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Practicum Survival Guide University of San Diego Marital and Family Therapy Program Fall 2010 Introduction Dear Practicum Student, Welcome to Practicum! Are you feeling overwhelmed? Don’t worry, you’re not alone! As you’ve surely discovered, it can feel like a big leap to move from student to therapist. This guide was created by fellow students to help you make that transition. We hope the reminders within will help you succeed in the coming year and beyond. Below is a list of what you will find in this year’s guide: Page(s) Topic 3-4 Confidence as a Beginning Therapist 5 Recommended Books 6 Words of Wisdom from Former Students 7-8 Self Care 9-10 Tools for Diagnosing: Rule Out Rules, The Five Axes, and Useful Mnemonics 11 Genogram Symbols 12-14 Theories “Cheat Sheet” 15-16 Mandated Reporting 17-19 Useful Resources Please share your feedback on this Survival Guide, including suggested additions, so that it can be improved for next year’s trainees. 2 Confidence as a Beginning Therapist A summary of: Bischoff, R.J., Barton, M., Thober, J., & Hawley, R. (2002). Events and experiences impacting the development of clinical self-confidence: A study of the first year of client contact. Journal of Marital and Family Therapy, 28(3), 371-382. As an aspiring Marital and Family Therapist, chances are strong that you’ve taken on helping roles throughout your life. Still, with all of that informal experience, you are probably nervous about this new role as a professional, and you may doubt your abilities. Research has shown that these insecurities are completely normal in first year therapists. Bischoff et al. surveyed 39 graduates over two years from the University of San Diego’s Marital and Family Therapy program. Their findings correlated with that of previous researchers—that most beginning therapists, despite sufficient training, lack confidence in their ability to help clients. Bischoff et al. went a step further and examined what factors contributed most to the development of this selfconfidence. They found that in order to build a foundation so that confidence can grow, new therapists first need to “internalize their clinical experience, “ that is, have the opportunity to fully process and make sense of what happens during sessions (p. 374). Once processed, therapists can then draw on these past experiences as they face new clients. Over time, scenarios that were once completely new and overwhelming become more familiar and manageable. Thus, self-confidence is built. Four factors affect this internalization process. The first is obvious: contact with clients. You cannot make sense of sessions until you have a few under your belt upon which to reflect. In the beginning as a new therapist, you are faced with countless firsts, which is inherently anxiety provoking. However, with time and more client contact, patterns start to emerge, and concepts are consolidated in your mind. As you begin to mentally categorize situations and problems, fewer scenarios surprise you, and doing therapy slowly feels easier. This is not a steady incline, however. Ups and downs in confidence during these initial months are common. You may feel elated after a sign of success with a client, but then a challenging session can leave you questioning yourself all over again. Furthermore, just when you start to get the hang of joining and assessing, it’s time to move on to a new phase of treatment, which can cause your confidence to dip again. Clients may also cancel appointments or simply not show up, which can be 3 discouraging even though it usually has nothing to do with you. As you ride this roller coaster of confidence, rest assured you are not alone. This is all a normal part of development as a new therapist. Another factor that can aid the internalization process is supervision. At first, it is hard to objectively observe your own behavior and simultaneously take in all of the new information being offered to you in session. This is where supervision comes in. A supervisor serves as a sounding board and helps you process what goes on in sessions. He or she also gives you ideas and redirects you when you’re off track. All of this adds to the foundation of experience that you can later draw on. You may think that praise alone from a supervisor might boost your self-confidence, but Bischoff et al. found that not to be true. Instead, trainees described a boost in their self-confidence when a