Los Angeles Chapter — California Association of Marriage and Family Therapists
Voices — October 2019
Christina Castorena President, LA-CAMFT
Dear Friends and Colleagues,
As we head into Fall and start getting out our therapy sweaters and drinking our pumpkin lattes. I just want to take a moment to share LA-CAMFT’s successes for the month of September. We had a wonderful networking event with over 80 attendees! We invited Dr. Barbara Nosal from Newport Academy to present on healing trauma through authenticity and authentic connections. Her presentation focused on attachment and how it impacts our relationships. The feedback was incredible! Thank you to our sponsor Angela L. H. Sayers, CPA, MBA. Her financial tips were very helpful and were just a fraction of the accounting information she has to offer.
If you missed out on our September networking event, you still have a chance to register for our October networking event. Dr. Myriam D. Savage, Ph.D., RDT-BCT and Danielle Levanas, MA, LCAT, RDT will be exploring the concepts of power and oppression through drama therapy. The event will be sponsored by Brighton Recovery Center.
Another success I’d like to share is the Diversity Committee’s first workshop! We held it on the same weekend as our networking event (what a weekend!). The goal of the workshop was to explore the influence of LGBTQ intersectionality in therapy. Our four panelists, Harpreet Malla, PhD, Stara Shatki, MA, AMFT, Andrew Sage Mendez-McLeish, MEd and Joe Garza, MA, AMFT offered professional guidance, interventions, vignettes and personal experiences to help inform treatment for people who are experiencing overlapping and interdependent systems of discrimination or disadvantage. It was such an honor to hear their stories and get to know a little about them. I know I walked away from that workshop with a greater understanding of intersectionality and the impact it has on many of my clients and also on my own life.
This workshop was not only the first workshop developed and carried out by the Diversity Committee it was also the first workshop that LA-CAMFT provided on the East side of Los Angeles. I want to thank the committee, Janaki Neptune, Christina Cacho Sakai, Marvin Whistler, Ava Shokoufi, Chasity Branner and Randi Gottlieb for all their hard work in creating this very important workshop for our community. In addition, special thanks go to Marvin, Ava and Chasity for recruiting our panelists and organizing the event. Thank you to the Violence Intervention Program (VIP) for allowing us to have the event at their state-of-the-art facility. The space was beautiful and the services that VIP offer are critical to the community.
I am very proud of all the volunteers who comprise LA-CAMFT and all the resources that they develop and offer to our community of healing professionals. If you’d like to be a part of this compassionate community please visit our website at www.lacamft.org and reach out to one of our board members to see how you can get involved.
Best Regards,Christina Castorena, LMFT
Christina Castorena, MS, LMFT, worked in community mental health before starting her private practice, Castorena Therapeutic Services, in 2016. She passionately serves adults, couples, and members of the LGBTQ+ community who are dealing with life transitions, parenting, relational conflicts, and anxiety. She employs family systems and mindfulness-based CBT. As president of LA-CAMFT, Christina strongly advocates for her professional community and celebrates the hard-working clinicians that facilitate healing. Her website is castorenatherapeutic.com. Christina may be contacted at president@lacamft.org.
Lynne Azpeitia, LMFT Voices Editor
Getting Paid: Talking Fees, Pricing, PricesThe Words You Use to Talk to Clients About Money Matters in Therapy Do Make a Difference
As a mental health professional, the words you use in money conversations matter to you, your clients, your colleagues, your employers, and to your therapy practice. When communicating about money and therapy services it pays to pay attention to the language we use in our clinical role because the meaning our words convey can either increase or decrease the amount of money you are paid as a therapist. Yes, the words and phrases you use truly contribute to the bottom line of your therapy practice.
This is the second article in a series on getting paid and talking with clients about money. If you’d like to read more, here’s the first article: Getting Paid: Talking with Clients About the Price & Value of Therapy.
Money Talk: Words & Phrases to Consider
Let’s look at some of the words that can make a difference when a clinician talks, writes, or communicates about therapy money matters—and how and why these words can affect the amount a person is willing to pay for the therapy services you provide as a clinician.
This information applies equally to face-to-face conversations in real time or virtually, to emails, texts, phone calls, social media postings, and what’s printed in marketing materials or is on your website. Yes, each one of these words and phrases can have a direct effect on the perceived value of the services a therapist provides and the amount a client is willing to pay you for the clinical services you provide.
