I’m on a short break, but will return to the office on May 2nd. If you are a potential new client, know that I have a couple of openings and will respond to your inquiry when I return. Meanwhile, the office (and the tropical fish, a favorite of many clients!) will be well cared for by another tenant in the building. See you all soon!
Archive for the ‘About my practice’ Category
I’ve never been to Burning Man, and as someone who’s not a huge fan of desert environments, I’ve never felt a strong urge to go. (I know, I’m probably missing out on a lot.) But this year I saw a sculpture featured there, and haven’t been able to get it out of my mind or heart. Here it is. It’s called “Love,” and was sculpted by Alexander Milov:
You can Google it to see more images taken at various times of day. I don’t want to over-interpret this art, and can only describe my own response to it, not only as a couples therapist but as a human being with a marriage and many other powerful relationships in my life. When I look at these images, I feel empathy for all four figures, the two adults and the two children. I suspect the adults know what the children are doing, and while the children extend their hands so simply, the adults are working out their ambivalent feelings of longing, resentment, hope, fear, regret, and love. And I notice that the children are not quite touching.
Oh, how I want those children to be able to touch hands, and embrace. I want this for all four of them. I want to help them.
This is my life’s work.
An article in the New York Times today is one of those articles that can be hard for therapists to read. It’s just one person’s account of her experience in couples therapy, but it’s pretty damning of my industry and craft. She offers cringe-inducing anecdotal reports from 30 years (off and on) of seeing couples therapists, who too often sound, well, like idiots.
But what bothered me the most about the therapists she described wasn’t the corny one-liners and trite advice they gave. It was the way they all seemed to be doing whatever they thought was the right thing to do, apparently without any set of guidelines or standards that all couples therapists follow. This can be messy work, and sometimes we don’t know if it was effective until we follow up with clients long after therapy has ended, but come on, really? Can’t we have some kind of assurance that every couples therapist will do (or not do) certain specific things, and with some reliable amount of quality control?
That’s why I’m in the certification track for Gottman Method therapy, and why, month by month, I work with a therapist supervisor one on one. I tell clients that our agenda matters a great deal to me, and I don’t want to do even one session with a couple without discerning clearly and thoroughly what we’re working on, how they’re doing, and what the specific next steps are. I also keep reading and integrating theoretical perspectives into my core approach.
Having said all that, I also know that there are moments in the room with couples when I need to follow my instincts and take the session in a direction that isn’t predicted or controlled by the various models and regimens I typically use. Sometimes I have an out-of-nowhere question for the couple that radically shifts the direction of our work.
So … how do I know that’s effective?
Well, sometimes it’s not. Other times—and this is true more often than not—it can be a breakthrough moment for the couple. One couple I worked with some time ago was coming to me with a lot of anger, particularly from the direction of one person in the couple, who seemed almost consistently irritated with our whole process. My approach was to ask about deep fears they both had, and how they were suppressing those fears in a way that fueled their pattern of anger and bickering. (That’s a fairly standard tack.) But my question didn’t come out of a textbook. It wasn’t vetted by a well-researched theoretical approach. It was something like, “You two sound pretty freaked out. Are you scared about your kids?”
And off we went in a new direction. Thankfully, I was right. It could have been a false move. In that case, I would have thought quickly on my feet and pivoted us back on our previous course. But it’s tricky, this work. It can sometimes fall flat, or backfire. But when it works, it can truly change the life of a couple.
So—I did it. I ran 13.1 miles in the 2015 Mercer Island Half Marathon, a race that raises funds to fight colon cancer. I personally also raised funds to support two other causes. In the course of all this, I learned a lot about myself, my body, and what I want to do—how I want to live—in the here-and-now of my forty-something life.
I’ve said to clients that I fly a chair every day in my work, so I need to play in a way that takes my body to the limit. Back in September 2014, I started working out in earnest, and by December I had a wild idea: what if I signed up for a race? I had been using the row machine at the gym, and it felt unsatisfying expending all that energy going nowhere. I started running on the treadmill, and soon recalled the thrill of running—really, it’s just the thrill of high-impact cardio work—when I was 17 years old, back in the 20th century. My 17-year-old self got in shape much faster (and could eat all the cookies he wanted), but even now I can readily see and feel the results of hard exercise. I’m hooked.
Then, in late January, I injured myself. I got ‘Pes Anserine Bursitis’ in my right knee, the result of poor running form in which I radiated my right foot (and knee) outward each time I took a step. It was painful, but the worst part was its persistence: I didn’t start to feel even a little better until mid-February, after a scary three weeks of physical therapy, acupuncture, and a sinking feeling that I wouldn’t be able to finish the race, or even compete: at its worst, I couldn’t run an eighth of a mile without severe pain.
