Articles

  • Wednesday, February 01, 2017 11:38 AM | Anonymous

    If you do not create your own estate plan, the law will create one for you at death, deciding which relatives get what portion of your property based on the relationship to you of the family members who survive you (known as "intestate succession").  

    But that plan may not comport to your priorities.  And if you become incapacitated without an estate plan, the law has a process for appointing a person (known as a "conservator") to make financial and personal care decisions on your behalf.  Again, these decisions and the people in charge of this care may not be in line with your wishes.  

    Creating a foundational estate plan ensures that your goals are achieved and that your family is taken care of after you're gone.  

    Having a plan can also protect you if you should become disabled or incapacitated. Below are the four estate planning documents that make up the foundational estate plan

    Living Trust

    A Living Trust allows you to determine how your estate will be distributed and in the vast majority of cases this can be done efficiently without court involvement.  If you have a Will, but not a Living Trust, then decisions about who gets your property can still be taken care of by the Will, but the process for executing your wishes must be supervised by the courts.  

    You also want to prevent disputes among your family members.  Your Living Trust can provide your loved ones guidance and clarification regarding your wishes and if you are concerned about particular disputes, an estate planning attorney can help you create incentives in your plan aimed at preventing strife and litigation.  You can also appoint the person you trust the most to administer your estate.

    Durable Power of Attorney

    The Living Trust is also useful in that it allows a person you trust to manage your property for your benefit (e.g., paying for your care and comfort) if you become incapacitated.  However, in order to have authority to do this, your property must be titled as trust property. 

    A durable power of attorney gives your chosen agent the power to take control of your property that is not titled in the Living Trust.  For example, IRAs cannot be owned by a Living Trust, so it is the agent under the durable power of attorney who might take distributions or make investment decisions in your IRA if you become incapacitated.  This person can make financial and legal decisions for you, so it is imperative that you appoint somebody you trust implicitly.  

    If you have a Living Trust, generally it is a good idea to name your successor trustee(s) as the agent under your durable power of attorney.

    Will / Nomination of Guardian

    If you have a Living Trust, you will need a document known as a pourover will.  This document is essentially a backup document in case you pass away with assets that are not titled in your Living Trust.  It instructs the executor of your Will to transfer any such property to your Living Trust. 

    Parents with minor children can also nominate a guardian for their children through the Will.  In some cases, a Living Trust may not be necessary and a Will may be sufficient for the at-death transfer of your property.  

    As a very generic rule, if you have no minor children, no real property, and the net worth of your assets is below $150,000, a Will may be sufficient for your estate planning needs.  You should consult with a lawyer before deciding whether a Will is sufficient for your goals.

    Advance Health Care Directive

    Your Advance Health Care Directive (AHCD) provides another person with the authority to make medical decisions for you if you're unable to do so. Again, it is vital that you appoint an individual that you trust to act in your best interests.  

    Your AHCD also outlines what you want to happen with your end-of-life care.  You can specify whether you want to receive artificial life support, donate organs, and how your remains are handled (i.e., burial, cremation, etc.).  

    It is imperative that you have open discussions with your loved ones about your wishes.  This will make facing the difficult situation easier and lift the burden of making end of life decisions from your loved ones.

    Estate planning is emotional, but it is one of the best gifts you can give yourself and your loved ones.

    Gadi Zohar, Esq., practices as a trusts and estates lawyer in Palo Alto, California.  He is also an LMFT and CEO of TherapistWill.com, an online professional will solution.  Gadi no longer provides professional psychotherapy or psychological counseling.  

    This article is for information purposes only, and is not intended to be legal advice.  The opinions of the author are not a guarantee of any particular outcome.  For advice regarding your individual situation you should consult an attorney.  Gadi welcomes your calls and emails and states that contacting him does not create an attorney-client relationship.

  • Saturday, October 01, 2016 11:49 AM | Anonymous

    I have been leading group consultation for over fifteen years now and I have come to believe that consultation is the key to a vibrant private practice. Having participated in group consultation since I was an intern in private practice, I have always valued it highly.  It is an excellent marketing and networking tool.  Whether you participate in the chapter’s free Newly Licensed Support Groups, a peer consultation group, or a facilitated Private Practice Consult, group consultation will always be worth the time and/or money you invest.

     Private practitioners who belong to peer consultation groups report such benefits as support for difficult cases, guidance on ethical and professional issues, sharing information, and countering isolation (Lewis, Greenburgh, & Hatch, 1988). 

     We work in a very isolated environment. At times, we can become so overwhelmed with the problems facing our clients, we lose our perspective. Case consultation in a group setting gives you the luxury of several unique perspectives and theoretical orientations.  Often times, clinicians do not see how truly “burnt out” they are and it takes other clinicians to recognize the signs. Group consultation can give you the empathy and support you give your clients. 

    Lawson (2007) found that counselors in private practice engaged in less consultation on average (2.34 hours a month) than counselors in all other settings, including K-12 schools, colleges and universities, hospitals and residential settings, and community agencies. Private practitioners also tended to engage in less peer and group supervision than colleagues in other settings, and in less individual supervision than everyone else except school counselors. 

    All of us in private practice know that it can be lonely at times. Running the business of a private practice, it is difficult to find time to read journals, sign up for CEU classes, and even attend SCV-CAMFT luncheons. Scheduling time to meet with other therapists to discuss cases can be overlooked.  A few minutes in the hallway with a colleague or over the phone, usually will not allow us to address the more in-depth issues we handle alone in our offices. 