As you read the following information, be sure to remember:
My fee . . . I charge . . . What I ask is . . . What is your fee? How much do you charge? What do you charge?
Do clients pay you or do they pay for therapy services or the sessions you provide?
The fact is that most clients don’t really want to pay you. Clients want to pay for therapy or services or for the help and expertise that a therapist provides. When therapists pair the words, “I, me, mine, you, your,” with fees and pricing it can make paying for therapy seem like a personal interaction instead of a professional one. Many clients will pay less or feel reluctant to pay for what seems like a personal transaction of caring and help
When a therapist uses the words, “I charge,” people unconsciously think, “Ok, you charge that; how much do others charge?” Saying what you charge sounds like it’s arbitrary and negotiable. When clinicians use the term, “my fee,” the same principle applies.
Making one small change—using the word “the” in place of “my, me, mine, and I”—works surprisingly well to communicate a professional charge for services rendered. The very personal and idiosyncratic “my fee” becomes “the fee.” “I charge,” becomes “the charge.” “Pay me” becomes “Paying for therapy or the session.” Which sounds more professional to you? Does “the fee” seem like it’s automatically open to adjustment?
Here are some alternatives:
The cost of the session is ___
The price of your session is ___
The charge for your session is ___
Using this type of focused clinical language activates the cognitive/thinking parts of the brain and helps a person operate from an integrated thinking, analyzing, and decision making mode instead of an “emotional” mode which is more feeling driven and can make these types of money matters conversations more personal, intense, and stressful for both therapist and client.
Therapists often use the word fee to address the amount of money that is charged for therapy services provided/delivered/rendered. However, the word "fee" seems to come with quite a bit of baggage for both clients and clinicians. To most clients encountering the word “fee” in the context of therapy is synonymous with “fees are always negotiable” or that the number is meant to be adjusted to a lower amount.
Substituting one of the following words in place of “fee”—price, charge, cost, amount, or rate—helps clients cognitively understand and process that this number is the actual amount it costs and that they’re expected to pay for services. With these words people don’t usually react so reflexively to negotiating to make the amount lower.
Think about this . . . when you go to the doctor or dentist or other professional, do they usually use the word fee? Most likely they use words like charge, price or cost. Consumers are used to this type of pricing language and understand this is the number they must pay. People do not automatically associate these definitive words with the possibility of negotiation and adjustment to a lower number.
By using this type of consumer wording, therapists can bypass the client’s automatic reflexive perception and response to the therapist’s “fee” as a starting point for negotiating payment even when no fee adjustment is realistically needed.
As a result, of making this change in wording the clinician’s money conversations are usually shorter and the amount a client pays for therapy is usually higher but is still what the client can afford.
My full fee is . . . My regular fee is . . . The full fee is . . .
What actually does “full fee” mean? Is there a “partial fee?” Why do we as therapists say, “full fee?” Why don’t we as therapists just use fee or price or charge without the adjective?
Attaching the word “full” to the word “fee” with regard to therapy causes the client to wonder, think, entertain, ask or explore what the fee that isn’t "full" is—and then clients ask you about that other fee! What a pickle for the therapist. As professionals, we don’t realize when we are inadvertently inviting discussion and negotiation about the amount of therapy payment when it’s not needed.
An alternative to using “my full fee” is to use more definite and clear language, such as “The price for a 50-minute session of therapy is . . . ” or “The charge for your therapy session is . . . ”
Decide for Yourself What Fits You, Your Clients, and Your Therapy Services Best
Confidently take charge of money conversations by using the aforementioned professional and clinical language suggestions and recommendations tailored to your client population and clinical practice. Focus on the value, cost, worth of the therapy service to the client and their life.
Remember to keep the language, wording, and focus of the clinical and professional money matters conversations on the client responsibility for payment for services needed, received and provided— not on what or how much the therapist gets or charges. Allow the client to pay a fair price for the therapy benefits they receive from you.
That’s all for this article on getting paid and how the wording you use as a clinician to talk about money matters can increase or decrease the money you earn from your client work. I hope you have found it to be useful, thought stimulating, supportive, and encouraging to your efforts to get paid what the therapy you provide is worth. See for yourself how the words you use can increase the amount of money you earn from your practice.
The next article, the third in the Getting Paid Series on money matters conversations, will address words to use to refer to the services you provide, to describe your prices and fee scale, and how to introduce and talk about your sliding scale.
Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative people across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop their careers and practices. To learn more about services, training or the monthly LA Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com.
LA-CAMFT'sNetworking Event & Presentation
Friday, October 18, 2019 9-11:30 am
Sponsored by
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Valerie "Billie" Klayman, LMFT Chief Financial Officer
October’s Featured Member: Laura Koonce, LMFT
Each month I will continue to write about our members and their connection to our chapter. As CFO, I can write all day about being involved in LA-CAMFT. I feel that hearing from other members is more authentic and genuine for all of you. For each month’s Member Spotlight, I’ll be reaching out to our members to write about their experiences in our chapter. If you would like me to write about you and why you’re a member of our chapter, please email me at cfo@lacamft.org.
This month I would like to feature Laura Koonce, LMFT, a member of our LA-CAMFT chapter, who practices in West Los Angeles and has a special interest in working with individuals and couples within the LGBTQ+ community. I met Laura when she helped out at one of our Networking Meetings.
Laura is one of our newest members and her areas of emphasis are:
Laura received her Master’s Degree in Mythological Studies with an emphasis in Depth Psychology, as well as a Master’s Degree in Counseling Psychology, both from Pacifica Graduate Institute in Santa Barbara, California. Her main focus and interest during this time of study was depth psychology and particularly the work of Carl Jung, Joseph Campbell, and James Hillman.
Laura did her training at the Southern California Counseling Center in Los Angeles, California, working with a diverse population of clients that included individuals, couples, and children. She furthered her training with the Pacific Gestalt Institute of Los Angeles and enjoys serving as a board member of the Gestalt Therapy Institute of Los Angeles (GTILA).
Enjoy reading more about Laura Koonce in her own words:
My own inner work is what set me on the path to becoming a therapist, and it is through the work of being with and healing from my own unique wounds that I am afforded the privilege of being with others in their journey to wholeness.
As a lesbian growing up in Louisiana in the 80s and 90s, I struggled with a lot of internalized homophobia. I learned to hide my authentic self in favor of doing what was expected of me, and in the process attempted to numb the pain by turning to drugs and alcohol.
After becoming sober, I decided to go to graduate school. My first degree in Mythological Studies with an emphasis in Depth Psychology led me to pursue a second Masters in Counseling Psychology. My journey through suffering and into healing inspired me to bring the gifts I received back into the world to help others. My belief is that to be a truly great therapist, one must be doing their own ongoing internal work.
This upcoming January I’ll celebrate ten years of sobriety. I’ll also celebrate ten years of understanding the freedom that comes from living authentically. My passion is to create a safe and nurturing space in which the wounds that keep one small and hiding can be compassionately transformed into the gifts of one’s own unique true nature.
As a psychotherapist, I work relationally with clients to provide a safe and nurturing space in which difficult issues in one's life can be gently and compassionately held, understood, and integrated in a way that facilitates strength, hope, and meaning. Through non-judgmental and attuned presence to one's sacred inner world, the client and I work creatively together to transform what once felt unbearable into a gift that will inspire authenticity, creativity, and deep connection to self and others. Incorporating Attachment Focused EMDR and somatic work to heal trauma in the body and nervous system, our therapeutic goal is living one's life with the greatest purpose and meaning.
Valerie "Billie" Klayman, M.A., LMFT, an integrative Meaning Centered Therapist, became a supervisor at Antioch University Counseling Center in 2014. Billie initiated a partnership between AUCC and the Culver City Senior Center offering pro-bono therapy and group therapy to members of CCSC. December 2016, Culver City hired Billie to help residents of the community at the Culver City Senior Center. She’s presented on Substance Abuse and Addiction. Billie can be reached at cfo@lacamft.org.
What You Need to Know as a Member To Update Your Profile Information, Renew Your Membership or Change Your Email Address
I'm writing to help all of you who are current or recent members of the LA-CAMFT chapter.
Did you know that members can edit their own profiles, including contact information, such as email addresses and phone numbers? As a member, you can easily update your profile information on the LA-CAMFT Website* or with the LA-CAMFT Wild Apricot Mobile App.
Sometimes when members try to renew their lapsed or current memberships, they think they have to create a new profile. You don’t! When you get the notifications that alert you to renew your membership, you must use the email you originally used to join. If you want to change your email address, do so after you renew your membership.
