Psychotherapy.net Team, Author at Psychotherapy.net

Perfectionism in Highly Intelligent Clients: Therapeutic Strategies

Posted on July 28, 2022March 13, 2026 by Psychotherapy.net Team

In my therapy practice, I work with adults who have what I call rainforest minds. They are often, but not always, also called gifted. These are people with advanced intelligence and high levels of sensitivity, empathy, creativity, and intuition. They love learning new things and often have many interests. They may or may not excel in school. It can be hard for them to find friends or partners due to their intensity and intellectual complexity. In my many years of working with them, I have seen that they all experience one or both types of perfectionism. Understanding this distinction, along with the other particular traits that often accompany their rainforest minds, has helped me make progress with these clients who might otherwise feel stuck or lost in therapy but not know why.

These clients do not enter therapy because of their struggles with perfectionism or even for the challenges of being gifted. They come to counseling for the typical reasons: anxiety, depression, childhood trauma, and relationship issues. But, as I get to know them, and if I see they have rainforest minds, and the perfectionism that comes with that, I have these strategies ready to share.

Healthy Perfectionism

My clients who manifest “healthy perfectionism” set very high standards and expectations for themselves. They strive for beauty, balance, harmony, justice, and precision in many areas of their lives. This can look like obsessive research, overthinking, or many hours spent in order to find the perfect word, music, color, book, surgical technique, equipment, course, choreography, or whatever they are working on. It can look like continually raising the bar when they reach a goal, not out of fear, but out of the excitement of intellectual curiosity. It can look like the meticulous, detailed designing of an iPhone.

This type of perfectionism is not easily recognized or understood. It can be underappreciated by the client as well as by their friends, relatives, and therapists. But it is truly how humanity advances and great beauty is created. There are challenges that go with this perfectionism, though, when it becomes all-consuming, overwhelming, or misdiagnosed.

Therapeutic Strategies for Healthy Perfectionism

I have found offering the following “normalizing” strategies helpful when working with clients who experience “healthy perfectionism”:

Understand what healthy perfectionism is. It is not something you can change or should want to get rid of. See it as a strength. Imagine how the world would be if everyone had such a desire for depth, comprehensiveness, and accuracy. Appreciate this about yourself.
Let this striving for perfection feed your soul, even if no one else understands. Even if they are labeling you obsessive or neurotic.
Give yourself permission to feel emotional over a gorgeous sunset, a star-filled sky, an exquisite symphony, a towering cathedral, a stunning painting, or a perfect paragraph.
There will be times when you need to compromise to get something important finished. Prioritize your projects and let the unimportant items be less than beautiful or precise. Do you really need to spend hours on that 3-sentence email?
Recognize that others may not share your high standards. This does not mean others need to change or work harder. You may have a greater innate capacity to produce quality. Find patience and tolerance for others. At the same time, keep looking for others with rainforest minds so you can feel seen and understood.
Get feedback on your work from other people with high standards and similar expectations. Then, you are more likely to respect and believe what they are telling you.
Remember you can have excellence without perfection. Your excellence may, in fact, look like perfection to others.
If you produce something less than brilliant, it is not a failure.
Find ways to get intellectual stimulation. You need it, just like others need food and water.
If you are in school or at a job and have a deadline you must meet, try to evaluate your work through a different lens. Is this good enough for the situation? Will you still get an A even though it doesn’t meet your standards? How important is it that this be as thorough as you would like? Will anyone else see all of the connections you see?
Read Your Rainforest Mind: A Guide to the Well-Being of Gifted Adults and Youth. The chapter on perfectionism includes case studies from my counseling practice and many more resources.

Unhealthy Perfectionism

Anyone can experience unhealthy perfectionism from growing up in a dysfunctional family. Clients who have rainforest minds, though, might be perfectionists for additional reasons. As children, rainforest-minded clients who have developed “unhealthy perfectionism” were often ahead of their peers in academic abilities and achievements. If their parents and teachers over-praised them for how smart they were, or repeatedly emphasized their accomplishments, the children may have felt the acceptance and love as conditional, based on being the best, winning, and achieving at all costs. As they grew, this pattern morphed into an extreme fear of failure, procrastination, avoidance of difficult activities, and generalized anxiety. Early on, their sense of self became dependent on what they did instead of who they were and would become. If they did not achieve at the highest level, then, they felt worthless. This dynamic laid the foundation for heightened anxiety, pressure to achieve, fear of failure, and avoidance of intellectual challenges. It also often became disabling in adulthood, especially if not understood and deconstructed.

Therapeutic Strategies Offered to Clients with Unhealthy Perfectionism

I have found the following to be very useful in working therapeutically with clients who are struggling from the impact of “unhealthy perfectionism”:

This is complicated and usually starts at a young age. Take time to unravel the threads of how your perfectionism began and allow for slow progress. You do not need to blame anyone for over-emphasizing your intelligence. They were probably not aware of the impact it might have. It can be hard not to overreact to a highly articulate or a cognitively advanced young child.
Strive for wholeness and balance instead of perfection.
Put more emphasis on the process versus the product. Measure your success by effort, enjoyment, complexity, opportunities for growth, learning, or meeting new people.
If you have a loud inner critic, spend time with them in a journal. Start a dialogue. Ask them what they need. What are they protecting you from? What can you do that will allow them to step back?
Avoid all-or-nothing thinking, such as that something is either perfect or a failure. One error does not make the entire project a failure.
Remember you learn more from your mistakes than from your successes.
Failures make great stories for holiday gatherings, memoirs, and TED talks.
Learn about the growth mindset that Carol Dweck writes about in Mindset. Being smart is not an either/or proposition. You may have strengths in one area and weaknesses in another. Even though you may have been born with a high level of intelligence, you can always change and grow. It will be important to explore new areas where you risk mistakes and failure.
Read the book Procrastination by Burka and Yuen. It provides an in-depth look at perfectionism as it relates to procrastination.
Break down projects into small steps if you are overwhelmed. Make a list of the steps then set either a minimal goal or a time limit to get you started. Give yourself small rewards as you go.
If you are used to easy A’s or quick success, you may panic if you run into a challenge. Know that this is common when you have a rainforest mind. It does not mean you are no longer smart if something is difficult. In fact, it is a good thing to have to struggle. Think of it as giving your brain an upgrade!
Make a list of self-soothing tools if you are often anxious. Check out apps such as Calm and Headspace. Read The Anxiety and Phobia Workbook by Bourne.
If you are the parent of a child with a rainforest mind, place more emphasis on their traits such as their compassion, empathy, and love of learning instead of their achievements. Rather than say “You’re so smart,” give specific feedback such as, “Your story has some fascinating characters, tell me more about them.” Encourage their curiosity and kindness. Ask how they feel about an accomplishment or what they might do differently next time. Avoid generic praise. Find opportunities where they have to work at something over time, such as learning a musical instrument, a new language, or a sport. Listen deeply.

***

Perfectionism in our clients is often seen as something to avoid and that is always problematic. And yet, for someone gifted or with a rainforest mind, it is not that simple. In fact, there are often two specific types of perfectionism in these clients that need understanding, explanation, and strategies. The reasons for perfectionism in this population are more complex, as are the solutions. When a therapist sees this in a client and explains the patterns and difficulties through the lens of the rainforest mind, change is possible, in ways that might otherwise be overlooked or dismissed. It can make all the difference. It certainly has for me in my work with these complex and fascinating clients.

Need Management Therapy: A Clinical GPS for Couples Work

Posted on July 26, 2022February 11, 2026 by Psychotherapy.net Team

A new couple enters my office, and instantly I sense a faint but still discernible vestige of feelings dating to my early years as a fledgling psychologist. In those days, couples therapy struck me as overwhelmingly rife with complexities and sundry conundrums, all charged with intense, volatile emotion. Like the wild, erratic dance of a fallen power line, couples would fling verbal darts and threatening accusations at each other. On too many occasions, I felt stunned and intimidated under the full, onerous weight of my inexperience.

The Woes of Being Novice

My novice, impoverished clinical efforts were wobbly, halting and stumbling. I confess, there were moments where, not knowing how to helpfully involve myself, I froze in a stasis I called “interventional paralysis.” Even more regrettably, there was that notorious—and seemingly inevitable—disastrous session where, failing to harness the couple’s rage, both partners bolted inconsolably from my office, leaving me in their frenzied wake feeling deeply discouraged and clinically impotent.

Notwithstanding, these haunting professional nightmares ultimately proved to be de facto growing pains that richly informed me in crafting a treatment approach to couple’s therapy, a new GPS for navigating the craggy but fulfilling landscape of the couple relationship.

Too often, it’s been my experience that distressed couples present to treatment desperately teetering on a precipice of separation and divorce, compelling me to make a quick, hopefully effective “first-responder” application of treatment an urgency. But even under ordinary, non-emergency circumstances, it has become increasingly evident to me that the intimate relationship delivers a steady supply of challenges, some of which are Sisyphean-like in difficulty. Arguably, intimacy is in a league of its own, no other relationship compares in complexity, difficultly, nor fulfillment. Yet oddly, there are no formal institutions that prepare us for it, nor are there standardized marital manuals offering precise, dependable, science-based guidelines.

Nevertheless, despite its predictable ruggedness, intimacy still promises us life’s loftiest personal rewards and its greatest joys. The question is, what are the best tools for harvesting them? Both personally and professionally, I feel there’s a glaring need for a reliable GPS for navigating a successful, emotionally safe therapeutic route through intimacy’s uneven, often hazardous terrain, which is characteristically pocked with conflict, frustration, and disappointment. So, out of arguable necessity, this proposed GPS is intended to serve the practicing clinician, their couple clients, and, for that matter, anyone partnered within an intimate relationship.