    The unique private practice dilemma of financial concerns like budgeting, billing, setting client fees, working with insurance, and renting offices, make consultation incredibly useful.  Private practice therapists always need to discuss how they will handle client referrals and advertising their practices. Consulting with a colleague who already has a thriving practice could be beneficial to MFTs first starting out or looking to improve their practices.

    Your fellow therapists are the only ones who can tell you to call and speak to a CAMFT lawyer. They are the ones who will say,” that’s a CPS report” or “you did the right thing sending that teen to the hospital.” You can always document consultation in your notes on difficult cases, therefore following ethical practices. Most importantly, other clinicians can give you reliable and diverse feedback on your cases.  One of the greatest values in group consultation is that your fellow MFTs can suggest when a case appears out of your scope of practice. 

    Depending on the focus of the consultation, consultants can provide specialized expertise, research knowledge, situation assessment, diagnosis, treatment recommendations, guidance on ethical concerns, and assistance with case conceptualization (Dougherty, 2013). 

    Many of us still remember our intern experience in group supervision.  The camaraderie with our fellow interns, the nervousness in presenting cases, and the security in numbers, propelled us through the process. Group Consultation harkens back to those days with the added burden of paperwork and monetary burdens. The idea of spending more money on another expense or taking time to meet consistently with fellow MFTs may seem superfluous. 

    The opposite is true. Spending the money and time to secure your success is wise. Having the balance in your practice of monthly consultation enables you to get invaluable feedback from your peers. Whether you are discussing a case that has kept you up the night before or addressing an issue with an insurance company, your colleagues have been in your shoes. They feel your pain and your joy. 

    A colleague in your consultation group will have worked with that child psychologist you need for your new child client or know a good software program to keep your practice up and running.  They may have a bookkeeping referral, a masseuse, or a bank that’s friendly. They may know an office in a different town that you are considering or a way for you to become involved in your CAMFT chapter so you can network and meet new clinicians. They will know which CEU classes are boring and which online referral services are worthwhile.

     Group consultation is a safety net.  Each of us has felt overburdened at times with the demands of our practice. More than your family or your friends, your colleagues   will recognize burnout.  They will not hesitate to encourage you to take a vacation or lower your case load. Group consultation can insure your work/life balance. It is well worth the investment of funds and time. 

    Mary Deger Seevers, MA, MFT (CA#35702) has been leading private practice consultation groups in San Mateo for over fifteen years. She is a certified CAMFT supervisor. Her current group meets on Friday mornings once a month. If you are interested in individual or group consultation, please contact her through mary@marydegerseevers.com

  • Thursday, September 01, 2016 11:51 AM | Anonymous

    September was alopecia areata awareness month so I wrote up this article to help educate my colleagues at SCV-CAMFT about alopecia areata, the stages of grief and loss one goes through with this condition, and the power of group therapy to help those who suffer from it and other unique conditions. 

    The beginning of my journey toward becoming an LMFT happened by chance in 2006 when I contracted an autoimmune disease called alopecia universalis (AU).  Alopecia universalis is the most rare form of alopecia areata (AA), which is characterized by rapid and unexpected hair loss over the entire epidermis.  In alopecia areata, the affected hair follicles are mistakenly attacked by a person's own immune system (white blood cells), resulting in the arrest of the hair growth stage.  Alopecia areata usually starts with one or more small, round, smooth bald patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or, as in my case, complete body hair loss (alopecia universalis). Eyebrows, eyelashes, and a full head of hair were all gone in six weeks. 

    Getting AU was like getting a body blow from Mike Tyson.  I was knocked down for the count.  While AU is not life threatening, it is life altering.  Initially, I was determined to defeat the disease with everything modern medicine had to offer.  What I discovered is that the sum total of the medical community's knowledge of AU is that there is no known cause, there is no known cure, and there is no common progression.  All my hair could come back tomorrow, or it could never come back.  No one knows what will happen or why it happened.  I found AU to be a psychological minefield, very hard to wrap my brain around.  I had now officially entered the world of grief & loss.  All the stages were there for me: denial, anger, bargaining, depression, and finally acceptance.  It took me four years to reach the acceptance stage.  But first, let’s go back a few stages. 

    One may think, why was this so hard for him?  There are plenty of bald men out there, and the bald look is in.  This perception is one of the many reasons why this condition is so hard.  People that don’t have alopecia areata have a hard time relating to the struggles of those that do.  Alopecia areata is so difficult, in my opinion, because it has to do with a loss of identity.  Whether we want to admit it or not, physical appearance is a huge part of one’s identity in today’s society.  Nothing defines our physical appearance more than our hair.  Take away our hair and we are unrecognizable.  This rapid and dramatic change in physical appearance wreaks emotional havoc.  Initially I felt AU was a horrible condition and a big black cloud that one-day just invaded my life.  I went into a deep depression. My usual sources of support weren’t helping.  The doctors couldn’t help.  Friends and family, while they cared deeply about me, could not seem to say the right words.  I heard things like “it’s only hair” and “it could be worse.” 

    The way I got better was with the help of a decent psychiatrist, a good psychologist, and even better group therapy.  The psychiatrist prescribed anti-depressant and anti-anxiety medications in the beginning.  Not wanting to take medications for the rest of my life, I found that hypnosis, combined with cognitive behavioral therapy, enabled me to cope in such a way that medications were no longer necessary.  Psychological counseling helped but the biggest turning point occurred when I went to a support group meeting in San Francisco and met people going through the same struggle, people like me.  I was no longer isolated and all alone.  Being able to process the emotions with people who understood was invaluable.  

