The short, successful relationship?

In the Sex and the City movie, lead character Carrie Bradshaw narrates something to the effect of "Not all great love stories are novels. Some are short stories. But they are just as filled with love." Can a relationship with a short life span be properly labeled a success?

It's not just a philosophical question. Marriage and family therapists must regularly wrestle with the question of how "pro-marriage" or "pro-relationship" to be with their clients. We balance the ethical requirement, to respect clients' freedom to make their own decisions about their relationships, with the research base for our field, which shows that (1) people live happier, healthier, and wealthier lives when they stay married, and (2) a large majority of couples who stay together through difficult times report strong marital satisfaction five years later.

In my own practice, I am unabashedly pro-relationship. I tell clients who come in for Emotionally Focused Therapy that I will work to preserve and improve their relationship until they call me off, no matter how desperate the situation may seem. Final decisions on whether to stay together are always up to them, but they need to know what I believe and how I work -- another ethical responsibility, this one for informed consent.

In "A Vindication of Love," Christina Nehring argues that short, passionate relationships are no less noble, and may be more so, than the modern standard of a long-term, companionate marriage. Passionate relationships, even if brief, force one to live in the moment, to experience life in a deeper, more mindful way than is possible when planning out a long-term coexistence. Meghan O'Rourke at Slate was not convinced, and I tend to side with her.

Still, the topic leads me to think about the couples who come to me for therapy. Of course, many come in seeking to restore or strengthen their mutual sense of security and stability in the relationship, to ensure they can make it over the long term. But there are also those who seek exactly what Nehring vindicates: Immediacy, passion, feeling. These couples often have security in spades -- they have a strong commitment to each other (and, often, their children). What they want is to get out of that long-term mindset and back into the intense, spinning experience that, ironically, may have led to the conception of said children.

There's nothing wrong with either goal, of course. And as therapists, we're able to accommodate either, though I would readily admit therapy tends more toward the restoring-security side than the restoring-passion. (With notable exceptions.) But in either case, we're talking about therapeutic processes designed to maintain and strengthen a long-term relationship. I've never had a client openly tell me, "I would happily trade the security I feel now for a little excitement," possibly because they believe it sounds immature or hedonistic. Yet that precise willingness is often reflected in their behavior, through affairs or other kinds of risk-taking that may enliven the moment but damage the primary relationship. So therapy sometimes will seek to heighten excitement or intimacy without negatively impacting the couple's security -- see "Mating in Captivity" -- a trade that some couples find difficult if not impossible.

The careful balance between excitement and security is often a challenge for one person on his or her own, and becomes even more complicated when two people, whose needs change over time, are involved. A short relationship can be filled with love, and could be labeled a success if it meets the goals and desires of both partners -- of that I'm sure. Whether short, risky relationships are a worthwhile goal for therapy... that's a whole different question, and much harder to answer.

Finding MFT jobs

The most common question I hear these days from marriage and family therapists (MFTs) is simple: "Where can I find a job as an MFT?"

The more pessimistic ones ask the same question, they just leave out the word "Where."

Even in the current economy, where budget constraints are pinching many public agencies, there are still literally thousands of jobs available, right now, for MFTs around the country. Here are some places to start finding them.

Professional associations. AAMFT and CAMFT (a California-based association independent of AAMFT) each have their own job-finder database. As of today (June 17, 2009), AAMFT's database lists 153 openings around the country -- admittedly not a great number, but better than none. CAMFT's database lists just 31 clinical jobs, but gets bonus points for a great directory of additional county- and hospital-based employment databases that MFTs will find useful. Both associations also offer events geared toward networking, and many job offers come out of the connections made at those events. They're worth attending.

Federal programs. USAjobs.gov is the best place to start looking for federally-funded jobs for MFTs. The trick here is to search wisely. Entering the keyword "family therapist" brings back 131 openings. However, broadening that to "mental health" leads to 1,750 jobs, many of which MFTs are well-qualified for. The database provided "suggested keywords" to help with your search in the past, but doesn't appear to now; it is good to search any related terms you can think of.

