In the early era of marriage and family therapy (MFT) there were no such professionals as “marriage and family therapists.” Pioneering practitioners were drawn from a number of disciplines: psychology, social work, medicine, the ministry, and juvenile justice, and brought with them the dominant mind-set from their core training. The theory and practice of MFT comprised a hybrid of these backgrounds. Not, however, a hybrid like a Toyota Prius whose electronic and internal-combustion engine hums, almost silently, and in perfect harmony. The MFT hybrid was more like the early, clunky skateboards that were patched together by cutting a two-by-four and bolting on salvaged skate wheels that rolled down the sidewalk clicking and clacking.

Eventually, the exciting but messy early era in MFT came to a close: the combination of attrition, licensing laws, new academic programs, published theory, and conferences made MFT a discipline unto itself. Practitioners came to appreciate that, while ideas from individual psychodynamics, interpersonal theory, medicine, and sociology were relevant to MFT, a new way of working required a new way of thinking and a new way of training.

An Opportunity

Care consultation and mediation (CCM) is being practiced by those who were trained outside the field—typically, in social work, nursing, legal mediation, counseling, and even financial management. These practitioners, as did the early MFTs, bring along the mind-set from their backgrounds and must learn their CCM skills on the job. Unfortunately, it can take years for that on-the-job training to turn into competence. The practice of CCM could benefit greatly from a new way of thinking and, with it, a new way of training.

There are tens of millions of potential clients and very few skilled professionals to serve them, but you won’t find a single training program that focuses solely on care consultation and mediation—again, a situation parallel to the field of MFT prior to the 1960s.

As with marriage and family therapy before the boom, health professionals believe that the field of CCM is not unique and that it’s being sufficiently addressed. It’s not. My practice is bursting at the seams. Though I can’t come close to covering the referrals that come my way, I have no one to refer to. I no longer market. Now I duck.

Lighted is not Enlightened

The need for CCMs is no secret, so what’s being done? The solution is being searched for under lighted lamp posts. There’s an old joke: It’s dark; a person loses a coin and is searching for it under a lamp post. A stranger comes along and agrees to help. After a while, the stranger asks how far from the lamp post the coin was lost. The searcher explains that the coin was lost across the street, a good distance from the lamp. The exasperated stranger wonders, “So why are you searching for the coin here if you lost it way over there?”

“Well,” the searcher explains, “this is were the light is.”

The lighted lamp posts, in this case, are academic programs in geriatrics, staffed primarily by research professors rather than by clinicians. But a degree program in geriatrics is no more an adequate training mode for care consultation than physics and wood shop are for hitting a baseball, or would be for physicians and nurses being training solely in human biology, hold the practicum. While understanding the physical and mental changes that take place in aging is useful, it’s insufficient training for clinical work.

To be effective, a CCM must be sensitive to at least as many influences in the lives of a client as should a family therapist. Typically, a CCM is brought in when a transition becomes necessary because the client is contending with the biological and psychological effects of aging. While finding the right placement for the client often becomes the focus, it’s commonly the easiest task.

Getting all those involved, especially the client, to agree to the transition can take the most delicate of negotiations. Negotiating a transition for the client can bring up latent or not-so-latent animosity between adult children and adult step-children, between parents and their children, between step-parents and step-children, and with anyone else who may have a long-term relationship with the client. One of the most challenging conflicts to contend with is when your client has remarried late in life and the couples’ children take sides against their respective step-parent. (You’d like to believe that everyone wants to do what’s best for the client but that’s not always the case.) And when every interested party is in agreement on the placement for the client, you still may have just started your work. If the client has behavioral problems, then you may have to become an ambassador between the facility and the client’s family. While the practice of CCM often brings images of “genteel old ladies and smiling family members,” when the negotiations get tough the negotiations are as genteel as partisan politics. CCM is not for wimps, at least not untrained wimps.

All this is to say that the competent practice of CCM is not something that you can pick up from reading a couple of books (as if there were any) or going it alone in the “school of hard knocks—not without casualties. As with any complex professional practice, your learning experience should be backed by theory, peer support, and supervision. If you can get that strictly on-the-job then you’re probably wearing tights and a cape.

Curriculum and Programs

A framework for a training program must take into consideration its current environment. As stated above, the practice of CCM is a distinct service but, at the same time, shares expertise with other counseling-related services—no point in throwing out the cat with the cat litter. CCMs will be typically working with a family, and often with physicians and other medical professionals, attorneys, guardians, caregivers, placement specialists, and others. Understanding of personal psychology, family systems, and social systems is essential. And as they’re usually working with elders, knowledge of the effects of aging is necessary. In short, while offering a distinct service, CCMs can learn much from what they share with other professionals in medicine, law, counseling, social work, personal coaching, and geriatrics.

Nevertheless, slapping together a training program by assembling professionals from other disciplines would be a mistake—remember the clunky skateboards. What we’re after is a program that makes the best use of available expertise, while starting on the road to attaining its own identity. The profession of care consultation and mediation is sufficiently complex and unique that it will eventually have its own literature, training, and perhaps, licensing—and, I hope, a shorter name.