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Carmen Knudson-Martin, Ph.D.. LMFT - Guest
Carmen Knudson-Martin, Ph.D., LMFT is a professor emerita in the Marriage, Couple, and Family Therapy program at Lewis and Clark College. Her scholarship focuses on how the larger social context influences health and well-being and how therapists can address the inequities that result. Carmen especially loves working with couples and is widely recognized for her work regarding gender, marital equality, and relational health. She is a founder of Socio-Emotional Relationship Therapy, an approach that attends to the ways couple interaction, emotion, and socio-cultural context come together in clinical process. Carmen’s teaching and practice are based on her conviction that how therapists conceptualize client concerns is an ethical issue and that clinical practices have consequences that are never neutral. Carmen is an AAMFT approved supervisor and licensed MFT. She served as an associate editor of the Journal of Marital and Family Therapy, vice-president of the Family Process Institute, board member of the American Family Therapy Academy (AFTA), and president of the California Division of the American Association for Marital and Family Therapy (AAMFT-CA). She is currently editor of the AFTA Springer Series in Family Therapy. Prior to coming to Lewis and Clark, she directed family therapy programs at Loma Linda University in Southern California, Montana State University, and Valdosta State University in Georgia. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D. (00:24):
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:31):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Today I'll be speaking with Carmen Knutson, Martin PhD, LMFT, who is a professor Emerita in the Marriage Couple and family therapy program at Lewis and Clark College.
Keith Sutton, Psy.D.: (02:30)
Her scholarship focuses on how the larger social context influences health and wellbeing, and how therapists can address the inequities that result. Carmen especially loves working with couples and is widely recognized for her work regarding gender, marital equality, and relational health. She's a founder of socio-emotional Relationship Therapy, an approach that attends to the ways couple interaction, emotion, and socio-cultural context come together in clinical process. Carmen's teaching and practice are based on her conviction that how therapists conceptualize client concerns is an ethical issue, and that clinical practices have consequences that are never neutral. Carmen is an American Association for Marital and Family Therapy approved supervisor and a licensed marriage and family therapist. She served as an associate editor of the Journal of Marital and Family Therapy, was vice president of the Family Process Institute, board member of the American Family Therapy Academy, and president of the California Division of AAMFT. She's currently the editor of the Afta Springer Series and Family Therapy. And prior to coming to Lewis and Clark, she directed family therapy programs at Loma Linda University in Southern California, Montana State University, and Valdosta State University in Georgia. Let's listen to the interview. Well, hi Carmen. Welcome.
Carmen Knudson-Martin, Ph.D., LMFT: (03:50)
Glad to be here.
Keith Sutton, Psy.D.: (03:52)
Oh, thank you so much for coming on the podcast. So I know you from AFTA, the American Family Therapy Academy that we're in together and you've been very involved with that organization, and I think I've gotten to some talks of yours at conferences. I think I had seen a tape of a couple you had been working with possibly. And then I was, we were having an annual teachers meeting, teachers of Family and couples therapy, and one of the folks was just raving about your new book and using it as her textbook in the family therapy course. So I got it. I've just started reading it. We ended up scheduling this podcast so quickly I've only gotten through the first chapter here, but, but I’m getting going. And then you also have a model, so I would love to hear all about your work, but first I always like to kind of find out about, you know, how you got to do and what you're doing, kind of the evolution of your thinking that that kind of led to the work you're doing.
Carmen Knudson-Martin, Ph.D., LMFT: (04:49)
Yeah, thank you. Well, I started in the field at the time when there were feminists who were critiquing systems theory and raising the question about power imbalances in relationships and such. And, so for a good lot of the early part of my career, I was focused primarily on gender and, studying that in non-clinical cases, how couples were managing that. And then in 2000 I moved to the direct to doctoral program in family therapy at Loma Linda University in southern California. And Douglas Ungar joined the faculty at the same time as I did. And Doug had been, he had been living in Florida, but he had been flying up to Washington, DC monthly to be part of a feminist supervision group with Maryanne Walters who
Carmen Knudson-Martin, Ph.D., LMFT: (06:02)
many people might know as one of those early groups that was critiquing family therapy from the feminist perspective. And Doug and I discovered that we thought very similarly about therapy. We'd actually had a supervisor in common, even though it was in different states and 10 years different in time, who was pretty experiential and structural in the things that he imparted to us. So Doug and I started doing co-therapy and invited students to watch.
Keith Sutton, Psy.D.: (06:45)
Oh, great.
Carmen Knudson-Martin, Ph.D., LMFT: (06:50)
And our goal was to be able to articulate the clinical dis-choices and decisions that we were making so we could teach others, because he and I seemed to kind of like intuitively know what to do, or we understood where each other was going and such like that.
Carmen Knudson-Martin, Ph.D., LMFT: (07:09)
So we were seeing pro bono cases at our training clinic there at Loma Linda. And later in 2008, we formalized it into an IRB approved, clinical action research study where we then were iteratively trying to figure out what worked and what didn't. And so over the years, we would do live therapy, and somebody, sometimes it was Doug or me, or both of us, sometimes it was one of the doctoral students, so we worked as a team with the observing there and such. Sometimes others would come in. And we have had over 60 different doctoral students be part of our research team. Oh, great. So, the model that evolved out of that is called socio-emotional relationship therapy.
Carmen Knudson-Martin, Ph.D., LMFT: (08:19)
And I actually have two new books, the one that you are just talking about, and an even newer book that is about that model. And the subtitle of that is a socially responsible approach to clinical practice. And once the model was developed, I moved to Portland, Oregon, which is, I'm talking to you from Oregon, to Lewis and Clark College, and I started working with Theresa McDowell. And so, at Loma Linda we were expanding to, you know, gender power and cultures. My PhD is actually in sociology, so I've always had it. It was an accredited program, but it was at the University of Southern California and sociology department. So I've always had an interest in how does the larger, what's happening in the larger societal context play out in people's most intimate aspects of their lives. And when I started working with Theresa, she introduced this idea of third order thinking, which wasn't, she didn't develop it, it actually evolved out of Bateson and people in a lot of other fields were looking at that, but it was, the language was new to family therapy, we all know about first order change and second order change but not necessarily third order change.
Keith Sutton, Psy.D.: (09:58)
Well, actually, for people that might not be familiar, can you make a quick comment on first, second, and third order change?
Carmen Knudson-Martin, Ph.D., LMFT: (10:03)
Oh, sure. So first order change are things that we do that might actually be very important and helpful to make our lives better. Maybe we learn how to breathe more slowly, or stop smoking or maybe we take a class in communication skill training and learn to listen a little bit better. Those don't change the system that people are engaged in. Second order change is what the field of family therapy has largely been organized around, saying that, in order to change whatever the symptom is, we need to change the system of relating that people are involved in. And so I don't just learn how to kind of relax and breathe more deeply, but I learn how to, well rather maybe my husband, my partner and I have been having fights about the children.
Carmen Knudson-Martin, Ph.D., LMFT: (11:23)
And we learn to not detour around the children, but to look at what some of the underlying issues might be so that we're actually changing the pattern in how we relate. And it's a pattern that each person's involved in. Third order thinking expands the lens. So that we're looking at the system that our own relationship system is embedded in. And we're paying attention to if we're gonna have change, how might we need, what other alternatives are there for relating that might not be a part of the dominant system. And a really big piece, especially in the socio-emotional relationship therapy, which is search but more, but in third order, thinking more broadly, is that in the United States especially and in most Western countries, we live in a very individualistically oriented society, that doesn't necessarily support relationships. And so third order thinking would help us sort of help clients become aware of ways that they might be organizing their life based on these larger societal discourses and patterns. And then consider, you know, is this the way it has to be for us? And that sort of thing.
Keith Sutton, Psy.D.: (13:06)
So kind of bringing awareness to the dominant, you know, kind of, social expectations and such, or the dominant narratives and how those might be affecting them or affecting their relationships.
Carmen Knudson-Martin, Ph.D., LMFT: (13:18)
Yes. And in therapy there's sort of two levels. There's the level of what we help our clients become aware of, but there's also the level of how we are ethically accountable for how we are positioning ourselves in therapy.
Keith Sutton, Psy.D.: (13:45)
In the session with our clients?
Carmen Knudson-Martin, Ph.D., LMFT: (13:47)
In the session with our clients. In that moment when we make a decision about what question to ask, who do we direct it to? How are we framing the symptoms that people are, the troubles that they're struggling with? And recognizing that as therapists, we may, without realizing it, be reinforcing and repeating a lot of those larger societal patterns. So it's not, this is a way of thinking especially the socio-cultural attuned textbooks that you are looking at where we apply this broad frame of thinking to, we use 10 of the major models of family therapy, and so it's kind of an umbrella model, a socio culturally attuned practice, which is another way of thinking about or talking about third order thinking.