But then that lifted, and I was back on my training schedule. I ran seven miles, then ten, then twelve, with alternating short runs in between. I learned that long runs (for me) are little spiritual exercises in persistence and patience. I learned to find the balance between taking care of myself and pushing harder. I’d be in the middle of mile eight, say, and feel utterly fatigued … and I’d keep going.
I started doing simple math on runs, which became a form of meditation. Every five minutes, the runkeeper app on my phone would tell me how I was doing, and I’d crunch the numbers while I ran: “I’m 6/16ths done now … so that’s 3/8ths … almost half …” Then, one fine day, the app malfunctioned and I didn’t get the updates. I ran in silence. I noticed that without the jabbering of the 5-minute updates, I could focus better, notice what was going on with more intention, and run more efficiently. In running, as in so many things, less is more.
On race day, last Sunday, March 22, I felt excited but not particularly nervous. I knew by then that I’d make it, and it was just a matter of doing it. I was more nervous about all the other runners and the unfamiliarity of the event: this was my first race, except for a little run I halfheartedly did about a dozen years ago, which was so halfhearted I don’t think it counts. My goals were to finish, and to not walk at any point on the course. Done, and done. The eighth mile was once again one of the biggest challenges: my right foot started to hurt, and it was hard to shake the thought that I had several miles to go. I said a little prayer to my higher power and punched through it.
Then there was the twelfth mile: brutal, because on this course most of the twelfth mile is a long, steeper-than-it-looks incline. I refused to walk it. I was slow, just chugging along, but I made it. A nice guy ran alongside me and encouraged me. Runners are kind to each other in these races, I learned.
It felt so good to finish. I felt alive, awake, alert. And of course, I thought, “Yeah, I want to do this again.” I don’t know if I’m up for a full marathon, which is a different race entirely, requiring more than twice as much training as the Half. The Half is challenging enough, I think. But my next goal is going to be about strength: I’ll keep running, but focus more on muscle development and physical strength.
I love to encourage clients to live life fully, so in a real sense this whole project has been a part of my job, even a part of my business plan. It’s important that I live what I suggest, to put my running shoes where my mouth is. And it’s a gift not only to myself, but to my family and friends too: when I’m in good physical shape, I’m in great emotional and mental shape. I’m a better friend, a better husband, a better neighbor.
I didn’t do it all perfectly. The injury taught me that. But I did it thoroughly, I scared myself with a daunting challenge, and I enjoyed my life while I did it … and that’s all I wanted.
Is it time for you to scare yourself?
Maybe it’s the name. “Marathon.” That word can freak people out. I’m thinking about other ways to label this form of therapy, but for now, let’s go with “marathon,” and I’ll just ask you to hang in there with me on this. It can be a powerful, profoundly helpful experience for a couple.
Here’s how it’s done: three days of therapy, five hours a day, for a total of 15 hours. We begin at 10:30 each day, take a lunch break at 1:00, and are done at 4:30. Ideally you make an additional investment of renting a hotel room so that you can truly get away from your lives for this time. (You will be tired! And it’s good to stay focused on your relationship, to keep it front and center.)
You can expect to make progress, relapse, enjoy a powerful breakthrough, relapse again, and so on. By day three, you will start to integrate our work, and you’ll finish up with a very clear idea of what you want to do, how you want to relate, and what your future holds as a couple. You will have specific “takeaways,” including both practical tools and deeper insights. You will go home feeling like you truly worked on—and greatly improved—your relationship.
Of course, there are no hard and fast guarantees. And there will be moments in the marathon when you feel hopeless. But like actual (running) marathons, the whole experience can end in an exhilarating finish.
Most people, when they contemplate couples counseling, imagine a half dozen or more sessions spread out over weeks or months. They try to fit the sessions into their busy lives, and the biggest barriers to success are low intensity, multiple distractions, and the sense that each time we meet, we have to “start the engine cold” once again. I make that format helpful, too, and pay close attention to the need to keep intensity high and generate strong momentum. But in the marathon, we don’t have to worry about that. We can go deep, and stay there until we make real progress … all in one weekend.
The cost? I charge $1800 for the 15-hour session, plus $29 for an online assessment that you can take beforehand. That works out to $120/hour, which is my standard fee in traditional couples therapy.
Lots of people find the idea of marathon couples therapy daunting, but I encourage you to think about it—and feel about it—for a while, and take it seriously as a real option for your relationship. Have you ever been to a couples weekend or pre-marital workshop? This is like that, except it is all for you. No classroom filled with other couples. No general lectures or activities that everyone learns together. Just you two. Imagine how healthy and invigorating this could be for your relationship!
