Focusing on MFT Advocacy

South Carolina Association for Marriage and Family Therapy President Dr. Karen Cooper-Haber recently wrote about key advocacy issues facing MFTs in our home state of South Carolina. The position paper she references in Spring 2012 SCAMFT newsletter feature article ( follows:


Following are a list of the issues that divisions are encouraged to pursue to obtain recognition and reimbursement for MFT’s. In most cases, other mental health professions such as social work or mental health counseling are already included in these laws and have an advantage over the MFT profession. In order for the MFT profession to grow and thrive, it is critical to be recognized in these programs and categories and have parity with the other professions.

MEDICAID – Medicaid (state medical assistance) is the health care program covering the poor and underserved. Medicaid is a federal program that is administered at the state level. Federal Medicaid law specifically allows states to determine which mental health professionals to reimburse.


State statutes and regulations (available on the Internet)

State Medicaid offices (Medical Assistance Offices)

AAMFT Website Resources & AAMFT Government Affairs Staff

STATE EMPLOYEES HEALTH PLAN (SEHP) – The State Employees Health Plan is the health plan for state government employees. It is the state equivalent of the Federal Employees Health Benefits Program (FEHBP). It is usually a large plan that covers many employees. It may compass several plants, such as indemnity (fee for service) plan or a managed care plan. The state plan is usually administered by the agency in the state government that is responsible for managing state government employment issues (i.e. the Department Of Human Resources). Plan provider issues may be made through statute, regulations, or internal policy.


State statutes and regulations (available on the Internet)

State Department of Human Resources or Personnel

AAMFT Website Resources & AAMFT Government Affairs Staff

STATE JOB CLASSIFICATION FOR MFT’s– The state government employs thousands of people under designated state job categories. Individuals apply to these job categories for employment with the state government. Most states have a job category for psychologists and social workers, but if you have a classification for MFT’s. Without an occupational classification, MFT is will not be able to be hired directly by the state government; although they may be able to be hired under another professional category (i.e. psychologist) or a general classification that may limit promotion or service delivery.

Most job classifications are overseen by the same agency that administers the State Employees Health Plan. This could be the Department of Human Resources or a similar entity, so it is recommended this issue can be dealt with in tandem with the State Employees Health Plan. The decision to include may be statutory, regulatory, or even subject to internal policies.


State statutes and regulations (available on the internet)

State Department of Human resources or personnel

AAMFT Website Resources & AAMFT Government Affairs Staff

FREEDOM OF CHOICE (VENDORSHIP) LAWS – There are many state laws that mandate reimbursement for health professionals who provide covered health services. Some of these laws currently recognize MFTs, but many do not. Inclusion of MFTSs in state freedom of choice laws will increase the likelihood that the profession will be included in private plan networks, but these laws do not apply to ERISA plans, which comprise the majority of the health insurance market. Regardless, freedom of choice laws are a good foundation for obtaining payment by insurers and health plans. Since freedom of choice laws relate to insurance, they are usually included in the state insurance laws and regulations.


State statutes and regulations (available on the Internet)

State Department of Insurance –

AAMFT Website Resources & AAMFT Government Affairs Staff

MFTS IN SCHOOLS – MFTs are routinely excluded from being employed by schools to provide behavioral health services. Many MFTs are in the schools as independent consultants or under another profession’s credential, but they are not permitted to be hired as MFTs by the schools. Social workers, psychologists, and counselors are employable by the schools in virtually every state (some states only requiring a bachelor’s degree).

School-based mental health professionals are usually credentialed under the Department of Education (DoE) instead of the Department of Health or Occupations where most health professionals are licensed. For MFTs to practice in the schools there will likely need to be a new certification created in the state under the DoE – such as “school family therapist” – which will require some additional coursework and training. In most situations, this is a statutory decision.


