The AAMFT Blog

Free Webinar: Online Supervision — What You Should Know

Join us Thursday, March 19 at 2:00 p.m. Eastern Time for a webinar on online supervision 101.

With the rise of telemental health, more therapists are switching to HIPAA-compliant video conferencing. You may know that online supervision (telesupervision) is now allowed for mentorship towards the AAMFT Approved Supervisor credential. And, depending on your state, some (or all) of your supervisee’s sessions can be done online as they work towards licensure.

If you’re looking for more information about online supervision, you can register for this free webinar exclusively for AAMFT members.

Click here to register!

Polyamory 101: What Every Therapist Needs to Know

Polyamory is in the news, in the movies, and in the therapy room. As media attention for this open relationship style grows, more and more people are giving it a try. In this webinar, Martha will provide an introduction to polyamory from a therapist's perspective, including explaining why she loves working with this population and thinks you will too. You will learn how challenges specific to polyamory present in therapy, and how to handle them with skill. There will be ample time for Q and A, so you can get the specific information you need in order to feel confident working with polyamorous clients in your practice.

Learn more and register for this webinar here.

Presenter: Martha Kauppi, LMFT, CST-S
Martha Kauppi, LMFT, is an AASECT-certified sex therapist and supervisor, and AAMFT-approved supervisor. She has a private practice in Madison, Wisconsin, specializing in relational therapy and a broad variety of sex-related concerns including alternative sexualities and marginalized populations. Martha trains therapists from all over the world to work effectively with sex issues through online trainings and in-person workshops. She blogs regularly about relational therapy, differentiation, attachment, sexuality, and polyamory. You can find her course offerings and blog at www.instituteforrelationalintimacy.com

Working Systemically with Nonbinary Clients

This webinar will provide a comprehensive overview of working with nonbinary clients. This will include an initial brief introduction to terminology, to the current WPATH Standards of Care, and to dominant treatment protocols for nonbinary clients in the US. We will discuss the issues that nonbinary clients and their families might bring to therapy and how to address these competently and systemically. The role that family therapists might play in the care of nonbinary clients and their families will be addressed, including the role that LMFTs might play in supporting clients who may pursue medical or legal transition processes. The importance of liaising with other providers, such as medical providers, will also be addressed. Participants will be invited to reflect on their own gender histories, identities and expressions. The webinar will be highly participatory and participants are encouraged to bring their questions and curiosity. Ethical issues in relation to power, dominant discourses of gender and the historical oppression and marginalization of nonbinary people will be woven through the webinar and will be addressed from an intersectional perspective.

Date: October 30, 1:00 - 2:30 PM Eastern

CE: 1.5

Register Here

Presenter Alex Iantaffi, PhD, MS, SEP, CST, LMFT is a certified sex therapist, family therapist, Somatic ExperiencingⓇ practitioner, clinical supervisor, writer and independent scholar. They are adjunct faculty at the University of Wisconsin-Stout and the chair elect for the Trans and Queer interest network of the American Association for Marriage and Family 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, and relationships. Alex is passionate about healing justice and community-based and engaged scholarship. They are a trans masculine, non-binary, bi queer, disabled, Italian immigrant who has been living on Dakota and Anishinaabe territories, currently known as Minneapolis, MN (US) since 2008. Alex has co-authored the books "How to UnderstandYour Gender: a practical guide for exploring who you are" and "Life Isn't Binary" with Meg-John Barker (Jessica Kingsley Publishers). They host the podcast Gender Stories. You can find out more about them at www.alexiantaffi.com or follow them on Twitter @xtaffi

Digital Intimacy: Attachment and Sexuality in the Technological Age

 

Join the Queer and Trans Advocacy Network for a webinar

July 19, 2019 from 3:00 PM to 4:30 PM (ET) 

Register here

In this webinar digital intimate connections between people and their technologies are explored. This presentation opens with a brief overview of intimacy, followed by a description of the predominant waves of the modern technological age. The presenter then discusses two types of intimacy—attachment and sexuality—in a digital context, which includes digital attachment (digiattachment) and digital sexuality (digisexuality). The presentation concludes with a brief overview of how to begin to attend to digital intimacy in clinical practice, including digiidentity development, digistigma, digiphobia, and erotocentrism.

