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You have probably noticed more discussion in the news recently about gender and pronouns. You may have encountered terms you don’t recognize, such as “cisgender” or “non-binary.” Having a close family member who identifies as transgender (which I’ll define below), I have made it my business to educate myself on my family member’s experience. As a therapist, I also care deeply about inclusive and compassionate therapy with all people. I hope that my journey can be helpful to you. While recognizing that I am not an expert, I’ll review some basics and share how I am learning to be more aware and more active in creating safe spaces for people who identify as trans, genderqueer and non-binary.*

Most of us have grown up with the belief that there are two genders, called the gender binary, and people are either strictly male or female. Under this view of the world, whatever sex you are designated at birth is correct and final. It is important to understand the difference between “sex” and “gender.” The term “sex” generally refers to the genitalia and genetic differences between males and females, whereas “gender” refers to your sense of your gender identity as well as the social construction of the roles of males and females in the society where you live.

If your experience of your gender matches your sex assigned at birth, then your behavior, appearance, dress, and genitals “match” how you feel about yourself and how everyone around you treats you. However, this sense of “matching” has never been true for everyone and many have suffered with shame and silence for not fitting into the strict binary system. Consider the discrimination and violence transgender people continue to face today.

We call someone whose gender identity matches the sex they were assigned at birth “cisgender.” For example, I was born a girl and feel that the female gender fits for me, expresses who I am inside, so I am cisgender. “Transgender” (or trans) is a term used broadly for people whose gender identity does not match the sex assigned to them at birth.

It is also important to know that “gender” and “sex” are different than “sexual orientation.” If someone identifies as gay, bisexual, lesbian, or heterosexual, this refers to their sexual orientation, or who they are attracted to and who they have sex with.

Transgender or trans people may be “non-binary,” meaning they don’t identify exclusively as male or female (and there is not a precise definition of non-binary, it can mean different things to different people). Trans can also describe people who do identify on the binary system, but as the opposite gender of the one they were assigned at birth, i.e. a trans man or a trans woman. Whether someone has medically transitioned is not determinative of their trans identity.

Let’s talk about pronouns and gender neutral pronouns. “Pronouns are just a substitute for a noun that you don’t know the identity of, or a shorthand when the person/place/thing you’re talking about is understood.” (A Quick and Easy Guide to They/Them Pronouns, by Archie Bongiovanni and Tristan Jimmerson, p. 11). We’ve been taught to use masculine or feminine pronouns when referring to individuals in casual English, but as we are seeing, this guessing may be incorrect. There is increasing support of and usage of pronouns that are not gendered. Generally, when you refer to another person by their pronoun rather than their name, you typically guess which pronoun to use, masculine or feminine, based on name, hair, clothing, deportment, and then use the corresponding gendered identifier he or she. The trans community argues persuasively that it is oppressive and harmful for anyone to simply assume someone’s gender and to “gender” them using he/she pronouns. This constant reinforcement of the binary gender code creates pressure for all of us (and especially trans people) to express ourselves in certain ways in order to be accepted and safe. Being “misgendered” serves to invalidate and make invisible people who don’t fit into the gender binary. It says, “you aren’t for real, we know who you really are, we get to say who you are.”

One change that we can make to make space for everyone is to ask people what their pronouns are, and to practice consistently using people’s self-identified pronouns (whether they/them or another gender neutral pronoun, of which there are a number).** At the beginning of a group meeting is a good time to open up space for people to identify their pronouns. This may be particularly relevant when working with groups of younger people, who are much more aware of a gender spectrum. A good way to start that conversation is to volunteer our own pronouns when we introduce ourselves to someone or to a group (“Hi, I’m Rowena and I use she/her pronouns”), and then invite people if they are comfortable to share their pronouns when they introduce themselves. We can also routinely use they/them pronouns when we don’t know first hand what someone’s pronouns are or what their gender identity is. Interestingly, some companies are already using gender neutral pronouns in their communications.

In my own journey, it has taken me time to get used to using they/them pronouns, which my family member uses to identify themself. For awhile, I would use they/them when I was around my family member, but would revert to their historical pronouns when talking with others, in part because I wanted to respect my family member’s privacy and also because it still felt uncomfortable. Eventually, I specifically checked with them and received permission to use they/them pronouns all the time when referring to them. I made a commitment to be consistent. While I continued making lots of mistakes, I became more comfortable over time and they/them started coming easily off my tongue. I also made sure when I made mistakes that my family member knew how important this was to me to get it right.

A significant milestone for me was becoming more comfortable using they/them pronouns with friends and family, when speaking about my family member. I learned to simply say, “they use they/them pronouns,” and to leave it at that. Sometimes people asked more questions and I would answer briefly. I am still finding a balance between respecting my family member’s privacy and being open and proud of their journey by using correct pronouns.

Language is powerful, it conveys the values of a culture. Therefore, I encourage us to take this issue of human dignity and respect very seriously. We have made other language changes in the past that signified the increasing strength and power of marginalized people, and the growing awareness in the population of important justice issues. We can make changes in our own language and knowledge right now that will speed along these changes in the wider culture. We’ve discussed becoming more aware of our gendered pronouns. We can also become much more aware of how we use gendered language everyday in ways that we might not notice. For example, saying “ladies and gentleman,” or “boys and girls” when addressing a group, or calling people “sir” or “ma’am.” These assumptions about gender are also harmful in the same way we have discussed, they make people who identify differently feel excluded and invisible. Someday soon, with our efforts, gender neutral pronouns and language will be the norm along with respect and acceptance of people all along the gender spectrum.

In summary, here are ideas for how to move this revolution along and to be part of positive change. Most importantly, when someone specifically requests that we honor their pronouns, we can make this change immediately and consistently (even while knowing that we will make mistakes). We can use they/them pronouns as the default until we’ve more specifically checked with someone about their pronouns. We can use they/them pronouns when we are speaking of someone in the third person whose gender identity we don’t know. We can practice getting more comfortable saying, “I use ______ pronouns, what are your pronouns,” when introducing ourselves, and then consistently using the pronouns someone has indicated.

