AAMFT-CA E-News Spring 2017
Stories from the 2017
AAMFT-CA DIVISION ANNUAL CONFERENCE
AAMFT-CA Division held its biggest and best-yet Annual Conference in San Diego on March 3rd and 4th, 2017. Thank you to the University of San Diego for hosting us on your beautiful campus. Thank you Sesen Negash, for your outstanding leadership as the Conference Chair and thanks to your exceptional Committee members: Alex Hsieh, Marian Sheppard, Angelina Miranda, James DiGloria, Panicha Sillapawatayanon, Klara Placek,Melanie Carlton, Alfred Valdes, Joseph Segal, Micaela Miranda. And -- of course -- thank you to YOU -- our members, presenters, workshop leaders, sponsors, volunteers and participants who made it all possible.
AAMFT-CA 7th Annual Division Conference: A Review
by Valerie Dapsis, MFT Trainee
This year, the annual AAMFT-CA Conference was located at the beautiful campus of University of San Diego. Each sunny day started with a large selection of tempting baked goods, teas, and coffee to prepare the presenters and attendees for the full day of content that followed. Each of the two days started with a keynote speaker, with David B. Wexler, Ph.D. being the speaker on Friday, and Scott Woolley, Ph.D. being the speaker on Saturday. An all-conference workshop followed each keynote speaker, and then attendees separated into smaller groups for either smaller workshops on Friday, or smaller research poster presentations on Saturday.
Dr. David B. Wexler spoke about innovative strategies to bring out the best of men in relationships, by which the audience seemed to be highly intrigued. He spoke about men’s tendency to withdraw and how to speak “male-friendly language” to promote compassionate communication with men in relationships. He discussed in abundance about how to speak to male clientele as a mental health professional and how understanding male emotional expression can help you feel more compassionate and willing to confront and influence change with males in couples therapy.
After Dr. Wexler’s presentation on Friday, Manijeh Daneshpour, Ph.D. took the stage and gave an all-conference workshop regarding working with multicultural couples in couples therapy. This workshop gave a powerful understanding to the potential complications that can occur during multicultural couples therapy work which lead to some great preparation for the smaller workshops that followed. In addition to multicultural couples therapy workshops, other workshops were offered that talked about neurobiological aspects of couples therapy, EMDR as a resource in couples therapy, working in collaborative care settings when providing couples therapy, and many other diverse topics and considerations in when providing couples therapy.
Dr. Scott Woolley gave the keynote address on Saturday morning. His presentation was a powerful talk on emotionally focused couples therapy and how including emotion in therapy can help with the change process within clients. Not only was his talk compelling but he also included a video segment of him using emotionally focused couples therapy with a real couple. The emotion experienced in the session was so powerful that several people in the audience became emotional and you could even see Dr. Woolley tearing up a bit in the video segment. It was wonderful to see how much of an influential affect emotion can have and how it motivated change within the clients in the video.
After Dr. Woolley’s presentation, Eva Van Prooyen, MA, LMFT lead an all-conference workshop talking about attachment theory and the neuroscience behind creating security within relationships. Her presentation was a great precursor to the research poster presentation that followed, which included many research topics related to attachment theory. In addition to attachment theory, there were various research topics presented, including working with polyamorous couples, cybersex infidelity, emotionally focused therapy and diversity, physical affection in Asian-Caucasian interracial relationships, mindfulness as an intervention in couples therapy, and many other interesting topics relating to mental health professionals and couples therapy.
This conference gave a comprehensive overview on diverse topics related to couples therapy work, having particular themes of multiculturalism and attachment theory. It was a remarkably useful source of information, insight, and training for mental health professionals who work with couples and likely left many professionals with elevated inspiration to work with couples in their clinical practice.
Valerie Dapsis is a Marriage and Family Therapist Trainee who recently completed her first year in the masters program at the University of San Diego. She has an interest in using mindfulness and experiential based modalities in her clinical practice, as well as an interest in taking an integrative approach. She has background with research on the mind-body connection and is currently beginning clinical training in neurofeedback. She is excited to broaden her clinical experience and has aspirations to continue her research experience as she develops as a clinician. Valerie can be reached at email@example.com for inquiries.
by Sharon D. Ellermann
I arrived in the early morning comically carrying and barely peering over a colossal piece of cardboard that felt like it was twice my height. What I lacked in stature was ameliorated by the elation of presenting a poster at the 2017 AAMFT-CA Conference. This year’s theme paralleled my interest in couples therapy. As a novice, a second semester MFT graduate student, I rolled up my sleeves of inexperience and full heartedly jumped into the uncertainty of the day. Greeted by warm smiles and an incredibly helpful conference staff, I began to get more of a Rosie the Riveter – “I can do this!” sense. I discovered that it was a wonderful experience which allowed me to not only learn from leading experts but also participate in the contemporary couples research discourse. With my poster as a conduit for communication, I explored ideas and networked with other professionals and peers. I also became more adept at leading discussions within the poster session group format.