supervisor gave them specific feedback rather than broad compliments. Therefore, if your supervisor is vague, be an advocate for your own growth and ask for details. It will clarify for you where you can improve and assure you of precisely what you’re doing well. A third element in making sense of your experiences and building confidence is contact with fellow new therapists. Share your anxieties and concerns with your peers, and you will discover they feel the same way. Lean on each other for suggestions, and you will see, one, that your questions and struggles are not unique and, two, that you do have wisdom to offer others. Also observe therapists who are just a year ahead of you, and realize that you, too, will get to that place of experience and confidence. Soon you will look back at the new trainees that follow you, and you will see how far you’ve come. One thing that can hamper your development as a new therapist is stress in your personal life. Difficulties outside work can be a distraction, and it is challenging to absorb and sort through your clinical experiences when your mind is elsewhere. Your energy will naturally go toward resolving your own crises, taking away from what you can offer clients. If you find yourself in this position, be honest with yourself and your supervisor, and get help where you need it. Next time you find yourself sitting across from a client and feeling like you have no idea what you are doing, take a deep breath and remember that every successful therapist once felt the same way. It is all part of the learning process, and it will get easier. 4 Recommended Books Essential Skills in Family Therapy (2nd edition) by Jo Ellen Patterson, Lee Williams, Todd Edwards, Larry Chamow & Claudia Grauf-Grounds (2009). New York: Guilford Press. NOTE: See chapter 1 for common developmental issues for beginning therapists. Essential Assessment Skills for Couple and Family Therapists by Lee Williams, Todd Edwards, Jo Ellen Patterson, & Larry Chamow (2011). New York: Guilford Press. Letters to a Young Therapist by Mary Pipher (2003). New York: Basic Books. The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions by Christopher K. Germer (2009). New York: Guilford Press. DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision by Robert L. Spitzer, Miriam Gibbon, Andrew Skodol, Janet B. W. Williams, & Michael B. First (2002). Washington DC: American Psychiatric Association. Diagnosis Made Easier: Principles and Techniques for Mental Health Clinicians by James Morrison (1995). New York: Guilford Press. 5 Words of Wisdom from Former Students “Although you are a student and have the mindset of a scholar, you are now transitioning to a working professional. With that, there are some things that one should also adopt as you go into a new environment. Some examples include, but are not limited to, advocating for yourself to a supervisor or other, being open to other coworkers and getting to know them as you would with a schoolmate, etc.” “Self-care is extremely important, as we all know. One thing to notice if you are overwhelmed is that you are just glazing over life aside from practicum. You might veg out in front of the TV more often than you'd like, "waste" time with pointless activities, like hours of Facebook, because your brain is fried.... Try planning a "self-care time" everyday that energizes you and replenishes you. It can be 10 minutes or an hour, but let it take your mind to a different state, other than worrying about your clients, for a little bit, THEN you can start researching more about interventions, read, or update on theories.... “ “I would encourage students to focused on the relationship with the client, as long as they can, before getting anxious and wanting to go straight in to apply interventions. Learn to take sessions in stride and be yourself, then apply the interventions. Often, we can get caught up, as trainees, to know and utilize interventions, but if we can give ourselves a little bit of legroom to adjust to doing therapy, our clients will appreciate it as much as we do. It becomes more natural once you understand your style.” “FOCUS ON YOUR OWN STYLE and what theory best matches. I got excited to try to use a number of different theories that fit with different client scenarios, but that can get overwhelming. If you've identified a theory you really like, stick to it for awhile, get to really know it, and then you can decide if other theories fit better or you want to develop them more.” “During practicum, continue to educate yourself either by reading or attending conferences such as CFHA, AAMFT, etc. This not only keeps your mind stimulated, but helps in guiding your cases and provides a continuous framework for your therapy.” 