    Emotional treatment is the only reliable and effective treatment that currently exists for AA.  Other alopecians were the main source of support for me on my road to recovery.  I found another support group at Stanford for parents of children with alopecia.  Soon I began to realize that I had AA, but AA didn’t have me.  I started to volunteer at the National Alopecia Areata Foundation (NAAF) offices.  Every year, I would attend the annual international NAAF conference and find healing amongst the 800 or so bald, men women and children that took over the hotel.  I have now been to eleven NAAF conferences, each one an anniversary reminder of my new identity.  

    The first four years I went to the conferences for myself, to get help.  Slowly, I started to feel ok about my condition.  The next four years I went to support NAAF by selling T-shirts and to see my new set of bald lifetime friends.  In the middle of all of this grief and loss, I found a new purpose in life.  Instead of selling high-end sports art, I decided to help others struggling in life.  I left my career in retail, went back to school and eventually got my LMFT#92542.

    Today I am a co-facilitator of the SF support group, a NAAF phone contact support person, and the last several years I have lead support groups at the annual conference.  The group that I originated at the NAAF conference is called “It’s OK to Feel Sad” and it’s about the stages of grief and loss associated with this condition.  I do a brief slide show with much of my own experience with AA included and then we circle the chairs to talk and process the emotions.  The main message of my presentation is that AA is really hard and that we shouldn’t try to conduct “business as usual” in our lives, that we should allow ourselves to feel the sadness.  

    In my opinion, denying the sadness will block us from progressing through the stages of grief & loss.  These groups are powerful.  The last couple of years I have lead groups of teens, tweens, and parents of children with AA.  In addition to grief & loss groups, I also lead other groups like “Relationships & Intimacy and AA”; “It’s Hard for Men Too,” and “Living the Active Life with AA.”  As you can see, the lemons of alopecia areata have turned into lemonade for me.  At this point, as strange as it may sound, I wouldn’t take a cure pill if one were available.  

    Matt Kelley, MBA LMFT#92542 has a private practice in Menlo Park where he works with teens, individuals, families and couples and his subspecialty is alopecia.  If you’d like to know more about alopecia areata, alopecia universalis, or any of the support groups you can contact him at (650) 319-6814 or through his website at www.stanfordtherapy.com.

  • Friday, July 01, 2016 11:59 AM | Anonymous

    At this point, it seems to me that following the rules of conventional article writing is useless.  I’m done with the rules.  Why?  Because you still don’t have a professional will.  (For the tiny minority of you who do have a professional will, I’m not talking to you.  I’m talking to just about everyone else.)  

    I’ve written articles in third person with citations.  I’ve shared real life stories of people who died without a professional will and my advising their survivors that they need to start the statute of limitation clock ticking, because someone can now sue the estate for malpractice.  I’ve cited to real cases where estates were sued for negligence for much less than failing to leave a professional will.   (There’s a citation for you.)  I’ve explained to people how the law creates a right to sue your estate for your malpractice even if you’re dead.   (There.  I just did it again.)  I’ve given talks.  Advertised in The Therapist.  Maybe I just need to break the rules and tell it like it is.

    Do we really need to wait for a colleague to die and cause “newsworthy” damage from failing to leave a professional will?  Because it seems to me that even a death of a colleague alone isn’t even enough to motivate most people to get this done.  Every time I mention this topic to a group of therapists, someone walks up to me with a story of how a colleague died without a professional will and the aftermath was trying for that person’s survivors.  

    What’s it going to take to get you to sit down and get your professional will done?  Hopefully this article will do it, because that’s my ultimate goal here.  Maybe you’re annoyed by my tone right now, but I hope you don’t use that as your excuse to continue putting this off.  Clearly I’m not trying to win a popularity contest.  You can focus on my tone or you can focus on getting your professional will taken care of once and for all.  You decide.

    I do not recall knowing about professional wills when I was practicing as an LMFT.  Maybe you’ve been in the same boat until this moment.  I happen to be a wills and trusts attorney and that is how I came to realize the gravity of this issue.  

    Professional Wills 101: Why You Need One

    If you’re not informed about professional wills, I’ll give you the quick explanation now.  CAMFT Rule 1.3 effectively requires that you create a professional will.   Unfortunately there are no guidelines for what a “professional will” should look like.  On top of that, a Licensed Marriage and Family Therapist must maintain clinical records (in accordance with HIPAA of course) for a minimum of 7 years after termination of treatment.   In the legal field, a common truism is that without a remedy, there is no law.  In other words if I say “stealing is illegal” but there is no legal consequence for stealing, it’s effectively legal to steal.  The converse applies here.  There is no statute that says you have to have a professional will per se.  But the rules and laws cited in this paragraph that create a remedy – you or your estate can be sued if you fail to create a professional will.  These rules and laws are the basis that forms a de facto requirement that you create a professional will.  Because if you (or your estate) can be sued for not doing it, you’re effectively required to do it.  Thus I would submit that where there is a remedy, there is a law.

    But do you really need rules and laws here?  I’m going to take a leap here and guess that you genuinely care about your patients and loved ones.  I know you do.  For no other reason than you just plain care.

