Many people with OCD aren’t easy to diagnose or treat. Clients with OCD can present as panicky, depressed, and agoraphobic, as well as with a wide range of personality problems and relationship issues. But by locating the obsessive thought that initially raises anxiety distress and the compulsive thought that provides the temporary relief, therapists can help these clients break their self-reinforcing cycles of anxious arousal and counterproductive stress-reducing behavior. Read More
My approach to trauma work is rooted in an experience I had in college. A friend asked me to teach her to drive—in a new car my father had just given me. Sitting in the passenger seat next to her as she prepared to turn on the ignition, I suddenly panicked. I quickly realized that before I taught her how to make that powerful machine go, I had to make sure that she knew how to put on the brakes. I apply the same principle to therapy, especially trauma therapy. Read More
Jay Haley was an unlikely candidate to become a founder of the early family therapy movement. An outsider to the field, he had no formal training in psychology or psychotherapy. But as someone who translated the abstruse concepts of cybernetics—the rules, sequences, and feedback loops that guide self-regulating machines—into the lingua franca of family therapy, Haley helped give the field its organizing principles. Read More
Empathy is the connective tissue of good therapy. It’s what enables us to establish bonds of trust with clients, and to meet them with our hearts as well as our minds. Empathy enhances our insights, sharpens our hunches, and, at times, seems to allow us to “read” a client’s mind. I first recognized the physical force of empathy as a college student. When I copied the swaggering gait of a cocky young man, for example, I’d momentarily feel more confident—even happier—than before. I found this secret street life fascinating and fun, but I didn’t think much about it until a few years later, when I started practicing clinical social work. Read More
When someone has been cut off by a family member, he or she often feels immense hurt, incomprehension, rage, rejection, and a sense of injustice. Of course, this can be true for the initiator of a cutoff as well. Even when someone initiates a cutoff for legitimate reasons, the initiator is still likely to experience regret, sadness, and longing for what might have been. Helping families heal cutoffs is painstakingly delicate work, and comes with a high risk for stumbling over buried land mines. But by taking the right steps toward initial reconciliation and properly managing in-session discussions, it’s possible to mend broken ties in a way that satisfies everyone.
Before it happened to me, I had never heard even my closest colleague talk about falling in love with a client. In our consultation group, the subject was once broached purely theoretically, and everyone became uncomfortably quiet. The message we gave each other was clear: Whatever you do, don’t talk about having a crush on a client. Yet, I want to break our conspiracy of silence so that we can get help when we need it. And believe me, when it came to Scott, I did.
In 1966, Jon Kabat-Zinn, a graduate student in molecular biology at the Massachusetts Institute of Technology, spotted a flyer advertising a talk about Zen. Today, nearly 40 years after that portentous afternoon talk, Kabat-Zinn is acknowledged as one of the pioneers in mind-body medicine—a field that integrates ancient spiritual traditions like yoga and meditation with mainstream medical practice. In 1979, Kabat-Zinn established the Stress Reduction Clinic at the University of Massachusetts Medical Center, the first center in the country to use meditation and yoga with patients suffering from intractable pain and chronic illness. Read More
Before the 1970s, almost no mental health authorities imagined, much less expected and prepared for, traumatic reactions to war to emerge years after the conflict ended. But after they returned stateside, almost 50 percent of Vietnam veterans began breaking down, months or even years later. By the late 1970s, it had become obvious to many therapists that the old diagnostic system had fatal flaws. DSM-II seemed to have been written for a world in which serious trauma virtually never occurred. While the veterans were struggling for recognition on one front, another campaign was being waged—which included some of the same people—on another, to get traumatic stress back into the DSM. Read More
I’ve begun to put aside my idealized view that unless people overcome their difficulties once and for all, therapy is somehow a failure. More and more, that perspective seems simplistic and disconnected from the realities of what psychotherapy, no matter how skillful the clinician may be, can actually provide. So what if we start to think differently about this? What if we view anxiety and depression—especially generalized anxiety and dysphoric states of mild and moderate depressions—not as disorders that will be cured, but as chronic, relapsing, remitting disorders? Read More
Throughout the 1980s and 1990s, mathematician-turned-psychologist John Gottman performed experiments in which he videotaped ordinary couples in their most ordinary moments—chatting, kissing, and watching TV. But he also recorded how much they brought up painful subjects, how they responded to each other’s bids for attention, and expressed emotion. Using complex computer models, he found that he could predict divorce with 91-percent accuracy, simply by analyzing seven variables in a couple’s behavior during a five-minute disagreement. What he discovered made him famous, and eventually became the basis of Gottman Method Couples Therapy.
As a systems therapist, incest survivor, and recovering alcoholic, I’ve lived through several stages of our culture’s attempt to come to terms with child sexual abuse–as a victim in the silent 1950s; as a therapy client in the oblivious 1960s and 1970s; and as a psychotherapist in the 1980s and 1990s, when once-dismissed accounts of abuse filled my therapy practice (and my television screen) only to be partly discredited within the decade during another swing of the cultural pendulum. Read More