Other ideas that we can try to incorporate over time are to become more aware of and find good neutral alternatives to gendered language that creeps into everyday usage. We can include our own pronouns in the signature portion of our email messages and in our therapy practice documents, where applicable, which signals inclusiveness and invites people to share their pronouns. We can educate ourselves—a website I recommend is mypronouns.org. We can encourage organizations that we’re involved with to be gender neutral in their materials.

This is a journey, it takes time and will feel uncomfortable. I encourage you to be kind to yourself as you are learning and experimenting with these ideas. I believe it is fully worth the effort. Being more aware of our language and our assumptions around gender is a powerful way that we can make the world safer for each other.

*This is not an exhaustive list of terms for identities along the gender spectrum.

**For other gender neutral pronouns and lots of other great information, including suggestions for correcting inevitable mistakes with pronouns, please check out the website mypronouns.org.

Resources used in writing this article:

• A Quick and Easy Guide to They/Them Pronouns, by Archie Bongiovanni and Tristan Jimmerson.
• mypronouns.org.
• Transgender identity terms and labels, plannedparenthood.org

Rowena Dodson has been a licensed therapist since 2016. She has a private practice in Mountain View, and works as a per diem therapist at El Camino Hospital adult outpatient behavioral programs. Her emphasis has been on helping adult clients find their voice and their power to shape the lives they want. 

For eleven years until this past December, I led one of the two newly licensed support groups sponsored by SCV-CAMFT (the first year was an enjoyable co-led experience).

As one might imagine, over eleven years I met many newly licensed therapists. Quite a few of those are now therapists you recognize today in many facets of our professional life, including those in leadership, excelling in professional specialities, providing workshops, and other excellent contributions to our profession.

As a certified group therapist, I was moved by witnessing the transition of the therapists in my group, and how they would join the group and quickly feel connected with the other therapists, the topics, and struggles in a very affirming manner. Facets of a therapist's professional identity can feel isolating at times; notably levels of anxiety and fear about being newly licensed and creating a practice from scratch. Invariably, there was agreement that the business model of starting a practice was neglected in graduate school and in other settings in which these therapists found themselves. This group seemed to fill that gap in a connecting and affirming way. I think most newly licensed therapists would benefit from joining a support group like this, to help them get their grounding after the long process of getting their required hours and taking the exams.

I was pleased to witness and be a part of a their growing sense of competence and comfort level, chipping away at the list of tasks to create a professional identity. They were encouraged to reflect often on their original motivation, goals, and dreams that brought them to graduate school in the first place.

I was honored and enjoyed providing the space for this budding transition. The attendees provided most everything else: energy, empathy, encouragement, resources, resourcefulness, ideas, care, compassion, and continuity. I know long-term friendships grew between the attendees through meeting in this group, as well as many other professional connections.

The benefit for myself, contributing two hours a month, was to witness and be a part of a significant experience at the core of our profession: growth, support, and service. It was a great experience to be part of this group; one that helped solidify for me what groups are about and specifically, support groups focused on a very timely and important topic.

It was with mixed feelings that I gave up my role and passed the baton on to another capable leader. I feel strongly that this part of what SCV-CAMFT offers is quite vital and noteworthy, and hope it continues for many years to come. I also hope that those of you reading this article will consider recommending this group to those who may be looking for this validation and mirroring. From my experience, it is very helpful for those who attend.

The lesson for me is that by contributing a small amount of time and effort, the rewards can be immeasurable. The experience of leading this group for so many years has proven this to be true.

Jamie Moran, LCSW, CGP, is a long time member of SCV-CAMFT. He specializes in long term psychodynamic group therapy, consults with therapists about groups and teaches aspects of groups in communities at large as well as being on the faculty of The Psychotherapy Institute's Group Therapy Training Program in Berkeley. Jamie has a private practice in Menlo Park. His website is jamiemoran.com.

Please note that I refer to dogs in this article, but any animal can be a therapy animal. I also refer to pet owners, rather than guardians, pet parents, etc., because that is still the legal term used (with a few exceptions).

Emotional Support Animal? Therapy Dog? Animal Assisted Activities Therapy Dog? Service Dog? Animal Assisted Psychotherapist? You've probably heard a few of these terms and wondered what they mean. It can be confusing, but there are differences between these roles. This article addresses the additional training and experience a therapist who wants to bring their dog into the therapy office needs in order to comply with certain laws. But first, let’s describe the roles dogs serve in the field of mental and/or physical health that you’re likely to encounter, as they are not interchangeable.

Emotional Support Animal

An emotional support animal (ESA) is a pet who provides a high level of support to its owner. Most of us love our pet and consider them a part of our family, yet an ESA takes on an even bigger role in their owner’s life, such as helping to decrease loneliness or isolation, severe depression, high anxiety, or other mental health issues. The client most likely has a small and/or weak support system, and their pet provides that additional support.

The law specifies only two rights that owners with an ESA are entitled to: they are allowed to travel on an airplane with their pet and allowed in homes that otherwise don’t allow pets. They are not allowed in any other place that a dog/pet is not allowed.

The ESA pet does not have specialized training, but does need basic obedience training. Landlords and airlines are legally permitted to remove a pet that misbehaves or causes a disturbance or nuisance to other people. While there’s no certification process for the animal, the owner must provide a letter from a physician, psychologist, or psychotherapist stating that the pet is needed for a client’s emotional support.

Be very cautious about providing these letters, and know your client’s needs well. It’s against the law to provide a letter to a client who doesn’t really need their pet for this level of emotional support and who you haven’t already established a strong therapeutic relationship with.

Service Dogs

A service dog is a dog that is trained to perform a specific task for a person who has a verified disability, either physical or mental health related, as specified under the American Disabilities Act (see www.ada.org for more information). Guide dogs for the blind, diabetes or epilepsy alert and response dogs would be included here, as well as people dealing with panic attacks or PTSD.

These dogs are extensively trained, sometimes up to 12-18 months depending on the disability. I heard of someone with PTSD and was triggered in crowds. The dog was trained to detect when she was about to have a panic attack and bark so that she could leave the situation quickly - she just told people she had to tend to her barking dog. As a side note, many people don’t realize that it’s illegal for the public to try to pet or try to socialize with a service dog who’s in public, as the dog is working.