    Recommended Content for Your Professional Will  

    The point of a professional will is straightforward.  If you die or become incapacitated, a clinician needs to be assigned to refer your patients out to appropriate care as soon as possible.  And then someone needs to take control of your clinical files in accordance with relevant privacy laws.  It’s a lot better for everyone if you leave some basic instructions.  Enter the document we’re calling a “professional will.”  Although I am not the biggest fan of the “DIY” approach for this type of thing, I’d rather you do it yourself than do nothing if those are the only two options.  So I’m giving you some guidelines.

    There is no particular set of rules dictating the elements necessary for a valid professional will.  But I’ll give you one imperative: Don’t over think it!  I’ve seen too many people get mired in thinking of just the right clinician to refer patients out, contacting the clinician, considering what to do about a funeral service, etc.  Done is better than perfect.  Get something done now and do your deep thinking later.  The purpose and nomenclature tells us that a professional will is substantially similar to a will or living trust that an estate planning lawyer would create.  Years of experience (and litigation) have yielded a number of best practices for drafting wills and trusts, which I have adapted into my recommendations for your professional will.  Some of these best practices in the context of a professional will can be summed up as follows:

    1. Identification of the creator.  It is a good idea here to use the name most people know you by, whether or not that happens to be your legal name.  You should also include your office address(es), and license number(s)  so that it is absolutely clear who you are.

    2. Appointing a “clinical executor.”   Generally, attorneys advise that only one person act as executor, because one does not want to slow down the administration process with disagreements among multiple executors.  This is not to say that the executor is not allowed and encouraged to seek outside assistance.  But there should be one person who has the final word where judgment calls are needed.  You should also name at least one and preferably two alternate clinical executors in case your first choice can’t/won’t act.

    3. Authority of the clinical executor.  The clinical executor should have express authority to access physical and electronic clinical files and to contact active patients.  It is always a good idea to spell that out, since this is probably the clinical executor’s most important function.

    4. Outside assistance.  This is very important in my opinion.  You should take steps to ensure that the clinical executor has quick access to clinical files.  It may be a good idea to name one or two people (a family member or close friend) who can help with non-clinical issues like access to the premises where clinical files are located and reimbursement for out of pocket expenses. 

    5. Compensation of the clinical executor.  This is tricky, because a professional will does not necessarily have the same force and effect of a traditional will.  Nevertheless, I feel strongly that some intent and authorization (whether or not legally enforceable) should be expressed for the compensation of the clinical executor because he or she is taking on personal liability by referring patients and taking possession of patient records.

    6. Overriding clauses.  Estate planning attorneys make a lot of money off of people who try to do their own estate planning, because often in such cases people write in terms that are unclear, incomplete, or unlawful.  This risk can be somewhat mitigated by clauses that instruct clinical executors to override any directives that turn out to be unlawful, unethical, or inappropriate under unforeseen circumstances.

    Estate planning attorneys could add many more terms like a HIPAA release in case of incapacity to permit doctors to speak with your clinical executor, various contingency clauses, and so on.  You should seek professional help from an attorney or an attorney-created template in order to incorporate some of these more technical clauses.

    Frankly, having a non-attorney complete this task makes me nervous.  I see a lot of plans go bad when people do their own estate planning.  But I’d rather you do it yourself than do nothing.

    Just get it done.  PLEASE!

    I have thought long and hard about this both from the perspective of a former clinician and as a practicing trusts and estates attorney.   I don’t need to preach to this audience about the tendency to avoid the topic of our mortality.  I’m not throwing stones from my glass house.  But at a certain point, you just have to sit down and get this done, because your patients and loved ones are counting on you.  Now it’s up to you.  You can focus on my unprofessional tone.  You can put this off for tomorrow.  Or you can do a little research and get this done.

    Gadi Zohar, Esq., LMFT is the CEO of TherapistWill.com, an online professional will solution.  He also practices as a trusts and estates lawyer in Palo Alto, California.  He no longer provides professional psychotherapy or psychological counseling.  This article is for information purposes only, and does not constitute an attorney-client relationship.  The opinions of the author are not a guarantee of any particular outcome.  

  • Wednesday, June 01, 2016 11:55 AM | Anonymous

    On September 12, 2015, just 35 miles northeast from my home, the Valley Fire began in Lake County; by evening it exploded to 10 thousand acres. The following morning I walked outside and smelled smoke. I checked online and discovered nearly the entire community of Middletown, California had been immolated while I slept. 

    The fire grew to a massive 76 thousand acres throughout Lake, Napa, and Sonoma counties. The Redwood Empire CAMFT (RECAMFT) Chapter serves those counties along with Mendocino county. A massive crisis was looming, and RECAMFT had no plan in place for how to assist those traumatized by the fire. 

    With some 40,000 California Licensed Marriage and Family Therapists (LMFTs), LMFTs represent the largest group of mental health providers in the state. Our training in family systems gives us a unique edge whether serving families, children, elders or first responders who have seen too much. LMFTs need to be networked into our local emergency response systems so when disaster strikes, we are prepared and trained to answer the call.  

    Crisis response mental health interventions are different. First we assess the basics: shelter, food, first aid, water. Once we have people’s survival needs addressed, we provide psychological first aid – normalizing the experience of those suffering acute stress. After the crisis is over, some who suffer posttraumatic stress symptoms will seek us out for additional services. Reactions vary given the impact of the crisis (for example, losing a loved one or one’s home will likely be far more stressful than simply being displaced for a time). 

