AAMFT California Newsletter, Fall 2014
Working with the Re-entry Population Opportunities and Training for MFTs
Interview with Sue Johnson
Member to Member
Take a Look – Legal & Ethical Resources
Together Against Stigma
Training to Work with the Military Population
Jobs Posted for CA Members
Working with the Re-entry Population New Programs, Expanded Funding, Increased Job Opportunities for MFTs
Olivia Loewy, PhD
AAMFT-CA Executive Director
It has been an ongoing process:
- In 2001 San Francisco jail officials said that the number of persons requiring mental health treatment had increased 77% in ten years.
- 2005, Los Angeles Sheriff Lee Baca said: “I run the biggest mental hospital in the country”.
- 2010: It was noted that 40% of individuals with serious mental illness have been in jail or prison at some time in their lives.
- 2011: Noting our state’s 67% recidivism rate, the U.S. Supreme Court ordered California to reduce its prison population by roughly 25% within 2 years. AB 109 was passed, which shifted responsibility from the state to the counties for lower level offenders and paroles.
Support for these community services has since been provided legislatively as well as fiscally, including $142 million in the 2013 California state budget for 2000 crisis stabilization beds to ease pressure on jails and emergency rooms. The major goals related to this reform include: Developing effective county programs; Transforming offender behavior; Incapacitating those whose crimes merit it; Ultimately reducing recidivism.
Most recently, on July 29, 2014, at a legislative hearing in Los Angeles about the intersection between mental health and the criminal justice system, Assemblymember Reggie Jones Sawyer, Chair of the Budget Subcommittee on Public Safety, pledged to seek more funding for this work. Proposition 47, a November 2014 Ballot Measure, decreases the penalty for several non-serious crimes (mostly small amount drug and small theft crimes) from felonies to misdemeanors and dedicates 65% of the state savings from reduced incarcerations (estimated at $150 – $250 million annually) to mental health and alcohol and drug treatment to divert people from the criminal justice system.
There will be employment opportunities for MFTs in these growing community programs throughout the state. However, working with the re-entering population is not “business as usual” and most clinicians have not been trained to respond to the multidimensional and complex needs of this population. Do you know:
- What is the difference between Jail and Prison? What is CCCMS? EOP? MDO?
- What is in an Aftercare Summary and how can you use it?
- What is Strength Based Assessment?
- What are your legal/ethical obligations in relation to addressing behavioral and treatment issues with this population?
In anticipation of the growing need for clinicians who are trained to work with the re-entering population, AAMFT-CA Division will be offering a new course for clinicians titled: How Do I Get There from Here? Clinically Supporting Resilience in the Justice Involved Adult.
This course is designed specifically for clinicians who want to be more knowledgeable, skilled, effective and marketable in working with the reentering population. You need to understand context and develop a specific cultural competence to work successfully with this population. This training goes from terms you’ll need to know, to desensitization exercises to active learning of clinical skills for assessment, goal setting, ongoing treatment and handling surprises.
Supporting Resilience will be a daylong course, following in the “tradition” of the ever-popular Transformed Supervisor training: two instructors; small class size; experiential, incorporating a multitude of learning exercises, videotapes, very active participation; and a lot of fun! At the end of the training, participants will be able to demonstrate relevant skills for utilization within this unique clinical context.
A dynamite committee of seasoned clinicians who are experienced with this work has developed the Supporting Resilience course, including: Marcelo Calvalheiro, LMFT, Brianna Dubbs, LMFT, Kelly Higdon, LMFT, Cheryl Malinowski, Ph.D., Lisa Moschini, LMFT, Mary Read, Ph.D., LMFT. The course will be piloted at the end of this month and will hopefully be ready to come to a classroom or agency setting “near you” before the year’s end. Supporting Resilience will offer 6 CEs while providing training that may make you more marketable in community behavioral health settings.
The funding is here and the community programs are continuing to develop. Help support the state’s effort to reduce recidivism by gaining the clinical skills and knowledge you will need to successfully work with this population.
AAMFT-CA is the MFT association in California that is focused on providing the information and resources you need to ensure your professional stability in the future. For more information, do not hesitate to contact Olivia Loewy: firstname.lastname@example.org.
