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Ethics

The Ethical Eye: Beyond “Risk Management”
By Ofer Zur
July/August 2007

Can We Talk?: Let’s End the Conspiracy of Silence about Ethical Dilemmas
By Mary Jo Barrett
March/April 2002

To Tell the Truth: Letting Go of Our Inscrutable Facade
By Jay Efran
March/April 2002

Nightmare in Aisle 6: A Therapist Caught in the Act of Being Herself
By Linda Stone Fish
March/April 2002

The Slippery Slope: Violating the Ultimate Therapeutic Taboo
By Susan Rowan
March/April 2002

The Crush: Challenging Our Culture of Avoidance
By Mary Jo Barrett
March/April 2002

The Necklace: When Does a Rule Become a Straitjacket
By Jenny Newsome
March/April 2002

Love, Dr. Lagerfeld: Sometimes It’s Okay to Trust Your Instincts
By Michael Hoyt
March/April 2002

A Triple Boundary Crossing: From Client to Friend to Client
By Arnold Lazarus
March/April 2002

Everybody’s Business: There Are Few Secrets in a Small Town
By Jan Michael Sherman
March/April 2002

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about the importance of ethics in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Ethics
Dual Relationships
Boundaries
Gifts
Risk Management
Self-Disclosure
Sexual Boundaries
Boundary Crossing
Boundary violation
Confidentiality
HIPPA
Records
Taboos

Sample from: The Ethical Eye, by Ofer Zur

The most frequently uttered words coming from these sources seem to be "don't" and "never." Consider the commandments regularly issued against what these experts consider dangerously risky behaviors. "Don't touch your clients—a handshake is the outer limit!" "Minimize self-disclosure; keep your anonymity intact!" "Never venture outside the office with a client!" "Don't accept gifts from a client!" "Never socialize or share a meal with a client." As Richard Leslie, an attorney specializing in psychotherapy issues and a consultant to the American Association of Marriage and Family Therapy, put it in one all-purpose rule, "If you have to ask, don't do it!"

The problem with these blanket condemnations is that many of the forbidden acts may be among the most powerful therapeutic methods at our disposal. We know that touch is one of the most elementary human ways to relate, and can have a powerful reassuring and healing effect. Self-disclosure can help fearful and defensive clients connect with us, and learn from us through modeling—a proven cognitive-behavioral intervention in itself. Sometimes going to the client, rather than making the client come to us, is the only reasonable way of doing therapy: take, for example, the empirically successful home-based family therapies with juvenile offenders, or therapy with a homebound sick or elderly client. A gift may be an important way for a client to express gratitude; refusing it could be deeply offensive and shaming. Sharing a meal with an anorexic client is often part of an effective, system-based treatment plan. "Dual relationships" with clients are often unavoidable and therapeutically helpful for a therapist who works in a small town or rural setting—your children may go to the same school as your clients' children; you may belong to the same church or synagogue. Conscientious, ethical therapists know all this, but even as we necessarily engage in these "forbidden" activities in the interest of being good therapists, we may feel a shudder of apprehension that we're somehow dangerously flouting rules written in stone.

From Psychotherapy Networker, July/August 2007

 

Sample from: The Slippery Slope, by Susan Rowan

Since that day seven years ago, I have been fortunate enough to be allowed to return to practice. I passed a forensic evaluation and my licensing board has reinstated me, under strict conditions that include having a mentor (a specialist in transference and countertransference) to oversee my clinical work. I've undergone prolonged retraining, including an individual ethics tutorial. I've studied the professional literature on ethics violations and have been educated in the need for boundaries. The lawsuit was settled by my insurance carrier and I stopped drinking. As a condition of my license reinstatement, I am required to undergo psychotherapy until my therapist and I feel I don't need to any longer--at least another two or three years.

I realize that some therapists reading this may feel sympathetic toward me--that I tangled naively with the sort of boundary-less client that we're frequently warned against. But the responsibility lies with me. It was my responsibility, not hers, to know my profession's norms and to preserve clinical boundaries. It was my responsibility to understand that power between a client and a therapist is never equal and that a so-called friendship is never appropriate after clinical work. It doesn't matter how provocative, vulnerable or seductive a client is. It is my responsibility not to create pathological dependencies.

From Psychotherapy Networker, March/April 2002


Depression

Finding Daylight: Mindful Recovery from Depression
By Zindel Segal
January/February 2008

Turning “I Can’t” into “I Will”: How to Motivate Depressed Clients
By Margaret Wehrenberg
July/August 2004

Exposing the Mythmakers: How Soft Sell Has Replaced Hard Science
By Barry Duncan, Scott Miller, and Jacqueline Sparks
March/April 2000

A Melancholy of Mine Own: Communicating the Uncommunicable Reality of Depression
By Joshua Wolf Shenk
July/August 2001

The Legacy: Inside a Family Haunted By Depression
By Martha Manning
January/February 1997

Stronger Medicine: Anti-Depresssants Haven’t Made Therapy Obsolete
By Michael Yapko
January/February 1997