6 Self Care Helping other people through their struggles can be draining for us. It is important that we take care of ourselves so that we don’t burn out. Out of a genuine desire to help, we may be tempted to work beyond our scheduled hours. However, we must recognize our own limits and set boundaries. If we are not well, we cannot help anyone else achieve wellness. Here are some signs that you may be getting burned out. You: drag yourself into work most days. find yourself repeating the same interpretations over and over give advice as a shortcut rather than helping clients learn and grow begin sessions late and/or end early doze off or space out during sessions experience a noticeable decline in empathy do things that would make your former ethics professor cringe push your theory, technique, or agenda rather than listening and adjusting feel relieved when clients cancel avoid reading anything psychology related self disclose in ways that don’t help the client fantasize about that high school job at the food court in the mall where you were appreciated, got tips, and left work at work Copied from Howes, R. (2008, November 13). Therapist burnout. Retrieved September 10, 2010, from http://www.psychologytoday.com/blog/in-therapy/200811/therapist-burnout. Remember the basics that we teach our clients: 1. Eat nutritious, balanced meals. That means taking breaks to eat rather than working straight through the day. 2. Get a good night’s sleep every night. The average adult functions best on 7-8 hours of sleep. 3. Set clear boundaries and honor them. 4. Seek therapy yourself. 5. Work reasonable hours, and take vacations. 6. Leave work at work. Don’t take it home with you, either in paperwork form or by dwelling on clients in your mind. Respond to phone calls and e-mails when you’re in the office, not during your free time. 7. Stay socially connected with friends and family. 8. Take time to have fun! Here is a list to get you started: 25 Fun and Free Things to Do in San Diego 1. Visit one of San Diego’s many beaches. Swim, surf, collect shells, or just relax in the sun. 2. Look for the “green flash” as the sunsets over the ocean. 7 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Stroll Seaport Village. Explore the Gaslamp Quarter. Fly a kite in Mission Bay Park. Enjoy a free concert at the Spreckels Organ Pavilion in Balboa Park. Wander back in time in Old Town. Bike or jog along the scenic trails of Mission Bay Park. Take a tour of the U.S. Olympic Training Center in Chula Vista. Stargaze outside the Reuben H. Fleet Science Center. On the first Wednesday of the month, the San Diego Astronomy Associations sets up huge telescopes for curious guests. Enjoy a drive to Mt. Laguna and hike through the pine trees. Delight in homemade apple pie in historic Julian. Watch the hang-gliders soar near Torrey Pines. Check out all the must-see places on the “59 Mile Scenic Drive.” Rollerblade, skateboard, or bike along the Mission Beach Boardwalk. Roam the pathways of Mission Trails Regional Park. Scuba dive or snorkel at La Jolla Cove. Bird watch at Torrey Pines State Reserve. Marvel at the architecture, museums, and gardens in Balboa Park. Visit the Museum of Contemporary Art on one of its many free days. Snuggle up to a bonfire on the beach. Search for sea anemones and crabs in the tide pools in Point Loma. Take in a 360-degree view at Mt. Soledad or Mt. Helix. Explore the natural beauty of Anza-Borrego Desert State Park. Peruse the many shops and restaurants along the “Big Bay.” Adapted from www.sandiego.org/article/Visitors/795 Visit the San Diego Convention and Visitors Bureau website at www.sandiego.org for even more ideas and a calendar of upcoming events. Need some company? Join a social or professional organization to meet new people. Almost every community has groups like a Chamber of Commerce, Rotary Club, or Exchange Club. Local alumni groups can be another great outlet. Many colleges, fraternities, and sororities have chapters across the nation. You can also find like-minded people on websites like www.meetup.com. There are groups doing everything from watching classic movies to zumba. You are sure to find somewhere you fit in. Need some extra