Please note: This blog is originally posted on the AAMFT website to support their upcoming webinar on Confabulation.
By Jerrod Brown, Ph.D.
Confabulation is an unintentional memory disturbance. Such an inaccurate memory can simply be a distortion of an existing memory or the fabrication of a new memory. For example, a client may mistakenly believe that a real event from decades ago instead took place recently. In contrast, a client could create a fantastic memory of an event that never occurred. The likelihood of this phenomenon is often increased by the presence of a range of disorders and conditions. This includes psychosis (e.g., schizophrenia), trauma (e.g., brain injuries), fetal alcohol spectrum disorder, memory disorders (e.g., dementia, Alzheimer’s disease, and Korsakoff’s syndrome), and other neurological conditions. In light of the co-occurrence of confabulation with these disorders, marriage and family therapists should have a strong working knowledge of this memory disturbance.
Failure to identify instances of confabulation can have deleterious consequences in treatment settings. This is largely due to the fact that many clinical activities are informed by information self-reported by the client. For example, inaccurate information can contribute to misdiagnosis and the allocation of inappropriate treatment options. Further, confabulation can result in credibility and countertransference issues where therapists may struggle in their decisions of what to believe or not believe. Beyond assessment and treatment, confabulation could result in false reports of victimization or even perpetration of physical and sexual abuse. In such instances, the marriage and family therapist may be obligated to report this information to the appropriate legal authorities. As such, inaccurate information can result in criminal charges and wrongful convictions.
Despite these difficulties, marriage and family therapists are well positioned to identify confabulation and provide support to clients suffering from this affliction. A necessary first-step in this process is corroborating self-reported information with reliable sources (e.g., family and friends). This is particularly true of clients suffering from clinical and neurological disorders and situations when sensitive memories with severe consequences have been recalled. As this process can be very challenging for the marriage and family therapist, the professional must keep in mind that confabulation is unintentional in nature and without malicious intents.
When confabulation has been discovered, the marriage and family therapist should work with the client to address any underlying clinical or neurological disorder and improve their memory recall. Interactions with the client should be slowly paced, use simple and clear language, and employ open-ended questions. Opportunities include teaching the client self- and memory-monitoring strategies and introducing the client to memory diaries. Similarly, the development of a strong support system of family members and friends is imperative. This group can not only serve as collateral sources of information, but also help ensure the client feels unconditional love and support throughout the therapeutic process. Through such a systematic approach, marriage and family therapists can help clients suffering from confabulation improve both their short- and long-term outcomes.
Jerrod Brown, Ph.D., is an Assistant Professor and Program Director for the Master of Arts degree in Human Services with an emphasis in Forensic Behavioral Health for Concordia University, St. Paul, Minnesota. Jerrod has also been employed with Pathways Counseling Center in St. Paul, Minnesota for the past fifteen years. Pathways provides programs and services benefiting individuals impacted by mental illness and addictions. Jerrod is also the founder and CEO of the American Institute for the Advancement of Forensic Studies (AIAFS) and the Editor-in-Chief of Forensic Scholars Today (FST). Jerrod has completed four separate master’s degree programs and holds graduate certificates in Autism Spectrum Disorder (ASD), Other Health Disabilities (OHD), and Traumatic-Brain Injuries (TBI).
The above article is an Editoral piece. Opinions expressed in the MAMFT NEWS do not necessarily reflect the opinions of the Editors or of MAMFT.
The Spring edition of MAMFT News is available now.
So far 2019 has proven to be a wintery blast of many unexpected snowstorms. In fact, for the first time in many years, we had to conduct a virtual board meeting due to a snowstorm. My hope is that by the time you are reading this article, you will find that spring is just around the corner and piles of snow are just a distant memory.
Even though I find myself longing for warmer days, I have realized that the silver lining with these snow days has been that I am able to spend more time with my family. Now that I am entering my second year as President of MAMFT, I am also grateful for the “family” that I have with the board. MAMFT believes that relationships matter, and I certainly have found that to be true throughout my life, but I have noticed that even more during my time on the board.
