Beginning the Conversation about Communication Between Family Therapists and Individual Therapist about Shared Clients

Posted by on July 30, 2016 with 2 Comments

SpencerI recently had a light-bulb-moment and realized I was being too rigid with my policy against communicating about shared clients between Individual Therapists (ITs) and Family Therapists (FTs). I analyzed the rationale behind my communication ban. Even though the ban was an overreaction, it was a reaction to something worth exploring. Therapists are heavily trained and supervised to be careful in how we speak to our clients, however, we are often not as mindful when communicating with each other about our clients. Obtaining a signed Consent to Exchange should not be our only ethical consideration when we decide to consult with each other about shared clients. I would like to “start the conversation” (get it?) exploring best practices for communication between ITs and FTs.

Please note; I am specifically addressing communication between ITs and FTs. Though some of the ideas can be extended when considering communication IT to IT, or consulting with a psychiatrist, teacher, or community worker, I have not fully considered nor addressed those contexts in writing this blog.

I believe I have become a little skittish about communication between ITs and FTs due to past conversations with therapists about our mutual clients that were unhelpful, and sometimes even detrimental to our work.  Even though we all had the best intentions when consulting, experiences of feeling gossipy, scolded, bossed, jumping to conclusions, and getting sucked into the system of dysfunction come to mind when I think of conferencing between ITs and FTs about mutual clients.

I believe that there are two main reasons communication between ITs and FTs is so precarious. One reason is that Individual Therapy and Family Therapy can often have conflicting agendas, especially in the beginning of therapy. ITs are advocating for the esteem and agency of the individual and Family Therapists are advocating for the family system, which may require individual sacrifice. If we are not careful to maintain our differentiation, we become vulnerable to getting pitted against one another. The other reason we need to be careful when consulting is a bit the opposite: that therapists can get along too well. Who better to talk to about a challenging case than another kind and empathetic therapist? This comfort-level becomes problematic when issues that should be brought to supervision get brought to the collaborating therapist. We would not process supervision issues with our clients, and we should not be doing so with their other therapists either.

Although there are risks to case consultations between ITs and FTs, there can also be significant benefits. It is truly case-by-case. I would like to create more permeable boundaries between myself, as the FT, and my clients’ ITs. Moving forward, I propose guidelines, dos-and-don’ts, and sample list of questions to guide case consultations between ITs and FTs.

Suggested Guidelines for Communication with Between ITs and FTs about Shared Clients

Note: Safety trumps all. If safety issues emerge, all therapists involved need to be aware.

  • Both IT and FT will thoroughly explore the pros and cons of communication between therapists before consulting. Not all clients who are in both FT and IT want, need, or should have their therapists communicate.
  • Both IT and FT will clearly outline what will be discussed between therapists. Therapists will clarify whether or not there is anything they would like to be kept from the other therapist.
  • If ITs and FTs participate in group supervision together, ITs or FTs will not be present during each others’ supervision about that case.
  • ITs and FTs will give impressions only and not direct quotes.
  • ITs and FTs will take time to develop an independent relationship first before exchanging information, about 2-4 sessions, so that everyone can form their own impressions.
  • ITs and FTs will not discuss the case unplanned and unbeknownst to the clients.
  • ITs and FTs will support each other’s work and stay united to the best of their ability.
  • This models a supportive and collaborative system.
  • Everything shared with IT and FT will be something that either has already been shared with clients, or will be shared with clients soon.

Times When it May be Appropriate for ITs and FTs to Conference:

  • Safety. Always.
  • When the IT needs more information to inform diagnosis
  • When IT or FT is working to engage or keep clients engaged.
  • When work in IT is largely related to goals in FT, ex. anger reduction, assertiveness

When Not to Conference:

  • When your objective is to advocate for your client’s side.
  • When you are doing the work of your clients. For example, sharing things they are shy to
  • share, coordinating logistics they could coordinate themselves.
  • When you are still emotionally processing a session.
  • When the client insists, along the lines of trying to send a message to the other therapist.
  • When what you are looking for is really supervision.
  • Casually, around the office or socially.

Sample Structure for Consultation:

  • How did you determine this dx?
  • What are the treatment goals?
  • What is the treatment modality?
  • What are the strengths you see this client can lend to individual/couple work?
  • What are the vulnerabilities and areas for growth you see could hinder this work?
  • How are you addressing safety?
  • What are your expectations of how IT or FT will support your work?
  • Are there any conflicting agendas? Can those be negotiated?