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in treating depression in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Depression
Antidepressants
Medication
SSRIs
ECT
Seasonal Affective Disorder
Mood Disorders
Prozac
Dysthymic Disorders
Chronic Depression
St. John’s Wort
Mindfulness Based Stress Reduction (MBSR)
Cognitive Therapy
Insomnia
Postpartum Mood Disorder
Loss
Grief

Sample from: Turning "I Can't" Into "I Will", by Margaret Wehrenberg

Method 4: Don't Listen When Worry Calls Your Name. Colleen feared I'd  think she was crazy when she said, "It's as if my anxiety has a voice. It calls to me, 'Worry now,' even when there's nothing on my mind. Then I have to go looking for what's wrong." And she was very good at finding something wrong to worry about. An executive who had a lot of irons in the fire, she had no shortage of projects that needed her supervision. On any day, she could worry about whether a report had been correct, or projected figures were accurate, or a contract would generate income for her firm. In describing the voice of worry, she was describing that physical, pit-of-the-stomach sense of doom that comes on for no reason, and then compels an explanation for why it's there. This feeling of dread and tension, experienced by most GAD clients, actually comprises a state of low-grade fear, which can also cause other physical symptoms, like headache, temporo-mandibular joint (TMJ) pain, and ulcers.

Few realize that the feeling of dread is just the emotional manifestation of physical tension. This "Don't Listen" method decreases this tension by combining a decision to ignore the voice of worry with a cue for the relaxation state. Early in treatment, GAD clients learn progressive muscle relaxation to get relief. I always teach them how to cue up relaxation several times throughout the day by drawing a breath and remembering how they feel at the end of the relaxation exercise. We usually pair that deeply relaxed state with a color, image, and word to strengthen associations with muscle relaxation and make it easier to cue the sensation at will.

We then use that ability to relax to counteract the voice of worry. Clients must first learn that worry is a habit with a neurobiological underpinning. Even when a person isn't particularly worried about anything, an anxiety-prone brain can create a sense of doom, which then causes hypervigilance as the person tries to figure out what's wrong. Colleen smiled with recognition when I said that, when she was in this state, it was as though her brain had gone into radar mode, scanning her horizons for problems to defend against. I asked her to pay attention to the order of events, and she quickly recognized that the dread occurred before she consciously had a worry. "But," she announced, "I always find something that could be causing the doom, so I guess I had a good reason to worry without realizing it."

From Psychotherapy Networker, July/August 2004

 

Sample from: Stronger Medicine, by Michael Yapko

What is it about psychotherapy that makes it so vital to treatment, that gives depressed clients something they cannot obtain from medications? People become and stay depressed partly because they tend to explain life's ordinary defeats and disappointments in terms of their personal inadequacies and failures, and then believe their own negative opinion of themselves. Others have deeply pessimistic worldviews that influence their mood states and tend to engender self-fulfilling prophecies. A healing relationship with a therapist can provide the kind of personal support and teaching that can clear up the misperceptions that contribute to the negativistic view of life typical of depressed people. Therapy can help clients see life events from different perspectives and reattribute experience by assigning alternative explanations for life events that are less damaging to themselves than the typical depressive worldview. The ability to see and interpret events from new perspectives is critical to mental health.

As we become increasingly a nation of wanderers, our lack of steady and sustained social connections and consequent lack of competence in relationship skills provokes even higher rates of depression. Our ethos of extreme individuality and personal rights over collective responsibility and social accommodation increases the likelihood that we will be lonely and depressed, without the deep ties to family and friends that can immunize us against alienation and despair. But there is no disease here, just a way of responding to life that is proving ever more toxic to our individual and collective psyches.

As therapists, what can we do in the face of this rising tide of depression, which deeply implicates not the faulty biology of millions of people but the depressing nature of our civilization? And how can we counter the myth of pharmaceutical omnipotence that undermines our own confidence in therapy and our appreciation for its irreplaceable role? We must be aware that therapy works with depressed people because it draws on the clinical skills and adaptability required to understand a complex disorder skills no pill can mimic. Therapists also need to emphasize active, solution-oriented treatments over pathology-based passive ones. Rather than search the dim past for causes of presumed deficits, we need to actively teach clients the specific skills they need to manage their feelings and develop what author Daniel Goleman calls their "emotional intelligence."