    Our nation was shocked by the terrorist attack in San Bernardino on December 2, 2015. Inland Empire CAMFT Chapter was suddenly in the same place RECAMFT had been - a disaster unfolding with no chapter trauma response team. 

    • CAMFT Chapters are in a unique position to lay the groundwork for a disaster mental health team in every county. Every CAMFT chapter can take a lesson from RECAMFT and IE-CAMFT and start a crisis response team now. My wish is for every LMFT to take at least one continuing education (CE) class in disaster mental health counseling in the coming months.
    • RECAMFT worked quickly to provide services to the community, identifying those trained in crisis response, and ultimately creating a list of over 50 members willing to give 3-5 sessions of free counseling to anyone affected by the fire. Chapter member, Doreen Van Leeuwen, subsequently took on the task of organizing a chapter crisis response team. It starts with every willing LMFT joining the Red Cross, taking their disaster mental health courses, and FEMA’s free online classes. The chapter crisis response team will organize additional training, communication trees, and network with county agencies.
    • Marin CAMFT has had a trauma response team for two decades. They have responded to traumatic deaths, child abductions, shootings, earthquakes, fires, and floods. The Marin trauma team chair, Jacque Ladrech, is a wealth of friendly information and advice.

    CAMFT’s Crisis Response Education and Resource Committee (CRERC) provides outstanding resources on the CAMFT website, including links to pertinent trainings. The people on this committee are some of the top experts in the state. CAMFT’s Annual Conference will be an opportunity to get training in disaster mental health. After my initial shock about the smell of smoke, I found myself on the phone with people who knew exactly what to do, and gave great advice. It was a comforting feeling, in the face of a fire burning out of control.

    Chris Hadfield said, “Ultimately, leadership is not about glorious crowning acts. It's about keeping your team focused on a goal and motivated to do their best to achieve it, especially when the stakes are high and the consequences really matter. It is about laying the groundwork for others' success, and then standing back and letting them shine.” 

    The stakes have never been higher or mattered more. Together we can bring our talent and expertise to shine in our local communities when disaster strikes. 

    Laura is a Licensed Marriage and Family Therapist (MFC 49174), Licensed Professional Clinical Counselor (LPC 149) and Certified Rehabilitation Counselor (CRC 00113822).  She is in private practice in Santa Rosa and specializes in trauma utilizing Stanford cue-centered treatment along with transformational sandplay and EMDR.  She is a member of the Redwood Empire Chapter and is currently president of CAMFT.

  • Wednesday, January 28, 2015 8:43 AM | Deleted user

    Assembly Bill No.1775 was signed by Governor Brown on August 22, 2014 and became effective January 1, 2015. This bill amends Section 11165.1 of the Penal Code relating to the existing Child Abuse and Neglecting Reporting Act: Sexual Exploitation.

    The purpose of this update is to provide you with information about how this law impacts our profession and assure you that SCV-CAMFT will be monitoring events as they unfold.

    Today I spoke with CAMFT attorney Ann Tran regarding this new law and below is a summary of our conversation.

    Penal Code Section 11165.1 does not specifically include Internet usage of child pornography within the definition of “sexual exploitation” because it was written before the prolific use of the Internet and does not reflect modern technology.

    Prior to the passage of this law the existing law, known as the Child Abuse and Neglect Reporting Act, defines sexual abuse as sexual assault or sexual exploitation for purposes of mandating certain persons to report suspected cases of child abuse or neglect. Under the act, sexual exploitation refers to, among other things, a person who depicts a child in, or who knowingly develops, duplicates, prints, or exchanges, a film, photograph, videotape, negative, or slide in which a child is engaged in an act of obscene sexual conduct, except as specified. Failure to report known or suspected instances of child abuse, including sexual abuse, under the act is a misdemeanor.

    The passage of this new bill provides that sexual exploitation also includes: A person who knowingly downloads, streams, or accesses through any electronic or digital media, a film, photograph, videotape, video recording, negative, or slide in which a child is engaged in an act of obscene sexual conduct. The bill imposes a state-mandated local program because it expands the scope of a crime and imposes additional duties on local officials.

    A Question about Sexting: Ann Tran said child sexual abuse reporting has always included sexting. Sexting includes printing, duplicating, downloading, a photograph in which a child is engaged in sexual conduct. However, there are a lot of interpretations, and it is not very clear when a report is required.

    I posed a couple scenarios and Ann responded:

    • If a minor is “sexting” a photo of herself in bra & panties to her boyfriend and she is not posing in an obscene manner, that may not be reportable.
    • If a minor sends a photo of herself nude, or posing in an obscene way, the exchange of those photos is reportable and was always reportable, even prior to the passage of AB1775.

    Law enforcement would say yes, sexting in both instances are reportable. Some therapists may say no, Item 1 is not reportable, because the example states she is NOT posing in an obscene manner. However, it becomes a problem if the boyfriend then forwards the photo to others.

    Regarding scenarios 1 and 2 above, according to Ann Tran, both are reportable because the law applies the words “a person” to the minor who “depicts a child in . . .” by sending the self-photo.

    However, here’s an interesting note: Texting sexual content (using words) is not reportable, according to Ann Tran.

    Should you report? Yes, if you make the report you’re protected. If you don’t make the report you can be fined or charged with a misdemeanor, or reported to the Board. And although it can have an impact on the therapeutic relationship, the law requires a report.