Image source: Courtesy of Olivia Loewy, PhD
INTERVIEW WITH SUE JOHNSON
Interviewed in February 2014
by Jim Thomas, LMFT
Denver Family Institute
Dr. Sue Johnson
the author of Love Sense: The revolutionary new science of romantic relationships
Hold Me Tight, your book for the public, was such a success. It is still published only in hardback in the U.S. because of the steady sales. Writing a book is no easy task. What compelled you to write your second book for the public, Love Sense?
Writing Hold Me Tight was very satisfying. It took the last 20 years of work in helping couples heal their relationships and put it in to a book for all couples to use and learn from. What it did not do was articulate what I’m most passionate about. Love Sense articulates the huge shift in understanding adult bonding and love. Love Sense is a big idea book. The core message is that it’s time to think about close relationships differently. It’s time to think about adult love differently. It’s time to think of us as a species differently. Let’s recognize that we have a whole new understanding of romantic love, of partnership and of close relationships. This is a paradigm changing book. I want nothing less than to challenge old, harmful and limiting ways of viewing romantic love that exist in our culture, the media and in psychology..
What is the core of this new paradigm about romantic adult love?
First, we must acknowledge that romantic relationships are bonds, not bargains or compromises. Adult love is not a mystery or fleeting in its core nature. If we can see romantic love as an attachment bond, we can make sense of it. If we can make sense of love, we can work with it and heal. This is why I called the book Love Sense. As a trainer and proponent of Emotionally Focused Therapy and attachment theory, I would go home from training events with the feeling that even therapists were not getting the revolutionary new vision that attachment theory and science offers us about ourselves as bonding animals. This love sense, this way of seeing love as an attachment bond is revolutionary. It changes everything for both couples and therapists. Beyond that, it impacts the vision of what a human being is and what a human society is. So Hold Me Tight was written for couples in distress. Love Sense is written for everyone. I would like policy makers to read this. I want anyone who struggles to understand love to read this. I particularly want therapists to read it because they are the ones who can help us change the paradigm around love from a “fall in” endeavor to a “shape it and make it” endeavor. Therapists are the front line of any revolution in our societies’ vision of love, in a sense, they are the people who make or break the scientific revolution because they are the ones who put our new knowledge into action and show people that love can work!
You get at this on page 7 in the introduction to Love Sense, that you write this as “a revelation and a promise.” Tell us more about that.
I was in Toronto a few days ago, tired after the 20th interview in 48 hours. An interviewer asked me what I was trying to do in this book, and I found myself blurting out, “I am trying to change the culture of romantic love in this book.” I think that I am trying to change a pessimistic culture that is amazingly dismissive of the power, hope and possibilities of romantic bonds. [This pessimistic culture] almost denies caring and love and the significance of these bonds. There is an urgency here. At times, I feel like I’m standing and watching couples, all of us, driving off a dark cliff while my colleagues and I are trying to hold up a sign post to a highway that leads straight home. We don’t have to give up on lasting relationships. Emotionally Focused Therapy demonstrates in 16 outcome studies that we can shape loving bonds. Attachment theory research shows us this straight road home again and again.
What are some of these terrible things we are led or convinced ourselves to believe about relationships in these other paradigms?
First and foremost is the myth that love does not work and cannot be understood. So love is a mystery? Do we want to base our precious love relationships on a mystery? This is not just benign misinformation. It sculpts our moves in relationships. If love is a mystery, then it simply comes and goes. We come to believe that there is little we can do. We simply fall in and fall out of love. Second, there is the idea that “needing” a partner is some sign of mental instability and immaturity. The idea is that you must become independent and have firm boundaries to stay separate and define yourself that way. And this becomes a rule for relating. We still have psychologists who stand up and deny the thousands of studies on attachment. They argue that the most functional way to be is to be essentially separate. I would argue that we are wired to connect and the best way for us to live and live well is to be securely connected to a few precious others. Third, concerning sexuality, there is the belief that the strongest drives are sex and aggression. Attachment science states that the need to connect is our strongest drive and puts sex into this relational context. Sex is a key bonding experience for mammals. Mammals that groom and protect each other and stay together to raise their young are flooded with bonding hormones when they mate. Is that an accident? Emotional intimacy and vulnerability fuels the best sex – synchrony sex, I call it. This kind of sex then fosters closer bonding. Sex and bonding are naturally entwined, but attachment is primary and defines much of how we are sexually.