Therapy Dogs

Therapy dogs fall into two categories: certified therapy dog or pet-assisted therapy dog. My dog is a certified therapy dog who provides Animal Assisted Activities (AAA). We are contracted with one of the local therapy dog agencies, and join other volunteers on planned visits to schools, libraries, retirement homes, hospitals, and other places that would benefit from therapy dog visits. We are volunteers for the agency we’ve joined as part of a therapy dog team, and never make visits on our own.

There are several local organizations that provide pet-assisted therapy services, and the specific policies/requirements are different at each one. In general, your dog must be well trained in obedience and under your control at all times. Many organizations require your dog to have earned their Canine Good Citizen certification, a special obedience test given by certified examiners from the American Kennel Club. Your dog must be unflappable, even tempered, and predictable in any type of situation.

In addition to the obedience requirements, an animal behaviorist from the agency you’ll be working with will do a thorough assessment to make sure your dog has the right temperament. Just because your dog is friendly, doesn’t mean they are suited to be a therapy dog. My Newfoundland has had a curious toddler stick her finger up his nose, his tail has been run over by someone’s walker numerous times, 15 or more people often crowd around him all at once to pet him, yet he remains quite calm through it all. And he thrives on all of the attention, another essential component.

By contrast, my other Newfoundland is very friendly, loves people, but after a minute she’s ready to leave the people behind and is distracted by everything else going on - she reminds me of someone with ADHD! Although not essential, it’s a great idea to have this type of experience with your dog before deciding to bring them to work with you.

Getting Your Pet Certified

So you’ve read this far, and have decided that you want to take the next step to become a pet-assisted therapist, bringing your own dog to work with you to help some of your clients. This is considered a specialty of psychotherapy, so what extra training do you need?

It’s of vital importance to remember that one of the laws we as psychotherapists must follow is Scope of Competence. Have you taken the steps to be in compliance with this law? Have you received additional training, education, experience, and supervision? Why are you using the dog as a part of the treatment plan? What is the purpose and goal for the session? There must be a therapeutic reason. It could simply mean providing the calming and peaceful presence of your dog for your client. It could mean helping a child learn how to deal with frustration by learning how to be calm while interacting with your dog. Maybe it’s helping someone learn how to be more assertive, build confidence, or reduce fear. The list and the interventions are endless.

What additional training do you actually need and where can you get that training? There are several organizations and associations that can provide you with the additional education, training, and experience you will need to embark on this work. A few universities offer post-graduate programs for graduate level therapists. But before you pay thousands of dollars for the training, check their references and the training and education they actually offer. As with anything else online, there are some scams out there.

I’m currently pursuing my certification at Animal Assisted Therapy Programs of Colorado, www.animalassistedtherapyprograms.org. It consists of 6 semester-length classes and when done I’ll earn my Certificate of Education in Animal Assisted Psychotherapy. I’m learning about the Human Animal Bond, the Legal and Ethical Issues in AAP, Animal Behavior and Training, AAP and Theory, as well as Treatment Planning/Interventions. These are all requirements to earn this specialization. At the end of it all, I’ll write a publishable paper showing my original work using the concepts learned with one of my own clients.

You don’t have to go to this extreme, though. At this same website there are training videos that therapists can study to document that they’ve taken the time to get the additional training required to pursue this specialty.

Although it may be time-consuming and expensive, our very own Ann Tran-Lien, JD, at CAMFT wrote an article in the September/October 2017 issue of The Therapist about a California LCSW who had strong disciplinary action taken against her for incompetence and gross negligence when her dog bit a child client at the end of a therapy session. This article should motivate therapists who want to use their dogs in therapy sessions to get that extra training.

I’ve had so much fun over the years taking my dogs to obedience classes, seeing the joyful effect they have on the people we visit, and someday using my own dog to help clients. One last reminder - be safe, make sure you’ve got the extra training and experience, and make sure your dog is properly assessed by someone other than yourself. Even though I’ve taken many workshops and training classes over the years with my dogs, I like knowing that they’ve been assessed by a certified animal behaviorist who has put them through the ropes to make sure they’re as suitable for this work as I think they are.

Elizabeth Basile, LMFT, practices in Mountain View. She works with pre-teens, teens, adults, individuals, couples, and families, addressing domestic violence, sexual assault, trauma and PTSD, illness, and eating disorders. She also has a certification in eating disorders. She’s looking forward to integrating her dogs into her practice with some of her clients. Her website is www.elizabethbasilemft.com.

Nancy Wesson, PhD, is a Licensed Psychologist psy9621, Certified Group Psychotherapist and founder of the Center for the Study of Group Psychotherapy (CSGP), a nonprofit group therapy training organization.

In my 30 years leading psychotherapy groups, I find that group psychotherapy is a very effective treatment modality. In this brief article I offer some pointers for starting a group and for keeping it going successfully.

“The joy of group therapy for me is watching group member connections, relationship building, and identification, that is, when members no longer feel alone with their psychological issues. This is one of the most important healing factors for group therapy. When describing the group, members will easily tell others that the group is not ‘the group’ but ‘my group’.” (Yalom & Leszcz, 2005).

Before starting the group

• Receive training in group psychotherapy to be able to effectively handle leadership challenges such as monopolizing, absenteeism, conflict, etc.

• Choose the type of group you would like to lead: process, psycho-educational, psychoanalytic, or a combination, and if you want a short-term or long-term group.

• Develop a written group agreement for the clients which includes confidentiality, time commitment expectations, absences, fees, acceptable group behavior (norms), and termination issues.

• Develop a marketing plan for attracting new group clients. For example, connect with individual therapists who are likely to refer their clients to your group.

Organizing the group

Once you have chosen the type of group you would like to lead, you need to find the right clients. Decide what criteria you are looking for in clients and interview them to make sure they will fit. It is important to consider if a client is appropriate for your group. Conduct a phone interview initially, and if they seem appropriate, conduct an in-person interview (if possible). It is also important to prepare the client for how the group will work and how it will feel to be a group member. This preparation will help your client feel more comfortable and committed to the group.