support? The Counseling Center at USD offers a variety of services. Students can receive free, short term counseling, or the Center can refer you to an affordable mental health provider in the community. The staff as the Counseling Center also lead various support groups throughout the year, including one for helping professionals like us. Call for details. Also check out their website for a host of useful links. Serra Hall, Room 300 (Walk In Hours: Monday through Friday 11 AM - 3 PM) 619-260-4655 www.sandiego.edu/usdcc 8 Tools for Diagnosing When determining if something is “normal,” consider the duration and intensity of symptoms and their impact on the client’s functioning. Before diagnosing, first think about the following: Rule out substance abuse, medication, toxin exposure Rule out a general medical condition (GMC) Rule out mood disorders Rule out factitious/malingering (conscious or unconscious feigning) Differentiate among similar disorders (Decision trees can be helpful!) Consider Subthreshold: Adjustment Disorder or Not Otherwise Specified or no disorder The Five Axes of the Multiaxial System in the DSM-IV: Axis I – Clinical Disorders or Other Conditions That May Be a Focus of Clinical Attention Axis II – Personality Disorders or Mental Retardation (lifelong and more intractable to treatment) Axis III – General Medical Conditions Axis IV – Psychosocial and Environmental Problems (current stressors like relationship or work conflicts) Axis V – Global Assessment of Functioning (GAF) To remember the major categories of disorders in the DSM-IV: “Depressed Patients Seem Anxious, So Claim Psychiatrists” Depression and other mood disorders Personality disorders Substance abuse disorders Anxiety disorders Somatization disorder/eating disorder (disorders of bodily perception) Cognitive Disorders Psychotic Disorders To Screen for Depression: “SIGECAPS” Sleep disorder (increase or decrease) Interest deficit (a.k.a. anhedonia) Guilt and hopelessness Energy deficit Concentration deficit Appetite disorder (increase or decrease) Psychomotor retardation or agitation Suicidality 9 To Screen for Suicide: “Is Path Warm?” I – Ideation S - Substance abuse P - Purposelessness A - Anxiety T - Trapped H – Hopelessness W - Withdrawal A - Anger R - Recklessness M - Mood change To Screen for Mania: “DIGFAST” Distractibility Indiscretion (excessive involvement in pleasurable activities) Grandiosity Flight of ideas Activity increase Sleep deficit (decreased need for sleep) Talkativeness (pressured speech) To Screen for Borderline Personality Disorder: “I DESPAIRR” Identity problem Disordered affect Empty feeling Suicidal behavior Paranoia or dissociative symptoms Abandonment terror Impulsivity Rage Relationship instability To Screen for Substance Abuse: “CAGE” C- Have you ever felt the need to CUT down on your drinking/drug use? A- Do you get ANNOYED at criticism by others about your drinking/drug use? G- Have you ever felt GUILTY about your drinking/drug use or something you have done while drinking/using? E- EYE OPENER: Have you ever felt the need for a drink early in the morning? To Screen for Somatization Disorder: “Recipe 4 Pain: Convert 2 Stomachs to 1 Sex” Presence of 4 pain symptoms (recipe 4 pain) One conversion symptom (convert) Two gastrointestinal symptoms (2 stomachs) One sexual symptom (1 sex) 10 Copied from http://courses.wcupa.edu/ttreadwe/courses/02courses/standardsymbols.htm 11 Theories “Cheat Sheet” Theory Bowen Family Systems Theory CognitiveBehavioral Therapy (CBT) Main Ideas Stress of burdens or a lack of differentiation leads to anxiety. Families manage anxiety through conflict, distance, cutoff, over or underfunctioning, or triangling. Distorted thoughts cause maladaptive emotions and behaviors. Brief and structured approach. Emotionally Focused Therapy Goal is to heal attachment injuries and encourage expression of primary emotion between couples or families. Clients learn to identify and communicate feelings through practice in session. Short-term therapy (8-20 sessions). Functional Family Therapy Empirically grounded. Useful in treating difficult or poorly motivated families. Effective family intervention for at-risk youth. Key Strategies/Interventions Create a genogram to look for patterns. Ask process questions (e.g., "Is this how you usually fight?"). Use "I" statements. Work toward differentiation Techniques include keeping a log of situations and associated automatic thoughts, emotions, and behaviors; questioning cognitive distortions and replacing them with alternative thoughts; and gradual exposure to previously avoided activities. Relaxation techniques are often used. 9 Steps: 1) Join and assess, identifying the core issues using attachment theory. 