The Group as Family: Using Group Psychotherapy to Promote Relationship Regulation

Posted by on July 5, 2015 with 0 Comments

“Empowering Women, Empowering Humanity: Picture It!”
(The UN’s 2015 international theme for March – Women’s History Month)

As I was preparing this blog post, I noticed earlier essays reflected commemorative themes for the given month. When I learned March is Women’s History Month, I immediately thought of Virginia Satir, one of our very own, as well as an international leader in Family Therapy. The UN’s March 2015 theme, noted above, evokes the empowering dynamics of Virginia Satir and resonates with her affirmation: “Peace Within, Peace Between, Peace Among.”

Virginia SatirI had the privilege of participating in half-a-dozen training conferences with Virginia Satir held between 1977 and 1981 during the launch of her Avanta Network Conferences. It was thrilling to experience her innovative principles of human-validation-through-personal-empowerment demonstrated with individuals, couples, and families. Her authentic connections engendered our trust and cooperation as she engaged with conference attendees in large and small groups. She invited us to bring our whole-selves into the here-and-now of our connection with her. It was as if each of us became a canvas upon which she imprinted the patterns of her magic so we could retrieve our personal understandings of her later in our own lives and work.

My early-encounters with Dr. Satir powerfully shaped my ways of knowing as a clinician. Her family sculpting seminars conveyed her belief that people are basically good, although at times misguided, and captured the essence of healing by showing us that change was an achievable goal. As she co-created a family system with audience volunteers by positioning them physically into emotionally-laden portrayals, she trusted they would become fully alive in the psychodrama to reveal the real issues underlying the identified problem. The principles embedded in her family sculpting trainings metabolized within me over time and became the foundation of what I refer to as the 4 R’s (rupture, regression, repair and resolution) – a helpful and easy-to-remember model I developed for clients to effectively approach, identify and manage internal and interpersonal upsets. In the example of Virginia Satir’s family sculpting demonstration that follows, I will identify how the 4 R’s are reflected in her process.

Imagine a large conference room filled with people focused on Virginia Satir’s commanding energy dominating the stage. She initiates a sculpting demonstration by requesting that a conference attendee volunteer to portray a difficult family dynamic and for him/her to be the “in-house family member” in the case presentation. Together they determine the “cast of characters” in the family representation. Dr. Satir then draws volunteers from the audience as “stand-ins” to represent the other family members. With great care and attention to detail, Dr. Satir physically positions the family “stand ins” to match the “in-house family member’s” perceptions of each family member’s particular role, attributes and interaction patterns, until the family difficulty is accurately portrayed (Rupture). Dr. Satir instructs the participants to freeze and hold these role-defined postures for what seems a very long time. She asks them to continue to hold these positions of collective distress, while she individually checks in with each of them. Dr. Satir gently approaches each family member, one after another, with physical proximity and remarkable rapport as she sensitively inquires about his/her feelings. Throughout this gripping and prolonged sequence, poignant and congruent emotions spill forth from each of them as they share their experiences with her (Regression). As Dr. Satir instructs them to shake off the sculpted postures and the associated emotions, she affirms and acknowledges their willingness to be open and vulnerable (Repair). The sculpting experience for the “in-house family member” is a profound learning experience. In addition, each of the “stand-in” family members also learns something personally significant about themselves (Resolution).

We all face interpersonal challenges in our relationships and struggle to make sense of what is going on and to regain emotional balance. Dr. Satir’s family sculpting exercise encourages us to look beyond the superficial details of an identified problem/rupture (as it is rarely the real issue); and instead asks us to go deeper to explore how regressive coping strategies, that once worked to protect us, can now be an underlying source of our problem.

Virginia Satir continually demonstrated the universal need for congruent connections and deeper understandings in our emotional relationships. Her amazing confidence in people was communicated every time she invited total strangers up to a stage to bond together in the common goal of healing. It seemed likely to me that if she could engage others in the process of healing and change, then perhaps I could too. So over the years, I integrated many aspects of Virginia Satir’s model both consciously and unconsciously and now notice how much they are rooted in my clinical work with individuals, couples, families and groups. Dr. Satir’s most significant influence is reflected in the trust that my clients are working toward their personal benefit and for the well-being of others.

My experiences as a marriage and family therapist and as a group psychotherapist have provided me a multi-faceted framework. This kaleidoscopic perspective provides insight into the intricacies of a client’s internal and interpersonal world. When such insight is elusive, I find that a client’s participation in group therapy can be particularly helpful. When a new member joins one of my groups, either from my private practice or as a referral from a colleague, s/he steps into a family sculpture of sorts. Within the secure and confidential space of group, members’ attachment and relationship patterns come into focus in the interplay of group activity.

