Since 2019, CenterLink (the Community of LGBT Centers) and the Yale LGBTQ Mental Health Initiative have been offering comprehensive trainings in LGBTQ-affirmative cognitive-behavioral therapy (CBT) for mental health providers serving LGBTQ clients.
Developed, tested, and refined over more than a decade by Yale researchers, LGBTQ-affirmative CBT is the first treatment shown across large-scale clinical trials to reduce depression, anxiety, substance use, and sexual risk among diverse LGBTQ community members. The treatment improves mental health and builds resilience by targeting the specific internal and psychosocial vulnerabilities that research shows are elevated among LGBTQ people due to early and ongoing exposure to LGBTQ-related stress.
Those who participate in one or more offerings of the Yale-Centerlink Training Program will gain the knowledge, hands-on skills, and confidence to implement LGBTQ-affirmative CBT. Most training offerings are open to professionals and trainees, including individuals for whom CBT is not their primary therapeutic modality.
The Yale LGBTQ Mental Health Initiative provides a home for scholars and scholarship devoted to understanding and improving the mental health of LGBTQ populations in the US and around the world.
LGBTQ individuals experience substantial disparities in mental health problems, from suicide to substance use. The Initiative applies Yale’s strengths in mental health, LGBTQ studies, and global health to solving this pressing public health challenge.
We achieve this mission through fostering highly collaborative research across schools and departments; sponsoring academic events meant to spark innovation in this field; and training and educating diverse future leaders in LGBTQ mental health research.
Our Initiative
The Initiative is housed within the Yale School of Public Health and Yale School of Medicine, Department of Psychiatry, and draws upon Yale’s interdisciplinary expertise to advance its mission.
Andrew Benesh, PhD, LMFT-Behavioral Health Education and Community Development Professional comments on drafted rule changes.
I know there’s a lot of anxiety floating around regarding upcoming changes to student loan rules, and their anticipated effects on students.
The Department of Education (ED) is moving forward with draft rules that will fundamentally change how graduate students finance their education. Under the rule ED will propose, many healthcare professions are not classified as professional programs, but instead as graduate programs. “Graduate programs” will have a $20,500 annual limit, with a $100,000 total cap, while programs defined as “professional programs” will have a $50,000 annual limit, and $200,000 total cap. This means that many students, including MFT students, would be subject to significantly lower loan limits. This change will take effect on July 1, 2026, and will apply to new borrowers. The ED is expected to open this proposed rule up for public comment early next year, most likely in January.
AAMFT has been actively advocating for the inclusion of MFTs in the professional degree definition throughout the rulemaking process, including joining coalitions of health professionals advocating for a more expansive definition of professional degree. AAMFT and many other healthcare associations will be submitting public comments to ED on this proposed rule. AAMFT will alert members once the public comment period begins.
What can be done before the public comment period begins?
It is important for Members of Congress to hear from their constituents on this important issue, and to ask Members of Congress to make sure that ED includes MFTs and other healthcare professions under the professional degree definition in the final rule. Use this link to contact your Member: https://lnkd.in/eZ6qQmaj
In addition, AAMFT wants to hear how federal graduate student loan program has supported your path to licensure and how these proposed limits would impact future students. Your stories will help show Congress the real-world impacts of these changes on current and future MFT students, as well as how these changes will exacerbate the shortage of behavioral health providers. Share your story here: https://lnkd.in/eBFKMdZh
The above is based Original Message: Sent: 11-24-2025 04:04 PM From: Neal Sombke
Hello Family TEAM members,
Thank you for your comments on this important issue. AAMFT has been actively advocating for the inclusion of MFTs in the professional degree definition throughout the rulemaking process, including joining coalitions of health professionals advocating for a more expansive definition of professional degree.
We have linked here two coalition statements AAMFT has signed on to within the last month that urge the Department of Education to classify MFT degrees and other healthcare degrees under a more inclusive professional degree definition.