State statutes and regulations (available on the Internet)

State Department of Education

AAMFT Website Resources & AAMFT Government Affairs Staff

BLUE CROSS / BLUE SHILED REIMBURSEMENT (BC/BS) – BC/BS plans are usually state or regional entities that make provider decisions independent of the national BC/BS association. Consequently, it is the state BC/BS plan that determines whether to include MFTs. Many state plans do, but several state plans do not. Those state plans that do not are often the largest insurer in the state. Consequently, MFTs’ ability to compete and earn a living in these states is severely inhibited.

Because provider decisions are made by individual state plans, each plan must be approached to encourage MFT inclusion. The method for obtaining inclusion is to advocate, much as you would a legislative or regulatory issue. Divisions and individual MFTs can push plans to include the profession. There is usually a provider relations department of the plans that addresses provider issues and a contact within that department would be a good place to start.


State BC/BS plans –

AAMFT Website Resources & AAMFT Government Affairs Staff



Licensed Family Therapists ( also known as MFT’s) should be made accessible to children in public schools by being explicitly listed as behavioral health service providers under the “Elementary and Secondary Education Act” (ESEA).

Why Recognize Family Therapists:

  • Family Therapists (MFTs) are the only mental health professionals required to receive training in family therapy/ family systems – skills-sets that prove useful for individual-based child      interventions.
  • MFT’s are one of five core mental health disciplines recognized by the Health resources and Services Administration (42 CFR Part 5, App. C). MFT’s are licensed across the country to diagnose and treat mental and emotional disorders, with a unique focus on the context of family/relational systems. They are required to obtain a minimum of a master’s degree – around 35% hold doctorates – and all have at least two years of post-graduate supervised clinical experience.
  • According to the Academy of Child and Adolescent Psychiatry, factoring in relationships such as “family      members in the assessment and treatment of infants, children, and adolescents are integral to positive clinical outcomes.” The Practice Parameters for the Psychiatric Assessment of Children and Adolescents (AACAP,      1995) state “the child’s functioning and psychological well-being are highly dependent on the family and school setting in which he or she lives and studies . . . Obtaining a full and accurate diagnostic picture of the child requires gathering information from diverse sources, including the family, school, and other agencies involved with the child.”

Current ESEA Law:

Federal law presently omits Family Therapists from the list of professionals in ESEA as qualified to provide mental health services as a part of the in-school behavioral health team. This omission causes school districts to develop regulations and grant applications that exclude MFT’s from positions within the school system. When ESEA was enacted in 1965, it defined specific “pupil services personnel” who may provide mental health services to school children (20 U.S.C. 7801). The definition included school psychologists, social workers, and counselors but does not recognize Family Therapists. Subsequently, school counseling programs were created – such as the School Counseling Demonstration and the safe and Drug Free Schools – that recognize only those providers listed in the definition of pupil services personnel. The consequences of omitting MFT’s from the definition of “pupil services personnel” is that most school districts have established policies recognizing only those practitioners specifically listed in the ESEA. Thus, MFTs are excluded from school systems, and students are denied access to a mental health discipline whose primary treatment methods have been proven effective with school-aged children.


According to the U.S. Surgeon General, at least one in five children and adolescents has a mental health disorder. At least one in ten, or about six million children and adolescents, have a serious emotional disturbance. Tragically, only one third of this population actually receives mental health care.  Public schools are the major providers of mental health services for school-aged children according to the U.S. Substance Abuse and Mental Health Administration report entitled “School Mental Health Services in the United States.” The same report indicates that the most commonly reported health problems for students in elementary and middle schools are “social, interpersonal, or family problems,” and that the need for mental health services is increasing.

The President’s New Freedom Commission on Mental Health noted a debilitating shortage of mental health professionals, particularly ones trained to serve children, stating “if the system does not appropriately screen and treat early, these childhood disorders may persist and lead to a downward spiral of school failure, poor employment opportunities, and poverty in adulthood.”

It further stated that “federal, state, and local governments should ensure that families, substitute families, and other caregivers, as well as youth, are full partners and have substantial involvement in all aspects of service planning and decision making for their children at federal, state, and local levels.” A federal research project funded by DHHS and investigated by Georgetown University developed competencies for professionals treating mental health problems in children, and identified many family-based competencies, including “fundamental family assessment skills.” The Surgeon General expressed similar sentiments, stating that, “families have become essential partners in the delivery of mental health services for children and adolescents.”