Elaborating the reasons for these proposals may be a longer conversation that I am happy to have, and for which we do not need a Consent to Exchange! I cringed as I wrote some of these down, as I have been in violation of many of my very own new ethical guidelines. I believe this exploration has already increased my awareness of how I conceptualize and consult about cases, which I hope will be an increased benefit to my clients. I hope it has been helpful for those reading this as well.

S. Spencer Northey, LCMFT
Licensed Clinical Marriage and Family Therapist

Filed Under: Uncategorized

Happy New Year 2016 from MAD-AAMFT President Lindsey Hoskins

Posted by on July 28, 2016 with 0 Comments

LMH - Alimond 1 low resA belated happy new year to all of you! I don’t know about you, but for me, 2015 was quite a whirlwind (personally and professionally) and it went by in a flash. I watched my daughter grow from a teetering 17-month-old to a proud and very verbal two-year-old, welcomed a new baby boy into my family, and fell even more deeply in love with my awesome husband as I watched him grow as a partner and father. And as MAD President, most of my energy was focused on the proposed bylaw changes that we voted on last summer, and the ramifications of that not passing. I can assure you that we haven’t seen the last of this issue, though things are quiet for now.

2016 will bring many exciting events and opportunities to the MAD membership. First up is our annual Advocacy Day event in Annapolis, which is happening next Tuesday, February 2nd. If you haven’t already done so, please consider joining us and register here. Advocacy Day allows us to spend time with some of our Maryland legislators in Annapolis, letting them know who we are and what we do. And more importantly, it gives us an opportunity to share with them our concerns and hopes regarding important pieces of legislation that will impact our field. There are two relevant bills being considered this year: One focused on Preventive Medical Care – Consent by Minors; and another focused on regulation of Teletherapy.

On February 26, MAD will welcome Barry McCarthy to speak at our annual conference, held once again this year at the Turf Valley Resort in Ellicott City, MD. Dr. McCarthy is a dynamic, engaging, and highly knowledgeable speaker on the subject of couples therapy and sexual issues, and will be speaking to us on the topic of “Rekindling Desire.” I have been fortunate to hear Dr. McCarthy speak in person several times, and can assure you that the day will be not only highly informative and educational, but a lot of FUN as well. We hope you’ll join us! Registration information can be found here.

We’ll also continue to host bi-monthly lunch & learns, held the first Friday of every other month at the University of Maryland, College Park. These are a great opportunity to network with other MFTs and get a FREE CEU in the process. Check out this year’s schedule here.

My hope is that 2016 will allow the MAD leadership to refocus our energy on promoting our profession and educating the public about who we are, what we do, and why we are the best equipped mental health professionals to deal with relationship issues. This issue is near and dear to my heart, and was really driven home by a recent experience I had in my practice. A new couple shared with me in their first session that I was their third therapist in a span of 18 months. After an affair came to light, they had seen the first therapist for about 15 months. They switched to a second therapist, then back to the first, before giving up on both and contacting me. Neither of the other two therapists were MFTs. At the end of our third session, they shared that in all those months of therapy, their sessions with me were the only time that there had been any continuity from one session to the next, or that their sessions had focused on anything beyond, “so, how was your week?” In a year and a half of weekly therapy, nobody had ever laid out a plan for them, given them thematic out-of-session assignments (or homework focused on anything beyond trying to re-establish connection), or actually helped them move past the affair in a meaningful way. Here’s the problem: even though they are smart, savvy consumers, they had no idea they should be looking specifically for an MFT. So instead, they wasted (their word, not mine) a great deal of time and money spinning their wheels in ineffective therapy.

Certainly, the couple that landed on my couch are not the only ones this has happened to. Their experience tells me two things: first, there is a lot of opportunity out there for us, as qualified, passionate couple and family therapists, to deliver much-needed services to a willing public; and second, that we have got to do a better job of telling people who we are, what we do, and why we’re the very best at delivering relational therapy. As a board, we’ve got some great ideas and plans in the works to make this happen in Maryland, DC, and Delaware. We also welcome your thoughts and ideas as we start focusing some of our resources on this issue. I’d love to hear from you directly if you’ve got something to share—I welcome you to email me at, or call 301-785-7184.

