The AAMFT Blog

September is National Suicide Prevention Month

Join AAMFT for a conversation on suicide prevention

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

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

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

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

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

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

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

REGISTER FOR THIS LIVE EVENT HERE

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.

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. 

Supporting Families When Kids are Becoming Sexually Active

Date: November 8, 2017

Time: 3:00 - 4:30 PM Eastern

Price: $50 members / $60 non-members

1.5 CEs

Register here

Presenter: Melissa Fritchle 

Facing the realities of a child’s sexuality can be difficult for any parent. As therapists, people turn to us for guidance on how to manage this aspect of parenting and family life. In this webinar Sex Therapist and Educator Melissa Fritchle will discuss developmental sexuality in the context of our modern life so that we can help parents be positive and proactive as their children grow into adulthood. She will outline some of the current topics families may face such as, masturbation, porn, consent, gender, STDs, birth control, abstinence. Providing diverse sex positive-therapy means focusing on ways to support parents to clarify and articulate their own ethics, fears, and hopes regarding their children’s sexuality, while always considering our own counter-transference and mythologies so that we can be more effective.

 

What We Know About Online Therapy

The world of online psychotherapy continues to develop rapidly. There are now dozens of videoconference platforms designed or marketed specifically to therapists. The research base is steadily growing. States and provinces are working feverishly to provide clarity in law for therapists working online.

In such a rapidly-changing environment, it can be difficult for therapists to reasonably assess the current state of online therapy. Here’s what we can safely say we know as of April 2017. Unless otherwise noted, “online therapy” here refers to interactive, video-based work. Other forms of technology, including phone, text, and chat, are often used in therapy, but less is known about them.

We know lots of therapists are working online

In a 2014 study of MFTs’ uses of technology, more than 20% had engaged in videoconferencing with clients. If the sample was truly representative of the MFT field, this would mean that thousands of MFTs around the country have already engaged in online therapy. While many were uncomfortable with the idea of using online therapy as the sole form of treatment (particularly if the client was a family), previous history suggests that many more of us will use the technology as it becomes more comfortable and familiar in other parts of life. In the same study, more than 80% of MFTs had emailed clients (Hertlein, Blumer, & Smith, 2014).

Even those therapists who do not provide therapy online are gradually moving elements of their in-person practice online. Several companies now offer secure platforms for electronic records, calendaring, and billing.

We know online therapy works -- with some caveats

Online therapy has now been shown to be effective on a level comparable to in-person therapy for a variety of specific individual problems, including anxiety, depression, eating disorders, obsessive-compulsive disorder, panic, and more. Online therapy has also been shown to be useful for specific behavioral change, like quitting smoking or losing weight.

The studies supporting these conclusions have typically utilized manualized forms of cognitive-behavioral therapy. Some have examined therapy delivered via video-conference, while others have reviewed therapy delivered by text exchange (messaging or email). Together, these findings show great promise for online work.

We know clients like online therapy

One of the expected advantages of online therapy is the convenience it offers to clients. Sure enough, clients report liking that they don’t have to travel to a therapist’s office to do therapy, saving them time and money. The online environment may also be less threatening to clients than meeting a therapist in person.

Of course, some clients still prefer in-person treatment. However, this may be a function of simple unfamiliarity with the online therapy process. One recent study found that negative attitudes toward online therapy can often be easily changed.

We know online therapy improves access to care

Another expected advantage of online therapy is that it allows clients to access mental health care who otherwise would not. That seems to be happening. Richard Bischoff and colleagues from the University of Nebraska-Lincoln gave a workshop at the 2016 AAMFT Annual Conference where they described their use of grant funding to provide online services to three rural counties. In that project, they were able to provide services to many clients who otherwise simply would not have been likely to access in-person care.

While text-based therapy remains controversial and has less research support, I’ve previously argued that the clients who are accessing text-based therapy are often those who would not or could not receive in-person therapy. As such, the ability to have at least some access to a therapist, even if by text, may be preferable to no access at all.

We know online therapy can be done legally and ethically

Therapists clearly worry about their ability to practice online in a manner that is both compliant and effective. Multiple studies have shown therapists’ discomfort with adopting new technology for their clinical work, especially in the context of a rapidly changing regulatory environment. Despite these concerns, actual complaints against therapy providers working online appear to be rare. And inexpensive resources for professionals continue to proliferate, including AAMFT’s new best practice guidelines for MFTs working online, books to guide therapists on HIPAA compliance, and additional platforms seeking to appeal to therapists and their clients.

We know that there is a lot more to learn about online therapy

We know a lot -- even a lot more than we knew just a few years ago -- about online therapy. We also know that there is a lot we don’t yet know. I’ll address several of those issues in next week’s post: What we don’t know about online therapy.

More in this series

What We Don't Know About Online Therapy 

4 Reasons to Move Your Practice Online

The Risks of Online Therapy

Benjamin E. Caldwell, PsyD is a Los Angeles-based Clinical Fellow of AAMFT. He chaired the workgroup that developed Best Practices in the Online Practice of Couple and Family Therapy. The Best Practices document is now available from AAMFT. Have questions about online therapy? Join Dr. Caldwell on May 5, 2017 for a webinar on online therapy hosted by AAMFT. More information can be found here.