The research I presented focused on the mitigating factors of stress in intercultural marriages. Technological progress, globalization, and changes in socioeconomic factors have facilitated the establishment of transnational courtships and, in the U.S., this population has burgeoned. I systemically investigated the implications of intercultural marital satisfaction with an attachment theory analysis. I found that intercultural marriages face unique challenges compared to homogenous ones. Three stress domains were identified as having notable implications on marriage conflict: (1) immigration, (2) acculturation, and (3) biculturalism. Secure attachment between couples may play a crucial role in coping with these hardships. Insecure strategies can be restructured to secure strategies through couples therapy. The prevalence of divorce in the U.S. and the associated risks of mental health problems warrant further investigation.
This coming summer, I will embark on my journey as a trainee in couples therapy with much to learn. I envision that an effective agent of healing can empower with empathy, understanding, and by instilling hope, taking special consideration of multiple contextual factors of the unique lived experiences of clients. As president of the Couples Club at Alliant International University, I have provided training and education to the community in attachment rooted treatment modalities. Although this is my population of interest at the moment, I also value giving liberty to curiosity to explore new horizons. In that same vein of development, I seek to define and sharpen my research interests. Upon graduation from my Master’s program, I will pursue a doctoral degree. I hope the MFT field will continue to guide my path, like a river carving a mountain, expanding with time and evolving symbiotically with the professional environment and direction of my passion.
Sharon D. Ellermann is a Master’s candidate in the Couple and Family Therapy class of 2018 at Alliant International University in San Diego, CA. Prior to enrolling into her Master’s program, she assisted in research development and treatment of populations suffering from Generalized Anxiety Disorder and Social Anxiety Disorder at San Diego State University. Her evolving research interests include the study of couples therapy and Psychoneuroimmunology, interventions for epigenetic-intergenerational transmission of familial stress, and attachment modification implications for impoverished and marginalized populations.
A Memorably Fulfilling Time (MFT) Volunteering
for the 2017 AAMFT Annual Conference
by Adam Neal
Arriving at the spacious, collegiate hall of San Diego University, I felt immediately welcomed into the AAFMT community, toward which I continue to forge my destiny as an eventual licensed MFT. Upon meeting the volunteer coordinators and fellow volunteers, I knew this would be not only a memorable experience for me, but also an enriching and significant one. As one of the few volunteers not affiliated with USD, I harbored a slight concern that my contribution might be a bit unbalanced with the others. However, once our organizational meeting commenced, following a lively group load-in of refreshments, any concerns I had were quickly assuaged.
During the two-day conference, I was able to assist with hospitality, refreshments, check-in, ushering for the keynote lectures, and offering general support to conference attendees. Throughout the conference, I felt privileged to participate as an audience member during most of the keynote lectures, including fascinating topics such as Masculine Gender Role Stress, PACT (Psychobiological Approach to Couple Therapy), counseling couples of racial and/or cultural difference, managing sexual challenges for couples, and Oncosexology. I was deeply moved by the discussion of this last subject, exploring sexual health among couples managing cancer. I had never considered this important and controversial topic prior, and it reaffirmed my connection with MFT ideology, its emphasis on systems and interpersonal dynamics, to have this discipline broached and openly discussed.
When it came time for the seminars, I found my selection process quite challenging, since each offered such intriguing prospects. I was ultimately treated to discussions of narrative therapy, the enhancement of medical professionals’ compassion through MFT intervention, and using a multidimensional approach for children living with chronic illness. Between these thought-provoking panels and the next day’s diverse offerings during the poster presentations, my notebook was filled with insights and new considerations. The opportunities I had to participate in the conference were far greater than in other volunteer situations I have undertaken. I also had the pleasure of meeting several new friends, one of whom is currently pursuing a similar low-residency graduate program to mine.
Volunteering at this year’s AAMFT-CA conference did not simply meet my expectations of a pleasant contributory experience – it far exceeded any expectations I had, being one of the most intellectually stimulating, connective situations I have ever been lucky enough to enjoy. As a resident of southern California, I hope to make volunteering at the AAMFT-CA conference a new personal tradition.