Fourth, there is the classic argument that monogamy is impossible and unnatural and having a long term love relationship is impossible without denying your sexual and identity needs. A reporter told me recently, “Ethan Hawk says we are not meant to be monogamous anyway.” I asked him why he wanted to base his guiding ideas about his relationships on the comments of an actor! But, if you don’t have a scientific map, how do you know what to believe? Ideas shape our experience and how we respond to our partner. These ideas shape our cultural conversation about adult love. They shape our love stories.
Such myths lead people and therapists in the wrong direction. We teach “skills” like set sequences of active listening, or we dive into teaching problem solving and negotiation skills. These things can help but they usually operate at the wrong level to really help couples move out of emotional distress and attachment panic. A huge advantage that comes with practicing EFT is that when a couple says to me, “Can we fix this and can you help us? Can we heal from this affair?”, I have a confident and positive reply to give. Based on my experience and the research on our interventions, I can say, “Yes, we see people heal and craft new loving responses and we can help you do this. I expect you to get better”. That is the first step out of despair for many couples. And as they delve into EFT couple therapy, I hear partners say, “This fits,” and “This gets us to the heart of the matter.”
I also have a secure base to lean on as a couple therapist in that attachment science gives me a key to love and loving. Again and again, attachment frames and attachment focused interventions guide couples back from the brink of divorce or the chaos caused by an affair. What would we want therapists to take from this attachment perspective that would change how they approach couples and families in therapy? I want therapists to see that they are engaged in a massively important enterprise. When a therapist helps a couple or a family gain more secure relationships, they are helping to create a civilization. They are creating the basis for happier and more stable families. They are creating the conditions that foster increased mental health and physical health. This new understanding of adult love and bonding allows us to offer what our clients so desperately need – a way to loving emotional connection and the resilience that comes from this connection. This is like gold for our field and it is desperately needed in our society. I see our job as helping people to learn about this code and use it. It is liberating as a couple therapist to work with the natural emotions and longings and the wired in ways that people naturally connect.
And I want to say, that the hunt for the simple magical intervention is the wrong way to go. I think this is looking for light in the wrong place. I think we need to tune in to the most powerful inherent force in us as a species and use this force to help people grow. The evidence is that the most powerful unconditioned, instinctive response in our species is the need to connect emotionally with another human being who would be there for you. Therapists recognize this when an individual client bonds with them and in doing so is able to access new resources and take new changes outside of therapy. We can help partners be this secure base for each other. Knowing how things work in love relationships allows us to access the power that is there. You don’t have to teach people how to bond – just provide a safe place for them to explore their pain of disconnection, their fears and longings together. It’s a matter of blocking the exits and helping them get out of their own way. If we help them tune into themselves and their partners, people already know how to be responsive; they just don’t know that they already know how to do it.
Why does E.F.T. get such powerful, robust and long-lasting results with couples?
We address people’s deepest, most significant emotional needs and longings, so our interventions are relevant to almost everyone. We do not get many drop-outs in EFT, in our studies or our clinical practice. Couples and families tell us that we get to the heart of the matter; we are on target. The experience, the emotional balance they gain and the closeness they achieve stay with them over time and deepen. Once they know how to meet each other’s attachment needs and longings, they keep doing this – it feels so good, and every challenge faced together strengthens their bond.
How did writing Love Sense change or impact you?
(Sue laughs heartily) Apart from exhausting me? Well, it focused my passion even more. As with couples in our sessions, when you focus on and really articulate something, you order and organize it. You get new clarity and integrate things deeply. And you grasp key meanings in a new way. Love Sense pulled me more into my passion for attachment. It intensified this sense that we need to be communicating to therapists and couples that this is the richest model and body of research we can use to integrate psychotherapy in general.
That is a bold statement. You are saying that attachment theory, the new science of emotions and this research can integrate psychotherapy in general, how?
