Articles

The SCV-CAMFT Board of Directors respond to CAMFT's proposed CAMFT Chapter Agreement. Members can view this PDF document, Click to view PDF.

In the last newsletter, we discussed the fact that in order to ensure complete psychological healing, we must heal not only the original core wounds, but also all the defense mechanisms that the person has created to protect themselves from feeling those core wounds. Those defense mechanisms can be quite complicated. They are often organized in layers, with each layer imperfectly solving the problems created by the layer just beneath it, and leaving problems to be solved by the layer above it, or not solved at all.

I presented a simple map for understanding the various layers of defense mechanisms. Starting with the simplest and proceeding to the most complex, it looks like this:

I hasten to point out that in real life the different levels and layers are not so distinct and separate, and one level may blur into another. Keeping that in mind, let's go through the layers one at a time and unpack each one.

In the last newsletter, we discussed in detail the first and second levels of trauma defenses, the levels of phobia and trauma. Now let's explore the third and fourth levels.

The 3rd Level - Addiction
At the third level, where we find addictions, we have all the trauma and defenses of the second level, but they are now buried under an additional layer of defense, an habitual behavior that serves to numb the person to the pain and anxiety of the core trauma. Here, the person's solution to the underlying problem has itself become a problem. Usually, people come for help with stopping the addictive behavior, completely unaware that it is their medicine for a deeper wound, and that we must heal that deeper wound to really cure the addiction.

The numbing agent may be anything. Some of the favorites are alcohol, drugs, food, sex, work, money, success, fame and popularity. But any substance or activity can be used, as long as it works well enough to dull the feelings from the trauma. What makes the behavior addictive, is that it is being used to dull the person's feelings. And what makes all addictive behaviors ultimately unsuccessful is the fact that “You can never get enough of what you don't really want.” If what you really want is to feel loved, there is no amount of food or drugs or money that will give you that feeling. If what you really want is healing for the original hurt, there is no amount of anesthesia that will work. Sooner or later, the numbness wears off and the hurt returns.

The extra layer of defenses makes the whole process of healing that much more complicated.

In addition to healing the original core wound, and the feelings, beliefs, and identity arising from it, the addictive behavior itself must be addressed. Typically, the addictive behavior has several components, including the craving for the drug of choice, the situations that trigger the craving, the habit of self-medication for the craving, and chronic psychological reversal, which supports the belief that this behavior is a good choice. All of these parts of the addiction are interwoven and mutually re-enforcing, which makes them very hard to untangle and dissolve.

The 4th Level - Self-Defeating Behaviors
The 4th level is the deepest and most difficult to change, because here a deeper and more effective numbing process has been added to the usual layers of trauma defenses, and there may be active addiction as well. This additional layer of defense is an unconscious, automatic habit of selfnegation. Self-negation is a much deeper and more damaging habit than addiction, because while addiction tries to bury the pain, self-negation tries to bury the self. It does this by stifling all the expressions of the self, such as initiating actions, having preferences and desires -basically all assertions of personal will.

Why would anyone adopt a habit of negating their own impulses, or of preventing their own self-expression? Like all defense mechanisms, it was the best solution the child could find for the problems they faced. In this case, the problem was a parent who could not tolerate the child's developing sense of will, separateness, and autonomy. To prevent this development, the parent set out to break the child's will by actively punishing the child's expressions of his own will and autonomy.

Today, such actions may seem bizarre or unusual, but during the 1800's and early 1900's, this practice was the norm. Most books on child-rearing from that era state that it is the parents' duty to break the child's will in order to civilize it. Although the instructions in child-rearing manuals have changed, there are still many parents who were brought up this way, and therefore cannot tolerate the development of a separate will in their child.

The core wounding usually goes something like this: around the age of two, the child naturally becomes aware of its separateness, and begins to express its will as different from the parents’. Instead of supporting the child's budding autonomy, the parent opposes it, using guilt, shame, manipulation, over-control, and often outright violence. At first, the child fights back, asserting its own will in opposition to the parents’ will. But the parent is bigger and stronger, and willing to escalate their reaction as far as it takes to force the child's compliance. Time after time, the child loses the fight. Eventually, the child concludes that “I can never win and any assertion of my bring more punishment.”

So, the child does the only thing that will stop the pain - it turns its own will against itself, and stops itself from feeling or expressing its own impulses, desires, and autonomy. It learns to automatically defeat itself before the parent can defeat it. This is the habit of self-negation. This habit then organizes the child's psyche and identity so deeply that the behavior persists long after the child has grown up and left home. Even as an adult, impulses and desires are derailed before they reach the surface and find expression. Projects are begun, but somehow never completed. Situations that would draw attention or praise are avoided, since those were the moments that also brought humiliation. Little is desired or accomplished.

These are the clients who have a reputation for defeating their therapists by somehow not changing, even when they want to change. They have painted themselves into a very tight corner. Under the self-negatio,n there is an ocean of pain and rage at the way they were treated. But the selfnegation is what protects them from all those overwhelming feelings. It is their medicine; their drug of choice. Selfassertion re-awakens the old fear of punishment, and being seen as successful can be terrifying. And besides, they have never gotten what they wanted before, so why would they think that they will get it now? For them, the only way to avoid losing big is to continue losing small.