From Psychotherapy Networker, January/February 1997


Creativity

The Big Moment: Inspiration Vs. Perspiration in the Therapy Room
By David Waters
November/December 2005

The Art of the Therapeutic Conversation
By Jay Efran and Mitchell Greene
November/December 2005

The Poetics of Progress Notes: Using Your Imagination with Tough Cases
By Brad Sachs
November/December 2005

Rediscovering the Mystery: For John O’Donohue, Therapy Is a Journey into the Unknown Self
By Mary Sykes Wylie
November/December 2005

The Practices of Transformation: With Ben and Roz Zander, Breakthroughs Are the Norm
By Richard Simon
January/February 2002

Beauty Resurrected: Awakening Wonder in the Consulting Room
By Michael Ventura
January/February 2001

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in using creativity in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Therapeutic Creativity
Transformation
Breakthrough
Inspiration
Insight
Improvisation
Problem-Solving
Use of Self
Mindfulness

Sample from: The Poetics of Progress Notes, by Brad Sachs

Reading the poem inspired by my session with Wendy crystallized for me how dutiful she was. She was essentially raising her two children as a single mother while tending to her adolescent-acting husband. She volunteered at the children's school and was team manager for her girls' lacrosse teams. She also regularly fielded her mother's calls for medical advice and made herself available to drive her to appointments, even though they lived almost an hour apart.

Perhaps, it occurred to me, her responsibilities were so oppressive that they were oppressing me, prompting me to avoid attending to her by allowing my own attention to roam. My reverie may have been serving the same purpose for me that her drinking did for her--allowing for a momentary break from a suffocating reality. After this insight, I was able to rouse myself from my previous torpor and focus on our sessions with more clarity. I helped Wendy begin to examine her ambivalence about setting limits with her children, her husband, and her mother. I encouraged her to start looking for ways to nourish and gratify herself that didn't rely entirely on meeting others' needs.

Thinking more about her own needs, she joined a senior swim team, and insisted that her husband be home the two evenings a week she practiced to supervise the girls' homework and nighttime routine, which, to her surprise, he agreed to do. She made some calls to a senior-support services center in her mom's neighborhood, and found that they offered free transportation for local seniors' medical appointments, which unburdened her as well. She also began attending Al-Anon meetings.

From Psychotherapy Networker, November/December 2005

 

Sample from: Beauty Resurrected, by Michael Ventura

The illness had stripped me down to the core of my being, which, like the core of anyone's being, feels itself most intensely when at the meeting-point of life and death.

And the window--the window!--had poured beauty into me at just that terribly vulnerable moment. And everything changed; or, to put it more accurately and less dramatically, many disparate and not-yet-coherent elements in me coalesced and found their focus.

Many walk into the therapist's consulting room exactly at the moment, and because of the moment, that they have been stripped to the core of their being. While not at the physical meeting-point of life and death, they are often at its emotional and spiritual equivalent. One element they seek and are desperate for, one element they usually feel they've lost, is beauty; they present a situation that's cut them off from experiencing beauty. They may not articulate it that way, but that's what's going on. Yet, beauty has not still been sufficiently recognized as both a healing balm and a necessity--something without which we may die, and through which we may live.

From Psychotherapy Networker, January/February 2001


Couples

The Art and Science of Love: Bringing Empirical Rigor to the Intuitive World of Couples Therapy
By Katy Butler
September/October 2006

Are You There for Me?: Understanding the Foundations of Couples Conflict
By Susan Johnson
September/October 2006

When Three Threatens Two: Must Parenthood Bring Down the Curtain on Romance?
By Esther Perel
September/October 2006

Scoreboard for Couples Therapy: Which Are the Winners in the Latest Research
By Jay Lebow
September/October 2006

Bad Couples Therapy: Getting Past the Myth of Therapist Neutrality
By William Doherty
November/December 2002

It Takes One to Tango: You Don’t Need Both Partners to Do Couples Therapy
By Michele Weiner-Davis
September/October 1998

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about helping couples in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Couples
Marriage Counseling
Couples Therapy
Couples Counseling
Infidelity
Affairs
Divorce
Couples Conflict
Conflict Resolution
Couples Research
Imago Relationship Therapy
Emotionally Focused Couples Therapy
Attachment Theory

Sample from: Are You There For Me? by Susan Johnson

With one couple, for example, every time the man--who completely avoided his wife and wouldn't sleep with her--tried, in a kind of embarrassed mumble, to justify himself, she'd respond, "That's ridiculous! You're just so incompetent!" After slowly helping them uncover and experience the emotions beneath their interaction, however, I noticed that he began to talk about his feelings in a different way--more openly, straightforwardly, without his usual awkward embarrassment. For the first time, he was really able to look at her, and say that it wasn't that he didn't care about her, but that he was so afraid of her rejection that he felt paralyzed. Again she responded "That's ridiculous," but her voice was softer, and as he repeated his message, she began to look at him with puzzlement--seeing something that had been invisible before. "I never knew you were afraid," she continued softly, looking him full in the face.

The look she had at that moment I now know well. I call it the "dog and recorder" look. It's named after the cocked-head and deeply nonplussed look my dog sported the first time he heard a human voice come out of a recording machine. Its best translated as: "What new thing under the sun is this?" I knew by that look that my dismissing client had begun to see her husband differently. It was moments like these, in which primary emotions were spoken clearly and pulled out new responses from a spouse, that seemed to make the difference in my sessions. What was going on here? I wondered.

