Articles

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.

The Newsletter Editorial Committee is very pleased to have the opportunity to again present the “Letters to the Editor” section. We encourage all of you to let us know when you have a response to some feature of this newsletter. We will happily do what we can to share it with the readership.

We believe the function of the committee is to edit submissions for grammatical errors and readability while maintaining the integrity of the author’s intent. We do not believe the function of this committee is to censor submissions and exclude or include them based on our values and beliefs. Please let us know your thoughts.

Kim Ives Bailey
Editor, SCV-CAMFT News

Dear Editor,

In April 2009, I was fortunate to have the opportunity to present my work on the psychological and systemic processes encoded in sacred religious texts, the Bible and the Koran, at MIT’s International Media Conference. In preparation for my talk, it was necessary to reflect upon the problem of shadow projection and resultant world violence. Close to that time, the Spring SCV-CAMFT newsletter arrived. The Well Being committee was featured with writings on how each committee member kept herself healthy and balanced. Each piece was skillfully written, and offered worthy models for well being in general, but the more pertinent question for me was unanswered. That is, “How does each member track her own unconscious processes that otherwise left unscrutinized, might enable her to project her own dark side and subsequently view it in another — rather than emanating from herself”? Given that this committee is in a position to judge others as competent — or not — the issue is essential.

History has shown time and again that a check with “consensus reality” is insufficient. Across aeons, Christian persecutions, Salem Witch trials, the holocaust and countless other tragic events were carried out by usually upstanding citizens.

As a result of decades interest in Jungian psychology, my own six year analysis, five years supervision with the late Jungian analyst, June Singer, assisting in the Dream Work and Depth Psychology course at Santa Clara University for six years — thus spending long days examining a dream with each graduate student — as well as examination of my own and my client’s dreams, I believe that constant study of one’s own inner life is essential. Given that the unconscious, according to Jung, is constantly emergent and produces new imagery, the way to track one’s own shadow sides, is to continually monitor the darker figures and situations in one’s dreams and imagination. Further, when one finds another individual problematic and disturbing, it may be that person threatens to evoke and expose his or her own shadow sides. Of course, these processes, like “scapegoating”, are mutually causal. Nevertheless, whenever one experiences intense reactions to another, self-reflection is in order.

Given that therapists are trained to accept counter-transference as a normal part of the psychotherapeutic process, this fact may blind us to the need for self-examination of our own unconscious dynamics — not just inside of our professional work, but outside of psychotherapeutic sessions as well.

I hope for a follow up article from the Well Being Committee that answers my question.

In case of interest in my work, it is on the MIT Media in Transition Website under abstracts and papers section under my name: web.mit.edu/comm-forum/mit6.

Sincerely,
Bette Kiernan, MFT

To clarify the purpose of the Well-Being Committee, the following is taken from SCV-CAMFT’s website: “The Well-Being Committee aims to promote and expand awareness of personal and professional well-being among members and colleagues of SCV-CAMFT. The committee designs and creates supportive and educational programs and services which encourage, enhance, and maintain wellness and effective functioning of SCV-CAMFT members.”

— Kim Ives Bailey, Editor, SCV-CAMFT News

The Well-Being Committee welcomes all submissions to the Reflections on Wellness column. Anyone inspired to address Bettie’s ideas is encouraged to contact us.

— Cathy Hauer, for SCV-CAMFT’s Well-Being Committee.

Dear Editor,

I appreciate our chapter board for the work it does and the many services that it provides. I was however disappointed by the last newsletter. I had hoped to read how the board planned to deal with the same-sex marriage issues raised in the May/June issue of The Therapist magazine. The absence of a response was conspicuous.

The June/July issue of The Therapist made it clear that the CAMFT board would not take a stand on same sex marriage. Instead they restated CAMFT’s ethical standards regarding discrimination in general. Although I agree completely with their restatement I do not think that this action was sufficient. The membership was asking CAMFT to represent its views regarding a particular civil rights issue; not to restate its ethics policy.

Unlike most political issues, marriage is an issue on which MFTs are in a unique position to comment. We are the only profession specifically licensed to treat marriages and families! The Psychiatric, Psychological, and Social Work professional organizations have all taken pro-same sex marriage positions and we alone have remained silent.

I hope that the SCV board does not think that remaining silent on issues of this import is seen as neutral. It is actually supportive of the status quo. And sadly, that consists of depriving a minority group, same sex couples, of the same rights and privileges that heterosexual citizens enjoy.

