Yes. I don’t work with the perpetrators of violence because I work with victim-survivors. There are specialized providers trained to do this work. Similarly, I don’t see couples in battering relationships. In addition, I don’t treat clients with moderate to severe OCD, moderate to severe panic disorder, those who are actively abusing alcohol or substances or are newly in recovery, or individuals who are chronically suicidal or self-harming. In all cases, there are evidence-based treatments available whose efficacy is supported by solid research, and they are best delivered by specialists trained in these methods.

People utilize therapy in a wide variety of ways. Some clients wish to change a specific pattern or are seeking clarity with a particular problem and work with me relatively briefly. Other clients benefit from longer-term, in-depth therapy to change destructive patterns and heal longstanding wounds. Some seek therapy to know themselves more deeply; they seek to live richer lives that honor their most deeply-held values and hopes for this one life we get, and the work is open-ended.

The fit, or resonance, between client and therapist is essential to the work. In fact, the most robust predictor of positive outcomes in therapy is the strength of the client-therapist relationship. Good therapists differ tremendously in both style and methods. To help guide your decision, I provide a good deal of information on my website to give you a feel for who I am and how I approach therapy. Our free 20-minute consultation will help you get an even better sense for whether we might be a good fit. Please contact me with any questions.

Therapy should never create more stress than it resolves. If it creates significant financial strain, you now have one more issue than you had when you began. It is therefore wise to find a therapist with whom you can work for whatever time is needed to resolve your concerns. I’d be glad to discuss your needs to help you make this decision.

Yes. It is my duty to practice ethically, and in certain cases it is unwise or unethical for me to be your therapist without additional support from other professionals. Something is not always better than nothing, because if I were to work with you without additional support, it would wrongly imply that my services alone are adequate to treat your condition. For example, depending on the severity of an eating disorder, I may require regular contact with your medical provider to monitor your physical status and/or require that you meet regularly with a dietician who specializes in this area. If you are early in your recovery from alcohol or substance abuse, I may stipulate that you are actively working with a sponsor in a 12-Step group or are taking part in a comparable program. If you have a condition for which the first-line treatment is medication (e.g., Bipolar I Disorder or other psychotic disorder), I require you to be concurrently under the care of a specialized medical professional. In my initial evaluation, I’ll assess your treatment needs and offer my opinion.

I usually recommend that clients start with weekly therapy. This allows us to establish a strong working relationship, develop a treatment plan to meet your needs, and make consistent progress. After that we can decrease the frequency as appropriate. With certain disorders that require a high level of care, I require that my clients initially come in biweekly. At some point many clients decide to come in on an as-needed basis, returning when they are struggling with a difficult issue or life transition. Now that I’ve had the privilege of being a therapist for several decades, I’ve had many former clients return for as-needed sessions with gaps of many years in between (the record is 12). Because I know your story and personal struggles well and we have a trusting relationship, the work proceeds quickly.

I don’t believe we can be “neutral,” which is why I use quotes. We dress a particular way, furnish and decorate our offices to suit our style, and so forth. That said, therapists vary a great deal in how much they share. Some share little about who they are as people and few if any details about their lives, and others share quite a bit. I tend to fall somewhere in the middle. You’re welcome to ask me questions about myself, and I’ll let you know how much I feel comfortable sharing.

Going back to childhood experiences is not an end in itself. We can gain deep insight and yet remain stuck. Insight is an important component of therapy, but because it is knowledge residing in our analytical minds, by itself it does not yield deeper healing. If you and I revisit childhood issues, it is for a very specific purpose: To understand, and find compassion and appreciation for, the childhood adaptations made under duress that were your best bet for gaining whatever attention, acceptance, and love you could get from caregivers. However, when we mold and shape ourselves to cope with difficult circumstances in childhood, we tend to maintain false assumptions about our worth and repeat patterns in adulthood even when when they now harm us. In therapy we don’t try to get rid of the judge (mine sits on my left shoulder); even as you heal, it will continue to offer its commentary now and then because it wants to keep us safe from harm. We can respectfully thank it for its service while no longer buying into its opinions, and it quiets down.

