Sacramento Valley CAMFT

 Support for Your Professional Growth



March 2015
 Newsletter Editors:  Heather Blessing &
 Karen Ulep & Margaret Greenough
newslettereditor@sacramentovalleycamft.org 
 

Letter from the Board

March 1, 2015

Dear SVC-CAMFT Member,

I am happy to report that 7 of us attended the CAMFT leadership Conference in Costa Mesa this last week.  It was a great opportunity for those of us new to the board to gain valuable information to advance our chapter. We were noted for our social media presence, which is due in great part to new member, Karen Ulep. We received many new ideas regarding outreach, membership and sponsorship that we are anxious to put into place. We will be meeting as a group this next week to debrief and put our plan into place.

We had a very successful Club 3000 Meet and Greet social with AAMFT Sacramento this month. A good time was had by all, and much networking took place. We look forward to our next one in April.
Our February meeting was well attended, and the evaluations reported that much was learned and our speaker, Jennifer Lombardi of the eating Recovery Center was extremely knowledgeable. Jennifer has agreed to join the board, and we thank her for her hard work and the sponsorship by her agency of the February meeting and catering.

We plan to begin visiting local colleges in the next month to share what our chapter has to offer. Patricia St. James and I attended a student outreach event at their site this last month and had the opportunity to meet some wonderful graduate students, some of whom joined us for both the pre-licensure and breakfast meeting this month.

All of us at SVC-CAMFT would like to thank Laura Fredrick for her wonderful service and dedication for the past several years as Administrative Assistant.  We are sad to see her go as she is like family to us but we understand that she will need more time to attend to the PhD program she has just started.  We wish her well and know she will do well because without her many of the transitions of SVC-CAMFT would have been nearly impossible.  As she leaves us she is again assisting with her amazing abilities in training our new Administrative Assistant, Karen Ulep.  (Many of you may have seen Karen around taking pictures at the training for our website and our logo and website update is her marvelous work.)

Thanks to all of you for your support of time and energy to our chapter.

Peace,

Ann Leber, LMFT

President


  This issue:
· Letter From the Board
· Legal Beagle
· Don't forget to renew your membership!

·  Presentation Summary
· Upcoming Meeting
Information
· Upcoming Board Meetings

· Interview with a Therapist
· Special Feature·
· Letters to the Editor

· Psyched about Books and Movies

· Advertising and Announcements

· Advertising Policy for the Newsletter

BOARD OF DIRECTORS
President:

Ann Leber, LMFT


President-Elect:
Patricia St. James, LMFT

Past President:
Jill  Lawler, LMFT

Secretary:
Becky Counter, LMFT

Treasurer:
Beverly Baldwin, MFT Intern

Members-At-Large:

Darlene Davis, LMFT
Joseph Borders, LMFT

Program Co-Chairs:
Carol Delzer, LMFT
Kari Deitrich, Trainee

Hospitality Co-Chairs:
Joshlynn Prakash, MFT Intern
Carol Mahr, LMFT
Nazia Khan, MFT Intern
Alexis Clemons, Trainee
Melinda Keeler, Trainee

Club 3000 Co-Chairs:
Sterling Evison, Trainee
Anna Garcia, Trainee
Charlotte Parks, LMFT

Volunteer Co-Chairs:
Maria Wheeler, LMFT
Amita Khare, Trainee

Membership Co-Chairs:

Jenna Bell, MFT Intern
Michael Tablit, Trainee

Sponsorship Co-Chairs:
Rebecca Kneppel, MFT Intern
Sara Coffill, MFT Intern


Newsletter Editors:
Heather Blessing, MFT Intern
Margret Greenough, LMFT
Karen Ulep
, MFT Intern

Legislative Chair:

Bylaws Co-Chairs:
Jennifer Lombardi, LMFT
Elizabeth Roccucci, LMFT

IT:
Jen Huber, Intern


Communication Specialist
Karen Ulep, Intern


 

Legal Beagle

dectective.pngWelcome to the section of the SVC-CAMFT newsletter, Legal Beagle written by Darlene Davis, LMFT. The chapter thought it would be helpful to keep you updated on new laws, legislative pursuits or actions, as well as ongoing legal and ethical dilemmas we all face in our career as Licensed Marriage and Family Therapists, Interns, and Trainees. Please feel free to ask questions that you have and I will do my best to investigate and post your answer in the newsletter. Please note that articles are based on information from CAMFT and/or the BBS and have been researched to the best of my ability. This is not meant to be legal advice.  Please contact CAMFT or Board of Behavioral Sciences for any legal matters you need assistance for. 