A New, Brighter Day

Fortunately, things are much different for me today. Now, when couples present for treatment, my overriding feeling is best described as clinical self-assuredness, born, no doubt, of greater experience. However, I’m convinced the lion’s share of it derives from my growing confidence in the new couples therapy model I’ve added to my clinical tool belt. With equal portions of relief and gratitude, I’m now more prepared to helpfully intervene. Perhaps just as importantly, my clinical confidence is transmissible, that is, it can be emotionally infectious, like a positive contagion that boosts a couple’s confidence in the therapy process. Amusingly, Bruce Wampold alleged that the clinician’s conviction of the efficacy of their treatment strategies is, in itself, therapeutically powerful, likening it to a witch doctor’s “curative” influence. Similarly, at the risk of sounding clinically omniscient or lacking in humility, neither of which embraces scientific objectivity, I have come to feel especially prepared and confident in this approach. This GPS, as I’ve nicknamed it, was born largely of my earlier feelings of being lost and in need of firm grounding and direction when working with couples struggling with intimacy and embroiled in conflict.

If you were to join me in my office, looking over my shoulder, you’d see that I’m especially watchful of a common tendency among partners to target one another with vilifying, non-specific complaints and vague, undefined references to their cripplingly poor communication habits. Commonly, couples seem all too happy to showcase their partner’s faults, foibles and imperfections, but rarely their own. And the accuser’s finger-pointing is typically served up with an accompanying plateful of insinuations that their relationship would be better if only their partner were to change. Of course, this change is often defined exclusively by the partner making the allegation. Obviously, the couple’s ranting indictments of each other typically fail to bring significant, durable change, and finally out of growing despair and necessity, they drag their wounded relationship, kicking and screaming, into treatment.

So, frequently and to the couple’s surprise, I explain that they probably would not be at loggerheads with each other if either or both of them had brought invalid needs to the other. After allowing a moment for this thought to percolate, couples, almost without exception, accept the cogency of this premise, which, as can often be predicted, effectively prompts partners to ask themselves, “Why are we fighting, then?”

Next, with some active nudging, I encourage each partner to look below the attention-consuming mismanagement of their own need to their need’s deep taproot of legitimacy. For example, partners need to be heard in a respectful, sensitive way, which is without question valid, even sine qua non, but can easily be mismanaged, e.g., “You never listen to me!” Here, attention is drawn to the critical, judgmental tone of the complaint, which then mobilizes the taunted partner’s defenses, thus turning their attention away from the validity of their partner’s need to be heard.

Conversely, if the need to be understood were effectively managed, it would sound more like this: “When I feel heard, I feel respected, cared for, and I’d sure welcome your understanding now.” Clearly, there’s less economy of time and energy in the latter example, but its payoff is great and can be measured by increases in self and partner respect, and even an elevated probability of need gratification that rewards the added efforts of the need manager. I’ve found that partners who respect one another are more likely to gratify the other’s needs.

Need Management Therapy

Before I continue unspooling the specific steps of this model, be reassured that it has evolved over years in practice and flows from the work of pioneers in the field of couples therapy, including Aaron Beck, John Gottman, Sue Johnson, and Leslie Greenberg. My use of the acronym GPS is metaphorical, designed to be a catchy, descriptive epithet for the model, whose formal name is Need Management Therapy (NMT).

Theoretically, or perhaps ideally, a couple is composed of two individual selves. While this may seem obvious, what is not so clear is the very concept of “the self,” which is up for definitional grabs; it’s a theoretical construct, and there are several competing versions of it lining the shelves of the scientific and self-help marketplaces. So, cautiously exercising my own theoretical prerogative, I’ve stepped out on a limb and defined the self as a composite of circulating needs of varying types and magnitudes. Further, by my calculations, human needs are self-defining, self-constructing psychodynamic entities that require active management, including the management of the feelings orbiting about them. These concepts have significant diagnostic and therapeutic implications, especially within the rigorous context of the intimate relationship. Convincingly, optimal individual and couple health can be realized by the effective management of both individual and shared needs and feelings.

In its simplest, most encapsulated form, NMT teaches the couple the tools necessary for the effective management of their needs and feelings. So, here’s a brief preview, a quick synopsis of NMT punched out in a one-to-three stepwise form. Later, I’ll further flesh out the model’s three lynchpin steps while fitting each one to a concrete couple example for a clear demonstration of how the steps are applied.

Step one is “need identification,” which endows partners with the Socratic “know thyself” advantages of self-delineation and self-cohesiveness. Step two is “need legitimization,” which assumes that partners bring fundamentally valid needs to one another and encourages partners to actively represent them. Step three, “need representation,” centers around creating and preserving self and partner esteem—legitimate needs must be given voice along with the feelings associated with them. This expression of the emotions encircling a partner’s needs amplifies the personal meaning of the need, and more, creates a deep connection within individual partners, predisposing a better quality of connection between partners.

Need Identification: The NMT therapist encourages the couple to identify the personal needs that each partner brings to the other, especially those that ignite conflict. To illustrate, consider the case of Justin and Stephanie. What ignited their most recent skirmish and finally drove them into treatment was Justin’s non-negotiated demand to purchase a mountain bike—his identified need. Stephanie had other plans. Her identified need was to replace the family’s aging car, which she thought ought to top their list of spending priorities. At this point, both partners identified their manifest needs.

Despite its propensity for generating couple conflict, this active process of need identification effectively constructs the self, and again, a well-constructed self bodes well for personal mental health and the health of the partnership. Poorly defined needs are more difficult to manage. Moreover, the intimate relationship confers immeasurable benefits upon its constituents, but it can also be notorious for its ability to dismantle personal identities, as partners often under-manage or fail to adequately manage their own needs. Sadly, these failings can occur for reasons related to a partner’s lack of self-acceptance and/or for understandable but misguided attempts to preserve couple peace and harmony by dodging conflict and reducing friction, which is always ill-advised.

Need Legitimization: NMT trumpets this bold presupposition: most, if not all, individual needs are fundamentally legitimate at their most basic, irreducible level; therefore, they cry out for active, effective expression and management. For example, partners have a deep-seeded need for sensitive, respectful understanding of their needs and feelings regardless of the nature of the need or the inevitable surface-level disparities between their own and their partner’s needs. Moreover, a partner’s failure to adequately imbue their personal needs with this fundamental legitimacy predisposes the non-or-undermanagement of their needs, creating a potential breeding ground of self and partner resentment. For example, if I fail to manage the valid needs I bring to my partner, this self-imposed forfeiture of my needs diminishes my self-respect. I’ve become someone less than I optimally ought to be, or who I fully am. Now, as a lessor presence in relation to my partner, a chink develops in my personal identity armor, and as a consequence I don’t like who I am vis-a-vis my partner. Conversely, by deliberately imbuing my needs with positive status, I elevate the probability of their active management. And, perhaps of greater value, I simultaneously spawn self- and even partner-respect as I bring a more defined, fuller version of myself to my partner that also ferries the additional advantage of invigorating and nourishing my relationship.

Referring back to the example of Justin and Stephanie, each partner brings a valid need to the other, and therefore each one ought to legitimize the others need, as opposed to entrenching themselves in a competitive or adversarial argument in which one partner’s need is pitched as more important than the other’s. When couples purposely legitimize their own and their partner’s needs, they create a mutuality of respect that can be immediately conflict-preemptive and even lay down a longer-term prophylaxis against future couple warfare. Moreover, this atmosphere of mutual respect paves the way for the usual problem-solving conventions of compromise, negotiation, bargaining or other quid-pro-quo options for resolving differences. A qualifying caveat to this is that all too often, partners rightfully assume their need is valid but wrongfully assume it should be gratified on the spot because of the legitimacy it holds for them. This all-to-common need mismanagement pitfall fails to calculate the fundamental validity of one’s partner’s needs and can thus seed couple conflict.

Partners could conceivably lock horns in perpetuity because each, at least from their own perspective, brings a valid need to the table. Do couples fight for reasons that are not valid? Not likely. Partners believe and, more importantly, feel their individual needs have importance, or else why express them, much less defend them, or worse still, launch their version World War Three over them? Couples fight not because they bring illegitimate needs to one another but rather because they fail to effectively manage their own basic needs and adequately validate those of their intimate other. According to NMT, poor personal need management is the crucial point d’origine, the epicenter of couple rancor, dispute, and conflict. And when couple dissension is relentless and protracted, the accumulation of the toxic emotional by-products of poor personal need management—frustration, hurt, betrayal, anger, confusion, disillusionment, depression, to name a few—disease the relationship, until it can become moribund and dies. Extending this NMT logic, could every heated argument, or every fight, be framed as an instance of poor individual need management? If so, in a perfect couple-world, where needs are well-managed, fighting would be nonexistent.

Need representation: After greasing the wheels of communication by respectfully requesting a dosing of their partner’s time and understanding—a necessary preliminary—each partner is then encouraged to express their needs in clear, understandable terms. But with even greater emphasis, couples are strongly coached to express the emotions whirling about their needs. A need’s personal “weight of meaning” is conveyed through this accurate expression of the feelings connected to it. As needs and their related feelings are expressed with sufficient depth and accuracy, partners achieve a profound connection within themselves, which, in turn, serves as a precursor to a deeply emotional connection between partners. In briefer terms, “I can be no closer to my partner than I am first close to myself.”

Lastly, partners are taught to prioritize the effective management of their needs over their gratification. To be sure, I’m all in favor of need gratification, but it should come via the steps of effective need management and therefore be of secondary importance. NMT holds that it is in the effective management of our needs, and not their gratification, that we develop our emotional maturity. In stark contrast, like an untamed and feckless reflex, the pursuit of immediate personal need gratification can harm partners, as it puts one partner’s need above the another’s, thus risking the moment-to-moment health of the relationship.

