Approach Archives - Page 35 of 41

Nancy McWilliams on Psychoanalytic Psychotherapy and Psychoanalysis

Posted on December 6, 2010February 11, 2026 by rezendevknowfully.com

Making Psychoanalytic Theory Accessible

Louis Roussel: In all of your books—Psychoanalytic Diagnosis, Psychoanalytic Case Formulation, and Psychoanalytic Psychotherapy—you're able to bring the essential features of psychoanalytic thinking into a language that is both accessible and practically useful, particularly for clinicians who are just beginning to familiarize themselves with these concepts. This is a vital project, in my opinion, particularly given the many misunderstandings and prejudices against psychoanalysis in contemporary Western culture. I wonder if you could say something about why this is so personally meaningful for you.

Nancy McWilliams: I come from a whole family of teachers, and I have had a teaching component to my career since the early 1960s if you count my years as a camp counselor, and at the college level since about 1970 in one form or another. So for a very long time, if I wanted to get people interested in the stuff that fascinated me I had to make it accessible to them.

I taught an undergraduate course in theories in psychotherapy for several years with people who had really no background in psychoanalytic thinking, and I slowly developed a kind of skill, I guess, in making it relevant to people's ordinary lives, as opposed to talking to other scholars or theorists in the field.

LR: Speaking to other colleagues and scholars in the field, I was quite struck with one comment that you made in your most recent book, Psychoanalytic Psychotherapy, that the contemporary psychotherapy field is one that is incredibly pluralistic, with many competing theories of clinical work. And there was a point where you spoke of how each of these theoretical perspectives really represents a unique understanding of very complex, multifaceted human problems and dilemmas.

And you spoke about suggesting a style of listening to alternative theories that is analogous to how a clinician might actually listen to a client in psychotherapy. I was particularly moved by that, especially given that it seems like that's not an easy listening stance to achieve, particularly with colleagues.

NM: I learned that there are a lot of identity issues involved in people becoming therapists and they tend to get organized around one theory or sensibility when becoming being a therapist. But all of us are looking at the suffering human animal and trying to be helpful, and eventually we're all going to learn similar things and have different language for talking about it.

I have tried to fight the tendencies in me that presume a position of knowing more than other people or making them the devalued other.

I have tried to fight the tendencies in me that presume a position of knowing more than other people or making them the devalued other. It's a natural human thing to do, but a lot of grief comes from it.

I've learned enormous amounts from people of very different paradigms than my own. You not only find a lot of common ground, but you find the areas where your own particular point of view has blind spots.

LR: Absolutely. As I was looking through some of your writings, there were a number of points where it seemed that you linked psychoanalysis with larger social political issues. You quoted one of the local analysts here in San Francisco, Michael Guy Thompson, when he spoke about psychoanalysis as an unremittingly subversive practice which gives voice to that which is most denied by the larger prevailing culture.

I was struck by that, because I think psychoanalysis is characterized in some ways as more conformist than I think its true essential nature is.

NM: I came to psychoanalysis not through psychology but through political science. My first experience reading Freud was as a junior in college, when my political science professor suggested I had a kind of psychological sensibility, so perhaps for my honor's thesis in political theory I'd like to read Civilization and its Discontents and talk about Freud's political theory. That's what sort of started me down this path.

I really found in the psychoanalytic movement a very subversive kind of orientation toward the world, and there were only a couple of decades where, for various interacting reasons, psychoanalysis was highly prestigious in American culture. During those decades of roughly the 1950s and 1960s, it was a quick way to prestige in the medical establishment if you were a psychiatrist. The way to get moving ahead in your discipline was to get psychoanalytic training, and that pretty much guaranteed you eventually a leadership position in the department of psychiatry. But that was sort of a fluke of the times, and it's behind us now.

I'm actually kind of happy it's behind us, because during those years a lot of people were attracted to psychoanalysis not because they loved it or they were really curious about the unconscious. They were attracted to it for narcissistic reasons, and they didn't tend to make very good therapists because they liked being right. They didn't like being surprised. They took a superior position toward their patients and talked down to them.

Many of the current troubles in psychoanalysis come from an era where people spoke rather arrogantly. They felt they were in the chosen profession.

Many of the current troubles in psychoanalysis come from an era where people spoke rather arrogantly. They felt they were in the chosen profession. I don't think psychoanalysis does very well when it's culturally at the center; it does much better from a point of view of marginality in describing things that the culture doesn't necessarily see so easily.

Therapy on the Margins

LR: That’s an excellent point. It almost seems as if the loss of prestige and the marginalization of psychoanalysis in some ways is connecting us with the beginnings of the movement. In the early days, it was quite a risk to become an analyst, and involved sacrificing more established, secure careers. Today, psychoanalytic practice is not the most popular road to go down.

NM: I do think it's very hard on contemporary students who fall in love with psychoanalysis and want to work in depth with people. Corporate agendas tend to have an awful lot of power in this culture, and it's in the interest of both insurance companies and drug companies to describe human suffering in a fairly superficial way and to apply either a drug or a short-term treatment to it.

These are hard times economically. People who want to really get to know their patients in all their complexity have to fight against some of the pressures to oversimplify things and do some quick-fix intervention. I think we've seen a paradigm shift from a cultural understanding that psychotherapy is a healing relationship in which you might use several different kinds of techniques, but the healing relationship is the definitional part of it. It's been redefined as a set of techniques that are applied to discrete disorder categories. It's moved therapists from being healers to being technicians—and often technicians at the behest of the larger culture, which has an interest in putting people in the cogs that exist in the great commercial machine, and not necessarily increasing the meaningfulness of life or the satisfactions of life.

LR: In your most recent book, Psychoanalytic Psychotherapy, you spoke of how psychotherapists in general tend to devalue what we do—activities that we view as passive and receptive, like listening, for example—and overvalue those based on doing, producing, manufacturing, achieving.

This speaks a little bit to what you were just touching on in terms of what is most valued in our Zeitgeist, and yet, what may not be in the best interest of our psychic health.

NM: Yes. I seem to be seeing more and more people lately that are coming to me for anxiety or depression or an eating disorder or something Axis I-ish, who, when I actually listen to their story, they aren't living a livable life. They're commuting one and a half hours to work. They're staying at work from 8:00 in the morning until 7:00 at night. They barely see their children.

They're trying to take care of a house, a summer house, a couple of kids, a boat—if they're people of reasonable means—elderly parents, a dog. And they're just driven. The culture seems to tell them that they should be happy this way. And of course, that's not a livable life. It's just crazy.

LR: Exactly. It’s quite an alienated existence you just described.

NM: Yes.

Psychoanalytic Love

LR: I was also very interested in something that I don't think analysts necessarily speak enough about. You spoke about psychoanalytic love, and this tension that I think clinicians face: How is it that we can basically accept someone in a very deep way in terms of who they are as a person, but still be on the side of growth and change?

NM: I don't think that being a therapist is like being a parent in most respects. But in terms of the affects involved, it's not too different. You deeply love your kids, but you also have hopes that they'll be their best self—not be satisfied with living a kind of minimal existence.

So I don't think that deeply loving people means that you have no hopes for their doing better.

So I don't think that deeply loving people means that you have no hopes for their doing better.

I think all the empirical literature on what's effective in psychotherapy, not just psychoanalytic therapy, ends up emphasizing relationship and personality. And when you talk about relationship or about the working alliance, you're talking about the two parties making an attachment to each other, which is just a fancy word for love. It certainly includes hatred and all the other affects, but it's a commitment. There's a kind of devotion that characterizes a therapeutic relationship in which somebody can grow. And we haven't talked too much about that.

We have some theories of it that are sentimentalized. You can't decide you're going to love somebody into health, but if you make a genuine authentic relationship with somebody and try to be honest with them, be honest with yourself, and help them increase their honesty with themselves, you're talking about a relationship characterized by love. You're accepting who they are, including all their darker parts. They're tolerating who you are, including all your mistakes and failures. And that sounds like love to me.

On Failure

LR: There have been some analysts who have talked about how we can't accept a patient into analysis, especially given the nature of the deep intimacy and the depth of emotional involvement unless, we have a deep sense that we like them. And yet I can think of many examples from my own experience where that feeling wasn't there at the beginning but it emerged later.

NM: Yes. On the subject of experiences where I felt like somehow I couldn’t get a therapeutic relationship really going, that’s happened many times to me, where I have failed with somebody. Sometimes I thought I failed, and many years later I find out that the patient really felt that they got something important. And other times I thought I’ve done a pretty good job, and I later find out that I missed something important.

You can’t be in this business for too many years without getting humbled about how little you really know.

LR: Yes, definitely.

NM: One person recently came back to me after 30 years, and I thought I had bombed with her. I was surprised that she came back to me, and, I reminded her that we kind of fizzled out. We both decided at a certain point that the therapy didn't seem to be moving. I asked her to just think out loud about what had happened.

What came out was a story about how, when she was little, her mother wanted her to be a musician, and she had no musical ear at all. Her mother's agenda was that she was going to be a great performer. She practiced and practiced, and went through excruciating performances, and tried to be good–and just didn't quite succeed.

I realized as she was talking about this that when I first worked with her, I was so excited that I had somebody that I thought was a good candidate to put on the couch and do real psychoanalysis with, that what I had enacted was, I was like her mother in wanting to fit her to a technique that I wanted to do, that really didn't suit her.

When we talked about that 30 years later, we decided that we would work face to face, and I would be more disclosing. I think we worked much better the second time around. You don't usually get the chance to undo your original mistakes.

In that case, I think that was a narcissistic thing. I wanted to see myself as an analyst, and here was a person that I thought I could put on the couch and ask to free associate. And I ended up replicating a childhood scene where the agenda of the authority didn't fit the particular inclinations of the kid—or the patient, in this case.

LR: This is so interesting in terms of having a particular valued notion in mind of what we would like to see happen, and how that can compete with how the analysis is actually meant to unfold.

I wonder if that also comes up in teaching, particularly teaching psychoanalysis. I have discovered that teaching psychoanalysis today requires a much greater level of flexibility and attunement to how students are, including some of the resistances that they sometimes come in with, related to stereotypical notions about psychoanalysis.

NM:

Teaching Psychoanalysis

I'm finding that students know a lot less about psychoanalytic ideas. Some of them have been very explicitly told that psychoanalysis has been empirically discredited, which is patently untrue. But there are a lot of academics that believe that.

Part of the reason for that is that there is an increased schism between academics and therapists at this point, for numerous sociological reasons. It used to be common that people who taught abnormal psychology might have a small private practice and know what it's like to be in the trenches trying to help suffering people. Now, it's so much harder to get promotion and tenure that they'd be crazy to do that. They have to chase grants. They have to turn out short-term studies and get a publications list.

So academics' image of therapists is often wildly off base from the therapeutic community as it actually exists. They tend to think that therapists apply their theory uncritically rather than try to adapt to every patient flexibly. So students are taught all that old psychoanalytic stuff, especially drive theory.

I haven't heard an analyst talk in terms of drive theory for at least 30 years. But the academics tend to think that psychoanalysis stopped in 1923.

I haven't heard an analyst talk in terms of drive theory for at least 30 years. But the academics tend to think that psychoanalysis stopped in 1923.

So students come in not knowing that there has been a whole scholarly evolution of psychoanalytic theory. One of the reasons they don't know this is that analysts pretty much pursue their interests in freestanding institutes and not in the academy, so there hasn't been cross-fertilization there. Analysts, I think, are to a great extent responsible for some of the estrangement with academic psychologists, because they wanted to develop in communities of their own.

So students now come to us with very little exposure to what's central to the psychoanalytic community. And we have to adapt to that. I've been asked in recent years, “What is the meaning of the term ‘transference’?” — something that any graduate student would have known 10 years ago. One student not long ago asked me what the term “ambivalent” meant.

On the other hand, as they get taught various cognitive behavioral techniques and so forth, they are often learning stuff that's very parallel to psychoanalytic learning. Some of what Marcia Linehan does is not too different from what Peter Fonagy or Otto Kernberg does. She just speaks a very different language. Jeffrey Young’s schema therapy is not too different from psychoanalytic ideas about organizing motifs in people. But students tend not to know that.

On Political Involvement

LR: Going back to something we talked about a before regarding the political and social dimension of psychoanalysis, it seems like in some ways the analyst is in a position where she or he could potentially make a valuable contribution in terms of speaking on the larger societal level, and yet it seems to rarely occur.

NM: Yes. It's an interesting thing. It used to occur. Certainly, Erich Fromm spoke a lot at that level. Robert Lifton and Karen Horney certainly did. There were a lot of social commentaries from analysts a few decades back—not so much now. Eric Erikson would be another good example, or Robert Coles addressing the problems of the poor and the marginal. But I think that was part of that European sensibility.

We're a little bit more narrow in the United States. We're a little bit more pragmatic. We're more optimistic—"let's figure out what this is and fix it."