Once when I was still pondering these issues, I went to a conference and got into an after-hours bar conversation with an eminent researcher in the field, who argued that getting and staying married was like entering and sticking to a bargain. I disagreed, saying, "The only time marriages are like a bargain is when the relationship is already as good as dead and all hope of intimacy is gone." Then I heard myself adding, almost without conscious thought, "Marriages aren't bargains. They're emotional bonds."

At that moment, it felt as if a door had suddenly opened in my mind and I could begin to truly see what was happening with my couples. I realized what should have been the most obvious truth of all: marriages were primarily about the emotional responsiveness that we call love; about fundamental human attachment. These bonds reflected deep primal survival needs for secure, intimate connection to irreplaceable others. These needs went from the cradle to the grave. How had we ever decided that adults were somehow self-sufficient?

From Psychotherapy Networker, September/October 2006

 

Sample from: Bad Couples Therapy, by William Doherty

In one of the early sessions, the therapist, who was highly experienced in couples work, empathized with the wife's feeling caught between the needs of her husband and those of her children, and supported the wife's decision to prioritize the children. The therapist explained that these years of raising school-age children are ones in which the children's time demands are huge, and the marital relationship inevitably has to take a back seat. She said that, as a wife and mother, she herself knew about these demands, which ease when children get older. In other words, the therapist normalized the marital gap in terms of the family life cycle, recognizing especially the unique strain on a wife who couldn't meet everyone's needs. The wife burst into tears at feeling so deeply understood and accepted. The therapist then turned to the husband and gently asked him for his feelings and thoughts as he'd followed the conversation and seen his wife's pain and tears. The husband, a "good guy," who didn't like conflict, owned that he'd been selfish and pledged to back off on his demands for more time with his wife, promising he'd be more understanding in the future.

The session ended with a warm glow. The couple agreed to continue working on other issues that had brought them to therapy. The therapist was pleased at how she'd been able to combine her clinical skills and her own experience as a wife and mother to help this couple. A few days later, the husband called to end the therapy, saying tersely that they'd decided to continue to work on things by themselves.

The therapist was stunned and consulted with me. I helped her see that she'd missed that there were two distinct family developmental stages at work in this case. Yes, the parent-child development stage was one of intense time demands (leaving aside for the moment the overscheduling supported by the wider culture), but the marital-developmental stage had its own pacing needs: a puppy marriage needs time for play and nurturing. To put aside their new marriage for years on end is dangerous. Of course, it's dangerous even in long-term relationships, but at least there may be a strong foundation and memories of good years. The husband was appropriately worried about the viability of a neglected new marriage. What struck me was how even a skilled, experienced couples therapist had misunderstood the special needs of a remarried couple.

From Psychotherapy Networker, November/December 2002


Children

See How They Run: When Did Childhood Turn into a Rat Race?
By William Doherty
September/October 2003

Beloved Stranger: Temperament and the Elusive Concept of Normality
By Alice Shannon
May/June 2005

The Rise of the ADHD Diagnosis
By Lawrence Diller
January/February 2008

The Worry Hill: A Child-Friendly Approach to OCD
By Aureen Pinto Wagner
May/June 2008

The Healing Power of Play: Helping the Traumatized Child Find Safety Again
By David Crenshaw
September/October 2008

The Impossible Child: A New Treatment Offers Hope for the Undiagnosable
By Karen Smith
September/October 2000

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about working with children and teens in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Children/Adolescents
Anxiety
Depression
Eating Disorders
Trauma
Parenting
Limit Setting
Boundaries
Time-Out
School Problems
ADHD
OCD
Learning Disorders
Oppositional Behavior
Conduct Disorders
Teenage Suicide
Self Injury
Play Therapy
Cognitive Therapy
Medication
Ritalin
Sensory Integration Disorders
Overscheduling

Sample from: The Worry Hill, by Aureen Pinto Wagner

To alleviate blame and shame and build an alliance with the family, I then discussed the current understanding of OCD as a neurobehavioral disorder. "Having OCD isn't your fault. It's not your parents' fault either. It's like having allergies or asthma—it happens to you because you're more sensitive to it. Sometimes there are other people in your family who are also sensitive and have OCD. OCD isn't something you do on purpose to get attention or because you're lazy. Sometimes your parents or your teachers or friends may think that you're just being stubborn or annoying. It's hard for them to understand that you don't want to do it, but you don't know how to stop." Maria glanced at her parents with a "See, I told you!" look, as her mother tearfully acknowledged having had such reactions.

Communication is key. Most children and families aren't aware that the body is designed to habituate naturally to anxiety. I developed the Worry Hill metaphor to make CBT more child-friendly and prepare children for treatment, by helping them understand how exposure leads to habituation. It's a drawing of a bell-shaped curve that graphically illustrates how anxiety rises with exposure until it reaches a peak, and then, if the child persists in resisting the urge to employ the usual anxiety-avoidance tactics, automatically begins to decline.