The Department of Education (ED) is moving forward with draft rules that will fundamentally change how graduate students finance their education. Under the rule ED will propose, many healthcare professions are not classified as professional programs, but instead as graduate programs. “Graduate programs” will have a $20,500 annual limit, with a $100,000 total cap, while programs defined as “professional programs” will have a $50,000 annual limit, and $200,000 total cap. This means that many students, including MFT students, would be subject to significantly lower loan limits. This change will take effect on July 1, 2026, and will apply to new borrowers.
The ED is expected to open this proposed rule up for public comment early next year, most likely in January. AAMFT and many other healthcare associations will be submitting public comments to ED on this proposed rule. AAMFT will alert members once the public comment period begins.
What can be done before the public comment period begins? The federal bureaucracy does listen to Congress. Therefore, it is important for Members of Congress to hear from their constituents on this important issue, and to ask Members of Congress to make sure that ED includes MFTs and other healthcare professions under the professional degree definition in the final rule. AAMFT has developed a grassroots message that you can send to your Members of Congress.
In addition, AAMFT wants to hear how federal graduate student loan program has supported your path to licensure and how these proposed limits would impact future students. Your stories will help us show Congress the real-world impacts of these changes on current and future MFT students, as well as how these changes will exacerbate the shortage of behavioral health providers. Please click here to share your story.
AAMFT continues to monitor the situation and how these changes will affect MFTs. If you would like to read about how these changes will affect MFTs, you can click this article. Please contact AAMFT at FamilyTEAM@aamft.org if you have any questions.
Recording therapy sessions is a powerful tool for promoting professional growth and improving therapeutic outcomes. Without this practice, therapists miss out on valuable opportunities for feedback, self-reflection, and skill enhancement, which are essential for ongoing development.
The Importance of Feedback in Therapy
Feedback is a cornerstone of professional growth in any field, and therapy is no exception. For therapists, receiving feedback on their work is crucial to understanding how their interventions are perceived, identifying areas for improvement, and refining their techniques. Without recording sessions, it becomes challenging to obtain accurate and detailed feedback. Relying solely on memory or subjective impressions can lead to a skewed understanding of the session, missing out on subtle but important nuances in the therapeutic process.
Enhancing Self-Reflection
Recording sessions allows therapists to revisit their work with a critical eye, enabling them to analyze their interventions, communication style, and the overall flow of the session. This practice fosters self-reflection, helping therapists recognize patterns in their behavior that may be hindering or facilitating the therapeutic process. For example, a therapist might notice that they frequently interrupt clients or that they struggle to maintain a non-judgmental stance in certain situations. Identifying these patterns is the first step toward making intentional changes that can enhance the effectiveness of therapy.
Facilitating Supervision and Peer Review
Recorded sessions are invaluable in supervision and peer review processes. Supervisors and colleagues can provide more precise and constructive feedback when they can observe the session directly rather than relying on second-hand accounts. This external feedback is critical for identifying blind spots, challenging assumptions, and exploring alternative approaches. Without recorded sessions, therapists may miss out on these rich learning opportunities, limiting their professional growth.
Improving Client Outcomes
Ultimately, recording sessions and using the feedback to improve therapeutic skills leads to better outcomes for clients. When therapists are more aware of their strengths and weaknesses, they can tailor their approach to meet clients’ needs more effectively. This continuous process of learning and improvement ensures that therapists are providing the highest quality care possible.
Conclusion
If you aren’t recording your therapy sessions, you are likely missing out on key opportunities for growth. By incorporating session recordings into your practice, you can enhance self-reflection, receive valuable feedback from supervisors and peers, and ultimately improve your therapeutic effectiveness.
We’re excited to share this month’s PCFTTC newsletter—packed with insights, resources, and opportunities to support your ongoing professional growth.
Here’s a quick look at what’s inside:
🌀 Tantrums and More Tantrums… A systemic reframing of what children’s challenging behaviors really communicate—and how ESFT clinicians can use family assessment tools to understand the whole system.