In addition to public and workforce studies demonstrating the need for skilled clinicians with family therapy training to treat school children, many clinical studies also identify family-based interventions (whether performed individually with children or in conjunction with a family member or other relations) as the most effective treatment. A meta-analytic study found that family therapy for conduct disorders and delinquency – including Functional Family Therapy (FFT), Multisystemic Therapy (MST), and Oregon Treatment Foster Care (OTFC) – are proven effective. The models have demonstrated significantly better outcomes for youths (and often times their siblings) involved in treatment at tremendous cost savings ($15,000-30,000/family) when compared to traditional delinquency interventions (e.g., incarcerations, boot camps, or probation). In general, the outcomes include reductions in delinquency and antisocial behavior, improved school attendance and performance, improved family interactions and involvement, reduction in substance use and abuse, reduction in out-of-home placements, and decreased psychiatric symptoms.

The techniques employed by MFTs are equally as effective as currently listed ESEA providers in treating behavioral and emotional disorders. In fact, MFT family-based models have been shown especially successful in reducing the symptoms of both Attention Deficit/ Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). Studies have shown improvements in family functioning and school performance; increased parenting skills; reduced aggression, inattention noncompliance, conduct problems, and hyperactivity; reduced parental stress, and increased parental self-esteem. For depression and anxiety disorders in children, family therapy – and particularly cognitive behavioral therapy – decreases symptoms, and is particularly effective with younger children and children whose parents may be experiencing symptoms of anxiety.

AAMFT Position

The need to offer school-based behavioral health services for school children with mental health needs in the context of a family/systemic model is indisputable. Licensed Family Therapists are the only mental health professionals who must obtain specific training in family therapy techniques. Therefore, to ensure the best care and development for our children it is critical that ESEA be amended to include MFT’s as an option on the list of school-based behavioral health care providers.


Remove the barriers to utilization of Licensed Family Therapists (MFTs) as providers of mental health services in the public school system by including MFTs among the professionals listed in ESEA’s definitions of “school based mental health providers” (20 U.S.C. 7161) and “pupil services personnel” (20 U.S.C. 7801. Add MFTs to the list of recognized professionals in school counseling programs (20 U.S.C. 7245).

For More Information:

            Melissa Stamps, 703-253-0445,

(AAMFT, 2011)


The Trevor Project Offers LGBTQ Youth Crisis Training For Professionals

Below please find a training invitation from Wes Nemenz, training manager of The Trevor Project.  The Trevor Project is the leading national organization focused on crisis and suicide prevention efforts among lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth.



The Trevor Project is proud to announce our new series of monthly webinars for youth service providers, mental health professionals, educators and school staff.

Previously only available in New York and LA, this online version of Trevor’s Connect, Accept, Empower, Respond (CARE) Training is now being provided for free.  Anyone can register to attend by clicking here   For more information on the training, see below:

  • What: This training provides an overview of suicide among lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth and the different environmental stressors that contribute to their heightened risk for attempting suicide. We’ll also cover how to identify warning signs, how to link youth in crisis to help, how to promote resiliency and provide practical steps that service providers, educators, and others can take to promote a positive environment for all youth.
  • When: Wednesday, March 28, 2012 from 4pm-5:30pm EST.
  • Who: Youth service providers, mental health professionals, educators and school staff.
  • How: Registration is required and can be completed here.

If you have any questions about this webinar or upcoming webinars, please contact Wes Nemenz, Education Manager – East at:

My best,

Wes Nemenz

Education Manager – East  /  The Trevor Project

212.509.0072 ext. 328


The Trevor Project is the leading national organization focused on crisis and suicide prevention efforts among lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth.

Text TREVOR to 85944 to make a $5 donation to The Trevor Project!