******************************************************************************************************

There is a lot going on in our profession and the BBS has been working very hard. Here are some of the updates I thought you might be interested in.

 

Laws Effective January 1, 2015:

 

AB809 Requires, prior to providing telehealth services, the health care provider initiating the use of telehealth to inform the patient about the use of telehealth. The provider must obtain and document verbal or written consent from the patient.

 

AB1775 Makes downloading, streaming, or accessing through electronic or digital media, material in which a child is engaged in an obscene sexual act a mandated report under the Child Abuse and Neglect Reporting Act (CANRA)

*There is a great article on the CAMFT website; Understanding Mandated Reporting Requirements: AB 1775 written by Cathy Atkins, Deputy Executive Director CAMFT

 

AB1843 Allows the BBS to access a child custody evaluation report for the purposes of investigating allegations that one of its licensees, while serving as a child custody evaluator, engaged in unprofessional conduct in the creation of the report.

 

SB578 Requires board licensees to retain patient records for a minimum of seven years from the date therapy is terminated. If the patient is a minor, records must be retained for a minimum of seven years from when the patient turned 18.

*many of us have done this all along now there is a law in place.

 

SB1012 Increases the hours of weekly supervision that a marriage and family therapist intern, marriage and family therapist trainee, and professional clinical counselor intern may count toward licensure from five hours per week to six hours per week. This applies to supervision hours gained on or after January 1, 2009

*This is why as a supervisor I recommend writing every hour on your experience logs even if you think you met a maximum!

 

Proposed changes to the law:

 

Revisions to supervised work experience hours The Board is sponsoring legislation to streamline the supervised experience requirements for LMFT and LPCC applicants. The bill eliminates the complex assortment of minimum and maximum hours of differing types of experience required for licensure (also known as the “buckets” of experience hours) and instead requires 1,750 hours of the experience to be direct clinical counseling hours. The remaining required 1,250 hours may be non-clinical experience – which may consist of activities such as direct supervisor contact, writing clinical reports, or attending workshops or conferences.

*When this goes into effect new applicants for licensure will have the option of submitting hours under the old law or under the new law (either/or) for 5 years.

 

Revisions to the Board’s Enforcement Process The Board is sponsoring legislation to modify the requirements for an individual to petition for termination of probation or modify an existing probation term. Under the proposal the Board may deny the petition without hearing, if the petitioner is not in compliance with the terms of his or her probation. Additionally, the bill clarifies that the Board has jurisdiction to investigate and take disciplinary action even if the status of a license or registration changes or if the license or registration expires.

 

Potential Bill Proposal that may effect Board Licensees and Applicants:

 

Suicide Prevention/Education Last year AB2198 was vetoed by the governor. This would have mandated new applicants graduating after January 1, 2016 to take a 15-hour course on suicide assessment, treatment, and management. Licensees would be mandated to take a 6 hour CEU course. As part of the veto message the governor has asked the licensing boards to evaluate the issues raised by the bill and to take appropriate action if needed. The Board has initiated a survey of schools to gather information. If you feel strongly about this issue you are encouraged to participate in the legislative process.

 

Next issue: Explanation on CEU providers and the new testing structure! 


*****************************************


Darlene Davis, LMFT Executive Director HOPE; Healthy Outcomes for Personal Enrichment MFT Stipend Coordinator for Greater Sacramento Instructor of University of Phoenix www.darlenedavismft.com www.hope-counselingcenter.org

 





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Go to Our Website http://www.svc-camft.org/join
And RENEW now so you don't miss out!




  February Presentation Summary

Understanding Eating Disorders (2 CEUs)

By Jennifer Lombardi

Jennifer is the executive director of the Eating Recovery Center of California (Formerly Summit Eating Disorders). She presented on the issues and challenges surrounding treatment of eating disorders. She provided the group with an extensive 19 page handout that detailed her presentation. She related her experience as a mother of 2 to her experiences working with eating disorder clients, and the challenges of involving family in treatment.

