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Interview with Scott Cohen

Scott Cohen is a former President of the Massachusetts Association for Marriage & Family Therapy. Scott served for 15 years on the Allied Board of Mental Health as a representative for MFTs, and he’s currently the Treasurer of the Association for Marriage & Family Therapy Regulatory Board.

This is a transcription from the interview conducted by Jeremiah Gibson, Executive Director of the New England Association for Family & Systemic Therapy (NEAFAST), with Scott Cohen on July 27, 2020. Watch the full interview here.

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Interview with Janine Roberts

I’m happy to be joined by Dr. Janine Roberts. Dr. Roberts has been a practicing family therapist for forty years. She was the chair of the doctoral and masters program in Family Therapy at UMass Amherst for some twenty years, and has trained and supervised in-home therapists in the US and in Latin America. Dr. Roberts if the author and co-author of four books including one poetry book The Body Altars, as well as some seventy book chapters and articles. She’s researched and written extensively about our social identities and therapeutic work, family stories and rituals, as well as supervision and training, among other topics. Janine is presenting at the in-home therapy workshop “Our Stories and Theirs: Fully Engaging Ourselves and Our Clients in In-Home Therapy” on Friday, April 24th at Brightside in Holyoke. We’re happy to co-sponsor that with the Couple & Family Institute of New England (CFINE) and Brightside for Children & Families.

Jeremiah Gibson: As a younger therapist, a lot of therapists that are within ten years of me are getting trained in agencies who do in-home therapy. And unfortunately, more and more, these newer therapists are kind of being thrown to the wolves, and kind of given a manual and being sent out working with some really challenging families…without the education tools, without the supervision tools that could really help them be successful. So I’m really excited to have your expertise and your presence at the workshop at the end of April.

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Interview with Bennet Tittler

From his evaluation of triangles as representations of anxiety in healthy communication to his work on how families transmit and project anxiety onto its members, Murray Bowen’s observations and research form the foundation for our perspective as systemic therapists. Bowenian therapy has a strong history in New England; I had the chance to interview Bennett Tittler, a board member for the New England Seminar on Bowen Theory, to discuss more about how Bowen’s theories are being actively taught and explored in 2020.

Jeremiah Gibson: Bennett, your organization, the New England Seminar on Bowen Theory, is hosting Bowen Theory, Family Psychotherapy, and Change on Friday, March 27 at Clark University in Worcester. Dan Papero is the presenter. Folks can attend for $115 if they sign up before March 16. For those who have limited/no information about Murray Bowen, what introductory information about Bowen theory might be useful for folks who want to come to this conference?

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Interview with Corky Becker

Interview with Corky Becker, PhD, a Family Therapist and Clinical Psychologist who is overseeing the Monthly Master Series in Couple Therapy: Seven MORE Approaches to Interviewing at Therapy Training Boston starting November 6, 2019. These are the highlights from the interview. Watch the full interview here.

Jeremiah Gibson: Tell us a little bit more about the Monthly Master Series. What’s the format of it?

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Interview with Acey Mercer

Interview with Acey Mercer, LMSW, Practice Manager at Choices Counseling & Consulting in Albany, NY. Acey is one of the Keynote Speakers for the Couple & Family Institute of New England's (CFINE) symposium Sexual Identity, Gender Identity: Staying Current in a Rapidly Changing Landscape taking place Saturday, October 26, 2019 at the Smith College Conference Center in Northampton, MA. These are the highlights from the interview. Watch the full interview here.

Jeremiah Gibson: How did you become interested in becoming a therapist?

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Interview with Nancy Knudsen (Excerpts)

Nancy Knudsen, Co-Director & Co-Founder of the Couple & Family Institute of New England (CFINE) in Northampton, MA was interviewed by Jeremiah Gibson, NEAFAST President, about CFINE's upcoming symposium Sexual Identity, Gender Identity: Staying Current in a Rapidly Changing LandscapeThese are the highlights from the interview. Watch the full interview here.

Jeremiah Gibson: We’re excited to announce and promote a symposium that CFINE is hosting on Saturday, October 26th called "Sexual Identity, Gender Identity: Staying Current in a Rapidly Changing Landscape."

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Interview with Jennifer Eaton (Excerpts)

Jennifer Eaton, Director of Dialectical Behavioral Therapy Training and Consultation at the Bridge Institute in Worcester, MA, is presenting Communicating Effectively with Children and Families: Key Strategies from Dialectical Behavior Therapy on Wednesday, October 9 in Worcester. She was interviewed by Jeremiah Gibson, NEAFAST President, about the intersection of DBT and family therapy. These are the highlights from the interview.