How, then, do we help someone who is stuck at this level? First, we need to recognize early on that self-negation is present so that we don't play into the try-and-fail pattern, and end up reenforcing it. Instead, we need to recognize the need to refuse to change, and give it a voice. Carol Look has beautifully laid out one way to do this in her Refusal Technique*. I find this technique very effective, both to break the logjam, and to confirm that selfnegation is the issue. If it is, doing the Refusal Technique will cause the client to become more animated. In fact, they often break into peals of laughter at this permission to finally say out loud what they have felt in silence for so long. This release may continue for a long time as they vent the pressure they've been carrying inside for years. And you may need to return to the Refusal Technique repeatedly, whenever the logjam reappears.

Since they are profoundly psychologically reversed*, I suggest also applying the un-reversal technique early and often. Their system is accustomed to being reversed, and you must help it gradually re-orient itself to being in alignment.

As you work down through the layer of self-negation (even temporarily), you can begin to address the underlying traumas, and the specific incidents that led them to employ self-negation in the first place. If addictions are present, you will also have to address them at some point, although this will be much easier if you can collapse the underlying traumas first. The person's identification with being “the loser” will also need to be addressed.

It will likely be a long and twisting road, but if you understand the function of self-negation in their psychic economy, you will make real progress.

Looking back over these four levels of trauma defenses, we can see how they are laid down, each one on top of the one below, each layer trying to solve the problems left by the previous layer. With this map in mind, I hope you will find it much easier to understand and heal the various trau- mas you and your clients encounter.

* Psychological reversal and the Refusal Technique are explained and taught as part of EFT, but explaining them here is beyond the scope of this article.

As an intern with less than half my 3,000 hours completed, I can say that the whole process at times seems overwhelming. The intern experience is awful and wonderful at the same time. Three thousand hours is an awfully large amount of time, but it gives me the space to ponder about some of my most wonderful and unique intern experiences. I’d like to tell you about one of those internships that I just completed.  

I have just completed an internship at the Santa Clara County Suicide and Crisis Service (or “SACS” for short). Prior to taking my 4-hour shift, I went through 80 hours of training which was very intensive, thorough but definitely worth every minute. So, before I actually sat down to man the phones, I was well prepared to handle most any situation that would come up. Of course, there is no substitute for experience. The phone experience of talking to SACS’ callers is so unique that I feel compelled to share it with you. 

Talking to SACS callers has given me the opportunity to be with ‘clients’ in totally different ways from how I was trained in graduate school. Even though they are not technically clients, and I am not technically practicing psychotherapy on them, they have given me much to wonder about. One of the things that I wonder about is the anonymity of the faceless and unobservable caller. For all I know he could be wearing slovenly clothes, unshaven and smell like stale cigarettes with a smile on his face while describing the death of his beloved basset hound. Conversely, the caller might be wearing designer clothes, flashy jewelry and sitting with her I-phone by the pool outside a million-dollar mansion while sobbing about money problems. As a SACS volunteer, all that matters is what I hear the client telling me. This contradicts some of my own training: Don’t listen only to the client’s story; observe your client’s actions. This unique SACS experience makes me wonder if pure listening frees me to hear these “Invisible Clients” in different ways.

Unburdened by visual observations which may become distractions, I listened to the client’s words without prejudice. I remember one caller who was very hard to comprehend. He was rambling on and on about people following him and they were ‘out to get him’. As I was listening to what he was saying, I began to realize that some of it began to make sense. Amid his ramblings, he was able to tell me how he wanted to visit his family, but he knew that in doing so he would only embarrass them. By focusing without distractions on what he was saying and how he was saying it (using only my ears), I could actually make some order out of his verbal chaos. 

Many SACS callers are people who call many times each day every day. Some of these “regulars” have been calling for years. Again, I wonder about anonymity and what it means to them. These callers know that the volunteers can’t see them thus judging them on behaviors or looks. I wonder if this frees them to talk about their situation in different ways than if they were face-to-face with the other person. 

Have you ever seen a radio personality that you have only heard for a long time, and when you finally saw him you were surprised by how he looked? He was completely different from what you imagined. You might now think of him in a different light.  So as I worked at SACS, where you talk to people you never see, I started to wonder about listening to people without physically observing them. Would I hear them differently if I actually saw what they looked like? 

Now, I know a ‘good’ therapist does not just listen to the content, flow, quality and connectivity of the client’s speech. He also observes affect, body posture, behavior, etc.  But my experience at SACS makes me wonder: What if we listen to our clients without all the distractions of body image, eye contact, affect, prominent physical abnormalities …. What if all we had to analyze was our client’s voiced story? Would we be surprised by our Invisible Client?

Submitted by,
Janice Shapiro, MFT Intern

For most new mothers, the days, weeks and months following the birth of a baby are challenging and exhausting.  And for some new moms the postpartum experience actually results in a crisis and a real collapse of self.  I believe this subsection of new mothers who suffer so intensely in the postpartum period might be more deeply understood and more successfully treated if we consider them through the lens of character style, and in this case, specifically the oral character style.  