Returning once more to the case of Justin and Stephanie, the third and final step of the model begins with a respectful investiture of partner respect prior to the expression of the need. For example, Justin might say to Stephanie, “Could I get a moment of your time?” or, “Are you real busy right now?” This common courtesy is a small investment in respect for Stephanie which literally credits Justin with a commensurate or reciprocating return of respect that can start the communicative ball rolling productively. Next, Justin makes plain his need for a mountain bike but, more importantly, he very purposely expresses the breadth and depth of his feelings related to his anticipated use of the bike. Lastly, and very importantly, Justin must strive to prioritize the management of his need for the bike over the immediate personal gratification of actually purchasing it. Challenging! But Justin’s goal is to learn that it’s the effective management of his need and not its gratification that ensures his maturation and growth and the preservation of the moment-to-moment health of his most prized relationship. The same exact process of effective need representation is repeated with Stephanie.

Adherence to this stepwise, simple orthodoxy of the NMT model can ensure growth in self and partner esteem as well as enhance the health of the relationship, meeting the highest needs of the individual. And, as an added incentive, good need management elevates the probability of personal need gratification.

A Personal Addendum

I have been deeply gratified and often immediately rewarded in “psychic dollars” as I’ve observed couples respond positively to NMT. Many times, within as few as one to five sessions, couple change occurs as partners learn to identify and validate the legitimacy of their needs by the deliberate, purposeful crowning of their needs with positive status. This process of self-generated validation of one’s needs can, and often does, encourage their active representation, and with it the door to a more fulfilled and maturing self is flung open.

Importantly, NMT theorizes that the intimate relationship is incomparable, like no other relationship because it creates the conditions by which the fullest maturation of the self can be realized. Outside its context, the same optimal emotional development may not be realizable. This is because of intimacy’s matchless features, chief of which is the endless stream of opportunities for personal growth through the development of effective need management skills.

By incorporating these simple, but compelling, principles into my treatment repertoire, I have been served a savory, delightful helping of clinical self-assuredness. But more importantly, I’ve witnessed the efficacy of this approach first-hand in the lives of the couples with whom I’ve worked. No more interventional paralysis, no more stumbling or bolting clients, and no more clinical nightmares!

The Secret to Successful Couples Therapy: Empathy Over Doubt

Posted on July 22, 2022February 24, 2026 by Psychotherapy.net Team

I sometimes forget that the work that I do with couples is actually effective.

Despite having seen many successful outcomes over the decade or so I’ve been doing this work, I can’t help but feel skeptical about the possibility of success in the face of challenging client situations. In part I think it’s due to sporadic bouts of impostor syndrome, which I have struggled with in small and big ways; and in part I think it’s just that on its face it sometimes just seems so unlikely that a couple can bridge the giant gap that separates them when they come in.

Take Molly and Grant. Molly wanted another child. Grant did not. When they came in for couples counseling, they were both pretty despondent about the possibility of working things out. Theirs was a stark difference of opinions to overcome, not to mention the impact of months of intensifying arguments over that difference which had left them frustrated, angry, spent, and dejected.

I doubted myself, but I plunged ahead with what my training, experience, and instinct told me: let’s build empathy, and then take a second look at the problem afterwards through a new lens. My style looks a little bit like Imago, a lot like Relationship Enhancement Therapy, and a bit like everything else too. (I tend to think that there are strengths in many different modalities, and I like to keep a variety of tools in my belt.)

Molly and Grant had one child so far, a mischievous and often oppositional three-year-old girl named Haley. They had their fair share of struggles with her, but both of course loved her deeply. Grant, however, had never really expected to be a father and still grappled with how exactly to fill the role; he had no need to double down on it. Moreover, he was afflicted with a physical disability that made him earnestly question whether he could physically handle parenting twice as many children as he was currently attempting to manage.

Molly’s emotional yearning for another offspring was diametrically opposed to Grant’s disinclination. She wanted it, needed it, pined for it. She considered leaving the marriage over it (knowing, of course, that at her age that would certainly not increase her chances of having another child).

Over the course of our sessions, we were able to illuminate (at least partly) the source of her powerful desire; it was no small matter. Her wish for a second child related to her worth as a woman, to her fraught family history, to the untimely death of her own sister years earlier, and perhaps most strongly, her profound wish to give Haley someone to rely on through thick and thin.

Whenever they began to cycle through the arguments for and against, we got nowhere. Instead, I guided them to focus on their feelings, their experience of life as parents, as spouses, as a man or woman, and to share those in a safe and structured space with each other.

Grant was skeptical. Molly was hopeful, and also doubtful, and kind of both at the same time. But they tried. They really tried. They failed a lot; then they tried again. I taught them to listen to each other. I taught them to talk to each other (rather than at or around each other). And soon each began to understand where their partner was really coming from. From there it was a short distance to caring about where their partner was coming from, and then to expressing that caring. I taught them to reconnect with their empathy.

It was somewhat astounding to me that after five sessions, they were savoring their connection once again. They thanked me for literally saving their marriage. They left with a deep commitment to each other and to the process. I trust that these will be assets they will use to continue the discussion around having further children. It reminded me of my own commitment to the process as well.

My work with couples, challenging as it often is, continually reminds me that relationships are never about the what, but about the how. When couples interact with each other on the basis of empathy, there is virtually nothing that stands in the way of deep connection (even in situations where the best thing really is to break up). Couples like Molly and Grant remind me of this truth. They give me something to hold onto when my impostor syndrome strikes. Like my clients, I’m not perfect. I don’t always say the right thing. I don’t always know the right answer. But I am pretty sure that empathy is the right way.

But I have no idea what, or if, they decided about having another child. After all, that was never truly the problem.

May You Practice in Interesting Times: An Invitation

Posted on July 19, 2022February 11, 2026 by Psychotherapy.net Team

“May you live in interesting times” goes the expression, although I won’t debate, as historians have, whether this is a blessing or a curse. Because whichever it is we most definitely do live, and in the case of psychotherapists, practice in the most interesting and challenging of times.

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As Psychotherapy.net’s Editor, I have had the privilege of working with you to bring those challenges to the forefront of our collective attention by soliciting, and at times writing content reflecting the ever-changing, always complex, and highly demanding landscapes in which psychotherapists of all levels and orientations work.

I aspire to content that holds up a mirror to the internal and external pressures that shape the practice of psychotherapy and counseling, one that reflects not only the clinical, but the personal, interpersonal and moral dilemmas that impact the way we think about ourselves as not only helpers, but as citizens, moral actors, and at times advocates within our private and collective spaces.

The Present

Some of our recent content has poignantly captured the challenges I allude to and invite you to reflect on just a small sampling of those.

Amanda Gregory’s, Trauma Survivors React to Overturning Roe shines an inescapable light on the very real, painful impacts of the recent Supreme Court decision.
Maggie Mulqueen’s, Acknowledging the Impact of Cancel Culture on Therapy brings the highly politicized, popular culture practice of muffling adversaries right into therapy.
Cindy Silitsky’s, InstaTherapy on Social Media: Caveat Emptor alerts us to the ways in which the various online platforms can help, but also hinder the progress of therapy.
Tom Medlar’s, Surviving Pandemic Pandemonium in Nursing Facilities reminds us that COVID’s grasp has not lessened in our society, especially among the more vulnerable.
Michael Sobocinski’s, Existentialism and the Environmental Crisis: The Urgency of Meaning frames global warming as not only a societal, but as a very personal threat.

The Future

Recently, the American Psychological Association published its “14 Emerging Trends”, highlighting some of the challenges that lay ahead, and which hopefully will inspire not only psychologists among us, but counselors, clinical educators and trainees. Some of these include:

Reworking Work is a call to clinicians to explore COVID-initiated changes to the landscape of the workplace and how our clients, particularly women, are adapting
Prominent Issues in Healthcare asks us to consider the serious and often long term impacts of the pandemic on healthcare providers (including mental health professionals) such as burnout and depression
Mental Health Meet Venture Capital highlights the promises and pitfalls of large, and often non-clinical entities purchasing clinical practices, both small and large
Childrens’ Mental Health in Crisis urges clinicians to turn an even keener eye towards the many ways that children and families continue to struggle in the post-pandemic era
Kicking Stigma to the Curb reminds us through celebrity support, that the struggle is real, especially for those who live in the shadows and margins of our society
Telehealth Proves its Worth validates the increasing role and importance of teletherapy, as well as remaining challenges to re-think traditional models of therapy service delivery

.
The Call

If you haven’t already guessed where this essay was leading, I’ll just come out and say it. You, we, all of us who are working with clients that are invariably impacted by any of the above issues and trends are in the best position to share those impacts on you and your clients. So please consider putting pen to paper (or fingers to keyboard) and submit a blog or article reflecting how these issues and trends are playing out in your own practices, whether small or large, whether in individual or group or family context. You already offer so much to your clients! Perhaps you’ll be surprised just how much you have to offer fellow clinicians.

Thanks so much for all that each of you does,

Lawrence Rubin, Editor (lawrence@psychotherapy.net)

References

APA’s 14 Emerging Trends

Judgmental Health

Posted on July 14, 2022February 11, 2026 by Psychotherapy.net Team

Call me naive. I am still taken aback when therapists—who are trained to be empathic, to start where the client is, to put aside their own values—are agonizingly judgmental of their own kind.

Perhaps it is because we all to some extent have a professional persona that is different from how we are with our friends and family. So maybe when we are “on,” we’re able to keep the judgment out of the conversation, but when we’re on our own time we forget? (Although truth be told I’ve heard stories from my clients of previous therapists who were painfully judgmental even with their clients in the therapy room.)

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I am a little weary of hearing comments like the following in therapist-oriented conversations, podcasts, and discussion groups:

“I don’t see how anyone can do trauma work without discussing issues of [race, family of origin, body image, etc.].”

“I don’t know how I was even effective before I learned [name of technique]!”

“If you haven’t done [name of method I personally use], you haven’t done couples counseling.”