What are chapter members to do? We have expressed our will in a chapter poll. Now we need our elected leaders to represent us and (1) issue a pro-same-sex-marriage statement as the East Bay Chapter has done, (2) provide a chapter forum at which the membership can discuss how to influence CAMFT to take a stand, and (3) continue to attempt to influence CAMFT to take a pro-same-sex-marriage position as the Marin, East Bay, and San Francisco chapters have done.

I know that our board works hard. I feel sure that other members, including myself, will assist you if you provide the much needed leadership in this important matter.

I hope to read soon that the board is taking positive steps.

Sincerely,
Alice Sklar, MFT, CGP

Dear Alice,

Thank you for your letter and we appreciate hearing your thoughts and opinions regarding marriage equality. Your letter was forwarded to the SCV-CAMFT Board of Directors.

We can certainly understand your position that the SCV board’s silence may have seemed supportive of the status quo, and we should have informed the chapter membership of our work and discussions on marriage equality sooner.

Earlier this year, the board created the Marriage Equality Committee to address this topic, discuss how to proceed with the survey results, and work on the proper language before releasing our statement.

Since the conversation you had with one of our committee members, Matt Larkin, the committee presented a recommendation to our board of directors at the August board meeting. The SCV-CAMFT board voted to support marriage equality and has formally sent a letter to CAMFT urging them to vote in support of marriage equality.

We appreciate the e-mails and letters from our chapter membership.

Warm regards,
Chandrama Anderson, Matt Larkin, LaDonna Silva
SCV-CAMFT’s Marriage Equality Committee

All of the articles in this newsletter are the opinion of the authors and do not necessarily represent the views of SCV-CAMFT. SCV-CAMFT encourages readers to submit letters or articles agreeing or disagreeing with anything printed herein. We value the diversity of the chapter’s membership and welcome a lively professional exchange. Please send your submissions to SCV-CAMFT News Editor, P.O. Box 60814, Palo Alto, CA 94306, or e-mail to mail@scv-camft.org. SCV-CAMFT reserves the right to edit submissions for clarity and length and accepts no responsibility for their return.

Licensing exams have triggered anxiety in pre-licensed individuals since their inception. While eustress can be beneficial, a high level of anxiety will often lead to avoidance, more anxiety, fear, and an inability to access one’s clinical knowledge and experience. Here are five tips for pre-licensed individuals and their clinical supervisors:

1. Talk about licensing exams — the earlier the better! Knowledge and preparation can go a long way to banishing anxiety. Think of exams as termination of therapy. We talk to therapy clients about termination from the beginning of treatment, not on the last day. Why not bring up the end point with interns at the beginning — not to increase anxiety — but to manage it?
    
2. Ask (and answer) questions about licensing exams. Many pre-licensed people carry around worries and misconceptions about licensing exams. Talking about these issues helps a supervisor to dispel common misconceptions and confront worries. Often, worries may be related to an area of clinical practice in which a pre-licensed person feels unqualified. What a great opportunity to identify a place for growth and create a teaching moment!
    
3. Know what the licensing exams cover. Clinicians in training and clinical supervisors have strengths and blind spots. The California Board of Behavioral Sciences goes to great lengths to spell out everything that could be included on the licensing exams. Use this list as a blind-spot and strength detector — and banish anxiety about exams at the same time!
    
4. Talk about anxiety. Everyone deals with anxiety at different points in life. Teaching pre-licensed individuals skills to manage anxiety (or identifying the need for a clinical level of treatment) is essential to the mentoring of pre-licensed individuals. A test-taker cannot access stored material during a test when experiencing high levels of anxiety neither can pre-licensed professionals respond to crisis situations effectively if they do not have a plan for anxiety management. The same skills interns learn for managing anxiety during sessions can be transferred to managing anxiety during the exam process.
    
5. Know what your resources are! The exam process is an incredibly personal journey. Understanding the options available allows test-takers to evaluate the plan that is best suited for them. What worked for the clinical supervisor or a friend may not be the right plan for another. Understanding the many different ways in which someone can successfully pass exams on the first try can open the door for pre-licensed persons to find their own path and the joy that comes from walking that path!

I hope these tips help you banish the fear and excessive anxiety that can keep the next generation from successfully navigating licensing exams. Happy talking, studying, and passing!