Starting the group

Begin your group when you have at least 4, preferably 5 clients who are ready to join the group. To create cohesion and connection, start the first session by encouraging members to connect with each other and to take time to discuss their lives and personal goals.

Most clients join groups not just for information but also for connection. You can encourage connection between group members by including time for group members to interact. The relationships between group members and the sharing of similar issues will bring your group members back to group each week.

It is helpful to see the “group as a whole,”(Bion, 1962) and not only as a collection of individual clients. Each group is an entity in and of itself, comprised of relationships as well as individual clients and help the group maintain it's own identity.

Maintaining the group

Keep the group stable, safe, and dynamic by addressing any issues in your agreement that come up in the group. If a member is not participating in the group, explore this gently in the group. (They may not think their contribution is important).

The group agreement is central to keeping the group safe and members committed. If a member is often late or absent, bring this to the group for exploration. If a member is very frequently absent and does not respond to group feedback, then meet with that member privately. Frequent absences by one member can easily lead to more member absences. The same is true for lateness and impulsive angry outbursts.

Encourage empathy, positive feedback, support, and the expression of feelings in the group. This will help group members feel connected to others in the group. Group members need to feel they are each an important part of the group.

Nancy Wesson, PhD, Licensed Psychologist, psy9621, CGP, has been trained by Irvin Yalom, M.D. and the American Group Psychotherapy Association. She is the founder of the Center for the Study of Group Psychotherapy, a nonprofit training organization (CSGP). She has led two psychotherapy groups for 28 years. For more information contact DrNWesson@CSGP.org, or visit the CSGP website at www.CSGP.org.

With busy lives, it can be hard to find time to volunteer. However, the benefits of volunteering are enormous to you, your family, and your community. The right match can help you reduce stress, find friends, connect with the community, learn new skills, and even advance your career. Giving to others can also help protect your mental and physical health.

Why volunteer?

Volunteering offers vital help to people in need, worthwhile causes, and the community, but the benefits can be even greater for you, the volunteer. Volunteering and helping others can reduce stress, combat depression, keep you mentally stimulated, and provide a sense of purpose. While it’s true that the more you volunteer, the more benefits you’ll experience, volunteering doesn’t have to involve a long-term commitment or take a huge amount of time out of your busy day. Giving in even simple ways can help those in need and improve your health and happiness.

Benefits of volunteering:

• 4 ways to feel healthier and happier
• Volunteering connects you to others
• Volunteering is good for your mind and body
• Volunteering can advance your career
• Volunteering brings fun and fulfillment to your life
• Volunteering connects you to others

One of the more well-known benefits of volunteering is the impact on the community. Volunteering allows you to connect to your community and make it a better place. Even helping out with the smallest tasks can make a real difference. And volunteering is a two-way street: It can benefit you and your family as much as the cause you choose to help. Dedicating your time as a volunteer helps you make new friends, expand your network, and boost your social skills.

Make new friends and contacts

Volunteering is a great way to meet new people, especially if you are new to an area. It strengthens your ties to the community and broadens your support network, exposing you to people with common interests, neighborhood resources, and fun and fulfilling activities.

Increase your social and relationship skills

While some people are naturally outgoing, others are shy and have a hard time meeting new people. Volunteering gives you the opportunity to practice and develop your social skills, since you are meeting with a group of people with common interests. Once you have momentum, it’s easier to branch out and make more friends and contacts.

Volunteering is good for your mind and body

Volunteering helps counteract the effects of stress, anger, and anxiety. The social contact aspect of helping and working with others can have a profound effect on your overall psychological well-being. Nothing relieves stress better than a meaningful connection to another person.

Volunteering combats depression. Volunteering keeps you in regular contact with others and helps you develop a solid support system, which in turn protects you against depression.

Volunteering makes you happy. By measuring hormones and brain activity, researchers have discovered that being helpful to others delivers immense pleasure. Human beings are hard-wired to give to others. The more we give, the happier we feel.

Volunteering increases self-confidence. You are doing good for others and the community, which provides a natural sense of accomplishment. Your role as a volunteer can also give you a sense of pride and identity. And the better you feel about yourself, the more likely you are to have a positive view of your life and future goals.

Volunteering provides a sense of purpose. Whatever your age or life situation, volunteering can help take your mind off your own worries, keep you mentally stimulated, and add more zest to your life. Older adults, especially those who have retired or lost a spouse, can find new meaning and direction in their lives by helping others.

Volunteering helps you stay physically healthy. Studies have found that those who volunteer have a lower mortality rate than those who do not. Older volunteers tend to walk more, find it easier to cope with everyday tasks, are less likely to develop high blood pressure, and have better thinking skills. Volunteering can also lessen symptoms of chronic pain and reduce the risk of heart disease.

Many people choose to volunteer their time via phone or computer. Many organizations need help with writing, graphic design, email, and other web-based tasks. In any volunteer situation, make sure that you are getting enough social contact, and that the organization is available to support you should you have questions.

Volunteering can advance your career

Volunteering can help you get experience in your area of interest, meet people in the field, and gives you the opportunity to practice important skills such as teamwork, communication, problem solving, project planning, task management, and organizing.

Teaching you valuable job skills

Just because volunteer work is unpaid does not mean the skills you learn are basic. Many volunteering opportunities can provide you with new skills. Joining a board of directors, helping with events, or communication can add to one's skill set. Volunteering can also help you build upon skills you already have and use them to benefit the greater community. Your volunteer work might also expose you to professional organizations or internships that could benefit your career.

When it comes to volunteering, passion and positivity are the only requirements.

While learning new skills can be beneficial to many, it’s not a requirement for a fulfilling volunteer experience. Bear in mind that the most valuable assets you can bring to any volunteer effort are compassion, an open mind, a willingness to pitch in wherever needed, and a positive attitude.

Volunteering brings fun and fulfillment to your life

Volunteering is a fun and easy way to explore your interests and passions. Doing volunteer work you find meaningful and interesting can be a relaxing, energizing escape from your day-to-day routine of work, school, or family commitments. Volunteering also provides you with renewed creativity, motivation, and vision that can carry over into your personal and professional life.