These indirect digs at other therapists hurt. Too often, I’ve left Facebook groups that turned into feeding frenzies; I’ve even witnessed therapists chased off such groups for not falling into line on some issue or other. This problem seems even worse when social and political issues enter into the discussions. Did you know that it’s possible to be a social worker and also, for example, be pro-life? Or to be a couples counselor who believes in polyamory, or one who doesn’t? We can discuss and debate these issues at great length. Is it really necessary for colleagues to belittle and besmirch those who disagree with each other? (Answer: no!)

Friends, let’s please not do this to each other. There’s more than one way to skin a catharsis. In fact, there are many. New evidence-based modalities are coming out every year, and research has shown that the style of therapy being used has surprisingly little impact on client outcomes relative to the relationship between client and clinician. This means that the modality one clinician uses isn’t any better than what the therapist down the street uses. You can do you, and I can do me, and let’s all do what we can to help those who are seeking our help.

I frequently let my clients know that if what I’m doing doesn’t work for them, there are other clinicians out there with different styles and techniques, and I would be more than happy to make a referral if they’d like to try something I can’t offer. I wish more therapists had an equally pluralistic view of the range of therapy models out there and the clinicians who practice them.

Neither am I, for my part, judging those therapists. I am dismayed by their perspective and by their parochialism, but I understand that they, too, are coming from somewhere—whether it is their own pain, insecurity, dogmatic upbringing, or training. I am not denouncing as much as I am asking for change in the way (some, but not all) clinicians relate to each other (especially on social media).

Whether a clinician uses CBT or EMDR, whether they lean psychodynamic or experiential, whether they consider themselves client-centered or systems-oriented, there’s room at the table for all. And since the demand for mental health care has exploded these past few years, with no sign of letting up any time soon, the time seems particularly right for putting a few more chairs around that table. We want you at the table. We need you at the table.

There is enough ugliness and pain in the world without professionals who share the core values of empathy and compassion turning on each other. We don’t need Twitter-shaming. We don’t need the public call-outs. We don’t need the passive insinuations. What we need is for clinicians to value and honor each other, and the contributions they each make to the greater good. When we do this, the profession is a far richer one, and the community of care expands rather than constricts.

Diversity is not just about race or gender. Every person’s unique self—this is true of clients and clinicians alike — is worthy of admiration and esteem. Synergizing our strengths makes this world a better place, one session at a time.

Trauma Survivors React to Overturning Roe

Posted on July 12, 2022February 11, 2026 by Psychotherapy.net Team

At the start of every day, I check the news – not because I’m a responsible citizen, but because doing so helps me prepare for my work as a psychotherapist who specializes in working with complex trauma. George Floyd’s murder, the COVID outbreak, the war in Ukraine: in the wake of these each of these events, I had to take deep breaths before seeing my clients. On the morning of 6/24/22, I read that Roe v. Wade had been overturned, and deep breathing was no longer enough. Instead, I held back tears as several of my clients bravely unpacked the ramifications of this historic decision for their safety, autonomy, and sense of self-worth.

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“When Will I Matter?”

Ruth is 72-year-old black heterosexual cis woman and complex trauma survivor who suffered from years of childhood sexual abuse as she was continually raped by her father. She participated in talk therapy for years with little progress and began seeing me in order to try EMDR, Internal Family Systems Therapy, and Somatic Experiencing. This combination of theoretical perspectives and interventions appeared to be successful, as Ruth reported feeling safer, an improved sense of self-worth, and the courage to begin exploring her sexuality (which had been developmentally delayed for most of her life). The day following the Supreme Court’s ruling on Roe v. Wade, Ruth arrived at our session appearing irritable and stated, “Don’t ask me how I’m doing, you don’t want to know.”

Even though she often presented herself to others as “the nice old lady” (which is a response to complex trauma that many mental health professionals refer to as “fawning” or “people- pleasing''), fortunately Ruth and I had developed a relationship in which she was comfortable feeling and expressing her emotions.

“What if I had gotten pregnant by my father?” she asked. “Some of these states would have forced me to give birth like it was my fault. It’s taken me most of my life to realize that it wasn’t my fault and that it was my father’s illness, but now it feels like there are people who believe that I would have been to blame and that I should have suffered the consequences.” Ruth’s voice began to quiver as her anger morphed into grief. “It’s like my father mattered more than me, my mother mattered more than me, and if I had gotten pregnant now, that fetus would have mattered more than me. When will I matter?”

Complex trauma creates and fuels low self-worth. Ruth was treated like a second-class citizen for most of her life: as a child, as a woman, and particularly as a black woman. The overturning of Roe v. Wade re-awakened and exacerbated past experiences that had nearly destroyed her self-worth. It’s difficult to sustain a healthy sense of self-worth when you are constantly barraged with messages – perpetuated by systemic racism and misogyny – that you are not, in fact, inherently worthy of life, liberty, happiness, or respect; that your life is disposable or only, at best, peripherally or instrumentally considerable. Under such circumstances, how can I help Ruth sustain the self-worth that she has fought so hard to obtain ?

“I’m Next, They’re Coming For Me!”

Leigh is a 32-year-old white married gay man and complex trauma survivor who experienced childhood neglect, abandonment, and emotional abuse. At 14, he was outed by a sibling and subsequently kicked out of his home. He lived on the streets and eventually found his chosen family. After Roe was overturned, he arrived at session making no eye contact, which wasn’t like him. He began the session stating, “I have to start by reading you one of my favorite poems.” I encouraged him to read the poem, which was written by Martin Niemöller.

“First, they came for the Communists
And I did not speak out
Because I was not a Communist
Then they came for the Socialists
And I did not speak out
Because I was not a Socialist
Then they came for the trade unionists
And I did not speak out
Because I was not a trade unionist
Then they came for the Jews
And I did not speak out
Because I was not a Jew
Then they came for me
And there was no one left
To speak out for me”

We sat in silence as his eyes darted around the room, desperately trying to find the words to express what he was thinking and feeling. “I’m next, they’re coming for me,” he whispered. Some therapists might categorize this thought as paranoia, but I didn’t. There are now rumblings to suggest that overturning Roe v. Wade will become a precedent for overturning same-sex marriage and legal consensual gay sex. Clarence Thomas has even explicitly suggested this.

Leigh arrived to therapy 2 years ago experiencing severe anxiety in social situations, sexual situations, and intimate relationships. He worked hard to address his trauma with attachment-based therapy, EMDR, and Animal Assisted Therapy in order to feel safe and secure in his relationships, sexuality, and social interactions. Now, once again, his safety is threatened. Every therapist knows that if your client doesn’t feel safe, they can only make so much progress. The client’s mind and body are focused on reestablishing safety, leaving little energy to focus on recovering from trauma or coping with the demands of their daily lives. Trauma survivors need to feel safe in order to heal, and now Leigh no longer feels safe.

“I’m Just a Vessel For Others To Use”

April is a 24-year-old nonbinary heterosexual Latina who survived multiple sexual assaults. At age 9, they were raped by an uncle, at age they were molested by a baby sitter, and at 15, gang raped at a college party. As a child, April was taught that they had no agency over their body. They were forced to hug and kiss their relatives on command, and thus they learned that adults get to decide what happens to their body – an experience that is all too common in many cultures. Unfortunately, these experiences caused April to internalize a lack of autonomy that made them unable to report their sexual assaults.

“Déjà vu,” April said, smiling wryly.
“Déjà vu?” I asked.
“My body isn’t mine, remember?”
“Yes, I do. Does this feel like before?
“Exactly like before.”

Due to a greater awareness of child sexual abuse and the importance of bodily autonomy, there is a movement in the psychology community that urges adults to ask children for their consent to acts of physical intimacy (e.g., hugs, kisses, snuggles, etc.) rather than command or coerce them to engage. There is a hope that these children will experience and internalize the value of bodily autonomy, practice establishing physical boundaries with adults, and be able to report violations of their boundaries. April never experienced bodily autonomy, and each sexual assault reinforced this lack of autonomy.

Over the past year, April addressed their trauma with Somatic Experiencing, EMDR, and Art Therapy. Slowly, they began to feel safer with others and in their body and were better able to establish boundaries in their relationships. I remember the first time they were able to say “no” on a date. They arrived at the session stating, “I didn’t want to go to his place and I didn’t care if he got angry.” Yet, after the overturning of Roe v. Wade, April experienced intense triggers that made them feel as if they were back at the beginning.

“I’m just a vessel for others to use,” April said as if it were a fact.

Once a trauma survivor is denied bodily autonomy, they are deprived of safey. The overturning of Roe v. Wade undercut April’s sense of autonomy, thus interfering in her trauma recovery. Will Ruth reclaim her self-worth? Will Leigh feel safe again? Will April reclaim her sense of bodily autonomy? I believe they will, but now they’ll have to struggle to do so more than anyone ever ought to have to. They have all made gains in their treatment that are still present at a deep level, and none of them are giving up.

As April proudly proclaimed at the end of their session, “ You know what? Fuck that, I’m not going back.”

Full Container

Posted on July 7, 2022February 11, 2026 by Psychotherapy.net Team

Seldom or never does a marriage develop into an individual relationship smoothly without crisis.
There is no birth of consciousness without pain.

C.G. Jung

Too Soon?

Upon leaving my hospice support group on September 11th, I turned on the car radio and heard that the Twin Towers had collapsed. Jared, a boy we knew with neuroblastoma, had also died early that morning. I became more disoriented than I already was. I can’t say I was any sadder, because that would be impossible. I met a friend at Perkins for lunch, and everyone there looked dazed like me. I didn’t feel like an alien anymore. Now everyone knew what I had already known—that complete devastation can happen in the blink of an eye.