Dr. Allison Lux: Illuminating Effective Couples Therapy

Dr. Allison Lux: Illuminating Effective Couples Therapy 


Dr. Allison Lux, a private practitioner and adjunct professor based in Monroe, LA, was kind enough to share her perspective as a couple and family therapist with MFT Matters. Dr. Lux approaches couples therapy from an attachment perspective, utilizing emotionally focused therapy as a core model, but integrates other techniques, approaches, and ways of being with clients to suit their needs. Her presentation at the most recent AAMFT Fall conference (2011) on moments of accessibility, responsiveness, and engagement as seen through an EFT lens helped to contextualize how attachment wounds may be observed within couples interactional patterns and how systemic therapists may intervene effectively and ethically.

Included below are excerpts from an audiotaped telephone interview with Dr. Lux conducted on October 1st, 2011.

The Interview

On Dr. Lux’s MFT journey and choosing couples therapy as a specialty:

When Dr. Lux studied psychology in her undergraduate career, she was drawn towards human behavior and the concept of couples and families as relational systems. As she started the Master of Arts program in Marriage and Family Therapy at University of Louisiana at Monroe, Dr. Lux remembers experiencing a combination of exhilaration and wonder at the principles underlying systemic thinking: “Once you change the way you look at the world, you can never go back. You’re forever changed for that experience, and everyone around you will react to that change.”

Dr. Lux gravitated towards couples work during the second year in her master’s program when she realized that she loved both the challenge and satisfaction inherent in working with couples. “(My) interest in the dynamics between intimate partners and human sexuality made couples therapy a really good fit for me,” says Lux.  During her practicum experience in the PhD program and through her work with couples in a nonprofit clinic that specialized in sexual abuse, domestic violence, and trauma, Dr. Lux discovered that the very dynamics and challenges that repelled other clinicians attracted her to working with couples. “Couples work was very intimidating for many other therapists; but the clinic knew to call me when they presented for intake. . . I loved the challenge,” remembers Dr. Lux.

What couples therapy models do you use most often when working with couples?

Dr. Lux naturally sees couple (and family) dynamics through an attachment lens. Dr. Sue Johnson’s conceptualization of problem development and change embodied in the Emotionally Focused Couple Therapy (EFT) approach resonated with Dr. Lux because her anecdotal experience with intimate partner conflict and dysfunction so correlated with the theory. In the final analysis, however, she prioritizes client needs over rigid adherence to a specific model. “First, I wait until I meet a client and determine where they are and what they need before locking in on a model. Many times, I utilize a core of emotionally focused therapy, but I’m not afraid to incorporate elements of John Gottman’s work, as well as collaborative language and solution-focused approaches as necessary. Often I’ll ask a client, ‘what has been working’? Sometimes, I’ll give cognitive-behavioral influenced homework.”

What about working with couples do you find most challenging?

“Whenever one or both partners is emotionally disengaged and that can come in many forms. Usually, one person has already moved out or filed for divorce and they’re coming in as a last-ditch effort and one person has probably already ‘checked out’. They are coming in for couples therapy, but really its one partner trying to make sure that the other will be okay without them. My success rate for these kinds of couples is not very good, but I’m careful not to take responsibility for that outcome.” For Dr. Lux, intercession of one form or another is critical before partners enter this point of no return.  She urges therapists, even in the context of individual therapy, to advocate for couple’s intervention if early warning signs of disengagement are apparent.

What elements of couple therapy do you find the most rewarding?

Dr. Lux shares, “When a couple comes in and the foundation of their relationship is based on respect and a true friendship, and they’ve built the intimacy and closeness upon it . . . and they may have gone off track little bit, and have stresses, maybe dealing with [life change], but after I’ve worked with them for a few sessions and they come back in and they have that spark in their eyes – and they’re looking at each other, and they’re laughing and they’re holding hands – and to know that I was able to be a part of that journey. That’s rewarding. That pumps me up!”

How do you approach person of the therapist issues when working with couples?      

