Relationships can be the source of our deepest pain and also — sometimes with the help of effective individual, couples, or family therapy — of our greatest joy.

I have a longtime specialty in couples & family therapy. Some of the most common focus areas in my practice include tools for effective communication, managing conflict, emotional intelligence (EQ) skills, difficulty sustaining relationships, differences between partners in needs for closeness, challenges around vulnerability, conflicts around money/sex/parenting/co-parenting/in-laws/elder care, struggles with the choice to leave a relationship, and so many more.

I have particular specialties in working with clients who want to heal and grow from deeply painful or traumatic relationships with partners, clients in relationships with highly challenging/difficult people such as narcissists, and clients who seek to end problematic patterns in relationship (eg. partner selection, codependency, difficulty saying “no,” over-caretaking, setting aside your own needs, reactivity).

It’s also common for clients to work on their relationship with themselves in therapy. For example, as a result of early treatment by parents or the social world, trauma, depression, painful relationships, and other factors, we can be excessively self-critical, wrestle with guilt or shame, and wish for higher self-esteem.

In addition, an insufficient number and/or quality of relationships in our lives can be profoundly depleting — for example, in 2023, the U.S. Surgeon General, Vivek Murthy, declared isolation and loneliness a public health crisis in our country. Feelings of not belonging and disconnection are pervasive — half of U.S. adults report experiencing measurable levels of loneliness — and are a profound threat to mental and physical health. And, other challenges can contribute to this as well. Depression often causes us to withdraw and contract. Social anxiety can make us reluctant to venture out. Relationship issues with people in our lives can make it hard to engage. Moving or losing a job can eliminate much of the connection with others that we had, and starting all over again can feel daunting. Therapy can be a safe catalyst for re-emergence into the nourishing world of relationships that you want to have in your life.

I draw from such models as cognitive-behavioral therapy, Relational Life Therapy, and Internal Family Systems in working with clients on these issues, based on my training with Terry Real, Dr. Sue Johnson, Dr. Richard Schwartz, Dr. Karyl McBride, and Dr. Rodney Shapiro.

With focus, the safe and connected experience of therapy can be an effective way to learn and practice new relationship skills, resolve relationship issues, and enhance your relational life.

Depression has a broad range of possible symptoms and severities. For example, sadness is not always present; a feeling of emptiness, hopelessness, or, particularly in men, irritability, can be the main mood symptom. Sleep disturbance, reduced or unbalanced appetite, persistently feeling bad about yourself, a markedly diminished ability to enjoy things, feeling like your body is moving through quicksand, difficulty concentrating, increased and persistent anxiety — any of these symptoms, among others, might be a sign that some level of depression is present for you.

And if it is, depression can loudly or quietly affect much, if not all, of your moment-to-moment, day-to-day experience, and also the experience of those with whom you are in relationship.

Therapy can provide the action-oriented, solution-focused support you need to address the thoughts, feelings, behaviors, relationships, past experiences, and/or life situations that point the way toward ending your depression and re-engaging with a meaningful and fulfilling life.

For so many of us, there is more stress in our lives than ever before. And, the stress can be cumulative, from the pandemic, relational life, the economy, politics, the climate crisis (I'm a climate-aware therapist), societal violence, and on and on. Acute or persistent stress can be debilitating, depleting and bring on depression or physical difficulties.

Sometimes, even when there is no stressor present, we can struggle with anxiety — persistent and excessive worry. The National Institute of Mental Health reports anxiety disorders are the #1 mental health problem in the U.S., and that 31% of adults will experience an anxiety disorder in their lifetime.

Situational anxiety, generalized anxiety, social anxiety (fear of embarrassment/judgment in social situations), panic, obsessions and compulsions, phobias (like the fear of public speaking, of flying, or of needles) are some of the typical challenges clients bring to me.

Stress and anxiety often respond very well to therapy, particularly cognitive-behavioral therapy, an evidence-based approach that helps you work with these challenges at a pace that you control. Sometimes, clients wish to address the root(s) of their anxiety, and find evidence-based techniques that I use in my practice, such as EMDR Therapy and the Flash Technique, effective and efficient at eliminating the power of negative beliefs and past distressing experiences to fuel anxiety.