If we examine pain in relation to your early attachment figures, the goal is never to make you blame them or turn you against them. In the process of therapy, you may well experience anger, blame, and sorrow as you recognize the harm you endured as a child through no fault of your own. As you come to appreciate the needless burdens you still carry, you can grieve the pain and losses of the past and let them go.

Never. True compassion for ourselves is inextricably linked with accountability for our actions, whether in relation to ourselves or others. If we are to look at ourselves in the mirror without flinching, our pain, self-blame, and remorse can be too much to bear if not held with great care. Compassion permits us to look at what’s there without judgment of who we are at our core. We can deeply acknowledge how we’ve hurt or failed ourselves or others. To forgive ourselves, we must clearly see what we’ve done or failed to do. And there’s a wonderful side benefit: When we’re more accepting of and accurate about our actual weaknesses (not the ones we’ve conjured up or those that have been inaccurately attributed to us), we can acknowledge our true strengths with a matter-of-fact humility. Our self-doubt and internal confusion ease their grip. We become grounded in who we are and, as a consequence, are much less easily shaken when others misperceive us or mischaracterize our motives. When we see that our actions or inactions have been problematic, we are able to acknowledge, take responsibility, and make changes, knowing at a deep level that our worthiness as human beings is not at stake.

I welcome feedback. My commitment is to be your best therapist, not “the” best therapist. Calling things to my attention strengthens our working relationship and helps me be more effective. Many clients grew up in invalidating environments where their worries were dismissed, shamed, or ignored. They may have been written off as "too sensitive" or even crazy, or told to "suck it up" or get used to it. Or maybe they were informed that "life isn't fair," as though that fact could erase pain. Sometimes they were gaslighted, their very reality denied. The beauty of therapy is that it provides a new experience of a close relationship that is affirming and validating. Many times clients are reluctant to speak up because they don't think their issue is important enough or that I've done anything technically wrong. That's irrelevant, because your concerns are never trivial; they’re important simply because you have them. I will receive your input respectfully, acknowledging your experience and taking responsibility for my contribution; avoid defending myself (or putting the problem back on you); and make changes to meet your needs and preferences. This process facilitates your feeling known and understood.

I try to balance taking an active role with listening and gently exploring your experience. I support, encourage, nudge, guide, and provide alternative perspectives. I sometimes assign formal homework which we design together to serve your needs. I often recommend what I call “behavioral experiments.” These are small, graded steps you take that call your problematic assumptions into question or help you work toward change that, if taken on all at once, would feel insurmountable. In session, I frequently guide my clients in practices that facilitate quieting the mind and entering their deeper, felt experience that lies beneath the level of thought. Of course, if I believe something you’re doing is actively harming you, I will offer my opinion. Only you will know what is right to do.

Yes. Competent professionals welcome second opinions. I may advise one if we're stuck in our work. You may wish to speak with another professional to see if they might be able to offer services that suit your needs better, find out if they advise I take a different course of action, and so forth. Should you decide to work with a different professional, we must end our work together for ethical and practical reasons. (Please see "Can I work concurrently with both you and my current therapist or a second therapist?")

No to all. Letters in support of emotional support animals (ESAs) and temporary disability from work, and custody or fitness-for-parenting evaluations are the province of independent forensic evaluators. If you are in a custody dispute, my letter to the judge notes only what dates you received services. I don't do court-ordered therapy.

Many good professionals feel they can work effectively with people who are in a partnership. I personally never do individual therapy simultaneously with both partners in a couple. I believe the risk to your therapy is always too high because our working relationship is founded on trust and the complete confidentiality afforded by individual work. I believe it is harmful for me to receive information about you from someone other than you unless you are present. On some occasions I have continued to do individual work with one partner after couples therapy ends, but only after a thorough discussion of the possible negative ramifications of the change. I do it with care because I almost never return to doing formal couples therapy. On the other hand, I frequently recommend that my individual clients invite their partners in as "guests." Please refer to the topic above, "What about bringing my spouse/partner, kids (whether adult or child), or parent(s) to some of my sessions?" I only work with relatives or friends if these are not people in your day-to-day life or people you need to discuss in therapy, and even then I proceed with great care. When one client needs to work on issues pertaining to the other, each will rightly worry that I’ve learned things about them they haven’t yet shared or don't wish to share, or things which may not be accurate. My duty is to serve your best interests and not risk compromising them. On the other hand, as above, I encourage you to invite important people to join you in session when it would be helpful.