Looking forward to a great year together!

Lindsey Hoskins, Ph.D., LCMFT
President, MAD-AAMFT

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MFTs in DC

Posted by on July 21, 2016 with 0 Comments

dsc_0689As Marriage and Family Therapists (MFTs), we know that we are uniquely trained in addressing mental health needs by treating the system and not just the individual. Unfortunately, as a profession we continue to face threats to our ability to practice to the full extent of our qualifications and training. Sometimes changes in policy and laws that affect MFTs negatively are targeted at us, but often they are simply the result of having no MFT voice at the table when the policies were created.

The latter seems to have happened in the creation of laws related to MFTs in D.C. MFTs living and working in D.C. are currently working to change two major policies that have long limited the practice of MFTs.

First, for MFTs just starting out, there is no ‘licensed graduate marriage and family therapist” qualification although there is a LGPC and LGSW designation. This is peculiar because according to current policy, MFTs working in D.C. for an employer and earning hours towards clinical licensure are able to practice in an essentially identical capacity to LGPCs and LGSWs. What this confusing policy means is that new MFTs must spend more of their job interviews in D.C. explaining that they can legally work in a clinical capacity and little time helping the employer discover if the therapist is a good fit for the position.

Many new MFTs get so frustrated or make such little headway in the job search that they give up on finding a job in D.C. and focus only on Maryland. Obtaining this one small designation of LGMFT not only will enable MFTs to begin careers in D.C. (and continue careers in D.C. for years to come), but would ease the mental health provider shortage that D.C. faces.

The second major policy change that is needed for MFTs in D.C. is to become an “approved qualified provider” under the regulations of the Department of Behavioral Health. Currently, the federal government recognizes five mental health disciplines as core mental health professionals. These are psychiatrists, psychologists, mental health clinical nurse specialists, clinical social workers and marriage and family therapists. Of these five groups, only marriage and family therapists are not recognized as AQP in the DC regulations. Marriage and family therapists are not seeking to expand the scope of mental health services covered by the regulations, nor are they seeking to expand their own scope of practice. Instead, MFTs are simply trying to correct an inequity that restricts beneficiaries’ access to a particular type of qualified mental health provider.

Failure to recognize MFTs as qualified mental healthcare professionals is a waste of valuable resources in the D.C. community.  MFTs are licensed to diagnose and treat mental health disorders in D.C. and in all 50 states. Yet, under the DBH regulations, we may only use our skills under supervision even if we have full licensure.  This stunts our ability to take on clients independently, use our family systems expertise to train and supervise new therapists, and work towards leadership roles in our clinics. Imagine the growth that community mental health service programs could achieve if MFT credentials were recognized.

As the “youngest” mainstream mental health profession we are still making our unique skills, perspective, and importance known to the wider community—even to other mental health professionals. We have something very important to offer couples, families, and local communities.

Now is the time to take action to advocate on behalf of MFTs. Educate yourself on the legislation in your state. Explain to others why MFTs matter. Meet with your government representatives to advocate for equitable policies for MFTs. If your voice is not at the table, MFTs will be left out.

If you are in D.C. and would like to join in our advocacy work, please contact me.


Lindsey Foss, M.S., LGMFT
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Creating Attachment Solidarity: The Family Meeting

Posted by on July 16, 2016 with 1 Comments

14615607_1319583968062747_5853720692279629736_oA client recently remarked how she loves spending time with her children, but needs time for herself; she struggles to balance all the needs. She hoped that her children would be closer and play together. She lamented on how she and her spouse rush each child to soccer, piano recitals and how they take turns tucking the kids into bed. She described feeling like they are all running from task to task without really connecting.

When couples describe not having time for each other Gottman’s Magic Five Hours and Sue Johnson’s A.R.E. Conversations are interventions that guide connection. My client’s family, like many families, discusses connection as being child centered, which is vital. Parents always need to reach for towards the child to meet their child’s needs. But, I wondered what about being family centered to build attachment solidarity within the family to establish a sense of belonging. That’s when I discussed Family Meetings to create balance and bonding between all family members.

Family systems are microcosms of the larger community, in that vein, having a voice, boundaries and shared goals improves the quality of life overall. The value of shared time and activities fosters connection, and trust and a sense of belonging to something greater than oneself. This allows children to develop skills needed to understand individual and community needs. In family meetings children learn to create and participate in solutions to shared goals. We know that when children have a sense of secure attachment they have more confidence to learn and engage in new activities. Attachment solidarity allows children autonomy to complete tasks that become part of a group effort, experience and shared memories.