Adam Neal is a recent transplant to Los Angeles from New York and is currently a graduate student in Counseling Psychology at the Institute of Transpersonal Psychology in Palo Alto. Formerly the associate editor of Psychology Tomorrow he compiled and edited articles by psychotherapists, physicians, visual artists, scholars, and authors, in addition to editing two full-length books. He is now consulting for a new therapist community online, Being Seen, a new venture of the Open Path Psychotherapy Collective, a non-profit with over 3,000 participating therapists around the U.S., all providing low-cost sessions to clients unable to afford services. Read more about Adam at his website, Paranormalyte.com, for which he writes exploratory articles about anomalous cognition and parapsychological experience.
Employment Options for MFTs
Save The Date
Phillips Graduate University, Chatsworth: September 29, 2017
Irvine: October 27, 2017
To learn more click here
Busy Legislative Season Underway
by Benjamin E. Caldwell, PsyD
It’s the busy time of year in Sacramento, as our Legislative and Advocacy Committee works to advance policy proposals we believe in and to improve those that we believe would be problematic for MFTs and the communities we serve. We have taken positions on these and several other bills so far this year:
AB 191: Psychiatric holds.
This bill would allow MFTs and LPCCs to serve as second signatories for extended psychiatric holds when a psychiatrist or psychologist is not available. Our position: Support.
AB 387: Minimum wage for interns.
This bill would require state and county agencies to at least pay minimum wage to those health care employees completing requirements for licensure. While we believe and have pushed for better wages for prelicensed therapists, the author of this bill intends to exclude all BBS licensees. Our position: Support if amended to include MFTs.
AB 1188: Mental Health Practitioner Education Fund.
This bill would increase from $10 to $20 the amount each licensed MFT contributes to the Mental Health Practitioner Education Fund as a part of license renewal. It also would add professional clinical counselors to the program. Our position: Support.
ACR 8: Post traumatic “street” disorder.
This bill (a resolution, technically speaking) would recognize post traumatic “street” disorder as a mental health condition with significant and growing implications. Our position: Oppose. We do not believe the Legislature should be creating new diagnostic labels.
We encourage every MFT to be involved in advocacy for our profession. One of the easiest ways to get involved is by attending public meetings of the Board of Behavioral Sciences, where policy changes impacting our profession often begin. A complete list of upcoming BBS meetings can be found on their web site. We would love to see you there!
- Benjamin E. Caldwell, PsyD is Chair of the AAMFT-CA Legislative and Advocacy Committee. He can be reached at firstname.lastname@example.org.
AAMFT Proposed National Restructure: FAQs
by Angela Kahn, AAMFT-CA Division Board President
AAMFT-CA Division Board President Angela Kahn answers your questions below about the AAMFT national restructure vote and your options for active involvement under the new plan.
- Why is the AAMFT board proposing a restructure again? Didn't we try this already?
Keep in mind that AAMFT members who responded to the board about the previous proposal, whether they were for or against it, agreed that AAMFT has to do something. There are some serious conditions that we, as an organization, are facing that seem to indicate a shifting of the tides, and if AAMFT doesn't respond in a timely manner, it is not hyperbole to state that we are placing ourselves in a vulnerable position in the future.
The most troubling statistic is the huge number of members over 65 who will likely be retiring in the coming years. As this occurs, the number of new members joining the association is not enough to maintain our current membership numbers - weakening us both in voice and relevancy in our industry and in the funding we can devote to protecting our profession.
Other national associations are facing the same aging out, but operate under a much more financially sound structure. It's also worth mentioning that out of all the mental health associations, AAMFT is the most expensive by far. We are the only association that has a mandatory requirement for members to join their state divisions in addition to the national association. In California, you might have noticed that in addition to your national dues ($201 for Clinical Members), you are required to pay an additional amount ($55 for Clinical Members) for California Division membership. You have no choice in the matter, whether you benefit from California services and products or not.
Another troubling fact is that many divisions across the country have, for several years, reported deficit spending. Furthermore, several have encountered legal challenges, and whole lot of them, including California, have reported the ever-so-difficult crisis of volunteer fatigue. These are serious problems. In the face of deficit spending, many divisions have simply continued to raise dues-not helping our original problem of being the most expensive mental health association. In the face of legal challenges and leadership problems, AAMFT's resources have had to be diverted to crisis management, and we have therefore missed out on important growth opportunities.
