When a person thinks of starting therapy, there can be a broad range in what he or she has in mind to focus on and expects out of the process. Sometimes the desire is very specific, like dealing with stress on the job or experiencing panic attacks. Some client’s needs and desires are more global or not so easily described. Dissatisfaction with things-as-they-are and the desire to feel or act differently may be the common thread that connects the various concerns that bring people to therapy. Every client I’ve ever seen has had another expectation for therapy and that is to matter: to be heard, respected, and valued as they are. Along with any other skill I possess, I plan to offer this most therapeutic of things.
When feeling especially challenged, “the problem” can feel bigger than life, bigger than you. People will say “I’m bad at relationships” or “I’m bipolar”. Often the difficulty feels so central the person might not have thought about the other parts of their self that they value. Our work will include understanding problems, seeking solutions and alleviating symptoms also. The main focus will be you and how all aspects of your experience contribute to your quality of life. Any problem or disorder, even a major one, is still one part of what defines and makes you you. Both clients and therapists can lose sight of this at times.
These issues are typical of the work I do with individuals. They may also form a part of couples counseling or family therapy as well.
Areas of Concern
Hover over the words for more explanations.
- Anxiety Excessive worry, worry interrupting sleep, social anxiety, anxious reactions to traumatic experience, anxiety-related physical problems, specific fears such as flying, death.
- Depression and other mood difficulties Feeling “down” often, low-grade depression for long periods, major depression now or in the past, low mood with fatigue, sleep problems, weight loss or gain, thoughts of self-harm, seasonal mood problems, menstrual-related mood problems, depression as part of bipolar disorder.
- Work stress Problems at work affecting emotions, energy or relationships at home, conflict with co-workers, management or others, concerns about performance, job security or finances, underemployment, unemployment or other issues related to the current economy.
- Parental difficulty with children and teens Parental consistency, addressing children's emotional and behavioral needs, parents supporting each other, improving communications with teens and “tweens”, helping teens handle more freedom and more responsibility, parenting in stressful times and situations.
- Changing family relationships Concerns such as raising family and caring for parents, moving, schedule change and other family disruptions, blended family, death, loss, illness or addiction in the family, additions to the family such as births, adoptions relatives, including grandparents and adult children.
- Loss and bereavement Includes impending loss, end stage dementia, suicide, violent death, death of abusers or other complex relationships, acute or chronic experiences of loss.
- Difficulty with trust and attachment Early attachment issues in teens or adults, fear or distrust of people in general, distrust due to repeated negative experiences, trust issues that negatively affect relations with others. Isolation due to fear or trust issues.
- Trauma: Childhood or Adult Childhood or adult recovery including history of physical, sexual or emotional abuse, childhood neglect, trauma in adulthood, effects of having lived in violent environments, trauma due to injury, crime or medical treatment.
- Post domestic violence issues Emotional recovery, adapting to new or transitional living situations, post violence parent issues with young or adult children, developing positive new relationships.
- Substance use (evaluation and referral) and recovery Evaluation and referral including assessing concerns about substance use, its role in other emotional difficulties, supporting client to access treatment, recovery process, recovery issues in the family. (I do not provide formal substance abuse treatment.)
- Concerns of sexual orientation and gender Wondering, worrying and questioning of sexual orientation or gender, internal conflicts, coming out, changing sense of self, relating to family and peers, parents or significant others’ concerns about loved ones.
- Disliking yourself or feeling unlovable Self-esteem and self-concept issues including distress due to disliking one’s self, feeling unlovable, overcoming effects of emotional abuse or bullying, developing confidence and resilience, personal growth and transformation.
- Adjustment to medical conditions or disability Stresses of post-injury or post-diagnosis treatment and recovery, physical and emotional changes, relationships and other’s responses to you, confidence and self-advocacy, “reinventing” yourself based on old and new experiences, interests and strengths.
- Body image issues Concerns and negative beliefs about one’s body, its attributes and value, history of criticism, ridicule, or bullying, anxiety or depression due to ideas about one’s body, process of changing one’s body image.