Keith Sutton, Psy.D.: (14:56)
Sure. Okay.
Carmen Knudson-Martin, Ph.D., LMFT: (14:57)
Then underneath that, the model that I've been developing, which we call SRT (Socioemotional Relationship Therapy Model), is an integrated model that's one way of applying it more broadly socio-culturally.
Keith Sutton, Psy.D.: (15:15)
Yeah. Okay. Great. So, yeah. So, you met Theresa and she brought in this kind of third order thinking that you had never, or you had not kind of incorporated before. And the first order kind of changes, like the symptom change. Sometimes I think about, right, when like a family comes in and things kind of get better just because they're kind of focusing on it in the several sessions, but if the system hasn't changed, right, they'll just kind of slide back after therapy. So that second order change is like helping shift the systems, the way the parents are interacting, or the kids, or, you know, or so on. And then this third order change is really looking at how the social sociocultural factors kind of affect clients and some of those dominant narratives, as well as being aware of the therapist's potential ability to reinforce some of those narratives too, and bringing awareness to one's own perspective or privilege, you know, because every therapist has power in that situation. And so there may be very many inter-sexualities, with that but it's really that we all kind of bring that power in. And so kind of being aware of that. And then in this textbook, you kind of go through the different theories, like structural, strategic, but then kind of putting this kind of sociocultural lens on it, or kind of awareness for the therapist. Is that right?
Carmen Knudson-Martin, Ph.D., LMFT: (16:35)
Right!
Keith Sutton, Psy.D.: (16:36)
Oh, great.
Carmen Knudson-Martin, Ph.D., LMFT: (16:37)
Yes. That's an excellent summary.
Keith Sutton, Psy.D.: (16:42)
Thanks. Okay, great. So tell me let's see, let's get into your SRT model. I'm really interested in kind of a little more detail around this and, yeah. Tell me a little bit about kind of what that looks like or how that plays out in, in kind of a, a progression of a therapy.
Carmen Knudson-Martin, Ph.D., LMFT: (17:02)
Well, when we were using systematic research, qualitative research, to look at the therapy that we were doing, and we used grounded theory techniques a lot to just help us sort out. We found that we were working in four areas, really, the social discourse that we've been talking about, the interaction patterns that would be a more structural way of thinking about things, but also power and emotion. And the light bulb went off for me when our group and I realized that emotion is a window into the larger context. Because I think most people these days, they know, we all know, that the larger context is important, but it seems so abstract, and like, how do you deal with it? And when we understood that emotion is, you know, it's physiological within our body,
Carmen Knudson-Martin, Ph.D., LMFT: (18:30)
our blood pressure might rise, we might start to sweat, our heartbeats faster, our stomach starts to churn. So it's very personal, very within us, and it serves a function of communicating to the people around us relatively quickly because human beings are designed to be social interactive creatures who need that feedback. And, that the meaning of the emotion, what we are actually feeling about, or what triggers our response is sociocultural or it's contextual. So it might be triggered by my partner or my child, but the meaning of that is way beyond us as an individual couple or family. And it takes its meaning from the larger societal discourses and structures that we live in. And then another, the power piece, is that who makes, who gets to determine what's important, what's valued the meaning of things,
Carmen Knudson-Martin, Ph.D., LMFT: (19:57)
is not equally distributed amongst people, that groups who have more in any society have the- it's just a natural part of being social, I guess, is they sort of determine what counts, what matters. And then you or I, or our clients might be judging ourselves and our partner and our children by that. And we also always, one of the things that I've been learning about recently, even after, in the more recent times as I was doing this new book on SRT is how connected emotion is to thinking, that and power. So that the power-the body always takes a scan of the power position, and so just like, you can't really, I was taught to separate thinking and feeling and
Keith Sutton, Psy.D.: (21:13)
Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (21:15)
but the newer understandings, as I read them, of how cognition and emotion and power all go together, is that they're so intertwined that you can't really separate them out. Yeah. And that, the emotional, the meaning part of emotion, there arises within a particular context. So then as a therapist, I'm always wanting to understand what is this context?
Keith Sutton, Psy.D.: (21:51)
Mm-Hmm.
Carmen Knudson-Martin, Ph.D., LMFT: (21:53)
In which this situation, these issues are arising. And when people, if they express, if they appear emotional, or if there are certain words, have more energy and salience to them, that's my clue that they're connected in some way to the larger context. And so that's part of what we mean then by being socio-culturally attuned.
Keith Sutton, Psy.D.: (22:23)
Yeah. Well, it makes me think of, I also do a, a cognitive behavioral therapy, and so that idea that there's a, right, a trigger, and then there's an emotional response, and that emotional response is, you know, kind of affected by the systems of thinking, which may or may not be aware of. And so it sounds like you're saying kind of understanding the systems of thinking, the beliefs, the kind of narratives that people have, that also may be including, or are including their social cultural context, which is then kind of influencing their emotional reaction. And so kind of not only looking at their thinking like, oh, I did a bad thing, or something like that, I'm bad. But also then looking at how that is determined or they're determining that's bad. Also based in a social, cultural context and how that might be playing into, I think about narrative therapy, the oppressive dominant narratives, and kind of looking at how gender sexism, financial, you know, all these kinds of things might be playing into their judgment of self. Is that kind of it?
Carmen Knudson-Martin, Ph.D., LMFT: (23:31)
Yes. And there's a chapter on cognitive behavioral therapy in the theories book. And yeah, I think what really is helpful when you expand the lens to say these ways of thinking and feeling are when you help the clients and yourself as you relate to your clients, see these as connected to those larger societal patterns of thought and thinking and behaving, it's much less judgmental. It's much less about, "Oh, I'm this, I've really learned to think, you know, erroneously.” Because I do worry sometimes that us therapists, we can inadvertently pathologize our clients and that they come feeling, and I, I think we all worry about this, but I think sometimes people identify who've been socialized as male, especially, there's such strong pressure to get things right.
Carmen Knudson-Martin, Ph.D., LMFT: (24:38)
And so, I've seen so many men come in and sort of say, you know, head down, okay, I've messed up, tell me what I need to do. Realizing that, yeah, you got things to learn to do, but no, but you weren't socialized to do them. Or and more than that, there's strong pressures on you to do things that serve competition and individualism and being sort of on top of things, the patriarchy, that really can make that hard. And I think, I remember when I used to teach a class on gender in the master's program at Loma Linda, and at the end of one of the classes, when I was asking about the effect of the class, one of the students said, I feel like I like men better now.In other words, understanding that it's not this person, but it's these patterns. And that we are living out these patterns that we may not want to do. Or if most of our clients sort of contradictory, like, we want our relationships, we love our family and kids, and we've learned these other societal messages and patterns that tell us to do something different.
Keith Sutton, Psy.D.: (26:11)
Well, there's often, yeah,the roles that they're playing or sometimes when I think about it too, in a more gender stereotypical couple, heterosexual couple, I use emotionally focused couples therapy and getting the men to be more vulnerable and show those emotions, and then how that affects the dynamic because that's, you know, they're being asked to share more emotion, but it's kind of against the socialization. And then sometimes their partner, although they want the emotion, kind of feels like, ugh, that you're being too sensitive. And kind of reacting from that kind of gender, learning that like, oh, you're supposed to, I'm supposed to be the emotional one, you're supposed to handle it all kind of thing and really kind of helping them to create space for each other in that kind of terrain.
Carmen Knudson-Martin, Ph.D., LMFT: (26:52)
Yeah, so the therapy helps everybody be, have more compassion for each other at the same time as being able then to have less blame and then more openness to actually trying things in different ways. So what you are describing is a big part of the SRT model in terms of, in so many of the relationships that we discovered that we've been, we're working with when they're distressed there's an imbalance in power, and that's reflected in who's, who's attuned to the other, who takes influence from the other, and who's sharing responsibility for maintaining the relationship. We call those four things in the circle of care.
Keith Sutton, Psy.D.: (27:50)
Can you say those one more time actually? Sorry.