P.S. I’m training for a half marathon this spring (the running kind). Since my job has me sitting down all day, it’s my way to stay fit, clear my mind, and build spiritual strength. 🙂
So, let’s talk about the Myers-Briggs. You’ve heard of it, even if you don’t think you have. The terms “introvert” and “extravert” come from the MBTI. It was developed a few decades ago by Katharine Briggs and her daughter, Isabel Briggs Myers. It’s grounded in Jungian thought, that is, the work of Carl Jung. I’m a certified practitioner of the instrument, and if you ask me, it’s pretty great. It helps people gain understanding about their personality preferences, and the differences they experience in others. It helps people communicate better, handle conflict better, and even plan their careers.
For some background on the MBTI and the MBTI services I offer, go here. I wanted to add a few thoughts in the wake of the Vox article, and all the fun we’re having trying to figure out if we have the same personality type as Frodo Baggins. 🙂
It is not a test. The MBTI is not a test that measures your worth, intelligence, mental health, or accomplishments. When you take the instrument, the results that it gives you are only a report on how you answered the questions. The results are not a final judgment of your actual personality type. Only you get to decide what your personality preferences are. You are free to reject the results. So when you hear people say, “I took the test and it assigned me N, but it used to say I was S,” please know that this is misusing the instrument. It does not tell you who you are. Only you can do that.
You have inborn preferences. Many people take the instrument at different points in their lives, and in different situations, so they may get slightly different results and conclude that they have changed or switched their preferences. Actually, how one takes the instrument can shift the results one way or the other: your workplace or school might not have prepared you correctly; or you might have felt internal or social pressure to answer the questions in ways that don’t reflect your true preferences. Consider also that at certain points in our lives, we experiment with out-of-preference behaviors while retaining our inborn preferences. For example, I prefer Extraversion. This is inborn: I will always be an extravert. But there are times in my life when I balance my inborn preference with quiet time, even seclusion. But that doesn’t make me an introvert. In addition, I was rewarded in my family of origin when I stayed calm and quiet (we were a big, busy family), and that early experience clouded my natural Extraversion preference.
It is well researched and internally validated. The Vox article seems hell-bent on rejecting the MBTI as an absurd hoax, but the reality is that for decades, MBTI researchers have followed many research populations in a variety of contexts to validate the instrument’s accuracy. In my own work with individuals, couples, and work teams, we typically see this too: people learn the theory, form a first hypothesis about their preferences, and then receive their instrument results, and by a vast majority, at least three of the four preferences in their instrument results agree with their first hypothesis, and the fourth is quite close. The Vox article criticizes MBTI because it hasn’t been subjected to a lot of external research in the psychology field. This is technically true, but it’s not because CPP (the company that administers and owns the MBTI) hasn’t tried to subject the instrument to external research. It’s because the origins of MBTI are qualitative, not quantitative: it is the brain-child of two brilliant women steeped in Jungian theory, so it did not originate in a widely-recognized university research facility, and it suffers more than a bit of derision as a result. I believe this negative attitude (exemplified in the Vox article) adds nothing to our understanding of the true value of this instrument (or anything else, really).
Have fun, but don’t mistake the online quizzes for the real thing. Most Buzzfeed quizzes offer just a few questions that haven’t been validated, much less interpreted, and while this may be obvious to you, it’s unwise to put much stock in quizzes designed to market products to you while helping you enjoy social media. Don’t get me wrong: I love to be told that I share a personality type with Gandalf the White. But for me, that’s just a laugh. It’s not the MBTI, and I can’t do anything with it.
Be sure to have someone interpret your results with you. This is a commercial for my services, I know, but it’s good advice: don’t do the MBTI by yourself. In fact, you can’t do the actual instrument without some interpretive help. When you take the MBTI seriously and work with an interpreter, you can gain powerful insights about yourself, your career, and your relationships.
I’ve written before about the difficulty of obtaining insurance coverage for couples therapy, but want to walk through my take on this again, to give couples a clear understanding of why I don’t accept it, and what I can do if they believe they have this coverage. This is a bit lengthy, but it’s an important issue, so if it impacts you, please read it through to the end.
Here’s the primary issue: the medical insurance model is based on individuals and the diagnosis of individuals with mental disorders, but my couples practice treats the whole couple as a single client. This means that even though couples therapy might help you when you are depressed, chemically dependent, anxious, or suffering from another mental or emotional problem, and even if your insurance company tells you that they cover couples therapy, I can’t ethically bill insurance companies for couples therapy, because they will require me to diagnose and treat one of you for an “Axis I mental disorder,” with the other listed as a spouse or family member of the person being treated. The two of you would meet with me for several sessions as a couple, and I’d be treating you as a single client, but the paperwork would tell a different story.