Before joining the board, I often thought that I would not have what it takes to be on the board. What skills did I have that would help the board? Surely there were many others that would be more qualified, right? My first job on the board was as Membership Chair. It was through this position that I was able to host a new member event. I was worried about how many people were going to come and if the food was good enough. At the end of the night, what I realized was that most people didn’t care about where we were meeting or how many people came. What they seemed to care about the most were the connections that they formed with other people. One person even said that she had relocated from California and was grateful for a chance to connect with other family therapists because she was feeling alone in her private practice after moving across country.
The key ingredient in being successful was right there all along- relationships matter. This event was a “success” because people had an opportunity to connect and form relationships. I applied this knowledge to the board as well. Being a successful board member does not mean that you are aware of all the legislative issues or that you are a great event planner. It also does not mean that you like to speak in front of others or have the best PR skills. Successful board members connect with others. They connect with members, potential members, legislators, colleagues, other board members, and even members from other states. These relationships help the board make decisions. These relationships help the board gain awareness about the families we serve. These relationships help develop trust and a sense of community.
As the snow eventually melts away and spring once again returns, please consider volunteering for the board or running for a position in the next election. There are no magic skills. We are not looking for a polished resume. We are looking for people that care about MAMFT. We are always hoping to form new relationships and perhaps the next one might be with you!
Megan Oudekerk, PsyD, LMFT, RPT-S, MAMFT President
MAMFT is assembling a task force to develop a five-year strategic plan for the association. Are you a visionary (yet task-oriented) person who is invested in the future of MAMFT? Would you be willing to participate in a task force to help shape the future of the organization?
As an organization that was created under and regulated by AAMFT’s structure and rules from 1981-2018, the MAMFT Board sees 2019 as an important time to re-evaluate our mission and strategically formulate a plan for the next five years. This plan will serve as a driving force behind board and committee decisions and will help ensure that all of MAMFT’s programs and processes are there with clear intention, are valued by members and support the agreed upon mission of the association. The plan will allow the board to transition from a “worker bee” board to a strategic board.
It is anticipated that the Strategic Plan Task Force (SPTF) will need at least five-six months of collaborative work to complete their task. During this time the group will:
The above information will be distilled into aspirations of the association for the next five years, from which the SPTF will propose a Strategic Plan consisting of a prioritized list of operationalized deliverables.
Task force members will be selected to ensure that diverse perspectives and all stakeholder groups are represented. Members will be expected to devote 3 hours per week for 5-6 months (May -October/November) to help the SPTF complete its work.
Update: Applications are no longer being accepted as the task force has been assembled.
If you have further questions please email MAMFT’s Executive Director, Sara Bidler at firstname.lastname@example.org.
We all have certain sounds that irritate us, but for those with misophonia the body’s response is far beyond that of irritation. With misophonia the body’s fight or flight response is triggered by certain sounds. It is an automatic response that doesn’t involve any cognition and the sound/trigger makes the body feel as if it is being assaulted. I know because I have struggled with misophonia since my tween years.
It started with my mom’s gum chewing when I was 11 or 12, then went to chewing sounds by both my parents, then my high school best friend’s gum chewing, then my college roommate’s habit of eating M&M’s throughout the day, and so forth. These trigger sounds instantly invoked feelings of intense anger, disgust and anxiety along with a strong urge to flee or lash out.
The worst part was not knowing why this was happening to me. No one else seemed to have this problem, which led me to feeling embarrassed and ashamed about it. The few times I brought it up to family or close friends it was treated as being comical or something I made up. I wanted therapy or some sort of help for it, but my requests weren’t taken seriously. I don’t blame my parents or friends for not being more supportive because at the time there was no name for it, they knew of no one else having this problem, and the way the symptoms manifest is confusing.
