Necessary Losses

I first read Judith Viorst’s book, Necessary Losses, when it came out in 1998, towards the early phase of my career. The idea that loss was necessary, not just an inevitable part of life, was somehow radical for me as a child of refugees, growing up with multiple losses of family, home, and history. Loss was something to be either minimized or its extreme version—overcome with immediate, nearly heroic stoicism and hard work—almost as if to reclaim or re-create as best as possible what was lost. The idea this book posits, that losses are necessary for growth, health, and maturity, was a turning point for me personally and professionally—perhaps a “final” reframe for making sense of the positive transformation that is possible from going through painful, and irreversible, life-changing losses.

Why am I writing this now, as President of AAMFT, at this point in time? Because as I reflect on our recent victory of obtaining Medicare inclusion as MFTs in December 2022, I am also aware of the “necessary losses,” or changes, that have occurred at AAMFT over the decades that have led us to this triumphant moment. Though I have not been around AAMFT since its beginning, I have been around since I was a student member in 1986, before “clinical membership” was automatically obtained with an LMFT (it has now recently been decoupled from the LMFT to allow for inclusion of qualified, systemically-trained clinicians from other disciplines). Since my involvement in the 90s in leadership (first as a Division leader), AAMFT has been on a successful quest of association best practices in furtherance of AAMFT’s primary mission to “promote and protect the profession.”

Along this lengthy path to achieve parity and recognition as a distinct discipline, there have been many victories, such as being included as one of the five core mental health disciplines (1992); obtaining licensure in all 50 US states in 2009; inclusion as providers in the Veterans Affairs Administration healthcare system (2006); awarded the funding to establish the Minority Fellowship Program (2007); the numerous achievements, past and ongoing, across the states to include LMFTs in third party reimbursement, school systems, and governmental programs; and finally the last remaining bastion of parity, inclusion in the federal Medicare program.

I wanted to take this opportunity to give thanks and credit to the previous Boards, led by the Presidents (see below), that worked hard to make tough decisions in order to keep us focused both on the activities necessary to achieve our primary mission, while ensuring that the Association continues to grow as a business enterprise in order to be entrusted with carrying forth this mission for future generations of MFTs and the communities we serve:

AAMFT has gone through many changes in order to not only adapt, but preferably predict the consequences from the natural socioeconomic/political evolutionary forces in society. We went through the difficult but necessary restructuring from the former Divisional structure to forming Interest Networks to increase more relevant and viable member participation and sustainability (2018); AAMFT restructured its pathway to membership and categories in order to provide for inclusion of qualified, systemically trained clinicians worldwide (2021); pivoted its programming during the pandemic (saying goodbye to its usual and customary programming of in-person events) resulting in virtual conferences and programming which has increased its reach and educational/networking offerings to more members both in the US and abroad (2020); and selling of the AAMFT building in Old Town Alexandria, Virginia, in December 2022 and shifting to a remote working structure for staff.

These decisions can sometimes seem to come at a cost, felt or experienced at an emotional level—as the relational beings we are, if nothing else! As the President of the AAMFT Board of Directors, I want to assure you that as a business, the Board operates on the level of “opportunity cost” when tough decisions need to be deliberated and made: the opportunity cost of a choice is the value of the best alternative forgone where, given limited resources, a choice needs to be made between several mutually exclusive alternatives (Wikipedia). This doesn’t mean, of course, that we do not also operate as systems thinkers to consider the personal and professional impacts on our members, and we do our best to inform, prepare, and support one another through times of change and transition.

Indeed, now that we have achieved this critical milestone of MFT Medicare inclusion (we still have A LOT of work to do to operationalize this systemically across institutions!), there will be new challenges and “opportunity costs” as the AAMFT Board of Directors carefully considers AAMFT’s future direction, especially during these quickly evolving post-COVID pandemic (or endemic) times as they are currently affecting our practice patterns and service delivery options/locations. If you haven’t read AAMFT’s Workforce Study which highlights what is occurring in the work lives among MFT providers since the pandemic started, you can access it here. More practitioners are practicing across geographical regions, making licensure in more than one state desirable. AAMFT is investing in licensure portability studies in order to ascertain the best, fiscally responsible path to expand service delivery for members. Money invested in any one important direction means evaluating other costs and programs that have outgrown their strategic importance—once again, we revisit the idea of “necessary losses.”

Gaining recognition as Medicare providers is wonderful! But it also increases our exposure and one could say vulnerability as other licensed professions may want to once again limit our scope of practice or relegate us to a specialty in order to preserve or obtain market share. Now, more than ever, the AAMFT Board of Directors and AAMFT staff are committed to staying vigilant and focused on our primary responsibility of “promoting and protecting” our profession.  Thank you for all that you do as a member and/or leader of our beloved Association!