If you renew with a different email address it will create a second membership and account and you will continue to receive email notices about renewing your membership.
To update your profile do so by clicking on Membership on our website menu and then clicking Login/Profile.
We at the LA-CAMFT Chapter value all of you, member or not, as part of our compassionate community.
Please don't hesitate to contact me at cfo@lacamft.org if you have any problems, need help, or want to send a check to our PO Box in lieu of using a credit card to pay for membership. Although all the board and committee members of LA-CAMFT are volunteers, we do our best to respond to emails in a timely manner, and we will continue that tradition. Our Webmaster is also very attentive to IT issues and usually responds promptly when Web or IT issues have to be resolved.
I hope this answers any questions or concerns regarding becoming a member or renewing your membership. I look forward to seeing you at our next event.
Please see below for step-by-step instructions for logging in as a member, renewing your membership, or for changing your profile information.
*On the LA-CAMFT website, members can change or update profile information by:
*To be recognized by the website as an LA-CAMFT member to renew your membership you must first login with the email address you used to join LA-CAMFT. This is your member email address.
Maria Gray, LMFT, NMP, CGP
Please Hang Up and Dial 911
Most of the therapists I know have some version of this language on their voicemail “If this is a client experiencing a medical emergency, please hang up and dial 911 or go to your nearest emergency room.” I’ve often wondered about whether I really needed this verbiage it on my voicemail; I understood that it was for legal reasons, but I thought it sounded strange.
I decided to call CAMFT and ask them if this greeting was required for LMFTs. Access to the lawyers at CAMFT is one of the many benefits of membership. My call was answered in about 15 minutes, which gave me the opportunity to fold some laundry while I waited. I spoke with Bradley Jordan Muldrow, one of the recently hired staff attorneys, and I asked him if I needed to maintain this greeting on my voicemail.
Bradley advised me to retain the greeting, he explained that it serves as an important reminder to my clients that I’m not available 24/7, and if a client was calling at 2:00 AM, my message would inform them of their options in a true emergency. He said that the combination of the greeting and language in my informed consent document helps to protect me from potential liability; of course, I chose to retain the language in my greeting.
I took the opportunity to ask another question. When I was an intern, my supervisor would cover my practice when I was on vacation and vice versa. I wanted to know if I needed to have another clinician cover for me when I was out. Bradley explained that I was not responsible for covering my practice during my vacations; all I need to do is create a vacation greeting that includes the same emergency language as my regular greeting.
Maria Gray, LMFT, NMP, CGP, is a psychotherapist in private practice in Century City, where she specializes in trauma and addictions. Maria is committed to supporting therapists who want to charge what they are worth, and she offers individual business consultation and live, online courses. To learn more, go to www.mariagray.net.
David Silverman, LMFT
Why Writers Have the Worst Time in Recovery
Anyone will tell you breaking into the business is the hardest part. Generally, rookie writers struggle to write on weekends or early mornings before their day job starts. If they don't take classes, or get feedback from reliable sources their learning curve can be steep.
Writing an original spec screenplay during this period can drag on for months. The first draft is one thing. The rewrites can go on, too. And there's no pay for those early efforts. And then there's the constant rejection. What motivates these writers?
Even when screenwriters do sell scripts, they often face ridiculous deadlines and write endless drafts to satisfy producers, directors, and actors. If they don’t satisfy these people, other writers are generally brought in to rework their original vision.
Most working writers at this level make around $50,000-$70,000 for a script. And if they're very lucky, they might sell a script once every three years. How do they keep going?
The best way to motivate yourself is to decide to stay fully committed to a life-long career as a writer.
Don’t treat writing as a hobby, or you will definitely lose interest. You should look deep into your heart and ask yourself if you’re willing to work the long hours months and years it takes to succeed.
If “life-long” sounds too difficult, decide to commit to writing for 10 years. Doesn’t sound quite as painful, does it? If 5 years sounds better, then set that goal.
If you want to be a professional writer—who sells scripts, or gets plays made, or gets novels published, this better be your top priority. If it’s down on your list, behind creating an internet startup, or becoming a lawyer, or a professional wrestler, it’s probably not going to happen.
You need to make writing the first priority to help you carve out time to write. A lot of great things happen when you make that decision. You don’t have to wonder anymore if you really should spend time writing. It’s obvious. You need to write. Not just once in a while. As often as you can.
