The AAMFT Blog

Juneteenth

 

By: Racine R. Henry, PhD, LMFT, CCTP

Juneteenth is a holiday that recognizes and celebrates enslaved Black people in Texas learning of the Emancipation Proclamation and their legal freedom on June 19, 1865. Despite slavery being abolished two years prior and the Emancipation Proclamation being signed in 1863, slavery continued in many southern states until December of 1865. Independence Day is widely known as July 4th and taught in schools as the day of our country’s freedom, yet Juneteenth is a holiday that many people don’t learn about until adulthood. While it has been a day of celebration hallmarked by gatherings and parades since 1866, Juneteenth only became a federal holiday in 2021. For Black people in this country across the diaspora, the seemingly reluctant acknowledgment of a significant day in U.S. History reflects the reality of our experience in two Americas: one that we continuously co-create with our ancestors and communities and the other that we have to navigate while remaining both unseen and misunderstood.  

As a Black therapist, I’m often asked about best practices to treat Black clients and/or considerations for working with couples and families in the Black community. I tend to oscillate between feeling excited and irritated by this question. It makes me happy that my colleagues want to provide the best possible care for those who look like me, but it is also frustrating that the Black experience is seen as “a thing” rather than a highly nuanced existence that is multifaceted and impossible to capture in a formulaic manner. There is no big answer to treating Black people as we are not a monolith or a foreign entity. To begin to understand what it means to live in the U.S. and identify as a Black person involves learning about the marred history of this country and how institutional racism, white supremacy, and racial/ethnic marginalization show up in every facet of life. This does not mean that Black people should be pathologized but rather that life for Black people, in my opinion, involves an ever-present awareness of our Black identity and what that could mean for those we encounter.  

Marriage and Family Therapy, as a profession, encourages clinicians to embrace a client’s reality, take on their multiverse, and hold their truths as our own. As a field, we can support the Black community by acknowledging that our beloved models and approaches were not designed with this population in mind. We can think critically about how racism and white supremacy show up in the way Black populations are represented in research and discussed in peer-reviewed journals and texts. We can create more explicit standards in our MFT training programs around how students are taught to clinically treat Black people, rather than promoting vague concepts like cultural competency or colorblindness. We can hold each other accountable for the lack of congruency between what we do as clinicians and how we treat one another as people and colleagues. We often talk about Self Of The Therapist or Person Of The Therapist as crucial to doing efficacious work yet neglect to be as introspective about how Black MFTs are regarded. 

Juneteenth, as a holiday, should remind us that the legal enslavement of Black people is part of the not-so-distant history of this country and that the concept of freedom can be a façade when considering the continued demonization and disenfranchisement of Black people in our very current society. Beyond the therapy room, conference halls, and pages of literature, every MFT, whether in training or enjoying tenure, should strive for alignment between how they approach clients being cared for and how they treat those in the larger community. As written on the Smithsonian’s National Museum of African American History & Culture website, “The historical legacy of Juneteenth shows the value of never giving up hope in uncertain times”. Juneteenth is about celebrating freedom from being treated and seen as three-fifths of a person without identity, community, or value. There is very little to be certain of both in this country and globally, but it is important that we, as MFTs, instill hope in our Black clients for a future full of promise, positivity, and alleviation of what is causing them pain. My personal hope is that we begin to set the standard across mental health professions of what it looks like to be congruent in both practice and personhood.  

Pride 2024 – Pride, Advocacy, and Dancing!

 

When asked to write a blog post for Pride, I was preparing to travel to Wilton Manors, Florida, a historic LGBTQIA community. I set the intention to keep the topic for the blog post, the importance of Pride Month and the advocacy for all members of the LGBTQIA community, in mind as I was enjoying my “gaycation.” The use of “gaycation” is intentional. I live in a small city, so I try to take vacations that focus on visiting predominately queer areas and areas where I am least likely to run into any current or future therapy clients. As I have returned and settled back into navigating the heteronormative community I live in, here are some of my takeaways: 

 

1. Being surrounded by the queer community is powerful. As someone who lives in a smaller city, there is nothing quite like being surrounded by queer-owned shops, restaurants, bars, and lots and lots of pride flags and support of the queer community. To walk around an entire gay neighborhood is something I never could have imagined as a kid growing up in rural Appalachia. To see everyone being their authentic self is adrenaline-charged. It is extremely powerful and essential for these spaces to continue to exist, especially in states that are actively passing laws that negatively impact the LGBTQIA community.  

 

1. The power of seeing and listening to queer elders. One of my favorite things that I experienced was seeing so much diversity in queer love and joy, and especially seeing older adult queer individuals and couples. I was reminded of the importance of listening to our LGBTQIA elders and learning from them about what they have fought for. I left reflecting on how I want to continue to age as a queer person and what I hope to accomplish, and what I hope to see our community achieve.  

 

1. The Queer Community is resilient and vibrant. The complexity of walking around a queer neighborhood in Florida was evident. As we know, Florida has been a leader when it comes to States passing anti-gay and transgender bills. Yet, there we were. Thriving. Proud. Dancing! We need to remember this when we discuss boycotting similar areas. The LGBTQIA community is there, on the ground, doing the work. Any support provided is helpful.   

 

This trip was vital in reminding me of the importance of advocacy for the LGBTQIA community. Advocacy that will allow us to maintain our space in this world that we have fought hard to have. When I think about advocacy, I think about how broad this term can be and how it can mean something different to everyone. I want to share some advocacy tips to start the conversation and provide guidance:  

 

1. Advocacy can be small or big and should be authentic to you. For example, my most extensive form of advocacy is being authentically queer in South Carolina and bringing that identity into the classroom as a program director for a COAMFTE MFT Master’s Program. I hope that I make a positive impact on my students and that this leads them to create change in the multiple systems that they are involved in. I hope it models for them how to be their authentic selves.  