⚔️ Wicked Competition Explore Elphaba through the lens of the family assessment tool and win access to Homestudy of your choice.
🎭 “I Feel Like an Imposter!” A post view of an October workshop on understanding and navigating persistent self-doubt in clinical work and supervision.
🎓 Free CE Credits – 11/19/25 Yes, you read that right! Don’t miss out on your chance to earn free CE credits during the training year.
We hope this edition brings you reflection, encouragement, and a few new tools to take into your work.
As always, thank you for being part of the PCFTTC community. Wishing you connection, clarity, and a meaningful month ahead.
In her 1985 article in PsycCRITIQUES, “Reaching Inward: A Way of Training in Human Systems Thinking,” Marion Lindblad-Goldberg presented a method for training people to think systemically about human behavior. The core of her work relates to family therapy and ecosystemic structural family therapy (ESFT), a model that considers how family members and their broader social context are interconnected.
Key concepts of the article
Training in systems thinking: The article discusses a training program designed to help individuals move beyond a linear, cause-and-effect understanding of behavior. Systems thinking involves seeing individuals and their actions as part of a larger, dynamic network of relationships and patterns.
Focus on internal context: The training emphasizes self-reflection and an examination of one’s own role within a system. This contrasts with a “system-as-effect” perspective, which blames external forces for a system’s behavior.
Emphasis on family systems: The article focuses on applying systems thinking to family relationships. Her later work emphasizes that a family is its own best resource for change, suggesting her training method helped therapists see the innate strengths of families.
A “way of being”: The training is not merely a set of tools but a fundamental shift in perception—a “way of being” that fosters curiosity, compassion, and courage.
Focus on relationships: The article explored how to help trainees understand the patterns of interaction and structural relationships that define human systems, rather than just focusing on individual actions.
The article is an early piece from Lindblad-Goldberg’s distinguished career, which heavily influenced the field of family therapy.
Pioneered ecosystemic structural family therapy (ESFT): Lindblad-Goldberg is credited with developing the ESFT model, which helps therapists work with families to identify dysfunctional patterns of interaction and connect families with community resources.
Founding of a training center: She is currently the Director Emeritus of the Philadelphia Child and Family Therapy Training Center (PCFTTC), which trains therapists in the ESFT model.
Informed later publications: Her exploration of systems thinking in this 1985 article provided a foundational basis for her later books and papers, such as Creating Competence from Chaos (1998) and Ecosystemic Structural Family Therapy: Theoretical and Clinical Foundations (2013).
I’m possibly hungry, tired, overwhelmed, lonely, or angry and I don’t know how to handle that yet.
I need to learn a new way to ask you for this need when I am calm.
I’m new at figuring out big feelings.
My brain can’t understand you when I’m feeling this much emotion.
I need you to be calm so I can figure out these feelings.
I don’t want to be acting this way.
I’m watching how you respond to my big feelings so I know how to respond next time.
I love you and feel safe with you.
Understanding Tantrums Systemically
In ESFT, a child’s tantrum is not viewed as an isolated behavioral problem, but as a signal of relational and systemic distress within the family. The therapist’s task is to uncover what the behavior is communicating about the family’s functioning, emotional regulation, and attachment patterns. To do that, ESFT clinicians rely on family assessment tools that help organize both data and hypotheses about family structure, meaning, and context.
1. Structural Map
A structural map helps the therapist visualize family hierarchies, subsystems, and boundaries.
Question: Who holds power in this system? Who regulates whom?
Application: A child’s tantrums may reveal an inverted hierarchy—perhaps the child has taken on a leadership or caregiving role due to weak parental alignment. The therapist uses this map to target parental leadership as a treatment goal.
2. Genogram
The genogram offers a multi-generational view of patterns, roles, and emotional themes.
Question: How has emotion been managed across generations?