2) Identify the problematic cycle that maintains attachment insecurity. 3) Uncover primary emotions. 4) Reframe the problems in terms of a cycle with underlying emotions and unmet needs. 5) Encourage individual acceptance of needs. 6) Promote acceptance of partner’s vulnerability. 7) Facilitate expression of specific needs and wants ("This is what I hear. Can you say that to him? How does it feel to say that?" "How does it feel to hear that?"). 8) Identify solutions to ongoing problems. 9) Summarize progress and promote generalizability of lessons. Phase 1— Maximize factors that boost confidence in treatment and minimize obstacles, build therapeutic alliance, and reframe maladaptive perceptions to build hope for change. Phase 2 – Implement specific and uniquely tailored behavior change plans. Phase 3 – Generalize positive changes to other problems and systems. 12 Theory Internal Family Systems Theory Interpersonal Psychotherapy Main Ideas All people have a pure core “self” that serves as our wise conscience. We all have multiple conflicting inner voices, or “parts.” All parts can play a positive role. Parts can become extreme and destructive because of life experiences. Our parts interact in complicated ways. Changes in how these inner voices work together will change behavior. Originally developed to treat depression. Short and focused therapy. Focuses on current and interpersonal rather than intrapsychic issues. Therapist takes an active coaching role. Multisystemic Therapy (MST) Addresses all systems (home, school, community, peers) that contribute to serious antisocial behaviors of children and adolescents. Short term but intense--meet 2-3 times/week for a few months. Narrative Therapy People’s stories shape their lives, sometimes in problematic ways. Therapy can help people find positive alternative meaning for their stories. Also challenges social and cultural beliefs that are unjust or destructive. Key Strategies/Interventions Help client recognize that the parts are not the self and that the self is good and trustworthy. Identify and make sense of each of the parts. Help the parts achieve harmony. Visualizations are a common technique. Diagnose patient and assign "sick role." Validate that depression is reasonable given their circumstances. Target problem area (grief, interpersonal role disputes, role transition, interpersonal deficits). Generalize lessons to future problems. Design interventions that build on existing strengths and develop new strengths. Emphasize the positive to keep people engaged and motivated. Organize problems into 1-2 themes the entire family can agree on. Stay present-focused and action-oriented. Target specific problems for immediate change. Interventions should require regular effort by all family members. Evaluate progress continually and adjust approach as necessary. Interventions should promote generalization and long-term maintenance. Listen openly. Externalize the problem. Find a “unique outcome” when the problem was not a problem. Use questions to help client create a new story. Find examples of the unique outcome in the past. Invite the client to envision how life will be different with the new story. Circulate the new story. Also can help people separate from dominant cultural narratives and deconstruct unhelpful beliefs. 13 Theory Object Relations Therapy Main Ideas Relationships are the main focus. Dysfunctional behaviors are seen as a result of early attachment traumas. Therapy allows the resolution of the trauma through the therapeutic relationship. Long-term process. Solution-Focused Therapy Very brief therapy. Focuses on solutions, not problems. Strategic Family Therapy Families are stuck in positive feedback loops that maintain problems. Symptoms serve a purpose. Making a change will have ripple effects throughout the system. Focuses on fixing symptoms rather than sorting through underlying problems. Brief therapy. Therapist takes a directive approach. Modifies the organization of the family to end dysfunctional patterns. Structural Family Therapy Key Strategies/Interventions Create a safe place for client. Client will attempt to pull therapist into maladaptive relational pattern. Confront these patterns