The Art of Therapy

Posted by on February 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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Happy New Year from MAD-AAMFT President Lindsey Hoskins

Posted by on January 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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Would anyone like a slice of Fruitcake?

Posted by on December 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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National Family Caregivers Month

Posted by on November 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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Supporting a Loved One Through Miscarriage

Posted by on October 1, 2014 with 0 Comments

LMH - Alimond 1 low resOctober is Pregnancy and Infant Loss Awareness Month, and I volunteered to write this month’s blog because this is a topic that hits close to home for me personally. In 2012, just after my husband and I decided to start trying for our first baby, I lost three pregnancies in eight months. This month, the first baby – Ziggy, to us – would have turned two years old.

Pregnancy loss is a particularly tough grief to carry, because it’s sort of invisible. For me, like many women, miscarriage happened before I’d reached the point in my pregnancy where I’d started to share the news with others. So when the pregnancy ended, it was difficult to talk about or ask for support. Doing so can be very awkward: “I was pregnant, but now I’m not.” Miscarriage is grief for a person we’ve never met, never saw, never touched – but to whom a lifetime of dreams are attached. It’s grief magnified by self-doubt; by persistent wondering if we’ve done something or not done something to cause this, if our bodies will be able to do it right next time, if there’s something “wrong” with us that might not be fixable. It’s grief accompanied by guilt, for having let down our partners and even more so, for somehow having failed our babies. It’s grief for one’s hopes of becoming a parent, or becoming a parent again, or giving one’s child a friend for life in the form of a sibling. And all these many layers of grief come on top of the intense physical challenges that a miscarriage brings – pain, fatigue, readjusting hormones, and sometimes frequent and invasive trips to the doctor.

Whether you’re the supporting a friend or a client through the experience of pregnancy loss, there are a few universal things you can do to provide effective support:

  • Encourage her to take some time for herself. Miscarriage can be traumatic, and if possible, it’s best to let the experience be private. If possible, encourage her to take a couple days off work, rent some good movies or grab a great book, and just relax and heal.
  • Be open, but not pushy. Some moms will want to talk about their experience, and some will not. The best thing you can do is to make yourself available to listen, but leave the decision up to her. Say something like, “I’m here for you if you want to talk about it, but please don’t feel like you have to.” Make this offer a few times, reminding her that the door is open.
  • Use your knowledge of her. One of the nicest things that anyone did for me when I miscarried the first time was to send me a beautiful, thoughtful care package. It contained a heartfelt card, a CD with a song she knew I’d like, a soft blanket in my favorite color, and a tube of my favorite lip gloss. It was simple, beautiful, personal, and made me feel so loved. Today, when I hear that song or use that blanket, I think of that friend and I think of Ziggy – but the feelings that wash over me are warm and safe.
  • Use HER language. Some of the language that surrounds pregnancy loss is tough to hear – the medical term “spontaneous abortion” is particularly difficult. When supporting a grieving mom, listen carefully to the words she chooses and then use them yourself. My husband and I talked about Ziggy, and called our baby that all the time (we still refer to him by that name) – it really meant a lot to me when friends called him Ziggy, too. It made him feel more real, even after he was gone.
  • Give her permission to grieve. It can be very helpful to just have someone acknowledge that a loss has taken place, and that grief is an appropriate response. Let her know that it’s okay to be sad, angry, confused, etc.
  • Don’t forget about the due date. Miscarriage grief often happens in two phases: when the loss actually occurs, and then when the due date approaches. But by the time the due date rolls around, the world has moved on and the sadness that re-emerges can be particularly tough to handle. It will mean a lot to a grieving mom if you remember the approximate due date and check in with her around that time, offering your gentle support and understanding.