Two weeks later, I called Hedy Schleifer, a renowned psychologist I spoke with when my two-year-old daughter Jillian was diagnosed with cancer. I asked if she thought I could handle the Imago Relationship Therapy clinical training, starting in November. Jillian had died in June. I was hoping Hedy would say, “It’s too fresh, you’re too vulnerable to take on such intensity,” but she didn’t. “Do it,” she said. “If not now, when?” I knew she was right.

Harville Hendrix’s Imago Relationship Theory is based on the idea that we marry our Imago—the image of the person who can make us whole again. We are attracted to the perfect mate to help us regain what we lost in childhood. But this person pushes all of our buttons first.

It was actually Tom who urged me to do this. He agreed to join me for the three one-week sessions, scheduled over a period of months. Tom and I had taken the two-day couples therapy workshop, but this training would allow me to become a certified Imago coach. I hadn’t seen any clients since Jillian got sick. Now I would have to see clients in order to provide the required taped coaching sessions.

On the first day of training, there were sixteen chairs in a circle. Hedy had “accidentally” included an extra chair. The empty chair supported a blue balloon with a blue ribbon. Jillian’s favorite color was blue. Was it a sign of approval? On each of the subsequent sessions, there happened to be a blue ribbon somewhere in the room. After Jillian died, a neighbor placed blue ribbons on all of the mailboxes in our subdivision. When someone we love dies, we grasp for signs that they are okay. I believe that sometimes they give them to us.

Hedy would begin each session by saying something like, “Today is November 14, 2001. It is the one and only November 14, 2001. What are you going to do with it?” She would also say, “It’s a great day. When I woke up this morning, I recognized myself.” Her mother, who had Alzheimer’s, could not. Just being in Hedy’s presence raised my consciousness.

Since most of the other therapists came without spouses, Tom and I were often the demonstration couple. It was like free therapy. After the first session, I made a Freudian slip that I had never made before. I said, “There’s my heaven,” attempting to say, “There’s my husband.” That’s exactly how I felt. Our connection was closer than ever; it felt like heaven.

Release and Containment

We were both still raw from Jillian’s death. Hedy suggested that we alternate crying in each other’s arms once a week. So that is what we did. After we got home, every Saturday we would alternate crying in each other’s arms. One of us talked or cried while the other listened and held.

When your child dies, it is extremely difficult to be emotionally available to your spouse. You both need someone, like a mommy, to care for you. We took turns caring for each other.

We were at the Comfort Inn on Miami Beach. Instead of lying on the moist sand, inhaling the salty ocean breeze, Tom and I sat face-to-face on gray cloth and metal office chairs, inhaling the basement’s mildew. It was the third and final week of our Imago Relationship Therapy clinical training. While a semicircle of seven participants observed, Hedy sat inches away, coaching our every move in this process, aptly named the “Full Container.” A conduit to deep emotional pain rooted in childhood, this exercise allowed one partner to fully express his or her rage while the other partner created a quiet, welcoming space to contain all of it. A spiritual energy pulsated from Hedy’s regal posture and her wispy salt-and-pepper hair, even through her dangling bracelets and flowing black, white, and red pantsuit. The three of us formed a triangle as we sat in open postures with our hands on our thighs.

Tom cleared his throat, “Uhum. Well, Sylvia.” Nervous smiles sprouted on both our faces as he leaned forward. “We even talked this morning about the thing I’m going to be mad about and you had no clue what it would be. Seventeen years of marriage, and we both knew what yours would be.” Tom raised his hands and plopped them back on his thighs. “But you had no idea what mine would be. Get a job. Get a job.”

Hedy whispered, “And it pisses me off.”

Tom unleashed his anger. “It pisses me off. It really pisses me off on many levels. It pisses me off on many levels.”

Tom’s accusing tone cut through to the back of my throat. For an instant I was a frozen little girl again, watching my own father derail. Hedy had prepared me so well for this exercise that I snapped back to the present and returned to Tom with loving eyes, open to the full extent of his rage. I could see both the face of a little boy and a man as he ranted.

Tom’s hands bounced up and down on his thighs with increasing intensity as he shouted. “We got married, and you had a degree in engineering and decided you wanted to go into psychology. I put your ass through school. You didn’t have to work at all. You didn’t have to work at all. I put you through school.”

Although I was able to maintain contact with soft eyes, I wanted to scream, “What are you talking about? I began working the second year of graduate school and worked until Jillian was born. That’s nine years.”

Instead, I tapped Hedy’s leg, per earlier instructions. She cradled my right hand in her left and waved her right hand over my chest a few times, helping me return to the present. While maintaining eye contact with Tom, I silently prayed for God’s love to channel straight through me to him. My task in this process was to contain his rage with every fiber of my being, so that he could allow the full extent of his life force to emerge in a safe environment, as never before. I relaxed my face and felt the light in my eyes as they reflected my thoughts. “I’m here again, Tom. I’m here again. My job is to see it the way you see it. Yes, you put me through school. I certainly haven’t worked as much as I could have.”

He scowled and shook his head back and forth. “All I heard was your bitching and moaning about having to do papers. Aaaah,” he mimicked me in a high-pitched whine. “I can’t do this. I can’t do that. Waaaah.”

His caustic masculine voice returned. “While I was working, all I heard was your bitching and moaning the whole time. You graduated. We had your big graduation thing. You thanked every fucking person in the whole world, except me, who put you through school. I was so mad. I thought I got over it, but I didn’t. I’m still mad about that.”

While still holding my hand, Hedy said, “Again,” to Tom. Amplifying his rage and enabling me to support him was her role in this part of the process.

“That really pissed me off that you thanked every fucking person in the world at the thing, publicly, except me, who put you through school.”

Hedy’s expression intensified, “Again.”

His now piercing volume escalated with each repetition. “It really pissed me off that you thanked every fucking person in the world, publicly, except me who put you through school! And, oh, thanks to your Mom, who’s out there golden.”

His sarcasm stung. Although the onlookers had faded into the background, they popped back into my awareness and I wanted to slink off my seat. What must they think of me? I became defensive, developing a silent counterattack. “I thanked you profusely in the written part of my speech. And besides, are you forgetting my mother was dying of cancer at the time?” Struggling to get my frontal cortex operational again, I squeezed Hedy’s hand. The rational part of me gained control as I told myself, “Stay here with Tom, stay here and try to see it the way he does. I did forget to mention him when I began talking spontaneously.”

He raised his lanky arms and waved them at his sides. “But Tom, who worked his ass off while you’re going through school. Oh, and I’m not supportive. I wasn’t supportive of you that whole time. I wasn’t fucking supportive. I heard that so many fucking times. It just pissed me off. No, I wasn’t supportive of you at all. It just made me so fucking mad.”

Tom’s voice lowered just a notch. “Then we get to this thing and I see how you’re wasting your talent.”

Hedy released my hand and leaned back in her seat. She knew I could fly solo at that point.

Tom’s hands clenched his thighs, and he nodded his head back and forth rhythmically; it was not quite a yes, more like a turkey gobble. “It’s like I signed us up for the Imago thing. Presumably I did it to improve our marriage. And then I saw how good you were on the two tapes. And I knew you were not going to fucking use it. You were going to have one or two clients. You knew you were going to lose five thousand bucks a year or whatever. You have a Ph fucking D! You ought to have been making more money than me. You shouldn’t have been losing money every year. It pisses me off completely that you’re so irresponsible that everything has to be on me. That you don’t make any fucking money. That you don’t take any responsibility for yourself. You make excuses, about Jillian or whatever. Oh well, look at all the other years. There are other years in there. Yeah, you worked, and you piddled around. You could never collect your money. You could never do what it took to be responsible to take responsibility for yourself. To make some fucking money. To take some pressure off me.”

My insides trembled, and I wanted to jump up and shout, “The money loss began after Jillian was born. I only saw a couple of clients because I was a stay-at-home mother, then she got cancer and then she died. When was I supposed to be making money?” Hedy was right when she said, “One partner’s deepest need meets the other’s greatest defense in this process.” I wanted to put my defenses aside, to remain present. To see it his way, I was irresponsible with money and have never earned what I’m capable of earning.

I’ve seen Tom enraged before, but never as physically and verbally unrestricted.

“Oh yeah, and I’m going to send you to Spain. And I want to do that for you. But there’s another part of me that’s really pissed off that you never took responsibility for yourself, that you never took the pressure off of me, that you were never there for me, that you couldn’t decide to pull your weight, to do your part.”

Hedy thrust her fist forward. “I’m sick and tired of it.”

“I’m really fucking sick and tired of it,” Tom repeated.

Hedy leaned in, “Again!”

“I’m fucking sick and tired of it. I’m tired of being the accommodator. I know you don’t want me to be the accommodator, but I’m tired of being the accommodator, the one who provides all the support, the one who has to be reliable.”

I Lost a Child Too

Tom mimicked my voice again, “Oh, waah. I’m going to cry for nine months about Jillian. You get to stay home and cry for nine months and act like you’re the only one who lost a child. You know what? I lost a child, too!” Sadness cracked through Tom’s anger. “I lost a child, too, and you don’t know I lost a child, too.”

Hedy waved her fist and rattled, “Keep coming with the anger. Feel the sadness and keep coming with the anger.”

“I lost a child, too, Sylvia, goddammit! You act like you’re the only one who lost her! You don’t know I lost her, too. I lost a child, too.” We both begin sobbing. “What about me? It makes me mad. You don’t see I was her father. I lay in that crib with her. I lay in that hospital bed with her. And you don’t see that I was her father.”

Hedy placed her hand on my belly and I took her hand. I breathed deeply and relaxed into the safety of her presence.

“You don’t see how much I loved her and how much she meant to me. But no, it’s all you, Sylvia, all that time. But, you know what? She was my child, too, and I loved her. You didn’t do shit.”

While still holding my hand, Hedy turned to Tom. “Feel the anger.”

“It’s all fucking your problem. I had to go to work every fucking day while you got to lay home and feel aaaah like shit, and I get to go to work every fucking day!”