I hoped it was something I would grow out of but when it continued to persist and worsen with each passing year, I had to accept it was going to be a part of my reality for the rest of my life. As someone pursuing a career in psychotherapy (and wanting to “job shadow” and work on my stuff) I saw a number of therapists with different skill sets over the course of my 20’s. At some point in the therapy process I would have the courage to bring up my aversion to certain sounds and was repeatedly met with bewilderment, blank stares and/or amusement…along with some empathy but no helpful insight into what it was (most considered it a form of anxiety). Then it occurred to me one day to do an internet search about my hatred of chewing sounds (this was before “Google it” was commonplace) and lo and behold there were forums a mile long of people struggling with the same thing! I spent hours reading the posts that first night. I laughed a lot because I totally understood where these people where coming from as they described their rage about sounds that are insignificant to the average person and how they would like to respond if there were no consequences (i.e. think adult tantrum). Knowing that I wasn’t alone was so validating and gave me hope.
Within a few years the condition had a name – misophonia. And when my son went in for some therapy five years later and I mentioned having misophonia during the family history portion of the intake process, it was the first time I encountered a therapist who knew what it was! I was thrilled word was spreading!
Fast forward to 2013 and the Misophonia Association was formed, which among other initiatives puts on an annual conference. And research is being conducted to better understand the cause of misophonia (hopefully leading to a cure)! Studies are showing there is a brain basis for misophonia and that misophonia is a neurological disorder.
There is no diagnosis for misophonia in the DSM, but a group of psychiatrists in Amsterdam who have been researching the condition have proposed the following diagnostic criteria:
So how can you support a client who presents with these symptoms?
1) Know what misophonia is in a general sense (finish reading this article and you can check that off or go a step further and watch “Quiet Please” listed in the resources below).
2) Make sure your client knows they are not alone and there is a name for their condition.
3) Share the below resources with your client. Help your client better understand the condition.
4) Encourage your client to exercise frequently and take time to do activities/be in settings that are calming to their nervous system.
5) Brainstorm coping strategies and ways to modify their environment to minimize triggers and the effect of triggers (ex. strategic placement of white noise machines).
5) Help the client in managing the emotions that come with misophonia (shame, rage, anxiety, grief). The following treatment approaches have shown to be effective with some misophonia sufferers: CBT, DBT, mindfulness, hypnosis, somatic work, EMDR, Alpha Stim and Neurofeedback. You may need to refer your client to someone who specializes in one of these treatments for misophonia-specific support, along with professionals in other fields who understand the condition such as chiropractors and audiologists.
6) Do systems work! In particular, work with anyone the client lives with (whether it be parents, a spouse, roommates, etc.) to help them better understand the condition and support the client in coping (along with validating their experience – misophonia is tough to live with!).
If you are an educator: Classroom settings are one of the most challenging settings for those with misophonia because of snacking, gum chewing, pen clicking, etc. Create a safe environment for students with misophonia to be able to let you know they have the condition and offer/brainstorm possible modifications so the student can better focus on what is being taught versus the sounds in the environment.
Making my condition known to all of you (especially considering my role with MAMFT) is another big step in my journey of combating misophonia. I hope it results in more and more clients feeling understood when they present with misophonia in therapy.
One of the reasons I hold back from telling people about my condition is that I don’t want people to feel anxious about eating around me. Fortunately, my misophonia isn’t on the severe side and my triggers are generally with those I spend a lot of time with. Gum chewing is the exception. It always triggers me. So now you know to not chew gum around me. The same goes with Oprah if you ever meet her.
Film: Quiet Please
Misophonia Facebook page: Stop the Sounds
Research Article: The Brain Basis for Misophonia
MN Audiology Clinic (source for white noise generators): The Tinnitus and Hyperacusis Clinic
Book: Understanding and Overcoming Misophonia: A Conditioned Aversive Reflex Disorder
Dozier, Thomas (2015) Understanding and Overcoming Misophonia: A Conditioned Aversive Reflex Disorder. Livermore, CA: Misophonia Treatment Institute
Schroder, A.; Vulink, N; Denys, D. (2013, January). Misophonia: Diagnostic Criteria for a New Psychiatric Disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553052/
Sara Bidler, MS, LMFT has a private practice in Maple Grove, MN: Authentic Living Therapy Services, LLC. She is an Advanced-Level Somatic Experiencing Trainee. In addition to helping people work through past traumatic experiences, Sara has a passion for helping those impacted by misophonia. She also serves as Executive Director for MAMFT. She can be reached at email@example.com. Learn more about Sara’s practice at www.authenticlivingts.com.