Presenter: Markie Louise Christianson (L. C.) Twist, Ph.D., a licensed marriage and family therapist and mental health counselor, as well as a Clinical Fellow and Approved Supervisor of the American Association for Marriage and Family Therapy, and certified sexuality educator and sexuality educated supervisor through the American Association for Sexuality Educators, Counselors, and Therapists. Dr. Twist is the Program Coordinator of the Graduate Certificate in Sex Therapy Program, and Professor in the Human Development and Family Studies Department and Marriage and Family Therapy Program at the University of Wisconsin-Stout. Dr. Twist is co-author of the book, The Internet Family: Technology in Couple and Family Relationships, and co-editor of the book, Eco-Informed Practice: Family Therapy in an Age of Ecological Peril. Dr. Twist also serves as Editor-in-Chief of the Journal of Sexual and Relationship Therapy. To learn more visit: drmarkie.com.

Sensate Focus Mindful Touch: An Adjunct to Marital and Couples Therapy

Join the Couples and Intimate Relationships Network for a webinar presented by Linda Weiner, MSW, LCSW.

Date: Friday, June 21 from 3:00 PM - 4:30 PM Eastern

Register Here

Relationship therapists and others who work with couples acknowledge the importance of physical touch and sexual intimacy as foundational to satisfaction. Many of our clients report this as a primary goal in couple and sex therapy. While some couples are able to recapture lost physical affection and sexual interest on their own through traditional couples therapy as their relationship improves, sometimes more direction is needed. This workshop is designed to add a skillset to assist therapists in addressing couples' intimacy and sexuality difficulties through the addition of Sensate Focus touching experiences. These "at home" touching experiences, developed by Masters & Johnson form the foundation of sex therapy but Sensate Focus can be a useful technique to build emotional connection and trust even without the existence of a diagnosable sexual dysfunction.

The workshop will identify the conceptual underpinnings of Sensate Focus, its connection to mindfulness and somatic therapies and its integration with relational therapies such as EFT; describe in detail the general protocol for Sensate Focus touching; present modifications for a variety of common sexual difficulties; and illustrate modifications for diverse client populations. You'll get a chance to hear Linda giving the suggestions and processing client feedback, as well as her offering of interventions for commonly encountered problems clients may bring to the therapist. 


Presented by: Linda Weiner, MSW, L.C.S.W As a therapist, Linda specializes in working with individuals and couples with a range of relational and sexual concerns. As an educator, workshop presenter and supervisor, she brings together many of the same qualities of insight, experience, connection, respect and humor characteristic of her therapeutic work. In recent years she has published numerous articles, a book chapter and a book on the use of Sensate Focus techniques, a foundational technique in sex therapy developed at Masters & Johnson Institute where she worked for five years before beginning a private practice. She and Dr. Avery-Clark are the authors of Sensate Focus in Sex Therapy: The Illustrated Manual, the first publication to detail both the updated sensate focus strategies of Masters & Johnson and to add the contributions of other clinicians and researchers involving more diverse clients. Linda taught at Washington University in St Louis Brown School for many years and has been a guest on numerous podcasts and media outlets, including CNN.

“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

“Small world, isn’t it?” Multiple Relationships in Small Communities & Subcultures

Join Dr. Sheila Addison, LMFT, for a webinar on multiple relationships on Friday, May 10, from 3:00-4:30 pm EST, presented by the Queer and Trans Advocacy Network. Register here.

Many MFTs enter the field because we belong to communities that have historically been poorly served by mental health.  We want to bring our expertise to bear, and offer culturally-sensitive services to groups of people whose well-being is important to us. Often, we wind up a minority within a minority – one of the few professionals with lived experience that relates to the people we most want to help.

At the same time, if we are also a part of those same communities, we may find ourselves repeatedly facing questions about how to manage multiple relationships in an ethical way. 