His girly voice faded in and out. “Oh, I can’t go to work.”

“Well fuck it, Sylvia. You’ve done that the whole time we’ve been married. You’ve always had some excuse why you couldn’t pull your weight. Why is it all about you? It had nothing to do with me. Jillian was my daughter too. She was my daughter.”

Hedy leaned in toward Tom, “Unclench your jaw.”

He flailed his hands at his sides like he was having a seizure. “She was my daughter. I feel that pain, I feel that pain as much as you!” He screamed at the top of his lungs. “You heard me wail, didn’t you hear me wail? I miss her like hell! Goddamm, I miss her!”

Hedy leaned toward Tom, “Open up the jaw.”

“I miss her. I miss her more than you.” He stuck out his tongue like a 5-year- old taunting his sister. “Aaaaaaaaaaaaaaaaaah!”

Even though I was petrified, I smiled when I saw that little boy’s face.

His brow furrowed deeper than I’ve ever seen, and his jugular veins bulged as blood rushed to his face. “She was Papa’s girl. Fuck it. She was Papa’s girl. She’d say that, wouldn’t she? She saw that, too, how everything was all about you. How it was all about you. How everything was about you. It made me so fucking mad. It was all about you and your pain with Jillian. It was never about me. You were ready to fucking divorce me while we were going through that shit, do you remember that? All that crap we were going through. I’d have to be the supportive one. You were ready to kill me because you were in so much pain. Jillian was in so much pain. And you told me, when this is all over, I’m going to divorce you. You were attacking the crap out of me. Fuck that. I’m doing all that shit. I was there with her, too, trying to support you and her, emotionally, physically, and financially.”

Part of me wanted to leave my body, but another part fought to remain there with Tom. I remembered Hedy’s instructions, 10% of this is about me, while the other 90% had its roots in his childhood. I opened up a closed space within and made more room for him.

His voice softened as he alternated between mimicking my voice and his own. “It’s all over, Tom, when it’s over, which it wasn’t. We didn’t do that. But goddamn, that pissed me off. Fuck it. It’s going to be all over. Fuck it. It’s going to be all over. You’re dead. You’re nothing.”

I sat with loving eyes, in a meditative trance, palms facing up on my thighs, realizing that he had hit the existential statement that led him back to childhood memories.

“Made me so fucking mad that I’m nothing. I’m fucking nothing.”

“Again,” said Hedy.

“I’m fucking nothing. I’m nothing to you. “I’m nothing.”

“Yes, five times.”

“I’m fucking nothing.”

“Stand up,” Hedy said as she rose. “I’m nothing!”

Tom stood and leaned over me. “I’m nothing. I’m nothing. I’m nothing. I’m nothing. I’m nothing, NOTHING!”

“Let what comes with that come. Scream it out.”

“I’m nothing. I’m fucking nothing. I’m nothing. I’m nothing, I’m nothing to you,” he said, whimpering.

Hedy guided me to my feet. Tom and I stood inches apart.

He sobbed. “I was nothing, nothing, nothing, to my parents, to my mother.”

I took him into my arms. He pulled me in and whispered. “I love you. I love you.”

From the corner of my eye, I notice the other therapists watching spellbound as Tom’s unspeakable pain flooded out on the floor in a torrent. A Kleenex box passed around the room and an occasional loud honking sound broke their silence. Tom and I were wired with microphones, but words were difficult to discern as Tom alternated between mumbling, moaning, and wailing.

Although my ego hung onto remnants of his earlier words, I decided to put it on a shelf until later. I patted his back. Hedy gently placed her hand over mine, to stop my automatic consoling. “Take all the time in the world. I’m right here,” she whispered.

I repeated her words in Tom’s ear.

“I was nothing to my parents. They never noticed me. I had to be invisible, this perfect little robot, responsible, reliable.” As Tom spoke between sobs, he transported us to a scene in his childhood. “I was all alone in my crib, crying. I was very lonely, but no one would come to comfort me. I stood in the crib, violently shaking it. The darkness and pit of loneliness in my gut stretched out to forever.”

“You were so little, so lonely, so afraid,” Hedy whispered.

As I repeated the words, Tom belted out a ghostly moan for several minutes before he began speaking again. “The crib slowly jerked across the wooden floor until it slammed into my bedroom door. The crib was just the right height to hit the doorknob and lock the door. I heard my father struggling to unlock it and push it open. My heart pounded. I stood quietly as my father managed to push the door open. He had a wild look in his eyes. I wanted to die.”

Tom moaned and moaned, I cradled his body with my eyes tightly shut. After several minutes, the crying stopped, but his breathing remained labored.

“How should it have been, Tom?” Hedy said.

I repeated her words in his ear.

“They should have heard me long before my crib made it all the way across the room to the door. They should have seen I was there. They should have held me when I cried. I would have felt safe and wonderful and that it was okay for me to be alive.”

As Tom wept, Hedy whispered in my ear, “That’s just how it should have been. Your parents should have come running when they heard a little peep from you.”

I whispered gently in his ear. “That’s just how it should have been. Your crib should have never shaken all the way to the door before your father came in. You should have been able to make the slightest peep and had your parents come and look in your eyes and know they had the most wonderful little boy in the world.”

“Peep, peep,” Tom said.

“Here I am,” I said, and we both giggled.

“Peep, peep,” he repeated.

“I’m still here.” I held him tight, now resting my head on his.

Hedy leaned in. “Reposition yourself slightly, so you can look in each other’s eyes and soak in all that you’re feeling.”

***

Tom and I gazed into each other’s eyes as time stood still. He looked different, more alive, somehow. I could really see him as I looked in his eyes, like clear pools, a direct link to the divine. The space between us felt sacred, alive with rejuvenated energy. Emerging from the invisible boy was the man I had waited for my whole life. He smiled a full, incandescent smile.

This article is excerpted from the unpublished book Why Jillian? by the author.

The Encounter at the Doorway

Posted on July 5, 2022February 11, 2026 by Psychotherapy.net Team

Francis Thompson was born on December 18, 1859, and died on November 13, 1907. He is the author of the great mystical poem “The Hound of Heaven.”

I fled Him, down the nights and down the days;
I fled Him, down the arches of the years;
I fled Him, down the labyrinthine ways
Of my own mind; and in the midst of tears
I hid from Him, and under running laughter.

So begins the first verse of the poem that is considered a spiritual autobiography of Thompson’s attempted flight from God, and the gentle and persistent presence that always pursued him no matter how much of a mess he made of his life. Francis Thompson was often homeless on the streets of London and addicted to Laudanum (alcohol with a tincture of opium).

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One day Francis went to the office of Wilfred Meynell at the Merry England magazine. At his desk, Mr. Meynell saw the office door open slightly and close, then open and close again. In the doorway, Francis had no shirt beneath his coat, bare feet in his broken shoes, and a soiled and wrinkled manuscript in hand. He was scared. Thankfully for Francis Thompson and for the history of English literature, the impeccably dressed Mr. Meynell looked beyond the surface of Thompson’s broken-down appearance. He read the manuscript with mounting astonishment, helped Francis get into a hospital, and gave him a job. Francis relapsed into addiction several more times between periods of rest and recovery at a monastery in the countryside and bursts of literary productivity, until his death that resulted from the effects of addiction and tuberculosis.

I have personally witnessed dramatic and counter-intuitive ways in which demographics have changed in skilled nursing facilities over the past several years. The general population may be aging, yet the trend nationally has been one of younger adults increasingly being admitted to nursing facilities. A dearth of funding for home-based services, and a lack of available and appropriate residential programs for psychiatric and substance abuse issues are among the factors that contribute to these changes, and those that most directly impact the clinical work I do with these populations.

In the nursing facilities where I work, I have encountered relatively young residents with complex medical and psychiatric and substance use disorders. I can attempt to prepare for these doorway encounters, as did Mr. Meynell all those years ago when first meeting Francis Thompson. But as Meynell’s first impression of Thompson was skewed by his streetworn and drug-addled presentation, so, too, might be our own first impression of a younger person whose substance abuse and psychiatric history has taken a toll on their body and mind. Their need to be seen fully as a person is no less than was Thompson’s when he first appeared in Meynell’s doorway. And, like Thompson, each of the residents who present in my clinical doorway is so much more than their respective psychiatric and substance abuse histories.

Every person wants his or her life to turn out well. The person with a substance use problem yearns to be recognized as someone who wants their life to turn out well, and who needs the help of others to rebuild that life. The person we meet might be a creative genius, but that doesn’t matter; they are always an individual human person of infinite value.

Residents I spoke to with a history of addictive illness have offered insightful comments that have guided me in my clinical role at these various nursing facilities.

“Staff make negative assumptions based on a person being homeless and self-medicating,” according to Casey. “It’s hell out on the streets; you get overcome and paranoid sometimes, and you use again,” Rod said. “Don’t tell them ‘Just get off drugs,’ but help them to get a job, a home, and social contacts,” he added. “You know, they once had a job and they were in society once; they need programs to help get back in society.” Casey said that staff should realize that for the newly admitted resident “their body is going through a metamorphosis because they are not drinking or using drugs.”

Trent pointed out that “you’re not relaxed and calm when you come into a nursing facility.” He suggested that too often caregivers have a negative attitude: “You’re busy and irritated, and it makes me irritated and angry.” Trent suggested that “it should be up to the patient if they want to talk about it [addiction].” “Too much pressure and they close up. You feel pressured by people always on your case, and telling you what to do, when you have to figure out what to do; it can be overwhelming, and you can clam up and want to be left alone,” he said.