Author:  Miranda Palmer

Miranda Palmer is a licensed marriage and family therapist in Modesto, California. She provides consultation for pre-licensed individuals to help them love the whole process from graduate school to licensure as a MFT. She has a free monthly newsletter for pre-licensed individuals and a free online study group for exams with over 600 members at http://mftguide.com.

Deductibles may be the most confusing, annoying, and disruptive part of working with any client who seeks reimbursement from their insurance. So even if you have never signed a contract with an insurance plan, this is stuff EVERY therapist should know.

What's a deductible? This is the amount that a client with insurance has to pay out-of-pocket before the plan pays a dime.

Do all plans have deductibles? Thankfully, no. This is more common if a client sees an out-of-network therapist (one who has NOT signed a contract with the health plan), but many plans have a deductible for all providers.

What's changed? In the olden days, deductibles were usually $100, maybe $250 at the most. But lately I have seen clients with $1,000, $3,000, even $8,000 deductibles. This coverage is great if you get hit by a bus, but not so great if you have a mental or physical illness.

Why the increase? Health plans are not making the huge profits they used to enjoy, so have developed this way to shift the high cost of health care to their members. Coupled with ever-increasing premiums and larger co-payments (often $30 or $40), therapy is becoming much more expensive for clients with insurance.

Why is this so important? Let's look at an example. You are a contracted provider with the client's health plan, which pays you $60 per session. Your client pays her $20 co-payment at each session. At the end of the month, you submit a claim. When the Explanation of Benefits (EOB) arrives six weeks later, you get no payment because the client has a deductible of $600. Now ten weeks into treatment, you turn to your client to pay the $400 balance (remember she paid $20 at each session). At the very least your client may be ticked off. Even worse, your client may not be able to pay you, and may drop out of treatment. Worse yet, your client may have already ended treatment at the ninth session, making it harder to collect.

What if my client pays in full when she comes? Let's say she submits the bill to her insurance plan, and finds out when the claim is processed that the plan won't reimburse her because of the deductible. She may have counted on this reimbursement when choosing to see you. So, she might be annoyed that you didn't give her this important information ahead of time, and if she isn't going to be reimbursed, she may be unable to continue treatment.

There's more. Let's return to the example above. As a preferred provider, the plan will only count your $60 contracted rate toward the deductible — you cannot charge more for any session you have with this client. If your client has a $600 deductible, the plan will not start paying until the 11th session.

Let's say you are NOT a contracted provider with the plan. In our example, you charge $125, but the plan caps its reimbursement at $80 per session for an out-of-network provider. Due to your client's $600 deductible and this $80 cap, she will not be reimbursed at all until the seventh session. Starting at the eighth session, her plan won't reimburse her for $20 of each session (this is her co-payment, the client's portion of the bill) AND won't reimburse the $45 difference between the $125 she paid you and the plan's $80 cap. Final tally? Of the $125 she paid you for the session, she will not be reimbursed for $65 of her payment, or more than half.

Just to make this more annoying, some plans have a separate mental health deductible, which may be split between you and any psychiatrist or other therapist (e.g., a couples therapist) the client is seeing. This means the client's visits to medical doctors may not reduce her mental health deductible.

One final complication: The deductible usually starts again at the beginning of the calendar year. This means when your client uses up her deductible, the whole out-of-pocket dance will start again in January.

My advice? Remember that even if you've never signed a contract with an insurance plan, this deductible stuff applies to your clients, too. This is one reason I STRONGLY advise ALL therapists to check coverage after the first session. In fact, I often get insurance information on the first phone call, telling my client that I want to be sure there are no surprises down the line. After this call, I'll be able to inform my client of any reimbursement for the first session(s). Then my client can decide if she can afford treatment — and I won't be stuck trying to collect for an unpaid session.

Barbara Griswold is the author of Navigating the Insurance Maze: The Therapist's Complete Guide to Working with Insurance — And Whether You Should (www.navigatingtheinsurancemaze.com). In addition to her private practice in San Jose and serving on the CAMFT Ethics Committee, she publishes a monthly insurance e-mail newsletter, and provides consultations to therapists with insurance questions.

According to wikipedia.com, technophobia is "the fear or dislike of advanced technology or complex devices, especially computers. The term is generally used in the sense of an irrational fear, but others contend fears are justified." I was surprised to find that technophobia is as old as the Industrial Revolution!

Many therapists are technology averse, don't know where to begin, or don't know what they don't know... as opposed to being actually technophobic. However, don't let these challenges stop you from harnessing technology to your advantage. We can joke all we want about using a desensitization process, or EMDR, but the bottom line is that technology can help you in your practice.