In our second session the next week, I explained to Maria and her parents, "Learning how to stop OCD is like riding your bicycle up and down a hill. At first, facing your fears and not doing your rituals feels like riding up a big Worry Hill, because it's tough. You have to work hard to huff and puff up a hill, but if you keep going, you can get to the top. Once you get to the top, it's easy and fun to coast down the hill.

From Psychotherapy Networker, May/June 2008

 

Sample from: The Healing Power of Play, by David Crenshaw

In the fourth session, we continued with these playful activities—dropping in and springing out of the water—repeated many times with the jungle animals, farm animals, dogs, and the figures of adults and children. All of them were jumping into and out of the water, obviously having a good time. Bobby's parents' active participation in the play therapy intervention was crucial because they, too, were "shell-shocked" by this horrific experience of almost losing their son, their only child, and had no idea how to help him. Engaging in the play activities with Bobby was empowering for them and for him.

A clear indication that Bobby was healing was his increasing ability to play again, both in the session and at home. He entered the play in each subsequent session with more gusto, even at times with screams of delight. This was particularly significant because the trauma event occurred while Bobby was running around in the backyard playing. Meanwhile, at home, he was recovering his language ability, was less fretful, and usually slept through the night, much to his parents' relief.

But there was one more major step left to accomplish: we needed to "bracket" the event for Bobby—make it clear that what he'd experienced was extremely unlikely to occur again. Even adult trauma survivors often find their assumptions of safety in the world so shattered that they need help placing traumatic events in a meaningful context, so they can realize emotionally that the trauma will not endlessly recur. Children have less ability to put traumatic events into perspective and understand that what happened was a rare, improbable event that won't need to be confronted over and over again. This bracketing of the trauma event was a challenge with a child as young as Bobby.

From Psychotherapy Networker, September/October 2008


Challenging Cases

Revolution on the Horizon: DBT Challenges the Borderline Diagnosis
By Katy Butler
May/June 2001

The Good, the Bad and the Ugly: Turning Ambivalence into Possibility
By Bill O’Hanlon
January/February 2003

The Pragmatics of Hope: What to Do When All Seems Lost
By Yvonne Dolan
January/February 2003

My Most Spectacular Failure: Voluntary Simplicity Meets Shop Til You Drop
By Mary Pipher
November/December 2000

A Matter of Life and Death: When the Therapist Becomes the Survivor
By Frank Pittman
November/December 2000

How Involved Is Too Involved?: Twenty-two Years and Still Wondering
By David Treadway
November/December 2000

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful when faced with challenging therapy cases. People searching for information on the following terms and concepts found these articles helpful:

Challenging Cases
Borderlines
Suicide
Self-Harm
Hospitalization
Dual Diagnosis
Depression
Dialectical Behavior Therapy

Sample from: The Good, The Bad And The Ugly, by Bill O'Hanlon

Abel's response to this approach--that it made him feel he couldn't do anything wrong--crystallized something for me. Here was a way to break up unconscious logjams; permissions enabled clients to experience two seemingly contradictory states simultaneously. The structure of hypnotic language freed people from the tyranny of having to choose, and choose correctly, what to feel and how to proceed. I began to appreciate the extraordinary power of permission, with or without hypnosis, particularly with my most challenging cases.

So I began focusing on how to most productively include the good, the bad, the ugly, and the in-between of my clients' experience to help them expand their sense of possibilities in life. But this was the mid-1980s, the height of the popularity of various forms of solution-based therapy, and people would sometimes come up to me at my workshops and say, "I really like your positive approach," thinking they were complimenting me, in spite of the fact that I wasn't particularly interested in accentuating the positive.

From Psychotherapy Networker, January/February 2003

 

Sample from: A Matter of Life and Death, by Frank Pittman

I was stunned. It was not just a personal loss (I wanted to save this guy); it was not just a blow to my grandiosity (I kept telling myself in my newfound humility, this sort of thing doesn't happen to therapists who work as hard and care as much as I). I was sad over the loss of what Adam could, with time and effort, have become. His suicide was a dumb and preventable waste. His children were devastated. Angela felt many things, among them relief: when the abuse started the year before, a well-intentioned counselor had warned her that violent men never change. She had been fearful that she could not get herself and the kids out of the marriage alive.

I had been trying so hard to respect Angela's need to empower herself and feel in control of her life and the marriage, I had been non-directive and neutral with her, so much so that she didn't fathom that I had hopes not only for Adam, but for the marriage. I certainly foresaw a different outcome than this.