The individual with a substance use illness will “need a little love; something like a Big Brother program for grown-ups,” said Rod. “Help them get to a place where they can at least have hope,” he said. “It’s going to take love and patience to help them rebuild themselves.” Casey suggested that nursing facilities might offer practical and age-appropriate group activities, and not simply Bingo or crafts. She suggested bringing in persons from the community to offer life skills training on how to budget, how to use the internet, how to interview for a job, how to prepare food, find an apartment, or apply for disability income. “You’ve got to help open doors to encourage people to want to do better: Give someone a reason to get up in the morning; you’re never too old to love to do something new,” she said.

I think we cannot reasonably say, “Let someone else deal with this; I’m not trained or qualified to deal with this kind of problem.” The residents I spoke with pointed out occasional shortcomings of the inpatient addiction treatment programs where they sometimes fruitlessly sought help. Frank was impressed by the practical advice and suggestions he heard during his first alcohol detox admission. He was surprised to hear the same points during his second admission, and then disappointed to find during repeated subsequent admission that “they just talk from the textbook, and they don’t really have something new to say to you.” Frank spoke of a 19-year-old woman who had been through 30 detox admissions—citing the evident insufficiency of the specialized treatment offered. The residents spoke to me about the perceived limited knowledge and understanding of some professionals with specialized credentials for treating persons with addiction. The residents stated that they could encounter negative judgmental attitudes and unhelpful advice as often in specialized in-patient treatment programs as in skilled nursing facilities.

In my own experience working with these residents, I have found it important to encourage fellow clinicians and nurses to acquire additional training and certification, yet not discount the array of skills, knowledge, and personal qualities that they already bring to bear in the service of these residents. Residents with addiction and/or psychiatric disorders tend to have developed acute BS-detectors; they observe us with an X-ray type of vision. The person with an addictive illness has a refined intuitive ability to notice the underlying attitude of the nurse or clinician who encounters them. That capacity typically emerges from the deep emotional wounds of shame that accompany an addiction. The person with the addictive illness feels under a cloud of suspicion and judgment from the first encounter. We should strive to receive that person with a wise and open heart, as well as with a wily awareness of the risks of manipulation that can also be an unfortunate part of the picture. We cannot hide or disguise attitudes of fear or revulsion or judgment from the awareness of the persons we meet and work with.

***

The encounter at the doorway is a two-way process: I encounter my personal attitudes and values and beliefs about illness, addiction, and homelessness as I also meet with a person in need of kindness and patience and practical encouragement. My own genuineness and authenticity and humility have often made the critical difference as I greet the other at the doorway of despair or new opportunity.

Our Masturbation Machines

Posted on June 30, 2022February 11, 2026 by Psychotherapy.net Team

Our Masturbation Machines

I went to greet Jacob in the waiting room. First impression? Kind.

He was in his early sixties, middleweight, face soft but handsome… aging well enough. He wore the standard-issue Silicon Valley uniform: khakis and a casual button-down shirt. He looked unremarkable. Not like someone with secrets.

As Jacob followed me through the short maze of hallways, I could feel his anxiety like waves rolling off my back. I remembered when I used to get anxious walking patients back to my office. Am I walking too fast? Am I swinging my hips? Does my ass look funny?

It seems so long ago now. I admit I’m a battle-hardened version of my former self, more stoic, possibly more indifferent. Was I a better doctor then, when I knew less and felt more?

We arrived at my office and I shut the door behind him. Gently, I offered him one of two identical, equal-in-height, two-feet-apart, green-cushioned, therapy-sanctioned chairs. He sat. So did I. His eyes took in the room.

My office is ten by fourteen feet, with two windows, a desk with a computer, a sideboard covered with books, and a low table between the chairs. The desk, the sideboard, and the low table are all made of matching reddish-brown wood. The desk is a hand-me-down from my former department chair. It’s cracked down the middle on the inside, where no one else can see it, an apt metaphor for the work I do.

On top of the desk are ten separate piles of paper, perfectly aligned, like an accordion. I am told this gives the appearance of organized efficiency.

The wall décor is a hodgepodge. The requisite diplomas, mostly unframed. Too lazy. A drawing of a cat I found in my neighbor’s garbage, which I took for the frame but kept for the cat. A multicolored tapestry of children playing in and around pagodas, a relic from my time teaching English in China in my twenties. The tapestry has a coffee stain, but it’s only visible if you know what you’re looking for, like a Rorschach.

On display is an assortment of knickknacks, mostly gifts from patients and students. There are books, poems, essays, artwork, postcards, holiday cards, letters, cartoons.

One patient, a gifted artist and musician, gave me a photograph he had taken of the Golden Gate Bridge overlain with his hand-drawn musical notes. He was no longer suicidal when he made it, yet it’s a mournful image, all grays and blacks. Another patient, a beautiful young woman embarrassed by wrinkles that only she saw and no amount of Botox could erase, gave me a clay water pitcher big enough to serve ten.

To the left of my computer, I keep a small print of Albrecht Dürer’s Melencolia 1. In the drawing, Melancholia, personified as a woman, sits in a room surrounded by the neglected tools of industry and time: a protractor, a scale, an hourglass, a hammer. Her starving dog, ribs protruding from his sunken frame, waits patiently and in vain for her to rouse herself.

To the right of my computer, a five-inch clay angel with wings wrought from wire stretches her arms skyward. The word courage is engraved at her feet. She’s a gift from a colleague who was cleaning out her office. A leftover angel. I’ll take it.

I’m grateful for this room of my own. Here, I am suspended out of time, existing in a world of secrets and dreams. But the space is also tinged with sadness and longing. When my patients leave my care, professional boundaries forbid that I contact them.

As real as our relationships are inside my office, they cannot exist outside this space. If I see my patients at the grocery store, I’m hesitant even to say hello lest I declare myself a human being with needs of my own. What, me, eat?

Years ago when I was in my psychiatry residency training, I saw my psychotherapy supervisor outside his office for the first time. He emerged from a shop wearing a trench coat and an Indiana Jones–style fedora. He looked like he’d just stepped off the cover of a J. Peterman catalogue. The experience was jarring.

I’d shared many intimate details of my life with him, and he had counseled me as he would a patient. I had not thought of him as a hat person. To me, it suggested a preoccupation with personal appearance that was at odds with the idealized version I had of him. But most of all, it made me aware of how disconcerting it might be for my own patients to see me outside my office.

I turned to Jacob and began. “What can I help you with?”

Other beginnings I’ve evolved over time include: “Tell me why you’re here,” “What brings you in today,” and even “Start at the beginning, wherever that is for you.”

Jacob looked me over. “I am hoping,” he said in a thick Eastern European accent, “you would be a man.”

I knew then we would be talking about sex.

“Why?” I asked, feigning ignorance.

“Because it might be hard for you, a woman, to hear about my problems.”

“I can assure you I’ve heard almost everything there is to hear.”

“You see,” he stumbled, looking shyly at me, “I have the sex addiction.”

I nodded and settled into my chair. “Go on…”

Every patient is an unopened package, an unread novel, an unexplored land. A patient once described to me how rock-climbing feels: When he’s on the wall, nothing exists but infinite rock face juxtaposed against the finite decision of where next to put each finger and toe. Practicing psychotherapy is not unlike rock climbing. I immerse myself in story, the telling and retelling, and the rest falls away.

I’ve heard many variations on the tales of human suffering, but Jacob’s story shocked me. What disturbed me most was what it implied about the world we live in now, the world we’re leaving to our children.

Jacob started right in with a childhood memory. No preamble. Freud would have been proud.

“I masturbated first time when I was two or three years old,” he said. The memory was vivid for him. I could see it on his face.

“I am on the moon,” he continued, “but it is not really the moon. There is a person there like a God… and I have sexual experience which I don’t recognize…”

I took moon to mean something like the abyss, nowhere and everywhere simultaneously. But what of God? Aren’t we all yearning for something beyond ourselves?

As a young schoolboy, Jacob was a dreamer: buttons out of order, chalk on his hands and sleeves, the first to look out the window during lessons, and the last to leave the classroom for the day. He masturbated regularly by the time he was eight years old. Sometimes alone, sometimes with his best friend. They had not yet learned to be ashamed.

But after his First Communion, he was awakened to the idea of masturbation as a “mortal sin.” From then on, he only masturbated alone, and he visited the Catholic priest of his family’s local church every Friday to confess.

“I masturbate,” he whispered through the latticed opening of the confessional.

“How many times?” asked the priest.

“Every day.”

Pause. “Don’t do it again.”

Jacob stopped talking and looked at me. We shared a small smile of understanding. If such straightforward admonitions solved the problem, I would be out of a job.

Jacob the boy was determined to obey, to be “good,” and so he clenched his fists and didn’t touch himself there. But his resolve only ever lasted two or three days.

“That,” he said, “was the beginning of my double life.”

The term double life is as familiar to me as ST segment elevation is to the cardiologist, Stage IV is to the oncologist, and Hemoglobin A1C is to the endocrinologist. It refers to the addicted person’s secret engagement with drugs, alcohol, or other compulsive behaviors, hidden from view, even in some cases from their own.

Throughout his teens, Jacob returned from school, went to the attic, and masturbated to a drawing of the Greek goddess Aphrodite he had copied from a textbook and hidden between the wooden floorboards. He would later look on this period of his life as a time of innocence.

At eighteen he moved to live with his older sister in the city to study physics and engineering at the university there. His sister was gone much of the day working, and for the first time in his life, he was alone for long stretches. He was lonely.

“So I decided to make a machine…”

“A machine?” I asked, sitting up a little straighter.

“A masturbation machine.”

I hesitated. “I see. How did it work?”

Not unlike Jacob, we are at risk of titillating ourselves to death.

Seventy percent of world global deaths are attributable to modifiable behavioral risk factors like smoking, physical inactivity, and diet. The leading global risks for mortality are high blood pressure (13 percent), tobacco use (9 percent), high blood sugar (6 percent), physical inactivity (6 percent), and obesity (5 percent). In 2013, an estimated 2.1 billion adults were overweight, compared with 857 million in 1980. There are now more people worldwide, except in parts of sub-Saharan Africa and Asia, who are obese than who are underweight.