A big part of the psychoanalytic sensibility is trying to help people accept what can't be changed. But that goes contrary to an American conceit that you can be anything you want to be, which, to me, is a pretty psychotic belief. I might want to be a giraffe; I'm not going to get there. But we actually raise our kids saying, "You can be anything you want to be."

And that's the kind of language of a young country that has enormous resources and not too many limits. I don't think it's the best language for us anymore, but we're kind of stuck with it. The sensibility of people who've lived with more limitation than Americans have is, I think, good for us to take in.

But I have to say that an awful lot of what psychoanalysis contributed to the United States had to do with people coming over before or during the Holocaust and having a kind of broad European learning that's not that common in the United States. And that whole generation has pretty much died off now. But they enriched not just psychology—they enriched the social sciences, the natural sciences, mathematics. We had an awful lot of very, very bright people who had a more wide-ranging set of interests than is typical for the pragmatic American sensibility.

The Future of Psychoanalysis

LR: Yes, that's so true. I wonder if you could say something about your sense of the future of psychoanalysis. Since its inception, since Freud's early days, psychoanalysis has been declared dead many times, and the decade within which we live is no exception.

There are certainly many who speak about psychoanalysis disparagingly as something antiquated, as no longer relevant. And there are those who even go so far as to say that psychoanalysis has reached a tipping point and we're on the decline and facing extinction. I don't share those views, but I wonder what about your sense of what psychoanalysis's future might hold.

NM: I'm not sure. I have my optimistic days and my pessimistic days. I think psychoanalysis will endure because we help people. They know it. They tell their friends. I see many people who've tried many other things, and they eventually come for analytic therapy and they get a lot out of it. But I don't think we're going to survive in the mainstream healthcare system.

I don't see any sign of that—at least not the more intensive, long-term, open-ended work that most of us like to do in the psychoanalytic community. I think it's hard to imagine, under the current circumstances, that the culture at large is going to support that being available for anybody but people who can afford it out-of-pocket. In the Scandinavian countries it's a little different, but they have a single-payer system.

Sweden, a few years ago, decided not to offer psychoanalysis—meaning several-times-a-week psychoanalytic work—on the national health plan, and there was a kind of grassroots objection to it and they put it back in. But I can't imagine that happening in this country. And in a few years, I think it's going to be unlikely in Sweden, because although it used to be a wealthy country, it's been stressed a little bit more in recent years. And as countries struggle, they try to cut down what they offer. So I just can't imagine that intensive long-term work is going to be supported in general.

Susan Lazar's recent book, Psychotherapy Is Worth It, really documents how cost-saving it is to get a lot of psychotherapy, even intensive psychotherapy. It saves on jail time, on sick days from work, on addictions. But most of the ways we measure the cost of healthcare is very long-term.

Insurance companies ask their benefits' managers, "How much money did you save us this year?" And people change their jobs, so they change their insurance. So they don't really have a 50-year view, or even a 10-year view, of putting out money now to do prevention in the long run.

I'm quite convinced—and there's plenty of empirical data to support this—that psychotherapy and intensive psychotherapy and psychoanalysis are very cost effective for the culture, but I don't see politically that we can make that argument effectively. So I think we'll become a kind of therapy that people will get privately.

Advice to Aspiring Therapists

LR: Yes, that’s true. If you had to give one piece of advice, maybe something you only discovered through a lot of personal struggle and pain, what do you think it would be? What advice would you give to somebody thinking about entering the field today?

NM: I don't know that I can honestly say that I have had to go through a lot of personal struggle and pain. I have loved my work. As soon as I discovered you could actually make a living by listening to people and getting close to them and trying to help them, I was thrilled. I feel very fortunate to have been able to have the kind of career that I've had. And I don't feel it's been Sturm und Drang at all. I've had very good teachers myself. I had a very good analyst. As I'm older, I realize more than I did when I was younger how lucky I was about that, because if I had a person who was a bad match—it's a powerful kind of relationship, and it can do harm as well as good. But I had good supervisors, good teachers, good colleagues, a good analyst, and I've been just constantly fascinated by the work. I guess I would tell students to follow their passion: if this is what they want to do, they can make a living doing it.

LR: Well, that’s great. Yes, that’s certainly been my experience. It seems like we’ve covered a lot of ground here. Is there anything else that you’d like to speak to?

NM:

Take to the Streets

The sermon I've been giving to psychoanalytic audiences lately is get out of your offices and talk to people outside the psychoanalytic community.

We have something very precious and valuable, and we can talk to each other about it until the cows come home, but

I think we have some responsibility to be socially useful and apply some of the knowledge to social problems and to making people's lives better—not just in the consultation room, but in the culture as a whole.

We should be talking about things like why the teenage suicide rate has gone up so high, and what our ideas are about the obesity epidemic, and what are the strains of contemporary life. When you were asked before about people who have commented more on the social level, and I was naming people like Erich Fromm, there are a few people now.

Christopher Lasch is dead, but he was trying to talk about that in recent decades. Jonathan Lear tries to talk about it. There are people that are trying to talk to the larger public about some of the knowledge that we've accrued over 100 years of listening carefully to people and their struggles, and I'd like to see us take to the streets more than we typically do.

LR: Do you have a sense of why we don’t?

NM: Part of it, I think, is that it involves being quite visible, including to our patients, and some of our patients are terribly upset when they see us out of role. I think analysts get very conservative about what they do because we’ve all had experiences of a patient being devastated when they find out when we have a different political belief from them, or that they disagree with something, or they’re ashamed of us. I think it’s very inhibiting being a therapist.

LR: I really appreciate your talking with me. This has been very enjoyable, and I've learned a lot.

NM: Thank you. I loved your questions and it was fun to have this conversation.

Bids for Emotional Connection in Couples Therapy

Posted on November 15, 2010February 11, 2026 by Psychotherapy.net Team

John Gottman’s concept, “bids for emotional connection,” is practically a complete theory of relationships in itself. Hearing the word “bids,” we picture partners reaching out to each other in a variety of ways. Gary Chapman, in his book, The Five Love Languages, lists five such ways: words of affirmation (“That situation was delicate and you really handled it beautifully”), touch (“How about a hug?”), quality time (“Let’s get a babysitter and make a reservation at Chez Alouette”), gifts (“This scarf was so gorgeous, it had your name on it”), and acts of service (“Why don’t you take a nap while I do the cleaning up?”).

Partners make bids to create, increase, maintain, and re-establish connection. Arriving home at the end of a day, we ask: “How was work today?” Noticing that our partner is preoccupied, we say, “What are you thinking?” Sensing something amiss, we send out a probe: “Are you upset with me about something?”

“Bids” are the active ingredient in a relationship. Gottman shows how people make bids in the fine grain of everyday life, often without knowing they are doing it: “Did you hear about…,” or “You’ll never guess what my sister told me today.” A lot is going on all the time in the form of these little signals that partners are often unaware of sending. These signals—these bids—are nonverbal as well as verbal: a wink, a smile, a shoulder rub, a gentle shove, or a mutual look of understanding about a friend’s quirks. What matters, Gottman suggests, is not depth of intimacy in conversation, or even agreement or disagreement, but rather how people pay attention to each other no matter what they talk about or do. What matters is the quality of attention, as my partner, Dorothy Kaufmann, puts it.

What the person making the bid wants, of course, is a positive response (“Oh yes—tell me. Your sister always has such a special angle on things”). What that partner doesn’t want is an angry response (“Don’t bother me; I’m not finished with the paper yet”) or no response (grunting in acknowledgement and continuing to read the paper). Borrowing terminology from Karen Horney, Gottman labels these three responses turning toward, against, and away.

Gottman’s major point is that repeated failure to turn toward in response to our partner’s bids leads our partner to stop making bids. The relationship sags and both partners feel lonely. Couples frequently find themselves in a devitalized relationship without knowing how they got there. Turning away or against their partner’s bids for emotional connection is how they got there.

Susan Johnson’s Emotionally Focused Therapy can be viewed in these terms. She focuses on the traumatic effect of having our bids for emotional connection rejected or ignored (our partner turns against or away), resulting in our being afraid to make further bids and, instead, attacking or withdrawing (turning against or away) in turn.

If turning away or against is a problem, shouldn’t we try always to turn toward? Perhaps. But forcing ourselves to be nice when we don’t feel nice also leads to devitalization or to a buildup of resentment that culminates in an explosion. And we may not always be able to turn toward; the impulse to turn away or against may be automatic or overpowering. Furthermore, the original bid might have been made in a manner that provokes a negative response—that is, it might have been offered anxiously, demandingly, reproachfully, or failing to take account of what the other is doing or feeling at the moment. Gottman says that temper tantrums may be bids in some situations.

But maybe we can create a vantage point above the fray—a platform—from which to report that we have turned away or against. We can say, “I know I’m over the top.” Or, “Wow, you don’t deserve my snapping at you like this.” Or, “I know I’m lousy company at the moment; I’m caught up in writing this thing.” We would be bringing our partners in on our concern that we are not doing right by them. We would be turning toward by acknowledging that we have turned away or against.

But it is difficult to be self-reflective in the heat of the moment. It would be easier to go to our partners later and say, “I was so focused on making that last paragraph work that I hardly said hello when you came in last night. I feel bad about it.” Or, “I hate how irritable I’ve been lately, and I’m sure you hate it even more.” Or, “I know I gave you a tough time when you made me those perfectly wonderful eggs this morning. I must have been still fuming over that comment you made Saturday.” Or “I keep forgetting that when you blow up like that it’s because you’re hurt.”

We would be making a bid to reconnect after having previously ignored or rejected our partner’s bid. We would be reconnecting in the act of talking about how we had been disconnected. We would be talking intimately about not having been intimate—which is perhaps the ultimate intimacy and the fullest way we can join.

Mark Epstein on Mindfulness and Psychotherapy

Posted on October 31, 2010February 25, 2026 by rezendevknowfully.com

Buddhism and Psychotherapy

David Bullard: Mark, I am very grateful and thankful that you found the time for this interview in the midst of a wonderful three-day workshop on Buddhism and Psychotherapy, which you are presenting in tandem with Tenzin Robert Thurman at Menla Mountain Institute. I’ve probably done this interview 40 times in the last couple of weeks, but this will be different because you are actually here this time! In preparation, I’ve considered a series of questions which led into more questions, and have already gotten a huge gift from the anticipation of having this time together. On the other hand, this interview should probably be organic and free-form, and grow from our being in the present rather than from a pre-selected list of questions.

Mark Epstein: Well, it’s great that you’ve been thinking about it so much, and to have really thoughtful questions formed could be very helpful.

DB: It could be, and that’s my desire. You’ve written a lot about the nature of desire and disappointment—we’ll have to see which this will be!

ME: Trust in your desire. We’ll get into that.

DB: Let’s begin with a brief review of your extensive writings on the integration of Buddhism and psychotherapy from psychoanalytic and psychodynamic perspectives, which include wonderful examples of your own process and journey. You have published five very influential books, as well as many articles and chapters; you have taught at NYU and have participated in many workshops, and, of course, continue your private practice. In Open to Desire: The Truth About What the Buddha Taught, your acknowledgement section lists 60 people, so you are certainly well connected in your professional and personal lives. I personally have also enjoyed your chapter “From Eros to Enlightenment” in Brilliant Sanity: Buddhist Approaches to Psychotherapy. So shall we begin the interview with your first exposure to Buddhist teachers and how they were helpful to you?

Buddhist and Psychotherapy Teachers

ME: I came to my first Buddhist teachers after a very short experience with psychotherapy; so those first encounters were framed with a beginning attempt to seek therapeutic help for myself at the student health services at Harvard, where I was given a practitioner of short-term psychodynamic psychotherapy. This therapist met me three times and told me not to worry—my anxieties were just a result of my Oedipal complex and once I understood that, I would be fine.I went from there to a Buddhist summer camp in Boulder, Colorado where I met my first Buddhist teachers: Joseph Goldstein and Jack Kornfield. They taught me mindfulness meditation, in which I learned how to actually be physically with my emotional experience. They refused to name it or to encourage me to name it, but really taught me how to dig down into it and know it, with less fear. So that was the first great gift that I got from Buddhism.

DB: Can you contrast that with any particular gifts received from your psychotherapy teachers and mentors?

ME: The insights from my psychotherapy teachers were many but came later, after, to my dismay, I realized that what I was learning from Buddhism still left me sometimes struggling, especially in my relational life. So I went back to psychotherapy informed by Buddhism, and then was touched by how deftly certain of my therapists worked with my relational self in the actual interactions with them in the moment. It seemed very Buddhist to me, only active and engaged. I have examples I have written about in my books, that crystallize for me what I think I learned from these interactions.In one, a therapist suddenly interrupted me as I was clumsily trying to explain what I wanted to get out of therapy, and asked me if I was aware of how I was sitting. I found this annoying. What was wrong with the way I was sitting? But he pointed out that I was sitting on the edge of my seat. “You give yourself no support,” he said.

