Los Angeles Chapter — California Association of Marriage and Family Therapists
Voices — October 2022
Leanne Nettles, LMFT
Remember Your Why
As we head into the last quarter of 2022, I am thinking about all that this year has entailed. For many, this year so far has been chock full of glorious victories and horrible tragedies on both large and small scales. Politics, friendships, professions, family, health, resources; there have been many changes and challenges. And just like finishing a marathon, the home stretch can be the toughest to get through, and feel like the longest, most laborious part.
If you are feeling like you're losing steam heading into this final quarter of 2022, I would encourage you to ask yourself: What is your why?
I work in Community Mental Health, and so often I hear and experience the constant demand of higher, faster, more! As I imagine many of you have experienced, sometimes I have those days when I just want to throw in the towel and think "I wish I could just work in a coffee shop, with predictability, simplicity, and an end time." Other days I just feel like going through the motions to make it through the day, but I know I can't just go through the motions when working with people's souls. So then, after giving myself permission to fantasize about the simple life, I come back to reality and find my motivation again through re-discovering my why.
Why do I do what I do? Why did I want to be a therapist in the first place? Why is it worth it?
When I sit and remember my why, I feel rejuvenated. I feel a renewed sense of purpose. I reconnect to the deeper meaning of the work. I step out of the current frustrations and view the big picture. My why gives me hope. And if my work doesn't align with my why, I can give myself permission to change it.
So wherever you are heading into the final stretch of 2022, if you're in need of a boost of momentum, take some time to remember your why.
Leanne Nettles, LMFT is a School-based Clinical Program Manager in a community-mental health agency and an Adjunct Professor at Pacific Oaks College. She specializes in child and adolescent therapy, while practicing and supervising from a systemic and structural therapy approach. Leanne works to advocate for cultural diversity and equity within the field, and is passionate about training quality mental health professionals to serve low income, historically disenfranchised communities using a team-based, collaborative approach.
LGBTQIA+ Affirmative Care:Now More Than Ever
Thomas Mondragon, M.A., LMFT
While much progress has been gained for LGBTQIA+ people, today we face an alarming increase in anti-LGBTQIA+ legislation and hate crimes across the country. The recent onslaught of anti-LGBTQIA+ violence tells us any advancement is being notably threatened, creating understandable anxiety and concern for many of our LGBTQIA+ clients. The impact of such socio-political violence towards LGBTQIA+ clients will be examined in conjunction with possible complex trauma rooted in heterosexism, cissexism and intersectional oppression. Taking an affirmative therapeutic stance to directly address such traumas led by your empathic presence, theoretical knowledge and your role as LGBTQIA+ activist will also be addressed.
Event Details: Friday, October 21, 2022, 9:00 am-11:00 am (PT)
Where: Online Via Zoom
After you register you will be emailed a Zoom link the Thursday before the presentation.
More information and register today by clicking the Register Here button below.
Lynne Azpeitia, LMFT
Getting Paid: Money Talk With Clients About Sliding Scale Prices — The Words You Use Do Make A Difference
How much do you charge? What’s your sliding scale? Is that the lowest you charge?
How much can you slide? How low can you go?
If you dread hearing these questions, you are not alone.
While questions about a lower price or a sliding scale used to be asked from time to time, therapists are reporting that now they are asked these questions all the time—from just about everyone who calls.
What’s problematic about this?
Well, before this recent phenomenon started, sliding scale requests came from just a few—usually those with a low income or reduced ability to pay, a financial hardship or significant unexpected expense. Now a majority of those asking for lower or sliding scale pricing more often have adequate resources, income, and an ability to pay. What’s a therapist to do?
Offering lower pricing to clients truly in financial need who require mental health services, is a time-honored tradition in the practice of therapy. Sliding scale and other types of price adjustments were instituted to make therapy services available to those whose economic circumstances didn’t allow payment for the full cost of services. Having these accommodations available allows therapists, at their own discretion, to adjust the amount a client pays and can manage on a regular basis
Like most therapists in the mental health profession, I believe in, and support, making affordable therapy available to people who don’t have much money and those experiencing a financial hardship. Clinicians, who are committed to this, routinely offer those in need a variety of options that allow them to afford and pay for needed mental health treatment. Many therapists also work with certain clients on a case-by-case basis to offer specialized arrangements based on their particular needs and circumstances.