Consider your goals and interests

You will have a richer and more enjoyable volunteering experience if you first take some time to identify your goals and interests. Think about why you want to volunteer. What would you enjoy doing? The opportunitiess that match both your goals and your interests are most likely to be fun and fulfilling.

How much time should you volunteer?

Volunteering doesn’t have to take over your life to be beneficial. In fact, research shows that just two to three hours per week, or about 100 hours a year, can confer the most benefits—to both you and your chosen cause. The important thing is to volunteer only the amount of time that feels comfortable to you. Volunteering should feel like a fun and rewarding hobby, not another chore on your to-do list.

Don’t be afraid to make a change. Don’t force yourself into a bad fit or feel compelled to stick with a volunteer role you dislike. Talk to the organization about changing your focus or look for a different organization that’s a better fit.

Enjoy yourself

The best volunteer experiences benefit both the volunteer and the organization. If you’re not enjoying yourself, ask yourself why. Is it the tasks you’re performing? The people you’re working with? Or are you uncomfortable simply because the situation is new and unfamiliar? Pinpointing what’s bothering you can help you decide how to proceed.

Article reprinted with permission from HelpGuide.org.

Nancy Wesson, Ph.D. is the founder of the Center for the Study of Group Psychotherapy (CSGP.org), a nonprofit group therapy training center.

Individual and group psychotherapy are both considered effective and highly therapeutic forms of psychotherapy. However there are differences in how the therapeutic process works in the two modalities of psychotherapy. In this article individual psychotherapy will be defined as the one-on-one therapeutic process between a client and an individual psychotherapist. Group psychotherapy will refer to psychotherapy within a group with several clients meeting at the same time. There is a special emphasis in this article on interpersonal group psychotherapy as defined by Dr. Irvin Yalom.

Different therapeutic alliance: in individual psychotherapy the therapeutic alliance is between a client and a psychotherapist. In group psychotherapy the therapeutic alliance is with the group.

Individual psychotherapy is a one-on-one therapeutic relationship with a psychotherapist. The group psychotherapist has a different role in the therapeutic process. The group psychotherapist leads a group comprised of several clients through the therapeutic process.Different therapeutic factors (components of the change process) are at work in individual and group psychotherapy. Unlike individual psychotherapy, group psychotherapy is a team approach.

Different Therapeutic Alliance

There is considerable clinical evidence which links therapeutic alliance (engagement in a therapeutic bond ) with psychotherapy outcome. Individual psychotherapy is a place for clients to work through psychological issues within the context of a one-on-one therapeutic alliance. In group psychotherapy, the therapeutic alliance is with the group comprised of peer group members and the group psychotherapist. The group psychotherapy alliance can be understood as the emotional bond held by each group member for the other group members and the group psychotherapist.

Different role of the psychotherapist

The individual psychotherapist’s role is to provide a one-on-one protected therapeutic relationship with a client. In contrast, the role of the group psychotherapist is quite different. The group psychotherapist leads several clients (peer group members) in an exploration of relationship issues and maintains the group process.

In individual psychotherapy, the focus is on the individual client and resolution of their psychological issues through the therapeutic process. The therapeutic change process in group psychotherapy is different. In group psychotherapy peer group members interact with each other and interpersonal skills are learned through several different peer relationships. The group members and group psychotherapist observe interactions as they take place within the group and provide feedback. This is a very different change process than in the one-on-one relationship of individual psychotherapy.

Different therapeutic factors are at work in individual and group psychotherapy

There are different factors that reflect different processes in individual and group treatment. The factors of insight and problem solving are more important to the process of individual psychotherapy. The therapeutic factors of altruism, interpersonal skill building, and group cohesiveness are emphasized more in group psychotherapy. This is a substantially different therapeutic process involving different therapeutic factors than individual psychotherapy.

Unlike individual psychotherapy, group psychotherapy is a team approach

Relationships between group members and the therapeutic bond between them are the most important aspects of the group therapeutic process. In group psychotherapy, members experience in-vivo closeness with each other, learn to trust each other, and develop a “team” approach which entails the development of an active cohesive group. In group psychotherapy clients become part of a community which is like a healthy family and clients have the opportunity to experience multiple positive and healthy relationships. This is known as the “corrective emotional experience.”

For many of our clients, relationships have been painful and difficult. As psychotherapists we work with our clients to improve the relationships in their lives. According to interpersonal theory, in group psychotherapy a client demonstrates the very interpersonal behavior which is causing problems in his/her relationships. This dysfunctional relationship behavior creates feeling reactions in other group members and is described and reflected back to the client through feedback. Clients become aware of their unhealthy interpersonal behavior through the eyes of peer group members and how this behavior interferes with closeness and support. They then have the opportunity to develop healthy interpersonal skills and practice these skills within the group. Clients learn how to develop meaningful and close relationships through this process.

Conclusion

The healing power of psychotherapy exists in individual and group psychotherapy. Involvement and engagement in healthy relationships with peer group members is an important aspect of the therapeutic process in group psychotherapy, which is different than the one-on-one therapeutic process of individual psychotherapy. In both forms of psychotherapy clients learn about the “work” and “joy” of relationships which have honesty and emotional depth.

Nancy Wesson, Ph.D., CGP, is a licensed psychologist and Certified Group Psychotherapist (CGP). She is the founder of the Center for the Study of Group Psychotherapy (CSGP.org), a nonprofit group psychotherapy training center which offers group psychotherapy training courses. Dr. Wesson has studied group psychotherapy for 30 years. She has been trained by Dr. Irvin Yalom, M.D. and the American Group Psychotherapy Association. She has led two weekly psychotherapy groups for 27 years. CSGP.org DrNWesson@CSGP.org.

References

Holmes, S., & Kivlighan, D., Jr. (2000). Comparison of therapeutic factors in group and individual treatment processes. Journal of Counseling Psychology, 47, 478-484.

Klein, A., Markowitz, J., Rothbaum, B., Thase, M., Fisher, A., & Kocsis, J. (2013) The Relationship between the Therapeutic Alliance and Treatment Outcome in Two Distinct

Psychotherapies for Chronic Depression. Journal of Consulting and Clinical Psychology, 627-638.