Rates of addiction are rising the world over. The disease burden attributed to alcohol and illicit drug addiction is 1.5 percent globally, and more than 5 percent in the United States. These data exclude tobacco consumption. Drug of choice varies by country. The US is dominated by illicit drugs, Russia and Eastern Europe by alcohol addiction.

Global deaths from addiction have risen in all age groups between 1990 and 2017, with more than half the deaths occurring in people younger than fifty years of age.

The poor and undereducated, especially those living in rich nations, are most susceptible to the problem of compulsive overconsumption. They have easy access to high-reward, high-potency, high-novelty drugs at the same time that they lack access to meaningful work, safe housing, quality education, affordable health care, and race and class equality before the law. This creates a dangerous nexus of addiction risk.

Princeton economists Anne Case and Angus Deaton have shown that middle-aged white Americans without a college degree are dying younger than their parents, grandparents, and great-grandparents. The top three leading causes of death in this group are drug overdoses, alcohol-related liver disease, and suicides. Case and Deaton have aptly called this phenomenon “deaths of despair.”

Our compulsive overconsumption risks not just our demise and death but also that of our planet.

The world’s natural resources are rapidly diminishing. Economists estimate that in 2040 the world’s natural capital (lands, forests, fisheries, fuels) will be 21 percent less in high-income countries and 17 percent less in poorer countries than today. Meanwhile, carbon emissions will grow by 7 percent in high-income countries and 44 percent in the rest of the world.

We are devouring ourselves.

***

From Dopamine Nation: Finding Balance in the Age of Consumption by Anna Lembke M.D., published by Dutton, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC.

Making Clichés Work in Therapy

Posted on June 28, 2022February 11, 2026 by Psychotherapy.net Team

My work with Nathaniel was focused on the growing intensity of his depression. Things were going badly at work, his intimate relationship was not providing him joy, and he felt increasingly lethargic and unmotivated. His affect was flat and his voice emotionless as he assessed his life through the lens of this depression. I reflected these feelings back to him, showing him the picture he had just painted. Nathaniel seemed to take it in and as we sat with it for a bit and expressed hope that one day he’d get over the sadness. I assured him he would but acknowledged the frustration that comes with not knowing when a bout of depression will end or what can be done to make it end. Nathaniel sighed and said, “I guess the sun'll come out tomorrow.” He groaned and slumped down further down in his seat, as if that phrase had just added rather than reduced the weight of his sadness.

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Phillipa had goals. Our main topic of discussion was dissatisfaction with her career. She was, however, in the process of taking steps to change this. She was exploring other areas of professional interest and talking to people in those fields, preparing both logistically and emotionally to engage in the kind of change she had expressed a desire to experience. After a few sessions in which she felt hopeful and inspired based on positive feedback from friends and family, Phillipa was riding high, until our most recent session, that is, when she learned that the career she most wanted to pursue required an advanced degree that she felt she was not in a position to pursue. Phillipa shook her head forlornly as she verbalized her frustrations, saying, “It just feels like it’s always two steps forward, one step back.”

Ravena craved a committed romantic relationship. We had identified her pattern regarding the development of these types of relationships, and her frustration that they did not end up in the place that she wanted. There was a cycle of intense attraction at first, with both emotional and physical connection, but these enjoyable beginnings always devolved into conflict, with Ravena experiencing difficulty understanding her instincts regarding boundaries and intimacy, and frustration that her instincts seemed to run counter to what she wanted. Ravena became more open to exploring her family of origin and the type of relationship modeling her parents provided, and our work became more about identifying how the best way to work towards positive relationships in the present was to examine the lessons imprinted on her from the past. “I guess I just have to learn to love myself before I can love someone else,” said Ravena, as she rubbed her temples and laughed bitterly in a physical manifestation of the frustration she was feeling inside.

***

These examples of work with clients are both specific to my experience as a therapist and universal to what it means to be human. The vignettes all demonstrate how, when assessing their progress and desires in therapy, clients often come to a point where they express their feelings and insights through cliché, and how the use of that cliché usually has a negative connotation. Why is this? Why does something as simple and universal as a cliché seem to leave such a bad taste in the mouths of these clients?

A cliché is an overused phrase or opinion that can often mimic an original thought or even epiphany. We call something a cliché when we’ve heard it a million times, so often that any meaning it once had has been eclipsed by our collective shrug when we hear it again. We sometimes experience negative thoughts about ourselves when we use these clichés because it implies we are lacking in original thought. And for some reason, to be lacking in original thought is a bad thing. We should suffer in original ways!

In addition, the fact that we are in therapy can color our response to clichés. When our clients are out in the world interacting with friends and family, they might find themselves using a phrase like “It’s always darkest before the dawn” or the classic “It is what it is” and feel okay about it. Or, more specifically, they don’t feel bad about it. The use of a cliché in these situations seems to pass by without much consideration, with no bad emotional taste being left in the cliché user’s mouth. However, in session our clients are at their most vulnerable, and often come in already feeling depressed or anxious or unsettled, and this baseline combined with the triteness of a cliché can make them feel worse. It’s a common reaction, and a wonderful opportunity to explore what these particular clichés mean and why our clients react the way they do, both in terms of what the clichés mean in general and what they mean to them.

Nathaniel seemed more depressed when he said that the sun will come out tomorrow. It seemed that in trying to make himself feel better, he had actually created more material to be depressed about. I mentioned Nathaniel’s mood and his reaction to the cliché, which he immediately responded to, almost eager to talk about how using this particular cliché made him somehow feel worse, even though the intended outcome was the opposite. I spoke a little about the meaning of clichés, how they come into existence, trying to work backwards from their origin to their original intent. We imagined the first person to use this phrase long ago, perhaps to cheer up a sad friend, and how that friend might have reacted. Nathaniel admitted that yes, this long-ago friend must certainly have been cheered up by this realization that the sun will come out the next day. We took turns interpreting what “the sun will come out tomorrow” actually means, both in terms of life in general and Nathaniel’s specific situation. By the end of the conversation, Nathaniel was sitting up in his chair, was more engaged, and spoke with more passion in his voice. I noted this, and Nathaniel admitted that he felt better. Talking more about clichés and how we react to them helped in this case. Our cliché journey had come full circle, from inspirational to trite and back to inspirational again.

Phillipa became frustrated at the first sign of resistance. After weeks of positive feedback and relative success, she would shut down at the first sign of trouble. She took plenty of steps forward, but those one-step-backs were devastating. We examined more closely the cliché about taking two steps forward and one step back, how this fit into a pattern for her like a dance step. When do we usually talk about things in terms of two steps forward, one step back? It’s usually when we have a goal and that goal feels like it’s far off in the distance, and we are slowly getting closer to it but we’re not moving fast enough to get over the frustration of not being there yet. I assured Phillipa that experiencing this cycle could just as easily be construed as a good thing. Two steps forward minus one step back equals a net gain of one step! For Phillipa, the frustration of not reaching the goal was eclipsing the very real process she was making. Our work together became about reframing the cliché as actually taking one step back from a kind of failure into a healthy break on the path of overall progress, as a necessary step in the dance of personal growth. Examining this cliché helped us realize together that the one step back is just as important as the two steps forward, and in the process we normalized that one backward step.

Ravena was so concerned with finding a partner that she had never pictured herself being alone. Just the idea of talking about what it would be like to live life by herself without a partner made her uncomfortable. The cliché about loving oneself became an opportunity to explore the fear that came up when we discussed the idea of being alone. This led to some significant insight into the nature of Ravena’s intimacy issues when relationships started to become serious, and after some time working on these issues, she noted that it was nice to focus only on her and the things under her control rather than on a relationship. In later sessions when Ravena had reflected on some understanding about why she reacted to some issue in “the old way” and recognized how she could change it, I noted that it seemed like she was really learning to love herself. This time the cliché was met with a smile and a knowing laugh.

***

Something about talk therapy I particularly enjoy is when the client and I identify a simple thought, perhaps one that is a part of the very foundation of how we see ourselves, and we turn this thought on its head. We examine it from a different perspective. We ask if this thought is still valid. When this occurs, things clients assumed they already knew transformed into opportunities for self-exploration and growth. I also react similarly when a client uses a cliché in a sad, pessimistic way. We take that seeming truth, turn it on its head, and ask, “Why does this cliché that purports to make us happier make us feel just the opposite? Let’s discuss.” This often results in clients begrudgingly admitting that yes, these clichés do have value, and sure, “maybe I should feel better than I do about using this cliché, and perhaps maybe even feel better about my life in general.” These cliché-dependent clients often benefit from the realization that they don’t have to feel bad about engaging in a cliché or have to necessarily feel better just because they happened upon on in a moment of seeming clarity. Sure, it’s trite, but let’s own that. It’s okay to feel trite. Better trite than depressed! Let’s give ourselves permission to not be original. I like to tell my clients that if they find themselves using clichés more often, it’s not something to sulk about, it’s a good thing. It means they can and often do actually see the light at the end of the tunnel and smell the greener grass on the other side of the street. Using and then mining the clichés can be and often are a sign that they are on the right path!

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Author: Psychotherapy.net Team

Perfectionism in Highly Intelligent Clients: Therapeutic Strategies

Need Management Therapy: A Clinical GPS for Couples Work

The Woes of Being Novice

A New, Brighter Day

Need Management Therapy

A Personal Addendum

The Secret to Successful Couples Therapy: Empathy Over Doubt

May You Practice in Interesting Times: An Invitation

Judgmental Health

Trauma Survivors React to Overturning Roe

Full Container

Too Soon?

Release and Containment

I Lost a Child Too

The Encounter at the Doorway

Our Masturbation Machines

Our Masturbation Machines

Making Clichés Work in Therapy