Whether or not you realize it, this decision is tied into your need to matter as a person. We all want to leave our mark on the world. We all want to express ourselves in a way that will be remembered. Somewhere in our dreams—we all want to leave some kind of legacy.
Some writers—very lucky writers, realize early that they have something to say.
I say lucky because they already have a vision or an idea that they want to express. Some people get into writing but don’t know what they want to say, they just want to be entertaining. And that’s okay.
Not all films have a message—nor do they need to. On the other hand, I think writers tend to be observers of human behavior. They generally have something to say about it, too. In my case I was clearly interested in the human condition—I loved psychology and graduated with a degree from Stanford.
I also knew I wanted to be funny. As a kid I had memorized comedy routines written and performed by my one-time hero Bill Cosby. When I was a kid, at camp in Boy Scouts, I’d entertain my friends with those hilarious routines. Such a shame what happened.
I was obsessed with comics and funny movies. I started writing short stories, then scripts, and then made short films that were funny. One of those scripts got me into the USC Cinema’s Professional Writing Program. I got some real experience writing screenplays with feedback from veteran screenwriters and Hollywood producers.
At some point (probably around my time at USC) I made a commitment to writing. What else could I do, I was in a writing program. I was writing nonfiction books and screenplays. At some level, I knew that I'd be writing for the rest of my life.
I worked pretty hard trying to write the best, the funniest screenplays I could. Whenever I had free time, I knew I should be writing. When I wasn’t writing, I was reading—The National Lampoon, and studying films like MASH, Lenny, and Play It Again, Sam.
Once I committed to writing, I sought out these people. I wrote with them. We sold screenplays.
I found writing partners. I wrote with lots of funny people. I wrote with my wife, Los Angeles Times Editor, screenwriter, tv writer and animation writer, Rogena Silverman. We sold feature and TV scripts. I wrote with a colleague at USC, Stephen Sustarsic. We were on TV staffs together for about 25 years. I wrote with friends I met on TV staffs, extremely talented writers, Steve Pepoon and Howard Bendetson. Created TV shows with both Steve and Howard.
Once you commit yourself to immersing yourself in your craft, thinking about writing every day and envisioning yourself writing films or working on a TV staff, you’ll be on the right track. Say to yourself, I’ll be writing (in some form or other—novels, films, poetry, whatever) for the rest of my life. Commit to it. Visualize it. Stick to it.
David Silverman, LMFT, treats creative and highly sensitive individuals in private practice in LA. Having experienced the rejection, stress, creative blocks, and career reversals over a long career as a writer in Film and TV, he’s uniquely suited to work with gifted, creative and sensitive clients experiencing anxiety, addiction or depression. For more information, visit www.DavidSilvermanMFT.com.
Image credit: FrolicRoomHigRes 2013 by Jacob Harnqvist is licensed under CC By 2.0.
This article was originally published on PsychCentral and is used with the permission of the author.
The Case for Pre-Engagement Counseling
Pre-marital counseling is now a thing. Couples call me requesting some counseling to “learn to communicate better” before their upcoming nuptials. Hmm.
The period before the wedding is full of metaphorical land mines. Anxiety is high and tempers are quick. Family is horning in on the wedding planning, and that’s a “whole ‘nother Oprah.” It’s certainly not the best time to learn emotional regulation and partnership skills.
How can we, as therapists, help change this situation for the better?
One important way is to strive to address your clients’ relationship issues in addition to whatever their presenting problem is. Otherwise, your clients may not address their relationship issues until they become completely unmanageable and the timing is far less opportune—when they are already engaged, or married, or are fighting about the kids.
For example, when I have clients who come to me for anxiety (and they all come to me for anxiety, one way or another!) I always ask them about their intimate relationship, because anxiety always affects our intimate relationships.
It’s a “chicken or the egg” sort of thing. Does the relationship dynamic give them anxiety that plays out in other ways, or does the anxiety that comes from stress at work, health issues, or dysfunctional FOO dynamic, and play out in the relationship?
In the end, it doesn’t matter. Intimate relationships create a perfect environment to learn the skills that lead to personal growth: emotional regulation, the ability to be vulnerable, and the ability to listen and seek to understand another even when you disagree or are feeling attacked.
