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.
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
In recent years, we’ve learned that repeating patterns of experience, attention, conversation, and behavior can “groove” the brain; that is, your brain gets better and faster at doing whatever you do over and over again. This includes “doing” depression, feeling depressed feelings, talking about depression, and so forth. Thus, we can unintentionally help our clients get better at doing depression by focusing exclusively on it. To counter this effect, I like to use a method that I call “marbling.”
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
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