Bigger job-search sites. The usual suspects are not great help, but you may luck out. Searching specifically for "marriage and family therapist" jobs returned about 20 results each on Monster.com and Yahoo's HotJobs. CareerBuilder.com was a bit better, but still only offered about 50 positions nationwide. Again, you will find many jobs for which MFTs qualify if you search under broader terms. Also, on the plus side, these sites are frequently updated and older posts are quickly removed, so their offerings are always fairly fresh.

County and state agencies. There is great variety in what you will find online, based on where you live. But where they exist, county and state agency sites are often the best places to go. Check out the web site for your county and state Department of Mental Health (smaller counties or states may use different names).

Larger nonprofit organizations. Many nonprofits, particularly those that contract with counties to provide mental health services, don't post jobs beyond their own sites these days because they don't need to. Ask friends and colleagues who the big players are in your county, and start at their site. Case in point: San Diego's Community Research Foundation, which posted eight openings for clinicians in just one day yesterday. (Full disclosure: I did an internship at a CRF program several years ago.)

Old-fashioned networking. Personal connections remain the best way to get an interview. If you're looking, take business cards and resumes with you to every CE event or other professional gathering you attend, and make a point of introducing yourself around. Even those who are not hiring now may be hiring at some point in the future, so it's always to your benefit to build strong professional relationships.

If there are other good resources for MFTs I've left out, please feel free to post them in the comments.

CAMFT articles supporting traditional marriage: A detailed response

CAMFT's latest issue of The Therapist claims to provide a somewhat balanced look at perspectives for and against same-sex marriage. The articles opposing same-sex marriage deserve a detailed response.

Full disclosure: I personally support same-sex marriage, and also believe a meaningful argument can be made against it, based primarily on the strange intertwining of marriage as both a religious and governmental institution. As you'll see below, I believe there are genuine ethical issues that will need clarification from mental health associations as gay marriage moves forward, to ensure that religious counselors are not discriminated against. In other words, there is a worthwhile discussion to be had here, on issues of ethics, law, and spirituality. Unfortunately, most of the articles presented in CAMFT's magazine feature irrelevant or inaccurate arguments, which is too bad. I've previously discussed why I believe the "debate" as CAMFT presents it is fundamentally flawed, but that was more of a broad-brush response. Below are more detailed responses to each article in the "Supporting Traditional Marriage" section.

An Inside Look at Gay Parenting

The lead article in the section details one woman's horrific childhood with a father who had horrible boundaries around his daughter and many male partners, but notably, stayed in a heterosexual marriage. Without a doubt, she genuinely suffered in her home, and I feel for her. Her plight, though, cannot be taken as an indictment of all gay parents any more than one case of horribly abusive, boundary-free heterosexual parenting can be taken as an indictment of all mother-father couplings. The author's experience was clearly very painful, but it is not the norm for any parents, gay or straight. It also does nothing to advance the marriage argument, given that her mother and father apparently remained married through the traumatic childhood she recounts.

Developments Ensuing Upon the Legal Recognition of Same-Sex Marriage in Massachusetts

To his credit, author Scott FitzGibbon gets his facts mostly right, and his article is well-referenced from relatively objective sources. I simply don't understand his alarmism.

As legalization of same-sex marriage in Massachusetts was arriving, Boston Public Schools developed a zero-tolerance policy for hate speech, including speech that would result in bias against gay or lesbian students. ("Bias" being a fairly vague term, the Boston policy has since been clarified to apply only to speech or action that results in a "hostile or discriminatory environment," a fairly important fact to be excluded from the article.) Zero-tolerance policies are generally bad policies, but this policy is neither especially egregious nor especially gay-friendly. Yes, teachers would be subject to discipline if their speech or actions resulted in a hostile environment against gay or lesbian students. They would be equally subject to discipline if their speech resulted in a hostile environment against straight students, or religious students. It's bad policy, but it's equal treatment.