Carmen Knudson-Martin, Ph.D., LMFT: (27:53)
So, the circle of care and what, and when they're, these four things are more or less over time, balanced out between partners, the relationships are more, not only more equitable, but they're able to be more caring and supportive. So vulnerability- mutual vulnerability just like openness to the other, willingness to admit, admit mistakes, feeling safe to express one's sensitivities. And then mutual attunement, just noticing the other you know, as therapists in our field, we, at least I was often taught to help people give “I statements”, which is useful, it's not that that's not useful and that we shouldn't expect our partners to be mind readers. Well, this mutual attunement actually says, yes, to some extent, not completely but to some extent, we do need to be tuned into, we can't expect, you know, our partners just to tell us everything that we need. And often we're in balance in that one partner is much more, and if that's related to power, whether it's gender or race, I mean the group that has more power doesn't notice what's going on with the other group as much.
Keith Sutton, Psy.D.: (29:24)
Yeah. Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (29:25)
Teachers with students, you know.
Keith Sutton, Psy.D.: (29:28)
Sure, sure.
Carmen Knudson-Martin, Ph.D., LMFT: (29:28)
Students are pretty attuned to what that teacher's looking for.
Keith Sutton, Psy.D.: (29:32)
Yeah, well and sometimes I think about with that attunement, like, are you holding in your heart kind of what I need or what I want, or who I am? And not that, yeah, that the person can read minds, but they at least are kind of thinking about the other and the effect that they may have on them.
Carmen Knudson-Martin, Ph.D., LMFT: (29:48)
Yeah. Exactly. That's exactly it. And it's often not, not balanced in a relationship. And then the third one is mutual influence. Like whose interests actually are organizing the relationship. And there's an overlap here with John Gottman's work, where he decades ago started talking about influence, the ability to influence each other. And he more recently, well, a decade ago now, but, he connected that to power and that it's not just being influenced by like, when I say something nicely to my partner and I want this, but being willing to be influenced by when they're upset. In other words, being willing to be changed by what your partner is experiencing. And that that's mutual and that each partner's doing it. And then shared relational responsibility. Which, in heterosexual relationships, women have been socialized, men and women have been socialized that women are supposed to play that role. But we found, you may know Naveed Jonathan. He is in,
Keith Sutton, Psy.D.: (31:14)
I do know of his, a little bit. I don't know him personally though. Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (31:18)
Naveed is in, I think he's in Anaheim, the Los Angeles area anyway. And he was a former student of mine when I was at Loma Linda. And, he did this study that I supervised with same sex partners and committed relationships. This was back before marriage was legal. And he did this study while we were developing SRT, and it's where we’ve got the no, I, realized how important focusing on attunement was because in general, same sex partners, he did, he interviewed 20 female couples with female partners and 20 couples with male partners. And he found essentially the same process whether we are talking about male couples or female partners. The majority of them, more, much more so than the heterosexual couples we were interviewing, they talked about wanting to attune to their partners.
Carmen Knudson-Martin, Ph.D., LMFT: (32:24)
They wanted relationship, they often structured ways to make sure that they had conversations and, and such about what was happening for each of them. But there were also same sex partners where it was imbalanced. So Naveen talked about attuned equality. Un-attuned, I mean, attuned inequality, so there were something, some same sex partners who, there were things like maybe things related to job and who's taking care of children and such, that meant there really was an imbalance in the relationship. But the couple was aware of it, and they were trying, trying to be really sensitive, the powerful partner was trying to be really sensitive and appreciative about what the person with less power was doing.
Carmen Knudson-Martin, Ph.D., LMFT: (33:27)
And then there was the untuned inequality. Which is the kind of cases, that there were only a few of them, but one partner was basically saying, I don't, you know, this is who I am. Take it or leave it. Yeah. And, but amongst heterosexual couples, the gender socialization meant that there was a lot more imbalance, and all of those four elements of the circle of care. And so as part of the SRT model of who are we directing our clinical interventions toward, we're taking into account that the imbalances in the circle of care. So if one partner's already more vulnerable because the other, because they've been carrying the weight in the relationship, and they already are showing at least signs of taking their partner into account that, you know, when they, they say, I know my partner sees this differently, but here's how I see it.
Carmen Knudson-Martin, Ph.D., LMFT: (34:45)
Then I want to make sure that I don't ask, I don't put the burden of change on that person who's already more vulnerable and already taking more responsibility, they will step up to do it usually so it's, so it's being a little more attentive, and you might think good therapists, or most of us might think good therapists regularly do this, that we would notice who's not attuned and that we would, but when we were looking at videos of our own work, not just other people, we found that we regularly were influenced more by the dominant partner that we, we would, attend more to them than to the other partner. And, that we'd often put the bur-, you know, like if you asked, if you're dealing with couples and you asked one of them to, one of them, they were unhappy about something and one person starts to cry,
Carmen Knudson-Martin, Ph.D., LMFT: (35:56)
then you might turn and you put the burden of the person who, who's crying to, to tell what's going on. It's not that we don't wanna hear from that person, we do. But be, but stopping and turning to the person who's, you know, more disengaged, less attuned and saying, do you know, your, your partner's crying. What do you think is going on for her? What do you think, how do you think what you just said might have affected her? Then you can check to see whether they've gotten that right from your partners. But you're starting to change that pattern of that the burden of responsibility is always on the same person to fix things. In attachment we might say to repair that relationship.
Keith Sutton, Psy.D.: (36:52)
Yeah. So the one that kind of affects the other potentially harms or, or the other one's upset, that kinda being, becoming aware of what's happening that's potentially leading to that rather than kinda like, oh, what's going on? And then having the other one and having, again, the responsibility to try to say, explain what's happening in the dynamic, and instead kind of the other person stepping forward.
Carmen Knudson-Martin, Ph.D., LMFT: (37:18)
Right. And staying with, helping that other person, the one that we would say the power, we think of power as not a personal property, but as a dynamic that happens in all relationships that flows from one person to the other, who has the ability to have an impact on the other and whose interests or on their social world. Because a lot of times these power issues are outside the relationship, they're not necessarily in relation to the partner, but oftentimes that's flowed into the relationship. So it is with the partner and then we need to stay with the person in the more powerful position,
Carmen Knudson-Martin, Ph.D., LMFT: (38:11)
To help them really be able to prac- to try to attune. Because at first they'll say, I don't know,
Carmen Knudson-Martin, Ph.D., LMFT: (38:18)
Or say: well, I see it differently. You know, and to sense it, you know, without attacking them or blaming them too much. Just not, just being aware that the power of our role, to say, are we going to let this, let a more powerful person off the hook? And put the burden back on the other person. Or not? Or are we going to, if it's related to injustices that are outside their system, are we going to name and acknowledge them? And give voice to them? Which is a big part of what we talk about in both these new books.
Keith Sutton, Psy.D.: (39:04)
Can you, can you give an example of that, of kind of bringing in the aspect of power outside of the relationship and how you kind of might bring that into an in intervention in your session?
Carmen Knudson-Martin, Ph.D., LMFT: (39:17)
Well, in terms of gender, just naming, you know, so where did this idea come- this idea that you should have all the answers. Where did this idea come from? Oh, well, my father, he always… Where do you think your father got that idea? And so expanding outward, but outside, so it might be related to feeling bad about yourself because you come from lower socioeconomic position, or a good example that I have in my book on SRT is a mixed race couple where they were having an argument outside in the driveway, and the husband was white and the wife was black. And they were still upset. They come into therapy, they're still upset about this argument, and they're both upset. And they were upset, the argument was about, in the book, the example is that somebody has knocked garbage over in their driveway.
Carmen Knudson-Martin, Ph.D., LMFT: (40:24)
So they, the husband starts to yell about this, he's not yelling at his wife, he's just yelling. And she wants him to be quiet. And then he's mad about that. Like, who are you telling me to be? And it isn't until we started saying, well, so what did it mean? Getting its meaning. What did it mean to you to be having this argument in the yard? Well, the husband says, he thought that the sister-in-law who'd come over to use their dryer, had left the gate open and knocked over the garbage or something. And he felt that he wasn't being respected and that he had a right to his voice and he had a right to be angry, and his wife was afraid the neighbors would call the police.
Carmen Knudson-Martin, Ph.D., LMFT: (41:19)
As a black woman living in a predominantly white neighborhood, she, he had a lot of sensitivities of a lot of ways. I mean, they had teenage kids who, with dark skin, they're aware of, you know, what that's like for their boys going out in the world. But he had no idea that when he yelled in the driveway, that it would just make her worry about that the police might come. And so, I mean, that's just one example,
Keith Sutton, Psy.D.: (42:02)
Yeah, like a, what's called a healthy cultural paranoia. And him not realizing and experiencing it as her trying to shut him down and dismiss feelings, but it was coming from a place of trying to create safety.