How to set up a monthly meeting:

1. Discuss Last month’s goal. What did each person like and learn? Validate member’s participation.

2. Create a new, shared goal, help define tasks, younger children can pair with parents and older siblings to complete tasks.

3. Use computer or pen and paper to list tasks for next goal and set a date for the activity.

Examples of family goals:

Plan a family party, a picnic, engage in social justice, pick a family book to read and discuss, Visit a farm, Prepare for a holiday, Create a garden, Cook together, etc.

Example of Family Goal and Plan

January “Family Goal” Family Book selected is Velveteen Rabbit Mom and children will reserve book from Library. Each person can read the book, or parents and older children can read it to younger children. Dad and younger children will make a dessert for the “Book Discussion on January 20th . Each person will discuss what they liked about the book, or draw a picture to describe the story.

Cynthia Rebholz, LCMFT
Welcome and Public Affairs Committee
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The Power of Supervision

Posted by on July 14, 2016 with 0 Comments

IMGP8937Ladies and Gentlemen, fellow MFTs! Step right up to one of the greatest professional relationships you’ll ever have — Supervision!

In supervision the other week, after sharing about feeling overwhelmed by my caseload, my supervisor offered me a metaphor. She said she could see clear signs of burn out—that my usually sharp therapy “knife” had a dull blade. The image of trying to cut with a dull knife was like a palm-to-forehead moment. Elegant marriage and family therapy requires a level of precision, a sharpness, that is skilled and carefully tended. My supervisor had held up a mirror to my experience and shown me the truth. I left feeling motivated to make changes in my schedule and looking forward to deepening self-care.

Supervision is important no matter what stage of your MFT career you’re in. In graduate school, supervision provides the emotional support and concrete treatment planning suggestions necessary to learn the practice of marriage and family therapy. As a newly licensed therapist, a supervisor helps you navigate clinical site issues and build confidence in your professional identity. Even in my case as a seasoned MFT, supervision is a helpful way to get case consultation and prevent burn out. Supervision should be a safe place where you can be genuine about all the amazing and difficult parts of being a therapist. It should restore you, inspire you, and support you.

Inspired to find yourself a supervisor? You can search for an AAMFT Approved Supervisor here. ( or there is also a list of supervisors approved by the Maryland Board of Professional Counselors and Therapists (

May we all find ourselves practicing marriage and family therapy with the help of a supervisor!

Emily T. Cook, Ph.D., LCMFT
President-Elect, Middle Atlantic Division AAMFT

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The Gift of Giving: Treating Insured Clients

Posted by on July 12, 2016 with 0 Comments

IMG_1975In this ever-changing economic climate it has been more challenging for some Licensed Couple and Family Therapists than others to navigate establishing an hourly rate for private practice that keeps us within reach of our target demographic while enabling us to collect wages that are reflective of our education level, extensive training, and the hard work we do with and for our clients.  To some extent, the geographic location of our practice, our operating costs, our preferred client population, our gender, and even our racial and ethnic background can impact how we determine a client rate that keeps a steady flow of business moving in our direction. In my 10+ years of experience, with 7 being in some form of private practice, I have found this to be a delicate and ongoing process.

In addition, many of us are faced with the decision to accept insured clients or not. Whether our practices are located in an area where potential clients can easily afford to pay our preferred rate consistently and also see the value in the services we provide, or it’s not as important for some of us to maintain a full practice to ensure our economic stability, the question of including the portion of the population that only has access to mental health treatment if they are able to use healthcare insurance benefits to cover a greater portion of the cost is perhaps an ethical one that we grapple with. Like most business owners who have a primary goal of remaining profitable, CFTs in private practice must juggle the viability of our business with our passion for helping. The hard truth is that some who need our help the most simply can’t afford to pay our rate without the help of insurance. For clinicians who have endured the healthcare insurance paneling process, we know of the huge discrepancy that exists between what our time and clinical skills are worth and the rate at which insurance companies are willing to reimburse us. This poses a huge dilemma: If we decide not to accept insured clients can we still feel good about our efforts to reach those we set out to help? If we decide to accept insured clients and it leaves us undercompensated in ways that affect our livelihood and our professional self-worth, have we achieved our goals as business owners and clinicians?