- But isn't the California Division thriving? Shouldn't we let other divisions solve their own problems?
While it's true that California is a strong division, and we have been "in the black" for several years, it's important to remember a crucial part of the context: Over half of the country's MFTs reside here in our state. We have a plethora of resources from which to draw, as opposed to a division like Maine or North Dakota, where the number of MFTs in the state falls somewhere in the double digits. You might be asking yourself, why should I care about Maine or North Dakota? Well, there's a scary answer to that.
You may be aware that the Texas Medical Association engaged the Texas MFTs in a turf war over diagnosis. In 2008, TMA sued the MFTs, alleging that it is not within the scope of Marriage and Family Therapy to diagnose mental illness. After a long court battle, the outcome was sobering: We lost with the lower courts. This was a frightening outcome because it could have set a dangerous precedent for MFTs all over the country, and many could have faced job loss. Luckily, this case was heard by the Texas Supreme Court in October, and the decision was released very recently: the Texas Supreme Court upheld the MFTs right to diagnose. This was a huge victory for us, but also a sobering wakeup call. A reality could have existed where it could have been illegal for an MFT to diagnose mental illness. If AAMFT cannot fight these battles successfully in the future due to a lack of funds to pay for attorneys, we, as a profession, may face dire circumstances.
- What's different about this restructure?
For one thing, there will be no changes to the elections council, as was proposed in the previous restructure. California didn't voice a very loud complaint in this area, but other divisions did, and the board listened.
This plan puts forward a similar interest-based structure as was proposed two years ago, but this time "interest networks" will be required to demonstrate financial stability. Divisions will have the option to form a geographical interest network, dissolve completely and allow their members to customize their memberships as they see fit, or create a completely separate entity that affiliates with AAMFT.
Advocacy will be subsumed under the existing Family TEAM, but California leaders have been approached to be heavily involved in advocacy training and national leadership.
- What do they mean by "Interest Networks?"
You may recall that the previous restructure intended to move the organization toward an interest-based structure rather than a state-based structure. At the time, they were called "special interest groups" (SIGs). The idea was that members could customize their memberships by having options to join groups that were organized around specific topics. For example, a member working primarily from a Satirian perspective with military families could potentially join both a Military Families SIG and an Experiential Family Therapy SIG. Another member working with trauma among Muslim-Americans could potentially join a Trauma Focused SIG and a Racial Diversity SIG. There was also the option for divisions to create a "geographic SIG" wherein members from the same geographical areas could potentially connect over that-their geographical commonalities.
This was a good idea, and it has been retained. What has changed are the requirements for forming such a group, as well as what they will be called. First, rather than "special interest groups" they will be referred to as "interest networks" (INs). Second, rather than making penetration rate the threshold for formation, interest networks will now require (1) submission of a balanced budget, and (2) demonstration of financial commitment.
Let's use an example above to illustrate the idea. Suppose Jane Smith, MFT and a few of her colleagues want to form a Military Families Interest Network. First, they would have to decide what it is they want to do. Do they want to hold trainings? What type? Where? How many? Do they want to simply be an online discussion group? Who will facilitate? Do they want to hold regularly scheduled face-to-face meetings? Where? Is there a cost? Who will participate? What will happen at these meetings? Once they decide what they want to do, they have to determine how much they'll need in terms of financing.
Let's say Jane and her colleagues want to hold an annual symposium in San Diego as well as a break-out "microconference" at the Annual Conference every year. First, they would put together a balanced budget illustrating how much this would cost-for argument's sake, let's say they come up with $5,000. Then, they would peddle their idea around to other AAMFT members to see how much interest they could drum up. They would be required to get a financial commitment from enough members willing to commit enough money to make their Interest Network financially sound. The nice thing is Jane's group could decide for themselves how much that would be. They could say that they need 500 members to commit to $10 each, or that they need 100 members to commit to $50 each. Once they have their list of initial contributors, and once their balanced budget is submitted, they'd wait for the green light.
Now, in the early years, AAMFT is likely to be generous and forgiving when it comes to start-up. In Jane's example, she may not need to demonstrate $5,000 worth of member interest up front, and instead hope that her conference proceeds will help to keep her group financially sound. AAMFT will assist groups with these early years, and analyze their early performance carefully so as to make informed decisions about which groups seem stable and which ones don't. There are no cold, hard answers to how this will be done since we're all forging new territory here. AAMFT will likely work on a case by case basis, and make its decisions based on what's best for the association, its members, and the MFT profession.