Recently, there has been an uptick in conversation regarding licensure, coaching, the future of this field, etc. The reality is, this is a really important conversation and requires some further input. Being licensed as a Marriage and Family Therapist is a pretty awesome thing however if you aren’t equipped with the right information and support system, being an unlicensed practitioner or a coach might appear to be a really appealing option. Addressing some of the reasons why people choose to ditch their license and justification for how to make having a license easier might convince people otherwise.
E: Well, the basic answer is, to protect the public. The MN Board of Marriage and Family Therapy originated in 1991 to provide the public with the opportunity to challenge if the care they were receiving from their LMFT was unethical. “The mission of the Board of Marriage and Family Therapy is to protect the public through effective licensure, and enforcement of the statutes and rules governing the practice of Marriage and Family Therapists to ensure a standard of competent and ethical practice.” Seems pretty basic. The reality is, as a marriage and family therapist, you are also a consumer. As a consumer of lets say medical goods, aren’t you glad some sort of rogue physician can’t treat your illness? Or operate surgery on your child? Or how about the nurses who support the physicians; they are all obligated to licensed by a board, too.
So while the Board of Marriage and Family Therapy might give off vibes that they are around to get therapists in “trouble,” they aren’t. Their only job is to ensure that the care offered by marriage and family therapist in the glorious state of Minnesota is ethical, to protect the public, and the greater field as a whole.
T: Having a license regulated means that there is a baseline standard of ethics and laws that someone who earns the license must abide by. It gives the public and other referring professionals an understanding that someone who has earned this credential should be experienced and competent to practice MFT.
Most importantly, the public needs to have recourse when a clinician is practicing unethically. Believe it or not, people do bad work. We hear about it from clients’ previous experiences and we may have even experienced it ourselves (therapists have therapists!). Without effective regulation, clients have nowhere to turn when a clinician is practicing unethically.
Ultimately, the Board isn’t there to protect you and me directly. Where in the mission statement does it say it protects clinicians? It protects the public, our clients. It helps to ensure that the work being done in the name of “Marriage and Family Therapy” is of a standard quality and basic framework. It protects our field.
L: The work that is done in the name of marriage and family therapy applies to both practitioners and professionals. A practitioner is someone who obtained their graduate course work and practicum hours and is not licensed yet. This means that if someone decided after graduating that they were going to open a private practice, they can not be advertising themselves as a marriage and family therapist, or mental health professional. That person is still a mental health practitioner and should be operating under the supervision of a board approved supervisor. When they talk about their cases with other professionals, it is not consulting, it is supervision. Again, this is to ensure that all practitioners are working and interacting in way that is ethical and protects the public.
T: The license process is not there to be convenient for us. It is a daunting process. And I believe it should be. When I go to see a professional, I want to know that there is a minimum requirement for their knowledge and skill. I want to know that they are required to continue to learn and hone their skill through continuing education requirements. None of this would be possible without a regulating body overseeing their practice. The Board of MFT is no different. I want to know that others in my field are meeting basic requirements ethically and if they are not, that their clients have a place to bring a complaint and find resolution.
E: There has been talk about how some people don’t like living with the “fear of the board.” This is the notion that the board will get you in trouble for something you did or didn’t do. While reporting to a licensing board can be a little nerve-wracking, most of the time it’s not. Most therapists only interact with the board annually when they renew their license or turn in information for CEU’s. If we want to debunk the biggest myth of the board; The reality is, you can’t get in trouble unless you violate one of the ethical rules (noted in the 5300’s). Even if you make a mistake and lose track of fees from a client, or slip confidentiality, and they find you “guilty” you still likely will get on a plan to correct the mistakes and you will get a chance to keep on practicing. Unless you are found in a violation that directly causes harm to a client, it is unlikely you will lose your license. And to be fair, if you lose your license, you probably shouldn’t have been practicing in the first place.
Additional fun-fact, MFTs have one of the shorter codes of ethics. Have you ever taken time to sit and read the social work code of ethics? You should, it’s got some good info in there. But ultimately, one of the reasons it’s so challenging to become a marriage and family therapist, is because once you get licensed, you’re operating at the highest level in our field, and you are trained to be great. The nitty gritty of our ethical code is to eliminate people from our field who don’t operate at such a high standard, or help people have advanced training (corrective action) in some areas to continue to support the high level of professional and ethical work we are trained to do.