In another, a therapist waited patiently for me to begin a session. I sat there wide-eyed, staring at him but with nothing to say. I was remembering how a spiritual teacher of mine, Ram Dass, used to begin our private sessions that way. “Blink!” my therapist broke in. He made me see how my efforts to prolong contact with him actually diminished it, that when you stare too long at someone or something, you actually lose touch with it. He was showing me something about the rhythm of intimacy and the pull of addiction.

In a third example, I was speaking to my therapist about how ‘”part of me” was angry and “part of me” understood that I didn’t need to be angry. He looked at me with barely disguised disdain and said, “Mark, you don’t have parts.” This has served as a koan for me over the years. “I don’t have parts? What am I, then?”

DB: Could you tell us what particular thoughts you like to convey both to beginning students and experienced therapists, eager to learn or deepen their understanding of the art and science of psychotherapy through Buddhist psychology?

ME: A lot of therapists come to me with an interest in how to use Buddhist psychology to enhance their work. And often they are thinking much more concretely about “should I teach my patients to meditate,” “how can I use Buddhist wisdom to help my patients feel better and help them resolve their neuroses,” etc. I always feel that the most important way Buddhism can impact psychotherapy is by helping the therapist.

What Buddhism teaches very practically is a psychotherapeutic attitude: how to deploy psychotherapeutic attention both intrapsychically within the self and as well as interpersonally. When you are training as a psychotherapist you don’t necessarily get specific help in how to deploy that kind of attention, but Buddhism is all about that. So I try to turn it back: “Here, this is for you.” If you get something from it, maybe you will be able to make it come alive for your patients.

Evidence-Based Buddhism?

DB: I’m smiling because I know that is your emphasis, in an era that is technique-oriented or theory-driven. Which brings us to the current hot topics of “evidence-based psychotherapy” and “empirically supported psychotherapy.” It is being greatly debated with some divisiveness in psychology organizations. Can you offer us your perspective on that?

ME: I think there is a huge need to increase the cost-effective delivery of health care and to make psychotherapy understandable to the general population in terms of weighing the economic costs. In terms of doing research in what is therapeutic and isn’t, I completely appreciate that way of thinking. And yet there is something to be said for the old-fashioned, psychoanalytic “not knowing” and groping around blindly in the unconscious—being able as a therapist to create an interpersonal field in which one doesn’t know what will emerge, and yet trusting that what does emerge will potentially be therapeutic. Whether that turns out to be cost-effective or not, or operationalizable or not, we don’t know yet, but is certainly worth the study.

DB: But are there other kinds of evidence, from the accumulation of thousands of years of Buddhist teachings that have survived, together with the Buddha’s injunction that each person must explore deeply the applicability of the teachings, rather than to accept them on faith? Is this a kind of empiricism, a kind of “single case study” that Buddhism encourages?

ME: I think one has to be careful with this kind of reasoning. Just because something has survived for centuries doesn’t necessarily make it right. War has survived, for example. People thought the earth was flat for longer than they’ve accepted it being round. Buddhism has cultivated an introspective method over the centuries. It could just be a sophisticated kind of brainwashing. The scientific method is certainly capable of holding it up for study. That is already starting to happen.

DB: Yes, as we see from the labs of Richard Davidson and of Dan Siegel, among others, increasing our understanding of the impact of meditation on the brain. Many exciting issues are emerging from this collaboration between Buddhist psychology and neuroscience.In another vein, therapist Michael Yapko recently said that he counted over 400 forms of psychotherapy. The vast majority of these, even if they are helpful, won’t be studied or validated by research. So what is psychotherapy?

ME: I think there is both science and method to successful psychotherapy, depending on the character structure and issues of the person needing psychotherapy. There are clearly different methodologies that are more or less effective, which a trained therapist will have some understanding of. And how these methodologies are deployed matters a lot—the fostering of a relationship that is beneficial or potentially destructive, or that could do nothing. So I think there is a lot to learn from all of the 400 schools—they probably all have something to teach. What I remember being impressed by, in terms of the research of the efficacy for a rather healthy population, is that the type of psychotherapy is less important than the relationship which ends up being fostered between the patient and therapist. And the quality of that relationship probably contains much of whatever it is that is healing in any kind of therapy. How to define that quality, other than using worlds like “love,” and so on, I think will prove difficult, but clearly people know when there is a positive or trusting relationship, and when there isn’t.

Safety in Psychotherapy

DB: You’ve expanded a lot on Winnicott’s idea of safety as a primary issue in psychotherapy.

ME: At least the possibility of safety. One finds in psychotherapy, even working with someone where there is a positive and good relationship, that there are things that people still don’t want to talk about or don’t feel safe talking about, that might emerge after many, many years into a given treatment. So even safety is a relative concept.

DB: So safety allows you to get to the edge of what they can talk about.

ME: There is always an edge to where someone feels safe, even with a therapist with whom one feels safe.

DB: No absolute safety.

ME: Yes, no absolute safety, and some fear, some trepidation, some insecurity. Pushing into that, playing with the edge of that, is something that can happen in a working psychotherapy that keeps it alive and vital and interesting.In talking about Winnicottian issues like safety, holding environment and good-enough mothering and so on, it’s easy to conceptualize the therapist’s role as being nothing but facilitating—psychotherapy as being primarily an empathic relating. But I think that that misses what the therapeutic task actually is. Therapists, in my view, have to be very clearly themselves, to be able to come from an authentically individualized place so that they are not just emoting or communing or sympathizing, not just providing a field. They have to be really there, and at the same time have to be able to not be so present that they are filling a space too much or intruding. Winnicott is excellent about talking about the middle ground or balance between impinging or intruding and abandoning. It’s easy to misinterpret the kind of presence that Winnicott encourages as being more selfless than a good therapist has to be. Therapists have to be very clear about who they are, and be able to use their own responses and opinions, their own techniques and methods.

At the same time, a therapist has to primarily be able to wait, and wait, and wait, and wait, and not be so anxious to display his or her intelligence or understanding or insights into what they think is going on, and to trust that there will be a time when it is obvious that what needs to be said can be said.

DB: In being authentic in the way I think you are speaking, the therapist doesn’t have to be perfect, and a client or patient’s reacting to the therapist’s imperfection can be a very deep part of the therapy work, providing for relational depth. For some, it can be very important to be able to challenge one’s therapist.

ME: Yes. Well, perfection is impossible, so one will always be failing one’s patients. But if you fail too much you do them no service, so there is a balance there, too. Using the word “authentic,” however, has become a cliché—the authentic therapist being too authentic becomes inauthentic. It is their image of what an authentic person should be.

DB: Maybe you are also speaking along the lines of a quote from Jung, who was asked how one learns to become a great therapist. My recollection of his comment is: “Go and read everything written about the art and science of psychotherapy, but then forget it all before you first peer into the human soul.“

ME: We should be able to have them and not have them at the same time. I’m not sure you have to learn them and forget them. I think once you learn them they are there, but you don’t have to be restricted by them. You can use them when you need them.

Should We Desire To Have Desire?

DB: I like your modification of my paraphrase! This might be a good time to segue into issues you discussed in your book, Open to Desire. Would you like to start with the story of Nasrudin eating the peppers?

ME: I wrote the book about desire because in Buddhism, desire has a bad name. One of the shortcuts in understanding the Four Noble Truths is that the First Noble Truth is the truth of suffering—that all experience, even pleasurable experience, has a hint of unsatisfactoriness or dukkha or suffering, because we are conscious of its transience. The Second Noble Truth, the cause of suffering, is sometimes given as desire. A deeper reading of the word the Buddha used translates better as thirst, craving or clinging, but we confuse our idea of desire with the Buddha’s notion of clinging. So I think that a lot of confusion has arisen about desire. Is desire okay? Is it evil? Is it bad? Is it wrong? My sense is that even within a Buddhist framework there is desire—the desire for liberation, the desire for enlightenment. That is obviously a desire. The Buddha’s solution to the predicament of suffering wasn’t to stamp out desire per se. It was to not cling to it, or to not cling to the object of it, more to the point.I remember a phrase that came from an Indian teacher: “It’s not desire that’s the problem, it’s that your desires are too small.” I use that as a jumping-off place because the problems many people have with desire are that their desires are too small. They are locked into the seeking of pleasures that once provided a huge relief but that now, over time, repeatedly provide only a shadow of the relief that they once did. To our minds, they seem to be the only sources of relief. The Buddhist teachings are all about opening up the seeking to find other kinds of pleasure.

The story that you were referring to is where Nasrudin, who is a kind of amalgam of wise man and fool, is sitting in the marketplace eating handfuls of hot, red chili peppers and tears are weeping from his eyes. His friends come to him and they ask, “What’s with you? Why are you always eating peppers that are making you sick?” And he says, “Oh, I’m looking for a sweet one!” So the small reading of the story is that desire is the source of suffering, “so why don’t you just stop eating the peppers?”—the idea that stopping acting on desire will stop suffering. The more nuanced reading of the story is that Nasrudin, in the guise of the fool, is demonstrating the potential of desire to ultimately find something sweet for his soul. I’m not sure which reading is right.

Disappointment and Relationship

DB: I came across a quote from Soren Kierkegaard you may know from the Western philosophical tradition: “Perfect love means to love the one through whom one becomes unhappy.”Can you share some thoughts about relationship and desire, the real world of living in a relationship, and disappointments?

ME: Disappointment in love relationship is often taken as the exit door, especially in our culture where it’s become more acceptable to actually exit. In many cases, that might be the right thing to do. And it’s impossible even for a therapist to be able to say for any given person. Often as therapists we are put in the position of “should I stay or should I go,” but that is a tough call, even for the individual in the relationship. But certainly from the Buddhist perspective, and I think from a psychodynamic perspective also, there is no love without disappointment. Even in what appears to be a true or perfect love, the idea that one could rest forever in that state, and that it would last unchangingly, clearly that is too much to ask of love. So then the question arises: Should we take disappointments as a defeat, or take them as an obvious shadow of love? A lot of that is in the attitude and the ability of both partners to continually reconnect without necessarily solving those aspects of a relationship that lead to frustration, disappointment or anger. I think there is something to be learned from both the Buddhist side and the psychoanalytic side. Instinctively, not too many people know how to do that easily.

DB: At last year’s workshop on Integrating Buddhism and Psychotherapy, Columbia University Professor and Buddhist scholar Dr. Robert Thurman reported that his wife once advised him: “Bob, you are going to disappoint people, so you might as well do it sooner rather than later.” I think that embodied a lot of wisdom! A week after Bob said that, a colleague of mine who is a longtime Zen priest and psychotherapist reminded me that disappointment is a major Zen teaching.

ME: In relation to this question I always read Winnicott, who talks so beautifully about both how important it is for a mother to be able to fail her child, and how normal it is for children to hate their parents and parents to hate their children. The “good-enough” mother doesn’t need to be taught, but intuitively knows her task, in relation to her child’s anger: to simply survive, not to retaliate or abandon, but simply to survive. And I think there is something in that intuitive sense that one needs to survive, without the need to abandon. To stay in that place allows an experience of both separation and union, so that it continues to unfold in an ongoing way.

The Joy of Meditation and of Psychotherapeutic Work

DB: Is there any additional question or issue you would like to address in this brief interview?

ME: It is a little hard to talk about, because I haven’t thought it through completely, but what I have been exploring a lot lately is the Buddha’s understanding of joy or happiness that is derived not from seeking after sensual pleasures but from non-sensual or non-worldly experiences. The Buddha, in that language, was talking specifically about experiences that come in meditation, when the usual seeking after pleasure or rejecting of unpleasure is suspended and one’s experience can withdraw, though that might not be the best word—that one’s experience can relax into the nature of mind. There’s an inherent joyfulness, an inherent balance, one could say loving or shining nature, to the mind that becomes available through the deliberate renunciation of the usual attempts at maximizing pleasure.So taking that seriously, I’ve been thinking about how some aspect of that is actualized in the psychotherapeutic relationship, as well. Which also involves a tremendous amount of renunciation, both on the part of the therapist and the person in therapy.

Joy, I think, is a good word to describe the feeling tones that can be opened up in the psychotherapeutic relationship, which I think therapists have been aware of since the time of Freud but have been scared of, and which people have continually tripped over because it can lead to the suspension of renunciation and the acting out of the feelings that are evoked. But one dimension that the Buddha’s world gives to us is this sense: not of the unconscious being only a whirlpool or cesspool of destructive feelings, but also a background of joyful and loving energy that is here if we are willing to look for it, or is even here if we are receptive to it.

The Courage To Create

DB: It sounds like another book is percolating: The Joy of Therapy, perhaps!Non-therapist acquaintances of mine sometimes remark: “Oh, I could never listen to people’s problems all day!” I often reply that, although I certainly hear painful, difficult and tragic life issues, I also hear of the courage in people’s struggles, and they also share their joyful moments of delight, aliveness, and triumph. It is a privilege to be able to learn deeply about the astonishing varieties of human experience. And at times, at its best, it is a form of I-Thou relationship.