 

1. Advocacy requires you to stay informed and build community. Policies and information move fast, requiring energy, time, and focus. I have found that creating a community of support with friends that I can “kiki” (a hangout with friends) about the current state of politics and policies helps with burnout and my mental health. Advocating in isolation can be scary, but working in a community and a support system is energizing.  

 

1. Find Your Rhythm. Advocacy can happen in many ways. Find what works for you and be okay with that. Allow others to find what works for them. For example, I plan to attend the 2024 Systemic Conference in Orlando, Florida, this November. My choice to do so is because I feel attending is vital for the Queer and Trans Advocacy Network (QTAN) community, and showing up as a queer person is a core value of mine. With that, I understand other’s hesitations and concerns. Do what is best for you and allow others to do the same. Decide with your community and support systems, and maybe travel with them. I know you will have a community via QTAN leadership in attendance.  

 

Lastly, I cannot talk about advocacy without discussing the Queer and Trans Advocacy Network. As the 2023-2025 Chair, I am proud of the work the leadership team has been doing over the past two years, and I’m thankful to those who have come before us to help build the network. Here are some ways to get involved and advocate via QTAN: 

 

1. Join the QTAN 2024 Virtual Conference, July 26th – 28th. 
2. Please attend one of the many QTAN events! 
3. Volunteer to help with social media, event planning, or running for an upcoming elected position. Reach out to leadership at [email protected] to see how you can get involved.  
4. Connect with QTAN Leadership at the 2024 Systemic Conference in Florida. We have sponsored a track of QTAN-focused presentations that will help bring awareness to and advocate for the LGBTQIA community.  

 

Stay Proud,  

Evan 

 

Websites for Therapists for a Successful Private Practice

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy. 

Websites are often one of the first things therapists think about when it comes to marketing their practices. If you have a website, you might remember the first time you bought a domain name or saw your website live on the internet. For me, it felt so satisfying and exciting. There is something about having a website that can make your private practice feel official. Yet, a website isn’t the thing that makes your private practice successful. At the intersection of what makes a private practice successful, you will find a private practice that is not only profitable but that is run sustainably (see you later burnout) and is consistently improving on clinical outcomes. Your website is a tool that can bring those three things together and we want to show you how.

 

 A Website That Works

Your website is how you keep the light on for your business 24/7. At any time in the day, a person searching for help can find you and reach out or get information that can truly transform their life. Your website can be the difference between someone feeling seen or motivated to take the next step toward therapy and a person giving up on the search for mental health services. Having your website do some of the work for you, lessens your burnout on running your private practice. It can hold a lot of information that otherwise would be laborious to get out into the world on your own. Your website makes your marketing plan more sustainable as it is consistently available to people searching for help. Your website also exists to attract the ideal client for your practice. The ideal client is the person you know you can help, and that you have the skills and passion to serve. This directly impacts the clinical outcomes of your practice. By working within your wheelhouse, you can continually improve on your service delivery. People are searching for the right therapist, but you are also attracting the right client for your practice. Your website serves both you and the client in making a match. When you work with your clients and get great clinical outcomes it acts as a loop, giving back to your practice. Your clients stay until they get the needed transformation, your retention improves, clients are more likely to refer to you and as you are more satisfied in your work it shows in the therapeutic relationship as well. This leads to more predictable income as well as consistent clients and clients referring to you. It’s a beautiful thing. But there are some things you need to make sure you have for a successful therapist website.

 Therapist Websites: Make It Connecting

A therapist's website is the hub for communicating who you work with, connecting with their pain, showing that you understand as well as talking about how you uniquely help and the transformational value of working with you. While people may find you in other places, they may come to your website for that final validation that you are the right person to reach out to. From the moment someone comes to your website, they should know they are in the right place. You want your website to reflect your ideal client through the copy and images. Because it is here that the first attunement can begin in the therapeutic relationship, far before the first session. Our coaching clients often remark how referrals reach out saying that they came to their website and wept because they felt seen for the first time. That’s the power of your website messaging. The message is about attuning to their pain. It’s not really about you all that much. When you talk about what the client is going through, you demonstrate your understanding of their pain far better than if you said “I understand, you aren’t alone.” Yes, you share how you help, but first and foremost you connect. Connecting through the website leads to attracting the clients that are right for your practice, the ones who get great clinical outcomes. Taking the time to create a website that really is a home base for your practice also makes your marketing way easier. Too often therapists think fancy designs make an impression when it really is the language used to connect.

Therapist Websites: Making it Accessible

 You want your website to be easy to use. Nothing is more frustrating than wanting to connect with someone from their website and it being hard to find out how to do that. You need a clear path on your website for what a potential client needs to do. Often that is going to a contact page to book an initial consultation, but whatever you want this person to do as a next step, make sure it is clear. Also, you want anyone coming to your website to get the information they need with ease. Making your website accessible means creating a website that someone with vision impairments can read, if there is audio or video then there is a transcript or captions, and the images have descriptions. The design should never distract from the content. We would also argue for using the language that your clients use. No more technical jargon that creates a barrier between you and the client.

 Therapist Websites: Making it Visible

You can have a great website that is connecting and accessible, but it must be visible and easy to find. When someone searches for a therapist in your area, you want to pop up as an option in their search. We refer to this as SEO, Search Engine Optimization (learn more about it here). We teach how to do this in our Business School for Therapists, but essentially you want your website to tell the search engines what your website is about and why it is relevant to show your website on search results. Creating a website isn’t enough, it has to stay up to date with information. Consider it an ongoing project to get your website to be ranked and visible. You also want to share your website with others. Put it on your social media accounts, email signature, business card, or digital card and in your other marketing materials. Since it is your hub of communication, with any points of contact with others you want to bring them to your website.