Jeremiah Gibson: There are some really neat things going on in the Worcester area. I'm curious, Jen, if you could talk for a few minutes about what's happening at the Bridge Institute? 

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Reflections on the Ambulatory Care 2

Last month, we wrote a blog post about the collaborative efforts of the Executive Office for Health and Human Services (EOHHS) as they help create processes that improve access to quality behavioral health care in our state. Quite a few NEAFAST members have attended these meetings and provided input, including Mary-Jean Beach, a licensed marriage and family therapist (LMFT) in Cape Cod, and NEAFAST Board Member. The following are her reflections from a listening session meeting in Cape Cod.

I went to the 2nd EOHHS listening session at Cape Cod Community College on June 18, 2019. It was very well attended by a representative sample of consumers, families, providers, schools, advocacy organizations, and constituents. Senator Julian Cyr (D Truro) came in and spoke about his interest and concerns. The meeting was informative, exciting, and affirming for me as a family therapist. In our community the important take-aways were: 1) family advocates and consumers pled for more family sensitive behavioral health care and support; 2) parents and young adults over 22 are left without help when they lose Special Education Services; 3) the future of ambulatory behavioral health care may be in schools and primary health care offices.

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Interview with Steve Gaddis (Excerpts)

An Interview between Steve Gaddis, Director of the Narrative Therapy Initiative, and Jeremiah Gibson, NEAFAST President

Watch Here

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We Do: A Book Review (part 3)

This is the third of a four part series of Stan Tatkin's new book, We Do: Saying Yes to a Relationship of Depth, True Connection, and Enduring Love. This portion involves how Tatkin addresses sexuality, substance use, and infidelity. A special thanks goes to Peter Jones, EdD for writing this series.

In We Do, sex, with its intensity of contact and proximity, is presented as a potential psychobiological minefield, fueling the troublesome triad of communication, perception and memory. Because “in the psychobiological world partners repeat the same mistakes everywhere, regardless of the situation,” what goes wrong in sex is predictable from trouble in other areas.  

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We Do: A Book Review (part 4)

This is the fourth of a four part series of Stan Tatkin's new book, We Do: Saying Yes to a Relationship of Depth, True Connection, and Enduring Love. A special thanks goes to Peter Jones, EdD for writing this series.

Some users may object that Tatkin’s vision calls for relationship relentlessly up close. They may prefer a vision of relationship with more distance and independence.

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We Do: A Book Review (part 1)

This is the first of a four part series of Stan Tatkin's new book, We Do: Saying Yes to a Relationship of Depth, True Connection, and Enduring Love. A special thanks goes to Peter Jones, EdD for writing this series.

In We Do, Stan Tatkin sets out a conception of successful relationships, what gets in the way, and what couples need to know to prevent and repair trouble.

With no lack of books on the market seeking to help couples, We Do is a significant contribution for its solid grounding in current neuroscience and attachment research, and Tatkin’s flair for making that research accessible in fresh language while articulating a rich model of successful relationship.

Tatkin offers readers a binocular perspective on relationships: one lens focusing on agreements, principles and social justice; the other lens focusing on automatic psychobiological (body/brain) wiring that can undermine couples’ best intentions. The binocular depth that results sheds new light on key areas of couples’ difficulties such as sex, fighting, and betrayal, while generating new strategies solutions and tweaks to handle them.

Tatkin argues that couples’ best chance at enhancing their survival in a dangerous world, and from there to thrive, is to adopt a model of relationship as “secure functioning”. We Do is a thorough exploration of secure functioning, what it looks like across lifecycle phases in a couple relationship, and how it can be unintentionally undermined.

Simply put, secure functioning couples learn who they are, including how they are shaped by their earliest experiences, know what they are doing together, what they agree to, how to collaborate on making changes, and how to minister to each other when in distress.

To do this well Tatkin helps couples collaboratively create explicit, shared “principles of governance” based in values such as fairness, justice, sensitivity and reciprocity. A variety of clarification exercises support users in exploring what the explicit underpinnings of their relationship are and agreeing to what they should be.

Success in secure functioning may be based in agreements but requires a sharp eye on how implicit human psychobiological wiring, especially the nervous system, either supports or undermines their collaboration.