             Jennifer identified family as one of the most important factors in her clients’ recoveries. She explained that effective treatment requires family support and diligence in supervising meals, and attending meetings. She presented data that showed that the average family has 38.5 minutes of “meaningful conversation” per week and many families don’t eat together or have a tv on during meals. These things need to change for the client’s recovery.

            Eating disorders have the highest mortality rate of all mental health disorders. The first most common cause of death is cardiac related problems and the second is suicide. Eating disorders are often thought of as “invisible diseases” and it is not uncommon for them to be misunderstood and ignored. Jennifer suggested reframing it for families by saying “If they were drinking what would you do?” ie: Julie is losing a lot of weight because of her anorexia vs. Julie is losing a lot of weight because of her drinking.

            Eating disorders have a real basis in brain chemistry. Low levels of serotonin are associated with bulimia and binge eating while high levels are associated with anorexia. Dieting reduces serotonin levels, which then make the anorexic brain feel more “normal”. Exercise can also burn off excess serotonin. In contrast, binging increases serotonin and balances the bulimia/binging brain. Purging also releases endogenous opiates.

            A primary goal of treatment is “intuitive eating”. Eating when you are hungry, and stopping when you are full. “We need to have food for fuel and for fun.” Eating disorder patients face the difficult task of re-training themselves to do this.


Summary by:

Joseph Borders, LMFT

 

March Meeting Information

Free Pre-licensed 3000 Club Meeting

Topic: Mental Health Assessments
Date:  Friday, March 20, 2015
Time: 8:30 AM to 9:30 AM
Note: Registration and membership are not required for the Pre-Licensed 3000 Club meeting

More info:
Mental Health Assessments
Assessing clients is a crucial component that informs treatment.  Charlotte Parks, Program Manager, at Heritage Oaks Hospital will be presenting on this essential skill.  Please join us to learn more.  A question and answer session will follow. 

Location:
Heritage Oaks Hospital
4250 Auburn Blvd.
Sacramento, CA 95841
(map)

Addiction Mindfulness (2 CEUs)
by Steve Brugge


Topic:  Addiction Mindfulness
Presenter:
Steve Brugge
Date:
 
Friday, March 20, 2015
Time:
9:30 AM to 12:00PM
Location: 
Heritage Oaks Hospital
4250 Auburn Blvd.
Sacramento, CA 95841
(map)

Workshop Information:

  • Overview of Relapse Prevention Models and History of Mindfulness
  • Prayers
  • The Stages of Change
  • Step Eleven: Sought through prayer and “meditation”  to “improve” our conscious contact.
  • Meditation
  • The Four Noble Truths:
    • First truth is that “suffering is”. Second truth is that “suffering has a cause”. The third truth is “that there is a way out”. The fourth truth. What kind of life that releases us from suffering looks like.
  • Definition of Mindfulness
  • Walking Down the Street: SOBER
  • Awareness of Triggers and Cravings
  • Mindfulness in different situations
  • Acceptance and Skillful Actions
  • Self-Care and Lifestyle Balances
  • Social Supports
  • Doorways:
    • Seeing the Magic in the Ordinary
    • Telling Life Stories
    • Journaling
    • Meditating
    • Recreation and Nature
    • Loving
    • Dreaming
    • Working
    • Transforming Negative Emotions
    • Living Moment by Moment

Includes continental breakfast and 2 CEUs

Register and pay online, register online and pay at the door, or register via email and pay with cash/check at the door: info@sacramentovalleycamft.org

Early registration ends Tuesday, March 17th
Early registration rates*:
2015 Licensed Member of SVC-CAMFT, AAMFT-Sacramento, and all local chapters of CAMFT: $20
2015 Pre-Licensed Member of SVC-CAMFT, AAMFT-Sacramento, and all local chapters of CAMFT: $15
Non-Member: $30
*Add $5 for late or "at-door" registration
For information on joining SVC-CAMFT or renewing your membership for 2015 please email: info@sacramentovalleycamft.org