Some of the options private practitioners use to make therapy affordable to clients in financial need are: pricing based on income; lower pricing; a percentage or number of lower priced client spaces; an allotted length of time or number of sessions of lowered pricing for a certain number of clients; flexible scheduling (three sessions per month, every other week, etc.); charging less for shorter sessions; payment plans; pro bono sessions for a client or two; charging less for sessions during slow periods of the day; special arrangements based on special circumstances; a limited number of reduced-price scholarships; sliding scale; etc.
With so many callers asking about the lowest prices they have, now therapists feel even more pressure to reduce prices because
While clinicians believe it’s important to offer sliding scale pricing only when a client is genuinely in financial need, unfortunately, when repeatedly asked about sliding scale or lower pricing, many end up undercharging, letting clients determine the fee, maxing out the number of low-cost clients their practices can accommodate, cutting prices below the minimum amount needed to keep their practice open, and feeling resentful or taken advantage of by clients they gave a lower price to and then discovered were spending large amounts on luxuries (new, high priced cars, jewelry, vacations, designer clothing; dining at pricey restaurants, etc.) after they’d claimed they couldn’t afford to pay for therapy and needed a lower session price.
Sliding scale, special arrangements, and lower prices upon request were never meant to be offered as options to those who had resources, could afford to pay the full price, and who, for other reasons, don’t want to or think they should.
It’s also not financially feasible for any private practitioner who wants to remain in business, to give a significant discount to every single client who wants to pay the lowest possible price for therapy—after all we need to keep our practices up and running, be able to cover practice and professional expenses, and support ourselves and our household.
Responding to callers and clients who are asking, but don’t really need or qualify for a lower therapy rate, is a very different type of conversation than the one clinicians trained for and are familiar with—people who genuinely have, a financial need.
As therapists, our task is to find the right balance of how, and how much, we can adjust session prices, for which clients, and how many—and not go out of business. In the current climate, navigating talking about prices with these clients takes more specialized skills and requires a totally different mindset, approach, and vocabulary.
So, what’s the best way to respond to a caller or current client who wants a price accommodation but doesn’t need one?
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 money matters involving sliding scale and adjusted pricing for those with limited income—and how and why these words can affect the amount a person is willing to consider or pay for therapy services.
This information applies equally to phone calls, face-to-face conversations in real time or virtually, emails, texts, social media postings, and what’s printed in marketing materials or written on a website. Yes, each of these words and phrases can have a direct effect on the perceived value of the services a therapist provides and the amount clients are willing to pay for the clinical services you provide.
As you read the following information, be sure to remember:
Now about that vocabulary . . .
As noted in Getting Paid: Money Talk—The Words You Use to Describe Your Services & Rates Can Make A Difference In Your Income, using the words fee, full fee, my, my fee, etc., currently seem to signal to those seeking therapy that any stated rate for clinical services is just a starting point. It’s automatically assumed therapists are open to requests and negotiating lower prices. You’ll notice that the words listed aren’t used in this article—that’s why. To review alternate wording, click the link. Using some of these suggested words may eliminate a client who doesn’t need a sliding scale asking you about one.
1. Low, lowest, lower…Reduce, reduced…Discount, discounted…
Lowest price/prices/rates/amounts . . . reduced price/prices/pricing/rates/amounts . . . discounted price/prices/pricing/rates/amounts
Are the people who call us about our services seeking therapy or shopping for therapy?
In today’s world using any of the words listed seems to put people on the “I’m shopping” channel. Not exactly the best channel to be on to seek professional help for mental health issues or work, family and relationship problems, self-regulation skills, healing past traumas, addiction, recovery, anger management, parenting skills, growth, etc. It’s sometimes very easy for people to get mixed up about what type of professional help they need and how much that professional service costs.
Are people looking for a professional who’s trained and skilled in helping clients like them with their presenting issues? Or are they looking for the lowest possible price for counseling? How much is it necessary to pay? What difference does the price make? These are all important questions for therapists to address when clients call about therapy and cost is discussed.