The US District Court for Massachusetts has held that the state's schools have a responsibility to present students with materials that will foster respect for diversity. While the decision focused on same-sex families, its principles apply equally to religious diversity. FitzGibbon warns of the "absence of a reference to promoting critical thought," as though teaching respect for diversity somehow excludes critical thinking; again, consider the parallel with religious diversity. Schools should be teaching students to honor and respect classmates whose religious viewpoints differ from their own. School is not the place for students to be taught that one religious viewpoint is better than another. The ruling seems both appropriate and appropriately limited.

Apparently readers are supposed to be shocked and alarmed by a partial transcript of a teacher providing eighth-graders with medically accurate sex education. I wasn't. That kind of open discussion is exactly what reduces unwanted pregnancies and sexually transmitted disease. If it reduces stigma for gay students at the same time, all the better.

The author goes on to equate same-sex marriage with abortion:

"which, like same-sex marriage, was imposed by the courts against the wishes of many Americans, and in conflict with the religion and morality by which many citizens have been guided, and which has therefore been made available through school clinics without parental involvement."

This is inaccurate - schools don't provide abortions through school clinics, they typically don't even provide contraceptives; and parental notification/consent laws for abortion are the norm, not the exception - but more importantly, this is irrelevant. The only connections between abortion, comprehensive sex education, and gay marriage appear to be that the author doesn't like any of them.

The article concludes with its second reference to Parker v Hurley, a Massachusetts case where a parent sought to have his child excluded from (or at least that he have notification of) "any materials or discussions featuring sexual orientation, same-sex unions, or homosexuality." In other words, the parent wanted to remove his child from any and all activities that even acknowledged the existence of gay and lesbian people. The father's argument was rejected in court because it's ridiculous on its face. Should any child be kept out of, or a parent given pre-notification of, all classroom discussions or activities that acknowledge the existence of African-Americans? Or that acknowledge the existence of Baptists? Of course not. No matter how strong one's racial, sexual orientation, or religious bias, you can't avoid the existence of those who differ from you.

Treating Marriage as Discrimination Threatens Religious Counselors and Therapists

I know, like, and greatly respect co-author Jerry Harris, and I think there is a valid argument to be made about the possibility that some therapists could be unduly punished if non-discrimination clauses in ethical codes are improperly applied. Harris and coauthor William Duncan make their case using flawed case examples.

An Eastern Michigan student was supposedly dismissed from her counseling program because she refused to affirm a client's homosexuality. Contrary to what the article suggests, the student was not dismissed over her religious beliefs; the university would have honored the student's religious assertion if she were consistent with it. She was actually dismissed for violating the ACA ethical code (by selectively using her religious beliefs to justify refusing treatment to gay clients, but saying she would willingly treat those involved with abortion, child abuse, or murder), and then saying she didn't think the ethical code applied to her. "Who's the ACA to tell me what to do," a quote from the student, are magic words pretty much guaranteed to get anyone kicked out of their graduate program. A lawsuit is pending.

Separately, a Purdue student suffered "continually poor treatment" because of his opposition to same-sex marriage. This case is not cited and I could locate no other discussion of it in print or online. Even if true, every student has a right to their own opinions, but no right to expect that other students will agree with those opinions or like them; in this case, the only harm the student appeared to suffer was social ostracizing.

The authors state that

"Conflicts with religious liberties will be unavoidable when the state and professional governing bodies begin to endorse the idea that same-sex marriage or equivalent unions are mandated by principles of non-discrimination."

While conflicts may be inevitable, resolutions are certainly possible. APA and NASW have clearly endorsed the notion that refusing to allow same-sex couples to marry is discrimination, and they have strong subgroups of religiously-oriented professionals.

The ethical committees of each professional association do, certainly, need to provide greater clarity on when a therapist's refusal to treat clients based on the therapist's religious belief is discriminatory, and when it is simply proper clinical care reflective of the therapist's scope of competence. Taken at face value, I agree with Harris and Duncan that some of the therapists discussed here may have faced consequences they shouldn't have. But that ethical clarity can be provided, and we can move forward.