First, ask yourself, "What is the technology for? What results are you seeking? Do you want a website and/or do you want technology for business use (such as billing, tracking financials, writing reports, etc.)?" In this article, we'll look at websites and discuss business uses separately.

Things to Consider for Your Website

Let's break it down into small steps:

1. So you want a website. What features do you want and why? You can have an information only website, or one that is interactive so clients can schedule appointments, pay online, etc. Many "bells and whistles" exist, so it's important to keep focused on the results you’re seeking.
2. What's your budget? $500 or $5,000?
3. Can/should you do it yourself or outsource it?
4. How do you find a website provider?

Consider what features you want and why you want them (this will save money). Just like writing a paper in school: answer who, what, where, when, and why. Personally, I want clients and potential clients to know what I do — my areas of specialty, where I am and how to get there, how I work, my general philosophy about therapy — and to provide them resources. I have sections specific to grief, to couples, and to Personality Mapping^TM, including a registration form that can be printed, completed, and faxed. You may want to include e-mail contact (consider legal and ethical issues of timeliness), online payment, appointment scheduling, databases, etc. Use technology to support your business the way you want to conduct your business.

Your Budget

What are you willing and able to spend on your website? This will help determine the features you select and whether you build it yourself or have someone else build it. Keep it simple, especially at first. Beware of "feature creep" — this can happen in any project. For example, say you're updating your kitchen — just new knobs and paint. The next thing you know you're tearing out cabinets and putting in granite countertops! This happens with technology all the time, too. Decide what is essential and what would be nice to have.

Can/Should You Do it Yourself or Outsource it?

There are really two parts to this question: are you comfortable enough and do you have the time to build your own website? Outsourcing is a fancy way of saying that you're hiring someone else. Trust your intuition in this decision.

Finding a Website Provider

Here are a few important tips for finding a website provider:

• Look at sites you like; who did them?
• Remember that when you search the internet for providers, the first providers are usually the ones that pay to be first.
• Ask your network of colleagues for referrals to three website vendors.
• Check references and be sure to ask how problems were resolved, if the site was done in a timely manner, etc.
• How long has the provider been in business?
• Check the Better Business Bureau
• Check your local chamber of commerce.

There are three parts to having a website:

1. The domain name (the URL or www.yourwebsite.com),
2. Hosting the website itself (a server that has your website on it), and
3. Developing the website (the features and content structure).

Providers offer one, two, or all three services. For example, I use Network Solutions. I was able to search for and have them register my domain names (www.chandramaanderson.com and www.personalitymap.com), my website is on their servers, and I used their simple drag-and-drop system to create my site with the features I wanted. One can also pay them to custom develop your website.

What Options Are There For Therapists?

Canned Solutions

Just like in cooking, you can buy broth for your base, or you can buy a chicken and make broth. Any feature you want for your website already exists: e-mail, e-commerce, appointment systems, etc. If you feel comfortable, you can put together a website yourself by finding a provider that has drag-and-drop canned solutions. You select the overall look of your site, easily add content, additional pages, and so on. Doing the basic setup is pretty quick; it can be done in a couple of hours. If you want it to look just so, it takes time to tweak it. You should plan on spending several hours if you do it yourself.

Vendor Using Canned Solutions

A middle-of-the-road solution is to hire a Web developer who will set up your website using existing modules. This is probably the best bang for your buck.

Vendor Personalizes a Website for Your Business

Another middle-of-the-road option is to find a local provider who will meet with you to determine your needs. You provide the images or logos and your content and the provider will build a two- to three-page site for you. This may cost in the $500-800 range, plus hosting, which is about $15-20/month. Anything more than two to three pages of content can climb over the $1,200 mark, depending on design, functionality, etc.

These two types of vendor solutions are probably the best choices for most therapists, since they are the most cost-effective (other than DIY — doing it yourself) and will provide the results you want.

Proprietary Website Development

Proprietary development means hiring a web developer who will write software code to provide the features you want. You need to know very specifically what you want, what you want those features to do, etc. A large company may have strategic reasons for wanting proprietary code. As therapists, most of us just want to provide information to make it easy for clients to find us.

Next Steps

Hopefully by now you have the terminology to ask yourself what you want and need, what your budget is, whether to be a DIYer or to hire a vendor, and what to ask when you interview providers for your website.