• Can my children and I participate in social activities at my temple if I’m one of the very few Jewish therapists in in my area and I have many Jewish clients?
• I attend a consultation group for Black therapists in my area. Now my partner and I are looking for relationship counseling, and all the Black therapists who take my insurance sometimes attend this same group.
• I’m a transgender man who works with many trans and non-binary clients. There’s an annual trans healing retreat coming up that I really need for my own self-care, but at least three of my clients are also talking about going.
• My spouse and I are non-monogamous, and I see a lot of non-monogamous clients as well. I’m always afraid one of my clients is going to turn out to have intimate connections to people who are connected to me, my spouse, or our other partners, and then what do I do?
• My kids go to school at the same school as some of my kid and family clients. What if my kid becomes friends with a kid client? Or worse yet, enemies? I’m the only therapist in my area with my specialty.

Most of us were taught that the ethical choice is to avoid these multiple relationships as much as possible.  But what about when it’s not possible? And what if avoiding them means cutting yourself off from relationships and resources that are important to you or your family?

This workshop will look at how we can move beyond a simple “avoidance” framework and engage with the work of how to identify, anticipate, and manage issues of overlap.  We will look at the AAMFT Code of Ethics in dialogue with other organizations’ codes, and consider various decision-making frameworks to use when considering the benefits and harms of our complex relationships with our communities.

You will have the opportunity to consider how your own connections, and those of your supervisees or students, can be both a benefit and a liability when it comes to navigating the dual role of “insider” and “service provider.”  Together, we’ll identify examples of the dilemmas that the “avoidance” framework creates for MFTs who are part of small communities, subcultures, and minority groups, and practice applying more nuanced thinking to the difficult choices we face.

 

Dr. Sheila Addison, LMFT, is a clinical fellow of AAMFT. She heads Margin to Center Consulting which encompasses her private practice and supervision, and cultural competency trainings for mental health professionals. She provides diversity and inclusion support, including the Ally Skills Workshop, to corporate, academic, and community clients. She resides in Oakland, California where her practice, focused on couples and relationships, is also located. In 2018 she was named “Best Psychotherapist in the East Bay” by the East Bay Express.

A Roadmap for Couple Therapy: Integrating Systemic, Psychodynamic, and Behavioral Approaches

On March 22, I will be presenting a webinar is titled A Roadmap for Couple Therapy: Integrating Systemic, Psychodynamic, and Behavioral Approaches, based on my recent book of the same name. This webinar is hosted by the Couples and Intimate Relationships Topical Interest Network. 

Register for the webinar here

Here are a few of the practical ideas and takeaways that I’ll be discussing in more detail in the webinar.

First, we can view conjoint couple meetings as like lessons. Just as when you take music, dance or sports lessons, it’s not sufficient to talk about what you do, it’s essential to show your teacher or coach what you’re doing so that he or she can help. This metaphor works for couples when I encourage them to talk to each other, rather than to me (something they find far easier as they try to convince me that they are right and their partner is wrong!). But what to do when couples really get into it and spin out of control? A first move is to halt this sampling of their process, calling “time,” and have the partners again talk to you which also allows you to talk to them empathically and supportively. This is basic but is key to survival and is a major reason many individual therapists dread working with couples—they are simply too passive and don’t know how to move in and out, alternating between having the couple “talk to each other” and talk to the therapist.

The next crucial thing to do is to focus on the details of the couples’ maladaptive dance, their “vulnerability cycle.” All schools of couple therapy do this, though they do it in different ways which we will discuss. The key is not to get bogged down in weekly discussions of “the problem du jour.” In most cases, problem solving will have to wait. In placing the focus on the couple “process” rather than the “content,” we are making that process the “shared enemy.” While this makes logical sense to many clients, most humans have trouble with the idea that a “system” has “emergent properties” (here destructive and amplifying ones) that can’t be blamed entirely on one or the other partner. Three metaphors help make this clear to clients:

