Articles

At this point, it seems to me that following the rules of conventional article writing is useless.  I’m done with the rules.  Why?  Because you still don’t have a professional will.  (For the tiny minority of you who do have a professional will, I’m not talking to you.  I’m talking to just about everyone else.)  

I’ve written articles in third person with citations.  I’ve shared real life stories of people who died without a professional will and my advising their survivors that they need to start the statute of limitation clock ticking, because someone can now sue the estate for malpractice.  I’ve cited to real cases where estates were sued for negligence for much less than failing to leave a professional will.   (There’s a citation for you.)  I’ve explained to people how the law creates a right to sue your estate for your malpractice even if you’re dead.   (There.  I just did it again.)  I’ve given talks.  Advertised in The Therapist.  Maybe I just need to break the rules and tell it like it is.

Do we really need to wait for a colleague to die and cause “newsworthy” damage from failing to leave a professional will?  Because it seems to me that even a death of a colleague alone isn’t even enough to motivate most people to get this done.  Every time I mention this topic to a group of therapists, someone walks up to me with a story of how a colleague died without a professional will and the aftermath was trying for that person’s survivors.  

What’s it going to take to get you to sit down and get your professional will done?  Hopefully this article will do it, because that’s my ultimate goal here.  Maybe you’re annoyed by my tone right now, but I hope you don’t use that as your excuse to continue putting this off.  Clearly I’m not trying to win a popularity contest.  You can focus on my tone or you can focus on getting your professional will taken care of once and for all.  You decide.

I do not recall knowing about professional wills when I was practicing as an LMFT.  Maybe you’ve been in the same boat until this moment.  I happen to be a wills and trusts attorney and that is how I came to realize the gravity of this issue.  

Professional Wills 101: Why You Need One

If you’re not informed about professional wills, I’ll give you the quick explanation now.  CAMFT Rule 1.3 effectively requires that you create a professional will.   Unfortunately there are no guidelines for what a “professional will” should look like.  On top of that, a Licensed Marriage and Family Therapist must maintain clinical records (in accordance with HIPAA of course) for a minimum of 7 years after termination of treatment.   In the legal field, a common truism is that without a remedy, there is no law.  In other words if I say “stealing is illegal” but there is no legal consequence for stealing, it’s effectively legal to steal.  The converse applies here.  There is no statute that says you have to have a professional will per se.  But the rules and laws cited in this paragraph that create a remedy – you or your estate can be sued if you fail to create a professional will.  These rules and laws are the basis that forms a de facto requirement that you create a professional will.  Because if you (or your estate) can be sued for not doing it, you’re effectively required to do it.  Thus I would submit that where there is a remedy, there is a law.

But do you really need rules and laws here?  I’m going to take a leap here and guess that you genuinely care about your patients and loved ones.  I know you do.  For no other reason than you just plain care.

Recommended Content for Your Professional Will  

The point of a professional will is straightforward.  If you die or become incapacitated, a clinician needs to be assigned to refer your patients out to appropriate care as soon as possible.  And then someone needs to take control of your clinical files in accordance with relevant privacy laws.  It’s a lot better for everyone if you leave some basic instructions.  Enter the document we’re calling a “professional will.”  Although I am not the biggest fan of the “DIY” approach for this type of thing, I’d rather you do it yourself than do nothing if those are the only two options.  So I’m giving you some guidelines.

There is no particular set of rules dictating the elements necessary for a valid professional will.  But I’ll give you one imperative: Don’t over think it!  I’ve seen too many people get mired in thinking of just the right clinician to refer patients out, contacting the clinician, considering what to do about a funeral service, etc.  Done is better than perfect.  Get something done now and do your deep thinking later.  The purpose and nomenclature tells us that a professional will is substantially similar to a will or living trust that an estate planning lawyer would create.  Years of experience (and litigation) have yielded a number of best practices for drafting wills and trusts, which I have adapted into my recommendations for your professional will.  Some of these best practices in the context of a professional will can be summed up as follows:

1. Identification of the creator.  It is a good idea here to use the name most people know you by, whether or not that happens to be your legal name.  You should also include your office address(es), and license number(s)  so that it is absolutely clear who you are.

2. Appointing a “clinical executor.”   Generally, attorneys advise that only one person act as executor, because one does not want to slow down the administration process with disagreements among multiple executors.  This is not to say that the executor is not allowed and encouraged to seek outside assistance.  But there should be one person who has the final word where judgment calls are needed.  You should also name at least one and preferably two alternate clinical executors in case your first choice can’t/won’t act.

3. Authority of the clinical executor.  The clinical executor should have express authority to access physical and electronic clinical files and to contact active patients.  It is always a good idea to spell that out, since this is probably the clinical executor’s most important function.