One of my teachers, Francis Weller, says that trauma is “any encounter, acute or prolonged, that overwhelms the capacity of the psyche to process the experience." And in one of my trainings, I heard the great trauma treatment pioneer Peter Levine say of the aftermath of traumatic experiences, “Trauma is what we hold inside in the absence of the empathetic other.” Deep aloneness is so often central to the human experience of trauma.

Certainly experiences such as surviving or witnessing physical or emotional violence, surviving a car or bike accident, and experiencing the death of a loved one or friend — particularly but not solely when the death is sudden and unexpected — are often traumatic. And, even more insidiously, complex trauma can result from being exposed to a stressful or traumatic situation repeatedly, sometimes even over years or decades: an abusive boss, a narcissistic parent or partner, an exceedingly high-stress or dangerous job.

Less well-known are the ACEs (Adverse Childhood Experiences): potentially traumatic events that occur in childhood and adolescence, such as abuse, rejection, and abandonment by caregivers; the loss of a caregiver; and growing up in a household with substance abuse problems, mental health problems, or instability due to parental separation or household members being in jail or prison.

Furthermore, intergenerational trauma can have not only behavioral and emotional but also epigenetic effects downstream: trauma in a parent can change how a child’s DNA works. First documented in children of Holocaust survivors, and since in many other cultures, as a consequence of such events as colonization, slavery, and displacement, teachers such as Aaron Johnson, Tirzah Firestone, and Daniel Foor have shown me that there are techniques for healing the effects of traumas that you literally may have inherited from your parent(s).

And sometimes, we just know we’ve had a traumatic experience, regardless of anyone’s textbook definition. A CDC and Kaiser Permanente study found that more than 67% of adults have been exposed to trauma — making trauma a silent epidemic.

Crucially, you need not meet the criteria for Post-traumatic stress disorder (PTSD) — a serious yet treatable condition that I see in my practice — for current or past trauma(s) to be having significant effects on how you feel about yourself, how you feel in relationship with others, and your ability to regulate your inner emotional life. In my experience, a variety of forms of depression, anxiety, relationship “triggering” (when disturbing situations in the present resemble similar experiences in the past), challenges with self-worth, and feelings of aloneness and isolation are not infrequently the consequence of incompletely processed trauma.

Sometimes talking in therapy, although usually very helpful and necessary, may be insufficient to fully metabolize your trauma, since the part of the brain responsible for talking and language is different from the part of the brain where traumatic memories are problematically stored. So, within your therapy and on your own, we may combine talking with somatic (physical) or multisensory activities such as movement, embodiment practices, music/singing, art, imagery, meditation, prayer, yoga, art, drawing, journalling, creative writing and techniques such as EMDR (Eye Movement Desensitization and Reprocessing) Therapy and the Flash Technique.

EMDR is not about reliving trauma; it is an evidence-based psychotherapy, grounded in 30 years of extensive research studies, that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences or intergenerational trauma. For most people, most memories tend to be stored as just the story of what happened with few vivid images. Memories for stressful and traumatic experiences can be stored in the brain with vivid pictures, sounds, thoughts, feelings and body sensations. EMDR reprocessing reactivates these different parts of disturbing memories and allows the brain to reprocess the experience. This is what normally happens in REM (Rapid Eye Movement) or dream sleep. Francine Shapiro, who first discovered and and developed EMDR, believed that is why we wake up feeling differently about experiences from the day before that were still upsetting when we went to sleep.

The alternating eye movements that we use in EMDR Therapy help the brain to reprocess the way information is stored in the brain. It is your brain’s own ability to heal that will be doing the all the work and you are in control of the pace of the therapy.

Although EMDR Therapy is best known as a rapidly effective trauma treatment, it has been proven effective with a variety of other issues, including chronic pain, anxiety, depression, grief, traumatic/complex grief, phobias, cancer patient experiences including diagnosis/treatment, and shame (feeling bad about oneself). EMDR Therapy does not necessarily involve reprocessing traumatic memories; for example, EMDR can create new internal resources for better resilience, such as resources for calming and confidence.

Here is a brief video overview of EMDR therapy, and here is a brief video example (by another clinician) of what an EMDR therapy session addressing a past memory can look like.