From Psychotherapy Networker, November/December 2000


The Business of Therapy

Harnessing the Winds of Change: It’s Time to Reinvent Private Practice
By Lynn Grodzki
July/August 2007

How to Develop a Money Mindset: Investing for Success in Your Practice
By Joe Bavonese
July/August 2007

Beyond Technophobia: Using the Internet to Grow Your Practice
By Casey Truffo
July/August 2007

Our Businesses, Our Selves: Learning to Love the Entrepreneurial Side of Therapy
By Lynn Godzki
July/August 2003

Psychotherapy’s Soothsayer: Nick Cummings Foretells Your Future
By Richard Simon
July/August 2001

The Future of Psychotherapy: Beware the Siren Call of Integrated Care
By Barry Duncan
July/August 2001

The Bottom Line: A Fee Policy Can Clarify the Therapeutic Relationship
By Lynne Stevens
November/December 1998

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about the business aspects of therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Private Practice
Referrals
Marketing
Billing
Networking
Insurance
Managed Care
Money
Internet
Website
Utilization Review

Sample from: How To Develop A Money Mindset, by Joe Bavonese

I spend a lot of time during breaks informally talking with a funny, balding, fiftyish man named George, a high school dropout who's a chimney sweep in Washington, D.C. Sheepishly, I admit to him that my only association to chimney sweeps is Mary Poppins. But when he tells me he has six centers and an annual income of $2 million, I drop my prejudice against blue collar work and suddenly develop enormous respect for chimney sweeps. George asks me how I'm funding my practice and I tell him it's been profitable from day one, and that's how I've managed growth. He looks at me incredulously. "What? You can't possibly get where you say you want to go without funding!" I think of where I want to go—middle-class security for my family of five—and feel a lot less smug. It becomes obvious that in comparison to most small-business owners, we therapists are incredibly risk averse and well, cheap.

George urges me to get a "small" $100,000 business loan to fund a major expansion of my marketing efforts and hire additional staff. The thought of huge loan payments every month fills me with dread, and, seeing my expression, he laughs out loud, yelling above the din, "Hey Doc! Who's the psycho, you or me?"

From Psychotherapy Networker, July/August 2007

 

Sample from: Beyond Technophobia, by Casey Truffo

From grade-school students to my 80-year-old dad, everyone is searching the web these days. It's estimated that there are 500 million Google searches every day. More and more consumers are using the Internet to find products, services, and service providers. They're searching the web for counselors too. Yahoo gets about 150,000 search requests each month for marriage counseling. Judy Gifford, CEO of Find-a-Therapist.com, an online therapist locator helping the public find counselors in their area, reports that her website had 4.5 million hits last year. I predict that, in the coming decade, online searches will be the primary way therapists attract clients.

When I explained this to Marla, she said "Technology! I don't know anything about computers and the Internet! My kids do, but I don't."

This is a common reaction. As therapists, we're comfortable in face-to-face interactions, and we've spent a lot of time mastering therapeutic theories and techniques. But our anxiety rises—if we don't go into full-blown panic mode—when we think of plunging into the world of electronic interactions. The idea is especially daunting for seasoned therapists, who've never had to market their practice before. I explained to Marla that she didn't have to learn everything in a day, and that some of it might be easier—and maybe even more fun—than she thought possible.

From Psychotherapy Networker, July/August 2007

There’s a Jungle in There: We’re Not as Evolved As We Might Think
By Lou Cozolino
September/October 2008

Brain to Brain: Applying the Wisdom of Neuroscience in Your Practice
By Bonnie Badenoch
September/October 2008

Our Serotonin, Our Selves: Can the Brains of the Dead Give Hope to the Living
Charles Barber
September/October 2008

Alice In Neuroland: Can Machines Teach Us to be More Human?
By Katy Butler
September/October 2005

Visionary or Vodoo? Daniel Amen’s Crusade Has Some Neuroscientists Up in Arms
By Mary Sykes Wylie
September/October 2005

Mindsight: Dan Siegel Offers Therapists a New Vision of the Brain
By Mary Sykes Wylie
September/October 2004

Mirror Mirror: Emotion in the Consulting Room Is More Contagious than We Thought
By Babette Rothschild
September/October 2004

Altered States: Why Insight By Itself Isn’t Enough for Lasting Change
By Brent Atkinson
September/October 2004

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about the emerging field of brain science and its application to therapy practices; as a way of understanding the brain within a treatment program for adult patients as well as teenagers and children. People searching for information on the following terms and concepts found these articles helpful:

Brain Science
Brain Imaging
Mirror Neurons
Neurotransmitters
Serotonin
Dopamine
Neuroplasticity
Lateralization
Meditation
Mindfulness
Neurofeedback
Interpersonal Neurobiology
Neurobiology
Neuroscience
Triune Brain
Brain Evolution
Brain Stem
Cerebral Cortex
Limbic System
Mammalian Brain

 

Sample from: There’s a Jungle in There: We’re Not as Evolved As We Might Think
By Lou Cozolino

...The potential for miscommunication among the networks of our brains might not be so bad if we lived in isolation, but our brains are social organs, which require sustained connection with other brains. At birth, we're totally dependent on our caretakers for our survival. If an average reptile is born knowing how to perform the basic tasks of survival—getting food, fighting, and mating—we're born dumb, so to speak. Our saving grace is that as babies we know how to attach to our parents and stimulate them to attach to us.

For human babies, survival doesn't depend on how fast they can run, climb a tree, or tell the difference between edible and poisonous mushrooms: it depends on their abilities to detect the needs and intentions of those around them. Throughout the millennia that we Homo sapiens have inhabited the earth, if we've been successful in our early relationships, we have food, shelter, protection, and a decent shot at eventually producing children of our own.