In the world of group psychotherapy, good-fit enactments often occur and powerfully reflect secure connections that influence positive self-esteem for group members.  More often, however, bad-fit enactments occur and highlight family distortions, disruptive behaviors and incongruent communications. As group members project their own family patterns onto each other and unconsciously assume varied roles from their families of origin, bad-fit dynamics in the group play out as internal and interpersonal ruptures with corresponding regressive feelings. While these interaction patterns in the group are similar to one’s family-of-origin dynamics, the good news is that they are not the same. The difference is that the group-as-a-whole contains, witnesses, and reflects on the ruptures and regressive feelings between and among its members.

The beauty of group therapy as a holding container for exploring family issues is that it is a powerful medium for healing, growth and change as members take risks to experience vulnerabilities they might not otherwise dare to express with a spouse, family member or co-worker. As group members observe, consider and mentalize their own and others’ behaviors and beliefs, they see how these dynamics can play out differently than they did in their families of origin. As repair and resolution become the new experiences that allow for deeper levels of self-awareness, group members discover how sincere communication patterns can powerfully reshape the quality of their relationships both in and out of the group.

I am thankful for Virginia Satir’s powerfully healing gifts. Her influence allowed me to develop an integrated sensitivity to family and group therapy dynamics.

Credit:Trish Cleary

Certified Group Psychotherapist (CGP)
Fellow, American Group Psychotherapy Association

Satir Photo Credit: William Meyer – Public Domain

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Back to School Thoughts from A Recent Graduate

Posted by on July 4, 2015 with 0 Comments

LB Headshot pink shirtHaving completed my Master’s program in Couple and Family Therapy in May, I thought it might be useful to direct my blog post for current MFT/CFT students.  The school year is about to begin.  Some of you might be entering your first year of a program and for others it might be just another start to the school year. I don’t know about you, but the beginning of the school year is one of my favorite times of the year. I can buy new school supplies, start to fill out my new planner, and get things organized. If I am lucky, I will buy myself a new first day of school outfit and take a first day of school picture, because no one is ever too old to do this.

Along with buying supplies, downloading syllabi, and ordering books for class, I think there are some other things to be mindful of when preparing for the school year. These points are certainly not an extensive list and are based on my personal experience.

1. Budget– First, figuring out what your budget for the school year looks like and making sure you stay within your means is important. My budget seemed to be something on the back of mind throughout the school year. Often times my financial situation caused moments of stress and anxiety. Make sure you are utilizing the budgeting resources available to you through your university or online. An important financial resource overlooked is finding an assistantship with the university if your university offers them. Assistantships are often posted on graduate listservs (make sure to sign up for them) or posted on HR websites.  Assistantships might also be provided to you from your academic program’s department. Typically, assistantships provide some sort of stipend and tuition remission. Check out your university’s graduate school information for more details about what assistantships provide. Another way students can find an assistantship is making connections with departments and offices on campus. Start making these connections early because the office might not have any openings this year, but might remember the connection you made with them and notify you of future opportunities.

2. Personal Resource Library– Since graduating, I am grateful while in school a professor, supervisor, or member of my cohort recommended a couple different ways for building up my own resource library. I
had an electronic folder and hard folder where I collected resources I could use throughout my career as a therapist. After the two years in the program, I had two file folders jammed with various handouts, activities, and psychoeducation tools I could use with clients in the future.  I also have an electronic folder full of additional resources I can pull from. Creating your own resource folders might be something you consider doing as well in order to begin building your own resource library.

3. Professional Development- I created two lists while I was in school regarding resources. One list was focused on potential trainings/continuing education opportunities. I created my list based on opportunities I was emailed about, heard in class, authors who interested me, and opportunities about different therapies I wanted to expand my knowledge base on or start a knowledge base. The additional bonus of creating this list was helping me know how to infuse professional development into my schedule and budget. Having an idea of the cost and how often an organization or person holds trainings allows you to plan out how you will be able to cover the cost and see when it fits best into your schedule. I was fortunate to be able to attend a handful of trainings and continuing education opportunities throughout my two years in school. I found many of these additional educational opportunities were worth the money spent and helped develop me as a beginning therapist.

4. Creating a Wish List– The other list I created was books, games, and other therapy tools I would like to have after I graduated.  Supervisors, professors, guest speakers, fellow students, and even clients have
great recommendations for books, games, and items that will be useful in session. I was writing down all the suggestions, but the information was not in one central location for me to find. An easy way to go about doing this is creating an Amazon Wish List. I found it quick and easy to find most of the items, books, or games I was interested in on Amazon. Then I would add them to my Wish List. Since graduation, I have bought several items off my Wish List in preparation for working in the field. It is nice and helpful to have this prepopulated, centralized list. I continue to add books and items.