The Flash Technique (FT) is an evidence-based therapeutic intervention for reducing the disturbance associated with traumatic or other distressing memories. Unlike many conventional trauma therapy interventions, FT is a minimally intrusive option that does not require clients to consciously engage with the traumatic memory. This allows the client to process traumatic memories without feeling much, if any, distress.

These are only some of the tools that I may recommend in working with clients on distressing or traumatic experiences. I do not have a “one size fits all” approach to trauma healing in therapy; our collaborative plan will be attuned to, and informed by, your unique experiences and needs. Generally, trauma treatment can involve restoring a sense of safety in your life and ensuring you are well-resourced internally and relationally; processing the trauma if and when that is needed and you are resourced sufficiently to do so; and integrating your experiences into your life and re-integrating into your web of safe and trusted relationships.

As with many psychological conditions, narcissism exists on a long spectrum. Yet even with just a few of the traits, a narcissist can negatively affect a child or partner.

If you are the adult child of a narcissist, or the partner of a narcissist, that person typically could not or cannot unconditionally love, empathize with, and emotionally support you. The consequences, for you, can be chronic self-doubt, chronic free-floating anxiety, a feeling of invisibility, learned problematic communication patterns, and not having a model for what healthy love and intimacy look like or feel like. You may feel unloved, unheard, and never good enough.

I’m certified in Dr. Karyl McBride’s 5-step recovery model for healing from narcissistic harm and dealing with narcissists. Together, we work to end the cycle of family trauma and rebuild psychological and emotional health.

Grief may be the experience we have most in common with all other human beings. As one of my teachers, Francis Weller, says, no one is exempt from this club.

The death of a loved one or friend, a type of loss with which I have deep personal and professional experience, is only one of the many types of loss we can experience in our lifetimes. Breakups, divorce, job loss, miscarriage, infertility, loss of physical functioning, the death of a pet, the loss of a dream or hope, losing financial security, moving to a new home, losing an identity or role (eg. child, sibling, caregiver), terminal and chronic illness, grief for what you expected in life and did not receive, losses you feel for others in the world, and the many losses that come from being of a people that was and is marginalized, displaced, and worse — all of these, and more, can be deeply painful parts of being human.

The impact of your loss can be more complex if it was sudden and unexpected. Conversely, as in the case of caring for a chronically ill or terminally ill loved one, the losses involved in long-term caregiving, including an anticipated death, can have a big emotional impact on you as well — for example, depression and anxiety, two of my other specialties, are common effects.

Sadly, our culture so often works against grieving, an enormously healing and liberating process that is a birthright for all human beings and key to good mental health and well-being. Three-day “bereavement leave” at work, people telling us we need to “just get over it” not long after a loss, insufficient information about how to architect an individualized grief process — these are only some of the ways that we can be swimming against the tide after we experience a loss. And, very few of us have our losses, particularly losses early in life, held well by others.

As a result, insufficiently grieved losses are among the most common contributors to mental health challenges that I see in my practice. These losses can stay lodged in us and create depression, or a kind of melancholy, or a kind of muting — an inability to fully experience aliveness in life, and many other unwanted effects.

Our work can involve your grieving, or more fully grieving, your loss(es); recovering from their impact; and finding renewed vitality in your life as it is now.

I began my mental health career as a grief counselor in the mid-90’s, I’m a graduate of Francis Weller’s Grief Ritual Leadership Training Program, and I’ve worked with many, many clients on a wide variety of losses.

Perhaps because I have had extensive personal experience in all of these roles, I frequently work with corporate leaders, artists & musicians, and competitive athletes on the wide variety of psychological factors that can impede optimal performance, success, and enjoyment in these life experiences.

Some of the skills we work on include:

• Managing Emotions — particularly anxiety, stress, worry, fear, and nerves.

• Handling Pressure

• Sustaining Motivation

• Dealing With Failure

• Building Self-Confidence — and its obstacles, such as shame, guilt, over-comparing oneself with others, and overly harsh self-criticism before, during, and/or after doing what you do.

• Communication and Cooperation — with difficult people in authority, with peers, with team members, and others.

Some of the tools we use to improve these skills include:

• Cognitive and Behavioral Tools — Such as visualization, breathing techniques, positive self-talk, goal-setting, limit-setting, channeling anger, and reframing.