1. The chemical reaction metaphor. The partners are likened to two colorless reagents in separate beakers that, when mixed, become drastically altered: perhaps becoming explosively hot, ice cold, or foul smelling. One of the reagents might think, “I was just fine before: not hot, cold, or smelly. This sudden change, in which I don’t even recognize myself, must be due to that other damn chemical!” This metaphor powerfully illustrates how group process is not reducible to individual behavior and is experience-near for individuals who are feeling blamelessly victimized by their partners.
2. Drowning swimmers to normalize off-putting demands: Escalation commonly consists of one or both partners speaking increasingly loudly, impatiently, and aggressively, perhaps while nagging, guilt-tripping, or swearing. These ineffective attempts to influence a partner tend to occur and intensify when the partner appears unresponsive. Therapists can normalize these counterproductive behaviors by explaining them in systemic terms. One metaphor I use is of a drowning swimmer calling for help. The more the swimmer fears drowning, and the longer the lifeguard fails to respond, the louder the swimmer screams. Often, it is more accurate to characterize both partners as drowning swimmers, even though one may superficially appear to be an unresponsive lifeguard.
3. Firefighters battling forest fires to normalize flight: Just as escalating pursuit can seem appropriate in some situations, so can flight. Withdrawal becomes more comprehensible and acceptable if one remembers that firefighters facing a raging forest fire must sometimes retreat temporarily.

I hope this has given you a taste of what the webinar will cover, which is designed to benefit couple therapists, from beginning students to skilled clinicians.

Arthur Nielsen, M.D. is a full-time, practicing psychiatrist, psychoanalyst and couple therapist. He is a Clinical Associate Professor of Psychiatry at Northwestern’s Feinberg School of Medicine, a faculty member at Northwestern's Family Institute in Evanston, and a faculty member of the Chicago Institute for Psychoanalysis. For many years and until recently, he was the coordinator of a popular for-credit course he developed for Northwestern undergraduates, “Marriage 101: Building Loving and Lasting Relationships.” He is the author of forty-some published professional papers in the fields of psychiatry, psychoanalysis, and couple therapy. His recent textbook, A Roadmap for Couple Therapy: Integrating Systemic, Psychodynamic, and Behavioral Approaches, forms the backbone for this webinar.

Webinar: Confabulation

 

Join AAMFT for a webinar titled Confabulation: A Brief Review for Marriage and Family Therapists on October 19, 2018 from 3:00 - 4:30 Eastern Time. Register here.

Confabulation is an unintentional memory disturbance. Such an inaccurate memory can simply be a distortion of an existing memory or the fabrication of a new memory. For example, a client may mistakenly believe that a real event from decades ago instead took place recently. In contrast, a client could create a fantastic memory of an event that never occurred. The likelihood of this phenomenon is often increased by the presence of a range of disorders and conditions. This includes psychosis (e.g., schizophrenia), trauma (e.g., brain injuries), fetal alcohol spectrum disorder, memory disorders (e.g., dementia, Alzheimer’s disease, and Korsakoff’s syndrome), and other neurological conditions. In light of the co-occurrence of confabulation with these disorders, marriage and family therapists should have a strong working knowledge of this memory disturbance.

Failure to identify instances of confabulation can have deleterious consequences in treatment settings. This is largely due to the fact that many clinical activities are informed by information self-reported by the client. For example, inaccurate information can contribute to misdiagnosis and the allocation of inappropriate treatment options. Further, confabulation can result in credibility and countertransference issues where therapists may struggle in their decisions of what to believe or not believe. Beyond assessment and treatment, confabulation could result in false reports of victimization or even perpetration of physical and sexual abuse. In such instances, the marriage and family therapist may be obligated to report this information to the appropriate legal authorities. As such, inaccurate information can result in criminal charges and wrongful convictions.

Despite these difficulties, marriage and family therapists are well positioned to identify confabulation and provide support to clients suffering from this affliction. A necessary first-step in this process is corroborating self-reported information with reliable sources (e.g., family and friends). This is particularly true of clients suffering from clinical and neurological disorders and situations when sensitive memories with severe consequences have been recalled. As this process can be very challenging for the marriage and family therapist, the professional must keep in mind that confabulation is unintentional in nature and without malicious intents.