4. Outside assistance.  This is very important in my opinion.  You should take steps to ensure that the clinical executor has quick access to clinical files.  It may be a good idea to name one or two people (a family member or close friend) who can help with non-clinical issues like access to the premises where clinical files are located and reimbursement for out of pocket expenses. 

5. Compensation of the clinical executor.  This is tricky, because a professional will does not necessarily have the same force and effect of a traditional will.  Nevertheless, I feel strongly that some intent and authorization (whether or not legally enforceable) should be expressed for the compensation of the clinical executor because he or she is taking on personal liability by referring patients and taking possession of patient records.

6. Overriding clauses.  Estate planning attorneys make a lot of money off of people who try to do their own estate planning, because often in such cases people write in terms that are unclear, incomplete, or unlawful.  This risk can be somewhat mitigated by clauses that instruct clinical executors to override any directives that turn out to be unlawful, unethical, or inappropriate under unforeseen circumstances.

Estate planning attorneys could add many more terms like a HIPAA release in case of incapacity to permit doctors to speak with your clinical executor, various contingency clauses, and so on.  You should seek professional help from an attorney or an attorney-created template in order to incorporate some of these more technical clauses.

Frankly, having a non-attorney complete this task makes me nervous.  I see a lot of plans go bad when people do their own estate planning.  But I’d rather you do it yourself than do nothing.

Just get it done.  PLEASE!

I have thought long and hard about this both from the perspective of a former clinician and as a practicing trusts and estates attorney.   I don’t need to preach to this audience about the tendency to avoid the topic of our mortality.  I’m not throwing stones from my glass house.  But at a certain point, you just have to sit down and get this done, because your patients and loved ones are counting on you.  Now it’s up to you.  You can focus on my unprofessional tone.  You can put this off for tomorrow.  Or you can do a little research and get this done.

Gadi Zohar, Esq., LMFT is the CEO of TherapistWill.com, an online professional will solution.  He also practices as a trusts and estates lawyer in Palo Alto, California.  He no longer provides professional psychotherapy or psychological counseling.  This article is for information purposes only, and does not constitute an attorney-client relationship.  The opinions of the author are not a guarantee of any particular outcome.  

On September 12, 2015, just 35 miles northeast from my home, the Valley Fire began in Lake County; by evening it exploded to 10 thousand acres. The following morning I walked outside and smelled smoke. I checked online and discovered nearly the entire community of Middletown, California had been immolated while I slept. 

The fire grew to a massive 76 thousand acres throughout Lake, Napa, and Sonoma counties. The Redwood Empire CAMFT (RECAMFT) Chapter serves those counties along with Mendocino county. A massive crisis was looming, and RECAMFT had no plan in place for how to assist those traumatized by the fire. 

With some 40,000 California Licensed Marriage and Family Therapists (LMFTs), LMFTs represent the largest group of mental health providers in the state. Our training in family systems gives us a unique edge whether serving families, children, elders or first responders who have seen too much. LMFTs need to be networked into our local emergency response systems so when disaster strikes, we are prepared and trained to answer the call.  

Crisis response mental health interventions are different. First we assess the basics: shelter, food, first aid, water. Once we have people’s survival needs addressed, we provide psychological first aid – normalizing the experience of those suffering acute stress. After the crisis is over, some who suffer posttraumatic stress symptoms will seek us out for additional services. Reactions vary given the impact of the crisis (for example, losing a loved one or one’s home will likely be far more stressful than simply being displaced for a time). 

Our nation was shocked by the terrorist attack in San Bernardino on December 2, 2015. Inland Empire CAMFT Chapter was suddenly in the same place RECAMFT had been - a disaster unfolding with no chapter trauma response team. 

• CAMFT Chapters are in a unique position to lay the groundwork for a disaster mental health team in every county. Every CAMFT chapter can take a lesson from RECAMFT and IE-CAMFT and start a crisis response team now. My wish is for every LMFT to take at least one continuing education (CE) class in disaster mental health counseling in the coming months.
• RECAMFT worked quickly to provide services to the community, identifying those trained in crisis response, and ultimately creating a list of over 50 members willing to give 3-5 sessions of free counseling to anyone affected by the fire. Chapter member, Doreen Van Leeuwen, subsequently took on the task of organizing a chapter crisis response team. It starts with every willing LMFT joining the Red Cross, taking their disaster mental health courses, and FEMA’s free online classes. The chapter crisis response team will organize additional training, communication trees, and network with county agencies.
• Marin CAMFT has had a trauma response team for two decades. They have responded to traumatic deaths, child abductions, shootings, earthquakes, fires, and floods. The Marin trauma team chair, Jacque Ladrech, is a wealth of friendly information and advice.

CAMFT’s Crisis Response Education and Resource Committee (CRERC) provides outstanding resources on the CAMFT website, including links to pertinent trainings. The people on this committee are some of the top experts in the state. CAMFT’s Annual Conference will be an opportunity to get training in disaster mental health. After my initial shock about the smell of smoke, I found myself on the phone with people who knew exactly what to do, and gave great advice. It was a comforting feeling, in the face of a fire burning out of control.