More Upcoming Meeting Information


 Month Topic
 Speaker Location         
 April 17
 Domestic Violence

 Margaux Helm
 Heritage Oaks
 May 15
 "Hot Flash Women" raising Adolescents

 Marti McClellan
 Heritage Oaks
 June 19
 Psycho-pharmacology

 John Preston Hertiage Oaks
 July 18
 Law and Ethics Seminar

 David.Jenson/CAMFT
 TBD
 September 18
 Cultural Diversity

 Tonia Elliott-Walker
 Heritage Oaks
 October 16
 TBA
 TBA
 Heritage Oaks




 
 
Interview with a Therapist

The Art of Therapy with Lynnette Browning-Love

                This month we had the pleasure of talking with veteran therapist Lynnette Browining-Love, MFT. Lynnette has been in the mental health field for over 20 years and has been licensed as an MFT for 7. Lynnette now works “in a private practice” “with all populations, adults, children, but mostly emotionally disturbed and developmentally delayed children.” In working with such a specific and difficult population Lynnette uses “primarily CBT, play therapy, sand-tray, I love sand-tray that is where you see what is really going on.” Lynnette specializes in treating emotionally disturbed children and specifically “I work with adoption and treating clients with reactive attachment disorder but I can only have a maximum of two clients with RAD at a time because they take so much effort.” In the past five years Lynnette has put a significant amount of effort and time into assisting with issues around adoption and is now on the board of directors of the Capitol Adoptive Family Alliance (CAFA) “they provide what adopted families really need, education, events, and a camp every year. It’s a great organization.” To treat such a specific population Lynnette utilizes cutting edge therapies including “EMDR, I have been doing it for three years. I use either a light stream, audio, or the pulsers. It’s so helpful for anxiety and depression too.”

                  Although Lynnette now has extensive experience in assisting some of our most in need population, what led her to the profession was her own experience as an adolescent “I was a horrible teenager, but my parents stuck by me. I realized that I would never have been the person I am if my parents did not stand by me. I realized how many kids who don’t have someone to stand by them. I mean I was a fashion designer in LA and I left because I wanted to help teenagers.” Lynnette went back to school when she was 35 and began her career in mental health. “I started in level 14 group homes. I think everyone should be forced to work in a group home as their start, or something like a hospital, where you get to see the real mental health system at work. I learned so much there.” This experience shaped her perspective and she strongly advises any mental health professional to avoid private practice until they have this experience “In a private practice you lose your support system. All pre-licensed need to work in an agency, see how the system works, learn protocol, appropriate behavior, professionalism. This experience molds you to understand the children and the system and the true sickness that is there.”

                  Lynnette understood that sickness early on and was not deterred. Lynnette now specializes in working with issues around emotionally disturbed and developmentally delayed children and recently in the last five years started to tackle adoption and attachment. This population can be demanding and Lynnette has developed a strong sense of boundaries and sense of self “I have been doing it so long that I trust my intuition. It has gotten stronger and it is tuned in. It helps with everything from he said she said. It’s a gut feeling.” The only thing Lynnette emphasizes more than instinct is the development of a practitioners boundaries especially when working with clients who do not have boundaries themselves. Lynnette is able to help clients with poor boundaries by “modeling mostly, because they were usually never taught. You can’t expect someone to have good boundaries if they never learn. You have to model, have the client go through the experience for themselves to learn.” Lynnette believes that as a therapist expanding your knowledge and awareness is key “you need to understand cultural differences and family structures, I saw when training interns they had no idea the differences in family systems.”

                  In being so aware of herself Lynnette is clear on the struggles of her clients and also the challenges of the career in general “The bureaucracy is the most challenging part. Realizing that helping children is actually a business. Helping people is a business. The realization hit not too long after I graduated. It was hard to accept. I wanted to save the world and then you realize that it’s not about the kids, it’s about the money. It’s hard to endure but you must accept it and be the best you can be. Work with the system to get clients the best possible care.” With so many possible reasons to be deterred Lynnette still finds the joy in her everyday work “When a client walks out happy after coming in sad, and I helped put their life back together. When you have parents come in at their wits end with an adopted kid and I can explain who the kid is, and how to better parent so they can form a family… I mean I wouldn’t do it if I didn’t get to see that. I like to see someone live the life they want to live, have the light come on, know they can be happy.”

