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Teenagers have a heavy burden to bear: in a few short years, they are expected to move from childhood to adulthood and acquire adult competency, balance academic pressures and social roles, all the while being assaulted by unfamiliar hormonal and physical changes. The pressure often takes its toll: children who never gave their parents reason for concern become introverted and secretive. Children who had minor behavior problems during childhood become rebellious and start engaging in unsafe behaviors. Parents usually bring their adolescent to therapy when home life becomes difficult, when their child’s school performance plummets, or when they suspect that the teenager engages in unsafe behaviors, such as drinking or drugs.
One of the challenges in parenting teenagers is that it is hard to differentiate between “normal” adolescent behaviors (such as sulkiness and the rejection of all things adult) and mental health disorders such as depression.
In therapy, I use the assessment phase to look into the client’s range of behaviors, in order to determine if they are within the norm or are symptomatic of a disorder.
When working with teenagers, I find myself navigating in uneasy waters, between the teenager’s need for independence and for differentiation from the parents, and the parents’ concerns about safety. In treatment, I engage the client in dynamic psychotherapy to help him or her sort through emotional processes and reduce emotional pain, and use Cognitive Behavior Therapy when behavior modification or additional structure is needed. Family therapy may become a part of treatment, since many of the issues are frequently related to the child/parent conflict. In family sessions, I support the parents in establishing a predictable, clear, yet flexible home structure and improving communication skills.
People come to psychotherapy for diverse reasons. Some seek help to address a mental health disorder, such as depression or adult ADHD, which becomes an obstacle to a successful life. Others find themselves battered by life circumstances: medical illness, loss, relationship problems, or high stress at home or at work. Yet others feel that they are out of sync with their life: middle age uncomfortably sets in, or the nest is achingly empty. Or else, one can feel “stuck” in one’s life instead of moving forward: some people feel that their professional lives or relationships follow the same negative or destructive pattern, which repeats itself with different people and circumstances.
When I meet a new client, I get to know his or her needs, goals, and personal style. These determine which clinical modalities will best fit the client’s issues. For example, for repeated negative patterns in the client’s life, or “stuckness,” I will likely use psychodynamic therapy as the central clinical tool. For adult ADHD I will probably use CBT (Cognitive Behavior Therapy). For relationship problems, I may use relational therapy, and for people who find themselves engaged in repeated self destructive behaviors, I will probably use portions of DBT (Dialectic Behavior Therapy) among other methods. Regardless of the clinical modality, I usually use the therapeutic relationship as a laboratory or a test case, examining the client’s other relationships and social interactions through it.
Keeping the “coupleness” throughout the daily grind and stressful times is difficult. Many couples find that the level of conflict in their relationship increases, as their tools to handle conflict prove insufficient.
In couples therapy, I help the couples identify and understand the dynamics of their conflicts, their triggers, the process of escalation, and obstacles to flowing communication. I also work with the partners on understanding underlying emotional reasons for relationship conflicts. Such issues may be different emotional needs, different styles of expressing feelings, as well as individual issues emerging from each partner’s life experience.
Families of origin come into play as the partners recognize that their style of interacting with each other is closely linked to the emotional lessons they have learned from their parents. Communication training helps the couple talk to each other in a non-blaming way, express needs, make requests, and negotiate for their needs, while learning active listening skills.
Often, a couple’s emotional distance and difficulty to communicate are echoed in their physical intimacy. Many issues that are labeled “sexual dysfunctions,” can improve or be solved by addressing sexual communication. After ruling out medical causes, I help the couple identify and resolve issues that hinder the flow of intimacy, such as power struggles, fear, and anger. Then, through discussions and home assignments, each partner learns to express his or her own sexual wishes and needs, as well as respond to the partner’s needs.
Divorce can bring out the worst in people. The result is misery not only for the two people at the center of the conflict, but also for innocent bystanders—usually children and other family members. Divorce counseling starts with a clear agreement from both partners that the marriage is over, but that an amicable relationship will benefit the divorcing couple and their children. In the long run, better communication and negotiating skills also save money and prevent further hurt. I help the couples modulate their resentment and focus on problem solving. I also guide the couple in how to address the separation and divorce with the children, assuring them that the divorce is not their fault, and helping the parents support the children through the process of grief over the loss of their family as they knew it. I also help the parents negotiate schedules for children’s visits and stays. When new step-partners are involved, I help the couple agree on etiquette and acceptable behaviors with the children.
The “client” in family therapy is the emotional process of the family. Addressing individual issues of each family member is secondary to the complex behaviors, communication patterns, and emotional bonds among the family members. The family is viewed as a dynamic system. The fundamental belief of Systems Theory, which is at the heart of most models of family therapy, is that when one person makes a change, the whole system changes. Therefore, any positive change in one person’s behavior is followed by the whole system adjusting itself to that change.
Usually, when families come to therapy, they seek help in addressing a particular dysfunction in the family. Often, there is a “target client” who carries the symptoms: a misbehaving child, a drug-using adolescent, a depressed parent. In the course of therapy, I help the family discover how the family dynamics enable, encourage, or sustain the behavior of this target client. We then find ways to improve family relations and reduce symptomatic behavior by family members.
Family therapy is often more directive and short-term than individual therapy. To enhance its effectiveness, I often assign “homework,” in which family members are given assignments meant to change unhelpful dynamics, and are asked to report on progress in the following session.
Because parents are so emotionally involved with their children, they sometimes miss opportunities to practice good-sense interventions with them. Issues such as tantrums, sibling rivalry, slowness in following directions and in completing homework, are familiar to most households. But when other stressors are also present, the pressure on the child and the parents increases, leading to constant conflicts that can take over the family life. During sessions of parent coaching, I help the parents acquire hands-on, practical skills. These include active listening and empathy-building, making a request, and designing a home structure based on a system of rewards and consequences. I always keep in mind that parent coaching needs to be anchored in a therapeutic system that also addresses underlying emotional issues pertaining to all family members.