Wesson, N. (2007). Becoming a true member of a psychotherapy group. The California Psychologist, 21, 22-25.

Yalom, I., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th Ed.). New York: Basic Books.

Integrating research and practice of evidence-based psychotherapy and Person-Centered Expressive Arts (PCEA) for healing and social change.

Recognizing, understanding and regulating emotions is complicated, which may a part of why therapists are in demand. As therapists, we have skills to help clients sort through the difficulties and challenges of life in order to create opportunities for meaningful change, improved clarity, insight, and relationships.

Person-Centered Expressive Art combines the creative process and psychology to promote emotional growth and healing. Therapists can use our inborn desire to create as therapeutic support to help initiate change, nurture well-being, and foster transformation.

On Feb 23, 2018 Santa Clara Valley Chapter of California Association of Marriage and Family Therapists (SCV-CAMFT) invited Julie Norton to facilitate a participatory professional engagement presentation, entitled “Ignite Creativity, Wonder, and Well-being.” The presentation offered an opportunity to explore our relationship with creativity to serve as a pathway to deep work with clients.

Creativity can be used for enriching a wellness practice, and creative expression can have many benefits for youth and adults alike. Creativity is highly connected to emotion. Active participation in art activities is one of the best ways to achieve benefits (Bolwerk et. al, 2014). Participants in this introductory Person-Centered Expressive Arts presentation were encouraged to reflect on their own wellbeing and their relationship to creativity, as well as that of their clients.

Creativity is a process that involves mental agility and cognitive resourcing. In order to increase creativity, research indicates that we need to tend to our wellbeing. Some examples are reducing the overload on working memory and lessening over-stimulation.

Participants who attended this presentation-explored ways that awe, wonder, and well-being can be modeled and applied. Each clinician had a chance to apply a multi-modal approach that included elements such as sounding, visual arts, writing, movement, and other forms of expression. According to Myers and Sweeny, “Wellness refers to the integration of mind, body and spirit into healthy balance.” In the session, participants explored what wellness and well-being meant to them and their clients.

Drawing can improve moods, reduce stress, and help regulate emotion by serving as a distractor (Drake & Winner, 2012; Stuckey & Nobel, 2010). People who report feeling happy and active are more likely to engage creatively (Silvia et. al, 2014).

One of the concepts and practices explored in the presentation was that of wonder. Wonder and awe are most likely to occur in places that have two key features: physical vastness and novelty. To experience a moment of awe, take a look at this resource provided by Greater Good in Action: Science-based Practices for a Meaningful Life. https://ggia.berkeley.edu/practice/awe_video This video was shared in the session and one participant said, “I loved the video clip! It was inspiring and very good priming for creativity, awe, and well being. I was in awe, so it was then easy to draw, use colors, shapes, etc.”

The person-centered approach offers qualities of empathy, openness, honesty and congruence as a foundational basis for creating safety and building trust in groups.

Person-Centered Expressive Arts Guidelines
Natalie Rogers, Ph.D. (2011). The Creative Connection for Groups: Person-Centered Expressive Arts for Healing and Social Change. Palo Alto, CA: Science and Behavior.

1. Be aware of your feelings as a source for creative expression.
2. There is no right or wrong way to do art. We create art to discover our inner essence.
3. Be aware of your own body, and take care of yourself.
4. Instructions are always suggestions. You have the option not to do them. Be your own boss, here.
5. These experiences stirrup many feelings. You may need to cry or let out loud sounds, which can be very helpful.
6. If you choose to observe, notice group dynamics or enjoy the experience vicariously. Please do not judge others.
7. The events in this session/program should be kept confidential. You may discuss the events with others outside of the group without attaching any personal names to those events. Thank you for keeping our trust.

Carl Rogers was known for his belief, “Experience is, for me, the highest authority.” Some feedback from participants who attended the presentation were: 

• “Great reminder to use our creativity and help our clients.”
•  “Sometimes we need to re-learn how to breathe. Inspiring and a breath of fresh air!!”
• “Enriching, inspiring, connecting.”
• “Great reminder for me to use the arts for myself, not just my clients. Loved it!”
• “Thanks, Julie! It was fun, informative, and refreshing. Well done!”
• “Crayons + stickers + pastels, oh my! Thanks for this opportunity to play and connect with myself and with others.”

Natalie Rogers, the pioneer of PCEA said, “It is difficult to convey in words the depth and power of the expressive arts process. Really, you must taste it to understand it.” The desire of Norton was for local therapists to get a nourishing morsel. 

The SCV-CAMFT presentation was popular and Santa Cruz therapists have asked Julie to do an encore presentation. 

Julie Norton, LMFT
Julie Norton is a licensed marriage and family therapist (MFC53057) and relationship specialist, trained to assess, diagnose, and treat individuals, couples, children, families, and groups to achieve more satisfying and productive lives. Julie presents nationally on resilience, social and emotional learning, and grief. She specializes in a Person-centered expressive arts, humanistic and strengths-based approach. Find out more: www.nortonmft.com.

References

Bolwerk A, Mack-Andrick J, Lang FR, Dörfler A, Maihöfner C (2014) How Art Changes Your Brain: Differential Effects of Visual Art Production and Cognitive Art Evaluation on Functional Brain Connectivity. PLoS ONE 9(7): e101035. doi:10.1371/journal.pone.0101035. 

Drake, J.E. & Winner, E. (2012). How children use drawing to regulate their emotions. Cognition and Emotion, 27, 3, 512-520, DOI: 10.1080/02699931.2012.720567 

Myers, J. E., & Sweeney, T. J. (Eds.). (2005). Counseling for wellness: Theory, research, and practice (pp. 29–38). Alexandria, VA: American Counseling Association.

Natalie Rogers, Ph.D. (2011). The Creative Connection for Groups: Person-Centered Expressive Arts for Healing and Social Change. Palo Alto, CA: Science and Behavior. 

