Fall from Grace: The Worship of Clinical Leaders

 Photo Credit Ian Espino unspalsh.com 

Photo Credit Ian Espino unspalsh.com 

Over the last year as the #MeToo and #TimesUp movement gained momentum, we have seen courageous human beings, women and men, non binary, gay and straight, diverse in race and religion, come forward to share stories of rape, harassment, and other atrocities that left them feeling terrorized and traumatized, sometimes for decades.

As a life long advocate for women's rights, LGTBQ rights, and human rights, I also have a story of overcoming sexual molestation, harassment, and bullying behaviors perpetrated on me by people within the foster care system, a grade school teacher, abusive parents, and a professional superior that created pain and trauma in my own life.

The healing journey for many survivors, myself included, is often marked by highs and lows. One of the most beautiful gifts in the wound is that healing my own trauma led me to a profession I love, as a therapist who is honored to help other trauma survivors heal and move forward. 




For decades I have stood and continue to stand in support of change and inclusive equality. And I have marched and continue to march with survivors as we move our message forward. The core of this message: That every human being deserves to be treated with dignity and respect. That every person deserves to ambulate through the world and workplace safely without the fear of being raped, harassed, threatened, shamed or bullied. 

This week one of our most esteemed and celebrated individuals within the clinical community, Bessel van der Kolk, fell from grace within some of our clinical circles based on accusations from former colleagues that he worked with. Those familiar with van der Kolk (both in and out of the therapeutic arena) know that he is an eminent psychiatrist who is most respected for his research and writing on how trauma impacts neurobiology, development, and attachment. 

The news of Dr. van der Kolk has polarized the clinical world, with many rushing to his defense, others rushing to condemn him, others demanding that the alleged victims speak out more publicly, and still others defending the alleged victims, and many shouting back and forth across the clinical divide. 

Before I continue, let me first clarify that joining in the angry fray, or pointing fingers in either direction is not what this blog is about. I am not writing this in order to take sides, to defend or to accuse. Allegations are not the same as evidence. The purpose for this blog is to thoughtfully consider a number of issues surfacing from this difficult situation including how we as a community tend to deify our leaders.

Rather than speculate on what happened and who is telling the truth, I believe that this situation provides an opportunity for all of us to look at assumptions, power dynamics, ownership, and to deconstruct what is and what is not an apology (as many in our community felt confused by the letter to his colleagues). 

This is not a space to bash Bessel, or to vilify the alleged victims, or to assume guilt. And it is not a space to bash or vilify me for wanting to better understand this dynamic. The perspectives I share may not resonate with you, or they may. The majority of the comments and emails I have received have been open, compassionate, grounded, and have included sympathy toward Dr. van der Kolk, empathy for the accusers, and appreciation toward me for creating  this blog. 

Most of the comments with respect to me writing this, even if we do not agree on particulars, have been professional, kind, and open as demonstrated in the conversations in the comment section. Some have shared that this blog has voiced their own thoughts and feelings on the matter, and others have let me know that they appreciate a place to simply express their thoughts on this unfortunate situation. 

However, there have been a small handful of mean spirited, unkind, and even threatening comments, with one therapist (yes therapist) stating that discussing my thoughts on this matter, thoughts I share compassionately and without judgment, would be the end of my career and that she "would see to it." 

Two therapists shared that they were "disgusted" and "angry beyond belief" that I would not side with the alleged victims given that I am a survivor. One went as far as to say that my, "Woman card should be revoked." And yes, these are clinicians writing this. 

Another person let me know that they would be "driving the 'so called' victims" out on a rail", and still another person declared that, "We will make sure that they (those making the allegations) and you are publicly humiliated!"

It is disheartening to read angry rants like this from clinicians. Threats to end my career because I won't choose a side? Publicly humiliated for what reason? Turn in my woman's card why? Because I dare to express my thoughts on this challenging topic? Is van de Kolk so untouchable that we cannot express ourselves on this topic in a professional and balanced way. 

These kinds of hostile threats toward me, toward Bessel or toward the victims do not add anything that is helpful or healing to this very sad situation. As such, they will not be included in the comments. And for those who are having such a violent reaction to my thoughtful expressions, I hope that you will take a breath and regulate your assumptions and rage as I share my experience in reading his letter of apology. Again, I respect that this may not be yours. 