I want to normalize the angst that can flare up periodically for all CFTs in private practice who have to make this tough decision. Based on all of the factors involved, choosing to accept or exclude insured clients is a very personal decision, and one that can change over time. Even the most seasoned clinician with a thriving practice full of private-pay clients can be periodically reminded of their desire to reach more people who are unable to afford their rate. I’ve been fortunate to serve so many clients who value and can afford my services. I have also remained paneled with one healthcare insurance company. This has been a gift for many reasons. First, the sheer volume of calls I’ve received from insured potential clients reminds me of how great the need is for what we provide, and that more and more insurance companies acknowledge a need for mental health treatment. Also, it is a rewarding feeling knowing that I have helped a client experience a life change that may not have occurred if their insurance company had not referred them to me and subsidized their out-of-pocket expense. Instead of focusing on the lower reimbursement rate, I choose to focus on my positive impact through my personal sacrifice. This provides balance for me. Since our work is a form of advertising, I have also gained clients from working successfully with insured clients. Lastly, I’ve enjoyed having a full practice over the years, and serving insured clients consistently has helped me to maintain that at times when the economy has put a severe strain on individuals and families who need help.  While this choice may not work for every clinician, it could be a precious gift to many potential clients as well as the giver.

Weena Cullins, LCMFT

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No time for hide and seek?

Posted by on July 27, 2015 with 0 Comments

182060_1867645252251_8130989_nWe live in a serious world. Terrorism, genocide, climate change, disease, systematic oppression, financial crises- it can all feel like too much at times. Life is hard, not just for our clients, but for ourselves as well. Sure, as responsible adults, we are serious about our lives because we have all kinds of obligations and challenges that need to be tended to daily. Yet what if our seriousness, in all of its enormity, tips the scale to the point of utter disequilibrium? Is that the point of no return, a place from which we cannot recover? And in this somber state, what chance at happiness do we have?

These are questions that have flooded my mind at various stages of my adult life, especially after I became a parent and my responsibilities increased twenty fold. How many times have my kids begged me to play hide and seek only to be met with another “no” because I have to prepare dinner? How many evenings before going to bed did my kids’ requests for tickles go unmet, because I was anxious for them to get to sleep so I could attend to my “to do” list? I realize now that at these critical junctures my kids were teaching me all I needed to know about keeping my scale from tipping too far in one direction.

Just a few weeks ago, I attended a workshop on Mindfulness Based Stress Reduction with Elisha Goldstein, an expert in the field of mindfulness. Goldstein emphasized the importance of play in the context of personal life and career; he deemed it “ a natural anti-depressant”. To drive this point home, he asked us to engage with a partner in a word game. The object was to have a conversation, but each sentence had to start with the letter that had finished off our partner’s sentence. It turned out to be quite difficult, and quite hilarious. Before long, the room was filled with laughter and everyone loosened up; the game had created a jovial atmosphere and had made strangers into friends.

In his book, Uncovering Happiness: Overcoming Depression with Mindfulness and Self-Compassion, Elisha Goldstein describes play as “a flexible state of mind in which you are presently engaged in some freely chosen and potentially purposeless activity that you find interesting, enjoyable, and satisfying”. He touts the importance of play because it has tremendous benefits like stress reduction, creativity, productivity, openness, and rejuvenation.

In the clinical world, the misconception is that games and play are reserved for clients who are children and teens. Our adult clients can also benefit from playful interaction, especially when it comes to building rapport in the therapeutic relationship. Moreover, making space for play in the therapeutic environment is good modeling for our clients; it shows them that they can approach their life with earnestness, but still have fun at the same time. In essence, we are demonstrating the value of having balance in our lives.

As therapists, we absorb so much pain and intensity in our work, so it is even more imperative that we hit the “pause” button and engage in some play ourselves. The question is, how can we be conscious about infusing a sense of play into our lives and our work? Here are a few suggestions:

1/ Remember what types of play you enjoyed as a child. Where can you make space for this activity in your schedule, and how can you make it a priority?

2/ Try to schedule your playtime so you don’t ignore it. Put that bowling date on the calendar, or sign up for that ceramics class.

3/ Give yourself permission to be silly and purposeless. Play hopscotch! Have a dance party! Make an obstacle course for your kids and join in!