Tatkin’s skill as an educator and writer shines in his ability to set out the complexity of this neuroscience and attachment challenge in fresh language. He grounds his exploration in the importance of grasping the “troublesome triad” of memory, communication and perception.

Memory stemming from our prior relationships, beginning in childhood, is our main resource for managing the present, and without awareness and skill, history will repeat itself.

Communication is necessarily partial and easily misleading, leading to compounding errors in perception if uncorrected.

Compounded errors in perception lead to compromised affect and arousal states, with partners increasingly seeming threatening to each other without intending it. In conditions of even low-level threat, collaboration and alignment with agreements and shared visions is compromised.

Thus, the job for couples is two-fold, with a need to explore and develop explicitly their shared vision on one hand, and on the other to watch for how their minds, bodies, and brains can play tricks on them.

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We Do: A Book Review (part 2)

This is the second of a four part series of Stan Tatkin's new book, We Do: Saying Yes to a Relationship of Depth, True Connection, and Enduring Love. A special thanks goes to Peter Jones, EdD for writing this series.

Drilling down to reveal how the troublesome triad of memory, communication, and perception plays tricks on us, Stan Tatkin devotes several chapters of We Do to our mostly implicit, mostly automatic psychobiological systems, which are by default expert at detecting threat and waging war.

Tatkin lays out the architecture of systems with a variety of simplifications, many familiar by now to therapists but less so to other users. Crucial to managing the war are emotional and arousal (energy) regulation, a spectrum of attachment styles, the nervous system’s fight, fight, freeze and collapse responses, the window of tolerance, and not least, the negativity bias, an overarching tendency for the brain to lean negative and store negative memories, weighting psychobiological systems towards ever finer perceptions of threat.

Tatkin shows how reliance on automatic functioning, on board since early childhood, can lead to partners attributing intentions to each other that are the residue of unreflected, memory-based functioning in real time.

Real time is too fast, Tatkin says, limiting error-correction of inaccurate perceptions by the higher cortical areas of the brain. Vignettes illustrate the functioning of these system in interactions couples are all too likely to recognize. Corrective vignettes show how couples might handle those situations in light of each other’s implicit wiring.

Crucial to error correction is coregulation, the capacity of partners to both take their partners’s nervous systems into account and make adjustments. Fast remediation of old responses, potentially rewiring for secure functioning, is possible with a renewed, better informed effort to coregulate. Failing to respond appropriately to the other’s state through coregulation, partners can easily spin out and begin to seem threatening and predatory to each other.

Tatkin offers secure functioning as the couple’s necessary antidote to the inevitable specter of threat, which all relationships must learn to manage. A relationship is secure functioning when couples can keep threat limited enough to support cooperation and collaboration on realizing their shared vision of relationship.    

The practical value of the binocular approach pays off in extended treatment of areas of perennial difficulty for couples such as sex, fighting, and betrayal.

For fighting, Tatkin leads with the secure-functioning directive that partners must learn to “take care of their partner and themselves at the same time.” This simplification is countered by the psychobiological limitations that come into play in a close relationship: the negativity bias coupled with attachment insecurities, each leading to coregulation difficulties.

The physiology of vision complicates matters and is crucial to understand; the depth of Tatkin’s approach is perhaps best exemplified in his treatment of the importance of visual coregulation during fighting.

We only see clearly out of the center of the eye, the fovea, which is the size of a pinprick; we are effectively legally blind to the side. Since we don’t have a clear visual stream coming from the side, if our partner is to the side  the amygdala will fire more often, prepping for threat. The brain, angling towards negativity and in the absence of eye-to-eye visual coregulation, will fill in the blanks of the visual stream based on memory.

If partners get into a difficult topic and don’t have a rich enough visual stream, while driving, for instance, they are more likely to misinterpret partner’s responses, introducing errors. Without crosschecking what they are hearing with clear and steady visual cues, which would allow them to respond to partner distress fast enough, couples may find these errors compounding, leading them to square off, undermining collaboration.

Difficult topics must therefore be worked through face to face and eye to eye, not pointed toward the TV, the wall, the road, or even the therapist. While face-to-face, couples are urged to focus on one difficult topic at a time, and to not hold the floor too long; with rising stress, the nervous system is undersupplying oxygen and glucose to the higher cortical areas of the brain, making it hard to stay in the listening position long. None of this allows couples to correct errors in perception quickly enough.

Couples may thus find that the knowledge of psychobiology supports their capacity to structure and manage better difficult discussions to fuel their partnership.