5. Professional Network– Another helpful component to be mindful of is creating support networks. For me, the support networks I was creating were both professional and personal. Creating my support networks is ongoing and changes regularly. I think it is important to think about who is in your support network and people you would like to add.  When you first enter school, you might not have an idea who you want to include in your professional support network and that is okay. I think if you keep an open mind and try to take away something from the various professional you interact with you will start to recognize the people who have similar philosophies to your own or philosophies you are interested in learning more about. Don’t be afraid to reach out to professionals to set up information meetings. Most professionals were once in the same student shoes like you! I have found most professionals are interested in helping out students in any way they can. Talk to the professors, supervisors, and other professionals you interact with to see if they have any recommendations of people you could reach out to. You will be surprised the connections you can make once you ask and put yourself out there.

6. Personal Network/Personal Well-Being– Just as important as professional networks is your personal network. Your personal well-being is important and having people who can help, support, and increase
your well-being can make a difference during your time in school. Your personal network can include whomever you want or need. I was fortunate enough to have an amazing group of students in my cohort who often were my first line in personal support, but sometimes it was helpful to get support outside my cohort and professional network.  I was able to get this support by scheduling time for it. I found it helpful to schedule “Me Time” throughout the year. Sometimes I used the time to be by myself, to do nothing, to relax, to go out and do something new, or to treat myself.  Other times I used my “Me Time” to connect with my personal support network. I found if I scheduled time just for myself to do whatever I wanted; it allowed me the time to re-energize my batteries to continue to push forward with school. It can be hard balancing the many responsibilities of being a student so try to figure out a system that works best for you in incorporating your personal network and time for you. Don’t forget to treat yourself (It is easy to forget or neglect)!

Lastly, I hope you have a great school year. Good luck. Be proactive, ask questions, and have fun!

Elizabeth M. Brown, M.S., LGMFT
Licensed Graduate Marriage and Family Therapist

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Expanding Mental Health Awareness Month

Posted by on July 14, 2014 with 0 Comments

Cindi business photo small

You have probably heard the public service announcements on television and social media announcing that May is Mental Health Awareness month. Since the 1940s National Mental Health Awareness Month offers education to the public about mental health with a focus on psychological disorders and a goal to reduce the myths and stigma surrounding mental health and treatment such as therapy. Raising awareness of mental health and normalizing counseling services are positive and effective steps in the campaign to improve the lives of millions of people coping with mental health concerns. However, mental health is much more than psychological disorders, it also concerns prevention and well-being, such as healthy coping for daily stressors, managing life transitions and the caring and tending of relationships, between parent and child, couples, family members, coworkers and even the relationship you have with yourself.

Research shows that mental health is not just important, but crucial; given the large numbers of people coping with stress, loneliness and a myriad of symptoms that can impact all aspects of life (World Health Organization, 2005). Taking a closer look, you may already know that Anxiety is the most common form of mental health condition. An estimated 40 million Americans aged 18 and older cope with an anxiety disorder. When you include all forms of both situational and chronic mental illness the number rises to 57.7 million people (NIHM). When we include other stressors such as marital conflict, a study from Utah State University shows that 40%–50% of all first marriages, and 60% of second marriages, will end in divorce. So, its clear that many people will face concerns that benefit from therapeutic services. In fact, Marriage and Family Therapists not only offer treatment for psychological disorders, but also relational issues, loss and stressors that can wreak havoc, if left unchecked.

It is important to celebrate and engage in efforts to bring public awareness to mental health concerns from Bipolar Disorder to managing the stressors of daily life. Marriage and Family Therapists are poised, ready to spring into action with therapeutic approaches and self-care methods for clients. But, with all the care Marriage and Family Therapists’ provide to others we can’t forget to expand Mental Health Awareness to therapists. We need to create boundaries and utilize self-care methods, just like our clients, to cope the unique issues of being a provider such as compassion fatigue, burn out and stress. Consider, how many times you have lifted a boundary to schedule a client, by cutting into personal time. Do you overwork or over schedule? Do you eat lunch at your desk? If you answered yes to any of these questions you may want to look at setting boundaries to help you balance work and life.

Do you actually, practice good sleep hygiene, take time to meditate and exercise? Do you reach out for support from colleagues? Do you drink enough water and eat a healthy diet. Are you are attuned to your experiences and needs. If, you answered yes, to most of these questions, you are doing a great job of self-care. If not, you may want to consider your own well-being, and put yourself first. May is Mental Health Awareness month for everyone, an opportunity to consider that the more you exercise your own emotional muscle, the more you provide your clients with stability, structure, safety and connection.

Cynthia Rebholz, M.S., LCMFT
Licensed Clinical Marriage and Family Therapist


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Happy New Year from MADMFT

Posted by on July 13, 2014 with 0 Comments

Happy New Year! January means new beginnings, right? There’s all the pressure to start the New Year off right. Maybe that pressure is why so few of us keep our New Year’s resolutions. My main resolution this year is to not end 2014 the way I ended 2013 – exhausted, burned out, and in desperate need of a break. Anyone else feel that way? A client I saw this evening summed it up perfectly: “2013, don’t let the door hit you on the way out!”

