CCAF Event 9/28/16 Supporting Transgender Young Adults: Working Collaboratively with Family and Individual Treatment

Join colleagues at Penn Medicine and CHOP for this exciting panel, lead by transgender activist and family therapist, DR. ELIJAH NEALY.  They will address the importance of family therapy in the treatment of transgender young adults.

Dr. Nealy will be joined by Jacqueline HUDAK, PhD., LMFT, The Center for Couples and Adult Families, Perelman School of Medicine, Linda HAWKINS, Ph.D., Gender and Sexuality Development Clinic, CHOP, and Benoit DUBÉ, MD, Perelman School of Medicine.

 Wednesday, September 28th, 2016


16th Fl., 3535 Market Street

Philadelphia, PA 19104

A light dinner will be served


For the past 25 years, Elijah C. Nealy, PhD, M.Div., LCSW has worked extensively with LGBTQ adolescents and adults in both pastoral and social service capacities. Currently an assistant professor of social work at the University of Saint Joseph, West Hartford, CT, his clinical practice has focused on transgender and gender diverse youth and their families. Ordained with Metropolitan Community Church, Dr. Nealy regularly preaches and provides trainings for clinicians, faith communities, and organizations. An openly identified transgender man, Dr. Nealy lives in West Hartford with his partner and is the proud father of three amazing young people. He is the author of Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition [Norton, February 2017].



The Family Life Cycle: Gear Shifts and Spirals, with Dr. Geri Fox

The Family Life Cycle: Gear Shifts and Spirals, with Dr. Geri Fox

Last month, CCAF faculty, residents and fellows were treated to a wonderful lecture by family psychiatrist Dr. Geri Fox.   “Gear Shifts and Spirals”  was an interactive discussion of video taken by Dr. Fox of her own family filmed over 25 years.  

Dr. Fox began her filming long before the now ubiquitous culture of self documentation.  She is a pioneer ethnographer, recording the turning points and challenges of everyday family life through the lens of her video camera.

She dedicated her talk to Dr. Lee Combrick-Graham, colleague and mentor who encouraged and nurtured this project.  

The images of gears and spirals were apt descriptions of the family life cycle.  Three dimensional, always in motion, the family is envisioned as  a system moving through time.  Dr. Fox described gear shifts as the ‘biobehavioral’ changes that are biologically driven – such as puberty.  These are times when the family’s world gets reordered, priorities shift, and boundaries diffuse.

As we know,  those changes, though anticipated,  can feel as sudden as accidentally shifting the car into reverse.

iStock_000023141413_MediumThe spiral conveys an image of coming together and then moving out again over time.   These forces are ever present in the family life cycle: the centripetal force that draws family together for the birth of a child, or a marriage; the centrifugal force that propels outward as children are launched into college and their young adult years.


It’s one thing to describe a case of normal sibling rivalry, but quite another to watch Dr. Fox’s daughter poke and prod her newborn baby brother as residents and faculty laughed in recognition of this utterly familiar family scene.  We follow her along with husband and children through the small daily life events that, taken together, tell the story of family development over time: bemoaning the adolescent who’s ‘never home anymore,’  a daughter uttering fears about those first days at college.  Perhaps it’s the combination of voice and image that combine to keep the audience rapt; the empty place at the table, the boxes stacked by the door, so powerful in their familiarity, and so expressive of the experience of family.

Dr. Fox’s Life-Span Development Video Curriculum is utilized by the majority of US medical schools as well as abroad. She has won multiple awards for film-making, including two INTERCOM Chicago International Film Festival Certificates of Merit: in 2010, for Normal Development Video Series: A Longitudinal Stimulus Video Curricular Resource for Educators; and in 2013, for Saying Goodbye: A Personal Documentary about Attachment and Loss at End-of-Life.

Geri Fox, MD, MHPE is Professor of Clinical Psychiatry at University of Illinois at Chicago College of Medicine. She currently serves as the Assistant Dean for Graduate Medical Education, as well as the Director of Medical Student Education in Psychiatry.