During the symbiotic phase of development, “there is no conscious differentiation between oneself and one’s caretaker” (Johnson, 1994).  The infant experiences the mother as its self, and the mother too has a sense of sharing her infant’s experience.  This symbiosis is critical to survival in that it forces the mother’s attention to be always on her newborn in a way that helps ensure proximity and acute awareness of the newborn’s needs.  Our earliest psychological developmental task is embodying the capacity for attachment and bonding (Johnson, 1994); failures in this period result in schizoid and oral adaptations in the fundamental structure of the infant and later the adult.  For mothers who suffer greatly in the months following birth, I believe it is often the case that their own early infancy was fraught with either harsh, aversive parenting or deprivation and unreliability.  It’s almost as though the birth of the baby forces the mother back in time to when she herself was an infant.  If the mother was well cared for by an attuned, consistent, responsive other, that newborn part of her will likely be well resourced and able to draw from her own full tank.  But a mother who did not herself receive the kind of attuned and empathic responses that a newborn requires for optimal development will find herself overdrawn and out of gas as she tries to nurture her own new baby.  The meaning that she makes of her struggle and the way in which she responds to the crisis also tend to fall in line with her established character style.  

The central theme of the oral character’s life is denial of her needs.  “Orality will develop where the infant is essentially wanted and an attachment is initially or weakly formed but where nurturing becomes erratic, producing repeated emotional abandonment, or where the primary attachment figure is literally lost and never replaced.  Essentially the oral character develops when the longing for the mother is denied before the oral needs are satisfied” (Johnson, 1994).  As an adult, the oral character suffers from “the inability to identify needs, the inability to express them, disapproval of one’s own neediness, inability to reach out to others, ask for help or indulge the self.  The individual tends to meet the needs of others at the expense of the self, to overextend and to identify with other dependent people” (Johnson, 1994).  Her false self appears to be nurturing and helpful, but in truth she is desperate for the kind of sustained care and love she never received.   This false self is her “compensated” self – that part of her self that has learned how best to function in a world where her needs could not be met by being helpful to others and denying her own longing.  She also has a “collapsed” self that emerges when the compensation fails, such as in the postpartum period.   

The postpartum period is a time when mother and infant need an extraordinary amount of external support.  Oral characters tend to find themselves in cultures that are consistent with their own style, meaning there generally aren’t supportive systems in place.  Consequently, as the new mother is coming into a psychological reexperiencing of her old injuries from her early infancy combined with absolute need for support in the present time, she experiences herself as alone and as burdensome and is re-injured in the same manner that caused her orality.  

The therapeutic aim in working with new mothers who are suffering in the postpartum period is to assist them in identifying resources and mobilizing adequate support as quickly as possible.  This can be quite challenging when working with women who fundamentally don’t know how to ask for what they need and don’t feel entitled to receive what is offered.  In her collapsed state, mom must be encouraged to go ahead and ask for and take in some of what she has always longed for and what she has secretly been enraged about never having received.  I find it necessary to bluntly state and firmly repeat a sort of mantra to these new mothers attesting to the naturalness of their immense needs in the postpartum period, the idea that mom is of little use to baby when mom is undernourished on any level, and also an ongoing, exhaustive review of all of her potential resources.  Allowing feelings of need and longing to emerge, to be named, felt and then grieved is the beginning of a transformative healing process.  We are gifted as mothers with an opportunity to readdress our early attachment wounds through the process of bonding with our own babies.  But as adults we now have the power to bring words and consciousness to the experience so that we can affect the outcome in ways that are consistent with our deepest values.  

Author: Jessica Sorci, MA, MFTI

References
Johnson, Stephen M. (1994). Character styles. W. W. Norton & Company.

A little introduction.... One of the tasks of the SCV-CAMFT Editorial Committee, of which I am a member, is to brainstorm ways the newsletter can be of more benefit to our membership. Recently, we identified a NEED we believe we can better address... facilitating a culture and community of connection (sound familiar?) amongst our members who provide supervision, and for those members seeking supervision. To this end, we will be collecting, coordinating, and disseminating this type of information. Stay tuned for further developments....

Additionally, we believe that publishing articles addressing the topic of supervision will likely further this goal. The following article is part one of the first article in such a series. We welcome your submissions. ~ Bonnie Faber

I have been supervising for almost 10 years now...having begun as soon as I was eligible -two years post licensure. Over these years, I have provided individual and group supervision for several community agencies, third party supervision (paid by interns who needed supervision for work provided to an agency), and supervision to intern employees in my private practice.

Additionally, I frequently provide consultation to more newly licensed therapists. I am often asked ?why I supervise, what I get out of it, and similar questions. I would bet that not one therapist who supervises gives the answer: ?for the money – at least not during the past decade! Personally, I have not encountered another supervisor who supervises because s/he can make more money. I don’t believe this is just because it may be the ?politically correct thing to say. Whether it is agency supervision as an employee or contractor, third party supervision, or private practice supervision, financial reimbursement for our investment of time and energy is fairly low.