As mental health professionals who are highly skilled and experienced, we don’t want to add to any confusion, so it’s important we’re aware of the words we use when we talk or write about the price for therapy services so we don’t inadvertently encourage clients to shift into a shopping for the lowest price mindset or turn into a “therapy price shopper.”
Clinical services are valuable and worth paying for since stopping unhealthy behaviors, healing trauma, learning new skills, and how to take better care of yourself, others, and your relationships can save both money and time as well as help you take advantage of opportunities that make your life better.
How much does money does therapy save when you don’t get divorced, lose your job, get a DUI or ???? When you compare the cost and benefit from what you receive then the price may seem worth paying—even if you must rearrange your budget, put it on a credit card, arrange a family loan or payment plan, etc.
Unless therapists are specializing in clients who only want to pay low, reduced or discounted prices for therapy services, in general, it’s best for those in private practice to use other words and not any variation of “low, reduce, discount” when referring to or stating pricing for therapy services.
2. Sliding Scale
When in conversation or writing, substituting one of the following words in place of “sliding scale,” price . . . rate . . . amount . . . pricing . . . cost . . . charge . . . along with adjust, adjusted, alternate, alternative, affordable, special, economy, helps clients understand, and cognitively register, that this isn’t the type of pricing range where a therapist will, upon request, “slide” all the way to zero, or some other very low price.
Adjusted price . . . economy rate . . . special pricing . . . cost adjustment . . . more affordable amount
Using this type of wording usually results in fewer requests and conversations from those not truly in financial need. With these words people usually don’t just automatically try to negotiate to make a stated price lower.
Let’s look at this from another perspective . . . When you go to a doctor, attorney, dentist or other professional, do they use the term, sliding scale?
Most likely these professionals use words like adjustment, introductory, limited time, or another pricing term. Clients are familiar with this wording. and when it’s used, don’t automatically assume that the price stated is open for negotiation to a lower one. Nor do they experience these definitive words as an invitation to ask for a discount or adjustment to a much lower number.
Now’s a good time to take a moment to think about and consider the words you are using with the people who call or clients who want to change the amount they pay, what you’ve read about this, and what your colleagues are saying about handling these things and if, and how, it’s working for them, and for you.
That’s enough for today on talking sliding scale pricing and getting paid. I hope you’ve found it useful to understand how the wording you use to talk about sliding scale pricing can increase or decrease the money you earn in your practice.
See for yourself how the words you use can make a difference.
Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping professionals develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com.
Working with Dissociative Identity Disorder
Cristina Mardirossian, LMFT
DID is very often misdiagnosed, misunderstood, and not taken seriously. Many of these clients have been diagnosed as bipolar, borderline, schizophrenia, etc., when in reality they have a dissociative disorder. This presentation will help you understand the complexities of working with clients with DID, how to assess for it, and how to treat it.
Based on The International Society for the Study of Dissociation (ISSTD) Guidelines for Treating Dissociative Identity Disorder, this workshop will address current theories of Complex-PTSD and dissociation, including case conceptualization, treatment planning, and phase-orientated therapy. This workshop is geared toward mental health professionals who are interested in developing their skills in treating clients with chronic trauma-related dissociative disorders.
Event Details: Friday, October 7, 2022, 9:00 am-12:00 am (PT)
Surviving Social Anxiety
Do you feel nervous, feel your heart racing, have trouble communicating, stutter or “freeze up” in front of a group?
I believe the source of all social anxiety goes back to a fundamental fear of being judged. Nobody likes to be judged, especially when you don’t feel you’re at your best.
When I feel that people are judging me, or my performance, and I’m nervous about it, I can suddenly think of a million reasons why they’re right.
The funny thing is, they most likely aren’t thinking anything of the kind. In fact, I’ve had plenty of positive experience giving presentations.
All too often though, I forget about the good experiences and go right to the bad ones. Do you believe that something like that is going on with you?
How can you relax around other people?
One thing you can do is take a deep breath. Before going into a meeting, try taking a few deep breaths, or engage in “yoga-breathing.” This means you inhale through your nose and exhale slowly through your mouth.
