VAMFT Newsletter (v. 7, no. 1)

• A Letter from the President
• Post Traumatic Stress Disorder (PTSD)
• Biographical Information for Student/New Professional Candidate
• A Thanks to Our Outgoing Board Members
• Research Based Practice: A Self Evaluation
• Election Time!!!
• Letter from the President

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A Letter from the President
by Alison Galway, Ph.D., LMFT, LPC

September 11 affected us as a nation, as families, and as individuals. As therapists, however, we also witness the worry, pain, and emotional trauma in the wake of 9-11 in our daily life as well as our professional practice. I reflect on my personal reaction as I listened to the unfolding of events reported on NPR, and tried to find out via cell phone about family members who lived and worked in lower Manhattan (all safe). My husband was in Africa for the fall and three of his sons lived with us - ages 18, 20, and 22 - in Blacksburg, VA. The youngest immersed himself in an on-line computer game; the second raised the flag in our front yard and then threatened to leave the country if the U.S. started a war on Islam; the third drank beer while watching 24-hour coverage on TV for 3 days and agonized if he should enlist. Over that initial week we talked as opportunities arose - about nations and history and violence and families and PTSD and responsibility and what to do today. I kept an eye on the boys and talked to far-flung family members almost daily. I also went into a low level depression and did not realize my own crisis of spirit until later. I apologized for being in denial about my professional role and not taking an active lead among Virginia MFTs.

A colleague familiar with public traumatic events replied: "... Please, be gentle with yourself ... Your reaction is not unusual or a profound professional lapse. We are all human beings first. This tragedy hits home for all of us. ... Just be sure to take care of yourself and your family along the way. This will be a long haul ... It can steal away a year or two of your life without you even knowing it. Give, give what you can, give because you have to, but also be gentle with yourself."

His advice has been very helpful. I understood only when the fog began to lift after Christmas. The boys seem to be back on course with a new awareness of world events and connection to others. As clinicians, let us notice how we ourselves are doing - and ask our clients how they have reacted.

Sincerely, Alison Galway, Ph.D., LMFT, LPC

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Post Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis for people who have endured a highly stressful and frightening experience and who are experiencing distress caused by memories of that experience. It is as if a person is "possessed" by memories of an experience and just cannot let go. Because anxiety is the major sign of PTSD, it is classified as an anxiety disorder. Other anxiety disorders are phobias, panic disorders, and generalized anxiety.

The good news is that it is highly treatable when diagnosed early. The bad news is that it is often missed by examining physicians and mental health professionals, or it is misdiagnosed as some other condition that is more neurobiochemical in nature. But there is no drug cure for PTSD.

What causes PTSD?

Catastrophe/traumatic events are the cause of PTSD. These events are sudden, overwhelming, and often dangerous, either to one's self or significant others(s), such as a car wreck, natural disaster, dangerous accident, war combat, robbery at gunpoint, or a near drowning; the person affected felt intense fear, helplessness, or horror either at the time or immediately afterwards. Close friends, family members, and professionals helping those who survive such catastrophes can also be affected by trauma. These helpers, because of their empathy and compassion for the person in harm's way, can be traumatized in the course of providing help.

A catastrophe or traumatic event is a source or cause of stress that most people experience. The stress experienced during or immediately after the traumatic event or catastrophe is traumatic stress. Similarly, the stress that is associated with the traumatic event/catastrophe and that is experienced well afterwards is post-traumatic stress. It is defined as a set of conscious and unconscious behaviors and emotions associated with dealing with the memories of the stressors of the catastrophe.

How can you tell if it's PTSD?

Most people who have been exposed to a catastrophe experience both traumatic and post-traumatic stress reactions. Most are able to survive and cope well; only a small percentage of people develop PTSD.

Authorities recognize four features that all those with PTSD tend to exhibit at some time during their illness: the person (a) has been exposed to a traumatic event; (b) re-experiences the most traumatic aspects of the event; (c) makes efforts to cope with these symptoms by avoiding exposure to reminders; and (d) is on edge, unable to relax, and unable to think about the event without being obsessed.

Is it possible that there can be a delayed reaction to the traumatic event?

Yes. There are three types of PTSD: acute, delayed, and chronic. Acute PTSD is when the above symptoms last between one and 3 months after the trauma. Chronic PTSD is when the symptoms last for at least 3 months following the trauma. Delayed PTSD is when symptoms do not show up for at least 6 months after the trauma. This is often found with adult survivors of childhood traumas.

What are other effects of trauma?