• Emotional Intelligence Skill Practice — In-session role-playing can strengthen such EQ skills as self-awareness, empathy, and self-regulation.

• EMDR Therapy — The gold standard for trauma treatment, EMDR can be enormously helpful when past traumas or highly distressing experiences are influencing performance in the present. Also, EMDR is a well-proven technique for reducing anxiety, a common performance-inhibitor.

• The Flash Technique — A complement to EMDR, clients usually know whether this technique is beginning to relieve performance-related disturbance within 5-10 minutes.

• Parts Work — Popularized by the Internal Family Systems approach to therapy, this work can be profoundly helpful with any or all of the factors that impede performance, particularly self-confidence.

Your work on performance enhancement in therapy can free you to achieve more, lead better, create more freely, and experience much more enjoyment and fulfillment in core activities of your life.

Emotional Intelligence (EQ) skills are the building blocks of healthy, nourishing, successful relationships at home and at work. I frequently work with my clients on such skills as developing better access to their emotions, more effectively managing their emotions, more easily and authentically expressing their emotions, and becoming more skillful at managing conflict.

I also often work with my clients on deepening their ability to be empathic with important people in their lives. Frequently such clients have a life partner, family member, friend, or business associate who wants my client to be better able to “get” them — to make them “feel felt” — rather than falling into highly common patterns such as jumping too quickly into making suggestions.

At home, this kind of skill-building can decrease hurt feelings and harmful conflict, and increase closeness and intimacy, making your relationships more nourishing for you and those you care about. At work, building EQ skills can make you a better communicator and a more trustable leader, which can translate directly into leading a more cohesive, effective team; and, it can translate into creating the psychological safety that more and more employees are requiring of their chosen workplace.

I bring a warm, non-judgmental, curious spirit to our psychedelic integration support sessions, which may involve one or more of:

• Pre-journey planning: Intention-setting, conscious choices about the journey environment, and other supportive practices can have an significant impact on harm/risk reduction and the value of the journey.

• Post-journey integration: The positive impact of a journey can increase dramatically when clients explore, discover, and make intentional choices about how the journey can positively influence their lives going forward, both short-term and long-term. Your “follow-up” and “follow-through” can be more effective when you have a safe, informed space to work with the material accessed during the journey, and any insights gained, in a way that benefits you and your community.

• Reducing the impact of previous negative experiences with psychedelics: For any number of reasons, clients may have had a negative experience in the past. Clients can make meaning from the experience and move toward closure about it.

I do not conduct psychotherapy sessions while clients are under the influence of psychedelics, nor do I dispense them or connect clients to possible sources of psychedelics, with the exception that I do provide referrals to medical professionals who offer Ketamine if clients request a referral and are deemed medically appropriate for this treatment approach.

In our psychedelic integration support work, we may focus on any number of dimensions of human experience, as you see fit, such as Body/Somatic, Mind, Heart/Emotions, Spirit, Community, and Earth. And, our work, and your work outside of session, may involve not only our conversations, but also other modalities that are a fit for you, such as music, art, dance, meditation, prayer, nature experiences, and ritual.

Psychedelic integration support work can help you set up your journey(s) in a way that’s aligned with your goals and intentions, help you work with what you feel is most crucial in your journey experience, and help you maximize the positive impact of your journey.

If you’re struggling with a mental health issue and you’re employed, it’s common for that issue to affect your functioning at work. Part of our work on the issue may involve developing strategies for mitigating its impact at work while you work in therapy, and between sessions, to reduce or eliminate the issue.

Relationship issues at work (see above and also the Narcissistic Harm section, in the case of a narcissistic boss or business partner) are also frequent subjects in therapy. Your relationships with your boss, peers, or direct reports can pose unique challenges and require specific solutions. There’s also the hidden toll of microstress, burnout, overwhelm, and job/career decisions that may trigger anxiety, depression, or other conditions.

I draw on my therapy training and experience, decades in the business and nonprofit worlds, and my executive coaching experience, to understand what you’re facing, to suggest tools that can help, and to work together toward solutions.

Deciding to enter therapy for the first time can feel vulnerable and challenging. And finding a therapist can be daunting. I have specific expertise in understanding, attuning to, and working with clients who are new to therapy.

In case these are helpful, this book and this book are two good introductions to therapy.