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Book Review: Eight Dates

NEAFAST members uphold our responsibility to learning about current trends and up-to-date research in family and systemic therapy. Plus, we love to read. Here's the initial installment of our Book Review series: Eight Dates, by John and Julie Gottman. A big thanks to Katherine Manners for writing the book review.


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The Relationship Checkup

“Jeremiah, we need to talk.”

As a 21 year old college student, those were some of the most terrifying words that I heard from my partner. My anxieties went on red alert. Is everything okay? Did I do something to mess this up? The ultimate fear lingered in the back of my mind: Are you going to break up with me?

The dreaded DTR, or “define the relationship”.

DTRs were commonly painful, stress-inducing conversations. They were also the times where my partner and I were most honest with each other. We allowed ourselves to be vulnerable in a completely different way—we dared to speak for what we needed, what we hoped for, how we wanted the relationship to be different, consequences be damned. They were also seldom as bad as I feared, as we reminded each other what was valuable about the relationship and each other.

The anxieties around DTRs never really went away. In fact, when my partner and I got married, we used a specific construct of marriage to prevent us from the self-reflection and self-improvement of DTRs. My understanding of marriage was the continuation of the relationship was the most important thing, and that if I spoke for what I needed, I risked upsetting my partner. I bought into the toxic masculinity that doesn’t get discussed in 2019: Happy wife, happy life. I swallowed my voice, put on a happy face, and perpetuated a homeostatic process for a disappointingly impressive amount of time.

I’m not alone in this story—many of my couples describe a similar process leading into couples therapy. We get into a routine. We develop assumptions about our partners and operate based on those assumptions, resulting in diminished intimate conversation. We believe that checking in on the relationship requires too much vulnerability, too much honesty, too much risk, so we kick the can down the road. As therapists, we have an obligation to encourage our individuals and couples to take relational risks, so that relationships can be a venue for growth and development, rather than stasis and stagnation.

I had the pleasure of interviewing Dr. James Cordova, professor of psychology at Clark University, and Dr. Tatiana Gray about the Relationship Checkup, a solution-focused interview process designed to help couples identify their strengths and growth areas in a safe, non-judgmental setting. Dr. Cordova is the author of The Marriage Checkup: A Scientific Program for Sustaining and Strengthening Marital Health. He and Dr. Gray are co-founders of Arammu Consultants in Worcester, and are presenting on the Relationship Checkup this Friday, 1/25, at The Bridge Institute in Worcester.

How did you become interested in doing couples therapy?

JC: As an undergraduate at the University of New Mexico, I was the assistant director of the University’s student-run suicide crisis hotline. One of my responsibilities was tracking the reasons that people called the hotline to make sure our training matched the most urgent needs of our callers. Month after month, for the entire time that I worked there, the number one issue, by a wide margin, was relationship conflict. That experience convinced me that people’s relationships are often the source of their most profound hurt and suffering. So, when I applied to graduate school, I focused on programs with faculty who specialized in developing and studying couple therapy. I was lucky enough to be invited to study at the University of Washington with both Neil Jacobson and John Gottman – both pioneers in the scientific study of relationship health.

NEAFAST: How did you decide to create the Relationship Check-Up?

JC: While on internship at Harborview Hospital in Seattle, I was trained in Bill Miller’s Drinker’s Checkup, which struck me at the time as a significant innovation in brief and effective intervention. The implications for relationship health were obvious.

In the Jacobson lab, we had been lamenting the clinical significance outcomes of even the most effective forms of couples therapy, because in the long run, though significantly better than no treatment at all, couples therapy had about a 50% chance of improving couples relationship health to a degree that sustained for at least two years. For me, the takeaway was that too many couples wait to go to therapy until it is simply “too little, too late.” Our understanding from the literature is that the average couple can wait 6-7 years within a significantly distressed relationship before seeking any kind of professional help. It appears likely that within that time, irreparable harm can be done to the emotional foundation of the relationship.

My idea was that something like the Relationship Checkup, could provide couples with something brief, easy, and even fun to do for their relationship health, on a regular basis, to maintain their intimate connection and identify and prevent the accumulation of irreparable harm. For me, the key innovation in relationship health care has to be prevention and early intervention. The emotional complexities of long-term, truly intimate, relationships are simply too challenging for most people to navigate entirely successfully on their own. It’s akin to being solely responsible for your own physical health without any access to regular consultation with medical professionals, except for emergency room care. It would be the rare individual whose physical health would not eventually be significantly compromised under those conditions. And yet, those are exactly the conditions for our relationship health at the moment. The Checkup is designed to change that.  