I also wonder if you would feel it appropriate to describe your current personal meditation practice, if it can be so described, other than the meditation-like experience of psychotherapy?

ME: My current meditation practice? I try to sit whenever I have time for it. In the morning if I can, in the evening before bed if the time is available. After reading the New York Times. And I try to go away on retreat (for a week if I am lucky) every year or two.

DB: In ending this talk with you, I am remembering Rollo May, who was another much-admired author I was honored to talk with many years ago. Of his many books, one of my favorites was The Courage to Create. So on behalf of all of your readers and all of the people who have been touched by you and your writing, I want to thank you for being willing to put all of these compassionate, thoughtful and wise explorations out there for us to read because it really does take courage to create.

ME: Thank you.

Working with the Unemotional in Emotionally Focused Therapy

Posted on October 27, 2010February 11, 2026 by Psychotherapy.net Team

It is pretty clear from research that focuses on how change happens in therapy, that emotional engagement is essential for significant change to occur. This is true in individual therapy (for example, research by Castonguay and by Beutler ) and it is certainly true in couple therapy (research by EFT therapists like myself). So what happens in an intervention like Emotionally Focused Couple therapy when one person emphatically denies or avoids emotion? The Boy Code insists that men are at their best when they are strong and silent. So, it is not surprising that male clients tend to deny their emotions a little more often than their female partners.

Process of change research and over 30 years of the clinical experience of numerous EFT, suggests that in fact, this does not seem to be a problem in EFT. Men who are described as “inexpressive” by their partners at the beginning of therapy seem to do very well in EFT. Now why is that?

First, it’s because as EFT therapists we have a map for emotions. For example, there are only 6-8 emotions that everyone on this planet can read on another’s face and assign a similar meaning to. The main difficult emotions that come up in couple therapy are reactive anger, sadness, shame and fear of rejection and abandonment. If you understand emotions, you can help people make coherent sense of them. Once you and your client find the order and logic in an emotion, it is much easier to deal with and work with. Emotions are the most powerful music in the dance called a love relationship and EFT therapists learn how to shape that music and use that music to guide partners into new dance steps.

Second, EFT therapists are emotion detectives. They know emotions are wired into our brains and they have simple, safe, systematic ways of helping folks access and explore them. So, Jim will say in session 8 of EFT, “I used to think I was just frustrated, angry in these fights with my wife; but now I see that mostly I am afraid. It’s a relief to get this – to understand my own feelings and to be able to ask my wife for reassurance rather than stomping around the house in a huff or zoning out and withdrawing into my loneliness.”

Third, tuning into your emotions, especially your fears and longings and shaping these into new messages to your partner WORKS. It is what securely bonded folks naturally do. It pulls our partner close to us and this connection sparks little floods of the cuddle hormone, oxytocin, in our brain. The calm contentment and a sense of belonging that oxytocin induces is the ultimate reward for our kind – little bonding mammals that we are.

When folks tell us, “I don’t have emotions”, we know that this person is working very hard and stressing out his body to suppress his feelings, so we gently explore how and why he does this. He always does it out of fear to avoid being overwhelmed, feeling helpless or ashamed, getting rejected or abandoned. The trouble is that when you shut down your emotions, you shut others out and then you are ………… all alone. No-one wants that. So if you show folks another path to take and support them, they will take it. Even people who do have to shut down as part of their jobs, firefighters, policemen, marines and surgeons respond to EFT. Even traumatized partners who swim in the turmoil of emotional storms learn to order those storms and use their emotions to tell them what they want and need and so find direction in their lives and with their partner.

The traditional route to change in psychotherapy is the haloed “corrective emotional experience”. Without this, any therapy is just an intellectual mist that evaporates once a strong emotion hits. The EFT experience is that even the most seemingly “unemotional” among us respond to corrective emotional experiences of being reassured and treasured. Who can resist this ? Who wants to?

Memories of Stonehenge, 1984: Conference of Women Family Therapists

Posted on October 11, 2010February 11, 2026 by Psychotherapy.net Team

In the summer of 1981 I was traveling around Ireland with Lynn Hoffman who was at that time- and for a great many years- a tremendous supporter of the work of a numerous others in family therapy. She was at that time especially supportive of therapy teams in many different places in the world and was telling me a good deal about all the creative women she had run into in her travels. I began to think about the need of women mentors in our field and what a good mentor she was to so many others herself, including two Irish women to whom I became very close: Nollaig Byrne and Imelda McCarthy. By the end of our trip I had hatched a plan to bring together women family therapists for a conference. I approached my friend Betty Carter, who agreed it was a great idea and asked if we could present it to her group: The Women’s Project (in which her compatriots were Marianne Walters, Olga Silverstein and Peggy Papp). I agreed and soon met with them to discuss the idea. They were, much to my surprise, not enthusiastic and decided against the idea. For some reason, they could not see the value of a meeting of women in the field. They were not the only ones. Virginia Satir, Mara Selvini, and Cloe Madanes were all negative about the concept when invited, and Lynn herself said she could not see the value of it and did not in the end participate.

In any case, I went to my handy-dandy sisters, Froma Walsh and Carol Anderson, who I knew would support the concept and we decided to do the conference together. I knew of a wonderful hotel in Ridgefield Connecticut called Stonehenge and we decided that would be our venue. It had space for a meeting of about 40 people so that was the number we decided on. We then began the planning through networking. We contacted women we knew or whose work we knew of and asked them to recommend others they knew and through that method of networking we eventually had a wonderful group of very impressive women family therapists who agreed to come to Stonehenge to share work, personal experiences and ideas for 3 days in September of 1984. It was a most impressive group of women- the outline of presentations and discussion emerged pretty organically as I remember from different ideas presented by various women. One that stood out particularly for me was Ellen Berman’s presentation of the “Glory-Work Ratio,” a presentation in which she proposed that we as women often under-sold ourselves when invited to do a presentation and would agree to meager terms, happy to be included and not realizing how much work, time, and energy were entailed in such presentations. She recommended that we always sleep on any invitation and not agree to it for at least 24 hours, by which time we might have had a chance to decide how much effort should be expended for what return. We all laughed, recognizing how many times we had found ourselves traveling to faraway places for micro-fees, while the men in the field commanded much larger honoraria, even when they did not prepare for the presentation.

Another highlight for me was a comment by, I think Kitty LaPerriere, still one of the unsung heroes of our field, who said at dinner on Saturday night how amazing it was that for so much of our lives we women always wanted a “date” on Saturday night–which meant with a man—and here we were and we all seemed to want to be where we were at that time and in that place and were so fine with it! We had amazing experiences hearing new voices from the field and also from experienced senior voices. the Women’s Project had decided to participate and even sponsored the welcoming cocktail party on the opening night of the conference and all of them shared many of their experiences as women breaking the glass ceiling of our field.

There were also difficult issues and discussions about why our group was almost all white and how could we do it differently—how could we change our thinking so we could become a more diverse group of women. For me the struggles with how to deal with the intersection of race and gender took many more years—many years to appreciate that we could not discuss gender without taking race into account at the same time. And the intersections of race and gender , along with class and sexual orientation—which have become such important parts of our conversation in the decades since that time—were just in their infancy and not well understood or dealt with. In the years since I have learned a lot about the naiveté and inaccuracy of trying to consider gender by itself rather than within the larger cultural contexts of race, ethnicity, religion, class, and sexual orientation.

At the same time that we made many mistakes in our efforts, there was something amazing that happened for many of us at that meeting, I think. From that point on when we saw each other at other meetings there was a sense of solidarity and of collaboration and support:we had acknowledged to each other at that meeting how isolated we often felt, competing with each other for the attention of the men in the field, and how much of our sisterhood we lost in that competition process. And we came to stand by each other better, to help each other out informally with writing and presenting and thinking about the research and clinical practice of the field. I think wee listened better to each other after that—I know I did, realizing how often I had not really appreciated the other women in our field.

In the years after that we held one other Stonehenge networking meeting (1986) and then an international networking meeting of about 100 amazing women in Denmark a few years later, where, once again, we relied on networking as the organizing principle, learning from each other about other voices in the field. And at that international meeting with women from as far as Israel, Japan and Africa, I remember being totally in awe of the amazing women presenters, one after the other, who taught us about ourselves and each other and how to think more creatively about families and about their experiences trying to be family therapists in different contexts. I think these meetings helped many of us develop our voices in the field and I am grateful to all the women who participated and shared their stories and their work in those earlier days of our field.

Empowering Clients in Couples Therapy

Posted on October 7, 2010February 11, 2026 by Psychotherapy.net Team

When I do couple therapy, I bring partners in on my concerns about what is happening in the session. If I am concerned that one partner might feel I’m siding against him or her, I might say, “Ben, I’ve just realized I spent more time today developing Lisa’s position today than I have yours. Is that your sense, too? And if so, do you feel left out or sided against or ganged up on?” The person (here Ben) often responds with something like, “Well, I was wondering when someone would start getting interested in what I have to say” or “Lisa doesn’t talk about any of these things at home. I’m just happy it’s all coming out.”

If I’m concerned that the partners are not getting at what they need to get at, I say, “Are we talking about what we need to talk about or are there other things we should get to today?” or “Will you suddenly remember on the way home that there was something you wish you’d brought up?” I am trying to decrease the likelihood that they will raise important issues as they walk out the door, that is, when there is no time to talk about them.

If I can’t tell whether the partners are repeating the frustrating conversation they have at home (in which case I need to do something about it) or are covering new ground, I ask, “Is this the kind of conversation you have at home or are you saying some new things?” or “Are you getting something out of this fight—a chance to say a few things or hear a few things? Or is it frustrating and the kind of fight that you’ve come to therapy to stop?" or “In what ways is this conversation useful and in what ways is it not so useful?”

If I’m concerned that they are going to leave the session angry and alienated, I might say “We have only 5 minutes left and it looks like you are going to leave the session angry and alienated. What is it going to be like on the way home? How long is the bad feeling likely to last and how are you likely to work out of it?”

I get the partners’ help in figuring out what the session is about. At the end of each session, I ask, “What are you taking away from this session that’s useful, if anything, and what has been not so great about it?”

Some years ago Lynn Hoffman wrote about putting clients on the board of directors. That’s what I’m trying to do. I’m appealing to the partners as consultants in dealing with the problems I am having conducting the therapy. By appealing to them in this way, I am creating a perch (a platform, a metalevel) from which the three of us can look at what is going on in the therapy, providing a sense of safety (they’re not left wondering what I’m thinking; I’m telling them), modeling how they could confide in each other (a goal I have for them is to develop such a platform with each other), and doing something for myself (it’s relieving to be able to share the problem with the couple).

Harry Aponte on Structural Family Therapy

Posted on September 17, 2010February 27, 2026 by rezendevknowfully.com

Putting Therapy in Context

Rebecca Aponte: First, just so our readers are not confused, we should clarify that neither of us knows of any family connection, despite our shared last name.

Harry Aponte: That’s correct.

RA: You primarily practice family therapy. It’s interesting, because family therapy seems to be in danger of disappearing–it doesn’t seem like most therapists do it at all. What’s your sense of the state of family therapy today?

HA: I think family therapy has gone through its phase of fanaticism. It’s like so many other perspectives on therapy: it went through a phase where people made a new discovery, and they got infatuated with it, and that became the answer to it all. I believe the thinking about working with families has matured so that it’s not such an exclusive focus. People are much more flexible about working with individuals and couples as well as families, and people are more flexible in terms of being prepared to work with some unit of a complex family system without necessarily seeing all the members of the family, while maintaining a broader perspective so that they understand that the individual or the couple in the context of not only family, but also of community. So I don’t think it’s dead at all. I just think it’s matured to the point that it’s been incorporated into the very large and complex field of therapy.

RA: Do you think that the perspective of keeping the broader sense of community is as integrated into most therapists’ minds as it should be?

HA: Well, to answer the last part of that question, I think it should be. I believe that we have become much more sensitive and knowledgeable and insightful about the impact of the broader social system on people’s personal functioning: the effect of people’s social economic circumstances, the effect of culture, the effect of people’s spirituality, and how all of those affect in a very intimate way how people think of themselves, how they relate to one another, how they understand their reality. Any therapist who wants to engage with another human being at any level at all–to understand that person, that couple, that family–has a lot of factors to take into consideration. And I think that’s happening. I think people are much more comfortable with looking at their clients from a variety of perspectives at the same time.

RA: Is that something you would actively reflect back to a client–that you have their broader context in your mind–although they might not be thinking about themselves in a broader context?

HA: What I reflect back to a client is what I think will be helpful to the client. I’m not there to give the client a lesson on what therapy should be. I’m there to be helpful to the client. I need to take responsibility for having all of those perspectives in mind and taking them into consideration as I explore what the issue is and the roots of the issue, and what resources are in that client’s life for that client to be able to make the necessary changes to solve the issue. I don’t need to explain that to the client, but I do need to be aware of it and work with it.