I see here a legitimate concern about the consequences of gay marriage, and how we can ensure that religious therapists will be able to continue to practice in accordance with their beliefs. But I believe that concern can be resolved to everyone's satisfaction, and I'm not convinced that it amounts to an argument against the existence of gay marriage.

Gay Marriage and Injustice

In case we needed a reminder that The Therapist is not a scholarly publication, here we have an article that mentions lots of studies while giving full references for exactly none of them. Author Walter Schumm starts by moving the target (emphasis in original):

"The argument for gay marriage is not about marriage but about benefits... The question is whether they [gay and lesbian couples] should be entitled to the same benefits granted to married mixed-gender couples."

If that were the question, it could be settled with civil unions. Gay and lesbian couples want marriage.

After making a slew of arguments completely irrelevant to what he says is the question at hand (at least one of which, the notion that gay parents are more likely to have gay children, has been thoroughly and repeatedly debunked), Schumm settles on the notion that same-sex couples do not have or raise children as often as opposite-sex couples, so they do not provide the same benefit to society and should not be supported in the same manner.

Two problems here. One, it's an equally valid argument for keeping the elderly or the infertile from marrying, and I don't see Schumm or anyone else opposed to gay marriage encouraging those additional restrictions. Two, for many gay and lesbian couples, they don't raise children because they're not allowed to, which presents a beautifully circular argument: Because same-sex couples are not given equal benefits under the law, they can not raise children as often as heterosexual couples. Because same-sex couples do not raise children as often as heterosexual couples, they should not be given equal benefits under the law. This is not an argument that makes enough sense to be debated.

Same-Sex Marriage: Not in the Best Interest of Children

"Proponents of same-sex marriage believe love is all children really need." This is fundamentally not true, and another logical fallacy. At least this article aims to look scientific, with dozens of references. However, the scientific community is largely in agreement that gay parenting is not harmful to children, and many in the community believe that allowing gay parents to marry will improve family stability and child functioning, not undermine it. For much more thorough, and more scientific, summaries of the research than what this article contains, just flip to the "Supporting Same-Sex Marriage" section of the same magazine. Or, see the following: ACLU summary (starts on page 24, runs for 50 pages) | APA 2005 research summary | APA policy statements | AAMFT consumer update (brief) | AAMFT task force full report (members only).

Among the few reliable research findings presented here and in Schumm's article, many of the comparisons are not related to the discussion at hand, a point well-made at the Independent Gay Forum:

"[W]hether or not gay marriage is allowed, children will continue to be raised by gay parents. The only question is, Will these children be raised in homes that may enjoy the protections and benefits of marriage? If it's better for children to be raised by a married opposite-sex couple than by an unmarried opposite-sex couple, it would surely be better for children to be raised by a married same-sex couple than by an unmarried same-sex couple. That's the relevant comparison, not the comparison of married straight couples to gay couples. If it's really concern for children that's motivating opponents of gay marriage, they ought to rethink their conclusion. They should be pounding the table for gay marriage."

Proposition 8 and the Attack on the Religious

Author Austin Nimocks starts by asserting that no matter what one's religious beliefs, he or she is accorded the right to "hold those beliefs and order your life accordingly." No argument there. He goes on to cite an example of someone forced from his role because his views opposing gay marriage became a distraction -- a phenomenon that cuts both ways, though I tend to agree that it's unfair on either end.

Nimocks goes on to cite the case of a marriage counselor in Georgia fired from her position for refusing to counsel a same-sex couple(1); it's also one of the cases Harris and Duncan cite, and I would respond the same way here: There is a genuine ethical issue that professional associations will need to resolve in ensuring they do not simply exchange one form of discrimination (against same-sex clients) for another (against religious therapists). It is resolvable, and doesn't advance or detract from arguments around gay marriage.

Most of the article, in fact, isn't relevant to the marriage argument; it's just fear-mongering. Gay marriage, he asserts, will lead religious therapists to be fired from their jobs, perhaps sued by clients. Yet of all the case examples in both this and the Harris & Duncan article, only one of them took place in a state where same-sex marriage was legal. So it's unclear how these articles advance the argument against such legalization.