There are also a few things to steer clear of when supporting someone grieving the loss of a pregnancy. Here are a few phrases to avoid:

  • Everything happens for a reason. This one stings, because although sometimes miscarriage does happen for a reason, it’s not often a reason a grieving would-be mom is ready to think about. For me, the reason I kept having miscarriages was because my body was malfunctioning and terminating instead of nurturing my pregnancies. So when people told me it happened for a reason, a voice in my head said, “yep, and that reason is me.”
  • At least you know you can get pregnant, you can try again soon.  I understand the spirit behind this one, but honestly, it’s small consolation when in the throes of grief and loss. The prospect of trying to get pregnant again feels daunting and far away, and thinking about another baby feels like a betrayal of the one just lost.
  • At least you weren’t that far along. This statement implies that there is some sort of timeline for grief. If I miscarried at 24 weeks, am I allowed to grieve longer and more deeply than if I miscarried at 8 weeks? Just like you can’t be a little pregnant, you can’t have a little miscarriage. It’s a loss, no matter when it happens, and each mother should be allowed to grieve in her own way and on her own timeline, without others making assumptions about how much grief is appropriate.

Early on in my experience with pregnancy loss, I made a conscious decision to be open about it, and I try to continue to do so. It bothers me that miscarriage is such a taboo topic – that we don’t talk about it or provide the support that’s needed because it’s uncomfortable to talk about or we’re embarrassed to admit that we’ve lost a baby. I hope that as more people talk about it, the conversations will become easier and the taboo nature of the topic will fade away.

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

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

Posted by on September 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

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The Perils of Overcommitment

Posted by on August 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: Blog

National Minority Mental Health Awareness Month

Posted by on July 2, 2014 with 0 Comments

Simkin Shana“Once my loved one accepted the diagnosis, healing began for the entire family, but it took too long. It took years. Can’t we, as a nation, begin to speed up that process? We need a national campaign to destigmatize mental illness, especially one targeted toward African Americans. The message must go on billboards and in radio and TV public service announcements. It must be preached from pulpits and discussed in community forums. It’s not shameful to have a mental illness. Get treatment. Recovery is possible.” – Bebe Moore Campbell, 2005

In May 2008, the United States House of Representatives proclaimed July as Bebe Moore Campbell National Minority Mental Health Awareness Month, providing organizations with the opportunity to raise awareness about severe mental illness in diverse communities, while highlighting avenues for wellness and recovery.

So what does this mean? Who was Bebe Moore Campbell? What can we do as Marriage and Family Therapists to support this proclamation?

Bebe Moore Campbell was an accomplished author, advocate, co-founder of the National Alliance on Mental Illness (NAMI) Urban Los Angeles and national spokesperson, who passed away of cancer in November of 2006.

Mental illness affects one in four adults and one in ten children in the United States. Note that the U.S. Surgeon General reports that minorities are less likely to receive diagnosis and treatment for their mental illness, have less access to and availability of mental health services, and often receive a poorer quality of mental health care. The stigma associated with mental illness is often a barrier to treatment and levels of stigma associated with mental health conditions are much higher in multicultural communities. Furthermore, mental illness is a leading cause of disability, yet nearly two-thirds of people with a diagnosable mental illness do not seek treatment, and according to NAMI, racial and ethnic groups in the U.S. are even less likely to get help.

Now, what can we do? During National Minority Mental Health Awareness Month, help raise awareness in your organization or community. Encourage your family, friends, loved ones, and clients to learn more about improving mental health and illness.

The NAMI Multicultural Action Center has provided several suggestions to help plan for National Minority Mental Health Awareness Month:

• Host an “Ask the Doctor” session focusing on a specific community or focusing on issues such as cultural competence in treatment.
• Host a free mental health screening at a multicultural location and make sure you have your screening instruments available in several languages.
• Donate minority mental health related books to your local library. You can order your books through the NAMI website.
• Partner with multicultural organizations to plan and host your events.
• Target multicultural media outlets to spread your message.

As clinicians, it’s up to us to help push through the stigma associated with mental illness and to educate others on mental health and the services available for treatment.