Moving on...

Like many of you, his book, "The Body Keeps Score" was life changing for me. It is a book that I treasure, will continue to treasure, and one that I put in the hands of the many hurting people to whom I provide counseling and support. 

When I first saw the article pop up in my newsfeed outlining allegations of his work place bullying, I knew the meaning of "a sinking heart".  As tears filled my eyes, my first thought was, "No! Not him too!" Surely there must be some mistake. How could this be? He wrote the book on this. He knows better - so how could he not do better? However, rather than taking the accusations at face value I wanted to better understand (as much as one can without being directly involved) what had transpired and to consider the various perspectives. 

Like many of you, I have wrestled with emotions that include confusion, shock, hurt, denial, anger, and sadness this week. Teetering back and forth between my own positive experience of his work through his books and presentations, vs. what it must have been like for those under his supervision, employment and on staff with him who have come forward with these allegations, vs. wanting to hold respectful space that allegations are different than proven facts. 

I can only imagine how difficult this must be for Dr. van der Kolk, and I also know all too well what it is like to stand in the shoes of someone with a bully boss; not knowing where to turn or who to go to with my complaints. Feeling shamed by their words, overwhelmed by their position, and intimidated by their power. It is a very small and highly vulnerable space to find oneself in. 

However, that is my own subjective experience. And the only people who know the truth in this situation are those involved. It is not my nature to draw a strong conclusion based on allegations, however I do have thoughts on the letter of apology that he wrote to his colleagues which I share below. 

A few days after the news of his public firing, van der Kolk wrote a message about what transpired from his perspective and included the letter that he sent to his trauma center colleagues. I'll start with his message, and then the letter (please note that he has stated a request on his website for this to be shared):

"By now many of you will have heard the press reports about my having been fired by JRI (not the Trauma Center- in fact, our entire management team unanimously & vigorously protested this stunning move). This happened in the wake of our executive director having been fired the month before, at which point JRI (Justice Research Institute) decided to take over the Trauma Center and scratch the Memorandum of Understanding with which we joined JRI, which guaranteed our autonomy in hiring & firing & specifically said that all funds raised by the Trauma Center will be specifically & only be used by & for the Trauma Center. When I sought enforcement of this MoU I was suddenly fired without any warning, while the rest of the management team was told to pass the message that I had been fired & would not be allowed to step foot at the Trauma Center on to our students, staff & patients. They unanimously refused to do so. 

In retaliation JRI has engaged in the public character assassination of me that most of you have by now heard about.
That is not to say that I cannot be impatient at times, and I have been known to be harsh-- that’s something that I’ve been working on in my own therapeutic endeavors & will continue to do. I actually think that kindness is the greatest virtue, & even as I try to practice it, I often fail at it.

I am deeply touched by the overwhelming support that I have received from around the world (in fact, it was really good to hear from so many old friends). 

We are working on reconstituting the Trauma Center by July 2018, with almost our entire current staff slated to join. We already have at least one (very lovely) location that is ready to receive us. 

One problem is that JRI is holding onto $2.7 million in Research & endowment funds that we have carefully accumulated to ensure the continuity of our programs. JRI refuses to release our funds that they claim they own, even though most of these funds were donated by grateful patients, students family & other people who have benefited from our work. So, that now sadly will be an issue that will have to be decided by the courts."

Bessel's treatment by the JRI executive is about manipulation, money and power. It seems to me that when we are so quick to jump on the negativity bandwagon, we too become the bullies and contribute to the traumatisation experienced by those in the fray."

And here is the letter that was posted underneath the message that was sent to his colleagues at the trauma center. This is the letter that I'd like to take a closer look at. Again, this was publicly placed on his website asking others to share. And so I share it here:

"Dear Trauma Center colleagues,

As you can imagine, I am devastated reading the allegations in the Boston Globe that I have been bullying and denigrating my colleagues at the Trauma Center.

I am also aware that such accusations cannot be entirely pulled out of thin air, and that some of you must have felt bullied and denigrated by be, though, as far as I remember, none of you have ever confronted me with such misbehavior. If I have inadvertently denigrated or bullied any of you,I would like to know about it, apologize and make amends.

As you know., I am a strong believer in doing your own personal work, and in my book, the Body keeps the Score, I describe some of that journey for myself, including with Dick Schwartz in Internal Family Systems Therapy, and with sensorimotor work, in disguised form.

