accept their present circumstances. Did I Ever Tell You How Lucky You Are by Dr. Seuss (1973) became one of my favorite books to read. I can’t remember how many times I shared this delightful book with my clients but I can tell you it was a lot.

Gratitude and Self-Compassion

My clients did not always perceive themselves in a positive way. They would often come to sessions quiet and numb. It was as if the trauma in their lives had paralyzed their very soul making it difficult to feel compassion for their own life circumstances. Their self-confidence was not only under attack by the world around them but also by their own internal dialogue. As I think back on my young clients I can see that they were not only carrying heavy backpacks full of books and homework but were also burdened with a heavy emotional load that weighed on their sense of self. Each reacted to the pressures in their lives in different but equally unhealthy ways. Because gratitude can lead to joyfulness, I found that any discussion we had about being thankful brightened their day and eased their mind. Dr. Kristin Neff reminds us how important it is to stop beating ourselves up. According to her, “One of the most robust and consistent findings in the research literature is that people who are more self-compassionate tend to be less anxious and depressed” (2011, p. 110). Savoring gratefulness became a normal activity during our sessions. As their mood lightened they became more relaxed and able to express their feelings and embrace their true self.

I have to admit that I am a firm believer in the practice of gratitude because counting your blessings tends to make you happier and less depressed. I have witnessed this reaction many times both with my clients and in my own life. Finally, I am very thankful to my young clients for teaching me about the power of gratitude.

 

References

Brown, B. (2012). Daring greatly. New York, NY: Gotham Books.

Davis, J. (2016). Ladybug girl gives thanks. New York, NY: Random House.

Emmons, R. A. (2016). The little book of gratitude. New York, NY: Gaia Books.

Hanson, R. (2009). Buddha’s brain: Oakland, CA: New Harbinger.

Neff, K. (2011). Self-Compassion. New York, NY: HarperCollins.

Rash, J., Matsuba, M., & Prkachin, K. (2011) Gratitude and well-being: Who benefits the most from a gratitude intervention? Applied Psychology: Health And Well Being. doi:10.1111/j1758-0854.2011.01058.x

Rast, D. S. (2013). A good day: A gift of gratitude. New York, NY: Sterling Ethos.

Seuss, T. (1973). Did I ever tell you how lucky you are? New York, NY: Random House.

Wood, A., Frosh, J., & Geraghty, A. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review. doi:10.1016/j.cpr.2010.03.005

 

Richard Durborow, MA, MS, LMFT, is an AAMFT Clinical Fellow in Ventura, CA, and the founder and CEO of FeelingsCount.

Why We Love Ethics (and You Should Too!)

Register for the Student Ethics Competition here (last day to register is March 16, 2018, at 11:59 p.m. ET)

It was this time last year, my fellow classmate and I made the decision to enter the 2017 AAMFT Ethics Competition. Participating in the ethics competition, winning first place, and attending the 2017 AAMFT Annual Conference in Atlanta, GA were incredible experiences for us both. It was fascinating to meet and hear professionals discuss their ideas and perspectives at the AAMFT conference.

Amanda Ortega shares......

“The experience and resources available to me at the AAMFT annual conference are among the things I value most from my participation in last year's ethics competition. There were countless opportunities and activities at the conference to further my education, such as workshops on moral injury and traumatic brain injuries. Although I have not yet started the clinical component of my master’s program, I feel more confident in making ethical considerations with the tools that I acquired as a result of having made the decision to compete.”

The 2017 AAMFT Ethics Competition stands out as a pivotal and defining moment of our graduate experience thus far. It was a phenomenal opportunity to integrate the conceptual classwork lessons into a true to life scenario. As teammates in the Master’s/PDI category, we were charged with the specific task of analyzing a hypothetical ethical situation. We first began by identifying ethical codes that were adhered to, and ones that were violated. Then, through the use of an empirically supported ethical decision making model, we were able to implement our analytical skills by formulating a comprehensive essay response to the case scenario.

Heather Frostman shares.....

"Since participating in the ethics competition, I continue to benefit from the experience. During the subsequent semester, I was jump-started into my internship within a mixed group of professionals, to include fellow interns and seasoned therapists. I have felt comfortable and confident in my abilities, interpretations, and presentation skills. I can trace much of my success at my internship site to the technical, teamwork, and networking skills that I developed over the course of my time at Regis University, to include my experience with AAMFT, and the recent ethics competition.”