Here’s the story the paperwork would tell: our therapy is about a sick person, just one sick person, and when that sick person feels better, therapy will end. This is just not what I do with couples. Both of you are “sick,” in the sense that your relationship is in distress, and both of you are doing or not doing something that is keeping you stuck. And—both of you are not sick! Both of you have skills and tools and gifts that will help you improve your relationship, and both of you are coping with the “sickness” of the other.
You might ask, “Who cares what the paperwork says? We know what’s really going on.” My answer: I do. I do not want an official record that describes my work with you in an inaccurate way, particularly when it pathologizes one of you. I just can’t be okay with that. And I know this: if I don’t take my own ethical concerns seriously, I can’t be a good therapist to you.
You might then say, “But my insurance says they cover couples therapy!” My answer: I hope so, and if they do, I’m willing to help you enjoy your benefit. Here’s how we will do it. You pay up front for our work, and I issue you an itemized receipt that includes the diagnostic code for a partner relational problem (V61.10). You can submit a claim for that, and hopefully receive reimbursement. I’ve not seen a lot of people actually receive this reimbursement, even though their insurance company told them that they cover couples counseling, but we can give it a try. Sometimes your insurance company’s customer service rep will tell you they cover something even though they don’t; or they cover it only in certain circumstances, such as your therapist giving you a diagnosis (major depression, for instance) that’s on the insurance company’s allowed list. But we can give it a try.
If you’re noticing some attitude on my part about insurance companies, you’re right. I have grown highly wary of them, and am fatigued by the many ways they avoid reimbursement over tiny technicalities. My biggest concern is their demand that I assign one of you a mental disorder, and not the other. Even the V code above is (in my view) inaccurate: sure, you have a partner relationship problem, but so does your partner! And s/he will not be seen as my client as far as the insurance paperwork is concerned.
You might then say again, “Who cares? We have this coverage.” My answer: Well, I will always care how my clients are labeled on official documents related to my work with them. And I’d love to talk to you about my deeper concern about insurance coverage, which is that third-party payment can make therapy less powerful for clients because it reduces the positive effect of an out-of-pocket investment in your own happiness. I’ve paid out of pocket for therapy for many years, and I realized last year that since 2006, I’ve paid my therapist the equivalent of what she paid for her (fairly inexpensive) car. “I bought you a car!” I exclaimed to her, with a smile. And as odd as this sounds, I felt good about that. I felt like I had given her something valuable in exchange for a life-changing therapeutic experience. I had invested in myself in a powerful way.
(By the way, I already have a good car, and my individual therapy relationship is far lengthier than a typical course of couples therapy.) 🙂
A final note about money, and lack thereof: If you’re concerned that when I hold the line on ethical insurance practices while encouraging clients to pay out of pocket, I’m running a business that only works for wealthy people, I want to reassure you that I routinely see a percentage of my clients at a reduced rate to accommodate their financial need, and honor my own ethic to give some of my work back to the community at a reduced rate (sometimes significantly reduced). I have to earn a living too, but this rate scale is also a part of my ethical approach to my business plan.
I hope this clarifies how I see things on this complicated issue, and that if not, you and I can discuss it more in person.
Please note that I suffered a technical failure this week that kept all of my voicemails in the ether until this morning. The oldest voicemail was dated last Sunday, six days ago. I’m working on this problem to ensure it doesn’t happen again, but in the meantime if you left me a voicemail and haven’t heard back from me, email me or contact me here to be sure I hear from you and respond in a timely way. Thanks very much, and I apologize for this inconvenience.
That’s the subject of a message I got from a friend, who was a little thrown by my previous post in which I confessed that I (like all human therapists) will have shifting thoughts and feelings about the people in my room. My friend understood what I was saying—that it’s simply inevitable that a therapist will think and feel like a human—but she was still not happy with what I said. “You’re supposed to be there for people when nobody else is!!” she wrote. “I am!” I answered back. “I always figure it out!” But she remained concerned.
So here’s some more from me on the topic, which I also told my friend:
The truth is, I love my clients, especially (and often particularly) those who from time to time might rub me the wrong way. And I’ve known since grad school that clients are supposed to rub therapists the wrong way: they’re supposed to bring to the room all the “stuff” they do and experience in their lives, good and bad, beautiful and ugly. I even know that I’ve driven my own therapist a little crazy from time to time.* Often enough, it’s that tension, that hard-to-pin-down energy, that helps therapist and client form a strong, positive therapeutic bond.