When PTSD is detected, other symptoms and characteristics are found too. This is why PTSD is so often misdiagnosed. Among the major sets of symptoms are phobia and general anxiety (especially among former POWs and hostages and natural disaster survivors), substance abuse, depression, psychosomatic complaints, an altered sense of time (especially among children), grief reactions and obsessions with death (especially among those who survived a trauma in which someone could have died), feeling guilty, and increased interpersonal conflicts. For some who have PTSD, these other features go away once the PTSD symptoms are eliminated through treatment.

What kind of help is there for PTSD?

Both drugs and psychotherapy can be helpful. The most effective treatment approaches are called "cognitive-behavioral" because they focus both on the way traumatized persons view the trauma and on their resulting behavior. Exposure therapy includes systematic desensitization (training to relax in the face of frightening reminders of the trauma) and imaginable, in-vivo techniques such as flooding or the process of putting the client back into the trauma psychologically. The most effective treatment for PTSD includes a variety of anxiety management training strategies. Some of these include Rational Emotive Therapy, various kinds of relaxation training, stress inoculation training, cognitive restructuring, breathing retraining, biofeedback, social skills training, and distraction techniques. Innovative therapists are successful in combining various techniques to fit the trauma and the patient's unique requirements.

Families are the best setting to help those who suffer from this stress disorder. Families know when a member is acting differently than before the traumatic event. A therapist may work with you or your family member with PTSD to remember the trauma and reprocess the information and mourn losses. This also means that you will learn self-soothing techniques and ways to limit the distress during and between sessions. Your therapist will help you disconnect from the trauma so that reminders do not arouse distress. In doing so, the therapist will help you reconnect to life now and in the future without being haunted by the trauma. Sometimes this transition to life without the trauma is harder than expected.

The reconnecting is especially important: once you are desensitized from the burdens caused by the traumatic event, family therapy enables you to turn your attention to the future. You will attempt to learn from the traumatic events and make needed changes in your personal life and relationships, especially love relationships.

What types of drugs might be used in treatment?

For some clients, drug treatment is a useful supplement to effective psychotherapy approaches. Drugs such as imipramine, amitriptyline, phenelzine, fluoxetine, and propranolol may provide temporary symptom relief for general anxiety, depression, insomnia, and related problems.

So there is hope for me and my family?

Family therapy offers an extraordinary and useful resource for helping families survive a major traumatic event. Social scientists have documented the remarkable and consistent patterns of emotional recovery from a wide variety of traumatizing events. There is a large number of treatment approaches available today. It is impossible to prevent traumatic events but family therapy can help promote recovery more quickly, and enable family members to get back to what they do best: love each other.

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Biographical Information for Student/New Professional Candidate

Name: JENNIFER L. MATHESON, MA

Jenny will complete her Master's degree in MFT from Virginia Tech in May, 2002 and has been accepted into their Ph.D. program. She presented at AAMFT in 2001 on her thesis, "MFT Faculty Member's Balance of Work and Personal Life." Jenny is an Intensive Family Therapy Intern at the Inova Kellar Center in Fairfax. She also has an MA in Sociology and has worked as a research policy analyst at Research Triangle Institute since 1991. Jenny believes one of VAMFT's most pressing issues is membership. Higher levels of recruitment, retention, and general interest from MFTs are crucial if the Association is to continue to have a lasting impact.

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A Thanks to Our Outgoing Board Members

Peter Michaels has served as Student/New Professional and continues to be active in VAMFT efforts. A fount of information, he is also our WebMaster and designed and maintains the site. Karen Rosen has served as Northern VP and been a source of ideas and enthusiasm. Both of these members served in a dedicated and responsible manner. Our heartfelt thanks goes to them and our hope that they will continue active support.

Yvonne Barry has offered to continue to serve as Central VP.

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Research Based Practice: A Self Evaluation
by Jeremy B. Yorgason, M.S.

There I sat, having just opened one of the envelopes for my preliminary exams in my doctoral program. I read the question over a couple of times: "Discuss the research in Marriage and Family Therapy, Family Studies, and Human Development that informs your framework. . . . [Discuss] specific research studies that inform your treatment of typical presenting problems."

My mind raced through my training and the many courses that I had taken. I searched through folders and binders looking for any empirical article that described research findings in support of the way I conducted therapy. I could remember the major text books, such as Nichols and Schwartz (2001), and I could also remember professors describing their own cases from a "Bowen Family Systems, Structural, Strategic, or Solution focused" perspective. In somewhat of a panic, I searched for anything empirical that supported my work.

My response to this question scared me for two reasons. First, it was an exam question, and my continuation in the program depended on my answering the question well. Second, and more importantly, I wondered if the work that I do in therapy has any empirical base.