Carmen Knudson-Martin, Ph.D., LMFT: (42:17)
Yeah. So they were both responding from what, in SRT, we call their felt identities. So it's a social, you know, location, but it's not just a category and it's unique. We don't all, you know, everybody with the same label doesn't feel the same. It's much more nuanced than that, but the felt experience of being in that category.
Keith Sutton, Psy.D.: (43:28)
So can you tell me a little more about felt identity and what that means or what that looks like? Or is that, you know, kind of the way the person identifies themselves?
Carmen Knudson-Martin, Ph.D., LMFT: (43:39)
Yep. It's all of those things. I think it's one way that, you know, I said earlier that the light bulb sort of went off when we saw how emotion was the window to people's larger experience. So now, instead of just thinking about people as a member of a group or a category, as a therapist and as a human being in any relationship, I want to know what their felt experience is. I think qualitative researchers sometimes call it lived experience. I think it got the name “felt experience” from my colleague Lana Kim who works with me, or I've recently retired from Lewis and Clark, but she was on the faculty with me at Lewis and Clark and took over as program director when I stepped down as family therapy program director.
Carmen Knudson-Martin, Ph.D., LMFT: (44:43)
But we've been continuing to study together about SRT and how to teach it to master's level students. And we had a chapter in the sixth edition of the Clinical Handbook of Couple Therapy. And Lana used the term felt identity. And I went, yeah, that's what it is, and so it kind of brings that, the social discourses, the social structures into somebody's lived experience. And I think the reason identity is important is because attachment is very important but so is how we kind of know ourselves. And when our sense of self is threatened or under or demeaned or ignored, then you know, we'll either fight to maintain it or we may get depressed and withdraw, but this identity piece, who am I and what is my worth?
Keith Sutton, Psy.D.: (46:06)
Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (46:08)
In this world. Yes to my partner, but also in this world. All of that gets nicely encapsulated into thinking about a felt identity.
Keith Sutton, Psy.D.: (46:21)
Okay, great.
Keith Sutton, Psy.D.: (46:23)
There's kind of like the, how do they say like, the difference with the emic in the attic, like the personal experience of culture and versus kind of the larger, like this is what it's like for this certain culture kind of the broader versus the micro experience?
Carmen Knudson-Martin, Ph.D., LMFT: (46:41)
Yes. And I think therapists, we need to learn about the broader culture to know what kinds of things to be, to ask about and to be interested in. I often, in things that I write, quote Celia Falicov who's also a AFTA member, and she says, we have to be both knowing and not knowing. We have to know that the larger context matters, that there's inequities. And if we just say that culture, it's cultural without looking at the inequities, but within cultures, or that some cultures are more valued than others and such, then we have to know that those things matter. But we also have to, she calls, looking, calls it, looking at each person's cultural niche. And that, you know, what is their unique intersection of all these pieces, their family experience, their life, their experience over what it's, it comes down too for us in SRT as felt experience and felt identity. Then who am I in this world?
Keith Sutton, Psy.D.: (48:05)
So kind of really getting a sense of how the client experiences themselves and their own experiences. And I think, I imagine you also talk about privilege, you know, and I know as a, you know, white, cisgender male therapist, that there's, you know, these aspects of privilege that as a therapist I oftentimes need to be doing work to bring that to the forefront, because sometimes the way I think about it, right, the definition of privilege is that we don't have to think about these things. And so actually kind of being aware of those blind spots and working to kind of bring those blind spots to the foreground. Do you talk about that or have any thoughts on that about, you know, kind of for therapists that hold a lot of privilege?
Carmen Knudson-Martin, Ph.D., LMFT: (48:52)
Well I have a chapter in the SRT book on some of the ways, because we, in addition to studying therapy, especially in, well, in both Loma Linda and at Lewis and Clark, some of the students studied their own process of learning and becoming aware of their privilege, either as, as you're talking about just in the society at large, and also their privilege as a therapist who, whether you feel it or not, you know, we get to define what's healthy, what's important, what gets talked about in session, all those things. And so in the book, we talk about learning to, beginning with understand, I usually would ask my classes to introduce themselves by sharing where they learned what normal was. What constitutes normal, and to bring in gender and race and such like that.
Carmen Knudson-Martin, Ph.D., LMFT: (50:10)
And to take, we give an example of a life map where we take the salient experiences in our life over time and then look at how our social locations, the privilege, the sources of privilege that we have, and the sources of less privilege or injust, oppression that we might have. And most people have some of each so just becoming aware of that, then it's, you know, once you become - you would know this - as you become aware, the more aware you are, the more you realize you're not aware. So it's sort of paradoxical, like a student might start out thinking they know a lot about this, but by the end of the class they realize they actually don't know very much.
Keith Sutton, Psy.D.: (51:18)
Well, I think that's my experience every time I go, like, in the AFTA facilitated listening circles, just like as people are bringing up different things, again, things that would not have even occurred to me, even though there's a lot of work that I do on this and aware that, that there's so many aspects out there that and I think that curiosity kind of, and that not knowing is so important that Celia is talking about.
Carmen Knudson-Martin, Ph.D., LMFT: (51:40)
Yeah. And so I think what I say multiple times in the book is that if you are in a position of, if you know you're in a position of power like you just own that, I certainly own that as a senior person in the field with books and, you know, somebody actually wants to hear what I have to say, and all that sort of stuff, then it's on me, it's on you to try to structure things to create a more equal playing field, whether that's how I teach my class and I make space for multiple voices, whether I'm a colleague in a faculty meeting and somebody ignore, maybe a young woman of color is being, has said something wonderful and then a white man says the same thing and it gets noticed, maybe I use my voice to just gently, you know, I don't have to make a big issue out of it, but I can say, you know, as the younger black woman was saying, this is really important. And giving, just recognizing that when you're in a position of privilege, there's so much you don't see, so you have to be more intentional.
Keith Sutton, Psy.D.: (53:13)
More responsibility.
Carmen Knudson-Martin, Ph.D., LMFT: (53:14)
Yes. You have to take more responsibility because people in lower power positions will have been, for example, people of color have, for generations, worked hard to keep things smooth, to not upset white people.
Keith Sutton, Psy.D.: (53:35)
Yeah. Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (53:37)
And white people may not even be aware that that's happening. I think it was in one of Monica Mcgoldrick’s edited volumes, I don't remember the names of the authors, but they were two doctoral students. I think they were at Syracuse University, this is probably 25 years ago they wrote this. They were from the same town in Georgia. One was white and one was black.
Keith Sutton, Psy.D.: (54:08)
Oh, wow.
Carmen Knudson-Martin, Ph.D., LMFT: (54:08)
When they went home to tell their families, guess who was in my class here in New York? The black family knew who the white family was. The white family had no idea who the black family was. And so you know I share that because that was one of the awarenesses for me as a white person about the privilege of being white. But it's just we're, you know, we're never gonna do it perfectly, but to be humble enough to try and to be accountable.
Keith Sutton, Psy.D.: (54:50)
Yeah. Well, and trying, you know, and taking the responsibility to be aware and also creating safety for feedback, but not necessarily putting it on the other to educate us, the person named Power Privilege. This is great work that you're doing. I'm so grateful that you're really kind of bringing this, and it sounds like, you know, from some of the teachers that I was talking to that are teaching family therapy courses, they were really loving this book and really felt like it's, you know, kind of really bringing in and melding a lot of important aspects of, you know, looking at these, family therapy theories and then also looking at how they play out in the room with clients and how gender and race and these social cultural aspects kind of also play out. And really bringing those and melding those two in an important way, in helping clients develop or therapists develop their abilities in family therapy.
Carmen Knudson-Martin, Ph.D., LMFT: (55:47)
Yes. Because Theresa, Maria and I, the three authors of Socioculturally Attuned Family Therapy, we believe those theories are important and, and it was a privilege in the sense that we were just talking about it to be able to pick out which theories we were gonna talk about and which concepts within those theories, we called them enduring concepts that we think are that important, that transcend time, but need to be looked at through a broader sociocultural lens.
Keith Sutton, Psy.D.: (56:21)
Definitely. Well, this is wonderful. You're doing such great work, and I'll link your books in the bio. Yeah, is there any last piece that you wanted to add in here?
Carmen Knudson-Martin, Ph.D., LMFT: (56:33)
Well, I guess I would just say the project I'm working on now is a workbook for couples.
Keith Sutton, Psy.D.: (56:38)
Oh, great.
Carmen Knudson-Martin, Ph.D., LMFT: (56:39)
Where I take all these same concepts that you and I've just been talking about, and try to explain them in ways that people can use, including, you know, how do we look at the power dynamic? It's a real interesting challenge. But it should, it'll be done, submitted in a couple months, so it should be out by the end of the year.