When you’re talking to people in a meeting, continue to breathe in and out slowly. There’s a method called “tapping,” where you tap acupressure points. You also can relax by slowly breathing on the back of your thumb.
Anything else that will relax you will help. Some people can do self-hypnosis. Some people can do stretches. Some people can actually just “shake it off.”
Think about what you’re doing rationally.
Say you’re giving a speech, and you have a of history of doing it successfully many times, but you’ve “frozen up” a few times, too.
Why does your mind go right to “freezing up?” You’ve given successful presentations before, but your mind doesn’t go there.
Even after you’ve practiced your speech in front of friends without a hitch. Even after you’ve given successful speeches in front of the same people.
We sometimes go there because fear takes over. When we talk about rational thinking, we mean thinking logically, without fear.
So, take a deep breath, do what you can to relax, and look at the situation rationally. Since you’ve done it before, you can do it again. Be confident.
Show up prepared.
What happens when you show up at a gathering alone, and unprepared? You become totally reactive; you wait for things to happen.
When you’re just waiting for something to happen, you’re not in control. You get nervous waiting, and you lose your confidence.
If you come prepared with an interesting story, or some news — even if it’s gossip — you can approach others at the event. You get to be in control.
Your confidence goes up. Everything that follows gets easier. Instead of waiting, be proactive. Approach somebody. Get it over with.
Everything gets easier once you’ve moved past the first part. Use whatever you can to get this over with. When it’s happened to me, I’ve sometimes used a “prop.”
I’d bring photos of my dog on the cell phone. I’d bring a friend to the party. I’d do anything I could think of, so I wouldn’t be the center of attention. It always helped.
I’d bring a PowerPoint presentation if I had to speak in front of a group. Then I could point to the screen the whole time.
On dates, I’d always suggest we go to a movie. After the show, I’d always have something to talk about, in this case, the film. What did you think? Did you like the ending? And so on. Anything was better than trying to talk about myself.
At parties, I’d use the “three-second rule.” I found that if I waited around to talk with somebody, I’d get anxious. If I just went up to someone before three seconds were up, I’d get it over with.
Attempt the easiest goals first, then build to the most difficult.
Stepping out of your comfort zone can be overwhelming, especially if you attempt to go too far too soon. If you have a goal that seems overwhelming, start small.
Always break overwhelming goals down into manageable pieces. When you’re working on being more social, start with something easy.
Ask a stranger for directions. There’s not a lot at stake. Work up to more difficult social situations slowly.
Every time you take steps outside your comfort zone, be sure to reward yourself, whether you have a positive outcome or not. Even if the stranger ignores you, you’ve succeeded by reaching out.
David Silverman, LMFT, treats anxiety and depression, especially in highly sensitive individuals in his LA practice. Having experienced the rejection, stress, creative blocks, paralyzing perfectionism, and career reversals over a 25 year career as a Film/TV writer, he’s uniquely suited to work with gifted, creative, and sensitive clients experiencing anxiety, depression, and addiction. David received training at Stanford and Antioch, is fully EMDR certified, and works with programs treating Victims of Crime and Problem Gamblers. Visit www.DavidSilvermanLMFT.com.
This article was previously published here and is used with the permission of the author.
Self-Compassionate Networking Workshop
Anna Chen, AMFT, APCC
We all know networking is important, and important things are the easiest to procrastinate on. In this one-hour presentation we will lay out actionable steps to get you connected with others and moving towards your networking goals. For best results, consider attending on a computer, plan to practice your willingness to be uncomfortable, and bring a healthy dose of self-compassion.
Event Details: Wednesday, October 26, 2022, 5:00 pm-6:00 pm (PT)
Joanna Poppink, LMFT
Panic Attack Can Be Part of
your Eating Disorder Experience
An OMG panic attack experience gives you more information about what's happening to you than the numbness an eating disorder provides.
The Panic Attack Symptoms Nobody Talks About by Rachel Gearinger is a short, well written and candid article that may have powerful significance if you have or had an eating disorder.
Eating disorders can create a psychological numbness that dulls your senses and, for a short time, relieves panic. But you don't feel relief. You feel nothing. That dullness or numbness could be a form of depersonalization and/or derealization, a little discussed aspect of panic.