But, as the record now stands, I will forever be remembered as the Trauma therapist who traumatized his colleagues, and who founded and ran a toxic environment. Somebody who talked a good game, but who was just a Harvey Weinstein in disguise. If you feel that allegation is correct consider justice to have been done.

If not, I hope you will be consider being vocal and public about how you feel about character assassination, and speak your truth.

Thank you, and I hope to see you all under better circumstances.

Devastatedly yours,

Bessel

Feel free to share.

Bessel van der Kolk MD
Medical Director Trauma Center
Professor of Psychiatry
Boston University School of Medicine"


What a tragic situation for everyone involved. Painful for him, painful for his colleagues, and painful for those of us who have been impacted on the periphery.  

While I appreciate his attempt to reach out to the colleagues who have shared feeling wounded by his words and behaviors, my experience in reading this letter is that it feels like less of an apology and more like damage control to me. This is understandable, who of us wouldn't want to do that if facing such public accusations?

After carefully reading this letter several times, it appears that van der Kolk may not understand why his colleagues did not come directly to him with their complaints. It remains to be seen if their accusations are true (though I'm uncertain why he would write a letter like this if they were being intentionally deceitful); if there is truth here, then they likely kept silent due to a power imbalance. 

In writing his letter of apology it would have been helpful for him to pull that particular power dynamic lens out far enough to gain enough perspective in order to respond to the victims he allegedly wounded in a more nuanced and appropriate manner. 

If his intention was to apologize to those who share being hurt by him, and it seems on the surface that was the intention, I wish his letter contained five important elements. These are the elements that are essential, at least in my life and in my clinical work, that support a sincere apology:

1. Expressed Empathy
2. Full Ownership
3. Compassionate Insight
4. An Authentic Apology
5. Changed Behavior Modeled Consistently Over Time

I've attempted to deconstruct the letter below as objectively as possible given I was not an eye witness to these events. That said, I will fully acknowledge my bias toward people in privileged positions who may use their power to manipulate and control subordinates, or toward those who they feel are subordinate to them. However, only van der Kolk and the accusers are privy to what really happened behind the scenes. 

Whether these allegations will be proven remains to be seen. My focus is less on the accusations and more on his public apology letter in response to his colleagues who felt victimized. Here is my assessment, one that you may or may not agree with. Again, it is simply my experience in reading and then further exploring his public letter of apology:

1. Expressed Empathy

It seems he is both writing to and not writing to those who were apparently hurt by him. Starting his letter with, "As you can imagine, I am devastated reading the allegations..." feels somewhat short sighted and slightly manipulative to me. 

I am certain that he is experiencing a deep sense of devastation. Even though I have not bullied or harassed people, and even though I have been bullied and harassed, I have compassion for his struggle. And I certainly have made my fair share of mistakes and missteps on my journey that have hurt others. However, my deeper empathy is extended toward the alleged victims and his seeming lack of insight in his apology letter. 

Beginning his letter this way implies that those he allegedly bullied should feel sorry for him. That somehow his devastation is due to their unwillingness to stand in silence and tolerate his alleged abuse. Because they have spoken out in advocating for themselves, he is now devastated. This one opening sentence belies empathy on his part. 

A better way to begin might have been,

"I have learned that on occasion my words and actions have emotionally injured and caused trauma to my employees and colleagues."

If he had started his letter this way, he then demonstrates empathy for those he allegedly victimized vs. moving in to the victim role himself, which brings me to my second point:

2. Full Ownership

In his second paragraph he states, "I am also aware that such accusations cannot be entirely pulled out of thin air, and that some of you must have felt bullied and denigrated by me, though, as far as I remember, none of you have ever confronted me with such misbehavior. If I have inadvertently denigrated or bullied any of you,I would like to know about it, apologize and make amends."

This paragraph appears contradictory. On one hand he indicates that there may be some truth to the "accusations" from "some" of the people who share being negatively impacted by his words and actions  (as an aside, I also wonder about his word choice with "accusation", in using this word he distances himself from ownership).