A couple of years ago, my therapist said something that upset me a lot. I left the session feeling pretty mad at her, and hurt. I came back the next time and told her that, and we had one of our best sessions in the course of our work together. So there are times when the back-and-forth of feelings between therapist and client can come out in the open and lead to a healthy breakthrough. Other times, it’s under the surface and operates the way I described in the last post: it’s just more data for the therapist to notice and use, for the sake of the client.
But most importantly, know this: I wouldn’t be in this business if I didn’t have powerful, positive, human affection for the lovely (and troubled) people who honor me with their stories, their issues, and their work. I wouldn’t still be at this 15 years after grad school if I didn’t find all clients delightful in some way. I enjoy the company of other people—I am an extravert, after all—and I love my work. So when I find myself in a challenging emotional place with a particular client, I often just say to myself, “Okay, get to work now!” And soon enough, my eyes open to a hard-to-define dimension of their life that makes them easy to understand, easy to like, and a pleasure to know.
My friend is cautiously okay with all this. And she raises a good point: the therapist’s office needs to be as safe as possible, a place free of judgment for people who too often are judged unfairly for being the ordinary persons they are. And I strive to offer that, and typically succeed. When it’s hard to do that, I simply notice that and work on it. And that’s just part of the joy of my profession.
* I believe therapists should have their own therapists, for a number of reasons. For me, it’s helpful to be challenged and supported by someone who knows my work from the inside, and knows how to help me sort out my own personal issues so that I can be a better clinician for others.
…and other hard truths from the world of therapy.
I’m in the mood to debunk a belief about my field, probably because I encounter this belief a lot, but rarely (if ever) see it borne out in practice. You’re probably familiar with it. (You may believe it yourself.) Typically I hear it in the form of a request someone makes early in our work together: “We’re just looking for someone who can be objective.”
The belief is that therapists are objective. And here’s what I say in response: I’m not objective, but I am aware of my biases, and I use them responsibly in our work together.
Therapists can’t be objective because, well, because we (like you) are subjects. We are creatures bounded by space, time, our own upbringing, culture, language, gender, race, sexual orientation, trauma history (most everyone has been traumatized to some degree), and so on. For example, I was born into a large family and have always known what it’s like to have siblings. I’ve also had only-child clients, and couples with diverse sibling backgrounds. I might resonate with the one who had a bunch of siblings, or I might admire or get along well with the only child (the way you love to learn about someone who’s very different)… And it’s not my job to not feel these things. It’s my job to handle these biases well. They tell me a lot about how this couple works, and probably give me a good idea of how most people experience this couple.
But here’s a harder example: often enough, I will naturally like one person in a couple more than the other. Sometimes this shifts over time: person 1 is more likable at the outset, and person 2 overtakes their partner in likability as therapy moves forward. It happens in the same way people are liked more or liked less by their various friends or family members. (There are times when I suspect my family of origin likes my spouse a bit better than me… but hey, that’s my therapy.)
So … what to do? Here’s what I do, and what any responsible therapist would do:
1) I accept my personal reactions to clients as information, as data, that can inform our work together. If I like your partner better than you at this particular moment, I flag that mentally and wonder to myself what I might be missing about you, or whether I’m just buying into the “public face” of your couple (most couples present a more likable person to the world, if only for the sake of a humorous routine that puts them both at ease). I wonder whether the likability difference “works” somehow for you two, and I actively think behind the scenes to debunk it. I’ll engage both people in different ways, either by connecting more with one of you, or hanging back. I’ll work the data into my theory, and reflect internally about what it might mean for your work and your goals. And 100% of the time, I see it shifting, right before my eyes: soon enough, I click with something the less-likable (in the moment!) person is saying or doing, and the dynamic changes.
2) I accept my personal reactions to clients as information, as data, about me, both as a person and as a therapist. Sometimes I’ll notice a little theme over time: I’ll notice that I’m agitated by several clients who share a certain personality preference, let’s say, and I’ll wonder to myself what that says about my own personal and professional work. “The talkative ones are rubbing me the wrong way this week,” I might notice to myself. “And isn’t that odd! I love to talk and relish verbal back-and-forth in here. What’s up? Am I tired? Are they talking about something that touches a nerve in me?” For me to be a good therapist, I have to be conscious of all this, and on top of it.
So there you have it: therapists are biased. It’s inevitable. In fact, it’s helpful: you’re much more likely to be helped by someone who knows what it’s like to be a subjective, mistake-making, self-aware, and mortal human, rather than an automaton that receives your data like a computer and spits out a standard behavioral prescription. I’m not objective, and that’s a good thing.