RA: I’m asking some of these from the perspective of therapists who primarily see individual clients, because that’s probably the most common today. If someone does come to you as an individual, how might you bring up getting their family more involved in the treatment? Is that something you would suggest right away, or does it happen over time?

HA: I’m a pragmatist, so what I do is I listen carefully to what the client’s issue is, and I try to understand the issue, and I try to understand the context of the issue: who’s involved, who’s touching on that issue of that particular individual, as well as what resources are available to that person in their context. And I will try to pull in whatever and whoever is necessary. Even if I need not pull them in, it doesn’t mean that I’m not going to work from a suspended ego complex or perspective. It’s rare that I not ask clients about the history of their issues. And if I ask about the history of their issues, I’m asking about them in the context of their current relationships, their past relationships, including their development within the family of origin. All of that helps me to get some deeper sense of what they’re struggling with and why they’re struggling with it the way they are.

Structural Family Therapy Defined

RA: Let’s back up a bit. What exactly is structural family therapy? Is the distinction from family systems therapy important?

HA: Structural family therapy is an aspect of systems thinking. You have to understand the origins of structural family therapy in order to appreciate its contribution to systems thinking. The work originated, of course, with Salvador Minuchin, Braulio Montalvo, and other people who were working together at the Wiltwyck School for Boys in New York. They were working primarily with all these youngsters who were black and Latino, and who were institutionalized. These therapists began to include the families of these boys in their efforts to be helpful to the boys, because they found that working with them in an institution, outside of the context of their families, they were not achieving the success that they hoped to achieve. As they included the families, they found their success rate change significantly.Well, what happened? Because they were working with boys and families that came from seriously disadvantaged circumstances, they found themselves working with families that were, more often than not, poorly organized, in that they didn’t have the kind of structure that normally helps families to cope with the challenges that life brings. A typical story for a therapist working with the families I’m describing is you find that when you begin to talk with them, they interrupt each other, they speak over each other, and very often it’s unclear who’s really in charge of the family. And if there is somebody in charge, they may be so totally in charge that other people don’t have a voice in the family. You don’t have an organization there that can identify a problem and come together in a way that can solve it.

It’s really no different from what one would be thinking of in another kind of system, such as a business, where when you see a problem in how that business is operating, you’re going to be thinking of the structure and organization of the people who are working within that business. If they’re not effectively communicating with one another, they don’t have a clear hierarchy, and they don’t have clear responsibilities, you’re going to find that things fall through the cracks and the system fails.

Well, that happens with families, and it particularly happens with families that come from disadvantaged circumstances because they also come from disadvantaged communities that are poorly organized. These families, then, suffer the effects of their community, and they’re not able to organize themselves in a way that normally enables families to meet problems and solve them. Every family has problems, but when you don’t have an effective organization, then it’s hard to talk about the problem, it’s hard to identify the problem, it’s hard to cooperate together, it’s hard to find leadership within the family so that you can work towards a particular goal and solve the problem.

That’s the first experience of therapists who worked with families from disadvantaged circumstances. The gift that Minuchin and his colleagues gave us was that they focused on that organization. They understood individual dynamics; they certainly understood the contributions of other systems therapists at the time. But they were dealing with a particular population that had a significant issue around family structure, and that is an aspect of systems thinking. When you are dealing with families that are well organized that still have problems that they can’t solve, you tend to take the structure for granted. You cannot take the structure for granted when you’re working with these families that come from disadvantaged circumstances and who themselves are not organized in a way that’s effective.

RA: It sounds like one of the things that they found was that the pathology of the boys they were working with existed within this much larger environment, far beyond what would have been within the control of the boys or even the therapists.

HA: That’s correct.

An Ecostructural Approach to Family Therapy

RA: You’re talking about major social issues that are much bigger than families as well. How do you overcome those obstacles in a family therapy situation?

HA: Early on, I wrote about an ecostructural approach to family therapy–“eco” referring to the social ecology of the family, highlighting how so many of these families’ problems had their roots in the community they lived in. You have schools that have not only poor resources, but that themselves may have gangs organized within them, that are physically dangerous places for the children there, that make it difficult for the teachers to run the classrooms and create an effective learning environment.When you are working in some of these neighborhoods, the street itself becomes a place that is dangerous. It becomes a place where children just cannot go out and mix together and play together and do the kind of social learning that is important for their development. They’re dealing with drug dealers and other kinds of factors in the community, in the street themselves, that affect how these children think about themselves and how they think about the world. They have to cope; they have to survive. They may have to be more aggressive than children under other circumstances. All of that affects their personal development. And in these neighborhoods, you have problems with getting proper healthcare as well as educational resources. So you have a lot of social factors that are impinging in very direct ways upon the ability of families to function well.

And these families cannot just put all of their energy into nourishing the family environment. They have to be thinking about how to deal with protecting themselves vis-à-vis the community, so they put energy out there that should be put more into the family itself. They’re dealing with difficult environments, and that affects the ability of the family to function successfully.

RA: It’s a lot to think about.

HA: It is a lot to think about. And when you’re thinking about the environment, and you’re thinking about the family, you really cannot offer families coming from these circumstances a service that is exclusively focused on the family unit itself. You have to take a broader perspective that says, “I’m dealing with a child that’s in the context of a family, that’s in the context of a community. So when I then conceive of the work that I’m doing with these families, I have to take all of these into consideration and organize my services so that I can mobilize various aspects of that complex ecosystem to support the goals that I have with this particular family.”My point, though, is that this work with disadvantaged families gave a gift to the whole movement of therapy. It highlighted the importance of this complex social ecosystem– its effect on individual functioning–and the need to be more sophisticated about the dynamics of these various levels, in terms of understanding how they work, and in terms of working with them so that we can achieve our goals. It opened up a whole area of thinking that had to be taken into account. I think it’s been incorporated naturally, and I think people today think in those terms much more readily than they used to.

If we go back historically to the psychoanalytic movement, that was a very intense focus on the individual and what was happening in the individual’s psyche. And that provided critical and wonderful insight. Then we realized, “Well, that’s not the whole person. We need to expand our perspective.” So we expanded it to the families. Then we worked with this particular population and said, “My goodness, we really need to be thinking about the context in which this family is developing.”

So it just broadens our perspective. And we’ve learned ways of understanding these dynamics so that we can actually work with them, not just as sociologists, but as therapists who can be quite focused on trying to obtain a particular objective.

RA: Particularly now that therapy is not just the realm of white, middle-class clients, as historically it has been, there’s a more focus on tailoring therapy to fit people from a multitude of different ethnic and economic backgrounds. Do you have specific advice for therapists who have worked primarily with middle-class individuals, on branching out and working with people who have these bigger issues? One aspect is just being cognizant of the fact that there are many aspects of someone’s development and someone’s selfhood that extends beyond them. But what do you do with that awareness?

HA: I think what we’ve seen now, as a very normal part of therapist’s training, is the therapist being more conscious of the factors of values, world views, culture, spirituality, how these affect the way they see their problems, and how they view a solution that is acceptable to them. We have a much more complex society today than we had 50 years ago or further back, where there was a generally accepted norm of what a family is, how a family should function, and what is acceptable behavior.Today, we have a society that is much more fragmented and often in conflict with itself about what is acceptable in terms of lifestyle and behavior. That changes what one may consider to be a problem, and it certainly affects what we think of as appropriate solutions to problems. That thinking–which was expanding already back in the ’60s, when The Families of the Slums was written by Minuchin and colleagues about the work at Wiltwyck–all of that has been incorporated into everyday, normal therapy.

Nowadays, I don’t know what therapist training doesn’t include some courses that say, “You need to be sensitive to race and culture, and sensitive in such a way that you understand how race and culture directly affect not only how we view the issues and how we work with them, but the very nature of our relationship with our clients, and how we join with our clients.” Therapists will have their own culture, they’ll have their own values, as well as certainly their own personalities and life experience. But how do these therapists relate and connect to clients who are always going to be different in some particular way or another, in a society that says we need to be more accepting of the differences among us? So we’re working in a more complex world today as therapists than we did in the past.

The Person of the Therapist

RA: Certainly. And it sounds like you’re saying, too, that it requires therapists to be more sensitive to themselves and to their own world views, and really have a clear idea of their own personalities and backgrounds and how they appear in the therapy.

HA: If you’re not aware of what you’re bringing to the therapeutic relationship and the therapeutic process, you can’t take responsibility for it.

RA: Is that essentially what “the person of the therapist” means?

HA: That’s exactly what “the person of the therapist” means. The therapy of today is a therapy in which therapists are certainly much more actively engaged with their clients or patients than what would have been the model in the psychoanalytic world. And certainly, if you read the writings on structural family therapy, you would see how therapists use themselves very actively to influence the dynamics within the family, and how they engage with individuals within the family. What I’ve done with the “person of the therapist” model is to try to take that a little deeper and say to therapists, “It isn’t just a matter of how you use yourself.” It starts with understanding yourself, not only from a psychological perspective, but also from a cultural and spiritual perspective. As a therapist I have to get in touch with what’s inside of me–and not only what’s inside of me, but because these are living, active dynamics, I have to get in touch with what I struggle with in my own life, what I struggle with psychologically, what I struggle with in my relationships with people, what I struggle with spiritually. I need to understand that, I need to be in touch with that, because all of those factors are active when I engage with the client. They’re going to affect how I see the client, how I hear what they have to say, how I connect with that person, how I even conceive of how we’re going to try to find some solutions.These factors are active even beyond our normal awareness as therapists. We need to get the kind of training that makes us experts on who we are and what’s happening within us, so that even as we are working with our clients, we’re conscious of what’s going on within ourselves, and we can take responsibility for what we communicate about ourselves and what we try not to communicate about ourselves and how.

RA: How do you practice that? Does that mean therapists do their own therapy, or is it more self-reflective?

HA: It’s a specific kind of training. Traditionally–certainly in the psychoanalytic world–therapists needed to undergo their own therapy. But that objective was one that said, “I need to try to solve my own personal issues so that I am freer to work more effectively with my clients. I’m not going to put on my clients my own hang-ups.” That way of approaching the work of the person of the therapist was continued and picked up by Virginia Satir and Murray Bowen, but again from the point of view of, “Let me identify my issues and try to resolve them so that I will become a more effective therapist.”What I’ve been emphasizing is that all of that is absolutely important and useful, but the simple reality is that we never resolve all of our personal issues. We struggle with ourselves the rest of our lives. We need to go through training programs where we become aware of ourselves in the context of doing therapy, not to resolve personal issues, but the primarily to understand ourselves in vivo: When I’m engaged with my clients, what’s going on inside of me? How do I get in touch with it? How do I decide how to use what’s going on within me in order to understand and empathize better with what’s going on in the client? How can I relate in a way that’s specifically useful to the client at this particular moment in time?

So it’s an approach to preparing the therapist to use this instrument that is me, in a way that is much more effective. Then I can use all of what I’ve learned technically and theoretically of other models of therapy, and I can use it through the person that I am in a way that amplifies the effectiveness of my work.

RA: So this model rejects the psychoanalytic idea of being a blank slate or completely neutral, and focuses instead on the therapist’s personhood.

HA: It certainly does. The advantage that classical psychoanalysis had was that the analyst was sitting behind the couch out of the view of the analysand, and wasn’t engaging eye-to-eye with the patient. Today, most all of our therapy is eye-to-eye, and we feel each other. We and our clients are engaged personally in the therapeutic process, and that’s a simple reality. The question is, how do I engage personally within the boundaries of my professional goals so that I can be of use to this person?

The Role of Spirituality in Therapy

RA: You’ve mentioned a couple of times the role of spirituality in therapy. How do you bring spirituality into the therapeutic relationship in a way that’s safe for clients who might have different views?

HA: It’s not a matter of bringing it into the process as much as it is of being aware that it’s there. Spirituality is just a normal aspect of who we are. We all have a morality of one sort or another. We all have a world view–a philosophical perspective on life and what’s important in life, what’s meaningful about life, what our goals should be in terms of moral principles. And that will certainly affect how we think about the issues that come up for us. A simple example that’s very relevant today is the postmodern view of reality, where reality is something that you cannot know directly, but only through what you sense–meaning that you cannot prove a truth, so truth is only in the eyes of the beholder. That’s a spiritual perspective; that affects the way we look at life.And if you do believe there is a reality that we can perceive, and that there is an objective truth that we can relate to, that’s very different from somebody who comes from a perspective that says, “It’s really what you perceive, more than it is what you think is out there.” That affects how we think of our problems; that affects how we’re going to try to solve our problems.

RA: So you’re trying to understand how clients perceive themselves and their problems, and having knowledge of yourself is primarily to keep you from being closed off from their world view when it’s different from yours?