When confabulation has been discovered, the marriage and family therapist should work with the client to address any underlying clinical or neurological disorder and improve their memory recall. Interactions with the client should be slowly paced, use simple and clear language, and employ open-ended questions. Opportunities include teaching the client self- and memory-monitoring strategies and introducing the client to memory diaries. Similarly, the development of a strong support system of family members and friends is imperative. This group can not only serve as collateral sources of information, but also help ensure the client feels unconditional love and support throughout the therapeutic process. Through such a systematic approach, marriage and family therapists can help clients suffering from confabulation improve both their short- and long-term outcomes.

 

Jerrod Brown, Ph.D. is an Assistant Professor and Program Director for the Master of Arts degree in Human Services with an emphasis in Forensic Behavioral Health for Concordia University, St. Paul, Minnesota. Jerrod has also been employed with Pathways Counseling Center in St. Paul, Minnesota for the past fifteen years. Pathways provides programs and services benefiting individuals impacted by mental illness and addictions. Jerrod is also the founder and CEO of the American Institute for the Advancement of Forensic Studies (AIAFS), and the Editor-in-Chief of Forensic Scholars Today (FST) and the Journal of Special Populations (JSP). Jerrod has completed four separate master’s degree programs and holds graduate certificates in Autism Spectrum Disorder (ASD), Other Health Disabilities (OHD), and Traumatic-Brain Injuries (TBI).

Helping MFTs Understand and Treat Chronic Pain

Join Martha, along with Don Teater, MD, MPH, for a webinar on treating chronic pain on Friday, September 7, from 3:00-4:30 pm EST. Register here.

It’s estimated that one-third of Americans live with chronic pain. As marriage and family therapists we know that this suffering impacts more than just the person who hurts, it takes a toll on the whole family system.

We are also aware that MFTs are up against an epidemic unlike any we’ve been faced with before. The scourge of opioid misuse and unintended overdose deaths is destroying individual lives as it wreaks havoc on couples and families.

These two issues are linked in a devastating way.

Chronic pain lasts longer than three months. It doesn’t respond very well to medication or medical interventions. People with chronic pain—and their therapists—may struggle to find solutions. The CDC (Centers for Disease Control and Prevention) has concluded that behavioral treatment is the evidence-based treatment of choice for chronic pain. That means that MFTs are front-line providers in treating pain.

The best supported approaches are familiar to most MFTs—CBT (cognitive-behavioral therapy) and mindfulness. While many clinicians have skills in those areas they may need some guidance in how to apply them to help distressed individuals and families.

CBT tools like the ABC worksheet, thought distortions, decatastrophizing, and automatic negative thoughts can help people take a new look at how they interpret their physical and emotional distress. We can equip people to modify their thoughts about their pain, leading to better outcomes.

Mindfulness approaches can help people feel calmer and less reactive to both physical and emotional discomfort. Mindful practices like relaxation breathing, meditation, yoga, body scan, guided imagery, individualized visualization, body scan, and progressive muscle relaxation can all provide significant relief from symptoms.

While MFTs play a leading role in pain treatment, we play a supportive role in treating opioid misuse. Treatment of choice for opioid use disorder (OUD) is medication-assisted treatment, which is methadone, buprenorphine (Suboxone), and naltexone (Vivitrol). OUD treatment is unlike treatment for any other use disorder. Research evidence shows no benefit to using the traditional model of detox, inpatient treatment, intensive outpatient, and abstinence-based approaches.

MFTs can help people in medication-assisted treatment rebuild their lives, reconnect with their families, and gain freedom from the heartache of a use disorder. We are well-positioned to provide meaningful support to people as they recover.

MFTs can make a significant difference for people and families who are hurting—literally. As we gain skills in treating pain we will also be reducing the risk of opioid misuse and overdose in our communities.

And that’s where MFTs shine—helping individuals, families, and communities overcome the burdens of chronic pain and opioid misuse.

Martha Teater, MA, LMFT, is a clinical fellow of AAMFT. A practicing therapist, she has worked in integrated primary care, medication-assisted treatment, and free clinic settings. She has provided hundreds of trainings across the U.S. and internationally. She is co-author (with Don Teater) of Treating Chronic Pain: Pill-Free Approaches to Move from Hurt to Hope.