- If an Interest Network generates revenue, do they get to keep it?
The short answer is yes! How cool is that? AAMFT will be setting aside any revenue generated by that Interest Network for future projects that the Interest Network may want to pursue. So, if Maria's Military Families Interest Network microconferences end up bringing in an excess of $1,000, Maria and her group get to decide what to do with it! (Within reason. They don't get to hop on a plane to Maui.)
- What happens if an Interest Network fails?
Although AAMFT has not yet provided a concrete answer to this, it's probably safe to assume that this will be handled on a case-by-case basis. If an interest network puts on an event that ends up losing money, or is unable to stay financially solvent, it will be up to the national leaders to decide whether to cover the deficit, and/or disallow the interest network from continuing to function. Additionally, some interest networks may ultimately accomplish their goals and be disbanded freeing up funding opportunities for emerging needs in the profession. This flexibility allows AAMFT to stay extremely relevant for member needs.
Keep in mind that interest networks will be required to submit a balanced budget annually. They must regularly demonstrate that they are conducting good and responsible business.
- What will become of our advocacy?
This is an excellent question, and, you may recall, was our key objection to the previous restructure proposal. Two years ago, we raised concerns about what appeared to be a centralization of all advocacy efforts across the country under Family TEAM, which would be run by AAMFT staff. California excels at advocacy, and we were concerned that our state efforts would be either abandoned due to a lack of funding, or completely taken over by national leaders who had little knowledge of the players and issues relevant to California.
This new plan seems to reflect not only an appreciation for California's talent, but a desire to partner with our advocates to expand our influence nationally. We have been approached to help design the infrastructure of Family TEAM, and to essentially institute a national advocacy training program that mirrors what we do in our home state.
We are confident that this means our state advocacy is not only valued, but will also be protected under the new plan. We are also humbled by the invitation to be a key player-indeed a leader-for other state advocacy under Family TEAM.
- Who can join Family TEAM?
Anyone! In fact, AAMFT would like to see everyone join Family TEAM, especially if you have a passion for MFT advocacy. And the best news...it's free!
- What about the AAMFT Approved Supervisor designation?
Nothing changes there. AAMFT will continue to offer approved supervisor trainings. Last year, all state-based training programs were transferred to AAMFT for smoother management and consistency in the quality of training. This will continue to be the case.
- Does this affect COAMFTE accreditation?
No. COAMFTE accreditation for Marriage and Family Therapy graduate education programs remains the same.
- I want to form an Interest Network. What should I do?
Great news! AAMFT is thrilled to hear of your enthusiasm.
If you're interested in forming either a Topic Interest Network or a Geographic Interest Network, please email President Angela Kahn at email@example.com with your name and a brief description of what you have in mind. Angela is attempting to connect interested parties with one another so as to avoid redundancy. Your group will be encouraged to connect over the phone to coordinate efforts when the time comes to submit an application.
- I don't necessarily want to form an Interest Network, but I'd like to know which ones are out there. How do I find out?
Trickier question. As this is a restructure, naturally we have to start at the bottom-that means that as we transition from our current structure to the new structure, we don't have any interest networks in place yet. As they are approved by AAMFT, they will be added to a centralized directory where you can find out more about their goals and you can decide for yourself which ones you might like to join. In the meantime, we plan to send regular updates as to what kind of interest has emerged in California thus far in case you change your mind about leadership in a group that appeals to you.
- This Interest Network idea really bothers me, and I'm unhappy with the direction AAMFT is taking. What are my options?
While the association would be sad to see you go, members are entitled to choose for themselves what will be right for them. You might choose to eliminate professional organizations from your life altogether (I hope you don't!), you might choose to join a different one, such as CAMFT, APA, or ACA, or you might choose to gather your colleagues and form a completely new entity. In the event you choose the third option, let me be the first to tell you that AAMFT would be very interested in forming an affiliate relationship with you-much like the relationship we currently have with CAMFT. We stand together on many advocacy issues, and we work together for the overall betterment of MFTs across the country.
- What if no one forms a California Interest Network?
In the unlikely event that California MFTs don't end up forming a geographic interest network specific to California MFTs, members will simply be invited to join other interest networks that appeal to them. As stated above, those groups will be listed in a central directory and available for joining as part of your membership renewal.
- Is Family TEAM an interest network?
Yes! And I'd argue it's the most important one. AAMFT is encouraging all members to join Family TEAM. As that group begins to take shape in terms of infrastructure, you will be invited to participate at whatever level best suits your interest and talent.