When I explain this to my clients, they are always happy to learn that making their relationship better will be an integral part of their own personal growth. It will help them calm their anxiety, upscale their mood, feel more connected, and increase their self-esteem. There is nothing more self-affirming than connecting with another person on a deeply soulful level—whether the relationship is intimate or not.
I work to enable my clients to discuss sensitive topics with their partners in a way that means each of them will feel seen and heard, even when they strongly disagree. Learning to express their thoughts and feelings in a way that is not blaming is almost as tough as learning to listen without being defensive. Once they have begun to practice these skills, they see how rapidly it changes their relationship, and they want to practice it more.
When they are able to discuss difficult topics with their partners in a non-confrontational way, I strongly suggest that they broach the following subjects, especially if they are considering getting engaged or making some other type of long-term commitment.
2. Kids. Whether you want them at all, how many, and when. How to raise them—boundaries, discipline, education, what is the children’s role in the family.
It’s only later, when the “honeymoon phase” is over and each partner reverts to type, that this becomes a problem, and many couples are surprised to
I often suggest that these clients take a break from online dating. Rather, they can put their energy into pursuing activities they love (which have often been taking a back seat to online dating!) and meeting interesting people. Maybe they will meet someone the old-fashioned way, but either way they will be “living” and not “waiting.” Online dating doesn’t guarantee happiness, but following your dreams and being open to meeting interesting people (romantic and non-romantic alike) is a way to build a life you love.
Leila Aboohamad, LMFT
Do You or Your Clients Love Too Much? The Fifth Step to Creating a Loving “I-Thou” Relationship
In working with the clients in my practice who are either in unfulfilling relationships or alone, I have discovered the steps they need to take and what they need to know and to find that perfect mate for them. This is the third in a series of articles on The Steps to Creating a Loving “I-Thou” Relationship.
The Fifth Step in learning how to create a loving, committed relationship is to understand the importance of setting boundaries. What exactly is a boundary in psychological terms? A boundary tells us and the world where we begin and end. It defines who, what and where we are, just as a country’s boundaries encapsulate the unique qualities of that particular entity.
Before we go on to more about the Fifth Step, here are the first four steps:
If you’d like to read more about Steps One through Four, here are the articles on Steps 1 & 2 and Steps 3 & 4.
Have you ever really taken the time to question your belief system, your needs as a person whether in or out of a relationship? Are you comfortable being with yourself or do you need another person to define and complete you? Remember “The Runaway Bride,” that lovely movie with Julia Roberts? She could only set her boundaries by literally running away from her groom as she walked down the aisle. At least she knew that her life with that particular groom wasn’t right for her. But did she really know why she fled and what was unidentified and unexpressed in her own self which compelled her to run? Too bad she caused so many broken hearts and confusion, but she saved herself and her groom a marriage based on lies and pretense.
So why do some people really glow with self-confidence and sureness about where they stand in the world? Why do they draw others toward them with that special light that inspires others? Why are their personal relationships so positive, life affirming, safe and inspiring? Why do their partners fit them like the fingers of two hands coming together to form a perfect connection? If they weren’t blessed with the perfect parents who modeled self-esteem, a solid sense of their ego identity, serenity, a faith in the positive aspects of this life, how did they learn to shine their light?
They did a personal inventory of their lives, realizing that something big was amiss and needed attention. They found a skilled therapist and committed themselves to healing that hurting wounded child who too often controlled their thoughts, feelings and actions. If that wounded inner child had been so traumatized by the “crazy” antics of their family of origin, they had no idea how they existed as a free-thinking calm, wise person in the world.
Do you know where you begin and end? If someone does not respect your person, do you know how to stop it and draw a line in the sand? Do you know how to say “no”? Do you swallow your feelings, afraid to voice your opinions and just acquiesce to whomever? If you answered yes to any of these questions, you may have been traumatized by your family of origin or other experiences and need to learn to let yourself and the world know where you begin and end…in other words, set your boundaries.
This may sound simple as the concept of setting boundaries is, however the actual implementation requires a lot of hard work. You must be willing to explore at a profound level your family history, the roles and rules of the system. Were the family system boundaries non-existent or very rigid? Who ruled the roost? Did you exist as a separate and individuated member of the family? If you are willing to take this journey toward freedom and true self- expression, you will create a life of adventure, love, success and serenity. Are you ready?