L: “Suspicion always haunts the guilty mind” King Henry VI-William Shakespeare. I pause when I hear people say they fear the board, and I always ask, “Why?” Are you operating in an ethical manner? If so, what do you have to fear? Those of us who have gone through our programs and then the arduous task of supervision usually come out the other side of licensure with a clear understanding of the ethics and standards of our profession. I know that I can consult with other professionals to talk out whatever I am facing. If I have a question about something, like rules or ethical considerations, I know that I can email the board and get an answer from the people who interpret our rules and statutes. An answer that protects the public and also ensures that I am meeting the standards of our field; as a bonus the people answering aren’t scary! As practitioners earning our license we should be embracing the oversight in knowing that supervisors are responsible for training us! When we become professionals we should be fiercely defending our profession against those who may bring us down by unethical behavior.
E: If the previous few paragraphs didn’t convince you that having a license is important, this next one surely will. Aside from protecting the public, being licensed gives the work you do standing in the greater medical community. Again, would you see a doctor who wasn’t licensed? Or even a hair stylist (They are regulated by the Dept. of Health too!)? When you see that someone has a license, you know they are respected in their work and you have instant confidence that they would be at minimum an ethical choice for picking as a therapist. In addition, therapists were not so highly regarded in the recent past. We still fight stigma every single day from people who think they should just “deal with it,” “it” being their mental health. Until recently (last 20 years or so), therapy was pretty taboo and people in the medical community didn’t refer to them much. Now they do. And to keep being a part of the mainstream medical culture, we need to show that we care about not only our profession but about our clients (their patients) as well. To note: the insurance companies only decided to put us “in network” and pay for our work, because we are licensed and regulated….
We are also here to remind you, YOU WORKED DAMN HARD FOR THOSE LETTERS AFTER YOUR NAME!! The reason why you worked so hard is because you believed that you could make change and impact people’s lives. Not to sound cliché, but are you really going to give up that easy because it’s not always pretty? I think it’s fair to acknowledge that a lot of people have doubts about the mental health field as a whole. We are definitely in dynamic times and there is major reform coming to the health industry, but that’s an opportunity to power through and create change. The likelihoods of anyone taking you seriously without that license? No clue. But I know first-hand, it helps get the change makers to listen.
T: I’m proud of the letters after my name. I know the effort that went into accomplishing it. It’s hard for me to put a word on it exactly, but I feel different after accomplishing this. there was a change in myself personally and professionally when I transitioned from LAMFT to LMFT. I know that it means something in my field, to other mental health professionals, other healthcare professionals, and my clients. They know that I have jumped through hoops and have proven a level of competence. Not one part of me regrets taking the 5 years that I did to get licensed. I did it at my own pace, in my own way, and with excellent mentorship and supervision along the way.
So, we know what you might be thinking, the 3 authors of this article, are involved in the system. We all volunteer our time to be part of the MAMFT board. Which is the professional association for Marriage and Family Therapists in MN and the distributors of this article. We are not members of the regulatory board. IF anything we know first-hand that there are lots of ways to get involved that can take a lot of time (if you’ve got it!) or next to nothing when it comes to making an impact and create change. It just takes dedication to your future, and faith in what we offer the community. Getting involved in the MAMFT, the legislation, showing up, sharing an article, or just being proud of your license are all small ways you can get involved. As a licensed professional in our community, it comes with some rules, some power, and a lot of respect. Respect that can create new laws, that can save lives, and create a future for mental health.
Being able to trust your therapist is vital to any sort of successful therapeutic work, but it is especially true for those in eating disorder treatment. Throughout my years as a therapist treating eating disorders in various settings, including residential treatment, day programs, and outpatient therapy, I have learned the significance of trust and vulnerability within the therapeutic relationship.