So, if not for the money, for what then? I will do my best to answer that question. And, in addition, I will be including some brief interview responses from other supervisors I know. My story.... I was extremely blessed to have some excellent supervisors on my path to licensure. Topping the list is Carmen Frank, MFT, in private practice in Willow Glen. I met Carmen when I was doing an intensive internship at CHD (Center for Healthy Development). She was first my group supervisor, and later became my individual supervisor. When she left CHD, she invited me to become an intern/ employee in her private practice. I consider Carmen to be my most influential mentor, and, now, a good friend, as well. My experience of being supervised by Carmen was truly life-changing. She provided me with such a terrific model to emulate. Always professional, yet warm and open, her intuitive wisdom in working with clients of all ages is something I continue to envy. She made it safe for me to have my own thoughts, feelings, wants, and needs, and fostered my ability to trust them. To me, in a nutshell, this is what supervision is all about. I feel most successful, as a supervisor, when I witness an intern develop into a more confident, less anxious therapist, with a style uniquely their own. This is big time reimbursement for me! (It’s easy to make associations to parenting, and I think these associations are just as valid as comparisons made to the pride we therapists often feel when we witness our clients blossom.) I have been fortunate to have a number of these experiences, one of which I will share below.

I felt compelled to interview Carmen regarding what motivated her to supervise, and this was her, as always, very honest response: ?It has been an interesting challenge to remember what it was about supervising that I was first attracted to at the time. I think that a big part of it, to be honest, was to develop a sense of myself as having something to teach or give. Like all of us, going through the learning of this great Art, it was not so easy on my ego. I was on the young side in the Santa Clara M.A. program, being just 23 when I started. Then, going through all of those internships, I often felt small...in the face of this mysterious therapy thing. When I was first asked to be a supervisor at Alum Rock Counseling Center, I was 31. I felt like such a big shot, and that was such a good feeling! I wish I could say it was a more altruistic motive, but, really, other than you, I found supervising a stress -handling projections of Good or Bad Mother from interns who I was surrounded by at the agencies I supervised for. I really did cherish being your supervisor and how that has led to a long-time friendship, being important to you, sharing intimate moments, seeing you bloom and come into your own – and knowing that some of that was helped by my care and love of you! That, at this point, is the thing that moves me the most when I reflect on the experience.

Now, fast forward about 10 years from the time I was an intern in Carmen’s practice, to when I hired my first private practice intern, Laura Raybould Wolfe, LMFT, who is now practicing in San Jose. My experience of supervising Laura was very much like Carmen’s description of supervising me. I now had the opportunity to be on the other side of the supervisory relationship-equation...and to ?pay it forward? if you will – an opportunity to ?give back? to the field that has enriched my life so very much. Laura was an absolute delight to supervise. She approached me as a possible supervisor, and, in addition to being determined, she was open and vulnerable with me, from the start. I could see how much ?work? she already had done to prepare for her future as a therapist, and it was a pleasure to get to know this very grounded, sensitive, and compassionate young woman. As time passed, and we thought and worked together on cases, I felt honored to witness her develop into the very gifted therapist she has become. Our relationship has developed into a friendship...one I know I will always treasure...just as much as I treasure my relationship with Carmen. How wonderfully fortunate I have been to share such intimate, impactful experiences with both a mentor and a mentee, both of whom I now call friends.

Another supervisor, and friend of mine, Terrance McLarnan, LMFT, in private practice in Santa Clara, and Executive Director of CHD for the past seven years, says this about why he continues to supervise: ?Since I started to provide clinical supervision in 1994, it has become an integral part of my professional identity and clinical development. I have been very fortunate to have my own wonderful supervisors, who have helped me develop my capacity to think analytically, for which I am grateful. For me, providing supervision is not unlike the process of providing a treatment. It requires a great degree of trust to develop an atmosphere where interns can express their confusion and other vulnerabilities (which I consider a significant competency), as they develop their own unique clinical identities. The aspect of providing supervision that I value most is that my own capacity to think is expanded. While I am not in the room with the patient, my faculty to imagine the patient and to use my counter-transference is exercised, and my ability to put vague feelings into words grows. Finally, as the director of The Center for Healthy Development, I have been in the unique position to help train the next wave of therapists. One life time is not really very long; there is a lot of suffering in our community, and I have a commitment to be part of the solution.

And, lastly, I asked my current mentor, Hugh Grubb, PsyD, LMFT, a well-known psychoanalyst, who’s been in long-time private practice in Los Gatos, to share what motivates him to provide supervision and consultation. Dr. Grubb says: ?I hope to provide support for the intense personal demands of doing our work, as well as a confirmation of the relevance of the innate, heartfelt responses we each have to clinical situations. I hope to be strengthening the professional community, supporting a particular kind of emotional presence: honest and resilient, yet also deeply curious and imaginative. I enjoy the work very much. For me it is an experience of mutual discovery, an opportunity for exploring what this profession calls for in each of us. We are colleagues on a fascinating journey. Often, I feel deep gratitude for the companionship. TO BE CONTINUED...... Part II (?... And What Am I Getting Myself Into?) will run in the March/April 2012 newsletter.