                  Lynnette emphasizes knowing yourself and having strength in your convictions, but it was not always that easy. It was only with the help of amazing and influential mentors such as “Jack Goswick was the principle at the first school I worked in.” “He taught me to be strong, to stand up when I didn’t believe something was right, taught me that I had the power to stand up for a child. Taught me I was a good therapist.” This strength shaped her therapeutic style “When I come into a session I tell the client what type of therapy this is going to be, I explain who I am as a therapist right off the bat. I want them to know my style is unique. I am going to be real, I am going to be direct. I assign homework. I don’t have a magic wand but I rely on unconditional positive regard, being genuine. Clients need to know you are genuinely there for them.”

So how does Lynnette balance her life with such a demanding clientele? “I have a fabulous husband, and take time for yourself. My daughter knows it as antisocial day. One day a week I don’t talk to people, I don’t take calls, I do whatever I want to do. I usually lay in bed watching old feel good movies. If you don’t take time for yourself you are not modeling good boundaries, I honestly question your style. Just take some time off, take a couple days.” And in the final words from Lynnette for future therapists “Make sure you have done your own personal work before moving to the next level, next position, getting licensed, anything. Make sure you have done your work. It is the only way you can be the best therapist you can be.”

Interview by:
Jennifer Huber, MFT intern




Special Feature

Nine Ideas I Wish I Had Known as a Beginning Therapist

by George Rosenfeld, Ph.D.

    

 

As a baby boomer psychotherapist approaching retirement I have been thinking about the need to preserve some of the useful ideas that I fear are in danger of being lost to the next generation of therapists who are being trained to provide short-term, evidence-based treatment. If I had honored these ideas earlier in my career, I would have been a better therapist. CAUTION: Some of these ideas may be untested or untestable by research.

 

Become aware of your countertransference reactions. Psychotherapy involves a struggle to notice and manage the therapist’s personal feelings so they can be therapeutically helpful. Defined broadly, countertransference refers to our conscious and unconscious reactions that are awakened by the experiences and feelings of a client and our interaction with the client. All our        responses in therapy are, in part, influenced by countertransference. As Anais Nin put it, “We don’t see things as they are. We see things as we are.” So, wherever you go, you bring yourself along; and you open your mouth and your Mother comes out. Our understandings, assumptions, and feelings during therapy are filtered through our needs, expectations, limited experiences, past dramas, life scripts, lessons taught by previous clients, and the role models living in our basement. Like Whack-a Mole, our needs and biases keep poking up and can interfere with our attempts to be present and objective; so that instead of reacting to the client and what is happening in therapy, we may be responding to other situations and less attuned to our clients than we think we are.

     

For example, presently, but particularly as a beginning therapist, I worried about being competent. This led to anxiety, secrecy, pushing clients too hard and fast, not pushing enough, and being too goal-oriented. This worry is fairly typical in beginning as well as experienced therapists. Now I am more comfortable sharing my doubts about appearing and being incompetent. To become competent, therapists would do well to nurture the ability to share their worries about treatment with colleagues. It is stressful enough dealing with clients in pain. Hiding ones doubts compounds stress and contributes to isolation. This is a profession that requires self-care and learning from mistakes; and consultation facilitates these practices.

 

Have realistic expectations for change.   As a beginning therapist I had unrealistic expectations for treatment: I intended to fix and to cure. Now I seek doable treatment goals. Today therapists are trained to expect changes after brief treatment, and they read about legendary therapists who provide treatment techniques that generate major changes in one session. However, our interventions are not as powerful as outcome studies would lead us to believe. There are many reasons for the divide between treatment and research. A main one is that the research on therapy interventions is based on populations that are different from treatment-seeking clients. Typically research studies exclude subjects who have severe or multiple psychological problems, co-morbid physical problems, substance abuse, suicidal ideation or intention, a personality disorder, or are an ethnic minority. In other words, they exclude clients. 