As someone who went through eating disorder treatment myself, I know the thoughts that went through my head and the thoughts that my clients now share with me. There was the common thought, driven by the dark voices of the eating disorder, that I should not trust or listen to my providers. I mean, how did they know what was best for my body? How could I trust that restoring weight would actually be helpful in a world that was telling me the opposite? My therapist and dietitian kept telling me that life would be better without the eating disorder, but how did they know? Had they been through an eating disorder? Throughout my treatment I never heard from someone who had actually recovered from an eating disorder. This made it hard to believe that recovery was worth it, let alone possible at all.
Eventually, after years of struggling and for a variety of reasons, I decided to give full recovery a shot. And, my providers were indeed correct, as I learned living without fear of food and weight gain was utterly freeing. However, I think it would have been easier to believe this in the first place if I had heard from someone with first-hand experience. I was always wanting to meet someone who was on the other side of an eating disorder.
This desire of my own eventually led me to speak publically about my recovery. I began to give speeches to educate the public about eating disorders and share my story. I was on radio shows and spoke at community events and recovery groups. After several years of sharing my personal narrative, my passion to help others and eradicate eating disorders continued to grow. I decided to carry out this passion further by becoming a therapist and working to help combat eating disorders professionally.
This brings me to my work as a therapist and how my own journey has influenced my current work. At the forefront of this work is my goal to thoughtfully use my own experiences to benefit clients.
In the world of substance use treatment, discussing one’s own recovery status as a professional is fairly common. Within eating disorder treatment, it is less so. However, it is my belief that hiding it just gives way to the stigma and shame that exists in our culture regarding eating disorders. Pretending and lying are not part of my repertoire. This is not what I want to model to clients. Thus, I model vulnerability by sometimes sharing with clients that I too have been through an eating disorder and the intense treatment that accompanies it.
However, at the forefront of my mind is always the question: How do I share in an ethical way in order to use self-disclosure in a helpful way?
First, I do not announce my story to every client. I do not share it in the first session or even the second. I use intuition and discernment to know when it might be helpful or unhelpful to share. I am also sure to keep in mind and tell clients that everyone’s journey to recovery is different, including mine. Something that is helpful for one person, might not be helpful for another.
So far, when I have decided to be vulnerable and use self-disclosure as a therapeutic technique, it has made a world of difference within the therapeutic relationship and for my client’s recovery journey. First of all, I notice right away that clients become more at ease in my office. There is less shame and more acceptance immediately felt, which allows clients to be more open to sharing.
Furthermore, the client’s ability to trust me as their therapist increases with self-disclosure. The eating disorder has less credibility and I gain more credibility, which makes recovery that much more possible. Trust and credibility need to be high because I am trying to convince my clients to do the things they have come to hate most – eating food and taking care of their body.
Clients report my self-disclosure has also increased their hope because they can start to believe full recovery is possible. This is one of the hardest things to believe when in the midst of an eating disorder. Some doctors, therapists, family members, and friends have even told my clients that they will probably struggle with eating their entire lives. I also heard this message while in treatment.
These comments lead to discouragement and often cause clients to ask, “What is the point of even trying?” I can be the person to tell them that trying is the best thing they can do because they do not have struggle for the rest of their lives. I tell them not to fall prey to this lie, and I use parts of my own story as proof. Yes, the journey is difficult, but the resulting freedom from an eating disorder is more worth it than I can ever express with words.
Ashley Baird Urbanski, LMFT is the current MAMFT Administrative Coordinator and also has a private practice, Holding Hope Therapy, LLC in Osseo. Ashley specializes in treating eating disorders, body image issues, and disordered eating. She is passionate about challenging cultural narratives about food and body in order to help others restore or create positive relationships with food and body.
The importance of establishing a therapeutic relationship is well known to clinicians. What is often ignored is the fundamental and essential role of body and movement patterns in forming and developing those relationships. In fact, non-verbal patterns – how we move and inhabit our bodies and world, communicate important truths about ourselves and others. They provide an essential lens for clinical work, establishing a non-verbal dance that takes place between therapists and their clients.