So I’m glad that 2014 is here and I’m ready to forge ahead, but I also know that I need to stop and take a look at why I was so spent by the end of 2013. I suspect I’m also not alone in why: there’s just so much to do, and so little time to do it! Plus, there’s so much I *want* to do – so many projects I’m interested in, so many people I want to spend time with, so many books to read…it’s a good problem to have, to be sure, but one that needs to be managed or life goes haywire.

My resolve this year is to do the best – the things that are most worthy of my energy and attention. It’s all good stuff, but I want to make sure I’m doing what only I can do. Right now, I’m in the midst of reading a book that states it this way: “80% of what you do could be done by someone else, and 15% of what you do someone else could do with some training. But 5% of what you do only you can do. Make sure you put that 5% at the top of your (never-ending) to-do list.”

So what can only I do? Here’s my list: only I can be a wife to my sweet husband Rob; only I can be a mom to my twin 8 year-old girls, Isabel and Emily. Only I can write and speak and encourage in my own unique voice, to clients, family, friends, and colleagues. And since these things also happen to be what I value the most in life, spending more time focusing on the 5% has the added bonus of putting the other 95% into better perspective.

I know I’ll have to re-learn this lesson many times over the coming year – and maybe even years beyond that (though I hope not!). But I resolve to remember it. It’s too easy to get lost in the weeds of all there is to accomplish, and miss the sweetness of life the way it is now. Our field’s current love affair with mindfulness is about exactly this – be in the moment, as much as you can. And though I can’t spend hours in meditation or days at a retreat, I can take a few minutes to play Batman or fashion show or Mario Kart, or spend an evening on a date with my husband so we can remember how much we enjoy each others’ company.

That’s a resolution I think I can actually keep.

(Is one of your resolutions to network more, get great training, or be more involved at MAD? If so, don’t forget to register for the MAD Annual Conference with Eliana Gil. It’s in February at the fabulous Turf Valley Resort and Conference Center, and registration ends Feb 12. When you’re there, stop and let me know how you’ve been doing with your 5%!) Register for the conference by clicking here.


Laurel A. Fay, M.S., LCMFT
Licensed Clinical Marriage and Family Therapist
President, Middle Atlantic Division of the American Association for Marriage and Family Therapy

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National Family Caregivers Month

Posted by on July 12, 2014 with 0 Comments

Susan passport photo 002November has been designated as National Family Caregivers month.  As America’s population is becoming increasingly older, many of us are or will be called upon to provide care for a loved one.   The American Association of Retired Persons (AARP) estimates that over 29% of the U.S. adult population is providing care to someone who is ill, disabled, or aged.  Family caregiving is now considered a normative family process in the family lifecycle stages.  (National Alliance for Caregiving in collaboration with AARP. November 2009.)

The responsibilities of a Caregiver range from visiting the individual, assisting with medications, and accompanying the individual to doctor’s appointments; to providing day-to-day care for a bed-ridden individual.  The complexity and diversity of the Caregiver’s tasks and responsibilities increase as the individual ages and/or their health condition worsens.

Those of us who have been a Caregiver recognize that assisting a loved one as a Caregiver can be overwhelming, but it can also be very rewarding.  Our family and close relationships provide mutuality and a sense of meaning.  Being bound to our loved ones brings a sense of commitment, loyalty, and respect to honor one another in our times of need.  We can begin to see these individuals in a new light and can develop a deeper connection with them.  By providing emotional support, active listening, and responding in a non-reactive way, we can connect heart to heart.  Communication can become more open about feelings and experiences in the past.  Fluctuating emotions including anger are common with both Caregiver and our loved one.  Our loved one may be angry at being ill, may have increased pain, decreased energy, and decreased frustration tolerance.  As the Caregiver, we begin to experience anger, frustration, grief, loss, and uncertainty as we observe our loved one’s struggle.  Tears can be cleansing for both Caregiver and patient.  Incorporating humor can assist in decreasing the intensity of the situation and shifting the focus to a more positive emphasis.

Being a caregiver puts a strain on one’s physical health, emotional health, finances, and other relationships.  Caregivers find themselves struggling to balance work and family responsibilities.  According to the National Alliance for Caregiving and the AARP, up to 70% of the caregivers who are employed experience work-related difficulties.  Work schedules may need to be rearranged, up to 4% chose early retirement, up to 5% turn down a promotion, and up to 6% gave up work entirely.  Wages, health insurance, and other job benefits may be sacrificed.   Employers report an increase in absenteeism and a decrease in productivity among workers who are in the dual role of Caregivers.  (National Alliance for Caregiving in collaboration with AARP. November 2009.)