Competing in the AAMFT Ethics Competition was such a uniquely challenging and exciting experience. We would encourage anyone who is considering a career in the counseling profession to pursue this opportunity. We truly feel that this experience helped prepare us for the responsibilities that will soon be placed on us as future licensed therapists, most importantly being that of maintaining a high degree of professional integrity.

We would like to thank Regis University Professor, and Licensed Marriage and Family Therapist, Dr. Roxanne Bamond, for encouraging us to compete; and for the valuable opportunity offered by the American Association for Marriage and Family Therapy.

Amanda Ortega is approaching her clinical component of the Marriage and Family Therapy program at Regis University, in Denver, CO. Her passion is working with service members, veterans and their families. In addition to a Master of Arts in Marriage and Family Therapy, Amanda is also pursuing the post-master’s certification in Counseling Military Families. Amanda is currently President-Elect for the Kappa Chapter of Delta Kappa Honor Society, and is an active member of the American Association for Marriage and Family Therapy.

 

Heather Frostman is a Psychotherapist Intern at People House in Denver, CO, where she provides individual, couples, and family therapy, in combination with mind-body medicine practices. Her passion is working with adolescents and their parents, navigating the challenges of the teenage years. Heather currently holds a Master of Arts in Applied Psychology (2010) and is in the process of completing her Master of Arts in Marriage and Family Therapy at Regis University, in Denver, CO (expected August, 2018). She is an active member of both Chi Sigma Iota, and Delta Kappa Honor Societies, and the American Association for Marriage and Family Therapy; and was recently admitted to the Ph.D. Mind-Body Medicine program at Saybrook University.

 

An Advanced Look at Polyamory and Kink Lifestyles in Therapy

Interested in this topic? Join us for a webinar on April 6, 2018 from 3:00 - 4:30 PM ET. Register here.  Catch up on part 1 of this series here.

While the typical American couple would identify themselves as monogamous and/or vanilla, more and more couples are looking for alternative ways to explore their sexuality. What is out there? In the image below, you can learn about a variety of styles of non-monogamy. Some of the types include swinging, casual sex, polyamory, BDSM play and Dominant/Submissive non-monogamy, open relationships and relationship anarchy, and many more.

As therapists, we need to take a sex positive approach with our clients regardless of whether or not we are comfortable with their life choices. What this means is that we respect the lifestyle and encourage people to take a positive and educated approach to sex. We are avoiding attaching shame to sex or sexual expression. How do we do this without knowing much about what is out there? How do we do this if our own values are vastly different from the clients we work with?

I often teach a model of sexual health first created by Michael Vigorito and Doug Braun-Harvey. In their 2015 book, “Treating Out of Control Sexual Behaviors,” they developed a great tool to teach individuals to make sexually ethical choices. These ethical rules include: consent, non-exploitation, honesty, mutual pleasure, shared values, and protection against unwanted STIs/HIV and unwanted pregnancy. This sexual health model is a helpful reference for clients across the spectrum.

Let's look at each part. The first and most important rule is consent of all parties. With the recent #metoo movement, it is becoming clear that people all across the country need education in consent.

In relationships where couples are exploring sex outside their marriage, they need to have direct conversations about consent. In kinky communities, they will talk in depth about sexual acts they like, sexual acts that are not okay with, and sexual acts that are somewhere in the middle—it depends on the context. In some lifestyle communities such as Sex Positive St. Louis, they are even educating their participants about both verbal and non-verbal consent-that someone may hesitantly say yes to something, but their body language may be showing hesitation. As clinicians, we can educate our clients about how to read non-verbal communication and build a deeper trust through consent even in monogamous relationships.

For the next rule, non-exploitation, you may need to describe what an exploitative relationship is with your clients. The easiest way for me to describe it is a one-down relationship. We discuss this in systems theory. As therapists, our clients are in a one-down relationship with us. We have some power in our position which is why it is important for us to have ethical codes to protect our clients.