empathically until client learns new ways of relating. Help client generalize these healthier ways of relating to other relationships. Use positive language and presuppose change. Look for exceptions to problem and then build on that. Have client do more of what works. Techniques include miracle questions and scaling questions. Identify the positive feedback loop that reinforces the problem behavior. Determine the family “rules” that support those interactions. Find a way to change the rules or interactions through techniques such as reframing, exaggeration, paradox, prescribing the symptom, ritual, and metaphor. Join with the entire family. Observe or facilitate enactment. Assess the family’s structure. Highlight and modify patterns of interaction. Strengthen boundaries (enmeshment) or break down walls (disengagement) as appropriate. Unbalance the power hierarchy. Challenge unproductive assumptions. 14 Mandated Reporting In any case where there is suspected abuse or danger, talk to your supervisor for guidance. Remember, it is better to err on the side of caution and over-report. Here are the laws in California, for your reference. Child Abuse The Child Abuse Neglect and Reporting Act (CANRA) applies to minors (anyone under age 18) and requires us to report suspicion of or the potential for the following when we are in our professional role: Physical Abuse Sexual Abuse Neglect Abandonment Isolation A verbal report should be made immediately or as soon as possible, followed by a written report within 36 hours (including weekends). In the state of California, if a minor has consensual sexual intercourse with an older (or younger) partner, must mandated reporters make a child abuse report? Age of Partner Age of Client 11 12 13 14 15 16 17 18 19 12 13 14 15 N N N Y Y Y Y Y Y N N N Y Y Y Y Y Y Y Y Y N N N N N N Y Y Y N N N N N N 16 17 18 19 20 21 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N N N N N Y N N N N N Y N N N N N N N N N N N N N N N N N N N N N N N N Chart based on design by David Knopf, LCSW, UCSF 22 Y Y Y Y Y N N N N Y = Yes, report required based solely on age difference between partner and client. N = No, report not required based solely on age. Reporter only must report if the or she has a reasonable suspicion of abuse, e.g., that activity was no consensual. San Diego County Child Protective Services: 858-560-2191 or 800-344-6000 15 Elder and Dependent Adult Abuse An elder is defined as someone age 65 or older. A dependent adult is any individual between 18 and 64 who is dependent on others for their welfare. We should contact Adult Protective Services if we witness, see evidence of, or are told about the following: Physical Abuse Sexual Abuse Neglect Abandonment Isolation Financial Abuse A verbal report by phone should be made immediate or as soon as possible, and a written report filed within two business days. San Diego County Adult Protective Services: 800-510-2020 Additional Notes About Breaching Confidentiality You must breach confidentiality in the case of suspected child abuse, elder or dependent adult abuse, if a client is a danger to him/herself (Bellah vs. Greenson), or if the client or client’s immediate family tells you directly of a serious threat of physical harm against a reasonably identifiable victim (Tarasoff). With Tarasoff, you must warn both law enforcement and the intended victim to obtain immunity from liability. You may also breach confidentiality to avert intended harm under Evidence Code 1024, when a client is a danger to him/herself, others, or the property of others due to a mental or emotional disorder. Evidence Code 1024 can by used only if necessary to stop the intended harm. 16 Useful Resources Resources for Clients San Diego 211: 211 or 800-227-0997 www.211sandiego.org The main directory for all social services in San Diego. Specialists are available over the phone 24 hours a day to assess needs and direct callers to the best resource. Assistance is confidential and offered in more than 150 languages. Website has a comprehensive database of nearly 3,000 services that can be searched by program and location. Behavioral Health Access and Crisis Line: 800-479-3339 Professional counselors are available 24 hours a day for crisis counseling or referrals to other services. Assistance is available in several languages. San Diego Police Department 911 or 619-531-2065 (24 Hour Emergency) 619-531-2000 or 858-484-3154 (24 Hour Non-Emergency) www.sandiego.gov/police 1401 Broadway, San Diego, CA 92101 (headquarters) San Diego Sheriff’s Department 911 (Emergency) 858-565-5200 (Non-Emergency) www.sdsheriff.net 9621 Ridgehaven Ct., San Diego, CA 92123 (main office) San Diego County (858-94-3900, Monday - Friday, 8 a.m.