Marriage and Family Therapists are a valuable resource to assist in the adjustment for the aging individual, the family, and the impact the Caregiving role has on the family system.  As we are included in the decision making process, we can assist families in sorting out the next steps to be taken.   We can provide broadening support to assist in networking and providing practical information.  Accessing abilities and emphasizing strengths facilitates resiliency. The MFT can facilitate the redefining of roles and the adjustment around the elderly individual’s self-concept.  We assist in the recognition of the connection of the personal and relational functioning to the level of physiological decline. Working collaboratively with the Caregiver, we can assist the Caregivers to create an environment that enables the older individual to enjoy these later years as much as possible. As the individual ages and declines in health, the MFT can assist in processing the symbolic or actual death of the loved one.  As we assist in the acknowledgement of the death and loss, we give the families the space to express and process the range of emotions experienced.  Our role includes assisting the family with the reorganization of the family system and reinvestment into future life direction without the loved one.

In facing the task of caring for a loved one, it is important for Caregivers to remember that they are not alone.  Nationwide there are more than one million Caregivers providing care.  Make Caregiving a family affair and involve others in the caring process.  Also, remember that there are many services available to assist you in caring for your loved one.  Below are a few resources and tips to assist the Caregiver:

Helpful tips and resources for Caregivers:

  • Develop good communication with care providers.
  • Day-to-day assistance including Home Health Aides available and paid for by some insurance plans;
  • Consider Respite care.
  • Alternate transportation options may be available including van and shuttle services; contact your area agency on aging.
  • Seek food services including Meals on Wheels to assist with meals.
  • Take advantage of counseling services, support groups, and online support groups.
  • Take care of your own health.
  • Find an Marriage and Family Therapist to assist you at:
  • Contact a Caregiving Hotline:  AARP 1-877-333-5885 Monday to Friday 9:00 to 5:00

Assistance to offer to a Caregiver:

  • Call or stop by to offer support and reassure the Caregiver that it is OK to ask for help.
  • Be a good listener for the Caregiver, and ask how they are taking care of themselves.
  • Offer to bring the Caregiver a meal.
  • Assist in providing Respite care or connecting Caregiver to Respite Care resources.
  • Help the Caregiver connect with other Caregivers and resources.

Additional Resources:


Administration on Aging (AOA) National Family Caregivers Support Program:


Easter Seals:

Family Caregiver Alliance:  800-445-8106;;

Family Caregiver Resource Center; 1420 Spring Street; Silver Spring, MD  20910; 301-588-8700;               

Holy Cross Caregiver Resource Center:  9805 Dameron Drive; Silver Spring, MD  20902; 301-754-7152;

Maryland Health Care Commission:  Consumer Guide to Long Term Care


National Alliance for Caregiving:  4720 Montgomery Lane, 2nd Floor; Bethesda, MD  20814; 301-718-8444;

National Council on Aging:

National Family Caregivers Association:  10400 Connecticut Avenue, Suite 500; Kensington, MD  20895;        301-942-6430;

Respite Services of Montgomery County; 11621 Nebel Street; Rockville, MD  20852; 301-816-9647


The National Alliance for Caregiving and AARP (2009), Caregiving in the U.S. National Alliance for Caregiving. Washington, DC)—Updated:  November 2012

Susan Blair, LCMFT, CCDP

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Would anyone like a slice of Fruitcake?

Posted by on July 11, 2014 with 0 Comments

Sept2013headshotDecember, quite fittingly, is national fruitcake month!  There are many different types of fruitcake, which take many different forms and what do they all have in common? Dried fruit! A brief sampling of fruitcakes: United Kingdom, Christmas Cake; France, gateau aux fruits; Germany, Stollen; Italy, Panforte and Panettone; Lithuania , vaisiu pyragas; Portugal, Bolo Rei; Romania, Cozonac; Spain, Bollo de higo; and I am sure many, many more.  A brief history of the origins of fruitcake can be found here. In spite of the much maligned, fruitcake, it endures just as our holiday traditions endure.

With the change of seasons, holiday decorations and fruitcakes begin to appear in the market, thoughts naturally turn to family traditions, celebrations, and many, many more thoughts about family, parents, grandparents and the ancestors who came before us. Thoughts about fruitcakes and all of the variations that each culture created, leads to thoughts of holiday food traditions. Regardless of family living near or far, faith or religious practice, the very thought of the holiday season can take you back to memories of those special flavors from your youth.  For many the memories are sweet. For many the memories are sour. Most often they are both sweet and sour.  Fortunately, you can learn to cherish beloved memories, heal painful ones, and create new memories and traditions, embracing what you value most, right now today.

This holiday season is a great time to reflect on the traditions you find meaningful, comforting, and joyful – those which connect you to the past, present, and future.  You can liberate yourself from the traditions that you continue because, ‘this is the way grandma always did it,’ if the tradition is something that truly does not speak to you.  You can also integrate a tradition that maybe was not one your family participated in, yet is one that speaks to you today.

Traditions can grow and evolve.