I acknowledge that there are many aspects of therapy that cannot be measured or tested. The practice of therapy is a form of art, and many theoretical approaches have not been studied empirically. My discussion here is to focus on applied techniques and skills.

My questions that day led me to ponder on the therapy services that I offer and their effectiveness in helping my clients. I felt that I had received excellent training, and that I had a theoretical framework that guided my work. However, I was still left with the question of what research literature supported my clinical work.

Within the growing field of marriage and family therapy, there is an increasing body of literature that provides empirical support of therapeutic practices. In addition, there are published explanations of therapeutic practices supported by clinical experience.

As a result of my prelim exam, I felt the need to gather some literature that supports my therapeutic practices, whether empirical, clinical, or theoretical in nature. One such source is in the October 1995 Journal of Marital and Family Therapy (JMFT) special edition entitled - The Effectiveness of Marital and Family Therapy, addressing specific disorders, such as, schizophrenia, conduct disorders and delinquency, marital conflict, and alcoholism. Other sources of empirical discussion are the most recent editions of MFT texts, such as, Nichols and Schwartz (2001). These texts now review empirical support for several of the theories discussed. Lastly, it has been helpful to seek out specific research support in specific problem areas. For example, when working with a couple in which one spouse experienced depression, it helped to review the literature regarding depression itself as well as couple treatment of depression.

My challenge to you is the same one I gave to myself: to take an inventory of your clinical practices by evaluating them in relation to:

1. your training experience,
2. theoretical orientation(s) to which you subscribe,
3. research literature that specifically addresses the theoretical orientations to which you subscribe, and
4. research literature that specifically addresses the types of problems your clients present in therapy.

By grounding my clinical approach in practice that is supported by research, I can have greater confidence that what I do will help others. You may want to research the grounding of your practice as you continue to develop your clinical skills and techniques.




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Election Time!!!

Volunteers for vacant positions needed:

• President-Elect (President) (Term of 2 years as President-Elect, 2 years as President, one year as Past President - total of 5 years)
• VP Northern (Term of 2 years)
• VP Eastern (Term of 2 years)
• Election Committee Chair and 4 Members (Term of 2 years)

Candidate for Student/New Professional Representative (Term of 2 years): Jennifer Matheson, Falls Church

Candidate for Central VP (Term of 2 years): Yvonne Barry, Chester

Please consider volunteering for one of these positions. Our professional well-being depends on an active and involved membership!
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Letter from the President
by Alison Galway, Ph.D., LMFT, LPC

In the last newsletter, I expressed concern about the future of the Virginia Association for Marriage and Family Therapy. The family therapists in Virginia are served well by our national presence in Washington, DC. AAMFT lobbies, produces publications, hosts a national conference, and dispenses information. Our university programs provide a new generation of professionals to move our profession forward in imaginative and research-based practice. We have a rich tradition.

Our daily clinical practice, however, is regulated largely by the Commonwealth of Virginia. Laws regarding licensure, continuing education, reimbursement by private and public agencies, and practice restrictions or obligations are created in the General Assembly. The Department of Health Professions implements regulations. The Board of Counseling manages oversight. Virginia is where we live and practice our profession.

VAMFT has an election coming up but we need nominees. The future of our profession in Virginia is at stake. Please consider coming into one of these posts. We have openings in the Vice-President position for the Eastern and Southwestern areas. The Election Board needs a chair and members. Some members are willing to volunteer, but a Chair is needed to coordinate the election effort.

Most particularly, we need a President-elect to "learn the trade." The initial hard work of getting licensure and getting mandated benefits status (7/2001) has been completed. The efforts of the past can be lost if we donÕt maintain a professional presence and continue to work for effective MFT representation among the mental health providers in Virginia. You must be a Clinical Member to be on the Board of Directors, but many other active roles, like newsletter editor, do not require Clinical status. Contact me or other Board members. Let us know what you are interested in doing. We need people.

Some concrete activities beyond Board service include a state conference, regional conferences, newsletter, a legislative committee, and an elections committee. These efforts take people willing to plan, coordinate, and implement, to show up for meetings, to stay in touch via phone and email, and to make suggestions and develop ideas. At this time, VAMFT is sending 3 people to the leadership conference in Washington DC in April. More of us need to prepare for leadership in VAMFT and help implement our good ideas.

Our next Board meeting is May 3 in Charlottesville, VA, 11 AM to 2 PM. I urge you to attend to get to know your board members and help us discuss the issues facing MFT's in Virginia over the next year.

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