Author:  Bonnie Faber

“Perhaps the truth depends on a walk around the lake.”

Wallace Stevens

This quote raises an important question for clinicians. What does our truth depend upon? Or even more important – what are the practices we engage in that enable us to stay connected to our truth, whereby we greet the world, specifically our clients, with authenticity and grace? What are the activities we provide for our own refreshment, renewal, connection with our imagination? What is it that deeply restores our mind, body, and soul? In our increasingly busy and complicated world, finding time for quiet reflection is necessary. Modern neuroscience has confirmed that meditative practices are healing for the traumatized or overworked brain.

Contemplative practices such as journaling, dream work, solitude, and silence are some of the familiar ways of finding space to quiet the soul. The labyrinth is an additional practice that many people are experiencing as a way of rest and renewal for weary hearts and minds. This meditative walking tool enables the body to participate, as well as mind and spirit.

The labyrinth is often associated with medieval cathedrals; the most familiar is Chartres Cathedral in France. Historically recognized as a contemplative meditation or prayer tool, it is now finding its way into schools, hospitals, and corporate settings as a peaceful space to walk and think quietly. It offers a contained experience for reflective thought on a variety of topics, such as transition, stress management, creativity, or innovation.

Unlike a maze, which is meant to confuse, a labyrinth has a single path leading to the center and back out, with no dead ends or decisions required. This allows the mind and body to slow to its own natural rhythm. There is no right or wrong way to walk a labyrinth, other than being respectful of those who are on the path with you. The recommendation is to experience it as a metaphor.

For instance, on a recent walk, I became aware of a pain in my neck (literal). I paused in my walking to twist a bit in order to loosen the muscular grip. While present to the physical, I began to consider whether there was something in my life that was a ?pain in my neck?(metaphor). I became aware of the intense concentration of each step I was taking ostensibly to appreciate the beauty, effort and craftsmanship of the rock path. I was behaving as if connection with each broken piece of granite was necessary for pleasure. This reminded me of our home construction project (literal), and all the details and decisions required to complete remodeling (literal), which are a ?pain in the neck? (metaphor). This physical pain offered me a choice to stop and consider my attitude and behavior. I trusted those working on my home; the project would be completed eventually, and perhaps letting go of some of the details that were creating a pain in my neck (literal and metaphor), would diminish the stress. My neck began to relax, and I resumed walking. This subtle movement back and forth between metaphor and literal experience allows an opportunity for insight needed for peaceful existence.

It is important to experience ?your experience? as you walk, and valuable to consider using a three-part process of Releasing, Receiving and Returning to facilitate your time. As you begin your walk, ?releasing? may involve a slowing down of your breathing, becoming conscious of your pace, and attending to thoughts that may arise. These may include the surrender of expectations for the walk, calming a critical voice inquiring how this time will be useful, or having concern over whether the walk is being done correctly. With a deep breath, or placing a hand upon your heart, these thoughts can be released. Perhaps you have entered the labyrinth with a question, concern, or dream that may need attention. Gently releasing the need for solution is helpful at this point, while holding it lightly in your thoughts.

Receiving is often associated with arrival at the center. This is a time to pause, feeling free to stay as long as you like in whatever posture feels comfortable. Many times there is room to sit or kneel. This is a place to deeply listen, appreciating the moments of silence and surrender. Walking out of the center, you will be returning to the opening of the Labyrinth taking the same path. During this time, it is helpful to consider how you will take in to the world what you have thought or heard within. Perhaps a new project will have appeared, or a deep sense of peace, strengthening, or relaxation. Some have said ?nothing happened,? but are aware in the next few days that a dream or inspiration materialized.

A common fear is that of getting lost. One of two things happen when one is lost on the labyrinth path. There will either be a return to the center, or finding oneself at the beginning without having reached the center. Choices abound at this point. One can always redo the walk, remembering again there is no wrong or right way other than the importance of holding the experience in metaphor. Perhaps inquiry may begin around feelings of being lost, or curiosity over what may have distracted you while walking.

Your pace and breathing may change during these three stages. Remain conscious of how the body, mind and spirit experience the walking meditation. It may be helpful to take a moment before leaving, to sit quietly or record your thoughts in a journal.

Whether you have a lake or labyrinth nearby, or just take a stroll in your neighborhood, my hope is for you to feel the nurture that comes from reconnecting with truth.

To find a labyrinth near you, check the website Veriditas.org, clicking on "Labyrinth Locator". Should you be interested in a private or group walk with a facilitator, please feel free to contact me for further information.

Author: Susan Rowland, M.A.

Often, it seems that your portrait is the very last thing you consider when planning your therapy business. How many of you have been faced with needing a photograph by tomorrow and all you can find is a blurry snapshot from five years ago? By nature therapists are a caring lot, always thinking of others first before considering yourself. However, as a budding therapist and a fairly seasoned entrepreneur I am beginning to understand the necessity for a good quality image as a therapist, a true portrait instead of that snapshot your friend took in your backyard last year that is, well, good enough. You can do so much better. In fact, it is the essential message of that Marketing 101 class that most of us never wanted to take, if it was offered at all. Thank goodness for the Casey Truffo’s of the world who are helping therapists develop professional images.