Silvia, P.J., Beaty, R.E., Nusbaum, E.C., Eddington, K.M., Levin-Aspensen, H., & Kwapil T.R. (2014). Everyday creativity in daily life: An experience-sampling study of “little c” creativity. Psychology of Aesthetics, Creativity, and the Arts, 8, 2, 183-188.

Stuckey, H. L., & Nobel, J. (2010). The Connection Between Art, Healing, and Public Health: A Review of Current Literature. American Journal of Public Health, 100(2), 254–263. http://doi.org/10.2105/AJPH.2008.156497

Note: portions of this article are adapted from a short piece on ACES by Kim Gulbrandson, Ph.D. and the research referenced is from https://thepsychologist.bps.org.uk/volume-24/edition-7/how-rudeness-takes-its-toll 

Fairy tales are important in our children’s lives. The classic stories heard frequently throughout childhood at bedtime, in Disney movies, in school and later into adulthood in ballets and operas contain special guides to behavior. According to psychoanalyst Carl Jung, we have a favorite fairy tale that goes with us throughout life that forms the pattern for our most significant development.

Fairy tale heroes and heroines all take the same journey. Most begin with an abusive home, but some start out on a quest. Cinderella is tormented by cruel stepsisters and Snow White’s step mother tries to kill her. Without parental protections, the main character is soon lost in a threatening dark forest. Although extreme challenges beset them in the woods, invariably helpers appear in the form of godmothers, helpful animals, or dwarfs. Strong inner resourcefulness is discovered as they master tasks of strategy and use empathic ways with others. Ultimately, the standard path leads to a high exalted place in society. The stories teach that quick wittedness and kindness leads one to a good end despite the necessary struggles along the way.

Some parents are concerned about the violent themes. Fairy tales often revolve around child neglect and abuse, such as in Hansel and Gretel, wherein the parents abandon the children to the forest, or The Girl without Hands, where the story centers on the father’s pact with the devil that ultimately leads him to chop off his daughter’s hands.

More than ever before, modern times are filled with the threat of violence and discord in the forms of terrorism, global warming, school shootings and myriad other representations. Because of rapid advances in communication technology such as the internet, it is impossible to hide these core realities. Children need models and guides for mastering threatening situations.

The fairy tale hero or heroine invariably finds the means to master disturbing events. Thus they teach that it is within one’s own power to thrive through creative and strategic action despite what appear to be overwhelming odds.

For example, In the Grimm’s tale, The Three Little Gnomes in the Forest, one learns that through a willing attitude to try difficult tasks, success follows. As the heroine successfully faces impossible challenges, such as gathering strawberries in bitter cold of winter, she gains strength.

“A man with a daughter loses his wife and marries a woman who has lost her husband and also has a daughter. The stepmother favors her own daughter and makes her stepdaughter do the nasty work. One winter day she tells the maiden to gather strawberries in the woods. The girl objects but is forced to the task. In the woods she comes upon a little house with three little men living in it. They pity her being in the snow and ask her why she is there. She tells of her task and shares her meager breakfast with them. They tell her to sweep the snow from the back door, which she does. So they grant her three gifts: that she shall become more beautiful each day, that gold will come from her mouth, and that a king shall take her for his wife. Meanwhile she has discovered ripe strawberries shooting from the ground; she fills her basket and returns home.”

Parents become concerned when their children are fearful. Yet it is part of normal child development to become afraid. During preschool, small ones may get distressed over the dark, monsters and ghosts, animals, and noises in the night. During school years, fears shift to fear of rejection or failure, being hurt, natural disasters, an angry teacher, being home alone, scary news, and death. These are frequently the main motifs in fairy tales! In symbolic language, classic stories encode the means to master fears. For example, the essential theme, the “dark forest,” always resolves with the heroine finding her way to safety.

Contrast the beginning of the story The Ugly Duckling, wherein “the ducks bit him, the hens pecked him, and the girl who fed him kicked him aside…..” “….Even his mother said “I wish you were miles away” with the ending wherein “He thought of how he had been scorned......and now he was the most beautiful of all birds”.

Tales teach although frightening situations exist, it is within one’s own power and resources to find the path to safety and eventual success. 

Bette Kiernan, MFT is in private practice in Menlo Park. She works with individuals, couples, groups, and families. Ms. Kiernan does trainings for corporations, cities, counties, and hospitals. She has taught at Santa Clara University, JFKU, UCSC, UC Berkeley, and Sofia University. MIT presented her work on fairy tales and sacred texts at their International Conference on Media in Transition. Ms. Kiernan is also a journalist for Splash Magazines Worldwide.

If you do not create your own estate plan, the law will create one for you at death, deciding which relatives get what portion of your property based on the relationship to you of the family members who survive you (known as "intestate succession").  

But that plan may not comport to your priorities.  And if you become incapacitated without an estate plan, the law has a process for appointing a person (known as a "conservator") to make financial and personal care decisions on your behalf.  Again, these decisions and the people in charge of this care may not be in line with your wishes.  

Creating a foundational estate plan ensures that your goals are achieved and that your family is taken care of after you're gone.  

Having a plan can also protect you if you should become disabled or incapacitated. Below are the four estate planning documents that make up the foundational estate plan

Living Trust

A Living Trust allows you to determine how your estate will be distributed and in the vast majority of cases this can be done efficiently without court involvement.  If you have a Will, but not a Living Trust, then decisions about who gets your property can still be taken care of by the Will, but the process for executing your wishes must be supervised by the courts.  

You also want to prevent disputes among your family members.  Your Living Trust can provide your loved ones guidance and clarification regarding your wishes and if you are concerned about particular disputes, an estate planning attorney can help you create incentives in your plan aimed at preventing strife and litigation.  You can also appoint the person you trust the most to administer your estate.

Durable Power of Attorney

The Living Trust is also useful in that it allows a person you trust to manage your property for your benefit (e.g., paying for your care and comfort) if you become incapacitated.  However, in order to have authority to do this, your property must be titled as trust property. 

A durable power of attorney gives your chosen agent the power to take control of your property that is not titled in the Living Trust.  For example, IRAs cannot be owned by a Living Trust, so it is the agent under the durable power of attorney who might take distributions or make investment decisions in your IRA if you become incapacitated.  This person can make financial and legal decisions for you, so it is imperative that you appoint somebody you trust implicitly.  