Ultimately, religious leaders of various faiths in Massachusetts have said that the legalization of gay marriage has not impacted their religious freedom.

Why Marriage Matters

It's about the children, writes William Jeynes. He warns

"Same-sex marriage will mean the law, the government, and and the public schools of California will educate the next generation that our older marriage tradition was based on bigotry and was discriminatory."

It was discriminatory, and we already teach precisely that: Our older marriage tradition was based on bigotry and discrimination. Ending race-based restrictions on marriage did not destroy the institution of marriage or weaken families. Instead, after Loving v Virginia, interracial couples who would not have enjoyed the institutional support of marriage were able to receive it, and I know of no one who in restrospect believes that Supreme Court ruling was a bad one.

Ironically, Jeynes goes on to make an argument that works better as an argument in favor of gay marriage than one in opposition: "Marriage, as it has existed through countless centuries, has stood as an institutional act of compassion that protects the present and future welfare of children and promotes physical and mental health." I agree wholeheartedly. If you want to protect the welfare of thousands of children who now lack certain protections, let their gay parents get married.

Excerpts from the Amicus Brief of Iowa

This section from an amicus ("friend of the court") brief submitted by about a dozen academics is straightforward enough, discussing the historical context of marriage as a union designed around procreation. This argument is demonstrably false, and more importantly: it lost. The Iowa Supreme Court decision takes apart the research cited in the amicus brief in far greater detail than I could here, so I'll simply direct you there.

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So we're left with a section of articles that distort facts, make irrelevant arguments, and would be quickly rejected by any kind of scholarly journal. Yet these articles are given equal time and weight with peer-reviewed, scientific articles supporting gay marriage that are copied from academic journals, as the though the two somehow have equal validity (or, on a more basic level, quality). A meaningful discussion could have taken place here, with religious articles as a counterweight to the scientific ones; but that isn't what is presented. Too bad. Genuinely written articles on the difficulties religious therapists have when confronted by a situation where they need to balance their empathy with their religion -- those would have been worth reading.

Footnote:

(1) There is some source material online in both the Eastern Michigan case and the Georgia case. Eastern Michigan: News story 1 | News story 2 | Transcript of formal hearing | Letter dismissing student from program | Lawsuit. Georgia: Initial legal complaint | News story

On same-sex marriage, CAMFT stumbles along

In response to the controversy over its steadfast and solitary refusal to even make a statement about same-sex marriage, CAMFT dedicated its May/June issue of its magazine, The Therapist, to discussion of the topic. In the process they got some things right, and others wrong. Credit, and blame, where due:

Right: On social issues, CAMFT has never stood for anything. In his column, board president Patrick Healy reminds readers that CAMFT has never taken a stand on any social issue. When called upon by groups of members to oppose the Vietnam War, stand up for women's rights, or move a conference from a hotel where labor abuses were taking place, CAMFT has a long history of inaction. Duly noted, and not exactly a badge of honor.

Wrong: If CAMFT takes a stand on gay marriage, it must take a stand on everything. As Healy puts it, CAMFT is not a social justice organization. He goes on with lazy "slippery slope" rhetoric: "If CAMFT ever gets into social justice work, I'd like to ask it to take up the charge" on a variety of issues, Healy says. But CAMFT is hardly locked in a quagmire if it takes on the topic; most mental health organizations have clear policies for determining what social issues are worthy of their attention, and have been able to take a stand on gay marriage (and limited numbers of other issues) without falling off of some social-justice cliff and losing sight of their purpose.

Right: CAMFT does not want to risk alienating a portion of their membership. I genuinely credit Healy for being straightforward in saying so: "Taking a stand would alienate a percentage of CAMFT members." The logic, of course, is easy to poke holes through: failing to take a stand alienates a portion of CAMFT members. The organization is making an active choice in whom it chooses to alienate.

