Middle Atlantic Division Dissolves 2018

Posted by on March 12, 2018 with 0 Comments

​​AAMFT held a second bylaws vote summer 2017 that was voted in — the new bylaws dissolved all geographic divisions in early 2018.

​​In early 2018, the remaining members of the Board of MAD voted unanimously to revoke the charter with the State of Maryland, thereby dissolving the division according to the AAMFT intention.

Please add your contact information to the following Google Form if you wish to be notified of next steps for MFTs in the DC-metro area (Maryland, Delaware, DC, and Northern Virginia).


Filed Under: News

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

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
Filed Under: Uncategorized

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
Filed Under: Uncategorized

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. (https://www.aamft.org/iMIS15/AAMFT/Content/directories/supervisor_terms_of_use.aspx). or there is also a list of supervisors approved by the Maryland Board of Professional Counselors and Therapists (http://dhmh.maryland.gov/bopc/Pages/index.aspx).

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

Filed Under: Uncategorized

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

Filed Under: Uncategorized

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


Filed Under: Uncategorized

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

Filed Under: Uncategorized

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 Amazon.com, click here.

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

Filed Under: Uncategorized

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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