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Children, whose emotional coping skills and problem-solving mechanisms are not fully formed, are particularly vulnerable to life’s stressors. A child who encounters a situation that overwhelms her coping skills may react with behavior problems or defiance, academic difficulties, loss of interest in daily activities, or demonstrate low self-esteem.
On meeting a new child and family, I start an assessment process, involving both the child and the family, in order to understand the underlying issues which contribute to the child’s symptoms. In treatment, I employ a variety of therapy techniques, as is indicated by the client’s needs: with younger children, I often use play therapy, which encourages the child to create fantasy narratives and scenarios with an assortment of toys or art materials. In the safety of the therapeutic environment, the child can explore and express feelings and concerns that are otherwise too difficult or scary to speak about. Once the emotional themes are uncovered, I help the child find resolutions to the conflicts revealed in the play. In further talk therapy, I address those underlying emotions with the child.
Cognitive Behavior Therapy (CBT) with children involves numerous techniques which are designed to correct a child’s unhelpful thoughts (about his worth or his abilities, about the options he has in responding to difficult situations, or about other people’s intentions). These cognitive interventions are augmented by behavioral interventions, such as coaching the child social skills, coping skills, impulse control, and organizational skills.
Often, parents’ anxiety about their children’s problems results in responses that are unproductive: being over-punitive or too forgiving, placing a structure that is too rigid or too loose, or erring on assessing the child’s developmental level. I consider family involvement a crucial part of child treatment. Continuous communication with the parents is maintained through frequent briefing, parent coaching, and family sessions, in order to address appropriate expectations, structure, and nurturing.
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: chldren 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 derision of all things adult) and mental health disorders such as depression or substance abuse.
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 his safety. In treatment, I engage the client in dynamic psychotherapy to help him sort through his emotional processes and reduce his emotional pain, and use Cognitive Behavior Therapy when behavior modification or additional structure is needed. Family therapy is often 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 improve communication skills.
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. It is important to note that parent coaching should always be anchored in a therapeutic system that also addresses underlying emotional issues pertaining to the child and the family.
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 synch with their life: middle age uncomfortably sets in, or the nest 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 include components of family therapy in the individual treatment, 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. Adult therapy can be contracted for a specific number of sessions, or open ended.
Keeping the "coupleness" throughout the daily grind and during stressful times is difficult. Many couples find that as the level of conflict in their relationship increases, their tools to handle conflict prove insufficient.
In couples therapy, I help the couple 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 styles of interacting with each other are 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, make requets, and express and negotiate needs, while learning active listening skills.
Couples therapy is typically short term, and can be open-ended, or contracted in advance to a concrete number of sessions.
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 their 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 partners are involved, I work with the couple 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.
I use interventions that are derived from several family therapy models. Murray Bowen’s Family Systems looks, among other things, at how emotional styles in families repeat themselves from generation to generation. Salvador Minuchin’s Structural Family Therapy seeks to correct inadequate boundaries and power structures in the family. Other techniques I use include communication coaching and Narrative Therapy, which retells the family member’s "story" of defeat into a victorious one.
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 designed to change unhelpful dynamics, and are asked to report on progress in the following session.