New Approach for Couples Therapy: Including Gender and Power

Social-emotional relationship therapy offers guidelines for how to address issues of power, such as class, race, gender and sexual orientation.  Read about this in the new AFTA Springer Series Brief: Socio-Emotional Relationship Therapy: Bridging Emotion, Societal Context, and Couple Interaction.

AFTA members can find the link on the AFTA home page:

And here is a wonderful blog post about the revolutionary potential of this model:


Dr. Nancy Gambescia, sexologist, author, couples therapist and CCAF Training Faculty, discusses the topic of infidelity: How is it defined? What is the therapist to do with this complicated situation?  And what about forgiveness? We are so fortunate to have Dr. Gambescia share her insight into this painful and complex issue.

When a partner consistently hides their thoughts, emotions, and behaviors from the other, a violation of the couple’s intimacy contract has taken place.

This is infidelity  – the failure to abide by the couples’ contract about intimacy.

Couples’ agreements about intimacy may be negotiated and stated explicitly, or just implied.   But when infidelity enters the relationship, a breach has occurred, whether emotional, physical, or both.  Secrecy, lies, and other forms of dishonesty are harbingers of infidelity, even if no physical contact has occurred as in cyber-infidelity.

When infidelity occurs, intimacy is diverted away from the primary couple relationship and expressed through other outlets or relationships.

The Grey Area: Is it infidelity?

Typically, the point of departure from the couple’s agreement regarding intimacy becomes an area of intense conflict. Often the partners disagree about whether or not infidelity has occurred. One way of determining that a line has been crossed is to trace the onset of deceptive communication.

Deception hides the behaviors involved with maintaining the affair and is often both very confusing and frightening for the betrayed partner.

Discovery or disclosure of infidelity precipitates a crisis in the relationship. Common initial reactions include shock, anger, and denial. The partners struggle with grief, self-doubt, and pessimism. Previously held assumptions about loyalty, love, and the couple’s sense of “we-ness” are suddenly in question. Often, partners wonder if the relationship is irreparably damaged as it rapidly moves from a context of security to uncertainty.

The role of forgiveness

By the time the couple seeks treatment, varying degrees of dishonesty and discord are present.  They come to therapy full of confusion, volatility, uncertainty, and pessimism. Each partner has extremely different reactions and it is challenging for either to understand how the other feels. Often, the betrayed partner is hurt and angry while the unfaithful partner is shameful, defensive, and sensitive to criticism.

Infidelity is a relationship issue

It is important to consider infidelity as a relationship issue, even if there is a clear offending partner. With infidelity, partners suffer together, and they must heal together to overcome considerable relational trauma and injury.

The process of rebuilding is typically fraught with emotional ups and downs. The couple can be helped to find reasons to stay together, develop the motivation to work on their relationship, and to forgive. This is accomplished by gradually recognizing the unifying factors that brought them together in the first place: empathy, hope, humility, and relational commitment. Commitment can be a struggle for a couple recovering from infidelity. Understandably, it is difficult for the partners to stay focused on healing in the presence of pain, misunderstanding, and pessimism. It is often easier to remain polarized through blaming and sustained anger.

Regardless of the circumstances surrounding infidelity, forgiveness is a central aspect of relationship healing. Considering the intense pain and confusion following the discovery of infidelity, partners, particularly the betrayed, may find the notion of forgiveness difficult to contemplate.

Four essential factors must be in place in order for forgiveness to occur: 1) a high degree of relational commitment, 2) genuine apologies and remorse from the unfaithful partner, 3) restitution for the emotional damage sustained, and 4) reassurance over time that the offending partner will not repeat the injuries.

The mutual desire to recover the relationship often provides the strongest motivation for engaging in the process of forgiveness.

Weeks, G., Gambescia, N., & Jennings, R.  (2003). Treating infidelity: Therapeutic dilemmas and effective strategies. New York: W. W. Norton.