HA: If I’m going to understand them, I need to try to understand them from an emotional perspective, but also from a cultural and spiritual perspective. So I’m listening for all of that. But I can’t listen to that and understand it unless I am aware of that within myself.You cannot see spirituality in somebody else unless you can see it within your life. How is it real for me? How does it affect me? The better I understand that, the more insight I’m going to have, and the better I’m going to be able to see how it relates to their lives. So that becomes something I normally look for as people present their issues. It also influences what kind of questions I’m asking them, so that I don’t just assume what their moral stance is on things.

For example, when you’re working with adolescents and their families, and their sexuality is an issue–which is almost inevitable when you’re working with adolescents–what is their moral view about sex outside of marriage? What is acceptable? What is not acceptable? That’s going to influence the work that you do; it’s certainly going to influence the goals that you determine are part of your work.

RA: I understand that you worked for some time with Sal Minuchin, and I’m sure some of our readers would like to know what he was like. How was it to work with him?

HA: Sal is a fascinating personality. The man is intellectually so bright and so original in his thinking, but he’s also very much a dynamic human being, and that influences his style of therapy. He always engaged with the clients very fully and emotionally–not only intellectually. It made his model a very dynamic approach to life, so that it could be challenging to therapists who tended to be much more reserved in how they relate to people. But Virginia Satir and Carl Whitaker were also individuals who had dynamic personalities, and used that dynamism in the way that they conducted their therapy. Sometimes people lost perspective and confused the dynamism of the individual with the theory and the technique that they were trying to teach.

RA: What’s your sense of yourself as you developed your own personal style of working in this frame of mind?

HA: Sal was more likely to be confrontive than I would be. My particular personality and style is that I tend to be very direct with people, but I also tend to be more inclined to want to join with people and relate empathically with them. You would get a very different feeling with me than you would have from Sal. Sal, as you see in his writing, talked more about unbalancing the system, and he would often unbalance that system in a more forceful way than I would. I would also unbalance it, but not in the same style.

This really emphasizes the importance of knowing one’s self personally and saying, “I’ve got to work through the person that I am, and not through the person of the guru that I admire.”

RA: Absolutely. You’ve been doing this for quite some time now; do you have a sense of your personal evolution and what’s changed? Do you feel yourself becoming more confrontive over time or less so, or just more refined?

HA: I think what has changed is that as I’ve matured, I’m more confident about myself when I’m with people, and I’m more confident about what my thinking is, so that I can risk being direct with people about what I see and what my opinions are about what’s going on, always allowing for the feedback and room for them to challenge me back. But the challenge is not so much a matter of me confronting as it is a matter of being able to state, “This is the reality that I perceive right now. Now give me your reality and react to what I’m suggesting to you.” That doesn’t work with certain clients, but I find it tends to work with people who are looking for results, and they say, “I can see what you’re saying and I can see why you’re saying it, and it does or does not make sense to me, but now I can give you back some feedback and we can work actively together to make something happen.”

RA: Do you have a sense of where you feel yourself being pulled in the future?

HA: As I look towards the future, I’m now continuing to focus on the person of the therapist and trying to develop that further, not only as an aspect of training therapists, but also as an integrating principle in the therapeutic process: we are integrating our technical and theoretical thinking around who I am and where I am in my life, so that when I do the therapy, it becomes very much my therapy. Even as I’m learning from other people, I’m moving more in that direction. But that also says to me that the common factors work being done by people like Sprenkle is an important contribution. I’m looking more at the common factors among the various models of therapy, and including these factors among the various views of the use of self. I’m thinking about how to highlight those common factors to encourage therapists to extract the essential elements of the therapeutic process, rather than having to choose between various camps of therapy, which I think is such a waste of time.

RA: We’ve definitely covered a lot of ground. Do you have any concluding thoughts you’d like to share with our readers about any of the topics we’ve discussed?

HA: We ended on the note that I hoped we would end on, which is the importance of therapists training to understand themselves more profoundly than they have in the past, not only from a psychological perspective, but also from a cultural and a spiritual perspective, so that they can use all of themselves more effectively in their therapeutic work, on the one hand; and on the other hand, the usefulness of thinking about common factors among the various therapeutic models so that people will not blind themselves to the contributions of the various models because they need to adhere to some particular school of therapy. From my perspective, there is no model of therapy that does not offer us an insight that is useful to all of us. I think it’s important that we open ourselves up to learning from the various schools and approaches to therapy, and then take that and integrate it within ourselves so we become effective therapeutic instruments.

RA: I think that’s sound advice. I appreciate you taking the time to talk with me today. I’ve very much enjoyed it.

HA: Good, I’m glad you did. It was a pleasure, Rebecca.

Walking A Tightrope: Family Therapy with Adolescents and Their Families

Posted on September 15, 2010February 11, 2026 by rezendevknowfully.com

Beyond the Comfort Zone

“Clyde is spiraling out of control,” she cried. “He’s begun to hang out with a bunch of do-no good, do-nothing hoodlums.” She was worried that failure—or worse, tragedy—was aggressively recruiting her only child. “He is a good kid,” she attempted to reassure me, “but I worry about him being in the wrong place at the wrong time.” Although he’d had no brushes with the law, she was terrified of any potential encounters he might have with the police—an encounter she intuitively knew could be a matter of life or death.

“Mrs. Gilyard, like so many other parents of color, was raising her child with the police foremost in her thinking.” While she and her husband enjoyed a solid middleclass lifestyle, both were African American and understood all too well the rules of the streets, especially regarding young black males. Mrs. Gilyard was worried because she understood that the urban streets were unforgiving for many young black males like Clyde. Unfortunately, Clyde, according to his mother, “knows everything and won’t listen to me or his father.” In fact, Clyde had, in a very short period of time, according to his mother, transformed from a “very respectful young man” to a disrespectful, self-centered, impulsive shadow of the human being he used to be. “He’s moody, often refusing to talk for days, and all he wants to do is sleep, text message, hang out with his friends, and download music. To be honest with you, Dr. Hardy,” Mrs. Gilyard said, “although he is my God-given son…” She paused. “I am quickly getting to the place where I can’t stand to be in his presence. I am not sure I even like him anymore. I can’t tolerate his nasty attitude. I have no patience with him. I’m worried that I might hurt him, or someone else will, if he doesn’t get some help.”

As our telephone conversation progressed, it seemed to have no end in sight. Mrs. Gilyard needed to vent and was oblivious to time or circumstance. I tried numerous times to gracefully end the phone conversation that was dangerously slipping into a full-blown noncontractual, nonconsensual therapy session, but Mrs. Gilyard was too consumed by her utter sense of desperation, now flirting with panic.

I commented that although she seemed to have moments where she felt disdain for Clyde’s behavior, her dominant feelings towards him seemed to be worry, fear, and a deep motherly love for him. I went on to suggest that I imagined the situation with Clyde was taking a huge toll on her, as well as the entire family, and although she was seeking treatment for Clyde, I thought it would be helpful for the entire family to attend. My comment and suggestion apparently surprised Mrs. Gilyard and immediately earned her ire. Her tone and approach to our conversation changed instantly.

“Why do we need therapy?” she demanded. “I don’t think there is anything wrong with Claude and me, and I honestly don’t know what there is for us to gain from coming into therapy. We will do whatever to help Clyde, but he has to find himself and nobody else can do that for him. As his parents, we have to provide him with love, support, and guidance, but he has to be willing to accept it. Right now, his friends and his music seem to be all he cares about! I don’t see how us coming to therapy is going to help him get what he needs.”

My interaction with Mrs. Gilyard suddenly shifted from the emotionally intense, unconditionally accepting reflective listening phase of engagement to one of the most delicate and thorny areas of family therapy: problem definition and who should attend the session. These issues are always critical dimensions of family therapy treatment. Mrs. Gilyard and I suddenly found ourselves on a major collision course. She remained convinced that Clyde was the problem and that whatever was going on with him needed to be fixed inside of him. In her world, problems were individual and the solutions were simple: you found out what was broken and you fixed it. From her perspective, Clyde was broken, like a malfunctioning carburetor in a car, and in either case the solution was a simple matter of targeting it and repairing it. She seemed to be oblivious to the fact that even the best mechanic in world could not repair a faulty carburetor without having access to the car! This was where our worldviews collided.

I believe that all problems are essentially relational and that we all are relational beings living our lives in a relational context. As a family therapist, I believe that problems are delicately and seamlessly interwoven in a nexus of relationships. “It is difficult for me, if not impossible, to envision any human interaction problem without considering the relational context in which it is embedded.” So, unlike Mrs. Gilyard, I assumed that the problems were embedded in relationships and the relationships were embedded in problems. In this regard, in cases such as the Gilyards’, it is my contention that family members contribute to the formation of a problem, the maintenance of it, or both. And if problems are embedded in relationships, so are solutions! Thus, having the entire family participate in therapy is essential.

However, from the perspective of Mrs. Gilyard, Clyde was the problem because it was his behavior that was problematic. It was he who was broken, malfunctioning, or deviating from family and societal norms. Accordingly, Mrs. Gilyard believed that the best solution to the problem was to treat the problem: Clyde! The dilemma was that if I dismissed Mrs. Gilyard’s definition in favor of mine, therapy could not occur. Yet on the other hand, if I abandoned what I believe, how could I possibly assist the family without further problematizing Clyde? Before ever meeting Clyde, it was crystal clear to me that he was considered the problem and would continue to be until his deeds, attitudes, and behaviors complied with his mother’s wishes. So in a sense, the only problem was the problem that was asserted by the family. And, if I insisted otherwise–i.e. that my definition of the problem should overshadow the family's viewpoint–then that would only result in creating yet another problem! This is the tightrope that all family therapists have to gently and delicately traverse.

Despite Mrs. Gilyard’s claim that she would do anything to assist Clyde “in getting his life back,” attending therapy with him was not on her immediate list. Because I often believe that a family’s refusal or reluctance to participate in therapy is usually a result of a tendency to think individually and not relationally, and an underlying fear of being blamed and/or exposed, I knew I had to tackle both of these issues with Mrs. Gilyard if family therapy were to ever take place.

I tried to reassure her that a family session would not be about finger pointing or keeping score about who did what to whom. “It will be a place where we can develop a deeper and better understanding regarding how the family operates and how each of you is affected by what everyone does,” I explained over the phone. “You know, families cannot function well when each member attempts to do what they think is right or best without considering how it affects others.”

At this point, although unfazed and unconvinced, she at least seemed willing to listen more carefully.

“You, along with your husband, seem to be concerned, involved, and loving parents. I imagine the two of you have an infinite reservoir of information about Clyde that you have been collecting since his birth. You, quite possibly unlike any other person on the planet, have cherished early life memories of Clyde that you have probably safely tucked away in the secure closets of your mind. I know you and your husband need my help, and I am honored that you are willing to trust Clyde in my hands. But I need you and your husband’s help as well. I need the infinite knowledge and wisdom that you and quite possibly only the two of you have about him as well. My time with him will be limited no matter how much time we have, and it would be great to have the two of you as resources. You know, I am sure you have heard that old African proverb expressed a million times that it ‘takes a village to raise a child.’ Well, if Clyde is struggling as much as you say he is—and I have no reason to believe otherwise at this point—he needs a village. And we will be Clyde’s village!”

After an impregnated pause and a chilling silence, Mrs. Gilyard, in a much softer voice, said with a slight sigh of relief and perhaps resignation, “Yes, you’re right. Clyde is a part of me. He is like my third arm or leg. I do know him. Or at least, I used to. I will talk to my husband. Doctor, I hope you—er, I guess I should say, I hope we can help my son.”

It Takes a Village

Exactly one week later following our phone conversation, Mrs. Gilyard made good on her promise. She, her husband of 30 years Claude, and their son Clyde arrived at my office for our first session. My initial interactions with the family were pleasant and polite as we engaged in light-hearted conversations about the weather and traffic. Throughout it all Clyde remained detached, appearing disinterested but respectful. There was an understandable tightness to the family. They seemed tense. Mr. Gilyard was noticeably uncomfortable and asked several times in the first few minutes about how long the session would last and how many sessions would it take before they would “see results.”

I thanked the family for coming and their dedication to finding answers to issues that were plaguing them. Then I turned to Clyde. “I’ve talked to Mrs. Gilyard on the phone and know that she is worried a great deal about you.”

He smirked slightly but refused to bite the bait and respond to me verbally. I was encouraged by the smirk because it was a sign of responsiveness to being engaged—a private mental note I made certain to record. I turned to Mr. Gilyard and asked, “Do you share your wife’s concerns?” Then, turning to Clyde again, “What do you think about all of this?” To increase the probability of participation throughout the therapeutic process, “it is imperative in family treatment to acknowledge all family members as early as possible and to invite their participation even if and when they passionately refuse.”

The room was quickly filled with a breathtaking silence and discomfort. Finally, perhaps as a function of her discomfort, Mrs. Gilyard broke the mounting minutes of silence that must have felt like hours to the family, by inexplicably saying: “You are so much smaller than I imagined you to be. I for some reason expected a bigger, older man.”