    

It is naive to feel we should be able to understand and help everyone who walks into our office irrespective of their age, intelligence, the flexibility and rationality of their thinking, sexuality and gender; their cultural, medical, neurological, genetic, ethnic, spiritual and educational backgrounds; their social class; the intensity and duration of their problems; their motivation to change; their abilities to handle anxiety; and their resources to overcome the obstacles to regularly participate in therapy.     

     

Often I told clients not to expect magic, but it took me years to understand that this warning applied to me as well. I know how difficult it is for me to change myself, my habits, fears and expectations, even when I am highly motivated to change them. Imagine how difficult it might be to change someone else who may lack motivation, knowledge, and emotional resources, and be embedded in an environment that does not support or even frustrates change.

 

Seek feedback about the session, course of treatment and the state of the therapeutic relationship. To improve outcome one of the most powerful things a therapist can add to what they already do is to seek feedback from the client. This is very scary to do. Bravery is required to ask clients if the session was helpful, if we covered the things they wanted to talk about, if we are going in the right direction, how they are feeling about the therapy and the therapist, and if we are making progress. Seeking feedback conveys an interest in responding to the client’s dissatisfactions and prompts the client to voice them.

   

In business, success and failure can be objectively measured in money, while in psychotherapy we rely on subjective reactions. I can be a poor judge of how treatment is going and have been surprised by the client’s feedback. For example, I had been seeing an anxious parent for Child Guidance for over six months and was quite pleased with our progress. Because of her anxiety I avoided silence and kept our conversation going by bringing up issues when the conversation stopped and she failed to initiate another topic. Probably because I expected a response that indicated her satisfaction with treatment, I asked her if there were issues that she wanted to talk about, but did not have the opportunity. She said there were. This feedback changed my treatment approach. We were able to identify our contributions to the problem (her anxiety and lack of assertiveness and my controlling the session) and concluded that we needed to share more equally the responsibility for generating topics for discussion.

    

When I have asked clients what has been helpful they often surprise me by saying things such as: “I loved the time we laughed about…” “You didn’t get mad at me when I said…” or “I didn’t realize I was depressed” or “I knew you cared when you…” Usually their responses are unrelated to the treatment techniques and interventions I have been crafting. Therapists can be unaware of their most therapeutic as well as damaging responses.

    

Client feedback can help to avoid the scenario in which the client leaves treatment and the therapist does not know why and did not have a chance to deal with the client’s frustrations. Without feedback, it is easier for ruptures in the therapeutic relationship to go unnoticed and sabotage treatment. Repairing ruptures can be one of the most productive events in therapy, because ruptures can provide an opportunity to directly identify and correct the client’s transference distortions.

 

Don’t beat yourself up if you miss dealing with something in a session.  Now I am less upset when I notice an error, because I expect that another opportunity will come around again. I want to focus on repetitive patterns that are so robust they innervate many aspects of the client’s life. If what is missed is important, then there will be other opportunities to deal with it. If the issue does not reoccur, then it may not have been important.

 

I am not immune to missing opportunities to provide perfectly timed interpretations. I used to think the best therapy involved fostering insight that would lead to behavioral change. But often intellectual understanding is not necessary or sufficient to create change. And it is difficult to know when the client is ready to accept interpretations. Often they are most ready when they are close to discovering it by themselves and our role may be to support this process of self-discovery. Many times clients are most able to benefit from an interpretation after they have made behavioral changes.  

 

Capitalize on both horizontal and vertical therapy.   Jay Haley divided psychotherapy into horizontal and vertical. He described vertical time as greeting the client, walking from the waiting room to the office, and getting settled prior to beginning “the therapy.” Alluding to Freudian psychotherapy during which the client lies on the couch in a horizontal position, Haley characterized the part of the hour labeled, “therapy” as horizontal time. When “the therapy” stops, the client returns to vertical and pays the bill, talks further about different content, and is accompanied to the waiting room where doorknob comments are made. Haley suggested that perhaps the most powerful things get said in vertical time when the defenses are down; participants are in less formal, rigid and artificial roles; and the client might be the most revealing and receptive to the therapist’s comments. I heighten my observation of the client and make interventions during the less formal, vertical time. Sometimes I end the horizontal time early and stall in the office to extend this less structured vertical time.