“I have good boundaries. I know that I am with that couple in that session, in the therapy room, in the moment, but once they leave I don’t take responsibility for their actions.” She elaborates, “I can see that if you didn’t do that or to find some way to be able to shut your brain off . . . you could get burned out really easily, especially if you are consistently working with couples who are in a desperate situation. It can be draining. If you’re working with a couple and after a few  sessions they decide to get divorced, you have to respect that clients are the experts in their own lives and the therapist should not take responsibility for their decisions.”

What have you found most effective when working with couples?

“Flexibility”- although Dr. Lux is passionate about and competent in emotionally focused therapy, she is quick to emphasize that no two couples are exactly alike. This perspective prompted her to research and become familiar with disparate models and techniques that could be brought to bear for the unique needs of different clients. Dr. Lux advises a balance between competence (expertise with a certain preferred model) and creativity (serving the unique needs of the client with fresh approaches). She encourages student therapists to be their authentic selves in the therapy room and cautions about becoming too married to one particular model.

What advice would you give to couples and family therapy students who are interested in specializing in couple therapy?

In addition to the guidance offered in other responses, Dr. Lux advises students to consider several important things:

  1. In order to provide the most effective therapy possible and to continue the healthy process of professional growth, Dr. Lux encourages MFT students to consistently read and research about new developments in the field of couple therapy and of MFT in general.
  2. She urges student therapists to continuously monitor how well therapy is going from both a person of the therapist and client-centered perspective. Is there a strong alliance? Are the clients’ goals being addressed in therapy? Is progress being made? If therapy is not working as well as it could, Lux urges newer therapists/ students to reevaluate and seek objective counsel and/or supervision. Dr. Lux believes that competent therapists are always questioning what is being experienced in therapy and often ask themselves: “The next time I do this, how can I do it better?”
  3. According to Dr. Lux, it can be difficult for student therapists to accept that when couples consider or contemplate change, it can destabilize things in the short-term. Dr. Lux believes that this is usually normal and healthy and cautions new therapists against getting too quickly derailed by the stress of this kind of conflict.  She advises students to stick to the processes and goals established for therapy unless there is new information that renders the established approach or model untenable (such as domestic violence).
  4. “If I was going to give advice to other therapists, especially students, about couple therapy I would say first make sure that you see both partners in session every chance you get and secondly, you have to be willing to jump into couples interactions when necessary to de-escalate,” states Lux. “Sometimes when couples get loud, new therapists are intimidated, but when you see that pattern you’ve just got to jump in and ‘catch bullets’. I think of two foundational principles to this day: first, one cannot not communicate and second, all behavior makes sense in context. It is important to not get too caught up in couples blaming cycles, rationales, or other content and to remember to prioritize the systemic or process-based interactions.”
  5. Dr. Lux strongly believes that therapists should be able to talk about sexuality and intimacy calmly, frankly, and objectively when communicating with couples. “If you work with couples, they need to know that you as the therapist are okay talking about it and sometimes you have to open the door for them by asking a question (about intimacy). Clients can sometimes beat around the bush and the therapist’s comfort level and knowledge is often a key factor in their opening up about what may be a crucial issue in their relationship,” Dr. Lux says.

With respect to boundaries:

  1. Dr. Lux remarks, “It really helped me after a session to go to one of my teammates or a supervisor while I was preparing to write the session notes and process the case with them for a few minutes. Secondly, I think there is real value in writing your session notes immediately after a session, put it in the file and put it away. As a student, it’s hard to say ‘never take your work home with you’; you’re going to. You’re going to think about people; you’re going to worry about some of the (clients) that you worked with that day. As you become more experienced you’ll start to let some of that go.”  In addition, Dr. Lux believes that all therapists should make time for relaxation, pleasurable activities, and quality time with loved ones and family. “It energizes you, clears your mind, and gets you ready to get back in the game,” she states.

Are you willing to describe a case where you felt the outcome was highly successful? . . . not as successful? What were the teachable moments in each?