4/ Acknowledge when life feels way too serious and overwhelming. Take a few minutes to make silly faces at yourself in the mirror or sing at the top of your lungs to diffuse the situation.

5/ Integrate a bit of play into your therapy practice, especially if you are first getting to know a client and could use some icebreakers, if your client has anxiety and needs to loosen up, or if you are at an impasse with a client and the mood needs to shift. Try something kinesthetic, like engaging a client in free association while tossing a ball or hopping on one foot.

6/ Recognize the value of smiling and laughter in our interactions with clients, friends, and loved ones.

Taking advantage of the opportunities for play keeps our scale balanced. A little bit of play goes a long way towards creating joy in our lives, and keeping us feeling vibrant, regardless of our age.  As George Bernard Shaw once said, “We don’t stop playing because we grow old; we grow old because we stop playing.”


Goldstein, E. (2015) Uncovering Happiness: Overcoming Depression with Mindfulness and Self-Compassion. New York, NY: Atria Books.

Caryn Malkus, MA


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The Art of Therapy

Posted by on July 18, 2015 with 0 Comments

Lauren A AndersonI’m a musician, artist, therapist, and coach. When I tell other therapists about my practice where I work with creative people, I often hear the reply “Oh, I’m not creative at all.” I get this notion. I used to think of my therapeutic work as something separate from my creative work. However, over time I’ve realized therapy can be just as creative as writing a song or painting a picture.

I often wake up with an original lyric or melody in my head. I have to jot it down quickly or I might lose it. As a therapist, an idea of how to work with someone might jump up and I have to do the same – run and write it down so I can work through it later on. Sometimes just a moment from the day will bring up a universal message that I share immediately via Facebook or Twitter. Often, I’ll bust out a blog in an hour after a random idea in the same way I might quickly paint something that appeared to me, fully formed and ready to go. These are all creative moments with a similar feeling.

Therapy also has its ups and downs, just like the creative process. As therapists, we have some days that just flow. We feel helpful, sessions feel intense, but meaningful and even inspirational. Other days can feel like a long hard slog. We feel like we’re not saying anything good. Creative work is like this. Sometimes it flows beautifully and other times we feel completely blocked, like nothing we create is any good.

As MFTs we are consistently thinking outside the box – less linear, more cyclical, systemic, or postmodern. We have to challenge ourselves and get beyond what people are saying. “What does it mean? What is the process? What metaphor can I use? How does this family view things?” While we have a lot of research and theory to back us up, being with someone in session requires us to quickly combine all that training with experience and even a little intuition, mixing and molding it all to fit with our client, right at this moment. One therapist’s work with a client will be quite different from another’s. The same goes for artwork. Artists often have to ask themselves “What’s the perspective? What’s the story? Who is speaking?” Skills are used to help with execution, but the work is unique to that specific artist.

The mothers and fathers of therapy are creative geniuses! Think for moment how outside of the norm it was (and still is) for Rogers to suggest that people are the experts on their own lives, for Bowen to recommend therapists work with more than just the “sick patient”, or for Hare-Mustin to point out that the systemic understanding ignores the fact that women are not seen as equal to men. These people looked at the therapeutic process, thought about it differently, and changed the way many of us work today.

So, if you’re a therapist, you’re definitely creative. When you think of your therapeutic work, what do you do that is similar to the way an artist works? What is it about you that is different from your colleagues?   How do your clients inspire you to shift your perspective?


Lauren A. Anderson, MS, LGMFT, NCC

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Summer Reading: A Book Review of “What Makes Love Last?”

Posted by on July 16, 2015 with 0 Comments

beachreadingThis past week my family has enjoyed a beach vacation to the Outer Banks. I always bring the stack of novels and therapy books that have been piling up at home (no e-reader for me yet) and look forward to quiet hours with a chair by the ocean’s edge. This year, with my one year old son with us, I didn’t get as much reading done as I might have in the past. But one of the books I was sure to make time for was “What Makes Love Last? How to Build Trust and Avoid Betrayal” by Dr. John Gottman and Nan Silver.