- Thought disorders Includes difficulties related to perception or reality, hearing or seeing things things others don’t seem to, history with periods of extreme distress and confusion that led to diagnoses of mania, schizophrenia, paranoia or psychosis.
- Adoption related issues Concerns of adolescent and adult adoptees, birthparents and family, searching for family connections, relations with adoptive parents or birthparents, parents’ concerns regarding child’s birthparent search, transracial adoptees or parents’ issues, adoptee identity issues.
- Cultural issues Effects of ongoing experiences of racism and/or other forms of discrimination, intercultural or inter-religious concerns within couples, families or extended families, multiracial/cultural personal development, identity and experiences.
- Concerns of older adulthood Emotional and physical health while aging, workplace issues and economic stressors, changes in health status, increased loss experiences, keeping active and involved with others, anxiety and mood concerns.
Counseling for Couples and Spouses
When couples find themselves struggling with situations affecting their relationship, even loving people with great respect for each other can succumb to the stress and frustration involved. It is easy to get so focused on what isn’t working that you can ignore what is working and forget that you’ve surmounted obstacles together in the past. Some couples who have been in conflict for a long time, come to see each other as enemies and rivals. While they both would like to end the fight, they may feel compelled to keep it going. Regardless of who believes they are “right”, both partners often end up feeling misunderstood, lonely and unloved. In relationship, it seems that either everyone wins or everyone loses. I believe both partners deserves more and can work toward developing a relationship that supports and brings out the best in each partner, drawing them together in positive ways.
Couple-related issues are usually addressed most effectively with both partners present. There are times and situations where this cannot occur, such as when domestic abuse is a factor or when one partner is unable or unwilling to participate. Relationship issues can be the focus of individual work. This work looks at understanding the issues, difficulties that affect the partner who is present and seeking ways to shift couple interaction in a more useful direction. Some people come to therapy to determine whether to work on or leave a relationship. In such cases, I assist the client or clients in sorting through their own thoughts, experiences and concerns related to such a decision. It is not my role to offer evaluative advice or opinions.
Here are some of the reasons people come to me and other therapists for couples’ counseling:
- Difficulties with communication
- Arguments that are verbally aggressive and/or unproductive
- Disconnectedness: lack of shared time and interests, lack of mutual support and enjoyment experienced earlier in the relationship
- Prolonged stressors: work, finances, childrearing, illness, loss, extended family concerns.
- Fundamental differences in values, beliefs or expectations.
- Sexual concerns: desire differences, sex life effected by physical/emotional changes, infidelity
- Infidelity and its aftermath
- Physical or mental illness of one or both partners.
- Exploring decisions to separate, end or commit to work on relationship.
- Separated or divorced parents who must communicate or interact to raise children
- Couples experiencing difficulties related to extended family.
Taking Your Sessions on the Road
In addition to the methods above, I incorporate other theories and tools to support the efforts made in our sessions and allow you to get the most “mileage” out of our time together. I may suggest any of these activities based on your needs, preferences and interests. The purpose is to clarify and increase awareness of matters discussed in therapy and to spearhead efforts toward problem solving, behavior change and wellness-promoting activity. Use of these tools is not required or even assumed. As in the old TV show, any form of homework is “your mission, should you choose to accept it” and not an expectation.
Observation: Paying attention and making mental (or literal) note of specific thoughts, behaviors, emotions etc. to learn more about when, how and why they occur. Knowing this makes changing to a more desired reaction much more possible.
Journaling: Logging or writing about observations, emotions, situations and things you want to remember and put to use. Even brief notes can help you clarify your thoughts and intentions, keep focus and notice when change you desire is actually occurring.
Experiments: Working together, we develop actions you can take that are small enough but challenging enough to gradually push your envelope toward your desired goal. You get to test and apply what we learn in therapy where it matters most, in your everyday life and relationships.
Self-care Activity: Includes any activity you choose to do that helps you feel emotional, mental and physical balance and wellbeing. We will assess what you already do that supports you and add other activities you may want to explore.
Exercises in mindfulness: Involve systematic ways of using attention, observation and intention to reduce stress, alter mood, cope and thrive through challenging circumstances. A more positive sense of self and compassion for others can develop over time.