 

Therapist Websites: Making It Ethical and Compliant

As a therapist, everything you do in your practice needs to be compliant with the ethics and laws of our profession. This means you need to have the proper notifications on your website, such as your terms of use, privacy policy, & disclaimers. Use tools on your website that are HIPAA compliant, even for your contact form. Your messaging should never offer false promises about what therapy can do. You can speak to the hope in the transformation, but using quotes and making guarantees about outcomes are something to avoid.

Website Perfection

It can be hard to make your website public or to promote it. You might want it to be perfect. We believe that most therapists can easily start their website with just one page. You don’t have to have all the pages, bells, and whistles together before you launch your first website. In fact, we don’t believe you have to hire a designer and pay thousands of dollars for your website. You can definitely do that if you have the budget, but in our website checklist for therapists, we cover all you need to know to get started or to revamp your website. The sooner you get yourself out there the sooner people can find you, even if it isn’t perfect.

 Website Mirage

Sometimes it can feel like all you are doing is working on your website, but you don’t know why the phone isn’t ringing. Fiddling with your website is just a marketing mirage. Your website is a piece of the marketing plan, a tool, and not necessarily the only way people find you and decide to work with you. You still need a marketing plan. When it comes to your website you do want to add pages and make updates based on the needs of your practice. You also want to keep your website fresh with new content such as through blogging. But you also want to be building relationships in the community, building your visibility with the people you serve. The website is just the start of expanding your marketing and making your message more accessible. It relies on you going out there in the world in order for it to do its job. Need more support with your website? We have a ton of resources on our website checklist for therapists here. Our hope for you is that you continue to hold your clinical outcomes as part of the foundation of a successful practice. Your website is another marketing plan cornerstone where you can make decisions that influence that foundation. It is with your website that you can find more ease, attract the right clients, and continue doing the work you love.

Access MFTs Portability Laws Pass in Multiple States – What Does This Mean for MFTs?

 

In recent weeks, MFT licensure portability bills have been signed into law in Virginia, Maryland, Tennessee, Iowa, Arizona, and Georgia. Similar bills continue to move through the legislative process in other states.  

 

Licensure portability is the ability to take an individual’s qualifications for a license in one state and apply them for licensure in another state. There can be many barriers that cause difficulty in this process, some of which are outlined in this Family Therapy Magazine article. The Access MFTs strategic portability effort works to identify those barriers and mitigate them as much as possible to create a much easier portability process for those within the profession. 

 

As we celebrate the legislative successes in these six states, we also want to inform MFTs about what this means practically for those seeking licensure in these states. The Access MFTs model is a true licensure by endorsement model, meaning that verification of your current license is the key requirement to obtaining secondary licensure.  

 

This will simplify and streamline the process of obtaining a license by endorsement in the Access MFTs states significantly. Prior to the passage of the Access MFTs bills, some states had lengthy active years of practice requirements before an MFT could even apply for an endorsement license, or required primary verification of all education, exams, and supervised experience to establish “substantial equivalency.” These unnecessary and duplicative requirements have now been removed. 

 

Now, all an MFT must do is provide evidence of their unrestricted license to practice in another state or territory and complete an application for licensure by endorsement.  

 

While we are not always able to achieve the model law exactly, our goal is to ease the portability process as much as possible in states across the country. For example, some states might have additional state-specific requirements, such as passing a background check or a state jurisprudence exam. Ultimately, this model requires significantly less work and documentation from the MFT to obtain licensure by endorsement.  

 

For the most up-to-date news on Access MFTs, click here. The effective dates for the Access MFTs bills signed so far vary from state to state, with most going into effect this summer or fall. If you need information about a specific state, please visit accessmfts.org or contact us at [email protected].  

Overcoming Your People-Pleaser Part: An MFT Perspective

 

By: Vanessa Bradden

 

As a therapist, I often discuss the complex issue of people-pleasing behavior with clients and colleagues. While others may initially see it as a positive trait—after all, who would dislike you for agreeing with them? —it comes at a significant personal cost. People-pleasers often mask their needs in their quest to be liked by others, a struggle that can be deeply challenging.  

 

People-pleasing is a learned behavior originating from childhood experiences and social conditioning. For example, children who receive praise and positive reinforcement for being helpful and obedient may learn that pleasing others is desirable behavior. In the right circumstances, going along with something is good; it is valid and leads to simplicity. However, it has poor outcomes for everyone when it becomes a chronic behavior.  

 

When we constantly go along to get along or say “yes” to keep the peace, we inadvertently dismiss an essential part of ourselves, resulting in what is known as an 'arrested development.’ When a young part of self cannot develop the skills to set healthy relationship boundaries, we carry it into adulthood. It can impair one's ability to navigate simple conversations for fear of being disliked and ultimately lead to lost opportunities and unrealized potential.  

 

Our people-pleaser part is a young self that internalizes the positive feeling of being praised by others. And when positive feelings are present, they make less desirable ones hard to tolerate. And if no one teaches us how to say "no" and still feel loved and cared for, we will take the path of least resistance every time. Think about the "carrot and stick" metaphor. When it comes to people-pleasing behaviors, the carrot represents an avoidance of anxiety at all costs because the stick is anxiety on steroids.  

 

People-pleasing behavior can also be a symptom of internalized trauma, a coping mechanism that forms in childhood. For example, when parents cannot manage relational tension or conflict, a child often acts as the mediator or soothing mechanism. This child, in turn, becomes wired to prioritize peacekeeping, as it provides temporary relief from tension and discomfort. The initial rewards of this behavior seem promising. However, they can lead to long-term consequences that are not immediately apparent, potentially significantly impairing our relationships and sense of self.  