Attachment integrates developmental, personality, interpersonal and neural science in one theory. There is no other theory that is empirically based and has such depth and breadth and it is a relational theory. It puts human beings in their natural ecological niche – relationships with others. Our world desperately needs to know about attachment. So many of our day-to-day problems arise from emotional isolation. We have electronic devices everywhere to allow us to always be in contact but not connected. Our mammalian brain, our hearts, our social selves long for deeper, secure attachments in our daily lives. Love Sense draws attention to the already huge body of evidence that close connection is the best recipe for mental health and physical well-being. So attachment theory, with its clarity about health and optimal functioning, risk factors and how we become stuck in dysfunctional affect regulation and interactional patterns offers a natural platform for the integration of psychotherapy. It gives a clear picture, for example, of how disconnection from others and insecure bonding may be fueling the rise in depression and anxiety rates in the United States. It has allowed us to address these problems in a couple therapy context. A recent study by my colleague, Wayne Denton, shows good results using EFT with couples who also struggle with depression. Strong bonds build strong individuals.
How does the vision presented in Love Sense and in EFT differ from other approaches to couple relationships in therapy?
The first difference is that we do not focus on just intervention. In general, couple therapy has been accused of being a grab bag of tools that addresses only the surface symptoms of relationship distress. Salvador Minuchin, one of the great pioneers in family therapy, has said that our field made a crucial mistake when it moved away from trying to understand relationships into first trying to treat and change them. I think this move came from a good intention: from therapists wanting to help. But without a grounded theory of bonded relationships, we are left seeking magic interventions to address the apparent “mystery” of affectional bonds. Attachment gives us an in-depth understanding of love and interdependence. This helps us understand how relationships work from the bottom up. Attachment also helps us understand relationships and how they evolve throughout our lives. It does so in a way that other models cannot; simply because they are not based on a well-researched socio-biological model of what is means to be human.
You know, if you are an attachment oriented therapist, that teaching cognitive negotiation skills is most often not that effective in couples and families. It happens at the wrong level. General research in psychotherapy outcome by researchers like Castonguay and by Coombs find that it is emotional engagement and connection with the therapist that predicts success in therapy, as well as a collaborative rather than a coaching approach to working with emotion. Attachment also offers a very clear view of what goes wrong in close relationships and what is necessary to make them right. A clear treatment protocol comes from a well-developed understanding of what the problem is and what is necessary to create the best solution. EFT is an attachment based approach to couple and family therapy. With 16 positive outcome studies, we see that it works. Numerous process studies of how change occurs have also helped us hone EFT interventions and training.
What was the most compelling or intriguing piece of research you came upon in writing the book from outside of E.F.T. research that supports this understanding of adult love?
There are lots of them; it is tough to decide; I like three in particular. Jim Gross has done great work on the suppression of emotion and how amazingly difficult and physiologically taxing this strategy is. It’s so taxing; it stresses you out and it stresses the people around you because they tune into your tension. It also shuts them out! Nancy Eisenberger’s work is also wonderful. She stresses that we are social and bonding animals. Thus, social pain from rejection or being ignored, are processes in the same way as physical pain. Both are danger cues, alerting us to survival imperatives. She finds this effect even in research tasks that involve strangers, imagine then the impact of rejection in our closest relationships. This kind of research helps us understand the huge impact that lovers and family members have on each other’s emotions, brain functioning and general physiology. Jill Hooley also writes on the toxic effects of criticism from those we depend on. She suggests that such responses are equivalent to low grade punches to the brain. These three stand out, but there were so many more that are outlined in the book.
And there is an exciting, ground breaking study on EFT – one that showed changes in the brain, (Johnson, Coan, et. al., 2013, PLOS ONE), can you tell us about that?
For the first time, this study demonstrates that a relational intervention led to changes in how the brain responds to both contact comfort from a partner and an imminent perceived threat – in this case the threat of a painful electric shock to the ankles. This study used fMRI imaging to show that, after EFT and key bonding conversations designed to create a more secure bond between partners, holding a husband’s hand modified the way women’s brains responded to threat and to the pain of shock. After therapy, but not before, these client’s brains were amazingly quiet and calm as they were given the cue that a shock might be coming, and they reported that the shock was simply uncomfortable rather than painful. Attachment theory predicts that a felt sense of secure bonding changes offers us a safe haven where threat can be tolerated and modified, and this is what we saw in this study.