Our prolonged dependency allows for an increasing amount of brain development to occur after birth, making each human brain an experiment of nature—a unique blending of genetics and experience. Our parents are the primary environment to which our baby brains adapt, and their unconscious minds are our first reality. Their nonverbal communications and patterns of responding to our needs when we're babies shape not only our perceptions of ourselves and the world, but also the architecture of our brains. Because the first few years of life are a period of exuberant brain development, early experiences have a disproportionate impact on the shaping of our neural systems, with lifelong consequences.

From Psychotherapy Networker magazine, September/October 2008

 

Sample from: Mindsight: Dan Siegel Offers Therapists a New Vision of the Brain
By Mary Sykes Wylie

...Academic psychiatry during the '80s, it turned out, was exactly the wrong place for someone eager to develop a holistic, integrated view of the mind and brain. An increasingly reductionistic biological (i.e. psychopharmaceutical) psychiatry had just begun its relentless push for dominance. With the advent of DSM III and the torrent of new medications pouring out of the pharmaceutical pipeline, psychiatry grew ever more inclined to define emotional and mental problems as purely medical illnesses reflecting biochemical imbalances in the brain. Diagnosis became a game of parsing DSM categories and subcategories, and treatment a matter of prescribing meds to amp up or dampen down the synaptic exchange of neurotransmitters. The last thing that interested these scientist-psychiatrists was a vaporous, 19th-century concept like mind. "There was no understanding that subjective human experience--feelings--was an objective scientific reality," recalls Siegel. "Psychiatrists were supposed to be experts on the brain, and all they were interested in was knowing how neurons fire--they weren't interested in feelings."

Siegel found the emerging infatuation with the DSM 'n Drugs combo deeply distasteful and a betrayal of what he considered the deeper mission of psychiatry. "I hated to see colleagues and trainees seeing patients for half an hour for a meds check, then sending them off until their next appointment three months later," he says. For him, the self-conscious scientism of the new psychiatry was a crabbed, distorted version of real scientific inquiry: "The only brain mechanisms we ever really talked about were neurotransmitter receptors."

One case from this frustrating period that underscored biological psychiatry's lack of imagination sticks in Siegel's mind. He was seeing a young woman in therapy who was suffering from unresolved grief and guilt at the loss of a parent. Eventually, she got better, and when she was ready to leave, Siegel asked her what had been most helpful about her treatment. She thought for a minute and then said, "When I'm with you, I feel felt. " Her remark about what is a perfectly commonplace experience in good therapy contrasted for Siegel with the indifference to relationship that he saw all around him. "She could see that my inner emotional state was affected by her inner emotional state, and that profoundly changed her experience of herself, which gave her hope that she could change." But the scientist in Siegel also wanted to know what exactly the objective brain mechanisms were that resulted in this profoundly healing interpersonal experience.

From Psychotherapy Networker magazine, September/October 2004

 


Adolescents

The Divided Self: Inside the World of 21st Century Teens
by Ron Taffel
July/August 2006

Cyberspaced: Hanging Out with the In-Crowd on MySpace.com
By Mary Sykes Wylie
July/August 2006

Lost in Electronica: Today’s Media Culture Is Leaving Boys at a Loss for Words
By Adam Cox
July/August 2006

Hungry for Connection: The Logic of Self-Injury
By Martha Straus
July/October 2006

Hallway Therapy: Systems Thinking Goes to the Classroom
By David Seaburn
January/February 2007

Mission Possible: the Art of Engaging Tough Teens
By Mathew Selekman
January/February 2008

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about working with children and teens in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Children/Adolescents
Anxiety
Depression
Eating Disorders
Trauma
Parenting
Limit Setting
Boundaries
Time-Out
School Problems
ADHD
OCD
Learning Disorders
Oppositional Behavior
Conduct Disorders
Teenage Suicide
Self Injury
Play Therapy
Cognitive Therapy
Medication
Ritalin
Sensory Integration Disorders
Overscheduling

Sample from: The Divded Self, by Ron Taffel

The crisis passed, thankfully with no health consequences, but the stand-up part of our sessions became a connecting ritual--a means for Adam to start expressing his feelings about his lack of popularity at school and discomfort at home. While discussing serious issues, we continued to make each other laugh, and the pleasure he got from his hysterical impersonations of celebrities and everyone in his life, including me, ultimately led him to seek out roles in his town's theater group--no small step for a coarse, pop-obsessed adolescent. Adam still needed to learn the boundary between humor and empathy, especially with friends and parents, but the jokes that punctuated our sessions helped break through his emotional divide.

The sanctity of session length is another artificial encumbrance that works against kids' ability to hear. Teen consciousness is so fragmented that it's simply grandiose to believe they remember a thing we say even two minutes after our most "important" pronouncements. So, if you're trying to make a point you don't want to get lost, why stick to the sacrosanct 45- to 50-minute session? As long as we fill out insurance and agency forms accurately, charge less, or make up the lost time, there's nothing inviolate about the "treatment hour." Especially with teens, cutting the session short to let a comment sink in or lengthening it to let a situation play out, helps grab their attention.