If you have a Living Trust, generally it is a good idea to name your successor trustee(s) as the agent under your durable power of attorney.

Will / Nomination of Guardian

If you have a Living Trust, you will need a document known as a pourover will.  This document is essentially a backup document in case you pass away with assets that are not titled in your Living Trust.  It instructs the executor of your Will to transfer any such property to your Living Trust. 

Parents with minor children can also nominate a guardian for their children through the Will.  In some cases, a Living Trust may not be necessary and a Will may be sufficient for the at-death transfer of your property.  

As a very generic rule, if you have no minor children, no real property, and the net worth of your assets is below $150,000, a Will may be sufficient for your estate planning needs.  You should consult with a lawyer before deciding whether a Will is sufficient for your goals.

Advance Health Care Directive

Your Advance Health Care Directive (AHCD) provides another person with the authority to make medical decisions for you if you're unable to do so. Again, it is vital that you appoint an individual that you trust to act in your best interests.  

Your AHCD also outlines what you want to happen with your end-of-life care.  You can specify whether you want to receive artificial life support, donate organs, and how your remains are handled (i.e., burial, cremation, etc.).  

It is imperative that you have open discussions with your loved ones about your wishes.  This will make facing the difficult situation easier and lift the burden of making end of life decisions from your loved ones.

Estate planning is emotional, but it is one of the best gifts you can give yourself and your loved ones.

Gadi Zohar, Esq., practices as a trusts and estates lawyer in Palo Alto, California.  He is also an LMFT and CEO of TherapistWill.com, an online professional will solution.  Gadi no longer provides professional psychotherapy or psychological counseling.  

This article is for information purposes only, and is not intended to be legal advice.  The opinions of the author are not a guarantee of any particular outcome.  For advice regarding your individual situation you should consult an attorney.  Gadi welcomes your calls and emails and states that contacting him does not create an attorney-client relationship.

I have been leading group consultation for over fifteen years now and I have come to believe that consultation is the key to a vibrant private practice. Having participated in group consultation since I was an intern in private practice, I have always valued it highly.  It is an excellent marketing and networking tool.  Whether you participate in the chapter’s free Newly Licensed Support Groups, a peer consultation group, or a facilitated Private Practice Consult, group consultation will always be worth the time and/or money you invest.

 Private practitioners who belong to peer consultation groups report such benefits as support for difficult cases, guidance on ethical and professional issues, sharing information, and countering isolation (Lewis, Greenburgh, & Hatch, 1988). 

 We work in a very isolated environment. At times, we can become so overwhelmed with the problems facing our clients, we lose our perspective. Case consultation in a group setting gives you the luxury of several unique perspectives and theoretical orientations.  Often times, clinicians do not see how truly “burnt out” they are and it takes other clinicians to recognize the signs. Group consultation can give you the empathy and support you give your clients. 

Lawson (2007) found that counselors in private practice engaged in less consultation on average (2.34 hours a month) than counselors in all other settings, including K-12 schools, colleges and universities, hospitals and residential settings, and community agencies. Private practitioners also tended to engage in less peer and group supervision than colleagues in other settings, and in less individual supervision than everyone else except school counselors. 

All of us in private practice know that it can be lonely at times. Running the business of a private practice, it is difficult to find time to read journals, sign up for CEU classes, and even attend SCV-CAMFT luncheons. Scheduling time to meet with other therapists to discuss cases can be overlooked.  A few minutes in the hallway with a colleague or over the phone, usually will not allow us to address the more in-depth issues we handle alone in our offices. 

The unique private practice dilemma of financial concerns like budgeting, billing, setting client fees, working with insurance, and renting offices, make consultation incredibly useful.  Private practice therapists always need to discuss how they will handle client referrals and advertising their practices. Consulting with a colleague who already has a thriving practice could be beneficial to MFTs first starting out or looking to improve their practices.

Your fellow therapists are the only ones who can tell you to call and speak to a CAMFT lawyer. They are the ones who will say,” that’s a CPS report” or “you did the right thing sending that teen to the hospital.” You can always document consultation in your notes on difficult cases, therefore following ethical practices. Most importantly, other clinicians can give you reliable and diverse feedback on your cases.  One of the greatest values in group consultation is that your fellow MFTs can suggest when a case appears out of your scope of practice. 

Depending on the focus of the consultation, consultants can provide specialized expertise, research knowledge, situation assessment, diagnosis, treatment recommendations, guidance on ethical concerns, and assistance with case conceptualization (Dougherty, 2013). 

Many of us still remember our intern experience in group supervision.  The camaraderie with our fellow interns, the nervousness in presenting cases, and the security in numbers, propelled us through the process. Group Consultation harkens back to those days with the added burden of paperwork and monetary burdens. The idea of spending more money on another expense or taking time to meet consistently with fellow MFTs may seem superfluous. 

The opposite is true. Spending the money and time to secure your success is wise. Having the balance in your practice of monthly consultation enables you to get invaluable feedback from your peers. Whether you are discussing a case that has kept you up the night before or addressing an issue with an insurance company, your colleagues have been in your shoes. They feel your pain and your joy. 

A colleague in your consultation group will have worked with that child psychologist you need for your new child client or know a good software program to keep your practice up and running.  They may have a bookkeeping referral, a masseuse, or a bank that’s friendly. They may know an office in a different town that you are considering or a way for you to become involved in your CAMFT chapter so you can network and meet new clinicians. They will know which CEU classes are boring and which online referral services are worthwhile.

 Group consultation is a safety net.  Each of us has felt overburdened at times with the demands of our practice. More than your family or your friends, your colleagues   will recognize burnout.  They will not hesitate to encourage you to take a vacation or lower your case load. Group consultation can insure your work/life balance. It is well worth the investment of funds and time. 

Mary Deger Seevers, MA, MFT (CA#35702) has been leading private practice consultation groups in San Mateo for over fifteen years. She is a certified CAMFT supervisor. Her current group meets on Friday mornings once a month. If you are interested in individual or group consultation, please contact her through mary@marydegerseevers.com