So picture this. Last week a friend of mine decided she was going to try therapy for the first time, so she called me up and asked me for some advice. I asked her what she had done so far. She explained that she had spent the entire afternoon scrolling through therapist after therapist on the Psychology Today website. After informing her about the CAMFT website (just had to do it) I asked her to continue. She went on to say that she was looking for “someone who looked warm and nice but smart and professional.” A tall order, yet most of us like to think we exhibit most of those qualities. When I asked what other traits she might be looking for, such as theoretical orientation she was completely stumped and said she could care less, she just wanted someone who would listen and make her feel comfortable enough to talk, someone she could trust with her secrets. Before a client ever meets you they may gaze at your photograph and wonder what kind of person you are. I suggest that you make it the best photograph you can. First impressions definitely count.

Sound too simplistic? Perhaps, but here’s the point.

Why would you go through so many years of education, internships, testing, and relentless training and make it this far to lose a client simply because they passed by your photograph as they were scrolling down a web page? Now, I understand that we bank a lot of our business on doing our utmost to deliver the best care we can, word of mouth referral, networking, etcetera, but what about those of us just getting started? And furthermore, even for the seasoned veterans out there, perhaps an updated image might be just the flash needed to re-ignite your business in this challenging economy. Sometimes your image changes over the years and it may be time to take a closer look. A new image of yourself can potentially be a therapeutic experience, offering you a fresh perspective on how you see yourself and, I turn, how your clients perceive you.

Put another way, you have simply invested too much time, energy and money in this whole business of becoming a therapist. Like it or not, it is undeniably a business and your number one resource is yourself. I encourage you to think hard about how you choose to present yourself to the world. Imagine if you could encapsulate all of the caring attitudes that you possess as a therapist in one image - your sincerity and admiration for the resiliency of the human spirit – indeed, your heart and soul in one portrait. That is what a good photograph can do to boost your business and enhance your self-esteem. Give it a shot.

Author: Kathleen Russ

Stories are important in our lives. We gain a sense of ourselves through narratives the telling of stories to self and others about what happened to us. Identities form through integrating family histories with cultural legends and myths. However, when our stories become sad, rigid, and repetitive, they may become the subject matter of therapy. An understanding of the dynamics represented in the journey of the fairy tale heroine or hero that leads them from misery to their highest realization, may reveal means for helping psychotherapy clients.

An exploration of fairy tales has long held special value for psychotherapy. Psychoanalysts such as Freud, Rank, and Jung, among others, looked to fairy tales and myths to represent the anatomy of the psyche. Close scrutiny of fairy tales patterns contemporary psychological perspectives as family systems, object relations, and cognitive frameworks can still yield new insights. Because fairy tales and myths follow the heroine or hero as they go through periods of darkness to transformation, classic stories encode patterns that enable the restoration of vibrant functioning. Like fairy tale protagonists, psychotherapy clients often begin a journey from a black mood of depression or personal crisis, onto a new path. Ultimately, through encounters with significant others and confrontation of challenging circumstances, both protagonist and therapy client, may be led to higher development. Cinderella encounters the fairy Godmother, and Snow White finds the dwarves. From a psychodynamic perspective, the harsh introjects formed from the poor treatment in the family are given a chance to heal through the compassionate responses of others. This is the same process that occurs in therapy: As the therapist responds with empathy, the patient learns to respond more kindly to herself.

Therapist and client tell and retell, and interpret and reinterpret, the story of the client. Both clients and heroes have typically had difficulties in the family of origin: they have often suffered child abuse, shame and humiliation, parental rejection and /or abandonment. In place of a nurturing caretaker, they must live with a tormentor. For example, Cinderella had a wicked stepmother and evil stepsisters. Snow White had a cruel stepmother who plotted to murder the beautiful girl in order to end the competition the girl's beauty posed to her fading beauty. Chance may also contribute to the woes of the protagonist. For example, in The Girl Without Hands, the father unwittingly makes a pact with the devil that ends in the sacrifice of his daughter's hands. In this story, the father dwells in poverty. His poorness can be viewed as a metaphor for a lack of emotional strength that can lead an actual father or mother to abuse a daughter or son. If a child is perceived by a parent as a potential resource to satiate his or her own unmet needs, then that child's development, like the hands in the story, may be sacrificed in the service of parental deficiency. Psychological wounding, such as symbolically expressed by the father in the fairy tale who destroyed his daughter's hands, is often at the core of psychotherapeutic treatment. In real life, dehumanization has murdered the souls of countless individuals who live tragic lives. A disturbing family casts a spell. Therefore, deeper understanding of the journey of the heroine, wherein she is resilient and eventually thriving, may illuminate pathways out of anguish for those suffering. Heroines are never defeated by the abuse. The more Cinderella and Snow White are victimized by cruel others, the more sympathy they elicit. By encouraging clients who have been abused to identify with fairy tale heroines, the therapist may help them to attain empathy for themselves.