Keith Sutton, Psy.D.: (57:02)
Oh, wonderful. I can't wait. Perfect. Well, thank you so much. You're doing wonderful work. Thanks for coming in today for the podcast.
Carmen Knudson-Martin, Ph.D., LMFT: (57:08)
Thank you.
Keith Sutton, Psy.D.: (57:09)
Okay. Take care. Bye-Bye
Carmen Knudson-Martin, Ph.D., LMFT: (57:12)
Bye.
Keith Sutton, Psy.D.: (57:14)
Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to https://therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to https://sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to https://sf-bacc.org and https://familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at https://sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:31):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Today I'll be speaking with Carmen Knutson, Martin PhD, LMFT, who is a professor Emerita in the Marriage Couple and family therapy program at Lewis and Clark College.
Keith Sutton, Psy.D.: (02:30)
Her scholarship focuses on how the larger social context influences health and wellbeing, and how therapists can address the inequities that result. Carmen especially loves working with couples and is widely recognized for her work regarding gender, marital equality, and relational health. She's a founder of socio-emotional Relationship Therapy, an approach that attends to the ways couple interaction, emotion, and socio-cultural context come together in clinical process. Carmen's teaching and practice are based on her conviction that how therapists conceptualize client concerns is an ethical issue, and that clinical practices have consequences that are never neutral. Carmen is an American Association for Marital and Family Therapy approved supervisor and a licensed marriage and family therapist. She served as an associate editor of the Journal of Marital and Family Therapy, was vice president of the Family Process Institute, board member of the American Family Therapy Academy, and president of the California Division of AAMFT. She's currently the editor of the Afta Springer Series and Family Therapy. And prior to coming to Lewis and Clark, she directed family therapy programs at Loma Linda University in Southern California, Montana State University, and Valdosta State University in Georgia. Let's listen to the interview. Well, hi Carmen. Welcome.
Carmen Knudson-Martin, Ph.D., LMFT: (03:50)
Glad to be here.
Keith Sutton, Psy.D.: (03:52)
Oh, thank you so much for coming on the podcast. So I know you from AFTA, the American Family Therapy Academy that we're in together and you've been very involved with that organization, and I think I've gotten to some talks of yours at conferences. I think I had seen a tape of a couple you had been working with possibly. And then I was, we were having an annual teachers meeting, teachers of Family and couples therapy, and one of the folks was just raving about your new book and using it as her textbook in the family therapy course. So I got it. I've just started reading it. We ended up scheduling this podcast so quickly I've only gotten through the first chapter here, but, but I’m getting going. And then you also have a model, so I would love to hear all about your work, but first I always like to kind of find out about, you know, how you got to do and what you're doing, kind of the evolution of your thinking that that kind of led to the work you're doing.
Carmen Knudson-Martin, Ph.D., LMFT: (04:49)
Yeah, thank you. Well, I started in the field at the time when there were feminists who were critiquing systems theory and raising the question about power imbalances in relationships and such. And, so for a good lot of the early part of my career, I was focused primarily on gender and, studying that in non-clinical cases, how couples were managing that. And then in 2000 I moved to the direct to doctoral program in family therapy at Loma Linda University in southern California. And Douglas Ungar joined the faculty at the same time as I did. And Doug had been, he had been living in Florida, but he had been flying up to Washington, DC monthly to be part of a feminist supervision group with Maryanne Walters who
Carmen Knudson-Martin, Ph.D., LMFT: (06:02)
many people might know as one of those early groups that was critiquing family therapy from the feminist perspective. And Doug and I discovered that we thought very similarly about therapy. We'd actually had a supervisor in common, even though it was in different states and 10 years different in time, who was pretty experiential and structural in the things that he imparted to us. So Doug and I started doing co-therapy and invited students to watch.
Keith Sutton, Psy.D.: (06:45)
Oh, great.
Carmen Knudson-Martin, Ph.D., LMFT: (06:50)
And our goal was to be able to articulate the clinical dis-choices and decisions that we were making so we could teach others, because he and I seemed to kind of like intuitively know what to do, or we understood where each other was going and such like that.
Carmen Knudson-Martin, Ph.D., LMFT: (07:09)
So we were seeing pro bono cases at our training clinic there at Loma Linda. And later in 2008, we formalized it into an IRB approved, clinical action research study where we then were iteratively trying to figure out what worked and what didn't. And so over the years, we would do live therapy, and somebody, sometimes it was Doug or me, or both of us, sometimes it was one of the doctoral students, so we worked as a team with the observing there and such. Sometimes others would come in. And we have had over 60 different doctoral students be part of our research team. Oh, great. So, the model that evolved out of that is called socio-emotional relationship therapy.
Carmen Knudson-Martin, Ph.D., LMFT: (08:19)
And I actually have two new books, the one that you are just talking about, and an even newer book that is about that model. And the subtitle of that is a socially responsible approach to clinical practice. And once the model was developed, I moved to Portland, Oregon, which is, I'm talking to you from Oregon, to Lewis and Clark College, and I started working with Theresa McDowell. And so, at Loma Linda we were expanding to, you know, gender power and cultures. My PhD is actually in sociology, so I've always had it. It was an accredited program, but it was at the University of Southern California and sociology department. So I've always had an interest in how does the larger, what's happening in the larger societal context play out in people's most intimate aspects of their lives. And when I started working with Theresa, she introduced this idea of third order thinking, which wasn't, she didn't develop it, it actually evolved out of Bateson and people in a lot of other fields were looking at that, but it was, the language was new to family therapy, we all know about first order change and second order change but not necessarily third order change.
Keith Sutton, Psy.D.: (09:58)
Well, actually, for people that might not be familiar, can you make a quick comment on first, second, and third order change?
Carmen Knudson-Martin, Ph.D., LMFT: (10:03)
Oh, sure. So first order change are things that we do that might actually be very important and helpful to make our lives better. Maybe we learn how to breathe more slowly, or stop smoking or maybe we take a class in communication skill training and learn to listen a little bit better. Those don't change the system that people are engaged in. Second order change is what the field of family therapy has largely been organized around, saying that, in order to change whatever the symptom is, we need to change the system of relating that people are involved in. And so I don't just learn how to kind of relax and breathe more deeply, but I learn how to, well rather maybe my husband, my partner and I have been having fights about the children.
Carmen Knudson-Martin, Ph.D., LMFT: (11:23)
And we learn to not detour around the children, but to look at what some of the underlying issues might be so that we're actually changing the pattern in how we relate. And it's a pattern that each person's involved in. Third order thinking expands the lens. So that we're looking at the system that our own relationship system is embedded in. And we're paying attention to if we're gonna have change, how might we need, what other alternatives are there for relating that might not be a part of the dominant system. And a really big piece, especially in the socio-emotional relationship therapy, which is search but more, but in third order, thinking more broadly, is that in the United States especially and in most Western countries, we live in a very individualistically oriented society, that doesn't necessarily support relationships. And so third order thinking would help us sort of help clients become aware of ways that they might be organizing their life based on these larger societal discourses and patterns. And then consider, you know, is this the way it has to be for us? And that sort of thing.
Keith Sutton, Psy.D.: (13:06)
So kind of bringing awareness to the dominant, you know, kind of, social expectations and such, or the dominant narratives and how those might be affecting them or affecting their relationships.
Carmen Knudson-Martin, Ph.D., LMFT: (13:18)
Yes. And in therapy there's sort of two levels. There's the level of what we help our clients become aware of, but there's also the level of how we are ethically accountable for how we are positioning ourselves in therapy.
Keith Sutton, Psy.D.: (13:45)
In the session with our clients?
Carmen Knudson-Martin, Ph.D., LMFT: (13:47)
In the session with our clients. In that moment when we make a decision about what question to ask, who do we direct it to? How are we framing the symptoms that people are, the troubles that they're struggling with? And recognizing that as therapists, we may, without realizing it, be reinforcing and repeating a lot of those larger societal patterns. So it's not, this is a way of thinking especially the socio-cultural attuned textbooks that you are looking at where we apply this broad frame of thinking to, we use 10 of the major models of family therapy, and so it's kind of an umbrella model, a socio culturally attuned practice, which is another way of thinking about or talking about third order thinking.
Keith Sutton, Psy.D.: (14:56)
Sure. Okay.
Carmen Knudson-Martin, Ph.D., LMFT: (14:57)
Then underneath that, the model that I've been developing, which we call SRT (Socioemotional Relationship Therapy Model), is an integrated model that's one way of applying it more broadly socio-culturally.