Definition of panic attack from Mayo Clinic:A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
If you think of your eating disorder symptoms as a response to panic you could have a greater appreciation of your experience and what is triggering your behavior. You might think that ice cream or a buffet dinner or meeting new people are triggers for your eating disorder. But that doesn't give you more awareness of your situation.
If you think those things trigger a panic attack and then a quick rush to eating disorder behaviors, you might start thinking of why or how these things would frighten you so much.
Experiences while in a panic attack:
Coping with a Panic AttackYou may feel one or several or many of these above symptoms. Or you may feel them rising up in you.
Instead of rushing to a binge or other eating disorder behaviors, go to your associations: Does panic attack feel familiar? Where and when else did you have this experience?
Breathe out. Get a paper bag and fill it with air. Often, during a panic attack you will think you can't breathe. That's because you are trying to breathe in when your lungs are full. You can't imagine breathing out. Filling a paper bag with air gets you breathing properly, reverses your continual attempt to breathe in, empties your lungs and reminds you that you can breathe normally. You are not dying.
A panic attack can be a natural response to a life-threatening situation. flight-flight-freeze.
If you are in a safe situation your panic attack could signal a reminder of a past dangerous situation, maybe one you don't remember with your mind. But your body remembers.
Panic attack and eating disorder connection Just before you binge or purge or have a restricting day you felt something, probably something close to what's on the above list of panic attack symptoms. You may not have felt them thoroughly. But you felt them enough to have a sense of what's coming and ward it off your favorite eating disorder behaviors. These are the behaviors that work for you. You reach a state of numbness that prevents you from feeling the attack.
Yet, the panic attack symptoms could be a treasure trove of clues held by your body of what really triggers your eating disorder behaviors. Exploring your body sensations through association and familiarity gives you an opportunity to learn what your body is trying to tell you. You can find various sources of your fears and attacks. Then you have the opportunity to build inner resources to cope with them.
Finding a mental place where you can observe and reflect on your experience of a panic attack helps you separate past danger from present safety. That process is an important aspect of eating disorder recovery psychotherapy and the road to your recovery.
LA-CAMFT Supervision CE Workshop:
Best Practices for Multicultural Supervision
Dr. Theo Burnes, Ph.D., LPCC
This interactive six-hour training provides background knowledge and context for clinical supervision and showcases a diversity of evidence-based approaches to conduct multiculturally competent supervision. Beginning with a review of current literature in clinical supervision, this workshop aims to provide the information necessary in assisting the supervisor to both support their trainees’ development and to maintain ethical client care. Specifically, this training addresses supervisory interventions from a multicultural framework in clinical supervision to create lasting meaning and impact across the professional lifespan of the mental health trainee and beyond.
Event Details: Sunday, October 30, 2022, 9:00 am-3:30 pm (PT)
People Love to Give You Money — and Great Deals on Cars!
“If you look up, there are no limits.” — Japanese Proverb
Goal setting is very important to achieving our dreams.
We have to know what the target is before we can hit it.
But goal getting is the next step—taking action to get the goal you set.
And you won’t even try unless you believe it’s possible to get it . . .
When I enrolled in Roger Lane’s The Finance Course, he sent me a form to fill out listing the things I wanted.
Then he called me to find out what I had on the list. I told him one of the things I wanted was a brand-new Mercedes Benz.
He said, “Great!” and asked me, “What model?”
I said, “Uh, I don’t know.”
Then he asked, “What color?”
I said, “I don’t know.”
“How much does it cost?”
“I guess I don’t know that either . . .”
Pretty wimpy, right?
Roger got impatient with me at this point.
He said, “Well, you’d better find out exactly what you want because that’s what we’re going to do in the class—get you the things you want. You can’t get anything if you don’t know what it is.”
I perked up at that and said, “Oh! I’d better go shopping!”
Now, you need to understand that at this particular moment in my life, my business was going very well and I was making good money, but I thought that there was no way I could really afford to buy a Mercedes Benz.
My belief was that those cars were driven by billionaire rich people and movie stars.
Well, I wasn’t that rich and I certainly wasn’t a movie star, so I “just knew” I couldn’t have one.