 

With a unique perspective, systemic therapists, like marriage and family therapists, illuminate the issue of people-pleasing behavior through a holistic lens. They view it as part of a larger, more intricate picture that often remains unseen until it affects essential relationships in a client's personal or professional life. By looking at how the behavior came to dominate, we can help our clients develop skills that better protect them from the slippery slope of going along with things to make others happy and avoid discomfort by saying “no.”  

 

When a young part of self cannot develop the skills needed to set healthy boundaries in relationships, it continues to operate this way into adulthood. The lack of healthy boundary development can impair one's ability to navigate simple conversations for fear of being disliked, leading to lost opportunities and unrealized potential.  

 

Saying "yes" to something when you want to say "no" or being agreeable with opinions that make you bristle is a disservice to yourself and puts you at risk of burnout, anxiety, and depression. The people-pleasing part is not protecting us from the discomfort of anxiety; it just kicks the can down the road by allowing us to stockpile our unspoken "nos" until we either implode, causing self-destruction, or explode and project our stored resentments onto the wrong people.  

 

To overcome your people-pleaser, you must understand the narrative that created this part of you while remembering it is just one part, a young part prevented from getting the traction needed to set boundaries. Still, you can learn new skills by working with a marriage and family therapist. Here are some tips to consider when the inner people-pleaser takes over.  

 

1. Learning to Let People Down and Be Okay with the Outcome 

Imagine this: your friend asks you to help move this weekend. You've already planned a self-care day. Your inner people-pleaser wants to cancel on yourself for fear of letting your friend down. Instead, offer an alternative solution that does not involve canceling your self-care day. For example, you can say: "I've got plans this weekend, but here's the number of a great moving company." You've said “no,” offered a solution, and kept your self-care intact. It is okay to say “no” to protect your self-care needs. Other people’s expectations belong to them. We are not required to fulfill them. Remember what Murray Bowen taught us about differentiation. “We are responsible “to” others, not “for” them.”  

1. Learn to Say “No”  

"No" can be gentle yet firm, and for people-pleasers, it comes with anxiety and guilt. However, you can harness this skill by reminding yourself that saying “no" is setting a limit intended to protect you from over-extending yourself for the sake of others. For instance, when your boss asks you to work late for the umpteenth time this month, instead of the knee-jerk "yes," try, "I understand the urgency, but I've committed to work-life balance. Can we find a solution that respects our time outside work?" This approach respects both parties and sets a precedent for future interactions.  

1. Boundary Setting in Action 

Boundaries are like your personal force field. Their purpose is to protect your emotional energy. However, they are invisible and can be hard to implement for those who find it hard to say “no” to others. Here is what it looks like in action. Let's say a relative has a habit of calling late at night to vent. You value your sleep, so you say, "I care about you and want to support you, but I can't take calls after 9 PM. Let's find a time earlier in the day to connect." This way, you're not just setting a boundary but also offering an alternative that respects your well-being.  

1. Communicated Your Needs Clearly  

The silent treatment never works. In fact, it breeds negativity that leads to contempt and resentment. Being clear and specific with others about your needs will help you avoid these adverse outcomes. For example, if you're always picking up extra shifts at work, and it's burning you out, sit down with your manager. Use "I" statements to communicate your need from a place of non-defensiveness. You can say, "I've noticed I'm often the go-to for extra shifts, which I'm happy to help occasionally. However, I need this to be more balanced with the team for my well-being." This conversation opens the door to change and shows you're proactive about finding solutions. 

1. Practice Self-Care  

Self-care is also setting boundaries with yourself. Say you're a chronic over-committer. The next time you're about to say "yes" to yet another commitment, pause. Ask yourself, "Is this something I genuinely want to do, or am I afraid of disappointing someone?" If it is the latter, it's time to practice self-care by declining. Leading with “no” will help you save your “yes” for something that meets your needs rather than the needs of others, which is a new skill for people-pleasers.   

1. Celebrating the "No" 

When you notice yourself saying "no" to something that you would typically say “yes” to, do something to celebrate – it can be as simple as treating yourself to a coffee or taking yourself out for lunch. These celebrations reinforce positive behavior, making it easier to say "no" in the future. 

 

Remember, you're not responsible for how others react to your newfound "no." If someone is upset because you're taking care of yourself, that belongs to them, not you. Your responsibility is to your well-being. Lasting change takes time, and talking to a marriage and family therapist can help you further clarify and define the changes you want to make to heal and overcome the people-pleaser part that keeps you from setting healthy limits with yourself and others. 

Multiple Streams of Income or Multiple Streams of Distraction?

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy. 

It seems like every other podcast and training for therapists is focused on multiple streams of income. Write a book, start a podcast, launch a course, start doing retreats, what about integrating plant medicine? 

The truth is, you DO have a lot of options as a Marriage and Family Therapist! But the grass is NOT always greener. Today we want to dive into how multiple streams of income can lead to more distraction, less profits, and more burnout so you can get clear about whether multiple streams of income really the right next step for you in your career is.

A Shaky Foundation

Many therapists get little to no training on how to run a business. In fact, many only have to take statistics in grad school- which is NOT helpful in developing a business plan! In fact, for many of us basic financial math was not taught or shared with us.

Colleges and universities would be doing themselves a disservice if they taught us financial math in many cases. Why? Because master’s degrees related to counseling and therapy continue to be among the top worst-paid master’s degrees. Showing a student the numbers in terms of income while they are investing sometimes over $100,000 in getting a degree is just bad math!