Keith Sutton, Psy.D.: (15:15)
Yeah. Okay. Great. So, yeah. So, you met Theresa and she brought in this kind of third order thinking that you had never, or you had not kind of incorporated before. And the first order kind of changes, like the symptom change. Sometimes I think about, right, when like a family comes in and things kind of get better just because they're kind of focusing on it in the several sessions, but if the system hasn't changed, right, they'll just kind of slide back after therapy. So that second order change is like helping shift the systems, the way the parents are interacting, or the kids, or, you know, or so on. And then this third order change is really looking at how the social sociocultural factors kind of affect clients and some of those dominant narratives, as well as being aware of the therapist's potential ability to reinforce some of those narratives too, and bringing awareness to one's own perspective or privilege, you know, because every therapist has power in that situation. And so there may be very many inter-sexualities, with that but it's really that we all kind of bring that power in. And so kind of being aware of that. And then in this textbook, you kind of go through the different theories, like structural, strategic, but then kind of putting this kind of sociocultural lens on it, or kind of awareness for the therapist. Is that right?
Carmen Knudson-Martin, Ph.D., LMFT: (16:35)
Right!
Keith Sutton, Psy.D.: (16:36)
Oh, great.
Carmen Knudson-Martin, Ph.D., LMFT: (16:37)
Yes. That's an excellent summary.
Keith Sutton, Psy.D.: (16:42)
Thanks. Okay, great. So tell me let's see, let's get into your SRT model. I'm really interested in kind of a little more detail around this and, yeah. Tell me a little bit about kind of what that looks like or how that plays out in, in kind of a, a progression of a therapy.
Carmen Knudson-Martin, Ph.D., LMFT: (17:02)
Well, when we were using systematic research, qualitative research, to look at the therapy that we were doing, and we used grounded theory techniques a lot to just help us sort out. We found that we were working in four areas, really, the social discourse that we've been talking about, the interaction patterns that would be a more structural way of thinking about things, but also power and emotion. And the light bulb went off for me when our group and I realized that emotion is a window into the larger context. Because I think most people these days, they know, we all know, that the larger context is important, but it seems so abstract, and like, how do you deal with it? And when we understood that emotion is, you know, it's physiological within our body,
Carmen Knudson-Martin, Ph.D., LMFT: (18:30)
our blood pressure might rise, we might start to sweat, our heartbeats faster, our stomach starts to churn. So it's very personal, very within us, and it serves a function of communicating to the people around us relatively quickly because human beings are designed to be social interactive creatures who need that feedback. And, that the meaning of the emotion, what we are actually feeling about, or what triggers our response is sociocultural or it's contextual. So it might be triggered by my partner or my child, but the meaning of that is way beyond us as an individual couple or family. And it takes its meaning from the larger societal discourses and structures that we live in. And then another, the power piece, is that who makes, who gets to determine what's important, what's valued the meaning of things,
Carmen Knudson-Martin, Ph.D., LMFT: (19:57)
is not equally distributed amongst people, that groups who have more in any society have the- it's just a natural part of being social, I guess, is they sort of determine what counts, what matters. And then you or I, or our clients might be judging ourselves and our partner and our children by that. And we also always, one of the things that I've been learning about recently, even after, in the more recent times as I was doing this new book on SRT is how connected emotion is to thinking, that and power. So that the power-the body always takes a scan of the power position, and so just like, you can't really, I was taught to separate thinking and feeling and
Keith Sutton, Psy.D.: (21:13)
Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (21:15)
but the newer understandings, as I read them, of how cognition and emotion and power all go together, is that they're so intertwined that you can't really separate them out. Yeah. And that, the emotional, the meaning part of emotion, there arises within a particular context. So then as a therapist, I'm always wanting to understand what is this context?
Keith Sutton, Psy.D.: (21:51)
Mm-Hmm.
Carmen Knudson-Martin, Ph.D., LMFT: (21:53)
In which this situation, these issues are arising. And when people, if they express, if they appear emotional, or if there are certain words, have more energy and salience to them, that's my clue that they're connected in some way to the larger context. And so that's part of what we mean then by being socio-culturally attuned.
Keith Sutton, Psy.D.: (22:23)
Yeah. Well, it makes me think of, I also do a, a cognitive behavioral therapy, and so that idea that there's a, right, a trigger, and then there's an emotional response, and that emotional response is, you know, kind of affected by the systems of thinking, which may or may not be aware of. And so it sounds like you're saying kind of understanding the systems of thinking, the beliefs, the kind of narratives that people have, that also may be including, or are including their social cultural context, which is then kind of influencing their emotional reaction. And so kind of not only looking at their thinking like, oh, I did a bad thing, or something like that, I'm bad. But also then looking at how that is determined or they're determining that's bad. Also based in a social, cultural context and how that might be playing into, I think about narrative therapy, the oppressive dominant narratives, and kind of looking at how gender sexism, financial, you know, all these kinds of things might be playing into their judgment of self. Is that kind of it?
Carmen Knudson-Martin, Ph.D., LMFT: (23:31)
Yes. And there's a chapter on cognitive behavioral therapy in the theories book. And yeah, I think what really is helpful when you expand the lens to say these ways of thinking and feeling are when you help the clients and yourself as you relate to your clients, see these as connected to those larger societal patterns of thought and thinking and behaving, it's much less judgmental. It's much less about, "Oh, I'm this, I've really learned to think, you know, erroneously.” Because I do worry sometimes that us therapists, we can inadvertently pathologize our clients and that they come feeling, and I, I think we all worry about this, but I think sometimes people identify who've been socialized as male, especially, there's such strong pressure to get things right.
Carmen Knudson-Martin, Ph.D., LMFT: (24:38)
And so, I've seen so many men come in and sort of say, you know, head down, okay, I've messed up, tell me what I need to do. Realizing that, yeah, you got things to learn to do, but no, but you weren't socialized to do them. Or and more than that, there's strong pressures on you to do things that serve competition and individualism and being sort of on top of things, the patriarchy, that really can make that hard. And I think, I remember when I used to teach a class on gender in the master's program at Loma Linda, and at the end of one of the classes, when I was asking about the effect of the class, one of the students said, I feel like I like men better now.In other words, understanding that it's not this person, but it's these patterns. And that we are living out these patterns that we may not want to do. Or if most of our clients sort of contradictory, like, we want our relationships, we love our family and kids, and we've learned these other societal messages and patterns that tell us to do something different.
Keith Sutton, Psy.D.: (26:11)
Well, there's often, yeah,the roles that they're playing or sometimes when I think about it too, in a more gender stereotypical couple, heterosexual couple, I use emotionally focused couples therapy and getting the men to be more vulnerable and show those emotions, and then how that affects the dynamic because that's, you know, they're being asked to share more emotion, but it's kind of against the socialization. And then sometimes their partner, although they want the emotion, kind of feels like, ugh, that you're being too sensitive. And kind of reacting from that kind of gender, learning that like, oh, you're supposed to, I'm supposed to be the emotional one, you're supposed to handle it all kind of thing and really kind of helping them to create space for each other in that kind of terrain.
Carmen Knudson-Martin, Ph.D., LMFT: (26:52)
Yeah, so the therapy helps everybody be, have more compassion for each other at the same time as being able then to have less blame and then more openness to actually trying things in different ways. So what you are describing is a big part of the SRT model in terms of, in so many of the relationships that we discovered that we've been, we're working with when they're distressed there's an imbalance in power, and that's reflected in who's, who's attuned to the other, who takes influence from the other, and who's sharing responsibility for maintaining the relationship. We call those four things in the circle of care.
Keith Sutton, Psy.D.: (27:50)
Can you say those one more time actually? Sorry.
Carmen Knudson-Martin, Ph.D., LMFT: (27:53)
So, the circle of care and what, and when they're, these four things are more or less over time, balanced out between partners, the relationships are more, not only more equitable, but they're able to be more caring and supportive. So vulnerability- mutual vulnerability just like openness to the other, willingness to admit, admit mistakes, feeling safe to express one's sensitivities. And then mutual attunement, just noticing the other you know, as therapists in our field, we, at least I was often taught to help people give “I statements”, which is useful, it's not that that's not useful and that we shouldn't expect our partners to be mind readers. Well, this mutual attunement actually says, yes, to some extent, not completely but to some extent, we do need to be tuned into, we can't expect, you know, our partners just to tell us everything that we need. And often we're in balance in that one partner is much more, and if that's related to power, whether it's gender or race, I mean the group that has more power doesn't notice what's going on with the other group as much.
Keith Sutton, Psy.D.: (29:24)
Yeah. Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (29:25)
Teachers with students, you know.