After many years of clinical practice, I am seldom surprised by the disclosures that are uttered within the private walls of therapy, but I was surprised by Mrs. Gilyard’s comment and wasn’t immediately sure what to make of it. I simply responded: ‘Oh, well… Thanks for your honesty… I always find it an interesting task to imagine what someone looks like based on their voice and telephone personality.”

It was of note to me that Mrs. Gilyard elected to make me the focal point at the precise moment that I was attempting to engage Claude and Clyde about their perceptions about the family. Maybe this was coincidental, but I wondered if I was getting a snapshot of how hard Mrs. Gilyard worked in this family. Since I had spent an appreciable amount of time with her on the phone, I really wanted to make a concerted effort to interact with Claude and Clyde. So I returned to father and son and asked, “What is going on with the family from where you sit?”

Mr. Gilyard then turned to Clyde and said: ‘The doctor’s talking to you. Tell him what you think. And sit up, please. And Clyde, take off the hat. And put that thing away,” she ordered, gesturing toward his son’s iPod. Clyde sat still and stoically, dressed in a blue-and-white NY Yankee baseball cap that he had on backwards, stylishly coordinated with an elegant blue silk tee shirt, and blue-and-white Jordan sneakers. He looked at his father and slowly removed his baseball cap, never uttering a single word.

Mr. Gilyard, after thinking for a few minutes, said he was worried about Clyde and believed it was getting harder and harder to reach him. He noted that he didn’t share his wife’s short fuse with regards to Clyde’s antics but was bothered by his son’s lack of direction. “He doesn’t take life seriously. He thinks it’s a joke, a game! He has no sense of the sacrifices that his mother and I and many who came before us have made for his benefit. He is reckless, impulsive, and irresponsible. He thinks only of today, this minute—this second! He has no goals or interest in anything. He wants to sleep his life away,” observed Mr. Gilyard, his voice rising. “I am so afraid that he is going to wake up one day and suddenly discover that life is indeed short, precious, and waits for no one—a realization that will come much too late for him to do anything about it.”

As Mr. Gilyard’s lower lip began to quiver, and his right eye began to slowly fill with a single developing tear, I asked him to turn to his son and to tell him that he loved him and that he was worried about him. The older man seemed stunned and paralyzed by my request. Obviously overcome and perhaps even slightly embarrassed by his emotions, he could only say to me in a tone slightly above a whisper, shaking his head slowly and affirmatively, that Clyde knew.

“But can you turn to him and tell him?” I asked again, to which he responded by repeating his earlier refrain: “He knows.”

A New Conversation

“Once again, Mrs. Gilyard was in her familiar role of working overtime for the family while Mr. Gilyard was working hard to emotionally retreat from the interaction.” Maybe there was something to this dynamic: maybe Mr. Gilyard’s “low pulse” for engagement heightened his wife’s anxiety, which she ameliorated by becoming more actively involved in an interaction. Her involvement in turn reinforced his low pulse, and his low pulse heightened her anxiety and so forth and so on.

Meanwhile, Clyde remained a central but peripheral figure in the family’s interaction. He was the frequent subject of his parents’ reprimands, criticism, and attempts to speak for him. While it was Mrs. Gilyard’s good intention to make sure that Clyde was reassured of the love that his dad was having difficulty expressing directly, it was nevertheless counterproductive to what I was trying to accomplish with the family at this point. So I decided to re-engage Mr. Gilyard by simply turning my body towards him and pointing to Clyde.

He started his interaction with Clyde by telling him, critically, why he needed to change. I immediately interrupted him. “I realize this is important fatherly advice you’re offering your son,” I said, “but I want you to suspend the advice giving for a moment and simply tell your son that you love him and that you’re worried about him.”

For the first time during the session, Clyde looked at me and said, “Boy, you’re a trip! Just give it up. Why keep asking the same frickin’ thing over and over again? I know he loves me. There. Are you satisfied? Now can we move onto something else?” It was striking to me that this one seemingly benign and simple request sent so many reverberations through the family while giving me a front-row seat to the family drama that had necessitated the Gilyards coming to therapy.

I commended Clyde. “I like the fact that you’re so honest and direct. You didn’t feel like you needed to sugarcoat your feedback for me. I think I like you, Clyde!” I hoped that my feedback would have some resonance with him and provide a small buffer against the barrage of negative feedback he was accustomed to getting from his parents. Clyde responded with a very faint smile, a slight shrug of his left shoulder, but for the most part he continued to sit motionlessly and without much overt expression.

The family’s process had been marvelously effective at maintaining their status quo. The climate in the room was much less intense and they seemed more relaxed, at least on the surface. Mrs. Gilyard scanned the room with a sense of anxious anticipation. She looked as if she was wondering, “What’s going to happen next?” Mr. Gilyard retreated and seemed far away, while Clyde nervously patted his right foot and stared at the ceiling. I sat quietly observing the family as my eyes occasionally connected with Mrs. Gilyard’s.

After a few minutes of silence, I commented to Mr. Gilyard, “It seemed like it was a little difficult for you to talk directly to Clyde a few minutes ago. Was it difficult?”

“You know, Doctor,” Mr. Gilyard quickly responded, “it is not difficult for me to talk to my son and I don’t really have a problem talking to him. It’s just sometimes it seems pointless because Clyde is going to do what Clyde wants to do. I feel like the things his mother and I say to him go through one ear and out the other. So sometimes my attitude is, ‘Why bother!’”

I noted how frustrating and seemingly futile such a dynamic could be, especially when there are legitimate worries and wishes that they would like to seriously convey to Clyde. Then I made an observation to Mr. Gilyard, trusting that Clyde and Mrs. Gilyard were eavesdropping.

“My early sense of Clyde so far is that he is self-reflective, contemplative, and a courageous communicator,” I said. “I have noticed the way that he has sat here very quietly but has been very attuned to what is going on here, though his words have been few. Yet as you observed a few minutes ago, when he had something to say, boy, did he say it with force, conviction, and clarity. I think a good conversation is possible between all of you if you could each attempt to have the conversation differently. Trying to have new conversations the same old way you have been attempting to have them is not working for the family. If you continue to hold onto the old ways you have been trying to engage with each other, this process will take forever and Clyde will turn to his friends for the conversations he should be having with his parents!”

Mr. Gilyard seemed intrigued, if for no other reason than my oblique reference to the timetable for treatment, which I knew was important to him. I then asked Mr. Gilyard, “So do you think taking a different approach to talking to Clyde is something that you would be willing to try?”

“I am willing to do anything that you think will help me reach my son,” he replied.

“I appreciate your willingness to give this a try,” I responded. “I would like to return to where we were earlier. When I listen to you, I feel a kind of underlying pain—almost haunt—that you have when you think about Clyde’s life. What I hear and feel from you is worry, fear, and pain, yet what gets communicated to Clyde, and probably what he hears, is criticism, rejection, and anger. I would like for us to try this differently this time around. Can you turn to your son and tell him you love him and that you’re worried about him?”

Mr. Gilyard looked at me with a slight sheepish grin and nodded. He then took a minute to collect his thoughts as he stared at something beyond the room in which we are sitting. Mrs. Gilyard fidgeted a bit and nervously rubbed her hands together. I could tell Clyde was very tuned in, although he outwardly retained his cool pose of detached disinterest.

The silence built and so did the intensity in the room. After a few more minutes, Mr. Gilyard turned to Clyde.

“I don’t know why this has been so hard for me,” he said to his son. “I don’t want you to think it had anything to do with not loving you…because I do love you very much, my firstborn son. I will always love you, and I am sorry if I have somehow ever given you the message that I don’t love you or that my love for you is conditional.”

“Can you also tell him about your worries?” I encouraged him.

Mr. Gilyard sighed. “I do worry about you.”

“Can you tell him about your worries?” I prodded. “The ones that keep you up at night.”

“I guess I worry all the time. I worry about drugs, although I don’t think you would ever be stupid enough to do drugs. I worry about you not giving your best in school and the ways that will hurt your future. I worry about…” “Mr. Gilyard’s breathing shifted; his words suddenly seem much harder to find.” His voice was beginning to break and he now seemed more hesitant to continue.

“You’re doing great,” I told him. “This is the type of conversation that you and Clyde have needed to have for awhile now. Please don’t hold back now. Tell him about all of the fatherly worries you have about him.”

“I worry… I worry…” Mr. Gilyard began to cry. “About something awful happening to you. About you dying, and there is nothing I or your mother can do to protect you. I worry about the damn trigger-happy police. I am worried that life is short and I don’t know what I would do if anything ever happened to you,” he sobbed. “The streets are vicious. People are vicious. And no one seems to GIVE A DAMN about young black boys like you.” He pounded the coffee table with his hand. “I can’t tell you, Clyde, the number of times that I have awakened in the middle of the night sweating from the same bad dream—the same nightmare that you are lying on 22^nd Street in a pool of your own blood which is OUR blood too.” He turned to his wife. “Tell him, Geraldine, how many times you have had to comfort me from the same goddamn dream. “ Mrs. Gilyard nodded in confirmation while I gestured to her to refrain from speaking at this point. Both Mrs. Gilyard and Clyde were now beginning to cry as well.

Clyde spoke. “I don’t know what’s wrong with you and Mom. All you do is accuse me of doing bad things and being a bad person. I go to school, I get decent grades, and yet I all I ever hear is, ‘You didn’t do this. You didn’t do that. This is going to happen. That is going to happen.’” Clyde was more animated than I had yet seen him, and his voice was raised; he was crying profusely .

“Clyde,” I said, “I am so glad to hear you say how all of this affects you. I would be surprised if your parents knew that you have been affected so much by their worries and criticism of you. Thank you for again being such a courageous communicator—you know, having the courage to say what needs to be said and not just whatyou think others think you should say. Your tears—who were they for? What were they for?”

“I don’t know,” Clyde said softly.

“Clyde, honey,” said Mrs. Gilyard, “I am sorry that I have been so caught up in my own worries that I have not taken a second to think about how all of this has been affecting you.” She began to cry even louder as she walked over and draped one arm around Clyde while reaching out with the other for Mr. Gilyard. As she held Clyde, sobbing, she repeated, “I am so sorry. I am so sorry.” I sat quietly, observing this pivotal and sacred moment for the family, and remained appropriately peripheral for the moment.

Mr. Gilyard broke the momentary silence. “Son, we didn’t mean to hurt you and put so much pressure on you. We don’t think you’re bad. We just worry about you.”

“I honestly don’t know why you are so worried,” said Clyde. “I feel like I can’t breathe without causing somebody—you or Mom—to worry.”

Finally I stepped in. “I want to thank each of you for all of your hard work today, and thank you, Mrs. Gilyard, for your hard work in getting everyone here today. Mr. Gilyard, I am so pleased that you were able to tell Clyde about your worries. Now he knows that there are real heartfelt worries beneath all of the criticism. My hope is that you and Mrs. Gilyard can be more diligent in expressing your worries without the criticism, and that, Clyde, you could remind yourself that somewhere beneath their criticism is an unexpressed worry. By the way, Clyde, I share part of your curiosity regarding the roots of your parents’ worries.” I turned to the parents. “I completely understand your worries about the police, school, and what happens if Clyde ends up in the company of the wrong crowd. I think it’s great that you are concerned and involved parents. But as I mentioned earlier, there seems to be a ‘haunt’ when it comes to your efforts to parent Clyde. It is particularly poignant with you, Mr. Gilyard.”

As I wrapped up our first two-hour session, I reminded the family that I am a firm believer in assigning homework between sessions. “Homework is a wonderful strategy for ensuring that families continue to work together outside of treatment and not rely solely on our weekly two-hour meetings to promote change.” The actual tasks to be completed are seldom as important as the spirit of cooperation, collaboration, and communication that is generated (or not) as a result of the assignment. The Gilyards’ first homework assignment was for each member of the family to generate a minimum list of three beliefs each of them had regarding why there was so much worry in the family. They should generate their respective lists separately and then share their beliefs in a brief family meeting that should be scheduled by Mr. Gilyard and must take place before our next session. Clyde was assigned the task of keeping track of whether all of the rules had been followed by all members of the family, including himself, of course. And finally, Mrs. Gilyard was assigned the task of taking a vacation day from all coordinating tasks associated with the homework assignment.

The Gilyards showed up for our next session on time, and not only had they completed the homework assignment but had done so by rigidly adhering to all of the specified terms. While the assignment failed to produce any revelatory moments for the family, it did lay down some important groundwork for several transformative future sessions.

A Haunted Past

“It was too much responsibility and too big of burden. How can you possibly protect your children from the perils of the world? My parents were super parents and even they could not protect Clyde and Roger,” he often reflected. “For many years of my life, the pain of losing my brothers was so painfully gut-wrenching, I couldn’t have imagined any greater pain had they been my children. And then Clyde was born. Everything changed. Suddenly I could imagine a greater pain than what I had already experienced. For a few years, especially the early ones, he actually helped to redirect some of the pain I felt about the loss of Clyde and Roger. Maybe he gave me something else to focus on that my own father never had after losing two sons. I know that both Mom and Dad never ever recovered from Clyde’s murder, and then when Roger was killed, they simply stopped living.”