This study was part of a larger study designed to show that EFT interventions can indeed change the security of a couple’s bond – the emotional responsiveness – the love they have for each other. It speaks to the enormous advances made in the social sciences that we can do a study like this – and it speaks to the enormous promise of our field. We talk lots about environmental sustainability but for me, human kind sustainability is all about whether we can learn to connect and co-operate to build loving partnerships and families that foster truly civilized societies.
When Ghandi was asked about western civilization he replied, “I think it would be a good idea!” It seems to me that professionals who know how to show others how to build loving relationships are a key part of this “good idea”. And we are moving to the place where we know how to help people build the kind of partnerships and families that to do just that – create an empathic and truly civilized society.
Thanks for your questions and for listening Jim.
Dr. Sue Johnson is an author, clinical psychologist, researcher, professor, popular presenter and speaker and one of the leading innovators in the field of couple therapy. Individuals, couples and practicing therapists all turn to Sue for her insight and guidance. She is the primary developer of Emotionally Focused Couples Therapy (EFT) which has demonstrated its effectiveness in over 25 years of peer-reviewed clinical research. Her website is www.drsuejohnson.com.
Jim Thomas, LMFT is a Certified EFT Therapist and EFT Trainer. Jim has over 25 years of clinical and supervisory experience with a style described by trainees and supervisors as “warm, supportive and encouraging.” He has worked with diverse populations & complex problems from the beginning of his career. Jim brings tremendous energy, deep compassion, and a seemingly natural talent for conveying EFT concepts in a clear and engaging manner. He offers not only knowledge but also inspiration for those learning EFT/EFFT. To learn more about his work with couples, individuals and families please visit www.engagingtherapy.com.
MEMBER TO MEMBER
Preparing ourselves for the future
Marilyn Davis, MFT Intern
TCSPP Counseling Center, Irvine
Is that what you tell your clients? Your children? Your associates? Everyday life is not made, it is. It is an “inescapable placard of the human condition: trouble, pain, difficulties, unrest, crisis, and defeat.” Everyday life is normal. That is the point argued by Philosopher Alain de Botton, and I agree with him. We do not have to go looking for trouble, it is right here, right now, wherever we are. We are surrounded by difficulties and sadness. How do we manage?
What do you think will happen if we begin to realize that difficulties are “normal”, that stress is “normal”, and that rejection is “normal”? Would we beat ourselves up less? It seems a lot of folks are writing about having an existential crisis which they declare is now “over”. Although this triumphed declaration is highly unlikely, it is typically perceived as ringing true on the surface because the person declared it. Consider one of life’s great truth: no human being can escape the pitfalls of “humanness”, in which sadness, pain (therefore suffering), trouble, and toil are all normal content of the condition. Crisis comes, it appears to go, but does it really? Think about this for a few seconds…neither money, status, celebrity, nor power can change the condition of being human.
Humans who get this point are able to live a more full and abundant life despite the everydayness of life circumstances. They set goals knowing that life can turn out quite different from what they hope for or strive for. They learn that one of the most precious abilities they can possess is the ability to adapt. Adaptation first requires acknowledging that trouble, pain difficulties, and unrest are normal. With such acknowledgement it is possible to achieve unimaginable peace, a kind of freedom that emulates in how one deals with the normality of everydayness. Hundreds of humans have learned to adapt, others are works in progress, making sure to unpack often. It is also possible to totally reject this whole idea–then that too would be normal, would it not?
Marilyn Davis, MSN, MBA, MA, MFTI, is a second-year Psy.D student in the marriage and family therapy program at The Chicago School of Professional Psychology (TCSPP) in Irvine, California. She provides psychotherapy services to children, individuals, families, and couples at TCSPP’s Irvine Counseling Center (ICC) under the supervision. The views expressed in this article are not meant to reflect the views of ICC. Marilyn is in the early stages of her dissertation work which focus on creating a program to help teachers identify and respond to traumatized children. Marilyn is also an actively practicing licensed registered nurse (RN). She resides in Corona, California.
She can be reached at email@example.com
TAKE A LOOK
Legal & Ethical Resources
The AAMFT website has a wealth of legal and ethical information your fingertip. Numerous “fact sheets” that are easy-to-read can be helpful when coming across a dilemma or trying to remember particular facts about an
ethical or legal issue.