Keith Sutton, Psy.D.: (29:28)
Sure, sure.
Carmen Knudson-Martin, Ph.D., LMFT: (29:28)
Students are pretty attuned to what that teacher's looking for.
Keith Sutton, Psy.D.: (29:32)
Yeah, well and sometimes I think about with that attunement, like, are you holding in your heart kind of what I need or what I want, or who I am? And not that, yeah, that the person can read minds, but they at least are kind of thinking about the other and the effect that they may have on them.
Carmen Knudson-Martin, Ph.D., LMFT: (29:48)
Yeah. Exactly. That's exactly it. And it's often not, not balanced in a relationship. And then the third one is mutual influence. Like whose interests actually are organizing the relationship. And there's an overlap here with John Gottman's work, where he decades ago started talking about influence, the ability to influence each other. And he more recently, well, a decade ago now, but, he connected that to power and that it's not just being influenced by like, when I say something nicely to my partner and I want this, but being willing to be influenced by when they're upset. In other words, being willing to be changed by what your partner is experiencing. And that that's mutual and that each partner's doing it. And then shared relational responsibility. Which, in heterosexual relationships, women have been socialized, men and women have been socialized that women are supposed to play that role. But we found, you may know Naveed Jonathan. He is in,
Keith Sutton, Psy.D.: (31:14)
I do know of his, a little bit. I don't know him personally though. Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (31:18)
Naveed is in, I think he's in Anaheim, the Los Angeles area anyway. And he was a former student of mine when I was at Loma Linda. And, he did this study that I supervised with same sex partners and committed relationships. This was back before marriage was legal. And he did this study while we were developing SRT, and it's where we’ve got the no, I, realized how important focusing on attunement was because in general, same sex partners, he did, he interviewed 20 female couples with female partners and 20 couples with male partners. And he found essentially the same process whether we are talking about male couples or female partners. The majority of them, more, much more so than the heterosexual couples we were interviewing, they talked about wanting to attune to their partners.
Carmen Knudson-Martin, Ph.D., LMFT: (32:24)
They wanted relationship, they often structured ways to make sure that they had conversations and, and such about what was happening for each of them. But there were also same sex partners where it was imbalanced. So Naveen talked about attuned equality. Un-attuned, I mean, attuned inequality, so there were something, some same sex partners who, there were things like maybe things related to job and who's taking care of children and such, that meant there really was an imbalance in the relationship. But the couple was aware of it, and they were trying, trying to be really sensitive, the powerful partner was trying to be really sensitive and appreciative about what the person with less power was doing.
Carmen Knudson-Martin, Ph.D., LMFT: (33:27)
And then there was the untuned inequality. Which is the kind of cases, that there were only a few of them, but one partner was basically saying, I don't, you know, this is who I am. Take it or leave it. Yeah. And, but amongst heterosexual couples, the gender socialization meant that there was a lot more imbalance, and all of those four elements of the circle of care. And so as part of the SRT model of who are we directing our clinical interventions toward, we're taking into account that the imbalances in the circle of care. So if one partner's already more vulnerable because the other, because they've been carrying the weight in the relationship, and they already are showing at least signs of taking their partner into account that, you know, when they, they say, I know my partner sees this differently, but here's how I see it.
Carmen Knudson-Martin, Ph.D., LMFT: (34:45)
Then I want to make sure that I don't ask, I don't put the burden of change on that person who's already more vulnerable and already taking more responsibility, they will step up to do it usually so it's, so it's being a little more attentive, and you might think good therapists, or most of us might think good therapists regularly do this, that we would notice who's not attuned and that we would, but when we were looking at videos of our own work, not just other people, we found that we regularly were influenced more by the dominant partner that we, we would, attend more to them than to the other partner. And, that we'd often put the bur-, you know, like if you asked, if you're dealing with couples and you asked one of them to, one of them, they were unhappy about something and one person starts to cry,
Carmen Knudson-Martin, Ph.D., LMFT: (35:56)
then you might turn and you put the burden of the person who, who's crying to, to tell what's going on. It's not that we don't wanna hear from that person, we do. But be, but stopping and turning to the person who's, you know, more disengaged, less attuned and saying, do you know, your, your partner's crying. What do you think is going on for her? What do you think, how do you think what you just said might have affected her? Then you can check to see whether they've gotten that right from your partners. But you're starting to change that pattern of that the burden of responsibility is always on the same person to fix things. In attachment we might say to repair that relationship.
Keith Sutton, Psy.D.: (36:52)
Yeah. So the one that kind of affects the other potentially harms or, or the other one's upset, that kinda being, becoming aware of what's happening that's potentially leading to that rather than kinda like, oh, what's going on? And then having the other one and having, again, the responsibility to try to say, explain what's happening in the dynamic, and instead kind of the other person stepping forward.
Carmen Knudson-Martin, Ph.D., LMFT: (37:18)
Right. And staying with, helping that other person, the one that we would say the power, we think of power as not a personal property, but as a dynamic that happens in all relationships that flows from one person to the other, who has the ability to have an impact on the other and whose interests or on their social world. Because a lot of times these power issues are outside the relationship, they're not necessarily in relation to the partner, but oftentimes that's flowed into the relationship. So it is with the partner and then we need to stay with the person in the more powerful position,
Carmen Knudson-Martin, Ph.D., LMFT: (38:11)
To help them really be able to prac- to try to attune. Because at first they'll say, I don't know,
Carmen Knudson-Martin, Ph.D., LMFT: (38:18)
Or say: well, I see it differently. You know, and to sense it, you know, without attacking them or blaming them too much. Just not, just being aware that the power of our role, to say, are we going to let this, let a more powerful person off the hook? And put the burden back on the other person. Or not? Or are we going to, if it's related to injustices that are outside their system, are we going to name and acknowledge them? And give voice to them? Which is a big part of what we talk about in both these new books.
Keith Sutton, Psy.D.: (39:04)
Can you, can you give an example of that, of kind of bringing in the aspect of power outside of the relationship and how you kind of might bring that into an in intervention in your session?
Carmen Knudson-Martin, Ph.D., LMFT: (39:17)
Well, in terms of gender, just naming, you know, so where did this idea come- this idea that you should have all the answers. Where did this idea come from? Oh, well, my father, he always… Where do you think your father got that idea? And so expanding outward, but outside, so it might be related to feeling bad about yourself because you come from lower socioeconomic position, or a good example that I have in my book on SRT is a mixed race couple where they were having an argument outside in the driveway, and the husband was white and the wife was black. And they were still upset. They come into therapy, they're still upset about this argument, and they're both upset. And they were upset, the argument was about, in the book, the example is that somebody has knocked garbage over in their driveway.
Carmen Knudson-Martin, Ph.D., LMFT: (40:24)
So they, the husband starts to yell about this, he's not yelling at his wife, he's just yelling. And she wants him to be quiet. And then he's mad about that. Like, who are you telling me to be? And it isn't until we started saying, well, so what did it mean? Getting its meaning. What did it mean to you to be having this argument in the yard? Well, the husband says, he thought that the sister-in-law who'd come over to use their dryer, had left the gate open and knocked over the garbage or something. And he felt that he wasn't being respected and that he had a right to his voice and he had a right to be angry, and his wife was afraid the neighbors would call the police.
Carmen Knudson-Martin, Ph.D., LMFT: (41:19)
As a black woman living in a predominantly white neighborhood, she, he had a lot of sensitivities of a lot of ways. I mean, they had teenage kids who, with dark skin, they're aware of, you know, what that's like for their boys going out in the world. But he had no idea that when he yelled in the driveway, that it would just make her worry about that the police might come. And so, I mean, that's just one example,
Keith Sutton, Psy.D.: (42:02)
Yeah, like a, what's called a healthy cultural paranoia. And him not realizing and experiencing it as her trying to shut him down and dismiss feelings, but it was coming from a place of trying to create safety.
Carmen Knudson-Martin, Ph.D., LMFT: (42:17)
Yeah. So they were both responding from what, in SRT, we call their felt identities. So it's a social, you know, location, but it's not just a category and it's unique. We don't all, you know, everybody with the same label doesn't feel the same. It's much more nuanced than that, but the felt experience of being in that category.
Keith Sutton, Psy.D.: (43:28)
So can you tell me a little more about felt identity and what that means or what that looks like? Or is that, you know, kind of the way the person identifies themselves?