- When will all of this take place?
This will appear on your 2017 ballot as an amendment to the bylaws. If it passes, divisions will cease to collect dues as of January 1, 2018. Applications for new interest networks will be due in the spring of that year, and likely given the green light soon thereafter. By 2019, the current division structure should be successfully dissolved, and our new structure should be in place.
- I still don't get it. Where can I go for more information?
We've tried our best to include all the available information here, but if we still haven't answered your questions, you are encouraged to contact AAMFT, or contact President Angela Kahn personally. Please hold in mind that we are talking about an uncertain future: Just as we encourage our clients to hold steady in the face of uncertainty, we (your leaders) encourage you to do the same. Many questions are not answered yet because they have not been asked or because they are specific to individual state laws. Many others won't have answers until this new structure actually starts to form. This is an exciting time for the association, and like many things, the excitement does bring with it a few question marks. We hope that isn't a dealbreaker.
TRUMPCARE and CALIFORNIA MFTs
What’s happening there? What’s happening here?
What does that mean for the profession?
by Olivia Loewy, Ph.D., AAMFT-CA Executive Director
We know there will be changes and we know that changes in healthcare legislation will affect our work. What does that mean for California MFTs in the immediate future? The following presents information about what is happening federally and at the state level that will impact how we are funded and the way we deliver care.
What’s Happening There?
As you are most probably aware, the House passed the American Healthcare Act (ACHA, a.k.a. Trumpcare) by a very slim majority vote on May 4, 2017. Some of the provisions of the bill are listed below:
- Reduces funding for subsidies in a way that helps younger adults and increases premiums for older people. Provides immediate tax cuts for those with incomes exceeding $200,000 per year ($250,000 for couples).
- Allows states to seek waivers to opt out of the Affordable Care Act rules that prohibit insurers from charging sick people higher premiums (pre-existing conditions)
- Allows states to opt out of or redefine the Essential Health Benefits (which includes behavioral health services). Strips funding for Planned Parenthood for at least one year, a provision that is renewable every year.
- Allows large employers to choose minimum benefit requirements from any state, including those who have waived all consumer protections.
- Ends Medicaid (MediCal in California) as an open-ended entitlement and ends Medicaid expansion.
We can state with much certainty that the AHCA, as passed by the House, will never become law. We can also anticipate a lengthy process before any new law is passed:
- The Congressional Budget Office (CBO) has reviewed the potential impact of the legislation as currently written and announced last week that it would significantly reduce the federal deficit but increase the projected number of uninsured Americans by about 82 percent over the next 10 years. This good/bad news dichotomy fails to define a united and clear direction for lawmakers.
- The Senate will need to pass the bill. Initial Senators’ reactions to the House bill imply that the AHCA, as currently written, will be completely gutted or substantially overhauled. The rewrite will pose a significant challenge.
- Once passed in the Senate, the revised version of the bill must then go back to the House for reconciliation, potentially creating complications and generating the kinds of objections that previously stalled the first voting process.
Bottom line: Obamacare is still the “law of the land” for now and we have a long way to go before any legislation is finalized – and even longer before any changes are implemented. A Senate committee will likely begin actively working on their version of the bill in early June and it appears a second group of more moderate Senators has also formed, indicating a continuing divide within the majority party over the direction of health reform. California Senators are not included in either of the major working groups.
What’s Happening Here?
With record numbers now insured through enrollment in Obamacare, California marches ahead “as if”. In our public system, Karen Baylor, MFT, who is the Deputy Director of Mental Health, Substance Use Disorder (MHSUD) for the Department of Healthcare Services (DHCS) has said: “Keep your head down, nose to the grindstone”. We are not changing course in the immediate future. This means that public systems of expanded, integrated care will continue to evolve, including two DHCS pilot projects:
- Whole Person Care: coordinates behavioral health and social services in a patient-centered approach.
- Health Homes for Patients with Complex Needs: provides coordinated services for MediCal-eligible frequent users with multiple, chronic conditions.
In the state legislature, bills have been introduced that confirm a spirit of protecting our progress and moving forward, such as: *
- AB 501: community residential crisis programs for children;
- SB 191: a framework for school-county mental health partnerships and targeted interventions;
- AB 473: University of California Criminal Justice and Health Consortium pilot project in sixcounties to create cost-effective services for MI/SUD adults in county jail systems;
- AB 477: establishes a statewide Behavioral Health Stakeholder Advisory Panel to provide ongoing assistance to improve collaboration of multiple agencies in the delivery system.