“Last summer, I had a couple that were not living together but had been dating for almost five years. And they were asking, ‘Are we ready to take the next step in our relationship?’ I first saw the woman and she told me that after all these years, they had broken up after talking about changes in the relationship. And she had tried to swallow a bunch of pills and commit suicide. Of course, after helping her become stable over some time, they finally came in together. When they first came in to session as a couple, he was defensive and referred to previous couples therapist as very preachy, always ‘firing questions at us’; he was very defensive and I thought, ‘What did I get myself into?’ After working with them for several months and exploring each of their perspectives . . . they came in one session and I noticed something on her finger. She had this huge engagement ring on! And I said, ‘So what is this?’ They had gone on vacation and he had proposed to her . . . and he had agreed to put his house on the market so they could move in together. They were so in love; and they told me, ‘this is where we were trying to get to but didn’t know how to get there’.”

The teachable moment:  “Connect with both partners. Often one partner of a couple will feel like they are being dragged into therapy, and as the therapist, you need to immediately find a way to connect with this person – because if you don’t they’re not coming back. I was listening for what didn’t work with his previous therapy and knew that I needed to do something different, so I put my notepad down and asked him to tell me about his life — tell me what I need to know.” In a later session, the woman (now a wife) communicated how Dr. Lux’ decidedly non-expert stance turned out to be the perfect approach for the couple to start deconstructing the cycles of blame.

Dr. Lux also shared a case where her zeal to help resurrect a couple’s marriage obscured the fact that one of the partners had simply moved on. In this case, the wife (who had experienced considerable trauma as a child) had most recently witnessed her husband’s infidelity and had experienced the heartbreak of a miscarriage. Dr. Lux recalls, “She had these two or three horrible attachment injuries and no matter what her husband promised, she could never really trust him. I remember reaching out to her emotionally, exploring her fragile attachments and I thought that at times she would ‘go there’ with me, but in the end, I always perceived a barrier . . . that could not be crossed.” Dr. Lux believes that, as resilient therapists, we must be willing to accept that the best we have to give may simply not be enough. “Not all marriages and intimate partnerships are destined to bear fruit,” she laments.

Do you incorporate a feminist, multicultural, and/or postmodern lens into couples and family therapy?

“I consider it all systemic – whether you call it postmodern or feminist or culturally bound. It’s all systemic to me in and no matter who I’m working with, I consider all aspects of the system and that includes power, culture, and values. If you’re going to be truly systemic you’re going to have to consider all of these aspects when working with clients,” states Lux.

In the context of you as a professional, is there a question that you’ve always wanted someone to ask, but no one ever has?

“One question deals with how I was able to gain confidence in working with couples. I like to reassure students that it is a process. You’re going to be uncomfortable at first; we all are! Systemic therapy is different – it’s a different way of looking at the world and it takes time to become comfortable working with couples and intimate partner dynamics – be patient and learn from every experience you have with a couple. . . be a noticer and learn about yourself. ‘What works for you? What doesn’t work for you? ‘You may want to use EFT with a couple, but if  it’s not working try something different – because if you’re uncomfortable the client is definitely going to pick up on that too. In regards to couples therapy, I think there are two books that every therapist should read – the latest edition of the Clinical Handbook of Couples Therapy and Systemic Sex Therapy. Those two books include the basic essentials of working effectively with couples.



Allison C. Lux, Ph.D., L.M.F.T., L.P.C., N.C.C. Director

~        Doctorate of Philosophy (Ph.D.) in Marriage and Family Therapy from the University of Louisiana at Monroe (May 2011)

~        Doctoral dissertation focused on Marriage and Family Therapists’ using PREPARE in premarital counseling

~        Master of Arts (M.A.) in Marriage and Family Therapy (May 2007)

~        Licensed Marriage and Family Therapist (L.M.F.T.)

~        Licensed Professional Counselor (L.P.C.)

~        National Certified Counselor (N.C.C.)

~        Certified facilitator of PREPARE/ ENRICH since 2009

~        AAMFT Clinical Member and supervisor-in-training

~        Member of American Counseling Association, American Association of Sexuality Educators Counselors and Therapists, Louisiana Association of    Marriage and Family Therapy, and Louisiana Counseling Association

~        Has provided counseling services at various settings since 2006

~        Has received additional training in premarital counseling, emotionally-focused couple therapy, human sexuality, domestic violence, and sexual assault.