For instance, when my husband and I married, I brought most of the traditions from my Italian American heritage to our Christmas celebrations.  My husband enjoys the special Christmas cookies and such, but there really was not a sweet that looked anything like his childhood memories of Christmas sweets.  We needed to create a new tradition, special to our new family, that respects both of our histories while at the same time gives new meaning to the family we created.  Just as our marriage is possible, because our great-great grandparents immigrated to the United States from very different parts of Europe, we needed to combine Italian, Irish, English, and Lithuanian traditions.  And we did. Now there is a place for each of these traditions at the table and one of our most anticipated and favorite holiday sweets, is the Irish Fruitcake!

This holiday season; take a few moments out of the holiday hustle and bustle.  Truly practice the renewal of beloved traditions that keep our links to the past comforting. Let go of those that are disappointing and create something special just for you and yours.

I wish you the most peaceful holiday.

Tracie Strucker Ph.D., LCMFT

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Valentine’s Day for the Unattached, the Attached, and Anyone in the Middle

Posted by on July 10, 2014 with 0 Comments

Lauren-Photo (1)-002Through the years, whether or not I’ve had a partner on Valentine’s Day, I’ve always tried to take the same perspective. To me, Valentine’s Day is a day when you’re reminded to tell the people that you care about that you love them. Sharing these feelings with those important people is quite important; it’s this connection that helps drive us, makes us feel worthwhile, and can simply brighten our day.

Perhaps against the grain, I never completely bought into the idea that Valentine’s Day is a holiday for couples to shower each other with chocolate, teddy bears, red roses, and fancy dinners. Rather than limiting the spreading of love to just one’s partner, I see it as a day for me to take the time to remind all the people who mean something to me that I am grateful for them. Valentine’s Day is like Appreciation Day for all the people in my life who support me and help make my life fulfilling.

No grand gestures are needed. Just a simple note or exchange will do. A quick message here or there is sufficient. It’s the fact that you’ve taken the time and energy, and the leap to tell that particular person you care about them that matters.

Try one of the following approaches this February 14th.

(1) The good ‘old fashion’ phone call is a great place to start. This works especially well with grandparents and parents who may especially enjoy hearing your voice. Something as simple as “Happy Valentine’s Day! I wanted to let you know that I love you!” will go a long way.

(2) Schedule to FaceTime or Skype, or Hangout through Google Plus with a relative who lives far away so you can see each other while you catch up. Ask them how they are spending the holiday and let them know that even though you’re not close by, you think of them often.

(3) Send a free online card using websites such as or . For your loved ones who accentuate your humorous side, maybe a card from would feel more appropriate. These cards are really quick to send along to one or a few people. You can include a personalized message that reads something like “On this day of love, let this card be a brief reminder of how important and special you are to me!”

(4) Or, send a real card through the mail. It can be a generic Valentine’s Day card or a “Thinking of You” card. Write a short, but heartfelt message expressing your gratitude for that person being in your life.

(5) Scroll through your pictures on your phone or computer and email one or two to your friends, to reminisce about times past and tell them you look forward to seeing them soon.

(6) Plan a day or night out with friends. See a movie or get dinner. Take the reins of planning the night to show everyone spending time with them matters to you.

Whether you are attached, unattached, or somewhere in the middle, consider taking time this Valentine’s Day to share an exchange with all the people who matter to you. No one is really alone on Valentine’s Day. Even if you’re currently not in a romantic relationship, you are still surrounded by relationships that matter a lot. This coming February 14th, do an inventory of those relationships and take some time out of your day to tell those in your life you love them.

Lauren Messina, M.S., LGMFT
Licensed Graduate Marriage and Family Therapist


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It’s Time to Do Something: How to Prevent Teen Suicide

Posted by on July 9, 2014 with 0 Comments

“Suicide is a permanent solution to a temporary problem.” ~ Phil DonahuePP-pic kate

 According to the American Academy of Child and Adolescent Psychiatry, suicide is the third leading cause of death among adolescents ages 15-24. This statistic hit home last year when two Montgomery County Public School students committed suicide. It is always tragic when someone takes their own life, but I think there is something especially tragic when such a young person with a long future ahead of them can’t see any other way out.

Adolescents are especially vulnerable to depression, self-harm behavior, and suicidal ideation. Adolescence is a time of emotional, physical, and social change. Adolescents by nature are impulsive and egocentric. Small problems seem like world ending problems and they are sometimes unable to see how their decisions today may have long lasting consequences on their future. Teens also generally lack the appropriate coping skills to help them manage some of their life stressors.

As if adolescence wasn’t hard enough, the introduction of social media has increased problems tenfold. Sites like Facebook, Kick, Twitter, and Instagram, meant to connect us with our friends and family, have quickly become a venue for bullying, isolation, and uninhibited self-expression.  Teens, who are impulsive by nature, post comments; videos and pictures without fully understanding or thinking about the impact it will have on themselves and others, often for years to come.  Information on the internet spreads like wildfire and communication intended for one person can be shared with the world. Despite numerous examples of this happening not only at a personal level but at a celebrity level as well, teens continue to put personal information out there.