So, pick up your phone and call your trusted colleagues to ask who they used for their website. Knowledge is power; you don't have to be technophobic any longer!

Chandrama Anderson, MFT, technical editor of Webmastering for Dummies and co-author of the Stanford Professional Education Workbook, Building an eCommerce Website, is located in Palo Alto and specializes in grief and loss, couples therapy, and is the creator of Personality Mapping^TM.

Reflections on Wellness Series
Self-Care Tips from the South Region Prelicensed Support Group

The South Region Prelicensed Support Group has been discussing how interns and trainees can take care of themselves while facing the multitude of entrance barriers to becoming a licensed MFT.

The barriers the group discussed include working on their master's program, dealing with insights and issues from their own lives, getting a good work placement, being a volunteer while working a second job or borrowing to pay for it all, dealing with clients' crises, supervisor's expectation, family and friends' "feedback" about becoming a shrink, and finally studying for the licensing exams. On top of this comes self-doubt: "Can I really do all of this?" and "How can I be financially viable when I am finished?"

The primary areas that we decided need self-care were maintaining physical health, emotional well-being, meaningful connection with others, professional and personal growth, and creating financial stability.

How Do We Take Care of Ourselves Now?

These were what the members listed as their activities, intentions, and attitudes (when they remember) for self-care. Many of these overlap and help to create a more satisfying life experience.

"Being physical and having fun!"

• Yoga and walking
• Salsa dancing, line dancing, and ballroom dancing
• Running, biking, and gardening
• Drumming and playing music
• Going to spas or getting massages
• Snuggling with others: partners, kids, friends, and pets

"Spending time with others!"

• Cooking and eating with friends and family
• Talking with friends and colleagues
• Going to therapy or support groups
• Joining book clubs, bridge groups, dance troupes, and hiking clubs
• Making time to truly be with your significant others

"Spending quality time with ourselves!"

• Delighting in the freedom of following our own path
• Sun therapy or meditation
• "Fear-proofing my life" with faith
• Journaling and reflective writing
• Reading for fun or personal growth

The list above is not only for interns, as all MFTs need to remember to keep a healthy, balanced lifestyle. But these activities are easy to forget or "not have time for," especially during the traineeship and intern years. Many interns talk about running from their paid job to their classes, then to their practicum, and then home to study and prepare for the next day.

Professional Self-Care

A very important issue for many of the members is how to get an appropriate placement for their field experience and internships. Some interns have found it very hard to find placements because their colleges didn't provide any support, while other schools have practicum fairs or have a placement coordinator who keeps lists of sites. There is also a listing of internship sites available on the SCV-CAMFT website.

We discussed that most internship placements interview between January and March. Other times that can be good to look are during the early fall to find sites that may have had some last minute openings. Openings can occur at any time, so keep calling places and be willing to be waitlisted. We also discussed networking with other interns to learn about openings at different sites and to get feedback on their experiences.

Other issues are whether to pick your area of specialty or your preferred therapeutic model during your internships and how difficult it is to find exactly what you want. Some interns are accomplished at networking and found placements in their areas of interest. Many found that they discovered new areas of interest and new types of therapy by broadening the scope of their searches.

Financial Self-Care

The most difficult type of intern self-care is often financial, since most placements do not pay their interns. One solution is to volunteer for the county, for a hospital, or for another entity that pays healthcare workers. When the placement is successful and the trainee is known as a good worker, they are frequently hired. One problem is finding a setting where there are supervisors to train interns and sign off on client hours. Some interns were able to pay for a group like PTI (Process Therapy Institute) to provide supervision once they found a placement that fit their needs, even though that placement doesn't normally staff interns.

Some of the members talked about creative ways they have found to address their financial needs while continuing to grow. One member reported having problems finding a placement that suited her love of journaling as a creative method of personal growth. She tried several places during her time as an intern without the level of support she would have liked, so she decided to create her own. She was able to find a local recreation department that hired her to teach journaling. This fulfilled her dream of working with people who want to learn to journal. She called CAMFT's legal department to get guidance on how to ethically and legally get paid as a trainer as long as she wasn't doing therapy. She won't get hours for this, but she can see ways to use this experience for networking and getting exposure. This is only one example of the creative things that can be done to support yourself while finding your path.

Enjoy the Journey

Becoming a licensed marriage and family therapist can be a great impetus to growth and self-actualization. The barriers that we have discussed are analogous to all of the life challenges both we and our clients are face all the time. The key to success is in your hands, stay mindful and connected to your support network and enjoy the journey!