Leila Aboohamad, LMFT, is a psychotherapist practicing in Brentwood, Santa Monica and West Los Angeles, California. She specializes in helping individuals and couples create successful, committed loving relationships. She has studied and practiced spirituality and mindfulness for over 35 years. Leila also works with gifted, talented and creative adults helping them to identify and share their special gifts and passions with the world. Website: www.leilalmft.com.
Victoria Van Zandt, LMFT
Addressing Chronic Illness in Psychotherapy with Your Clients
The Center for Disease Control states that 6 in 10 Americans have a chronic illness. Chronic, meaning the illness does not go away; it is there for the long haul. So, the chances of you seeing a client with a chronic health condition is likely. I am one of these individuals; I’ve lived with a chronic illness since the tender age of 15, so I speak from a very personal perspective as well as a professional one.
In my private practice, I see clients who live, struggle, and thrive with various illnesses, and I have learned much over the years about how chronic conditions affect peoples’ lives. Illnesses such as heart disease, diabetes, Crohn’s, kidney, arthritis, and various other conditions come with their own challenges. There are treatments, but no cures.
From the time a person is diagnosed until the time he or she takes a final breath, each person with chronic illness lives with the diagnosis, the side-effects, and the co-occurring mental health conditions, such as depression, that can occur, and exacerbate, living with a chronic health condition
Chronic medical conditions also increase the chances of having depression and anxiety, as these conditions add many stressors to a person’s life. Stressors include navigating the healthcare system, diet, doctor’s appointments, medication management, body image, insurance issues, tests, work, disability, sex life, economic adjustments, and the shifting sense of identity that can occur along with the ups and downs and contradictions of life with a chronic illness.
So, what do I think therapists should understand when working with a client with a chronic health condition?
The following are some of the questions that can be looked at in therapy:
These are just a few of the questions that can be explored in therapy.
A therapist must also become familiar with their own countertransference around the subject of illness and mortality. Because we still live in a culture that values health over sickness and shies away from discussions about illness and death, we sometimes never get a chance to look at our own reactions to the subject.
To that end, I’ve included some questions you might want to contemplate on your own or in supervision or consultation. The following questions are important to explore—and you might even want to journal about them.
As an art therapist, I believe strongly in the creative process—and journaling is one way to have a deeper understanding of our feelings and work with clients, with no client names mentioned, of course!
Here are some questions to ponder:
Why is it important to explore these questions? As with any population that is marginalized and stigmatized, having an understanding of, and knowledge about, the challenges these clients face can only enhance the therapeutic relationship.
I see chronic illness as being on a spectrum; the client might come to you in the midst of a physical and/or emotional flare up such as fatigue, pain, and hopelessness or the illness might be stable with fewer physical and emotional symptoms. The client might also be living with more than one illness that includes many symptoms or they might be functioning well with few or no symptoms? But, even during times of stability, clients face uncertainty.
Whether a client is newly diagnosed or has lived with an illness for a long time, it is likely their mental health has been affected. Learning to find a new sense of normal among our culture’s stigmatization of the “sick,” only adds to the stressors.
One of the constant challenges that can plague clients is finding a strong sense of self. There is the “sick self,” and the “well self,” and, the so-called “normal self” that existed prior to the diagnosis. Many times, these “selves” create identity confusion, as the client struggles to embrace a true sense of self. There are days spent in bed and days functioning, or days that fall somewhere in-between.
Developing a healthy identity can be challenging especially with daily limitations. The chronic illness wears and tears at the core self. A client might ask, “Am I damaged or whole?” The therapist and client can then explore the aspect of feeling whole when living with an illness.
Can you imagine asking a client to do a pie chart diagram that shows how much of the pie the illness takes up? This exercise can give the therapist a clearer understanding of what a client feels in relationship to the illness. Additionally, having the client fill in the areas and space that happiness and fulfillment take up can help the client explore and visualize other areas of their lives they may have forgotten about. This exercise can help clients see themselves as whole rather than damaged and lacking a healthy sense of self.
Victoria Van Zandt, LMFT, Art Therapist, is in private practice in West LA where she works with clients with chronic illness, career and life transitions, and those who identify as emotionally intense. In her bi-monthly Creativity 4 Women Workshops, Victoria helps women access their creative spirits, decrease anxiety and depression, and promote calm and joy. Learn more about how Victoria focuses on empowering women, whether coupled or single, young or middle aged at www.ArtTherapyLA.com and www.LAWomensTherapy.com.
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