Many of us couple and family therapists use Dr. Gottman’s classic book, “The Seven Principals for Making Marriage Work,” in our work with couples. This newer book is an extension of his theory of a sound relationship house, mixing the mathematics of game theory and new assessment measures into core constructs like the Four Horsemen and attunement. His central idea is that betrayal is the central problem of every failing relationship. And he doesn’t just mean infidelity–pervasive coldness, selfishness, forming a coalition against your partner, and breaking promises are all examples of destructive behaviors that betray marriage vows. The antidote to betrayal’s dangerous relationship poison is, not surprisingly, trust. Mutual trust enables partners to feel safe with each other, deepen their friendship, and remove stress.

Although several of the chapters focus specifically on recovering from an affair, I anticipate using this book much more often to help couples struggling to heal from other types of betrayal. The step-by-step instructions for communicating with intimacy and constructively processing conflict, the helpful self-assessments for relationship trust and sexual passion, and his illustrative examples of real couples’ conversations, together make this a valuable and accessible book for our clients. But maybe what resonated with the most was the clear, hopeful tone– it’s written in a voice that truly believes in couples’ ability to solve their problems and reestablish connection.

Have you read any great therapy books this summer? Please share titles and reviews in the comments!  Here’s to summer reading 🙂

If you’d like to check the book out on, click here.

Emily T. Cook, Ph.D., LCMFT
President-Elect, Middle Atlantic Division AAMFT

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Happy New Year from MAD-AAMFT President Lindsey Hoskins

Posted by on July 15, 2015 with 0 Comments

Greetings, and happy New Year! I am both excited and nervous to kick off 2015 – and my time as MAD President – with this month’s blog post. I’m excited because, as a long-time board member and passionate advocate for the profession of Marriage and Family Therapy in the State of Maryland, I see unlimited potential for growth, advocacy, and connection. I could not be more thrilled with the excellent MAD Board I’ll be serving with for the next two years, and I truly believe that we can and will accomplish great things together. I want to continue the excellent momentum established by my friend predecessor, Laurel Fay. Laurel put tremendous energy into increasing member benefit, truly working to make MAD an organization from which YOU, the members, can get what you need. We exist because of our members, and we want to work for our members in whatever way we can. We’ve got networking events, social events, and exciting Continuing Education opportunities coming up, starting with this year’s Annual Conference featuring Bill Doherty. Dr. Doherty, a seasoned couples therapist and academic with a great flair for public speaking, will spend the day teaching us about Discernment Counseling and its use with couples in which members have different ideas about whether or not to continue their relationship. Bill is a fantastic speaker, and this is going to be a can’t-miss conference – we REALLY hope to see you there on February 27th at the Turf Valley Resort. You can register online here.

My nervousness comes from one thing: this year’s vote to decide whether or not to make organization changes to the structure of AAMFT that would mean serious change for us here in Maryland, DC, and Delaware, as well as for the rest of the country. As Laurel shared with you in her last President’s Letter in the Winter issue of Connections, the Central AAMFT board has put forth a proposal to centralize and do away with Divisions altogether. At first glance, maybe this seems appealing – it’s a simpler, cleaner model, to be sure. But what we miss when we do away with Divisions is all of the excellent, state-specific, unique knowledge and energy that gets things done where they need to be – the “boots-on-the-ground” work that is essential for the successful growth and protection of our profession. This is a big, big decision, and one that each of us needs to weigh carefully. In June, you will be invited to cast a vote, either for or against the motion to restructure. My mission for the first six months of my presidency is to make sure that all 336 members of the Middle Atlantic Division are fully informed about what their vote will mean. Toward that end, I’d like to personally invite each of you to attend a members-only lunch meeting, to be held on February 27th, 2015 at Turf Valley Resort (if you’re attending the Doherty conference I mentioned above, the meeting will be during the lunch break; if you’re not attending the conference, you are still invited to the meeting). Lunch will be provided. I truly hope to see as many of you there as possible. The decision we face with our vote could not be more critical, and the Board and I have quite a lot to share with you as we each prepare to cast our votes.  You can register here for the lunch. If you’re unable to attend, I invite you to contact me directly, either by telephone (301-785-7184) or email (, and I’d be happy to share my thoughts with you, as well as to answer any questions you might have.

So, excited and nervous, that about sums me up today. I hope you’ll share in my excitement about all that’s ahead for MAD this year, and that you’ll share in as much of it as possible. I look forward to seeing you all soon, and again, Happy New Year!

Lindsey Hoskins, Ph.D., LCMFT
President, MAD-AAMFT

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