A shift occurs with a subtle implication that the victims are either possibly telling the truth ("thin air"), or they might be lying, or their silence is to blame for his devastation because they did not confront him on his behavior "if"  he "inadvertently denigrated or bullied..." which leads me to my third point:

3. Compassionate Insight

Dr. van der Kolk seems to lack insight about why the individuals who shared that they were hurt and impacted by his words and behaviors did not immediately and directly address this with him (assuming that his memory is correct and people did not approach him, or if they did, that he was open to making time for them).

What he fails to acknowledge in his letter is the power dynamic involved, that these individuals were likely intimidated and uncertain on how to confront him and assert their boundaries. The imbalance of power is often far too great in relationships like these. 

Additionally, by virtue of his own research, if his alleged bullying modeled the victim's early FOO trauma, then PTSD may have been present which informed their silence. This atmosphere of fear may have contributed to a PTSD response of silence, and, if so, then it makes sense that they would hesitate in confronting him.

And I do not believe it is too far of a stretch to imagine that he would know this from his own research. 

Again, it is worth repeating that if these accusations are true, and that still remains to be seen, van der Kolk also seems to be missing the privilege dynamic at play here. He is a white, educated male, a renowned doctor, a man of power, and because of his race and gender, he likely had opportunities that others may not have had. Even if every one of the accusers had the exact same privileges that he has had, the power imbalance still remains. 

This lacks both insight and compassion on his side. If he were in any other profession, perhaps we could understand this lack of insight into power dynamics, but by his own admission, he is a person who has done his "personal work."

He outlines this by writing, "As you know, I am a strong believer in doing your own personal work, and in my book, the Body keeps the Score, I describe some of that journey for myself, including with Dick Schwartz in Internal Family Systems Therapy, and with sensorimotor work, in disguised form." 

This particular statement has an undertone of assumption. The tone and tenor also feels somewhat lecturing toward his alleged victims. It assumes they ought to know that he has done his work even though, according to their reports, his alleged behavior toward them demonstrated the opposite of a person who has done his personal work.  And it subtly implies that they should be doing their own personal work (on this I agree, but it is tone deaf to include that kind of scolding in an "apology" letter). 

This statement also indicates that he has continued to work on himself, even though his colleagues apparently did not experience this "work" in his words and actions toward them. 

If this happened, then this is the very definition of Gas Lighting: Telling people that their experienced reality is not true and giving "facts" to support that their experience of him is not true. This is further traumatizing and shaming to victims of abuse, and that is not an apology. Which leads me to my final point:

4. An Authentic Apology

Stating, "If I have inadvertently denigrated or bullied any of you, I would like to know about it, apologize and make amends." Beginning this sentence with the word "If" implies that there may be some doubt on his part that their experience was real. And that may be true. He may not have any awareness at all of what he was doing. 

Which is somewhat startling to consider, but is certainly a possibility as lack of insight goes hand-in-hand with power and privilege. 

Simply saying that he would like to know about "it" so that he can "apologize and make amends" assumes an awful lot on the part of those he allegedly "denigrated". Using the word "it" vs. naming the alleged behaviors is a way of distancing and minimizing. And, if the environment was as toxic as these individuals have shared due to his words and behaviors, and given the lack of insight in his letter, why would he assume that any of the alleged victims would jump at the chance to converse with him? 

Perhaps a better way to phrase this might have been:

EXAMPLE OF A HEALTHY APOLOGY:
"It has come to my attention that I have denigrated and bullied some of you. Upon deep self reflection, I agree that my words and actions have been unkind and belittling from time-to-time. Words like (name them) and behaviors like (name them) are not acceptable in a healthy and supportive work environment. Knowing that I created fear, shame or trauma is unacceptable. And I am deeply sorry for my words and actions that have caused you harm. I am learning that this is a form of privilege and it is unacceptable. And I realize that due to the power differential, many of you may have felt intimidated to approach me on my words and actions. Please know that I would like to create a safe space, however and wherever you would like, in order to listen to how I have harmed you, and to personally apologize to each and every one of you that I have harmed. I realize that given your experience, perhaps this will feel frightening, but I hope that you can hear my sincerity in wanting to make amends. My deepest desire is to learn and grow from this experience, but not at your expense or to further your pain. I am very sorry."

However, in his letter, he did not say he was sorry. He did not demonstrate insight or empathy. He did not create safety or healing. His letter appears to be written, at least in my estimation, to save face and to set the record straight from his perspective. A perspective that seems more outraged for being called on the carpet than remorse for the actions he is being accused of. In fact, he goes on to minimize his actions and the impact that they may have had on others. And if none of this happened, then why write a letter like this in the first place? Why not state clearly and emphatically that the accusations are untrue ("I did not do this, these people are lying" for example).