    This is a new law and there are a lot of concerns. How does reporting a teen sexting a photo to a friend impact that young person’s future? There is concern among therapists with specialties in sexual addiction and those who work with sex offenders. How are they able to help their clients if they are mandated to make a report for downloading images electronically?

    A Petition for Writ of Prohibitory Mandate, Request For Immediate Stay of A.B.1775‘s Amendment of Penal Code Sections 11165.1, Subd. (C) has been filed. It will be going through the court system and there may be changes. But in the meantime, we must follow the current law, which became effective January 1, 2015.

    You can read more about AB1775, the Petition, and various articles at the following link http://stopab1775.org/articles/

    I asked Ann about the contents contained in the above link and she stated the site is a good source of information regarding this new law. She also stated that she disagrees with a few opinions in some of the articles there and cautioned readers to keep each author’s perspective in mind while reading.

    This law is generating much discussion. With so many moving parts, information about the law may be confusing and vague. It will be interesting to see what happens when the Petition is heard in court. SCV-CAMFT will be monitoring it closely.

    In the meantime, feel free to use the chapter exchange to share new information you may receive or new links that may be beneficial for our membership regarding this new law.

    Disclaimers:

    • With respect to the discussion of legal and ethical issues affecting the practice and business of marriage and family therapy, SCV-CAMFT encourages members to consult with CAMFT legal staff, the CAMFT Executive Director, or a personal attorney if they are seeking information or consultation on a particular matter.
    • SCV-CAMFT is unable to analyze the contents of all the information posted on links or within the chapter exchange by our members and therefore, cannot guarantee the accuracy of any information or facts.
    • SCV-CAMFT accepts no responsibility for the opinions and information posted within these links or within the chapter exchange by members.
    • SCV-CAMFT in no way endorses or expresses any opinion with respect to any information or opinions mentioned in any of the links provided.
    • Members who rely upon information obtained through the Internet, mailings or within the chapter exchange do so at their sole discretion and their own risk.
  • Saturday, August 02, 2014 8:44 AM | Deleted user
    The SCV-CAMFT Board of Directors respond to CAMFT's proposed CAMFT Chapter Agreement. Members can view this PDF document, Click to view PDF.
  • Thursday, October 18, 2012 8:54 AM | Deleted user
    In the last newsletter, we discussed the fact that in order to ensure complete psychological healing, we must heal not only the original core wounds, but also all the defense mechanisms that the person has created to protect themselves from feeling those core wounds. Those defense mechanisms can be quite complicated. They are often organized in layers, with each layer imperfectly solving the problems created by the layer just beneath it, and leaving problems to be solved by the layer above it, or not solved at all.

    I presented a simple map for understanding the various layers of defense mechanisms. Starting with the simplest and proceeding to the most complex, it looks like this:


    I hasten to point out that in real life the different levels and layers are not so distinct and separate, and one level may blur into another. Keeping that in mind, let's go through the layers one at a time and unpack each one.

    In the last newsletter, we discussed in detail the first and second levels of trauma defenses, the levels of phobia and trauma. Now let's explore the third and fourth levels.

    The 3rd Level - Addiction
    At the third level, where we find addictions, we have all the trauma and defenses of the second level, but they are now buried under an additional layer of defense, an habitual behavior that serves to numb the person to the pain and anxiety of the core trauma. Here, the person's solution to the underlying problem has itself become a problem. Usually, people come for help with stopping the addictive behavior, completely unaware that it is their medicine for a deeper wound, and that we must heal that deeper wound to really cure the addiction.

    The numbing agent may be anything. Some of the favorites are alcohol, drugs, food, sex, work, money, success, fame and popularity. But any substance or activity can be used, as long as it works well enough to dull the feelings from the trauma. What makes the behavior addictive, is that it is being used to dull the person's feelings. And what makes all addictive behaviors ultimately unsuccessful is the fact that “You can never get enough of what you don't really want.” If what you really want is to feel loved, there is no amount of food or drugs or money that will give you that feeling. If what you really want is healing for the original hurt, there is no amount of anesthesia that will work. Sooner or later, the numbness wears off and the hurt returns.

    The extra layer of defenses makes the whole process of healing that much more complicated.

    In addition to healing the original core wound, and the feelings, beliefs, and identity arising from it, the addictive behavior itself must be addressed. Typically, the addictive behavior has several components, including the craving for the drug of choice, the situations that trigger the craving, the habit of self-medication for the craving, and chronic psychological reversal, which supports the belief that this behavior is a good choice. All of these parts of the addiction are interwoven and mutually re-enforcing, which makes them very hard to untangle and dissolve.

    The 4th Level - Self-Defeating Behaviors
    The 4th level is the deepest and most difficult to change, because here a deeper and more effective numbing process has been added to the usual layers of trauma defenses, and there may be active addiction as well. This additional layer of defense is an unconscious, automatic habit of selfnegation. Self-negation is a much deeper and more damaging habit than addiction, because while addiction tries to bury the pain, self-negation tries to bury the self. It does this by stifling all the expressions of the self, such as initiating actions, having preferences and desires -basically all assertions of personal will.

    Why would anyone adopt a habit of negating their own impulses, or of preventing their own self-expression? Like all defense mechanisms, it was the best solution the child could find for the problems they faced. In this case, the problem was a parent who could not tolerate the child's developing sense of will, separateness, and autonomy. To prevent this development, the parent set out to break the child's will by actively punishing the child's expressions of his own will and autonomy.