Social media has also been used as a place for teens to reach out for help. In 2012 a video by a 10th grader named Amanda Todd went viral after she committed suicide. There have been numerous videos of a similar nature posted since by other teens struggling with bullying, depression, and suicidal thoughts. While many of these videos garner outpourings of love and support from some, they also get extremely cruel words from others. So, how do we help our teens survive the turbulent waters of adolescence safely?

When someone takes their life, it is not uncommon for people close to them to ask themselves what signs they missed and if they could have prevented what happened. As they say, hindsight is 20/20. Often it is not until after a person’s death that we are able to reflect on and recognize the cries for help and signs of desperation.  It is also not uncommon for people to underestimate the seriousness of the warning signs expressed by those who are struggling. Sometimes the signs are obvious, while other times they are inconspicuous. Here are some of the common warning signs to look out for.

 Warning signs:


Depressed mood

Frequent running away

Expressions of suicidal thoughts and talk of death

Withdrawal from friends, family, and activities

Impulsive and sometimes aggressive behavior

Alcohol and drug abuse

Engaging in high risk behaviors

Social isolation

Poor self esteem

Giving away meaningful belongings

Self-harm behavior

Social media messages, videos, posts

One of the hardest parts of my job is knowing that I am responsible for seeing and acting on these warning signs in the children that I work with and the children that attend my school. I have had more sleepless nights than I can count wondering if I missed anything or whether I did enough to prevent something from happening. I wonder day to day if I ask the right questions, if I provide a safe enough space for a teen to share about their suicidal thoughts, or if I handled something the right way. At some point, maybe due to self-preservation, I have had to recognize that no one can read someone else’s mind and/or predict the future. However, with that being said, I do believe that working with kids is a big responsibility and should not be taken lightly. There are things that we can do.

Whether you are a parent, educator, friend, or complete stranger, there are always ways that you can help.  Here are just a few:

Learn and pay attention to the warning signs: If you notice any of the signs listed above, take it seriously and check in with the teen. Often it is other kids who see the first warning signs. Sometimes it is in the form of gossip, a text message or a youtube or facebook post. On several occasions I have had students come to me concerned about a peer’s safety. I encourage them to take any threat seriously and check in with the friend they are worried about. At school, we encourage teens to tell an adult if they are concerned about a peer. Sometimes teens are wary of making a big deal out of nothing or making their friend mad. I remind them that when all is said and done, their friend will be grateful that they cared and didn’t ignore their pain. Ultimately, many teens contemplating suicide simply want others to recognize their hurt and show that they care. By calling attention to a cry for help, you are showing the teen that they are important and that you care about them. This alone can sometimes help a child get on the path to healing.

Ask a child if he/she is considering suicide: It is important to be direct and not dance around the word suicide. It can be a scary thing to ask and some incorrectly believe that asking about suicidal ideation will plant the idea in a teen’s head. This is simply not the case. You should ask a teen if they have any thoughts of suicide, a plan, previous attempts, access to weapons and/or a means to carry it out. Listen without judgment, share your concern, and reassure the teen that help is available.

Seek professional help: If the teen has a plan they should be taken to the local ER or Crisis Center for an evaluation. Even as a mental health professional with training on appropriate suicide assessment, I frequently refer teens to the Crisis Center for a second opinion. I feel that the more eyes on a child the better. It also sends the message that you take their concerns seriously and want to make sure that they are safe. It is also important, if the teen is not already in therapy, to connect them with therapeutic services.

Be a support: Whether a teen has reached out for help or not, it is important to always be available as a support. Say hi, ask a teen how their day was, and show interest in their activities. Even a stranger’s smile or recognition can make a difference. You may never know that your simple hello made someone’s life worth living another day.

Be involved: As a parent it is important to be involved in your teen’s life. Stay up to date and check in on their social media. Encourage family time. Encourage your teen to share about their life by providing a space without judgment or punishment.

September is suicide awareness month. I encourage you to think about those teenagers in your life and make a special effort to be available for them and let them know that they are important and that you care. Make yourself aware of resources available in your area and be prepared to help a teen in need. Don’t wonder what you could have done; ask yourself today what you can do to help save a life.


Kate Alcamo, LCMFT
Secretary, MAD-AAMFT

Filed Under: Uncategorized

The Perils of Overcommitment

Posted by on July 7, 2014 with 0 Comments

Headshot While it may not be an officially sanctioned month, I tend to think of August as Back to School (or work, etc.) Month.  As we wind down from summer and move toward fall, I think commitments, and more specifically, the dangers of over-committing are really important areas to think about and discuss. For students, there are new clubs, extra curricular activities, friend groups, AP Classes, and so much more that can pull students in so many directions. For parents, the PTA, carpools, coaching, committing to transport children to a variety of activities all come flying at us as the first day of school draws closer and closer. For individuals, lures of new job opportunities, volunteer positions, recreational activities, career enhancing or leisure classes, exercise classes, church opportunities, invitations for special events, and the list could go on and on. If we are not careful, before we know it, we can find ourselves committed to so many different activities that we may have left no room in our schedules for ourselves.