- 5 p.m. www.sdcounty.ca.gov 1600 Pacific Highway, San Diego, CA 92101 Comprehensive website provides information on all County services, including Child and Adult Protective Services (under “Healthy Kids and Families” tab) and a list of certified treatment providers in anger management, child abuse treatment, domestic violence treatment, elder abuse treatment, parenting, sex offender treatment, and stalking offender treatment (under “Public Safety” tab and then “Probation”, “Adult Information”, “Treatment Providers”). Poison Control Center: 800-222-1222 (24 Hour, Over 100 languages available) www.calpoison.org San Diego Behavioral Health Network of Care: http://sandiego.networkofcare.org/mh/home A comprehensive website concerning behavioral health with links to area resources and more. 17 National Mental Health Information Center: http://mentalhealth.samhsa.gov A comprehensive website with information about mental health and links to resources and treatment programs nationally. Community Health Improvement Partners www.sdchip.org Collaborative effort of healthcare providers. Informative website. CHIP publishes the resource book entitled The Help Connection. Available in English or Spanish under “Chip Library” and then “BHWT Publications.” Neighborhood House Association www.neighborhoodhouse.org Offers a variety of employment, healthcare, child, family, and senior services, including Project Enable (short-term intervention for adults with serious mental illness) and emergency services. National Alliance on Mental Illness 619-543-1434 or 800-523-5933 (San Diego office) www.namisandiego.org (local) or www.nami.org (national) Advocates for people with mental illness. Offer support groups, classes, and a variety of other resources. Community Research Foundation 619-275-0822 www.comresearch.org 1202 Morena Blvd Ste. 300, San Diego, CA 92110 CRF provides a variety of psychiatric services for children and adults, including individuals with cooccurring mental health and substance abuse problems. CRF runs the START Programs (Short Term Acute Residential Treatment) Programs, crisis homes for voluntary adults. CRF also oversees PERT (Psychiatric Emergency Response Team). Website has a comprehensive list of programs sorted by region and types of services. Family Justice Center: 866-933-HOPE (4673) or 619-533-6000 www.sandiegofamilyjusticecenter.org 1122 Broadway, Suite 200, San Diego, CA, 92101 (new address as of 9/21/10) The FJC provides a variety of free services to victims of family violence, Monday-Friday, 8 AM - 5 PM. Center for Community Solutions: 888-DV-LINKS (385-4657) (24 hour hotline, free, confidential, English and Spanish) 858-272-5777 (Coastal location) 619-697-7477 (East County location) 760-747-6282 (North County location) www.ccssd.org CCS provides services for victims of domestic violence and sexual assault. 18 Alcoholics Anonymous (AA): 619-265-8762 (24 Hours) 7075 Mission Gorge Rd., Ste. B, San Diego, CA 92120 www.aasandiego.org Main office. Website lists all meeting dates and times. Narcotics Anonymous (NA): 619-584-1007 or 800-479-0062 619-491-1984 (Spanish) www.sandiegona.org www.bajason-na.org Spanish 4689 Felton St., San Diego, CA 92116 Main office. Website lists all meeting dates and times. Resources for Therapists California Board of Behavioral Sciences: 916-574-7830 (Monday-Friday, 8 AM-5 PM) www.bbs.ca.gov 1625 N Market Blvd., Suite S-200, Sacramento, CA 95834 American Association for Marriage and Family Therapy: 703-838-9808 www.aamft.org 112 South Alfred Street, Alexandria, VA 22314 California Association of Marriage and Family Therapists: 858-29-CAMFT (292-2638) www.camft.org 7901 Raytheon Road, San Diego, CA 92111 Collaborative Family Healthcare Association: 585-482-8210 www.cfha.net P.O. Box 23980, Rochester, NY 14692 BehaveNet: www.behavenet.com Behavioral healthcare information and resources, including an online version of the DSM-IV-TR Massachusetts General Hospital Psychiatry Academy: www.mghacademy.org or www.mghcme.org Become a member for free and gain access to a mental health resources and trainings. International Association of Eating Disorders Professionals: www.iaedp.com The San Diego Chapter frequently offers free or low cost workshops. 19