    Today, such actions may seem bizarre or unusual, but during the 1800's and early 1900's, this practice was the norm. Most books on child-rearing from that era state that it is the parents' duty to break the child's will in order to civilize it. Although the instructions in child-rearing manuals have changed, there are still many parents who were brought up this way, and therefore cannot tolerate the development of a separate will in their child.

    The core wounding usually goes something like this: around the age of two, the child naturally becomes aware of its separateness, and begins to express its will as different from the parents’. Instead of supporting the child's budding autonomy, the parent opposes it, using guilt, shame, manipulation, over-control, and often outright violence. At first, the child fights back, asserting its own will in opposition to the parents’ will. But the parent is bigger and stronger, and willing to escalate their reaction as far as it takes to force the child's compliance. Time after time, the child loses the fight. Eventually, the child concludes that “I can never win and any assertion of my bring more punishment.”

    So, the child does the only thing that will stop the pain - it turns its own will against itself, and stops itself from feeling or expressing its own impulses, desires, and autonomy. It learns to automatically defeat itself before the parent can defeat it. This is the habit of self-negation. This habit then organizes the child's psyche and identity so deeply that the behavior persists long after the child has grown up and left home. Even as an adult, impulses and desires are derailed before they reach the surface and find expression. Projects are begun, but somehow never completed. Situations that would draw attention or praise are avoided, since those were the moments that also brought humiliation. Little is desired or accomplished.

    These are the clients who have a reputation for defeating their therapists by somehow not changing, even when they want to change. They have painted themselves into a very tight corner. Under the self-negatio,n there is an ocean of pain and rage at the way they were treated. But the selfnegation is what protects them from all those overwhelming feelings. It is their medicine; their drug of choice. Selfassertion re-awakens the old fear of punishment, and being seen as successful can be terrifying. And besides, they have never gotten what they wanted before, so why would they think that they will get it now? For them, the only way to avoid losing big is to continue losing small.

    How, then, do we help someone who is stuck at this level? First, we need to recognize early on that self-negation is present so that we don't play into the try-and-fail pattern, and end up reenforcing it. Instead, we need to recognize the need to refuse to change, and give it a voice. Carol Look has beautifully laid out one way to do this in her Refusal Technique*. I find this technique very effective, both to break the logjam, and to confirm that selfnegation is the issue. If it is, doing the Refusal Technique will cause the client to become more animated. In fact, they often break into peals of laughter at this permission to finally say out loud what they have felt in silence for so long. This release may continue for a long time as they vent the pressure they've been carrying inside for years. And you may need to return to the Refusal Technique repeatedly, whenever the logjam reappears.

    Since they are profoundly psychologically reversed*, I suggest also applying the un-reversal technique early and often. Their system is accustomed to being reversed, and you must help it gradually re-orient itself to being in alignment.

    As you work down through the layer of self-negation (even temporarily), you can begin to address the underlying traumas, and the specific incidents that led them to employ self-negation in the first place. If addictions are present, you will also have to address them at some point, although this will be much easier if you can collapse the underlying traumas first. The person's identification with being “the loser” will also need to be addressed.

    It will likely be a long and twisting road, but if you understand the function of self-negation in their psychic economy, you will make real progress.

    Looking back over these four levels of trauma defenses, we can see how they are laid down, each one on top of the one below, each layer trying to solve the problems left by the previous layer. With this map in mind, I hope you will find it much easier to understand and heal the various trau- mas you and your clients encounter.

    * Psychological reversal and the Refusal Technique are explained and taught as part of EFT, but explaining them here is beyond the scope of this article.

  • Saturday, September 15, 2012 8:58 AM | Deleted user

    As an intern with less than half my 3,000 hours completed, I can say that the whole process at times seems overwhelming. The intern experience is awful and wonderful at the same time. Three thousand hours is an awfully large amount of time, but it gives me the space to ponder about some of my most wonderful and unique intern experiences. I’d like to tell you about one of those internships that I just completed.  

    I have just completed an internship at the Santa Clara County Suicide and Crisis Service (or “SACS” for short). Prior to taking my 4-hour shift, I went through 80 hours of training which was very intensive, thorough but definitely worth every minute. So, before I actually sat down to man the phones, I was well prepared to handle most any situation that would come up. Of course, there is no substitute for experience. The phone experience of talking to SACS’ callers is so unique that I feel compelled to share it with you. 

    Talking to SACS callers has given me the opportunity to be with ‘clients’ in totally different ways from how I was trained in graduate school. Even though they are not technically clients, and I am not technically practicing psychotherapy on them, they have given me much to wonder about. One of the things that I wonder about is the anonymity of the faceless and unobservable caller. For all I know he could be wearing slovenly clothes, unshaven and smell like stale cigarettes with a smile on his face while describing the death of his beloved basset hound. Conversely, the caller might be wearing designer clothes, flashy jewelry and sitting with her I-phone by the pool outside a million-dollar mansion while sobbing about money problems. As a SACS volunteer, all that matters is what I hear the client telling me. This contradicts some of my own training: Don’t listen only to the client’s story; observe your client’s actions. This unique SACS experience makes me wonder if pure listening frees me to hear these “Invisible Clients” in different ways.