As we start to move into seeing clients during practicums and internships, we are often unpaid or severely underpaid. I was lucky enough in California as an MFT Trainee to have a job paying $15/hr where I could also gather hours. People were jealous of my income. And yes, I had to take a pay cut to do this work because I had been supporting myself working in corporate America previously.

Getting paid ANYTHING feels like a luxury. Most people around us aren’t getting paid much. So, being overworked and underpaid feels normal. It is normal… in this profession. We often replicate this when we start our private practices. Of course, we end up with practices that leave us living paycheck to paycheck, client to client, or without any retirement. You are NOT alone if you need more income as a therapist. You didn’t do anything wrong if you replicated and emulated what you learned and saw and are realizing it doesn’t work for you.

So, isn’t another stream of income, passive income, or a side hustle the obvious solution to this problem? In our experience, having coached therapists for almost two decades, in 90% of cases, it is a distraction from the real issue, and it will actually exacerbate the lack of income and overworking versus solve the problem.

Why are multiple streams of income a distraction for most MFTs?

The truth is, you likely don’t have additional time or energy as it is. You’ve been overworked and underpaid for so long. There are so many hours in the day. Many MFTs today are literally living and working with poverty wages, even with a master’s degree (or higher) and a professional license and it is NOT ok. The first step is not to create another stream of income and replicate being underpaid in a new way.

The first step is to get to the bottom of why your current business or full-time income is not fully supporting you. You should be able to live comfortably, have a savings account, go on vacations, pay down debt, and yes even do a bit towards retirement with one stream of income. If you living paycheck to paycheck, on income repayment for your student loans, etc. something is out of alignment. So, let’s start there.

Are you charging a fee that is truly sustainable?

We know you want therapy to be accessible to as many people as possible. But, if you are struggling to pay your bills, or even losing your love for the work because of the financial struggles that is not going to make therapy more accessible. In fact, more people are leaving the mental health field than entering it right now. We need as many MFTs to stay in this work as possible to make it accessible. So, can we get honest about what it takes to do this work? Here is a link to our free how to set fees training for therapists where we will dig into ethics and give you a clear formula for setting a sustainable fee.

Are you accepting sustainable reimbursements from insurance companies?

Why are therapists in Conway, AR getting reimbursed 40% more for the same CPT code as a therapist living in Los Angeles, CA? We can tell you it is not related to the cost of living. The truth is, insurance companies decide their reasonable and customary rate based on what therapists will agree to and based on making profits. In fact, according to Becker’s Payer Issues the top 5 insurance companies had profits of more than 40 billion dollars after paying their providers. Have you gotten clear on what your average fee or reimbursement rate needs to be in order to sustain. The truth is, the insurance companies are required to have available providers. They are not required to pay well. But, of course, in places where there are fewer therapists willing to say yes to low reimbursement rates, the rates will shift.

Are You Undervaluing Your Labor?

 Over the last several years we have seen online mental health tech companies come in and disrupt the mental health space in some good and bad ways. They helped normalize therapy. They helped normalize online therapy. But, in many cases they normalized very low contract rates for independent contractors, as well as putting advertising over quality of care. If you feel angry at what online mental health tech companies are doing there is only one solution. Do not give them your labor. Without access to boundless, cheap labor these companies cannot continue to underpay therapists.

While we believe multiple streams of income can be great- it is SO important that you focus on having one solid, sustainable source of income first. Often even additional sources of income come out of a balanced life and some stability. Otherwise, we will just keep replicating the therapist’s way of being overworked and underpaid.

As a member of AAMFT, you get special discounts for Business building help from zynnyme. You can learn more about how we help and your discount here.

AAMFT Celebrates World Health Day

 

By Mary Hotvedt, PhD

World Health Day is celebrated on April 7 annually each year and draws attention to a specific health topic of concern to people all over the world. The date of April 7 marks the anniversary of the founding of WHO in 1948.

For marriage and family therapists, nothing could be more central to our core than focusing on systemic mental health—in the US and abroad. With this in mind, AAMFT is pleased to announce that we will be publishing in the May/June issue of Family Therapy Magazine, The Assisi Manifesto, a document originating from a 2023 conference held in Assisi, Italy, where over 1,000 psychotherapists from various countries convened to discuss family therapy and its role in contemporary society. The manifesto, by Maurizio Andolfi, outlines key points regarding the importance of family therapy amidst new challenges facing mental health treatment globally.

The manifesto emphasizes:

• Listening to Youth Voices: It highlights the rise in adolescent mental health issues exacerbated by societal factors such as family disintegration and social media. The manifesto stresses the need to listen to the voices of young people and incorporate their perspectives into therapy without resorting to prejudiced labeling.
• Addressing Couple Crises and Divorce: Couple crises are recognized as not just private issues, but as affecting the broader family system, including children and extended family. The manifesto advocates for a multigenerational approach to healing and resilience within families experiencing such crises.
• Navigating Loss, Trauma, and Resilience: The manifesto acknowledges the inevitability of loss and suffering and calls for a culturally sensitive approach to mourning. Family therapists are encouraged to facilitate processes that strengthen families coping with trauma and loss, including those stemming from global crises such as wars and forced migrations.
• Confronting Social and Cultural Discrimination: The manifesto addresses social injustices such as discrimination, economic disparities, and political repression, recognizing both the vulnerability and resilience of families caught in these circumstances. It advocates for therapists to engage not only in therapy rooms but also in broader social contexts to promote empowerment and inclusivity.
• Advocating for Professional Training: The manifesto stresses the importance of intensive training for therapists working with families and communities, emphasizing ongoing education and understanding of both client and therapist traumas and resilience.
• Recognizing the Family as the Foundation of Society: In light of global political divisions and crises, the manifesto underscores the need to strengthen families as the cornerstone of society and a vital source of healing.