~        Has published articles in peer-reviewed journals in the U.S. and China

~        Presents locally, state-wide, and nationally on various therapy topics

(Reprinted with permission from Lux Counseling [website, 2011])

Happy Holidays from MFT Matters

Thanks to our loyal readers, fellow contributors and volunteer editors for helping us launch MFT Matters in 2011. We are blessed to be able to share ideas and dialogue about the field of couple and family therapy!  While many of us are fortunate enough to celebrate a holiday with friends and family, too many on our planet will face another in an endless string of days simply trying to survive. May 2012 provide us opportunities to help with the plight of our less privileged brothers and sisters.

MFT Matters

Voice of Reason: A Couple Therapy Technique Inspired by Neuroscience

Voice of Reason: A Neurobiologically Inspired Couple Therapy Technique

Edward C. Thomas IV

A couple in their mid-thirties presented at a clinic location for marital counseling. The male reported a history of depression since teen years and the female presented with mild learning disorders, family of origin conflict, and anxiety symptoms. She described times when a family member would make a seemingly innocuous comment and that she would feel a rush of shame and anger all balled up in one and she would launch a vicious verbal assault at whoever was in proximity. When she and her husband argued in therapy, we were able to soften automatic responses through a process where each partner adopted a curious rather than angry stance. This produced insight and greater respect for each other’s perspectives. The challenge came, the couple reported, when there were at home for one or two weeks between therapy sessions and these emotionally reactive incidents would hijack the relationship anew. I recalled Brett Atkinson’s article, Rewiring Neural States in Couples Therapy: Advances from Affective Neuroscience, where he described a technique using audio recordings whereby clients could interrupt self-defeating narratives and emotional reactivity between sessions.

Research in neuroscience suggests that when environmental cues are threatening, emotive circuits in the brain can derail cognitive processes of reasoning and self-awareness (Atkinson et al., 2005; Cozolino, 2010). In contrast, when emotionally neutral or “healthy” stimuli are introduced, the prefrontal cortex (thought to be responsible for self-awareness and mindfulness) is returned to the neural “driver’s seat” and in time create new re-wired emotional responses. Atkinson et al. (2005) describe how this theoretical framework changed the way they practiced couple’s therapy:

“Up to this point, our goals had been to help partners develop new narratives, trade in their problem-saturated stories for new, empowering ones, drop their critical and defensive attitudes and adopt tolerance and understanding for each other. But we came to realize that problem narratives, critical and defensive attitudes, intolerance and lack of understanding were driven by powerful brain states that our clients didn’t volunteer to have. Rather than trying to help clients think and act differently, we started trying to help clients shift the automatically activated mood states that blocked new thinking and interaction from flowing naturally (p.4).”

In Atkinson’s technique, the therapist records a calm and reassuring message on the client’s personal video recorder that:

  1. Validates a partner’s anger at the actions or words of the other
  2. Encourages the reactive partner to realize that the other partner will most assuredly not act in a kinder way if the recipient of an escalated verbal attack
  3. Suggest that the reacting partner create some space for reflection – this may be as simple as counting to ten or taking a walk.
  4. Reinforces that the perceived slight needs to be addressed, but at a time when both partners can respect the perspective(s) of the other

I’ve adapted Atkinson’s recorded message technique as follows: First, I offer to record a similar message on partners’ recorders and/or cell phones, but suggest that their own calm, in-control voices can be even more powerful.  I usually incorporate humor, bantering that the idea is a “little corny” but can be remarkably effective.  I work with the client to develop the full message and instruct them to listen to it whenever those first fleeting feelings of conflict arise.

In the case of the thirty-something couple I referenced earlier, the reports I’ve been receiving are encouraging.  To paraphrase the female client, “You were right; it is a little strange, but when I hear my own voice coaching me to keep my head, it usually works.  I’ll sometimes take a walk outside and when I’m back, the comment or criticism I felt so strongly seems like nothing.”  I’ve expanded this technique to several clients including an adolescent whose message simply says “chill girl.”  This technique is neither model dependent nor intended as a replacement for the multi-faceted approaches we often use with couples, but can help to nullify some of the toxic partner exchanges that can derail client progress.