Very rarely. While my Ethics Code does not explicitly prohibit this practice, it strongly advises to proceed with caution, for a variety of sound reasons. Among these is the fact that good therapists see certain issues differently and handle them very differently, and when these opinions or approaches come into conflict, the client is caught in the middle.

When conducting family therapy, I work with kids and teens of any age. I also see them when they come in as guests of my adult clients and are not themselves clients. In certain instances, I also work with mature adolescents in individual therapy, but only with very specific preconditions. First, I require that parents/guardians be willing to strictly maintain a "zone of privacy" with their teens and not ask about what we discuss in therapy. If teens wish to share, it is their prerogative. Second, I never speak to parents or others without my adolescent client present, because the teenager understandably will wonder what information I possess or if I have a hidden agenda. Trust is impaired and the work becomes ineffective. The one important exception occurs because parents have the right to essential information about the health and welfare of their minor child. Examples include, but are not limited to, my learning that my teen client is repeatedly engaging in unprotected sex, being exploited (even if the law wouldn't define it that way), putting themselves in dangerous situations, or engaging in repeated, problematic alcohol or drug use. In these cases, I first let my teen client know that I must inform their parents so that we may discuss how to best present the information. We then have a family meeting to lay out the issues together and discuss them. Third, I require that parents actively take part in their teen's therapy by attending sessions either on a regular schedule we discuss or as requested by my adolescent client or myself. Caring parents seek to act in their children's best interests and would not feel comfortable having therapy be a black box. Having parents join us allows my teen client and me to keep their parents/guardians abreast of the general nature and progress of therapy. Another reason I require parents to take part periodically is that adolescents are typically living in the home, and the impact of one hour a week of therapy on their mental health does not override that of the family environment, which remains the strongest influence on their wellbeing. Although I can provide a unique and powerful form of help, the greatest benefit arises when we also work on interpersonal issues as they arise in the family. With me there to bring out the important themes and guide the conversation, addressing the issues with everyone together facilitates mutual understanding, improves communication, and allows direct and efficient problem-solving, . My goal is never to blame parents or turn my client against them; to do so would run entirely counter to my teen client's best interests. When family tension decreases, people understand each other better, and family dynamics improve, my client inevitably benefits.

No to both. I will recommend that you consult a qualified medical provider if I believe you could benefit from psychiatric medication as an adjunct to therapy. I explain what I see as the potential benefits, which you weigh against the drawbacks. Ultimately it is your choice. I never recommend medication alone to treat psychological concerns and disorders. Although medication can be remarkably effective in treating symptoms, it does not address the way you live that is causing suffering, teach coping or problem-solving skills, or address issues of meaning and purpose in life. Medication's impact typically lasts only as long as you take it, whereas psychotherapy's effects are long-lasting. I don't prescribe medication and am not interested in doing so. In a few states psychologists can receive prescription privileges after gaining extensive post-doctoral education, training, and supervised experience. Generally, however, this is the domain of physicians and nurse practitioners, both independent medically-trained professionals.

Virtual therapy is indeed more complicated when the couple, not an individual, is the client. I've had remarkable success with couples therapy when each person joins on their own device. Obviously we'll need to assess whether teletherapy for you and your partner is feasible, or whether you'd be best served by seeing a clinician in person.

Having conducted an extensive amount of remote work now, I can attest to the fact that it is just as effective in the great majority of cases. A robust literature comparing virtual and in-person work is consistent with my personal experience. I certainly didn't expect this, and I still believe that there is something special about meeting in person when possible. There are important exceptions, however. For example, if a client is chronically suicidal or self-harming, virtual therapy is contraindicated.