    Unburdened by visual observations which may become distractions, I listened to the client’s words without prejudice. I remember one caller who was very hard to comprehend. He was rambling on and on about people following him and they were ‘out to get him’. As I was listening to what he was saying, I began to realize that some of it began to make sense. Amid his ramblings, he was able to tell me how he wanted to visit his family, but he knew that in doing so he would only embarrass them. By focusing without distractions on what he was saying and how he was saying it (using only my ears), I could actually make some order out of his verbal chaos. 

    Many SACS callers are people who call many times each day every day. Some of these “regulars” have been calling for years. Again, I wonder about anonymity and what it means to them. These callers know that the volunteers can’t see them thus judging them on behaviors or looks. I wonder if this frees them to talk about their situation in different ways than if they were face-to-face with the other person. 

    Have you ever seen a radio personality that you have only heard for a long time, and when you finally saw him you were surprised by how he looked? He was completely different from what you imagined. You might now think of him in a different light.  So as I worked at SACS, where you talk to people you never see, I started to wonder about listening to people without physically observing them. Would I hear them differently if I actually saw what they looked like? 

    Now, I know a ‘good’ therapist does not just listen to the content, flow, quality and connectivity of the client’s speech. He also observes affect, body posture, behavior, etc.  But my experience at SACS makes me wonder: What if we listen to our clients without all the distractions of body image, eye contact, affect, prominent physical abnormalities …. What if all we had to analyze was our client’s voiced story? Would we be surprised by our Invisible Client?

    Submitted by,
    Janice Shapiro, MFT Intern

  • Monday, January 09, 2012 9:00 AM | Deleted user

    For most new mothers, the days, weeks and months following the birth of a baby are challenging and exhausting.  And for some new moms the postpartum experience actually results in a crisis and a real collapse of self.  I believe this subsection of new mothers who suffer so intensely in the postpartum period might be more deeply understood and more successfully treated if we consider them through the lens of character style, and in this case, specifically the oral character style.  

    During the symbiotic phase of development, “there is no conscious differentiation between oneself and one’s caretaker” (Johnson, 1994).  The infant experiences the mother as its self, and the mother too has a sense of sharing her infant’s experience.  This symbiosis is critical to survival in that it forces the mother’s attention to be always on her newborn in a way that helps ensure proximity and acute awareness of the newborn’s needs.  Our earliest psychological developmental task is embodying the capacity for attachment and bonding (Johnson, 1994); failures in this period result in schizoid and oral adaptations in the fundamental structure of the infant and later the adult.  For mothers who suffer greatly in the months following birth, I believe it is often the case that their own early infancy was fraught with either harsh, aversive parenting or deprivation and unreliability.  It’s almost as though the birth of the baby forces the mother back in time to when she herself was an infant.  If the mother was well cared for by an attuned, consistent, responsive other, that newborn part of her will likely be well resourced and able to draw from her own full tank.  But a mother who did not herself receive the kind of attuned and empathic responses that a newborn requires for optimal development will find herself overdrawn and out of gas as she tries to nurture her own new baby.  The meaning that she makes of her struggle and the way in which she responds to the crisis also tend to fall in line with her established character style.  

    The central theme of the oral character’s life is denial of her needs.  “Orality will develop where the infant is essentially wanted and an attachment is initially or weakly formed but where nurturing becomes erratic, producing repeated emotional abandonment, or where the primary attachment figure is literally lost and never replaced.  Essentially the oral character develops when the longing for the mother is denied before the oral needs are satisfied” (Johnson, 1994).  As an adult, the oral character suffers from “the inability to identify needs, the inability to express them, disapproval of one’s own neediness, inability to reach out to others, ask for help or indulge the self.  The individual tends to meet the needs of others at the expense of the self, to overextend and to identify with other dependent people” (Johnson, 1994).  Her false self appears to be nurturing and helpful, but in truth she is desperate for the kind of sustained care and love she never received.   This false self is her “compensated” self – that part of her self that has learned how best to function in a world where her needs could not be met by being helpful to others and denying her own longing.  She also has a “collapsed” self that emerges when the compensation fails, such as in the postpartum period.   

    The postpartum period is a time when mother and infant need an extraordinary amount of external support.  Oral characters tend to find themselves in cultures that are consistent with their own style, meaning there generally aren’t supportive systems in place.  Consequently, as the new mother is coming into a psychological reexperiencing of her old injuries from her early infancy combined with absolute need for support in the present time, she experiences herself as alone and as burdensome and is re-injured in the same manner that caused her orality.  

    The therapeutic aim in working with new mothers who are suffering in the postpartum period is to assist them in identifying resources and mobilizing adequate support as quickly as possible.  This can be quite challenging when working with women who fundamentally don’t know how to ask for what they need and don’t feel entitled to receive what is offered.  In her collapsed state, mom must be encouraged to go ahead and ask for and take in some of what she has always longed for and what she has secretly been enraged about never having received.  I find it necessary to bluntly state and firmly repeat a sort of mantra to these new mothers attesting to the naturalness of their immense needs in the postpartum period, the idea that mom is of little use to baby when mom is undernourished on any level, and also an ongoing, exhaustive review of all of her potential resources.  Allowing feelings of need and longing to emerge, to be named, felt and then grieved is the beginning of a transformative healing process.  We are gifted as mothers with an opportunity to readdress our early attachment wounds through the process of bonding with our own babies.  But as adults we now have the power to bring words and consciousness to the experience so that we can affect the outcome in ways that are consistent with our deepest values.  

    Author: Jessica Sorci, MA, MFTI

    References
    Johnson, Stephen M. (1994). Character styles. W. W. Norton & Company.

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