Why notice movement and body patterns in therapy? On a fundamental level, everyone has a body and everyone is always moving in ways that uniquely reflect and communicate all of aspect their experiences, stories and histories. In addition, non-verbal interactions are the foundation of how we understand ourselves, process our world and form relationships. Neurologically, our bodies receive and respond to non-verbal information through mirror neurons, the Vagus nerve, the Limbic system and other neurophysiological structures. From our birth, patterns of relationship we are hardwired to connect through reflexes and other early neurological patterning which promote a sense of safety, nurturance and support (Attachment Theory and Object Relations as well as Polyvagal Theory, Neurological research). Because these early experience are the foundation for future relationship patterns, infants who are not able to feel sufficiently safe, supported and nurtured develop relationships more cautiously later in life. Throughout the lifespan, the client’s movement patterns will communicate the timing and process needed to establish a therapeutic relationship.
Many therapists already intuitively incorporate this on a rudimentary level. However a more nuanced ability to work with and understand non-verbal expressions requires additional training and skill. Attuning to details such as the size or dynamic quality of the movement, the shape, and quality of how the body is held, and the phrasing of movement sequences help to establish non-verbal synchrony and promotes feelings of connection. This facilitates interpersonal rapport and trust. Alternatively, therapist non-verbal mis-attunement can impede or even block the development of therapeutic relationships
How does this look in a typical session? When clients enters my office, I immediately observe their movement patterns including the way they inhabit the space around them, and how they live in their body. I also notice their movement dynamics and the phrasing and rhythms of their movement patterns. I also notice aspects of their movement that are potential expressions of other aspects of their history and identity. Next, I compare my observations of the client’s current to their past movement patterns, as well as my own movement patterns. Finally I modify and attune my own movements to join with the client on a non-verbal level. I am learning how to dance with them, and I join by following their lead and trying on their rhythms. With more withdrawn or cautious clients, I also use empathetic attunement to adjust to their non-verbal responses, as a way to signal my willingness to meet them where they are and follow their timing. Together we are co-creating a dance. The process is iterative and takes less time to do, than to describe. It promotes therapeutic relationships more quickly and effectively than a more verbally-focused process.
As therapists, our mirror neurons also activate our kinesthetic, proprioceptive and neuroceptive responses. Using Dance/ Movement Therapy (DMT) techniques, paying our own attention to our own inner responses can providing insight about countertransference, transference as well as the client’s experience of the world. (These techniques work best when the therapist is curious and honest rather than judgmental, about their own embodied experiences.) ‘Somatic countertransference,’ the therapist’s awareness of their own somatic responses to the client, is an important tool for becoming aware of and distinguishing between the therapists’ ‘body biases/prejudices’ and what they are sensing from their client’s experiences. ‘Kinesthetic empathy,’ the intentional embodiment or taking on of their client’s movement patterns, can provide clues to the clients experiences and their sense of the world. Both techniques provide insights into the non-verbal inter- and intrapersonal dynamics present in the session.
Finally, from a systemically lens, consciously or unconsciously, the therapist’s body, gestures and movement patterns are always part of and influencing the therapy session Just as therapists use words intentionally and mindfully, their embodied presence – the ‘Embodied Self-of-the-Therapist’- is also an important element that can promote therapeutic relationships. The process is a dance and following our client’s non-verbal lead and synchronize our rhythms with theirs we promote trust and safety: Won’t you join the dance?
Barbara Nordstrom-Loeb MA, MFA, LMFT, BC-DMT, CMA, PWAssoc, SEP, WoS, has a private practice and supervises in Minneapolis. She also teaches at UMN, received a Fulbright Scholarship to teach in Estonia, and has also taught in Lithuania, China, and South Korea. She has extensive diversity/multicultural curiosity and experience. As a therapist she focuses on the use of embodiment and creative expression for psychological, somatic, and spiritual transformation.
 Dance/ Movement Therapy (DMT) is a creative arts psychotherapy that works directly with embodied experiences as well as words to achieve clinical goals.
The above article is a Letter to the Editor. Opinions expressed in the MAMFT NEWS do not necessarily reflect the opinions of the Editors or of MAMFT.