    

A corollary to this concept involves slipping information in under the defenses by placing it in subordinate clauses. For instance, saying, “Meeting people can be scary, even for an approachable person like you,” can implant the thought that the client is an approachable person. The client might not challenge the thought because his or her attention is focused on how meeting people can be anxiety provoking.

 

Develop a menu of useful interventions to draw from and keep evaluating their effectiveness.   I frequently ask the Miracle Question. To motivate clients and help them identify reasons to change I often ask them what their life would be like if they did not have the problem they are working on. I look for the client’s past solutions and see if we can build upon them. I seek opportunities to normalize, reframe and externalize problems. Most therapists have their personal favorites.            

Don’t buy the medical model. It assumes a passive client and a beneficent therapist who provides the intervention of choice that causes the change. This model ignores most of what is therapeutic. It marginalizes the contribution of the two most powerful forces in psychotherapy: the therapeutic relationship (Lambert & Barley, 2001) and the client, each of which is sufficient to create change as well as to derail treatment. The medical model minimizes the client’s role in fostering or limiting change, because it does not adequately focus on the client’s level of motivation and capacity to change that can determine outcome. Some clients are so motivated to change that the therapist’s role is to keep out of the client’s way. Some clients cling to irrational thinking and are so defended and embedded in their patterns that change is elusive. Interventions are the most powerful when they are tailored to the client’s goals and motivation to change. The effectiveness of interventions can depend on the clients’ anticipation that an intervention will be of benefit because it makes sense to the client. That is, the intervention matches the client’s theory of change and beliefs about the causes of his or her problems. My greatest error in therapy has been to offer interventions before the client is ready to use them.

    

Furthermore, the concept of a treatment of choice for particular problems may not be supported by the research. The Consumer Reports survey (“Mental Health,” November, 1995), the National Institute of Mental Health (NIMH) Treatment for Depression Collaborative Research Program (Elkin, et al., 1989), and meta-analyses of comparisons of active treatments (Luborsky, et al., 2002; Miller, Wampold, & Varhely, 2008) indicate that there is not a significant difference in the effectiveness of different treatments based on different theoretical orientations. Because the difference between therapies is small or nonexistent (about one-tenth of a standard deviation of the difference between treatment group means), the sources of change appear to reside in the factors that effective treatments have in common, not in the unique aspects of each treatment.

 

Go slow. Especially at the start of treatment I feel a pressure to initiate rapid change and clients wanted me to help them right away. But for some clients their symptoms protect them from discomfort that can overwhelm them. Their symptoms may be defenses that they need. We should not ask them to abandon a lifeboat until another comes along.

    

I hesitate to challenge established defenses until clients are armed with the skills necessary to handle new anxieties. Before being exposed to anxiety, clients may need the skills to handle the anxiety generated by change. These stress-management skills might include being able to: 1. Self-soothe (breathe, deep-muscle relaxation), 2. Pace (regulate stimulation in session and in life) 3. Use grounding skills, and 4. Obtain and utilize social support. Also, it is important to make sure they leave the office stable enough to deal with their world.

    

I have had clients who thought their role demanded they reveal their past traumas early in treatment.  In the process of trying to be a good client, they exposed themselves to more anxiety than they could handle and they left the session in a dissociated state. In ignorance I thought we had had a great session because they shared so much, and I was surprised when they failed to attend the next session. I should have slowed them down, supported their defenses, taught coping skills, and more actively managed their exposure to anxiety.

     

I want to monitor the client’s anxiety and keep it at a level that motivates him or her to productively participate in treatment. If clients do not have enough anxiety they are probably not motivated to change. If they are too anxious, they cannot benefit. John Briere conceptualized regulating the client’s anxiety in terms of keeping the client within “the therapeutic window.”  He described effective treatment as needing to take place within the space between (a) too much anxiety when the client’s self-capacities are overwhelmed with affect so that the client cannot benefit from the session, and (b) not enough anxiety when the client lacks motivation and the therapist provides support in a way that interferes with needed desensitization or the processing of anxiety-provoking material.

