What to Expect
My approach depends entirely on your needs, but the following is a fairly typical way that I work with my clients:
As soon as you enter my office I will ask you what you are hoping to get out of therapy and what has prompted you to seek services at present time. I will listen to and together with you thoroughly try to understand the problem-areas of your life. My role is to listen carefully and understand your situation fully -- your priorities and the changes you envision. As you tell me your story I will not only listen to what you are saying but also to what you are not saying, or saying indirectly; I will look at what is going on with your feelings, anxiety, and how you are relating to me and to yourself. As I begin to see patterns emerge or as I am having thoughts about what I am seeing and hearing, I will actively share them with you in real time in a way that I think will be helpful to you. I will aspire to hold up a mirror so that together we can be conscious and clear about the nature and meaning of what you are struggling with. If I am off or only partially right about an observation, I might ask you to correct me so that we can have the same vision and be on the same page about what is taking place.
Because I am and expect to always be a work in progress, I have found that inevitably there are times when I will not see what is really going on for you, times when I will be less attuned to you than I would like to be, and when this happens I make it a habit to let you know that I see how I have fallen short. This can lead in different directions, but more often than not these discussions tend to further the therapeutic work. Being open with my observations, even when they include insights about where I failed to recognize something important in your experience – and then seeing where that takes us – is central in my approach to therapy.
As for my observations of what I see in you:
Since what I will be saying is so immediate and personal, you may have a reaction to my input, and together we can look at what your reactions are. Chances are that the way you will respond and react to me will be similar to how you respond and react to other people outside of my office, and by closely examining your responses together as they occur we can begin to understand your life in a way that is experiential. Also, in examining your present time experience in this kind of detail, we will have a chance to actually do something to change the patterns in your life that no longer serve you.
In this way we will not just be talking about your life, which is certainly important, but we will together be able to observe, at an experiential level, what is going on inside of you and how you are in relationships. This offers a unique opportunity to address your difficulties in a way that is not just intellectual.
In this type of therapeutic work it is common to uncover conflicting motivations. My work is designed to mobilize your strongest and healthiest motivations and through combined efforts, overcome the obstacles between you and your goals.
A similar process takes place in couples work, though with couples I will focus more on how you as a couple relate to each other and the styles of communication that you engage in. I will also aspire to help you find alternatives to the status quo, with the idea of making each of your lives easier while at the same time creating more dialogue and intimacy in your relationship.
After listening to your points of view and observing how you interact as a couple I will suggest ways of communicating that will increase the likelihood that each of you get your needs met. My suggestions are aimed at moving you away from communication styles that undermine your goal of being seen and acknowledged in the relationship.
In addition to highlighting how your communication styles might be getting in the way of your relationship goals, I also keep an eye out for the “elephant in the room,” the over-arching dynamic that, for many couples, form the center of the conflict in the relationship. Once this core issue is identified, working on improved communication often becomes more meaningful; new communication skills are now worked on in the context of the central underlying conflict being addressed directly. The particular nature of the core conflict tends to be unique to each couple.
My work with children, teens, and parents draws from psychodynamic understandings of human development, in particular, the importance of healthy attachment. Secure attachments to caretakers are crucial in the development of youth, therefore my work with children and teens centers on fostering repair in ruptured/fractured emotional bonds to significant people in the youth’s life-orbit.
Other sources of inspiration include the work of Dr. Harvey Karp and his emphasis on honoring children's emotions while modeling and setting limits to how those emotions are expressed.
It is not uncommon for me to ask parents to partake in sessions with children even when the youth is the identified client, as therapeutic progress with children typically hinges on all family members learning to approach and relate to each other with new skills and understandings. Family (parent) participation is therefore a central part in my work with youth.
My work with youth and their parent(s) centers on finding healthy ways of relating. Based on my experience, difficult behaviors are altered not through punitive consequences or sweeping conflictual material under the rug, but through learning to validate the youth’s emotions while carefully guiding and setting limits on how the emotions are expressed. In this process the parent(s) or caretaker may also have strong feelings, and keeping an eye on the feelings of the parent(s) and making sure that the parent(s) have the support to manage their own feelings in ways that leave space for the youth’s emotions and needs, is often an important first step, though each family is unique and there is no telling how the therapeutic process will exactly unfold with a given family.
Some parents want their child or teen to engage in extensive homework, complete worksheets, and other assignments. Though I would certainly be happy to look into doing that type of work if it seems productive, my therapeutic bias is, more often than not, to address real-time behaviors between parent and youth, and address obstacles to a healthy connection where everyone feels heard and respected and parent(s) learn to clarify their natural authority in ways that stress that the best interest of the youth is what is guiding the parent(s) thinking.
It is natural for parent(s) to have strong hopes and agendas for their children, and I will certainly consider these agendas, but my main focus is the youth and the youth's own point of view in regards to what they want to work on.
I do not conduct formal psychological evaluations or tests with children, nor do I involve myself with legal disputes, except in cases where I am mandated to report abuse.
All parties with custody rights need to agree to the child's treatment and all parties with legal custody rights need to be involved in the youth’s treatment. I am not accepting cases where there is an active custody battle or cases where parents of the youth are divorced, share custody rights, and are not willing to see me together. I am open to meeting with divorced parents to work on a co-parenting plan so that both parents can participate in the youth’s treatment.
In cases where divorced parents are willing to work with me and jointly participate in the treatment of the youth, communication from me is always to both parents – I do not communicate separately with divorced parents as that often leads to confusion and miscommunications.