Atkinson, B., Atkinson, L., Kutz, P., Lata, J., Wittman-Lata, K., Szekely, J., & Weiss, P. (2005). Rewiring neural states in couples therapy: Advances from affective neuroscience. Journal of Systemic Therapies, 24(3), 3-16.

Cozolino, L. (2010). The neuroscience of psychotherapy: healing the social brain. New York: W. W. Norton & Company.

Becoming a Postmodern Therapist

Dr. Harlene Anderson, who with Harry Goolishian co-developed the collaborative language model, maintains a robust website replete with helpful articles, multimedia resources, and information about post-graduate training programs.  Dr. Anderson is strongly informed by postmodern thought and the theoretical formations of constructivist philosophers including Heinz von Foerster (second-order cybernetics) Michael Foucault (culture defined by discourse) and Kenneth Gergen (contemporary social constructionism).   She’ s penned several articles highlighting her journey that can be accessed here:

Part 1

Part II

Depressed Mothers’ Offspring Have Enlarged Amygdala

Research findings supporting the transmission of mood regulation from mother to sibling is growing increasingly robust.  Researchers from the University of Montreal studied a population of children raised by depressed mothers and found that a statistically significant number of children had an enlarged amygdala, an almond-shaped structure within the basal ganglia often identified with emotional reactivity and corollary memory processing. Study author Sonia J. Lupiena states, “This strongly suggests that the brain may be highly responsive to the environment during early development and confirms the importance of early intervention to help children facing adversity. Initiatives such as prenatal and infancy nurse home visits and enriched day care environments could mitigate the effects of parental care on the developing brain.”

The article can be found in full text here:

Geriatric Cognition and Anxiety

“Geriatric Cognitive Change, Anxiety, and Corollary Treatment: A Literary Review”

Author:   Brenna von Hauzen, Converse College

Edited by:  Jacklyn Murphy, Converse College

Over the past century, enormous changes have occurred within the geriatric population and the mental health field of study.  Firstly, the population of geriatric clients has risen significantly, creating a dedicated and specialized field of study within the mental health world.  Secondly, the psychological side effects and symptoms have been reevaluated, reclassified, and identified on a scale relating more to psychological events, rather than in direct relation to a physical event.  Additionally, symptoms and disorders that would not ordinarily fall within the realm of mental health are now being identified and treated by both medical doctors and mental health practitioners. Examples of these unique symptoms and disorders include the rising number of dementia-related medical syndromes, including Alzheimer’s disease.  Therefore, a larger focus has been placed upon the lifelong changes of cognition, and the subsequent effects of these changes.  Additionally, focus is placed upon the frailty of the client, any co-morbid conditions that may occur, and how these change as cognition changes.  The exploration into the topic of cognition and the geriatric world prove to be helpful as mental health professionals look to assist with life-long mental health and wellness. 

For Brenna’s full paper, use this link:

Social Networking: Beyond the Stereotypes

University of Pennsylvania’s Dr. Keith Hampton studies communication technologies and their social impact.  He will be a plenary presenter at the upcoming Fall AAMFT conference, “The Science of Relationships”, in Ft. Worth, TX Sept. 22-25.  For a condensed summary of current research on the impact of social media, see his interview on AAMFT’s website:

Attachment Theory and Play Therapy

Clinical Fellow in Psychology at the Harvard Medical School and play therapy researcher Dr. Anne Stewart integrates attachment theory and play therapy in the Circle of Security model, an evidence-based intervention particularly relevant for children who’ve experienced maltreatment and/or trauma.

On Friday September 16th, 2011, Dr. Stewart will lead a workshop entitled Applying Attachment Theory and the Circle of Security Model in Play Therapy, at Georgia State University in Atlanta.  Students receive discounted registration fees.  More information can be found here