Overall, the Assisi Manifesto calls for a renewed focus on family therapy as a means of addressing contemporary mental health challenges within the broader social and cultural contexts in which families exist.

I am also pleased to announce that I have authored a companion piece to accompany The Manifesto which looks at the text from an American lens.

In my piece, I note that The Manifesto responds to the perceived decline in the prominence of family therapy, emphasizing a return to fundamental principles. It invokes the spirit of early pioneers in the field, such as Minuchin, Satir, and Whitaker, who passionately championed family-centric approaches. The document serves not only as a statement of principles but as a call to action, urging practitioners to integrate these principles into their work.

My key takeaways from the Manifesto include:

• Emphasizing the importance of the family unit and community support.
• Embracing inclusivity in practice, considering diverse cultural and familial contexts.
• Recognizing training as a continual process and encouraging therapists to confront personal and professional challenges.
• Advocating for social justice and community involvement.
• Encouraging boldness in practice, akin to the pioneering spirit of early family therapists.

Ultimately, the Manifesto is seen as a revitalization of the foundational spirit of family therapy, calling practitioners to recommit to its core principles and advocate for families' well-being. It challenges therapists to transcend mere professionalization and embrace the interconnectedness of human existence within families and communities.

Coming soon, AAMFT will be holding a new At Home webinar on Thursday, May 23, at 1:00 pm ET, titled Listening to Teen Voices in Family Therapy, with Maurizio Andolfi.

In this webinar, Maurizio Andolfi will outline the essential need to listen to youth voices in therapy without prejudice and labeling. Their voices, sometimes arrogant or bizarre, angry or provocative, are often a despaired cry for love and care. By showing a video of a family session from the Academia Multimedia Collection, Andolfi will illustrate how to build an alliance with a withdrawn teenager with the use of relational questions in the presence of his mother and maternal grandparents. Registration will be announced soon!

And one final note, the Journal of Marital and Family Therapy has opened a Call for Papers on Emerging Trends in Systemic Family Therapy Around the World. Please see the full details at the link below.

Please join us in celebrating global systemic mental health this April 7 on World Health Day, and look for the upcoming May/June issue of FTM where you can read the full pieces described above.

Download JMFT.special.call.

Mary E. Hotvedt, PhD, is an anthropologist and an MFT. Mary served as President of AAMFT. She has worked with Dr. Maurizio Andolfi for over 35 years. She is currently Chair of the Board of Regents for Western New Mexico University.

Different Stories, One Song!

By: Dr. Michelle Karume, DMFT 

Just like biases we often don’t think we have them until we sometimes find ourselves working with clients from various walks of life and recognizing we have some adverse thoughts or attitudes about them, their practices, their culture, their beliefs etc. it happens to be best of us. In the same vein racial discrimination (RD) does not discriminate; sounds like a double negative but it’s not. The truth of the matter is, the field of MFT is not immune to racial discrimination. One could argue, how can that be, when we are arguably the most competent when it comes to working within a systemic framework? Afterall, we are able to hold spaces for people who are different from us and serve as catalysts for change within their relational issues.  That’s a fair question! We can each point a finger on who should do what better, but the blatant truth is, we each have a critical role to play. One that perhaps will call on us to be vulnerable and transparent for the greater good. I figure if we don’t, then who will.  

     Before going into how we, in the field of MFT can start to have these conversations on racial discrimination, let’s take a brief look at the effects it has on individuals as well as families. Studies have shown that (RD) has adverse effects on individuals and family’s mental health, physical health; if we Use the biopsychosocial-spiritual framework we can see that racial discrimination has its tenets in these various areas. In their study Chen & Mallory (2021) found that individuals who had experienced RD were at higher risk for physical diseases as well as mental health diseases such as depression and anxiety and also substance use disorder. Similarly, a study by Lavner et al., (2023) reported significant correlations between depression in adolescents who have experienced racial discrimination. However; though these negative experiences are still present today, the complexity of racial discrimination also begs to highlight that even though there is still some work to be done; there however has been progress.  

     I’ve heard it said that charity begins at home. If we use the same thought process, we can see the importance of protecting our field from the fault lines that RD can cause. The detriment of these cracks in the field cannot be taken lightly for the negative impact is too costly. Perhaps the first step to this change is a paradigm shift from how we view changing the climate of RD. Due to its historical traumatic experiences and effects, I can see why aims at making changes on the same have also had some aggression towards them. But if we, in the field of MFT saw this as,  

“as advancing the understanding of a psychological phenomenon rather than as something more threatening, such as “pushing an agenda” (Roberson, 2023., p.181) maybe we would approach it less armed or guarded and more open to the need for this change. Once we have this paradigm shift I think we can then be more open to creating safe spaces just like we do for our clients. When the space is safe, people are more amenable to trust us with their stories-it would not be any different for us the clinicians. As an African myself, one of our traditional ways of healing societal challenges was through stories and folk songs. Whereas I am not asking us to sing; although that would be pretty amazing, the power of storytelling is one we can all relate to. Here as a chance for us to re-write this story on racial discrimination in the field of MFT. How do we tell our stories? Perhaps through our written works, through our platforms such as teaching, or during our conferences or simply by sharing it with other MFTs in the field.  These stories would specifically focus on what led us to the beliefs we hold regarding racial discrimination, what were our experiences? Similarly, when we do genograms with our clients the historical view allows the client to see what was but more so it gives them the opportunity to see how to effect change and not repeat the same.  Another suggestion could be having a sense of pride-through their program in working with families to disrupt the negative consequences of racial discrimination, Berkel, C.,. et al. (2024) found a key component in “overcoming discrimination” was this element of ‘Black pride’. It was what parents also used to give their children a sense of belonging and pride in who they were. Could we in the field of MFT embody a similar key factor that bonds us together? I want to believe we are proud to be MFTs but something that unifies us deeper on this very issue so much so that it could start the elimination process of this issue? Something that we would be proud to say that the field of MFT prides itself in implementing this change. I hope we can. 