What is the Relationship Check-Up, and what are specific dynamics that the Relationship Check-Up hopes to better define?

TG: The Relationship Checkup is a fun, proactive approach for couples to take care of their relationship health. Akin to regular dental checkups, the Relationship Checkup provides an opportunity for couples to stay active and engaged in the long-term vibrancy of their relationships. Specifically, the Checkup involves a one-hour online video meeting with a trained relationship health consultant. The meeting provides an opportunity for couples to tell their story and connect with their early history of falling in love. It then moves towards identifying the strengths in the couple’s relationship and intentionally celebrating and capitalizing what they do well together. The consultant then helps identify any potential concerns about their relationship and helps them understand the roots and causes of those concerns in a more thorough and compassionate way – creating intimate connection where before there may have only been hurt and frustration. After the Checkup meeting, the couple is provided with a personalized summary of their Checkup, with a list of helpful suggestion for continuing to take active and loving care of their relationship.

What information can couples hope to receive in their assessment? How do you communicate that to the couples you work with?

TG: Our intention in the Checkup is for couples to connect with the positive aspects of their relationship, as these are the parts that are easy to take for granted. In addition we hope that they leave their Checkup with a deeper and more loving understanding of the places where they tend to get stuck, and then use their personal summary to start to more actively address their concerns in the ways that makes the most sense for them as a couple. Ultimately, we hope to provide couples with the context to feel more connected, understood, and happy in their relationships. Our intention is that this type of brief and regular intention can prevent the accumulation of misunderstandings, resentments, and emotional distance, and foster deeper and more loving connection in both the short and long run.

How does the Relationship Check-Up differ from PREPARE/ENRICH, and other similar relationship assessments?

JC: The PREPARE/ENRICH curriculum tends to target couples before they get married, is typically group based, and is primarily focused on teaching couples skills. The Relationship Checkup, on the other hand, is available for all couples at any stage in their relationship, is a completely personalized experience (with just the couple and the consultant), and focuses on eliciting understanding and compassion by using their concerns to build intimacy bridges. In particular, the Checkup does not assume that couples are necessarily lacking skills that they need to learn in a workshop format. Rather the Checkup’s philosophy is that partners generally care deeply about one another and already know how to be loving and effective communicators, what they need help with is seeing the habitual places where they get stuck from a different, more helpful perspective – and from this new perspective will be better equipped to gracefully traverse those places in the future. Given the context of the Checkup, the consultant is able to see the couple’s unique strengths and concerns so that she can provide them with a deeper understanding of one another and their relationship.

How do you collaborate with other couples therapists?

TG: We are currently developing a model where we train couple therapists in the Relationship Checkup theory and approach so that they can license the automated material and use the protocol in their own clinical practices.

Likewise, in what situations might other couples therapists collaborate with you?

JC: We are always looking for talented and enthusiastic clinicians to be a part of our team. Once they go through the training process, couple therapists could offer Checkups to couples through our web-platform. We envision this being an effective way to fill open hours in clinicians’ schedules.

Your organization is deeply interested in research, particularly around preventative relationship care. What are some specific research projects you’re currently working on?

TG: We are currently focused on our Randomized Clinical Trial funded by the DoD providing Relationship Checkups to active duty Airmen and their partners within an integrated behavioral healthcare system. We are in the final year of this multi-year, multi-site study are hopeful that we will be able to demonstrate successful outcomes for the relationships of service members in the Air Force. We are also working with several VAs to run pilot studies with Veterans and their spouses, particularly those at a higher risk for suicidality and PTSD.

You’re presenting at the Bridge Training Institute on Friday 1/25. What are one or two pieces of information that you hope participants leave with?

JC: We hope that the participants leave with a thorough understanding of the theory of intimacy (the driving force behind all the positive outcomes of the Checkup), and several strategies that they can use to elicit compassion with individual clients, couples, and even loved-ones. One of our favorite aspects of conducting trainings is that the information is deeply relevant to participants on both a professional and personal level.   

What is something different you’d like to see in the field of couples therapy in the next 10 years?

TG: We’d love to see relationship health being prioritized with the same importance as physical and mental health. It is our vision that in 10 years, every couple will believe that it is just as normal and available to receive an annual Relationship Checkup as an annual physical health checkup.