Chris Hadfield said, “Ultimately, leadership is not about glorious crowning acts. It's about keeping your team focused on a goal and motivated to do their best to achieve it, especially when the stakes are high and the consequences really matter. It is about laying the groundwork for others' success, and then standing back and letting them shine.” 

The stakes have never been higher or mattered more. Together we can bring our talent and expertise to shine in our local communities when disaster strikes. 

Laura is a Licensed Marriage and Family Therapist (MFC 49174), Licensed Professional Clinical Counselor (LPC 149) and Certified Rehabilitation Counselor (CRC 00113822).  She is in private practice in Santa Rosa and specializes in trauma utilizing Stanford cue-centered treatment along with transformational sandplay and EMDR.  She is a member of the Redwood Empire Chapter and is currently president of CAMFT.

Assembly Bill No.1775 was signed by Governor Brown on August 22, 2014 and became effective January 1, 2015. This bill amends Section 11165.1 of the Penal Code relating to the existing Child Abuse and Neglecting Reporting Act: Sexual Exploitation.

The purpose of this update is to provide you with information about how this law impacts our profession and assure you that SCV-CAMFT will be monitoring events as they unfold.

Today I spoke with CAMFT attorney Ann Tran regarding this new law and below is a summary of our conversation.

Penal Code Section 11165.1 does not specifically include Internet usage of child pornography within the definition of “sexual exploitation” because it was written before the prolific use of the Internet and does not reflect modern technology.

Prior to the passage of this law the existing law, known as the Child Abuse and Neglect Reporting Act, defines sexual abuse as sexual assault or sexual exploitation for purposes of mandating certain persons to report suspected cases of child abuse or neglect. Under the act, sexual exploitation refers to, among other things, a person who depicts a child in, or who knowingly develops, duplicates, prints, or exchanges, a film, photograph, videotape, negative, or slide in which a child is engaged in an act of obscene sexual conduct, except as specified. Failure to report known or suspected instances of child abuse, including sexual abuse, under the act is a misdemeanor.

The passage of this new bill provides that sexual exploitation also includes: A person who knowingly downloads, streams, or accesses through any electronic or digital media, a film, photograph, videotape, video recording, negative, or slide in which a child is engaged in an act of obscene sexual conduct. The bill imposes a state-mandated local program because it expands the scope of a crime and imposes additional duties on local officials.

A Question about Sexting: Ann Tran said child sexual abuse reporting has always included sexting. Sexting includes printing, duplicating, downloading, a photograph in which a child is engaged in sexual conduct. However, there are a lot of interpretations, and it is not very clear when a report is required.

I posed a couple scenarios and Ann responded:

• If a minor is “sexting” a photo of herself in bra & panties to her boyfriend and she is not posing in an obscene manner, that may not be reportable.
• If a minor sends a photo of herself nude, or posing in an obscene way, the exchange of those photos is reportable and was always reportable, even prior to the passage of AB1775.

Law enforcement would say yes, sexting in both instances are reportable. Some therapists may say no, Item 1 is not reportable, because the example states she is NOT posing in an obscene manner. However, it becomes a problem if the boyfriend then forwards the photo to others.

Regarding scenarios 1 and 2 above, according to Ann Tran, both are reportable because the law applies the words “a person” to the minor who “depicts a child in . . .” by sending the self-photo.

However, here’s an interesting note: Texting sexual content (using words) is not reportable, according to Ann Tran.

Should you report? Yes, if you make the report you’re protected. If you don’t make the report you can be fined or charged with a misdemeanor, or reported to the Board. And although it can have an impact on the therapeutic relationship, the law requires a report.

This is a new law and there are a lot of concerns. How does reporting a teen sexting a photo to a friend impact that young person’s future? There is concern among therapists with specialties in sexual addiction and those who work with sex offenders. How are they able to help their clients if they are mandated to make a report for downloading images electronically?

A Petition for Writ of Prohibitory Mandate, Request For Immediate Stay of A.B.1775‘s Amendment of Penal Code Sections 11165.1, Subd. (C) has been filed. It will be going through the court system and there may be changes. But in the meantime, we must follow the current law, which became effective January 1, 2015.

You can read more about AB1775, the Petition, and various articles at the following link http://stopab1775.org/articles/

I asked Ann about the contents contained in the above link and she stated the site is a good source of information regarding this new law. She also stated that she disagrees with a few opinions in some of the articles there and cautioned readers to keep each author’s perspective in mind while reading.

This law is generating much discussion. With so many moving parts, information about the law may be confusing and vague. It will be interesting to see what happens when the Petition is heard in court. SCV-CAMFT will be monitoring it closely.

In the meantime, feel free to use the chapter exchange to share new information you may receive or new links that may be beneficial for our membership regarding this new law.

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