MAMFT would like to provide the following resources for recent students of Argosy’s MFT program:
Information from the MN Office of Higher Education
I started treating OCD somewhere between 1-2 years ago. After discovering that it runs in my family, I became interested in how the treatment works and why exposure and response prevention (ERP) is almost always pointed to as the gold-standard treatment. I’d never been very interested in Cognitive Behavioral Therapy (CBT) modalities prior to this time because they struck me as automated and less personal than more relational or insight-focused types of therapy. I’d like to share more of what I’ve learned since I’ve begun treating clients with OCD about how important the therapeutic relationship actually is.
To have some background, our training doesn’t do much to help us identify OCD in clients. Recently, as I was “Konmariing” my office with the rest of America, I came across my old (OK, really old) “abnormal psychology” paperwork. Sure enough, I found the criteria for OCD, indicating that I did actually cover OCD in school. But what this class did not do for me, was to make OCD real in a way that I could understand how it shows up for people, and how I might identify it in clients.
Here is how the IOCDF.ORG website (an incredible resource) defines OCD:
“Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.”
What this description and the description I found from my old notes don’t indicate is how incredibly terrifying the obsessions can be for people who suffer from them and the intense responses that result. People with OCD can be in the middle of fight, flight, or freeze responses over and over and over, without relief. Many fears can’t be avoided as they often can with phobias, because it is thoughts that are driving the pattern.
Another very important point these brief descriptions omit is that many types of OCD include “non-observable” compulsions. The IOCDF.org does eventually go more into the type of mental compulsions I’m addressing here, which can include a sort of “heavy analysis” or excessive attempts to “figure out” an obsessive problem or situation. Here is an example. A common theme in OCD includes the obsessive thought: “What if I am a pedophile?” Importantly, this is in the absence of any actual inclination to behave as a pedophile. However, the obsessive thought feels real and terrifying to the sufferer. The compulsion arises as attempts are made to talk oneself out of the obsession. “But I’ve never wanted to hurt a child… But I love my baby…But I’ve always enjoyed children…” All these rationalizations can be countered by very creative “What ifs…”, such as “What if I am a pedophile and I’m just realizing it now?” Or the very clever: “What if I’m in denial?”. In addition to the mental compulsions/rationalizations, a sufferer might start to avoid children. This is especially sad when we think of a new mother or father avoiding their baby. To increase the isolating nature of OCD, it is not hard to imagine someone feeling hesitant to tell their therapist: “What if they report me to CPS and I lose my child?” This is a very common theme, and so common in the OCD world it is called “pedophilia OCD”, or pOCD.
Sometimes obsessions can center around more typical life problems, such as in romantic relationships (rOCD). Some sufferers worry about whether or not they are attracted to their partner. They might find themselves unwillingly focused on a perceived imperfection, then begin to try to talk themselves out of this concern. Hours can be spent in worry about if they love their partner. This issue can also bring up feelings of guilt, which the client might think will be relieved if they confess to their partner about their struggle, thereby causing the partner confusion.
Anxiety tends to be about avoidance. If I have an unpleasant feeling, I avoid that thing that I think caused it. With OCD, the difficult thought/obsession creates an unpleasant (often terrifying) feeling. The compulsion is one’s attempt to neutralize the difficult feeling and thought… and it might work initially. However, as the distressing thoughts continue to arise, more compulsive attempts are made to try to neutralize the thoughts and feelings. Over time the OCD takes on a life of it’s own.
This is where exposure and response prevention (ERP) comes in. With ERP, and the gentle help of a therapist, the client gradually “exposes” him/her/themself to the distressing thought and feeling. This experience can be both terrifying and exhilarating for clients after they have been trying to suppress the thoughts and feelings, often for years (on average it takes 14-17 years for OCD sufferers to find the support they need). The therapy process can be incredibly liberating for clients and very rewarding for therapists as clients reclaim their lives.
So what I’ve learned through treating OCD using ERP is because I am asking people to do things that cause them to feel like their lives are going to fall apart, the therapeutic relationship is crucial. A metaphor is often used for OCD that says that being in the middle of an OC cycle is like standing on a train track with a train coming toward you, but you are the only one who can see it. This is a terribly isolating picture. Consider how comforting it would be to have a therapist to step into that world with you.
– Lucy Grantz, LMFT
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