When it comes to accepting or denying requests for commitments, the only one that can decide what is enough and how much is too much is you. A desire to be helpful and agreeable can often leave one feeling overloaded, which can lead to burnout, or bitterness and regret toward the commitments that we were once eager to accept. Additionally, overcommitment can lead to paying less attention to the commitments we have and an overall decline in how well we are able to manage these commitments. In the helping profession especially, we have a desire to be helpful and assist people, but it is important to set limits and boundaries and be realistic about what we can and cannot do. We often see clients who are so overloaded with responsibilities that they repeatedly tell us that there is no time for self-care because everything else takes up all their time.

When you are asked to help with something or offered a new opportunity to commit yourself, it can be helpful to ask yourself questions like these:

  • Do I want to do this? What will I gain from doing this?
  • Do I feel pressured to accept?
  • Do I have the time and energy to do this?
  • By accepting this, will it mean taking away from something else that I am already doing? What would I be giving up?
  • If it feels like too much, is there a way to accept a lesser commitment? Or could I accept at a time when I have more availability?
  • What would happen if I said no?

The last point is particularly important. We can remind ourselves, and our clients, about the importance of being able to say “no.” Many perceive declining something as rude, or unhelpful, but in reality, accepting a commitment that you do not have time to honor, or that will affect your mental or physical well-being is not fair to you, or the person asking for help. Saying “no” is critical for setting personal boundaries and is an important skill to have. If it is difficult for you to say no, you can practice it with your therapist, or on your own and find ways to decline that feel comfortable to you.

A handy tool to use when approached with a new commitment opportunity is to use an acronym to remind yourself of considerations, maybe something like this—CAP IT (which also reminds you to set a limit for how much you commit to!):

Care for yourself and be sure you are not stretching yourself too thin
Analyze whether or not you can fit the activity in your schedule
Prioritize your commitments and accept the ones that are most important, or that don’t take away from existing commitments, or eliminate commitments that you have to fit in this new opportunity
Invent ways to say “no” that are comfortable for you and practice so that you can say “no” without feeling bad
Take time if you’re not sure if a commitment is too much. It is okay to take time to think about it before agreeing or disagreeing. Be open to negotiation for a lesser version of the task.

As fall approaches and most of us tend to ramp up our activities in a variety of areas, keep in mind the importance of being mindful of yourself, and avoid the perils of overcommitment. What do you think? Have you ever had an experience of feeling overcommitted? How did you manage it? Share in the comments below.

Liz Ott, M.S., LGMFT
Social Media Coordinator, MAD-AAMFT

Filed Under: Uncategorized

The Month of the Military Child

Posted by on July 7, 2014 with 0 Comments

The number of post-9/11 era veterans living in our Middle Atlantic Division geographic area is projected to surpass 100,000 by the year 2020 and the majority of these veterans have young families. Nationally, there are as many as 700,000 children under the age of five who currently have a parent serving in the military.IMGP8937

April is recognized as the Month of the Military Child ( As the weather warms up and we begin to see more children playing in our neighborhoods and local parks, it is important to consider the unique childhood experience of military children.  Many military children have moved multiple times during their lives, disrupting school years, friendships, and care provider relationships.  Many have parents who have been deployed to combat zones, and many have parents who returned from those deployments with emotional and physical changes.

But the most important thing to remember is that most military children are resilient—they demonstrate a strong sense of belonging in military communities, they are uniquely adaptable and tolerant of diversity, and they exhibit positive coping skills to handle stress.

As Marriage and Family Therapists, we are uniquely qualified to help military children adjust to the family stressors of their parent’s active duty deployment and reintegration to civilian life. Here are some helpful resources to learn more about working with military families:

Receive Clinical Training from the Center for Deployment Psychology

The Center for Deployment Psychology provides gold-standard continuing education for clinicians interested in learning evidenced-based therapies for working with military families.  Courses are offered online (many for free, or for a fee if seeking CEUs) or as in-person workshops.

Provide No-Cost Sessions to One Military Family

Many military families need high-quality couple or family therapy services, but many may be unable to pay full fee-for-service rates.  Registering as a provider with Give An Hour means that you commit to seeing at least one military client at a time pro bono.

Network with the National Military Family Association

The National Military Family Association is the leading non-profit organization advocating on behalf of military families. As a dues paying member or as a volunteer, you can connect and network with other professionals interested in the important issues facing military families.

Download Fun, Interactive Session Tools for Military Families

The DOD has partnered with the Sesame Street Workshop to create useful and fun interactive session tools to use with military families. Free resources to download include videos, activity pages, and information handouts.

Emily T. Cook, Ph.D., LGMFT
Licensed Graduate Marriage and Family Therapist


Filed Under: Uncategorized