Application: If a parent grew up in a family where emotional expression was punished, they may struggle to tolerate their child’s big feelings. This insight helps the therapist reframe the tantrum as a learned systemic response rather than defiance.
3. Ecomap
An ecomap situates the family within their broader social ecology—schools, community supports, stressors, and resources.
Question: How do external systems impact the family’s capacity to regulate and connect?
Application: Chronic financial stress or social isolation might amplify dysregulation. The therapist identifies potential supports and incorporates them into the treatment plan.
4. Critical Events Timeline
This tool tracks significant family stressors, transitions, and traumas over time.
Question: What events preceded the escalation of tantrums? What strengths exist to help caregivers maintain self regulation and leadership?
Application: If tantrums increased after a loss, move, or separation, the therapist links behavior to attachment disruptions and works to strengthen co-regulation and caregiver attunement.
These patterns identify how members respond to one another based on the structural map at admissions and how the members respond when the family is unbalanced and second order change occurs.
Question: What is the pattern that binds the family in crisis? What is the pattern that frees the family from crisis?
Application: A tantrum might trigger parental withdrawal, reinforcing the child’s fear of disconnection. The therapist works to interrupt this sequence through enactments that promote repair and attachment, alliances, co parenting, parental leadership and co-regulation.
In Summary
Using these tools, the ESFT therapist doesn’t just describe a child’s tantrum—they contextualize it. The behavior becomes a portal into understanding family structure, attachment, and emotional organization. The treatment goal shifts from stopping the tantrum to restoring relational balance so the family can regulate together.
YOU MUST BE SUBSCRIBED TO THE BLOG FOR YOUR ENTRY TO COUNT
Enter the family assessment tool competition to win free access to one HOMESTUDY CE PROGRAM from the PCFTTC store (APA or ACE category).
Using the movies Wicket Part 1 and Part 2 (or the Broadway production), and Elphaba as the identified patient complete at least two family assessment tools from this list:
Structural map with identified family type
Negative Interactional Pattern with at least three people in the pattern.
Ecomap
Genogram
Critical Events Timeline
Entries can use their imagination to fill in the gaps of information not provided during the films. The most creative information and with the most assessment tools accuracy wins!
Entries are accepted until 11:59am on December 19th. Entries should be electronically submitted to training@pcfttc.com .
For generations, helping professionals, educators, and even family members have been trained to ask, “What’s wrong with you?” when someone behaves in ways that seem confusing, defiant, or self-destructive. It’s a question rooted in problem identification, but it often carries an unintended message—that something inside the person is broken, defective, or in need of fixing. In Ecosystemic Structural Family Therapy (ESFT), we take a different approach. We ask, “What happened to you?”
This question changes the entire frame of understanding. Instead of pathologizing behavior, it invites curiosity, compassion, and context. It shifts our focus from the individual as the source of dysfunction to the system—the web of relationships, environments, and experiences that have shaped the person’s current way of coping.
When we ask, “What happened to you?”, we are not excusing behavior; we are explaining it. We begin to see behavior as communication, not simply as a symptom to be eliminated. A child’s aggression, withdrawal, or defiance may no longer appear as “bad behavior,” but as an adaptive response to chronic stress, trauma, or unmet emotional needs.
This reframing is also healing for caregivers. Parents often feel blamed or powerless when a child struggles. But when professionals help them see the child’s behavior in context—through the lens of what happened—they can respond with empathy and leadership instead of frustration and guilt. This approach restores the caregiver’s confidence and invites them into collaboration, rather than correction.
From a clinical perspective, “what happened to you” thinking leads to interventions that are relational, not punitive. It allows for joining, reframing, enactment, and anchoring—the hallmarks of ESFT—to take root in a way that promotes lasting change.
Ultimately, asking “What happened to you?” honors the truth that all behavior makes sense in context. It opens the door to healing by helping individuals and families see themselves not as problems to be fixed, but as systems capable of resilience, repair, and growth.
When we lead with curiosity instead of judgment, we don’t just change our questions—we change lives.