Additionally, toward the end of his apology letter he talks about his character being assassinated by his alleged victims. Dr. van der Kolk goes on to say, "consider justice has been done." In writing this, he assumes that this was the hope of those wounded - that his character would be assassinated akin to Weinstein and this would give them a sense of justice.

This is not an apology in as much as it is a defensive accusation veiled in a somewhat threatening suggestion to those he apparently hurt to either step up or retract their allegations. It feels a bit like bullying to me. Subtle, but there is a flavor of it present. The last part of his letter feels somewhat intimidating as well. Frankly, I doubt I would take this as a safe and open invitation to safely express myself to him if I were one of the staff who had been "denigrated", if that is what has happened. 

Toward the end of his letter he states, "But, as the record now stands, I will forever be remembered as the Trauma therapist who traumatized his colleagues, and who founded and ran a toxic environment." Again, this attempts to extract sympathy from those who he has allegedly hurt, or those of us reading this public apology. I can extend sympathy for what he is dealing with without it being manipulated. I do have sympathy for him, and if he did treat colleagues in a way that left them feeling emotionally abused, then I certainly extend empathy there as well. 

This statement also assumes that all of us can only hold one opinion at a time: He is either a man who traumatized colleagues, or a trauma therapist who respectfully contributed an excellent body of work toward trauma research. I can't speak for anyone other than myself, but I can certainly make room for his being a trauma therapist, a brilliant researcher and writer, and a fallible human being who may have made choices that may have hurt colleagues now and then. I don't need to label him as a sinner or a saint. He is an imperfect human being like anyone else. And his assumption about how I or others will experience him "forever" is just that, an assumption. And a rather dramatic one at that. 

As I bring this blog to a close, in sharing my thoughts about this very sad situation, I realize that I am not standing in his shoes, nor have I witnessed or experienced the alleged behavior first hand. Thus I am aware that this affords me the vantage point of examining his apology letter from a distance. However, expressing opinions on challenging topics like this does not eliminate due process. We can discuss difficult topics in our community without slinging mud, threatening those with whom we disagree, or vilifying others. No need for that. 

I prefer not to judge or accuse this fallible man in our discussions. I hope that comes across in what I have written here, but I am OK if it does not. It was more important for me to share my thoughts and risk alienating colleagues, vs. remaining silent and standing in popularity.

And should one of his colleagues who has made these allegations read my thoughts on his letter, and should those accusations be true, I hope they feel validated and heard in some small way. It must have been very frightening to come forward against such a well known and well respected powerhouse in our community. 

It is also disheartening to see some of our clinicians shame colleagues for expressing their opinions or concerns in a respectful, non assumptive manner on this topic. Expressing one's opinion, sharing one's thoughts is not the same as accusing or attacking the man. We can still have civil discourse and discuss varying opinions on his public letter.  You are welcome to share your own thoughts respectfully below, even if they are in contrast to my own, as long as you are not threatening in your statements toward Dr. van der Kolk, the alleged victims, or myself. 

My intention in writing this was not and is not to cast stones. Rather I was motivated to explore the way we set our leaders up on high mountains, the power dynamics present in particular relationships, the subsequent letter - all with the intention to better understand why we as a clinical community tend to raise people, often highly educated straight white males, to God like positions with awards and endless accolades, and then salivate with delight and speculate on their demise when they fall from grace. 

On that note, it has been disturbing for me to witness the breathless fan like trance that washes over some our colleagues in our field. People like van der Kolk are raised up on thrones and treated like Kings, they are fawned over, they are celebrated in a way that is narcissistic in nature, they are asked for their autographs, given standing ovations, offered the best positions and are layered with awards and money. This kind of attention would be hard to resit even among the best of us. Whose head wouldn't expand being surrounded with constant praise and adoration? I am sure that my own ego would be vulnerable as well. 

This is not to imply that we should not honor our colleagues when they go above and beyond. I believe in rewarding people and acknowledging their work in a special way. He is clearly a brilliant doctor who has greatly contributed to our field. But blind worship and healthy rewards are very different things.

