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Therapy in the New World of Kids and Teens

While at first glance, 21st-century adolescents appear impossibly cool—cooler than we could have ever been ourselves—teens today are running hot with cultural forces that have redefined the nature of their consciousness and experience of selfhood. Therapy with adolescents needs to change fundamentally. We may not have the power to alter the techno-pop culture that defines so much of teen experience today, but by focusing treatment squarely on how to engage adolescents in a vital relationship, we can make an enormous difference in their lives.   Read More

Psychotherapy Beyond the Books and Manuals

The growing emphasis on treatment manuals and empirically validated methods is a step in the wrong direction. Yes, the public needs to be protected from quacks, and managed care organizations certainly want some assurance that their money is being spent wisely. In the final analysis, however, the effectiveness of a client-therapist pairing is a function of their collaborative dialogue—a process that resists standardization. Therapy requires a certain creative ambiguity that can’t be reduced to stock exercises or “bottled” like an antidepressant.   Read More

Ethics of the Greater Therapeutic Alliance

I believe that some elements of our ethical codes have become so needlessly stringent and rigid that they can undermine effective therapy. Take, for example, the almost universal taboo on “dual relationships,” which discourages any connection outside the “boundaries” of the therapeutic relationship, such as lunching or socializing. These “boundary crossings,” are rarely harmful and may even enhance the therapeutic connection. My experience with Mark and Sally was one such boundary crossing.   Read More

Can Mood Science Save Us from the Depression Epidemic?

How can it be that—despite all the efforts aimed at understanding, treating, and educating the public about depression—the number of people suffering from depression continues to rise? Why have our treatments plateaued in their effectiveness, and why does the stigma associated with this condition remain very much with us? Depression has clearly been a tough nut to crack, but we haven’t focused much on what’s at the center of that nut: mood.   Read More

Mindfulness Therapy: The New Trauma Treatment?

When we catch ourselves in a state of nonpresence, we’re likely to chalk it up to “mind chatter.” When a client reports these repetitive intrusions, we may wonder about a tendency toward obsessiveness or the possibility of depression and/or anxiety. While all of these interpretations may have some validity, I believe that much more is at stake. I propose that in many of these moments of body-mind intrusion, our brain is trying to protect us from mortal danger arising from memories of old, unresolved threats. In short, we’re in survival mode.   Read More

The Best Practices of Highly Effective Therapists

That therapists differ in their ability to affect change is hardly a revelation. But we also recognize that some practitioners are a cut above the rest. With rare exceptions, whenever they take aim, they hit the bull’s-eye. Nevertheless, since researcher David F. Ricks coined the term supershrinks in 1974 to describe a class of exceptional therapists—practitioners who stood head and shoulders above the rest, little has been done to further the investigation of supershrinks, and pseudoshrinks—those whose clients experience poor results.   Read More

Sex Therapy for Building Intimacy

Today, sex therapy consists mainly of counseling and “homework” in which new experiences are tried and new skills practiced. If clients are too tense or reluctant to try something new, systems approaches, couples therapy, prescription drugs and psychodynamic therapy may be tried as well. Once anxiety is lowered, sex therapy often proceeds successfully, especially in treating the following common problems outlined here.   Read More

Depression Unmasked

In spite of profound historical changes that make us more vulnerable to depression, the entire mental health establishment still regards the condition much as it did more than two decades ago—as an individual problem, confined within an individual skull, best approached with individual therapies or nostrums. In the face of massive evidence that “individual” depression is really a vast social and cultural problem inextricably linked to the habits, mores, and expectations of our era, our tunnel vision is remarkably unchanged. So why do we continually use a relentlessly individualized remedy to fight a socially mediated disorder?   Read More

Applying Attachment Theory in Schools

Pepperdine professor-psychotherapist Lou Cozolino believes that the key to improving our schools is learning how to incorporate an understanding of attachment theory and social neuroscience into our educational system. Throughout his career, he’s devoted himself to bridging the world of academic research with the realm of practical applications.   Read More

Does Couples Therapy Work? When Therapists Avoid These Mistakes, It Does.

Couples sessions can be scenes of rapid escalation uncommon in individual therapy, and even in family therapy. Lose control over the process for 15 seconds and you can have a couple fighting with each other to the point where the argument dominates the rest of the session, each partner wondering why they’re paying you to watch them mix it up.As in any sport or art form, there are beginners’ mistakes. Here are a few of them.
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Creating a Therapeutic Alliance with the Troubled Teen

Building rapport with provocative teens in therapy can be a challenging task for even the most experienced therapists. A teen client can be a master at putting up the invisible force field while pushing our buttons, or telling us what we want to hear and side-stepping responsibility. Through the years, I’ve developed several engagement strategies that I regularly use, singly or in combination, that have consistently helped me establish a therapeutic alliance with even the toughest teen client.   Read More

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