Psychological healing is often associated with the mastery of positive, cognitive reframes of disturbing situations. Fairy tales, with their powerful imagery of the protagonist as she overcomes destructive forces through creative action, lend themselves easily to the creation of new stories about the defeat of depression and anxiety. As the protagonists survive the dark forest, and its attendant perils destroy the witch or wicked stepmother, their resilience strengthens. The hero or heroine models one who struggles, yet eventually succeeds, by taking potent action, and by their example, may stimulate others to do the same. “Heroines are never defeated by the abuse. The more Cinderella and Snow White are victimized by cruel others, the more sympathy they elicit. “ The factor that enables abused children to transcend bad treatment, and to live successful lives, was a “caring other”. Classic stories contain these deep truths. Sociologist Lillian Rubin, has shown in her book, The Transcendent Child, that an experience with a supportive person outside the family is the factor that determines successful adaptation. The use of fairy tales as reframes enables clients to view difficulties as prerequisites for change. Life is unjust, yet compassion may lead to escape from pain. Contrast the beginning of the story of 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."

Bette U. Kiernan, MFT is a psychotherapist in private practice in Palo Alto, where she works with individuals, couples and groups. She has widely taught the Meanings of Fairy Tales. She has twice presented her work at MIT’s International Conference on Media in Transition.

Author: Bette U. Kiernan, MFT

Reflections on Wellness Series

Therapist in Crisis
Sitting in the emergency room following the dog attack, trying not to feel, it occurred to me how convenient it was for this to happen on a Thursday evening. I had no clients to reschedule the following day. I was grappling with excruciating knee and genital pain amidst the horror of what had just transpired. The physical injuries and trauma were compounded by the dog owner, a psychiatrist, leaving the scene of the incident.

I knew that soon I would have to figure out how to provide my clients with quality care while navigating through my own nightmare. How? Even when life is relatively in sync, at times I wake up and say, "No, not today... I do not want to be a therapist today." Typically, naming my truth, such as momentary resistance to my work, provides enough release to bring me back into focus. In crisis, I found this process to be far more complex.

Presence
I engage in intimate relationships for a living. To honor this gift, my full presence is required throughout the day. I function as a model for interpersonal communication in each unique non-mutual relationship. This job calls for a Wellness column!

During my crisis, the thought of relating on this level was sometimes daunting. I valued my therapeutic presence and intended to maintain that. There was no time or energy for this life disruption. PTSD, however, spoke to me through the language of nightmares, flashbacks and startle responses... the works. I got it: This is happening, make the space for it in order to remain present.

Crisis as Opportunity
I was introduced to the Chinese symbol for crisis two decades ago when I worked as a crisis counselor. A picture I have from that time remains in my office today. The background has shifted from dark to faded pink, but the two black characters remain bold, reminding me of its impact. One symbolizes danger and the other opportunity.

Looking at this symbol did not send me into a flurry anticipating opportunity. My experience and hard-wiring, however, comforted me on a cognitive level. I knew that eventually I would transcend the various aspects of pain I felt. I already walked through the world perceiving experiences as opportunity for spiritual growth; that ought to help. Still, it was a daily nightmare. I encouraged the thinking and feeling centers of my brain to communicate with each other. That went well. It was like the futile "Hello? Hello?" between cell phone users who know they have lost connection. Opportunities mostly crystallized for me toward the latter part of my healing. I am certain that I will discover others over time.

Reasonable Expectations
During the crisis, my "To Do" lists spiraled out of control as rapidly as my hair in humid weather. Semi-manageable lists morphed into scarcely legible scribbles pleading, "Elisa, really, today." Feelings of vulnerability extended to my professional life. I questioned how my practice would be impacted if I could not do enough, but my priority was physical and emotional healing.

So, I stepped up my pre-existing selfcare routine and set limits. I went to doctor and physical therapy appointments, and Eye Movement Desensitization and Reprocessing (EMDR) (which I found to be difficult yet transformative). I consulted about cases to address potential counter-transference, and went to therapy. When necessary, I cancelled client appointments. I put non-priority items into perspective. I informed colleagues to temporarily stop referring trauma and high-anxiety cases. I lost income and risked losing potential future referrals.

I continued to move my body, play, laugh, write and connect with my Jewish spiritual community. Nature remained necessary and so did friendships. My partner had her own crisis and we proactively attended to our relationship.

Despite my losses, I was determined to keep these and other sustaining forces in my life present, even if they could not be uncomplicated. Through the disruption and challenge, I gained clarity and became further grounded in self -care. I believe I transmitted this healing to clients. Keeping my own expectations under scrutiny enabled me to be present for clients to explore their own.

Healthy Surroundings and Clean Air
In order for me to provide a space for clients to heal, I attend to what I breathe in and what I emit, physiologically and energetically. When I encounter judgment or negativity, I metaphorically head for the hills. I conceptualize this as running toward, not away from something, like Maria in the Sound of Music. I like to think that the Castro Movie Theatre sing-along audience, who year after year faithfully shout "Run Maria, Run!" at Julie Andrews, is right there with me with a Jewish spin.

When I began sharing my story, I was reminded that transference is not limited to the therapy room. Projections from others felt as though I was inhaling carbon monoxide. I was given unsolicited advice, void of authentic connection. Some responded with inappropriate jokes, ?What did you do to make that dog attack you?? Others minimized my trauma through the power of language, changing my words ?vicious attack to ?bite. The dog may not have been vicious, but the attack was. The language mattered.