And censoring conversations with intimidation, shame, or threats of lawsuits is disgusting. We are therapists, we should be open to discussing hard topics, and be able to communicate various points of view respectfully, and even tolerate those who feel differently than we do. Isn't this part of what we teach our clients in their sessions? 

The bigger question is, how have we been complicit in elevating the God complex within our ranks extended only to a chosen few from a narrow demographic? For example: 

  • Do we support organizations that do not provide equal opportunity for women, people of color, or our gay or trans clinical colleagues?
     
  • Do we look the other way if a leader is inappropriate with colleagues? 
     
  • Do we make excuses for unprofessional behavior by calling that person a genius? 
     
  • Do we dare stand up to injustice?
     
  • Are we willing to use our voices in a way that supports equality?
     
  • Do we attend conferences where the line up of speakers are primarily white males?
     
  • Do we pay for trainings that focus on one demographic only?
     
  • Do we support research that focuses on only one particular group of human beings?
     
  • Do we hold our leaders accountable in our hospitals, agencies, organizations and practices? 
     
  • Do we stay away from or do we participate in gossip?
     
  • Are we willing to take a stand, even if it is unpopular? 
     
  • Do we regularly examine our own biases?
     
  • Do we threaten colleagues if we do not agree with their point of view?
     
  • If we are in leadership, are we open to hearing from others and take their point of view in to consideration?
     
  • How will we begin to support change in our own clinical community?

No matter where we stand, we can all agree that what has unfolded this week is a real tragedy all the way around. Much like Icarus flying too close to the sun, when we place our leaders on impossibly lofty thrones, or when we fall in love with our own fanfare, and/or do not know how to wear the crown humbly, it is inevitable those who we give God like power to  will eventually fall from grace. 

And when/if they do, can we agree not to stomp on their wings, but instead to hold a space for accountability, insight, growth and healing? To extend grace with compassionate truth.

Let's try hard to remember through the disappointment and pain of watching a beloved therapist struggle and flail, that we must model what we talk and write about as therapists, vs. smugly looking on as they are held accountable in the most public of ways.

Instead of ripping in to these men and casting them aside as "all" bad or "all" good, perhaps we can choose to be imperfect healers that walk our healers talk in every relationship, including bringing our best selves to the relationships we have with our colleagues and leaders.

This way a letter of apology is just that, deeply and honestly apologetic because the person under fire feels safe enough in our community to own their shit (or alleged shit) and make it right. By extending more compassion and speaking truthfully about these kinds of challenges, we can be safe role models for those human beings who look to us as the wise counselors in the human tribe.

And I am certain that we can agree that we need more compassionate wise men and women in our tribe of counselors with healthy egos who treat one another with respect, and fewer clinical kings and queens to worship and adore. 

Finally, a message directly to Dr. van der Kolk from my imperfect heart to your imperfect heart:

Bessel, if  you should stumble upon this blog and read what I have shared, I first want to thank you for the healing work and incredible research you have contributed to our field. I greatly appreciate your research and writing on a personal and professional level. 

I will continue to recommend your books to my colleagues, clients, and loved ones. I hope that you can read this blog knowing that though my thoughts are shared through my subjective lens, they are shared with compassion.

My sincerest hope is that you may learn and grow from this challenging season you are facing, and if these allegations are true, that you will take full ownership for words and behaviors that have wounded your colleagues, and that by doing so, healing can happen on both sides.

If this is not true, then I hope you will help us understand why this letter was written and what your intention was behind sharing your thoughts publicly. Regardless, I want you to know that you are welcome to reach out if you would like to discuss this. As your colleague, my door is open.

 u

Finally, I hope that you know that this is written from a sincere place of supporting more balance, safety and equality in our field, and that I am an imperfect work in progress who shuffles along on feet of clay, and will likely trip and fall a few more times on my own journey. 

For my other colleagues (or non colleagues), you are welcome to leave respectful and appropriate comments below that add healing to the conversation. 

No matter what continues to emerge from this troubling situation, perhaps the more important focus is to remember that our words and actions do impact others. To broaden our lenses past our own experiences and communication styles, to take responsibility for our behaviors, to make a true amends when we have hurt others -inadvertently or not- and  to lean in to a willingness to accept feedback as we grow and evolve...imperfectly. 

 

With respect and kindness,

Mari A. Lee, LMFT, CSAT-S