 

Use active-listening as a primary and fallback strategy. When I am not sure what to do I channel Carl Rogers and try to provide emotionally attuned reflecting of the client’s emotional state. This is not easy. It can be a challenge to remain present and focused on the client in the face of the feelings the client elicits. Attunement is not totally expressed through language, but by almost instantaneous responses of tone, gesture, and posture similar to the way parents mirror and soothe their pre-verbal child. Therapists who have not experienced this type of caring in their life may find it more challenging to provide this to their clients. It has even been speculated that they may not have fully developed the neurological structures to easily provide the accurate empathy that helps clients to feel seen and accepted.  As we help our clients to build these neurological pathways, perhaps we are building them in ourselves.

 

Conclusion: Irrespective of our stage in our careers, we can strive to be more effective psychotherapists if we cultivate the abilities to listen to and respect each client and his or her theory and pace of change; manage our anxieties; foster hope, reasonable goals, expectations, and a therapeutic relationship strong enough to allow uncomfortable emotions to be processed; and develop the courage to pursue self-awareness and seek feedback from our clients.

 

Dr. Rosenfeld is a Clinical Psychologist who teaches at USF, Sacramento. He is the author of Beyond Evidence-Based Psychotherapy: Fostering the Eight Sources of Change in Child and Adolescent Treatment. Routledge, 2009.  He can be reached at geo.rosenfeld@gmail.com

References are available from the author upon request.

 

The views expressed in the Special Feature Articles do not necessarily reflect the Sacramento Valley Chapter of CAMFT or CAMFT. They should be understood as the personal opinions of the author. No information in this articles will be understood as official.  Other views and commentary are welcome and will be published as long as they are respectful and stick to the topic.

 


Letters to the Editor
Welcome to the Letters to the editor Section.  We want to hear what you want to say about SVC-CAMFT, CAMFT, current events and issues.  Please see below guidelines on submitting a letter.



 We Have No Letters to the Editor!  Let your voice be heard!  Write a letter to the editor!
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 Letters to the Editor Guidelines
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Psyched about Books and Movies

Welcome to "Psyched about Books and Movies!"  Each month we include a book or movie review by one of our readers.  Please see below guidelines on submitting a review.  Happy reading!


Title:  Basic of California Law for LMFTs, LPCCs, and LCSWs
Publisher: Benjamin E. Caldwell (self published)
Copyright: 2015
Author:
Benjamin E. Caldwell, PsyD
Reviewer: 
Heather Blessing, MFT Intern
Review: 
This is a book is the easiest to read book on California Laws that affect the MFT.   Dr. Caldwell just released the 2015 edition to keep us up to date with the latest changes that have come about.  This is my go to for anything I need to know for the licensing exams because the book's layout makes it quick and easy to find what you are looking for in understandable terms. 

I highly recommend this book for trainees and interns to help them understand the different laws that we need to understand in order for us to do our work.  It would benefit licensed MFTs too as laws are always changing and recently there have been many changes.

 

Book/Movie Review Submission Policy

All reviews are not to exceed 1000 key strokes.
Your review should include the title, a short synopsis about why you like or dislike it, and the author’s name & publication date. You can also include a picture of the book and/or movie. After review, we will publish your review in our next newsletter. Reviews submitted that are longer than 1000 characters will be returned for editing. It is best to type your review in a Microsoft Word document to note how many key strokes (characters with spaces), how big your review is, and for your own record keeping. You can then copy and paste it into the online submission form located here (
http://www.sacramentovalleycamft.org/Newsletter.html) To learn more about checking your review for key strokes, spelling grammer and size click below: (http://www.sacramentovalleycamft.org/How_to_check_review_in_microsoft_word.doc).

It is your responsibility to check for spelling and grammar errors.  Reviews must be received by the 20th of the month in order to appear in the next newsletter.

You can submit your review by: Visiting our webpage: www.sacramentovalleycamft.org

Mailing it in: P.O. Box 163385, Sacramento, CA 95816

 





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Ads submitted that are longer than 1000 characters will be returned for editing. It is best to type your ad in a Microsoft Word document to note how many characters, how big your ad is, and for your own record keeping. Please visit our site to find more information on how to use Microsoft word for editing. You can then copy and paste it on our online submission form located here (http://www.sacramentovalleycamft.org/Newsletter.html)

It is your responsibility to check for spelling and grammar errors.

 

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