Additionally of note: our California budget subcommittees are led by two very knowledgeable MDs, both who have expressed interest in issues related to behavioral health:
Senate: Dr. Richard Pan, pediatrician, interested in early intervention, prevention. One of his goals is to make Behavioral Health screening a routine part of every primary care visit.
Assembly: Dr. Joaquin Arambula, Emergency Room physician. He supports alternatives to taking people to the E.R. or jail as a first/last resort for addressing the needs of people in crisis.
While Governor Brown’s May proposed budget included shifting costs to counties in a way that would impose behavioral health funding cuts, California’s related goals remain solidly in place for the time being.
As we continue to move forward, the growing behavioral health provider workforce shortage has emerged as an area of significant concern related to our expanding systems of care. Veteran mental health lobbyist and Proposition 63 (MHSA) co-author Rusty Selix stated: “…there is no question that the workforce challenge is greater now than any time in the past.”
In March, the California Mental Health Planning Council’s Workforce Summit in Sacramento attracted a diversity of participants including legislators and policy makers as well as reps from counties, community agencies, education and all clinical provider disciplines. Presentations addressed a range of topics concerning workforce issues from research and funding resources to educational/training programs and systemic, collaborative innovations. It is clear and widely recognized that we need more behavioral health providers to work in California’s ongoing, expanding systems of care.
What Does This Mean for the Profession?
California’s current resolve to move forward with the implementation of integrated, coordinated and collaborative systems of care means expanded employment opportunities for MFTs. The growing provider workforce shortage can be good news for MFTs seeking employment, but this does not mean that anyone pursuing a placement or employment in public behavioral health is a good candidate. Those clinicians who are aware of and prepared to work in the new systems of care will be the successful candidates.
Evolving systems are subject to continual change. Clinician flexibility, spirit and attitude jump to the top of the “desirable traits” list as employers struggle to provide consumers with the security of consistent, continuous, quality care, while shifting long-standing procedures and structures in accordance with new outcome measures and funding requirements. It becomes a balancing act, requiring skills beyond clinical to navigate this often uncharted territory. It is a challenging time.
This is also an exciting time and – something that MFTs may particularly appreciate – it is all about systems. Evolving programs of care at the national and state levels involve systems that have historically overlapped but may not have structurally merged, such as mental health, social services, primary care, substance use disorder, schools, justice system. In these new systems, the whole person is being viewed as the “patient” and the whole community is designated as responsible for care. This concept produces programs that encompass an extended population of providers from a diversity of professional and clinical disciplines. Some examples include:
- Sutter Health/Steinberg Institute have joined One Mind at Work to develop programs of coordinated workplace intervention.
- Pilot programs sponsored by the national Health Resources and Services Administration (HRSA), in which multigenerational critical social services are provided to the entire family as part of integrated care.
- Stepping Up: counties, state governments, justice center and APA collaborative program to reduce numbers of mentally MI/SUD adults in jails.
Considering the direction in which healthcare is moving, we encourage MFT educators and clinicians in California to broaden your perspectives in relation to treatment. Policy briefs published by the national Behavioral Health Workforce Research Center in 2016 have called for the expansion of occupational scopes of practice and also highlighted the following conclusion: “Integrated care training should be expanded in academic curricula, as most workers learn to work in team based care models on the job”. **
Integrated, expanding systems can be envisioned almost like nesting blocks: the smallest piece is the individual in need of services; primary care enlarges the block; family, social services, employment counseling, justice system, schools, etc. all may be added as blocks that enlarge the world of treatment options surrounding the individual. We’ve come full circle, back to the MHSA foundational principles: “No Wrong Door” and “Whatever it Takes”. With our training in systems and relational work, the MFT scope of practice can comfortably lend itself to expansion if we are able to see the professional landscape with altered views:
- Think Context: The clinical concepts and skills that you have learned are solid but the context within which you apply them may be different. In expanded systems, there is a need for MFT knowledge and skills. Because new structures are continually emerging and changing, you can help to define a place for MFTs and for yourself during the development process.
- Think Teamwork: Emerging, expanded structures of care incorporate multidisciplinary provider teamwork. To contribute most effectively on any team, you need to know the game plan, clarify your position and assess how your own personal competencies can contribute to the collective goals. As in all teamwork, there is an interdependence that requires inclusiveness, clear communication and mutual trust.