Fortunately my lungs and heart expanded also to receive oxygen. I inhaled supportive words, ?That sounds horrible let me know if you need anything,? and gentle guidance. I breathed in the solid presence of those who sat with me while I sobbed. I opened to\receive protection. In some moments I held compassion for those whose own vulnerabilities blocked them from giving it to me.

I feared I would have less to give my clients, but worked hard to create space for availability. I sat more aware of the gifts of breath, language and presence.

What a Laugh
For me, surviving in this serious field necessitates humor. I cherish my ability to laugh at this work, myself and life in general. Sometimes my partner or I will exclaim, "I’m having Family-of Origin issues," which always invokes laughter. I revel in my trusted relationships with friends, family and colleagues and our comfortable walks along the continuum of gravity and levity. With clients I use humor when appropriate and witness its connective healing power.

I’ll Take It
My life was impacted more than this article contains. Considering the CEU opportunities of life, I would have opted for a different course. Although I did not need this particular experience to deepen my psycho-spiritual process or enhance my clinical insights, I am grateful it did both. I ingest the language and meaning of the bold Chinese symbols. Crisis as opportunity? That, I’ll bite.

Elisa Friedlander, MFT, has a full time practice in downtown Burlingame. She has extensive experience working with children from a very young age up to adolescents, and enjoys balancing youth with her adult client population. Elisa works with parents of children with special needs and disabilities, adults, teens and children with generalized anxiety disorders and OCD, and deaf and hard of hearing individuals. www.ElisaTherapy.com .

Author: Elisa Friedlander, MFT

President's Column:  July/August 2010
Terryann Sanders, M.S., MFT

We recently released a membership survey to get your ideas on how we might better serve you. We had approximately a 30% response from our members! I would like to thank all of you who took the time to respond and let us know your thoughts.

Here are some highlights from the survey:

87.3% of responders are licensed and 83.6% are in private practice

85.1% of responders joined the chapter for information and training, 70.2% for networking opportunities, 70.2% to support the profession, and 53.4% for the chapter newsletter.

In response to what topics you would like to see ad- dressed in the future you ranked the topics as follows:

1. Private practice issues – 60.8%
2. Couples therapy – 58.2%
3. Neurobiology – 54.5%
4. Trauma – 43.7%
5. Marketing – 39.9%
6. Family Therapy –37.3%
7. Addictions – 28.5%
8. Self care – 25.3%
9. Childhood behavior problems – 23.4%
10. HIPAA – 21.5%
11. Eating disorders – 20.9%
12. Technology – 13.9%

92% of responders said they read the newsletter on a regular basis, 82.2% said they are somewhat willing, to very willing, to receive an electronic version in lieu of the printed copy, and 17.8% said they were not very, or not willing at all, to get an electronic version only.

55% of responders said they currently attend luncheons, and 80% had attended workshops in the past.

56% of responders said they could attend SCV- CAMFT events on Fridays, 22% on Saturdays, and less than 10% would be able to attend on other days.

81% responded that they use the SCV-CAMFT website.

Clearly, these results tell us that what’s most important to you are opportunities for educational training and information, and ways to network with your colleagues. While many of you attend luncheons (55% of responders), I would like to see this number higher. Look for some changes in the luncheon program in the future, in an effort to improve attendance and its benefit to members. A recent change has been the move of venue in the Chapter’s north region to the Marriott San Mateo. At the time of this writing, we have not yet attended our May scheduled luncheon there; however, my hope is that this new venue will attract more members.

I am excited to know that 80% of responders have attended our workshops in the past, and 81% use our website! We will continue to offer workshops, and hope to have some exciting offerings based on the topics you have reported as the most meaningful to you.

As you may know, we have recently contracted with Michael Jaret, our new webmaster, who is working hard to improve our current website, based on responder’s valuable suggestions. By the time of this reading, my hope is that most of the bugs have been worked out and we have been able to make valuable improvements.

The good news is that it appears, most of you find value in our current offerings including the newsletter, workshops, the website and luncheons. Now it is the challenge of the board of directors to put some things in place that will make your membership even more valuable to you. In an effort to do this, your board will be holding a strategic planning meeting in July to align our current goals with the needs and desires of our chapter members.

In the May/June 2010 newsletter, I talked about wanting to further our culture of connection. To that end, we have created a new committee devoted solely to reviewing our current offerings, seeing what we are doing well and what we might offer to entice members to spend more time with their colleagues in chapter activities. Pam Milliken, Chair of this committee, along with committee members Carol Marks and Tracy Guglietti, are using the survey results to direct their energies. They are talking with chapter members and members of other regional chapters to determine what would make SCV-CAMFT members feel even more connected and included. Some ideas they are exploring include new member teas, special interest groups, such as hiking, professional book clubs, and movie nights, additional professional trainings, community volunteer opportunities, and more. If you have ideas that you would like the committee to consider, please contact any of the committee members.

Once again I invite you to email me at any time to let me know your thoughts.