     Finally, MFT programs-curriculum in the MFT programs could include a course or material on racial discrimination and tribalism specifically, there effects and most importantly how to disrupt them. I think part of the problem is that we are not taught how to best manage and or talk about it. If this is made a requirement then from the collegial level, we learn how to implement the relevant techniques.  I truly believe that we are a more similar than we are different-if so; then let’s make our field an example of this. 

 

 

 

References 

Berkel, C., Murry, V.M., Thomas, N.A. et al. The Strong African American Families Program: Disrupting the Negative Consequences of Racial Discrimination Through Culturally Tailored, Family-Based Prevention. Prev Sci 25, 44–55 (2024). https://doi.org/10.1007/s11121-022-01432-x 

 

Chen S, Mallory AB (2021). The effect of racial discrimination on mental and physical health: A propensity score weighting approach. Soc Sci Med. 2021 Sep;285:114308. doi: 10.1016/j.socscimed.2021.114308. Epub 2021 Aug 8. PMID: 34399293; PMCID: PMC8451383. 

 

Lavner, J. A., Ong, M. L., Carter, S. E., Hart, A. R., & Beach, S. R. H. (2023). Racial discrimination predicts depressive symptoms throughout adolescence among Black youth. Developmental Psychology, 59(1), 7–14. https://doi.org/10.1037/dev0001456 

 

Roberson, Q. (2023). Understanding racism in the workplace. Journal of Applied Psychology, 108(2), 179–182. https://doi.org/10.1037/apl0001079 

AAMFT Statement: Regarding Change Healthcare Cyberattack

 

Last month, Change Healthcare was the target of a major cyberattack that has impacted many marriage and family therapists (MFTs) and other healthcare providers. Owned by UnitedHealth Group (UHG), Change Healthcare processes up to 15 billion healthcare transactions annually. Due to this cyberattack, MFTs, other individual healthcare providers, hospitals, and clinics are not receiving payments for services recently provided to clients. This disruption significantly impacts the finances of MFTs and other providers, especially smaller providers. 

AAMFT recognizes the impact of this cyberattack on MFTs who process payments through Change Healthcare and has reached out to share these concerns with Change and UHG. Change Healthcare shared that they will not resume electronic payments until March 15 at the earliest. 

AAMFT fully supports the statement by the U.S. Department of Health and Human Services encouraging insurers to make interim payments to impacted providers. We applaud the Centers for Medicare & Medicaid Services for making accelerated payments available to Medicare Part B providers. We urge other payers to make advanced payments to MFTs impacted by this cyberattack.

Providers can learn more here: https://www.hhs.gov/about/news/2024/03/10/letter-to-health-care-leaders-on-cyberattack-on-change-healthcare.html

https://www.unitedhealthgroup.com/changehealthcarecyberresponse

Medicare Providers can learn more here: https://www.cms.gov/newsroom/fact-sheets/change-healthcare/optum-payment-disruption-chopd-accelerated-payments-part-providers-and-advance

Why You Don't Want to Be a Therapist Anymore

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy. 

I stared at a stack of yellow files, all waiting for my review to be sent to Medicare for payment. Piles of notes and treatment plans made my soul sink. I didn’t go to school for this, pushing paper and unrealistic expectations and quotas on other therapists. I was worn out, irritable, tired and no longer finding joy in the work that I once had loved so much.

That’s when the thought hit me, “I don’t want to be a therapist.”

But I had invested so much time and energy to get here. Even after looking into other grad programs for a medical career, I decided to try shifting how I was doing the work and began a business on my own. 

Private practice was my last-ditch effort to fall back in love with my career.

Maybe you’ve felt it before, that inkling that something isn’t right or is creating a level of discomfort that you aren’t sure how much longer you can tolerate. Truth is, we have more people leaving our field than entering it. But why? Why do we really not want to be therapists anymore and is there anything we can do to change the course?

Reason #1 You Don’t Want to be a therapist: The mental health system is set up for burnout.

For all of us in this mental health field, we were born out of systems that do not serve us. Working for unpaid internships and practicums, and acquiring high student loan debt. All while the powers at be KNOW we are in fact some of the worst paid masters degrees. We come out of graduate school already set up for stress and overwhelm.

Add to that the weight of people’s lives that we serve, being told we are responsible for the outcomes when the resources of the system are so limited. The system is the cause of a lot of their mental distress, much of which we can’t do anything about.

When we wrote the book on Therapist Burnout, we realized that many people thought burnout came from just feeling stressed about work. Burnout in the mental health system is almost always  seen as a personal weakness, instead of a normal response to a broken system. In order to heal burnout one of two things needs to happen. One,  the system has to change or, two, we have to change how we interact with the system.

For example, I left my government job because it was causing burnout. I created a practice from there that supported my needs as well as for my clients. Changing the setting made all the difference in me continuing on my path as a therapist. Suddenly I truly loved being a therapist again, and I felt inspired to help other therapists find their love again too. It was like a switch flipped.

I know private practice isn’t the path for everyone, and that is ok. For those who don’t want to take the entrepreneurial route, can you change the system from within? it’s going to take push back, setting new boundaries and speaking up all in the name of self care to heal the burnout. The truth is, your labor is incredibly valuable! We are taught often that we are expendable, but truly our work is invaluable.

Reason #2 You Don’t Want to be a therapist: Private practice is failing you.