Shana L. Simkin, M.S.
DC Chapter Chair, Middle Atlantic Division of the American Association for Marriage and Family Therapy

Filed Under: Blog, Minority

A Beginners Understanding of Post Traumatic Stress Disorder

Posted by on June 5, 2014 with 0 Comments

2014-03-14 16.58.24Perusing the internet for potential topics for this blog, I came across a list of awareness topics by date and month. I saw listed for June the following topics: AIDS Awareness month, Children’s Awareness month, Father’s Day month, Student Safety Awareness month, Gay and Lesbian Pride month, and National Post Traumatic Stress Disorder (PTSD) Awareness Day. While all of these topics are important and relevant to Couple and Family therapy, I am going to focus on National Post Traumatic Stress Disorder (PTSD) Awareness Day on June 27, 2014. By no means am I an expert in this area, rather I am embracing the opportunity to use this blog post to further my education and knowledge about PTSD.  I was fortunate enough to take a course on Trauma and Addiction that started my education on trauma and PTSD (Thanks fellow MAD-AAMFT Member Wendy Wilcox!).

Traumatic events occur more often than one thinks. Over 60% of men and over half of all women experience at least one traumatic event, which means most people you meet probably have experienced a traumatic event (National Center for PTSD, 2013). I had not realized trauma was so prevalent in individual, couple, or family’s lives. Before studying the topic, my knowledge of individuals with PTSD was limited to soldiers and veterans. My scope and assumption were narrow on the prevalence of trauma in everyday life. I also think it is important to note that not every person who experiences trauma develops PTSD. Only about 7% of all people develop PTSD in their lifetime (National Center for PTSD, 2013). The systemic study of the human response to trauma and traumatic stress are fairly new stemming from the aftermath of the Vietnam War (Briere & Scott, 2013). The term posttraumatic stress disorder did not appear in the mental health world until the mid-1980s.

Stress can be caused by a myriad of different things like doing your graduate school homework, paying the bills, losing a loved one or job, or positive events like getting married. Traumatic stressors are different because they are events in which someone feels their life or the lives of others are threatened (National Center for PTSD, 2013). These traumatic stressors can be witnessed or experienced directly. Examples of major types of trauma are child abuse, mass interpersonal violence, natural disasters, fire and burns, rape and sexual assault, motor vehicle accidents, large-scale transportation accidents, intimate partner violence, stranger physical assault, war, torture, sex trafficking, witnessing or being confronted with the homicide or suicide of another person, murder, suicide, or life-threatening medical conditions (Briere & Scott, 2013). These events are not always independent of one another, but that also does not imply experiencing one type of traumatic event will increase the likelihood of another. It is also important to consider for some people stressful events like losing a partner or having a partner cheat might be worse than some traumatic events, but that doesn’t necessarily result in PTSD.

For the DSM-5 diagnosis for PTSD, you need one of these specific types of trauma exposure:

• Directly experiencing a traumatic event, such as being in combat or a hurricane.

• Witnessing an event that happened to someone else, such as seeing a serious car accident.

• Learning about a traumatic event that happened to friends or family, such as learning about the homicide or suicide of a family member. (Having a family member die of natural causes does not qualify).

• Or, experiencing repeated or extreme exposure to aversive details of traumatic events such as collecting human remains after combat or terrorist attacks (National Center for PTSD, 2013).

This diagnosis is for adults, adolescents, and children over the age of 6. Along with the type of trauma experienced, a diagnosis of PTSD requires a combination of symptoms from specific symptom clusters: re-experiencing, avoidance, negative alterations in cognition or mood, and hyperarousal (American Psychiatric Association, 2013). These symptoms must be present for more than one month and must cause significant distress or impairment. While I have not had a course yet on DSM-5 diagnosis, I believe it is important to know and understand the criteria outlined for the disorder to know what to look for because maybe what you thought was once a consideration or factor might not be one now.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Briere, J.N. & Scott, C. (2013). Principles of trauma therapy. A guide to symptoms, evaluation, and treatment (2nd ed.). Thousand Oaks, CA: SAGE Publications.

VA National Center for PTSD. (2013, March). PTSD 101 Course: Epidemiology of PTSD. Podcast retrieved from

Elizabeth M. Brown
MAD-AAMFT Student Member
Couple and Family Therapy Graduate Student Intern
University of Maryland, College Park


Filed Under: Blog, PTSD

Expanding Mental Health Awareness Month

Posted by on May 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


Filed Under: Uncategorized