Sexual Desire Issues in Couple’s Therapy

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

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

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

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

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

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

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

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

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

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

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

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

All Loss Is Not The Same

While our responses to loss have common features, not all loss is the same nor is all loss recognized in the same way.  For those who struggle with infertility, pregnancy loss, and the unexpected results of genetic testing, grief is layered and complex. It is often unseen or marginalized by others, making the grieving process all the more difficult. Couples who experience these types of losses are mourning multiple events. And clinicians need to be aware of these losses in order to help clients mourn and move toward healing.

The disappointments caused by these losses are often overlooked. When we encounter infertility, for example, we tend to think of the couple’s inability to conceive and do not see other hidden pain they experience. Few people recognize the full impact of the sadness that the infertile couple is going through. The loss of a hoped-for future is one of the complex layers felt by the couple experiencing infertility. It can be very difficult to allow oneself to grieve over something that has not come into full existence, as is the case with the dream of having a life with children.

Couples who have gone through a pregnancy loss or the unexpected results of genetic testing, suffer the loss of the future in a way that is different from the struggle of those experiencing infertility. Every couple has a vision of their baby and the life they are going to have with him or her. And when that is lost, the pain is crushing while the loss is often mourned in silence.  Grief then turns invisible, unacknowledged even by well-meaning others who respond with such comments as “you can have another” or “it’s not your fault.” Or in such cases as multiples where one twin is lost, people might attempt to console with,  “at least you have one baby.”

The number of these experiences is not negligibly small; of course, even if it was, sufferings that are rare are harrowing or isolating in a special way. But most of the invisible losses we have in mind here are common. To take just one type of loss, today as many as 20% of clinically diagnosed pregnancies will end in a miscarriage. Despite this high number, these experiences are not widely announced or shared. Even the tendency of today's social media to share, and even overshare, life events and updates does not usually extend to these kinds of hardships.

What does this mean for our clients who experience invisible losses and are suffering in silence? We need to remember that these clients walk into our office carrying the heartache of days, months and sometimes years of cumulative loss. They are mourning—over and over.  It is our task to witness and help them express the roller coaster of emotions that they are experiencing. Our clients need to feel their way through the losses and over time, fold them into their lives—finding a “new normal” and creating an expanded life narrative.

We need to ask ourselves, how comfortable are we giving a name, a story, and a voice to their pain?  If we, ourselves, can get comfortable with and take seriously the losses of our clients, we can then make the gentle inquiries into the invisible and unspoken worlds of infertility, pregnancy loss, and unexpected genetic diagnosis. Through sharing their heartache with us, with their partners, and with trusted loved ones, our clients will eventually heal and move forward with a “new normal” in place. When we help our clients bring loss out of invisibility and silence, we help them live their lives out of the shadows feeling loved, accepted and supported by those around them. While the human lens toward the world is forever reshaped by a loss, the experience of joy can be recovered and even increased. Their stories have been validated and honored, and they can once again live meaningfully and fully.

Interested in this topic? Find it on Teneo: "Invisible Losses: Working with Couples Coping with Infertility, Pregnancy Loss, and the Unexpected Results of Genetic Testing." 

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

Michele Weiss, LMFT has a private practice in Chicago.  She completed two years post-masters training at The Chicago Institute of Psychoanalysis and received a certification in Adult Psychoanalytic Psychotherapy. Michele is a member of The American Society for Reproductive Medicine: Mental Health Professionals Group and has developed a special interest and proficiency working with individuals and couples coping with postpartum depression, perinatal mood disorders, and infertility.

Dating, Mating & Marrying in the Age of Social Media

Apps, texts, status updates, and profiles - we communicate, socialize and even date via our social media networks. But what are we missing while we wait for the next text or update? What do we miss out on if we're always logged in?

On Friday September 25, Dr. Alexandra H. Solomon will host a webinar about the intersection of technology and love. She will discuss how our digital age has added enormous complexity to relational communication and romance. Dr. Solomon will provide participants with information and ideas about how to help individuals and couples use social media to enhance and expand their love lives, not replace them. Specifically, participants will learn how to:

• Consider how technology is influencing how we think about and experience love including common misconceptions, timeless questions, and recent trends
• Engage clients in dialog about modern romance in a way that avoids simplistic formulations and easy answers
• Create a therapeutic environment in which clients, especially emerging adults, can quiet the external noise in order to grow their relational self-awareness and create authentic and healthy intimate relationships

Register here!

Dr. Alexandra H. Solomon is an Assistant Clinical Professor in the Department of Psychology at Northwestern University, and she is a licensed clinical psychologist at The Family Institute at Northwestern University. In addition to her clinical work with couples and individuals and her clinical supervision with gradate trainees, she teaches at the graduate and undergraduate level at Northwestern University. She teaches Intimate Relations I in the Master of Science in Marriage and Family Therapy (MSMFT) program and Building Loving and Lasting Relationships: Marriage 101. This innovative and popular undergraduate course has received local, national, and international media attention. Dr. Solomon has published a number of articles and book chapters, she presents to a variety of audiences, and she consults frequently with the media on topics related to marriage and family, including Oprah Winfrey Network (#OWNshow), O Magazine, The Atlantic, CBS Early Show, and NPR.

Dr. Solomon is the author of Brave, Deep, Intimate: 20 lessons to Get You Ready for the Love of a Lifetime (New Harbinger) which will be published in February 2017.

She can be found on the web at www.dralexandrasolomon.com, on Facebook at Dr. Alexandra Solomon, and on Twitter at @AHSolomon.