Carmen Knudson-Martin, Ph.D., LMFT: (43:39)
Yep. It's all of those things. I think it's one way that, you know, I said earlier that the light bulb sort of went off when we saw how emotion was the window to people's larger experience. So now, instead of just thinking about people as a member of a group or a category, as a therapist and as a human being in any relationship, I want to know what their felt experience is. I think qualitative researchers sometimes call it lived experience. I think it got the name “felt experience” from my colleague Lana Kim who works with me, or I've recently retired from Lewis and Clark, but she was on the faculty with me at Lewis and Clark and took over as program director when I stepped down as family therapy program director.
Carmen Knudson-Martin, Ph.D., LMFT: (44:43)
But we've been continuing to study together about SRT and how to teach it to master's level students. And we had a chapter in the sixth edition of the Clinical Handbook of Couple Therapy. And Lana used the term felt identity. And I went, yeah, that's what it is, and so it kind of brings that, the social discourses, the social structures into somebody's lived experience. And I think the reason identity is important is because attachment is very important but so is how we kind of know ourselves. And when our sense of self is threatened or under or demeaned or ignored, then you know, we'll either fight to maintain it or we may get depressed and withdraw, but this identity piece, who am I and what is my worth?
Keith Sutton, Psy.D.: (46:06)
Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (46:08)
In this world. Yes to my partner, but also in this world. All of that gets nicely encapsulated into thinking about a felt identity.
Keith Sutton, Psy.D.: (46:21)
Okay, great.
Keith Sutton, Psy.D.: (46:23)
There's kind of like the, how do they say like, the difference with the emic in the attic, like the personal experience of culture and versus kind of the larger, like this is what it's like for this certain culture kind of the broader versus the micro experience?
Carmen Knudson-Martin, Ph.D., LMFT: (46:41)
Yes. And I think therapists, we need to learn about the broader culture to know what kinds of things to be, to ask about and to be interested in. I often, in things that I write, quote Celia Falicov who's also a AFTA member, and she says, we have to be both knowing and not knowing. We have to know that the larger context matters, that there's inequities. And if we just say that culture, it's cultural without looking at the inequities, but within cultures, or that some cultures are more valued than others and such, then we have to know that those things matter. But we also have to, she calls, looking, calls it, looking at each person's cultural niche. And that, you know, what is their unique intersection of all these pieces, their family experience, their life, their experience over what it's, it comes down too for us in SRT as felt experience and felt identity. Then who am I in this world?
Keith Sutton, Psy.D.: (48:05)
So kind of really getting a sense of how the client experiences themselves and their own experiences. And I think, I imagine you also talk about privilege, you know, and I know as a, you know, white, cisgender male therapist, that there's, you know, these aspects of privilege that as a therapist I oftentimes need to be doing work to bring that to the forefront, because sometimes the way I think about it, right, the definition of privilege is that we don't have to think about these things. And so actually kind of being aware of those blind spots and working to kind of bring those blind spots to the foreground. Do you talk about that or have any thoughts on that about, you know, kind of for therapists that hold a lot of privilege?
Carmen Knudson-Martin, Ph.D., LMFT: (48:52)
Well I have a chapter in the SRT book on some of the ways, because we, in addition to studying therapy, especially in, well, in both Loma Linda and at Lewis and Clark, some of the students studied their own process of learning and becoming aware of their privilege, either as, as you're talking about just in the society at large, and also their privilege as a therapist who, whether you feel it or not, you know, we get to define what's healthy, what's important, what gets talked about in session, all those things. And so in the book, we talk about learning to, beginning with understand, I usually would ask my classes to introduce themselves by sharing where they learned what normal was. What constitutes normal, and to bring in gender and race and such like that.
Carmen Knudson-Martin, Ph.D., LMFT: (50:10)
And to take, we give an example of a life map where we take the salient experiences in our life over time and then look at how our social locations, the privilege, the sources of privilege that we have, and the sources of less privilege or injust, oppression that we might have. And most people have some of each so just becoming aware of that, then it's, you know, once you become - you would know this - as you become aware, the more aware you are, the more you realize you're not aware. So it's sort of paradoxical, like a student might start out thinking they know a lot about this, but by the end of the class they realize they actually don't know very much.
Keith Sutton, Psy.D.: (51:18)
Well, I think that's my experience every time I go, like, in the AFTA facilitated listening circles, just like as people are bringing up different things, again, things that would not have even occurred to me, even though there's a lot of work that I do on this and aware that, that there's so many aspects out there that and I think that curiosity kind of, and that not knowing is so important that Celia is talking about.
Carmen Knudson-Martin, Ph.D., LMFT: (51:40)
Yeah. And so I think what I say multiple times in the book is that if you are in a position of, if you know you're in a position of power like you just own that, I certainly own that as a senior person in the field with books and, you know, somebody actually wants to hear what I have to say, and all that sort of stuff, then it's on me, it's on you to try to structure things to create a more equal playing field, whether that's how I teach my class and I make space for multiple voices, whether I'm a colleague in a faculty meeting and somebody ignore, maybe a young woman of color is being, has said something wonderful and then a white man says the same thing and it gets noticed, maybe I use my voice to just gently, you know, I don't have to make a big issue out of it, but I can say, you know, as the younger black woman was saying, this is really important. And giving, just recognizing that when you're in a position of privilege, there's so much you don't see, so you have to be more intentional.
Keith Sutton, Psy.D.: (53:13)
More responsibility.
Carmen Knudson-Martin, Ph.D., LMFT: (53:14)
Yes. You have to take more responsibility because people in lower power positions will have been, for example, people of color have, for generations, worked hard to keep things smooth, to not upset white people.
Keith Sutton, Psy.D.: (53:35)
Yeah. Yeah.
Carmen Knudson-Martin, Ph.D., LMFT: (53:37)
And white people may not even be aware that that's happening. I think it was in one of Monica Mcgoldrick’s edited volumes, I don't remember the names of the authors, but they were two doctoral students. I think they were at Syracuse University, this is probably 25 years ago they wrote this. They were from the same town in Georgia. One was white and one was black.
Keith Sutton, Psy.D.: (54:08)
Oh, wow.
Carmen Knudson-Martin, Ph.D., LMFT: (54:08)
When they went home to tell their families, guess who was in my class here in New York? The black family knew who the white family was. The white family had no idea who the black family was. And so you know I share that because that was one of the awarenesses for me as a white person about the privilege of being white. But it's just we're, you know, we're never gonna do it perfectly, but to be humble enough to try and to be accountable.
Keith Sutton, Psy.D.: (54:50)
Yeah. Well, and trying, you know, and taking the responsibility to be aware and also creating safety for feedback, but not necessarily putting it on the other to educate us, the person named Power Privilege. This is great work that you're doing. I'm so grateful that you're really kind of bringing this, and it sounds like, you know, from some of the teachers that I was talking to that are teaching family therapy courses, they were really loving this book and really felt like it's, you know, kind of really bringing in and melding a lot of important aspects of, you know, looking at these, family therapy theories and then also looking at how they play out in the room with clients and how gender and race and these social cultural aspects kind of also play out. And really bringing those and melding those two in an important way, in helping clients develop or therapists develop their abilities in family therapy.
Carmen Knudson-Martin, Ph.D., LMFT: (55:47)
Yes. Because Theresa, Maria and I, the three authors of Socioculturally Attuned Family Therapy, we believe those theories are important and, and it was a privilege in the sense that we were just talking about it to be able to pick out which theories we were gonna talk about and which concepts within those theories, we called them enduring concepts that we think are that important, that transcend time, but need to be looked at through a broader sociocultural lens.
Keith Sutton, Psy.D.: (56:21)
Definitely. Well, this is wonderful. You're doing such great work, and I'll link your books in the bio. Yeah, is there any last piece that you wanted to add in here?
Carmen Knudson-Martin, Ph.D., LMFT: (56:33)
Well, I guess I would just say the project I'm working on now is a workbook for couples.
Keith Sutton, Psy.D.: (56:38)
Oh, great.
Carmen Knudson-Martin, Ph.D., LMFT: (56:39)
Where I take all these same concepts that you and I've just been talking about, and try to explain them in ways that people can use, including, you know, how do we look at the power dynamic? It's a real interesting challenge. But it should, it'll be done, submitted in a couple months, so it should be out by the end of the year.
Keith Sutton, Psy.D.: (57:02)
Oh, wonderful. I can't wait. Perfect. Well, thank you so much. You're doing wonderful work. Thanks for coming in today for the podcast.
Carmen Knudson-Martin, Ph.D., LMFT: (57:08)
Thank you.
Keith Sutton, Psy.D.: (57:09)
Okay. Take care. Bye-Bye
Carmen Knudson-Martin, Ph.D., LMFT: (57:12)
Bye.
Keith Sutton, Psy.D.: (57:14)
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