In our own AAMFT ethical codes 1.4 and 1.5, it states that clinicians are not supposed to engage in a romantic relationship with our clients. That is because the relationship would be exploitative in nature. Other relationships that have a similar one-down situation include adult/child, manager/employee, prison guard/prisoner, and doctor/patient. In each of these relationships, the person in the higher position has more rights, more privileges, and/or more power. Clients need to be aware of this dynamic and try to find relationships that are on more equal footing. In actual dominant/submissive relationships, the couple is typically on equal footing and has consensually created this power dynamic for the purpose of mutual pleasure.

The next rule is honesty. Since sex can be a shameful topic, it can be difficult for clients to share honest feelings about sex, sexual desires, and even kinks. As a sex therapist, I have found increasingly that people are more similar than different. A lot of our shame comes from society and the way we were raised. If as a culture, we could encourage sex positivism, it might be easier for clients to be direct about their needs and desires with their partners.

In the case of my clients, I always try to help them express their honest feelings about sex. I also encourage clients to take a curious, non-judgmental approach to their partner's sharing so that people can build trust. Remind your clients that talking about sexual fantasies does not necessarily mean acting on them. There are many people who like the fantasy of a threesome but would not be comfortable with the actuality. If we can encourage honesty up front, then couples can make conscious decisions about who to couple with and who to break up with if their sexual interests are too different.

Another helpful rule is to make sure there is mutual pleasure (among all participants involved). Pain can be involved in pleasure. For people who have never explored sadism or masochism, it can be difficult to understand why getting a serious spanking could be pleasurable. When I speak with clients who explore this, they state they get a lot of pleasure out of the experience. To be helpful to clients, clinicians need to develop a non-judgmental approach to what it can mean to have mutual pleasure.

Many vanilla couples aren't paying attention to the mutual pleasure rule. Sex can become all about male pleasure while women are having sex “just for him.” As a sex therapist, I try to make it a point to ensure that both partners (or more), are getting something pleasurable out of the situation for themselves. Even in a situation of polyamorous lovers, all parties often describe the feeling of compersion, which is defined as getting pleasure from a partner's romantic relationship with another person. This suggests that even in cases where partners are having sex outside of their primary relationship, they are still getting mutual pleasure out of the situation.

Another important rule is for the partners to have shared values. People involved in swinging communities have similar values. They may have their primary partners, husbands or wives, and then they share and act on sexual fantasies with the bigger group. If all parties involved have a similar value of, “Couples who play together stay together,” then the group can have a great time and enjoy various sexual encounters.

Problems can occur when one person in a relationship wants these things and is trying to strong-arm the other person into situations counter to their values. Going back to the previous rule, if we can help couples be honest, we can help them decide how to incorporate alternative sexual expression safely or guide them in how to respect each other’s differences without harming the relationship.

The final suggestion in the model is that all parties be protected against unwanted STIs and unwanted pregnancy. This is a great rule for all individuals to have with new partners. Recently, I have had a great number of divorcees who are newly dating and concerned about this conversation. The reality is that many people do not have great sex education, so the idea of asking a partner if they have an STI or if they could use a condom may be terrifying.

I have interviewed people in the polyamory community about safe sex practices who state that they get regular STI checks and have very upfront conversations about STIs with potential partners. In fact, in one interview with Kevin Patterson, author of the book, “Poly Role Models,” he stated that the STI conversation is sexy because you know if you are talking about this, you are about to get busy! I find this both hilarious and deeply respectful. As long as your clients are having similar conversations and protecting themselves, they may be in a better spot than some of our clients whose spouses are cheating on them non-consensually.

As long your clients are following these guidelines, then they should be free to explore whatever sexual interests they desire no matter how wild or out of our comfort zones as their clinicians. I hope you will join me for my upcoming webinar An Advanced Look at Polygamous and Kink Lifestyles, in which we will go into a more in depth discussion of various non-monogamous and kinky sexual lifestyles and how we can be helpful as their clinicians.

Angela Skurtu is a Licensed Marriage and Family Therapist in the state of Missouri and an AASECT Certified Sex Therapist. She is also a speaker and author of two books, Helping Couples Overcome Infidelity: A Therapist's Manual, and Pre-Marital Counseling: A Guide for Clinicians. She runs a YouTube channel and is cohost of the About Sex Podcast.