- Think Collaboration: Beyond the collaborative approach among care providers, recovery oriented care encompasses collaboration with the consumers and their broader personal communities. Our expertise and skills in facilitating active communication can potentially become a critical part of a functional, integrated system.
- Think Inclusion/Overlap: Ideally, our teams will honor and respect the input of all interested parties as well as all of the provider disciplines. The goal is effective treatment response. There are enough consumers to go around and no place in these systems for a territorial spirit. Could an addictions counselor, nurse practitioner or probation officer have information about your client that might be news to you? Open arms reaching out to all providers can yield more comprehensive information and result in a more effective collaborative response.
- Think Accountable Care: How do we assure our funding sources that they have made the right decision in spending their money on us? Systems of accountable care and funding shifts from “Volume to Value” require comprehensive assessment, careful treatment planning and skillful documentation. These competencies are critical in the new structures of care.
For private practitioners, even if you have no plans to work in a public setting, your practice referrals and payment mechanisms will be impacted by the impending, widespread changes and it will be to your advantage to stay informed about national and state legislation and the evolving systems.
Finally, from broad concepts to more specific content, MFTs would benefit from gaining knowledge and skills about:
- Recovery Oriented Care
- Substance Use Disorder
- Cultural Humility
- Working With the V.A. and the Corrections Populations
- Evidenced Based Practice
- Integrated Services
- Language and Culture of Primary Care
- Seriously Mentally Ill Population.
For California public behavioral health, the immediate future is funded: there will be community programs; there will be meaningful initiatives; there will be jobs for MFTs. If you want to do the work, move forward with your plans. If you want to consult with us, please feel free to contact me: firstname.lastname@example.org .
* For current detailed information about California legislation: http://leginfo.legislature.ca.gov/
Treating Couples with a Bipolar Diagnosed Partner
by Regina Bordieri PsyD, LMFT
Marriage and Family Therapists often feel ill-equipped to treat serious mental illness, but our systemic training makes us uniquely qualified to work with clients diagnosed with bipolar disorder. As specialists in relational therapy, we routinely explore interpersonal patterns and client identities in the context of their larger social systems and experiences of privilege and oppression. MFTs can utilize this same systemic lens when treating bipolar disorder, which functions as a marginalized aspect of identity due to chronic symptoms that persist throughout the lifespan. Bipolar disorder is highly stigmatized and often met with social and institutional discrimination. As a result, diagnosed individuals and their family members typically experience internalized stigma and shame that influence interpersonal functioning.
Couples therapy is often overlooked as a viable treatment option for bipolar disorder despite evidence of a reciprocal relationship with couple functioning. No systemic protocols specifically designed or modified to treat couples with a bipolar diagnosed partner currently exist, nor is there sufficient research to inform the development of such treatments. The primary goal of my research is to help clinicians treat bipolar disorder from a systemic perspective. Using a sample of 57 couples, I measured diagnosed and non-diagnosed partners’ perceptions of attachment behaviors that signal accessibility, responsiveness, and engagement. To increase the relevance of my research to couples therapy, I used dyadic analyses to statistically account for the interdependence of partner experiences. Perceived attachment behaviors and symptoms of depression accounted for 60% of the variance in dyadic adjustment among diagnosed partners and 65% among non-diagnosed partners in my sample.
Results suggest that therapy for couples with a bipolar diagnosed partner should increase attachment security and reduce depressive symptoms to improve partner adjustment, and that interventions focused on either goal are likely to result in progress toward the other. Systemic treatment protocols therefore have the potential to offer therapists a framework to integrate relationship enhancement and symptom reduction as one interwoven process in couples therapy. Results are also consistent with the systemic viewpoint that bipolar symptoms are only one factor relevant to dyadic adjustment and support the conceptualization of couples with a bipolar diagnosed partner, as opposed to only individuals, as a viable treatment population.
I had the privilege to share my research by presenting at the 2017 AAMFT-CA Conference this past March, and will also present on attachment security in couples with a bipolar diagnosed partner at the upcoming 2017 AAMFT Conference held in Atlanta, Georgia this October. I look forward to continued opportunities to advocate for the systemic treatment of bipolar disorder and to support MFTs to effectively treat couples with a bipolar diagnosed partner as a researcher, speaker, and educator.
Regina Bordieri, PsyD, is a LMFT in California and New York State specializing in the systemic treatment of bipolar disorder. She can be reached for more information about her research, clinical work, and therapist trainings at email@example.com and will be launching her website, BipolarCouples.com, as a resource for clients and clinicians.