Wrong: The "pro" and "con" arguments presented in the magazine are equally valid and deserve equal space. The "Professional Exchange" section consists of one batch of articles supporting same-sex marriage, and another opposing it, on very different grounds. The "pro" articles are mostly copied from academic journals, and show just how clear the scientific evidence is: same-sex parents raise their children just as effectively as heterosexual parents, and same-sex couples and their children suffer due to marriage discrimination. The "con" articles are largely made up of arguments that are inaccurate or irrelevant (much more on that to come in a separate post).

While I am solidly on the pro-gay-marriage side, I do believe there is a real, cogent argument to be made against same-sex marriage based on how marriage intertwines with religious principles. I also believe that religious therapists have a genuine struggle to balance religious belief with appropriate care, and that all mental health professions need to find ways to affirm same-sex couples without discriminating against clients or therapists based on religion. This section is largely not that kind of discussion, though, which is disappointing. If anything, it seems to be a disservice and an insult to those who would have valuable and intelligent points to make in opposing same-sex marriage.

Wrong (maybe): This collection of articles will settle the angry mob. In spite of the headline "Tackling the Issues of Same-Sex Marriage" on the magazine's cover, presentation of a variety of viewpoints while disavowing all of them does not constitute "tackling" of anything. If CAMFT really wanted to "tackle" the issues, it would appoint a committee to examine the research and solicit member comments, and then make a policy recommendation (that the full board would hopefully endorse). This selection of articles moves no closer to such a resolution. I find it hard to believe that those therapists who have been dissatisfied with CAMFT up to now will find themselves appeased.

More to come on this topic.

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A quick point of clarification, for those who are unfamiliar: CAMFT is the California Association of Marriage and Family Therapists. It is not in any way affiliated with AAMFT, the American Association for Marriage and Family Therapy, which has a California Division: AAMFT-CA.

Why MFTs struggle to influence public policy

As marriage and family therapists, we have a vast body of knowledge supporting our work with families and communities. Many of the pinciples and interventions from this body of knowledge could be utilized in public policy, to great positive effect. As two examples, family breakdown could be reduced, and juvenile crime recidivism decreased, both in ways that actually save taxpayers money. Politicians of all parties should be chomping at the bit for such policies.

Except that they don't. And the April Family Relations journal helps us to understand why not.

In "The voice of experience: How social scientists communicate family research to policymakers," authors Bettina Friese and Karen Bogenschneider discuss why family research is not as utilized as it could be in policy, carefully avoiding blame and focusing instead on those practices that have been shown to work -- in the rare instances in which they've been used. For example, the seemingly obvious step of taking "the initiative to contact policymakers or policy intermediaries" had been taken by only one of the 49 participants in the study. And these were 49 leaders in applying research to policy, who had actually taken part in Wisconsin's "Family Impact Seminars" for legislators and their aides.

So, just as MFTs could gripe that policymakers are not putting our work into policy, policymakers could just as easily complain that we're not reaching out to them with anything useful.

The other recommendations show similarly pragmatic ways MFTs can improve information delivery to make it more useful (and influential). "Conceptualize policy work... as developing relationships" rather than providing one-shot informational pieces seems to be good advice, as does "Communicate research findings in ways that meet policymakers' information needs." On the latter point, if researchers don't help, legislators may rightly feel the need to do it themselves. This publication, essentially a content analysis of abstinence programs, seems like it ought to have been done by a non-governmental agency.

The article's final recommendation, "Be patient and self-rewarding in defining success," shows most starkly the difficulty educators and researchers have in gaining support from their universities to assist in policy discussions:

According to seven researchers from land-grant universities that are expected to translate research for public consumption, policy work is time consuming and too often considered "an extracurricular activity."

In spite of the barriers, there is room for optimism here. MFTs can and do influence public policy, and professional associations AAMFT and NCFR have made infusing research into policy discussions a key element of their work. And these associations are generally eager to enlist willing MFTs in the effort, especially at the state and local level. All that's needed is the energy and interest to be part of the discussion.