A few examples include:
- What to do if you receive a subpoena
- Termination of treatment
- Telephone therapy
- Billing insurance
- Getting started in Private Practice
- Keeping clinical records
Check out these and more:
In addition, AAMFT members have access to an Ethics Case Manager, by phone or email. To schedule an appointment/consultation, call 703.253.0471 (as for an Ethics Case Manager) or email firstname.lastname@example.org
AAMFT-CA Pushing to ease Challenges in Getting Licensed
Benjamin E. Caldwell, PsyD
AAMFT-CA Legislative and Advocacy Chair
Did you know that, on average, it takes longer for MFTs to get from graduation to their licensing exams than it takes clinical social workers?
It’s true. Despite rules requiring Clinical Social Workers (CSWs) to collect 3,200 hours of experience for exam eligibility – all of it post-degree – data from the Board of Behavioral Sciences shows that they reach exam eligibility faster than MFTs, who need only 3,000 hours and can count up to 1,300 hours within the graduate degree program.
While there are many factors that may contribute to this, one of the key struggles facing MFTs is the complexity of requirements for supervised experience. We currently have no less than nine categories of hours, five of which have various minimums or maximums attached, and two more combined maximums. This complexity is a major reason why MFT license exam eligibility applications take so long for the BBS to process; their staff have to make sure that the hours an applicant gained all fall within those many limits. CSWs, on the other hand, divide their hours into two categories: Clinical and non-clinical. They have one separate minimum within the clinical hours. Their experience is much easier to evaluate.
Looking at the categories of hours eligible for MFT licensure, and the various minimums and maximums on each, it is easy to see how we landed here. Each category, and each limit, appears sensible enough when viewed in a vacuum, and they were mostly put into place one by one. However, the categories and their various limits were not based on any scientific evidence. When each of these individual choices is put together, we can see what a lumbering monstrosity of a licensure process we are left with.
We at AAMFT-CA see this as a significant problem, and made addressing the difficulty in getting licensed as an MFT one of our advocacy priorities for 2014. We have developed a white paper on this issue, the final version of which will be released to members and posted on our web site this fall. We are also working closely with the BBS and with CAMFT on possible legislative solutions. While we have been pleased to see the BBS processing delays improve in recent months, we know that only a substantial change in the licensing process can resolve the struggles of many interns to get the specific kinds of experience they need, and end the boom-and-bust cycle of processing delays.
Benjamin E. Caldwell, PsyD chairs the AAMFT-CA Legislative and Advocacy Committee. He can be reached at email@example.com
Image source: Courtesy of Ben Caldwell, PhD
Together Against Stigma
AAMFT-CA is proud to be able to participate in planning the 7th International Together Against Stigma conference. The conference will be hosted by the California Institute for Behavioral Health Solutions, CalMHSA, the County Behavioral Health Directors Association of California and the World Psychiatric Association Section on Stigma and Mental Health.
Much like it before, this conference will bring together researchers, mental health professionals, policymakers, consumers and other mental health stakeholders from across the world. The focus of this year’s conference is: Each Mind Matters: Empowering Community Mental Health through Research, Practice, Policy and Advocacy.
This is a prestigious, international conference and the Committee really wants to bring in presentations from around the country and around the world. We are presently distributing a Call for Abstracts (research submission) and a Call for Presentations (non-research submission).
If you are interested in attending this conference, please click below for details and links to the registration: http://cibhs.networkofcare4elearning.org/EventDetail.aspx?pId=279&OrgId=223
TRAINING TO WORK WITH THE MILITARY POPULATION
Star Behavioral Health Providers (SBHP) is a resource for veterans, service members and their families to locate MFTs and other behavioral health professionals who have received specialized training in understanding and treating military service members and their families. In collaboration with the UCLA Nathanson Family Resilience Center and the Center for Deployment Psychology, SBHP recruits and trains interested civilian behavioral health providers in military culture and treatments that focus on the needs of service members, veterans, and their families. SBHP maintains a registry of providers who have received this training.
The SBHP training is being offered to MFTs and other licensed behavioral health providers in California. This training will allow California MFTs to receive training in working with the military population, earn recognition as having completed this advanced training, and receive CEUs at little or no cost. More information on the SBHP training can be found here. MFTs can register on the SBHP California registration site. Training is available at several California locations.
JOBS POSTED FOR CA MEMBERS