Verna Nelson graduated from Santa Clara University in 2002 and became licensed in 2005. She joined the SCV-CAMFT Board of Directors in 2006 and is currently serving as the Director of Programs & Evaluation. She leads the South Region Prelicensed Support Group and has a private practice in Los Gatos, www.vernanelson.com.

Author: Verna Nelson

"This I Believe..." is an international project engaging people in writing, sharing, and discussing the core values that guide their daily lives. These short statements of belief, written by people from all walks of life, are archived and featured on public radio in the United States and Canada, as well as in regular broadcasts on NPR. The project is based on the popular 1950s radio series of the same name hosted by Edward R. Murrow. We on the Therapist Well-Being Committee want to share some of our thoughts with you. Won't you please join us? Send in your contribution (see below) or visit their website to hear something from the archives (www.thisibelieve.org).

This I Believe... from Alice Sklar, MFT

...That wellness is an ideal toward which most therapists aspire. Its literal meaning is different for every individual but physical, psychological, and social health are usually components of its definition. Because wellness is an ideal it is rarely achieved. We have to strive for it. It requires us to reassess ourselves regularly and to seek feedback from others in order to enjoy the reward of attaining or regaining it from time to time.

If we were perpetually well, it would inhibit our motivation to seek new ways to manage and change our lives. That would inhibit some of our most creative moments, and creative moments are so very precious. I'm reminded of the many artists whose struggles to overcome illness and tragedy created lasting works of art.

Personal growth occurs when we strive for wellness because we learn about ourselves throughout the process. My personal struggles have led me to greater depth and understanding. They have also broadened my appreciation of others. A small example: I had back surgery in December. Not being allowed to drive left me uncomfortably isolated. After a while I did something very uncharacteristic and difficult for me; I reached out to friends and colleagues for support. The flood of good will that I received was overwhelming. I'll never find it as hard to say "help" again.

I don't expect to always enjoy wellness any more than I expect to live forever. But I hope to have the courage to continue to work against the natural tendency toward non-wellness, and I hope to be able to encourage others to take the same active stance in their lives.

This I Believe... From Mary Jo Trusso, MFT

...That most of us have a monitoring system, sometimes conscious and sometimes not, that helps us be aware of what is good for us. In my therapy practice this shows up when I close a few files at the end of a long day and say, "I'll finish the paper work tomorrow." Usually at that point I feel a twinge in my stomach.

I recently did something special for an office mate and felt foolish when I heard laughter after I made what I thought was a helpful comment. I felt a twinge in my stomach.

I go to my Tai Chi class and don't tell the instructors that I feel frustrated because I haven't learned anything new in three weeks. I feel a twinge in my stomach.

For me, my stomach twinge means that something is going on that is not good for me. It may be procrastination, overbooking, or lack of appropriate assertiveness. I believe that if I don't pay careful attention to my internal monitoring system I will be off my wellness track and not available in a meaningful way to myself or to my clients.

This I Believe... from Cathy Hauer, MFT

...That every therapist wants to do the best for themselves and their clients. That we really do have good intentions, and that our best intentions aren't always enough.

I believe that we need to check in with ourselves often: am I taking good care of my physical, psychological, intellectual, and spiritual health? Am I getting needs met in my circles of friends, colleagues, family, and companion animals?

I believe that when we get off track, whether by a little bit or a lot, we can make a course-correction. We may have to do some soul-searching, we may have to ask for help, we may have to make some changes, but I do believe we can do it.

Most important, I believe in the basic goodness of all people. We all swim in this amazing, crazy, stunning thing called "our life, the world, these times." So, when I believe in all of our basic goodness, I can be compassionate when I miss my mark, or when I worry you might be missing your mark...and then I'll know what to do. I believe that our interdependence demands that we help each other swim back to the safe and healing shore.

Alice Sklar, MFT, is in private practice in Los Altos; Mary Jo Trusso, MFT, is in private practice in San Jose; Cathy Hauer, MFT, is in private practice in San Mateo. All three are long-time members of the SCV-CAMFT Therapist Well-Being Committee.

We want to thank you for your participation in the chapter's recent marriage equality e-mail survey. The SCV-CAMFT board was aware that this is a difficult and potentially divisive issue. However, we were asked to contact our members for their opinion, and felt that it was very important to do so. The survey method is a way to capture a reasonable number of members' opinions in a timely manner. We understand that this was an imperfect survey, and that some of the questions may have appeared slanted. Since we had very little time to formulate the survey questions, have them e-mailed to you, and get the results forwarded to CAMFT, we had to make rapid decisions on what we included.