You and I will both be monitoring your progress and staying mindful of whether or not our work is addressing your needs. If you or I believe our work isn't helpful, we’ll discuss the issue thoroughly to see if I might change my approach or style to benefit you. We may determine right away or after I make changes to my approach that referring you to another provider is the appropriate route. If so I'll work hard to ease this transition. If I’m not able to be of help, there is someone else who can. No therapist is right for every person or every problem, and the client is never (ever!) to blame. One other reason that clients do not always improve is that it is simply not the right time to be in therapy. They are capable of changing, but need to wait until the time is right. Trying to force it is discouraging, wrongly suggests to you that you can’t get better, and causes needless suffering.

I frequently recommend this to my clients, with almost uniformly positive results. Guests are visitors, not clients, and they come in at your invitation. In these sessions, we most often meet to help you listen deeply to each other so you can understand where the other is coming from. These meetings can be remarkably helpful in short periods of time. Most commonly guests are partners, parents, and kids (including adult kids–I’ve worked with a parent-child pair that were 70 and 90 years old!). To maintain your confidentiality from our individual work, I work only with issues raised explicitly in the session. Guests understandably may worry that we will gang up on them, but it is quite the opposite; I must be respectful and even-handed if I am to serve your best interests.

Definitely not! A wise colleague once told me that we’d need day jobs to supplement our work if people always took good care of themselves. Psychotherapy is an amazing resource, but other forms of self-care are also powerful and often adequate to ease certain types of psychological suffering. Good self-care includes obtaining adequate sleep, physical activity, nutrition, and exposure to natural light; spending time in nature; being in community; being of service to others; and engaging in meditative practices of all sorts. Research has even demonstrated a powerful connection between our gut biome and our mood. Many of my clients care for others much better than themselves, and improving self-care is an important component of therapy.

No to the first, and “why?” to the second. We get this one trip to the planet, and many of us spend our time making things needlessly difficult! It is a sign of strength, not weakness, to acknowledge that your struggles are bigger than you, or simply to recognize that you’d prefer to have someone accompany you. We “should” be able to do lots of things, but for whatever reason we don’t. Or we simply prefer not to when there are other options. The fossil record suggests that human beings have been in community for the entirety of our existence, surviving by solving problems together. The genes of those who tried to go it alone didn’t last long.

All mental health providers are trained to practice psychotherapy, though not all continue to do so professionally after they graduate. The most important distinctions among providers that I see are in the areas of psychological assessment, academic research, and the prescription of medication. All psychologists, which include those with the PhD and PsyD degrees, are doctoral-level practitioners. All are trained to conduct psychological assessment, including neuropsychological and intellectual assessment. Some of us, including myself, do not continue in this work and quickly become unqualified to do it without additional training and supervised experience. Many who attended universities as I did, as opposed to free-standing psychology graduate programs, are also highly-trained as academic researchers prepared for university professorships. Psychiatrists are physicians and are licensed to prescribe medication. During their four-year residency, they receive additional specialized training in delivering psychotherapy. Psychiatric nurse practitioners are independent medical professionals with prescription privileges and therapy training. In a few states psychologists have limited prescription privileges.

If your concerns were trivial, you wouldn’t be struggling; the reason doesn’t have to pass a litmus test. Consider a time when you got through something with relative ease that would likely have been overwhelming for someone else. We just never know, nor do we need to; we can trust our pain as our guide. Beating ourselves up for overreacting or being too sensitive invalidates our experience and serves only to feed suffering.

No. I hear this fairly often from individuals who are prone to self-criticism and self-doubt. What causes suffering in one person may seem trivial to others, but if it is troubling you, it is by definition worthy of compassionate exploration. Many clients are indeed fortunate in many respects, but they wield their good fortune against themselves like a weapon, admonishing themselves to stop “making a big deal out of things” because others have less or have suffered more. The problem is that self-criticism and guilt-tripping prevent, rather than promote, healing. There is an infinite supply of compassion in the world; if you treat yourself with compassion, it doesn’t mean someone else gets less. The world is already overwhelmed with suffering, and by casting judgment on yourself for wanting help, you’ve just added to it. Whereas guilt paralyzes, gratitude quiets our minds, opens our hearts, and energizes us to serve others or our one planet.

Therapy is about working with your experience of suffering, not about adjudicating who is right and wrong or assigning blame.