I had given up before I started! I had already looked at and was ready to buy another, medium-priced car.
As luck would have it, two days after this conversation with Roger, I went to a networking group and a woman who sold Mercedes Benz automobiles stood up and said that there was currently a special savings on car leases.
I made an appointment to see her the next day.
When I walked into the Mercedes showroom, there in the middle of the room, sparkling in the sunlight, was a beautiful metallic teal-green sedan with gold pin-striping.
I was in love.
Barbara came over to me and I told her, “I want this one.”
She, good salesperson that she was, said, “You can have that one!”
“Yeah, sure,” I said, disbelieving. “Show me the money.”
She proceeded to calculate numbers and then reported to me, “I can get you in that car today for $500 a month.”
My mouth dropped open.
“Is that all?!”
She smiled and said, “Yes!”
I said, “I had no idea. I was ready to buy an Acura for $468 a month. This Mercedes is only $32 a month more! I’ll take it!!”
Barbara had the car washed and I drove it home that day.
And then I drove it to Roger Lane’s workshop that weekend.
When I walked in the room, he said, “Hi, Chellie. Do you know what color Mercedes you want yet?
I smiled and said, “Yes, I do. Green. Want to see it?”
His mouth dropped open and he said, “You got it already?!”
I nodded and he said, “Come on everybody!” And the whole class trooped out to the parking lot to see my new car.
Afterwards, I thought about how many times I might have stopped myself from having things I wanted merely because of a mistaken belief about the price, my worthiness to have it, what bad thing might happen in the future if Indulged myself . . .
How about you?
Are you stopping yourself from the rich life you deserve?
Goal getting is knowing what you want, investigating what it will take to have it, and then taking the action steps to have it.
Add positive affirmations and what often happens is that you get it a lot sooner than you expect!
Today’s Affirmation: “I am a money-making machine and I’m making a lot of it today!”
Chellie Campbell, Financial Stress Reduction Expert, is the author of bestselling books The Wealthy Spirit, Zero to Zillionaire, and most recently From Worry to Wealthy: A Woman’s Guide to Financial Success Without the Stress. She is widely quoted in major media including Redbook, Good Housekeeping and more than 50 popular books. She has been treating Money Disorders like Spending Bulimia and Income Anorexia in her Financial Stress Reduction® Workshops for over 25 years. Her website is www.chellie.com.
LA-CAMFT TOC Grant
LA-CAMFT Grant Award for Pre-Licensed Members Who Are Therapists of Color
The LA-CAMFT Grant Committee is pleased to announce that LA-CAMFT will be awarding two grant awards In for LA-CAMFT Pre-Licensed Member Associates, Trainees, and Students who are Therapists of Color.
If you are not an LA-CAMFT member, in order to apply for the award, you must first join LA-CAMFT.
Registration for the LA-CAMFT 2022 Grant Award for Pre-Licensed Members who are Therapist of Color opens on September 7, 2022, and closes on November 5, 2022. The drawing will take place on November 6, 2022.
Please read the information below regarding the description of the grant award, criteria for applying, application process, and selection process.
Description of the LA-CAMFT Grant AwardEvery 4 months (3x per year), a grant award will be offered to two applicants who meet the following three criteria:
Grant winners will receive:
The $500 award can be used at the recipient’s discretion based on their own individual needs (whether it be for BBS fees, testing materials, memberships, living expenses, etc.).
Confirmation for what the Grant Award money is used for will not be required.
Application and Selection ProcessInterested Pre-Licensed LA-CAMFT members who are Therapists of Color can complete the 2022 Grant Award Application on the LA-CAMFT website.
The selection process entails using a Randomized Generator of the applicants who met the full criteria and complete the application online in order to take out human bias and decrease activation of one's trauma history.
The drawing will be recorded via Zoom and posted onto social media along with an announcement naming the grant winners, who will also be contacted via email directly.
Registration for the 2022 LA-CAMFT Grant Awards for Pre-Licensed Members who are Therapists of Color opens on September 7, 2022, and closes on November 5, 2022.
The drawing will take place on November 6, 2022.
The LA-CAMFT TOC Grant Committee
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