But what if you are already in private practice and you don’t want to be a therapist anymore? Private practice is the dream for a lot of therapists. It signifies independence and freedom. Often that freedom is sucked away by fears around marketing, low paying insurance companies with horrendous clawbacks, tech companies that take advantage of therapists and their clients and overwhelm with learning how to be a business owner. It is a lot and nobody learns these skills in grad school.

Many therapists go into their private practice with the same mindset they had in their agency work and replicate processes and ways of doing/being that often continue the harm they were trying to leave, such as unrealistic sliding scale fees, overworking, documentation that is over and above what is needed, and accepting any potential client who calls. Any chance to deviate from those norms has often led to being shamed by peers who tell them that what they are doing can’t be done or is unethical, such as charging a rate for therapy that allows them to live beyond the poverty line.

Side note: The sliding scale fee structures that we bring from non-profit organizations are often based on millions of dollars worth of grants that allow for pro bono or sliding scale spots. Those sliding scales aren’t appropriate, or sustainable for most for profit models without extensive grants. In fact, mental health attorneys advise AGAINST sliding scales in private practice for legal and ethical reasons. You can learn more about the law, ethics, and legal advice in free How to set fees training.

Before you end your career as a therapist, first look at what you created with this private practice and ask yourself:

• Is this really working for me? It is so easy as therapists to stay checked out focusing on everyone else. What is your body, mind, heart, and spirit saying about your life right now? Is work and personal life in balance and truly aligning with your values?
• Am I making a livable private practice salary? You may need to relook at your financial plan to ensure you have a fee that is viable for your needs to live in your community with balance and health.
• Am I doing things that don’t make sense and drain me? Whether it be your documentation processes or billing, look at how you have been running your process and see what you can streamline, eliminate or delegate.
• Do I have support in private practice? Private practice can be isolating. We have seen many therapists go back to employment simply because they felt so alone in private practice. You want community in your personal life and in your business. For your private practice, that might mean getting involved in a local AAMFT chapter, inviting colleagues out to get together, signing up for group case consultation and more. You may need some direct guidance and support from an expert, whether that is clinical or in the realm of running a business. You don’t have to do everything on your own.

Once you look at these questions you can either choose to make adjustments or you may decide that private practice isn’t for you. That is all ok. The goal is to create a way of working that really lights you up, not sucks you dry. Private practice may not be for you or your private practice may simply need some adjustments.

Reason #3 You Don’t Want to be a therapist: Obligation is dictating the focus.

The style of working or the way you offer your services might be coming from a place of obligation and not conscious creation. You do what you have been taught to do or feel you must do. You know when you were taught that a 45-50 minute session is the standard of care. Sure, for billing insurance companies it is, but that doesn’t mean that is proven to be what is needed for great clinical outcomes with the clients you like to work with and how you like to work.

Many therapists who don’t want to do this work anymore are really no longer wanting to do the work in a way that doesn’t fit them. Yet, we are raised to fear losing our license so heavily that we become paralyzed with our innovation and creativity.

We have helped many therapists engineer clinically outcome focused services that break the mold of traditional therapy. From walk and talk therapy, intensives, retreats, longer sessions, shorter sessions, it’s all a perfect opportunity to really evaluate if the service you are providing is one that you believe in and do good work in.

Reason #4 You Don’t Want to be a therapist: Clients are draining.

Another reason you may want to quit being a therapist is because of who you are doing therapy with. This is not to blame or shame the client. This is to simply explore that you may have said ‘Yes” to working with people who are not a good fit. Or, something for you has shifted and who you once loved to work with, is no longer the case.

How does this happen? There is often an unspoken code that if you are a helper and a healer, you do not discriminate or turn people away from healing. That would be cruel! You can’t be a good therapist unless you are truly willing to help anyone that comes through your door.

It could be argued that it is quite the opposite, the more clarity you have leads to better clinical outcomes and is better for the clients for you to refer out than to work with them from a half hearted or burned out place. People get better clinical outcomes when they have a focus, speciality or passion behind who they are serving.

Take Sam for example. They loved doing couples work but after their own recent divorce, they find working with couples to be absolutely challenging. We would never suggest that Sam just suck it up and work through it. Instead, we recommend Sam to honor the challenges and changes in their own life and to see where else there might be passion for them to see clients - such as with individuals. Ask yourself if the clients you are working with are ideal for you and make a commitment to only working with those who you feel drawn to support out of ease and confidence, not fear or scarcity.

Reason #5 You Don’t Want to be a therapist: Avoiding the feeling and projecting the solution.

You might be blaming the work of therapy for dissatisfaction in your life that is sourced from elsewhere. Instead of giving ourselves space to feel our feelings and understand the sadness, yuck and muck we can tend to look at our work as what is wrong and what needs to be fixed.

“I went to work today and I just didn’t want to hear another person talk about their pain.”

You can’t address an internal issue from the outside. It has to come from within.

Sure, this could be because you don’t want to do therapy, or it could be that you aren’t well resourced in your own life due to stress and other circumstances. But then it can quickly turn into “the solution could be a career change”.

I can’t count how many times people have come to me wanting to quit, and then with time and feeling they realize what is really going on are things in their personal life - all very valid and real stressors.

Before you jump ship, look at your life and what it is asking of you. Does it need more time and attention, compassion and love so you can then make a decision about your work from a place of grounded confidence and not exhaustion from your daily struggles?

Please don’t go.

Or at least, before you do consider whether your environment or system needs a shift. If you still feel a change is necessary, know that the lessons learned will enrich your next journey. Creating a fulfilling career is about discovering or even inventing paths that bring joy to your life.

Need assistance? Our Business School for Therapists, operational since 2010, has aided thousands of therapists in finding their passion and navigating the financial aspects of their practice. We're here to support you in this journey.