Mr. Gilyard’s protracted mourning and shame never allowed him to be honest with his son about his uncle and namesake. He created the story about Viet Nam because it allowed him to recreate his brother in an image that was more positive and less burdened by the all of the familiar stereotypes of black men. This, unfortunately, was a huge piece of his son’s burden—a burden he undoubtedly carried from birth. He was not only his fallen uncle’s namesake, but he was a psychological object of possible redemption for his father. Suddenly all of Mr. Gilyard’s worries made sense to me. How could he not possibly once again find himself facing the dawning of the period of adolescence, without re-living the traumatic loss of his two younger brothers? How could he not worry about Clyde, the flesh of his flesh, possibly following the pathway of brothers Clyde and Roger? “After all, life had taught him a brutally cold and unforgettable lesson that young black boys don’t live beyond age fifteen”, and Clyde was now fourteen.

As our sessions continued, it was a bit unnerving to discover just how unkind the untimely death of young boys had been in the Gilyard’s family. Mrs. Gilyard also had a younger brother, Will, who was killed at age seventeen in a terrible car accident. Although Clyde knew of his Uncle Will, and the circumstances of his death, he did not know that his uncle was illegally intoxicated at the time of his death. According to Mrs. Gilyard, Will was a passenger in a car that was driven by his best friend who was also intoxicated at the time of the accident. As Mrs. Gilyard told the story of Will’s final moments, she wept as if it had just happened yesterday. She maintained that had Will not been in a state of an alcohol-induced stupor, he could have possibly survived the tragic accident. Clyde’s surge into adolescence had been a significant unintended catalyst for re-igniting the unresolved grief that haunted both of his parents. In a strange way, Clyde’s life was a powerful symbolic reminder of the Gilyards’ ongoing struggle to make peace with death and loss.

I continued to see the Gilyards for a total of eleven sessions, and I believe they made tremendous strides, though there was still additional work to be done. As a result of family therapy, the parents had a better understanding of how the tragic losses of their siblings were infiltrating and sabotaging their best efforts to be the type of parents that they ultimately wanted to be. They were far less critical of Clyde, but still resorted to blame and criticism when they felt anxious about their son’s life. The Gilyards had made significant progress in granting Clyde considerably more breathing room, and yet this was still a major challenge for them to completely master. Our work together had also been instrumental in helping Clyde to see and experience his parents with far more complexity. While he strongly resented their “constant nagging,” he also now understood and felt more genuinely their love for him. From our sessions together, “he had the opportunity to experience his parents as human beings with real feelings—hurt, pain, and joy”—and not just as critical, robotic and detached enforcers of the rules. He was able to develop more compassion for his parents and them for him. The family sessions afforded Clyde the opportunity to both fight with them—something that the family excelled at—as well as to cry with them—something they were not very good at. Yet, on the other hand, and in spite of it all, Clyde also continued to live up to his reputation as an adolescent. His failure to follow through with chores, spending too much time of his cell phone, and his frequent flashes of self-righteousness continued to be challenges for him and his parents.

Providing the Map

Both Mr. and Mrs. Gilyard terminated therapy with the understanding that the difficulties that brought us together were much bigger and more complicated than what rap music Clyde listened to or “his no-good, do-nothing hoodlum friends.” While Clyde expressed a number of troubling behaviors that at times appeared depression-like, “his” problems were much more complicated and intricately embedded in family dynamics and history than he or his parents realized Clyde’s symptomatic behavior was as much an indication of a family system that was not functioning properly as it was a sign of his individual pathology.

While the issues that constituted the core of Mrs. Gilyard’s early concerns about Clyde were significant issues, they paled by comparison to the complex, systemic, and intergenerational issues that made the Gilyards’ task of parenting so challenging. Through my work with the family, I was able early on to get a poignant snapshot of how the family was organized and how they interacted. I was able to rely more on what I observed than what they told me. There is something powerful and transformative about the process of witnessing—having the ability to experience and re-live the stories of another’s life with them. Had I complied with Mrs. Gilyard’s request and “treated” Clyde independently of his family, he would have probably continued to live his life in the shadow of his Uncle Clyde without him or the family acknowledging it, while the family simultaneously and unfortunately maintained that the uncle who had been murdered unceremoniously and without distinction on the streets of the inner city, was instead a Viet Nam veteran and hero. It was interesting and prophetic that Mrs. Gilyard, before our first session, noted passionately that Clyde had “become a shadow of the human being that he used to be.” I guess he had.

During this pivotal moment of therapy, Clyde was able to bear witness not only to his father’s shame, humiliation and hurt, but to his pain and humanness as well. It changed forever how he saw his father, understood him, and more importantly, experienced and related to him. Mr. Gilyard, in return, was able to give his beloved son and the namesake of his twin brother a gift of humility and a context for better understanding his father’s worries. And Mrs. Gilyard was finally able to “catch her breath” and exhale. She, for once, would not have to over-function to compensate for Mr. Gilyard’s reticence and emotional blockage. Finding the lovingness in him as a father also allowed her to add depth to the lovingness that she had for him as a spouse, which had the unplanned consequence of further strengthening their marital bond as well. “This is the beauty of family therapy: when it works well, it helps families to recalibrate and to experience reverberations throughout the system even across generations.” If Clyde someday decides to become a father, I believe that the shifts he experienced in the relationships with his father specifically, and with his parents in general, will impact how he parents. As a result of the family’s involvement in family therapy, the generational and relational arteries that connected the lives of Clyde, Uncles Clyde, Roger, and Will, as well Mr. and Mrs. Gilyard and many others, have been refreshingly and painstakingly unblocked, but will require ongoing work to remain so. This, too, is part of walking the tightrope: helping families find ways to celebrate newfound highs while simultaneously keeping them grounded enough to confront the next new challenge.

Family therapy, especially with adolescents, is often about walking on a tightrope: dangerously and delicately walking the fine line between hazard and hope. The tightrope is ultimately about encouraging and exploring that undefined, often difficult-to-measure balance between clinically taking positions and imposition, between promoting intimacy and compromising safety, and between increasing intensity and fostering comfort. Having a willingness to tiptoe along the tightrope often means that in my work with adolescents and their families, I have to stretch myself well beyond my zone of comfort and safety. As a family therapist I have to earnestly and relentlessly push myself in treatment to ask one question more than the question I am comfortable asking, and to take risks that might expose me to failure, while at the same time offering tremendous potential for the promotion of healing and transformation.

Ethical and Legal Issues in Telephone Therapy

Posted on September 8, 2010February 11, 2026 by Psychotherapy.net Team

With today’s technology we are an ever mobile yet increasingly connected society. For example, a client who you have been treating in office and perhaps with a few phone sessions when he was stuck downtown at his office has now relocated out of state and wants to continue his therapy sessions. With telephone, Skype and e-mail, why not? Why not expand your practice and “see” patients across the country, especially if you have expertise in an area of treatment?

Over the past decade or so therapists have been warned of the pitfalls of telehealth. For example, bogus identities, unintended recipients, individuals lurking in group therapy sessions. There can also be misunderstanding or unavailability of the nuances of communication (verbal and nonverbal) through e-mail or the internet. In more recent years, various Codes of Ethics or statements from national organizations (ACA, APA, etc.) have provided guidelines about the need for informed consent, maintenance of privacy and confidentiality, and billing issues.

Most recently individual states have started to enact statutes regulating telehealth. While all 50 states have laws regarding general telehealth, only few have laws specific to psychologists and therapy. Few state licensing boards also have enacted formal regulations regarding telehealth practice. However, it seems to be only a matter of time until more states enact laws to protect their residents and to hold therapists accountable to their residents. The APA Practice Organization recently published an article about legal basics for psychologists and telehealth that has a concise review of the current legislative actions regarding this topic (APA Practice Organization. Telehealth: Legal Basics for Psychologists, Summer 2010)

Telehealth can be viewed in two broad categories: practice within state and practice across state lines. Within state, the therapist need only refer to the state specific statutes and good clinical practices. Providing therapy across state lines is a little trickier. The APA article noted that there is a strong legal argument that the therapist should be licensed in both the state in which the therapist resides and the state in which the client resides. Most states allow nonresident therapists to obtain a temporary license to practice for a prescribed number of days a year (often 30 days total). Although this may be cumbersome, it will decrease the probability of licensing board sanctions for practicing within another state without a license. Another alternative, for psychologists, is to obtain an interjurisdictional practice certificate to facilitate temporary practice in other states.

Framework for risk management: (1) Review the telehealth laws in your home state and the state of your client. (2) Contact the psychology board of your home state and the state of your client to identify specific telehealth policies. (3) Confirm with your insurance carrier the limitations , if any, to your policy for telehealth for in-state and between-state clients.

Gottman and Gray: The Two Johns

Posted on September 3, 2010February 11, 2026 by Psychotherapy.net Team

Walk into any bookstore in America —perhaps the world—head for the psychology shelves, and there bound together until sales do them part are the two gurus of relationships, John Gottman and John Gray.

John Gottman virtually invented the science of observing behavior in relationships and can predict future happiness with scary accuracy from groans and grimaces we're scarcely ever aware of. He's a very prolific writer, but most of his work appears in the academic literature. A couple of years ago he penned a popular book, Why Marriages Succeed or Fail. It sells respectably.

Of course, nothing like the books by John Gray: at last count six million copies of Men Are from Mars, Women Are from Venus. Even his several other books— his latest is Mars and Venus on a Date—sell in the hundreds of thousands. Hey, why save a hot concept for married folks, or even adults? The Mars/Venus juggernaut is readying a kids' version. We haven't even talked about the audiotapes. A run on Broadway. Celebrity Line cruises. CD-ROMs. Seminars, and now the first franchise deal to hit psychotherapy. For a few thousand dollars, plus a yearly renewal fee, you too can buy the right to call yourself a Mars/Venus counseling center. You lack the professional credentials to practice? Don't worry—so does Gray. For somewhat less, anyone with a pulse and a purse can buy the right to lead Mars/Venus groups in the nabe.

John Gottman and John Gray, side by side. The placement invites—no, commands—a comparison of the two. How does their information and advice stack up? The short answer is that Gottman is the gold standard while Gray is the gold earner. Gottman creates top psychology, while Gray mines pop psychology: Even that he's turned into "poop psychology," in the words of one Psychology Today reader. We've extracted the pith from their writing and sayings to compile a handy crib sheet. Judge for yourself.

A Tale of Two Relationship Gurus

Issue	John Gottman	John Gray
Chief Motivating Force	Research	Revenge (first wife Barbara de Angelis taught him seminar biz then ditched him).
Formal Research	Naturalistic observation of couples living in apartment laboratory, plus video and physiological monitoring.	None.
Number Of Couples Actively Studied	760	0
Longest Period Of Follow-Up	14 years	0
Academic Credentials	Ph.D., University of Illinois	Ph.D., Mail order, Columbia Pacific U. (unaccredited institution).
License	Psychologist	Driver
Number Of Journal Articles Written	109	0
Cardinal Rule Of Relationships	What people think they do in relationships and what they do do are two different things.	Men and women are different.
Defining Statement	The everyday mindless moments are the basis of romance in marriages.	Before 1950 men were men and women were women.
What Makes Marriage Work	Making mental maps of each other's world.	Heeding gender stereotypes.
What Makes Marriage Fail	Heeding gender stereotypes.	Misunderstanding gender differences in communication style.
Heroes	Men who put the toilet seat down	Men who escape to their cave
Role Of Gender Differences	Mark of an ailing relationship.	Recipe for success in relationships.
View Of Intimacy	Comforts men	Scares men
View Of Humor	Right up there with sex; communicates acceptance.	"Men will tolerate humor. Women won't."
Signs Of Marital Apocalypse	Criticism, contempt, defensiveness, stonewalling.	Arguing
How Spouses Do Best	Accepting influence from one another.	On separate planets.
Key Gender Difference	Men's and women's bodies respond differently to conflict	Women talk too much about feelings.
Why Men Withdraw	Their stress systems are over-activated during marital conflict.	They can only tolerate so much intimacy.
Cause Of Conflict	Virtually inevitable between two people.	She hates Super Bowl Sunday.
Men's Big Mistake	Failing to deep breathe during conflict.	Solving her problems.
Women's Big Mistake	Stating complaints with criticism.	Giving advice.
Why Men Don't Help More at Home	Their brain cells were not trained to notice domestic themes.	They give their all at the office.
Marriage Math	There must be 5x as many positives as negatives in marriage.	Men and women keep score differently.
What They Say About Each Other	"I envy his financial success."	"John who?"

This article was previously published in Psychology Today, November 1997 (Vol. 30, No. 6), © Hara Estroff Marano. Reprinted with permission

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