The board is very grateful that so many of you responded. We welcomed the well thought through and heartfelt feedback that we received. We truly appreciated hearing all voices on this topic.

The survey did not reflect the personal interests of the board, nor indicate what any of our responses would be to the questions that were included. We voted to do this survey, so that we could give you the opportunity, should you choose it, to let CAMFT know what you are thinking about the issues involved in marriage equality and whether you would want the state board to take a position on this or other issues in the future. We sent every item of SCV-CAMFT chapter member feedback to CAMFT including member comments.

You may view the the results of the survey.

 These results have been forwarded and presented to the board of directors of CAMFT. We have also included the comments we received about the survey below so you may review the feedback we collected from our members.

Thank you again,
The SCV-CAMFT Board of Directors

Members' Comments/Feedback from Marriage Equality Survey

1. I find this survey biased and contrary to every ethical concern known to our profession. We provide therapy for everybody, regardless of race, ethnicity or sexual preference. Topics like this should be left to the politicians and to the voting public and, like it or not, the voting public has spoken. Let's not politicize SCV-CAMFT with this kind of stuff!
    
2. I believe CAMFT needs to be clear with its members that we do not discriminate. I don't think it is our place as an organization to contribute money or "march" for it, necessarily.
    
3. I personally am attending and supporting efforts in my personal life, to weigh in as a straight, married woman to support the rights of all citizens to be married. I believe that if gay and lesbian people can have the dream to marry their loves and receive similar tax breaks and Social Security benefits as straight couples, we may have more successful couples openly contributing to harmony and stability in our country.
    
4. This issue is probably like abortion in that many in our society see it as a moral/religious issue. I'm glad you are polling our members to see how we all feel about this subject. But it's one thing to see that we as MFTs should not discriminate against clients who are in a same-sex marriage and another thing to say that we, as an association, should use our influence in support of same-sex marriage. I personally support the idea of two people of the same sex marrying, and would be glad if there were no law against it. But I'm not so sure that we, as an association, should push for it. I guess the action I would like is that we discuss it more.
    
5. While I believe wholeheartedly in gay marriage, I am concerned about using CAMFT's resources and alienating members by taking a stand on any political and sociological issue that does not directly affect our ability to make a living as MFTs. I do not want to lose conservative members, just as I would hate to see CAMFT be asked to take stances on other emotional topics of our time (couldn't CAMFT be asked to take an anti-abortion stance by a subset of members?). And how would we choose which issues to take on and what to support and say? I feel we have other avenues to fight against social injustice. But — Having said all that, I know that MANY members in the SF-CAMFT chapter and East bay (and perhaps our chapter and elsewhere) perceive the State organization as unresponsive and deaf to their pleas for issuing a public statement against gay marriage, such as the APA did. I know members are resigning over this issue. It may be worth opening up public discussions at a state level so that members feel heard and represented. I think the discussions should be around the issue of — should CAMFT retain it's classic neutrality stance in all cases? Or do our members want this to change? What are the pros and cons for our organization? We need to show members what the potential losses are, or at least how the organization views it. I recommend a written response from Mary R. or our State Board pres. in the Therapist about this issue. No matter what the conclusion, I recommend dialogue.
    
6. I believe that publishing the result of a large enough poll of MFTs, regarding that issue so that the results of the poll become public, in order to preserve the diversity of opinion within CAMFT and prevent polarization.
    
7. Thank you for doing this; my "other" is that our Board join with the other local boards to demand that they issue the supporting statement ASAP (vs. requesting...re-opening the topic)
    
8. Support current law chosen by voters.
    
9. It is hard at times to understand the paradox that exist between religious and secular issues. In my heart this is my religious feelings and yet I 'pain' for how this affects others.
    
10. We are relationship counselors-the issue of semantics should not be involved. If a couple presents as a couple who define their relationship as a marriage we work with that as their reality and the basis of ours.
     
11. Provide a public organization "statement" claiming that the rescinding of same-sex marriage rights is discrimination.
     
12. I would like to address the fact that number 3 cannot be answered since same-sex marriage does not legally exist in California. I would like to see CAMFT take a stand in favor of same-sex marriage.
     
13. Solicit statements of support from CAMFT members in favor of allowing same sex couples to marry in California, for submission to our government leaders.
     
14. Refrain from political influences not related to our profession!
     
15. Report not only the "majority" response to the petition to State CAMFT, but also the PERCENTAGES in favor & opposed. For State CAMFT to be guided by its members, the State Board needs to know the pro-con BALANCE with the membership on this issue. A close "split" would suggest (to me) that State CAMFT should NOT "take a position."
     
16. Through lobbying, etc., participate in legislative efforts to legalize same sex marriage if the Supreme Court does not overturn Prop 8.
     
17. The action I'd like SCV-CAMFT to take is to rewrite this survey so it reflects objectivity, which it does not. The bias is obvious. For example, why does #6 only state specific options for supporting same-sex marriage, aside from "other" or "none"? Why is #4 worded as "rescinding the right of same sex couples to marry" instead of "supporting the voter-passed constitutional amendment defining marriage as between one man and one woman?" You may not like reading this, but CAMFT has a large and diverse constituency, and if your survey itself isn't even objective, how can you be trusted at all?
     
18. Respecting our clients that believe marriage is between a man and a woman is also our responsibility. Although we as professionals must accept our clients and their lifestyle and educate about tolerance, we are not called to change the ruling of the majority which on this issue is to keep the definition of marriage between a man and a woman. As a therapist I will support my gay clients and find resources for them, but as a member of my community I believe the foundation of society rests on families. To me family can be defined many ways, and people understand that. Public policy is best kept traditional in its definitions, man and woman and children make families as the unit that is fundamental to our society. Other forms of family, be it gay partners, group homes, adopted kids, they are still accepted as families within the policy we have that does define marriage as between a man and woman. Changing the definition in our public policy will not make "coming out" any easier or more accepted, only more easy to press charges against anyone standing up for traditional marriage, such as religions, leading to further discrimination against traditionalists.
     
19. SCV-CAMFT should take a position that ensures rights (aside from marriage) are upheld for same-sex couples.
     
20. Insist that "do not condone... discrimination" means just that. If the therapist is countertransferred and feels disgust with his patients, he shouldn't treat them.
     
21. A public statement re-affirming that all couples have the right to assistance from Marriage and Family Therapists and that the title of our license does not bar us from providing services to same-sex couples or individuals. Our license and ethical standards do not require us to take sides in the legal dispute, and doing so may jeopardize our ability to help by alienating a portion of our client base. P.S. Question #2 is worded poorly and is leading; that's why I didn't answer it.
     
22. The letter should be about non discrimination, not same sex marriage. I am for same sex marriage but I am not sure my professional organization should be getting involved in this issue, but rather the issue of discrimination.
     
23. I'm not sure...
     
24. "Non-discrimination" does not mean support for an issue/group. We need to be advocates first for all kinds of healthy relationships — marriage, co-habitate, same-sex, parent-child, interracial, etc.
     
25. CAMFT to advocate for civil unions which would be the legal vehicle for all contractual relationships. Marriage would then be an optional religious ceremony in accordance with individual belief.
     
26. Participate in educating members about GLBT issues educating members about heterosexism and how it impacts their clinical work. Education about religious homophobia and social sanctioning of gays as second class citizens in California and in State CAMFT. Educating State CAMFT Employees, like Mary Riemersma in customer service would be a good idea. So many people that I have spoken with are appalled by the offensive and dismissive tone that she has taken with members on the state listserve. Helping to shift the tone of the discussion so that GLBT people would not be treated so badly by this organization. Educating the chapter membership about the organizing that has been happening in response to CAMFT's silence and the impact of this on the membership. As you know, this has been affecting quite a few members who are refusing to sit down and be quiet while the organization and it's employees takes gay money and treats them badly. I'm so glad that they are not able to be silenced, and that so many members see CAMFT's response as covertly abusive and collusive.
     
27. CAMFT should definitely support equal rights for legally-recognized domestic partners (which CA law already grants) and therapists should treat all clients to the highest standard, regardless of sexual orientation, legal status, etc. However, CAMFT should not advocate changing the definition of marriage, legal or otherwise, without a close look at all that changes for therapists legally, long-term effects on families and children, and the social ramifications of such. If CAMFT takes a stance and supports same-sex marriage, I will seriously consider leaving the organization.
     
28. Don't call it "Marriage". Support individual rights in same-sex "UNIONS."
     
29. I think the wishes of California voters should be respected.
     
30. Support changing definition of marriage between a man and a woman to define legal contract as "civil union" between two consenting adults.