From Psychotherapy Networker, July/August 2006

 

Sample from: Mission Possible, by Matthew Selekman

 

Cecilia, who was 16, had a long history of running away from home, prostitution, incarceration, abusing inhalants, and gang involvement. Former therapists had labeled her a borderline, sociopath, and resistant. Sensing that she had all of the power in the family, I decided to meet alone with her first before seeing the parents separately.

I asked her what her former therapists had tried with her and her family that she didn't like and was "a real drag for her," so that I wouldn't make the same mistakes again. Immediately she responded, "Siding up with my mom against me . . . that makes me mad!" From that point on, I began each family meeting by seeing Cecilia alone first, giving her sufficient time to strengthen our alliance, and regularly soliciting feedback about how our work together was going. She later told me she felt "respected" by me and felt like her "voice was heard for once in counseling."

From Psychotherapy Networker, January/February 2008

 

 

 

 

 

 

 

 

Popular Topics: Anxiety
 

The Ten Best-Ever Anxiety Management Techniques
By Margaret Wehrenberg
September/October 2005

Facing Our Worst Fears: Finding the Courage to Stay in the Moment
By Reid Wilson
November/December 2006

Nightmind: Making Darkness Our Friend Again
by Rubin Naiman
March/April 2008

Sleepless in America: Making It Through the Night in a Wired World
By Mary Sykes Wylie
March/April 2008

The Anxious Client Reconsidered: Getting Beyond Symptoms to Deeper Change
By Graham Campbell
May/June 2001

Confronting the New Anxiety: How Therapists Can Help Today’s Fearful Kids
By Ron Taffel
November/December 2003
 

Content Search Overview:

Therapists, social workers, counselors and others found these articles helpful in learning more about causes and management of fear and anxiety; medication versus therapy as part of an anxiety treatment program for adult patients as well as teenagers and children. People searching for information on the following terms and concepts found these articles helpful:

  • Anxiety Disorders
  • Social Anxiety
  • Phobias
  • Social Phobias
  • Generalized Anxiety Disorders (GAS)
  • Obsessive Compulsive Disorders (OCD)
  • Panic Disorders
  • Panic Attacks
  • Agoraphobia
  • Cognitive Therapy
  • PTSD
     

Sample from: The Ten Best-Ever Anxiety Management Techniques by Margaret Wehrenber

…What is it about anxiety that's so horrific that otherwise high-functioning people are frantic to escape it? The sensations of doom or dread or panic felt by sufferers are truly overwhelming--the very same sensations, in fact, that a person would feel if the worst really were happening. Too often, these, literally, dread-full, sickening sensations drive clients to the instant relief of medication, which is readily available and considered by many insurance companies to be the first line of treatment. And what good doctor would suggest skipping the meds when a suffering patient can get symptomatic relief quickly?

But what clients don't know when they start taking meds is the unacknowledged cost of relying solely on pills: they'll never learn some basic methods that can control or eliminate their symptoms without meds. They never develop the tools for managing the anxiety that, in all likelihood, will turn up again whenever they feel undue stress or go through significant life changes. What they should be told is that the right psychotherapy, which teaches them to control their own anxiety, will offer relief from anxiety in a matter of weeks--about the same amount of time it takes for an SSRI to become effective.

Of course, therapists know that eliminating symptomatology isn't the same as eliminating etiology. Underlying psychological causes or triggers for anxiety, such as those stemming from trauma, aren't the target of management techniques; they require longer-term psychotherapy. However, anxiety-management techniques can offer relief, and offer it very speedily.

From Psychotherapy Networker magazine, September/October 2005
 

Sample from: Sleepless in America: Making It Through the Night in a Wired World by Mary Sykes Wylie

…Insomnia. Almost everybody has it at one time or another. Some poor souls live (or barely live) with it. It's hard to know exactly how widespread it is—prevalence rates are all over the map. As many as 30 percent of the population, or as few as 9 percent (depending on the source of the statistic, or how insomnia is defined, or what impact it has), suffer from some form of it at least some of the time. Critics maintain the higher estimates are overblown, partly by insomniacs themselves, whose suffering leads them to overestimate the time they spend lying awake (10 minutes of lying wide-eyed in bed feels like an hour) and by the pharmaceutical industry (that all-purpose villain) in order to sell billions of dollars in sleeping potions.
Definitions of insomnia are loose to the point of inanity. DSM-IV defines "primary insomnia" as "a difficulty initiating or maintaining sleep or experiencing nonrestorative sleep that results in clinically significant distress or impairment in functioning." Insomnia has been divided and subdivided into a bushy tree of overlapping categories: primary, comorbid (occurring with a boatload of mental and physical health problems), idiopathic (lifelong inability to sleep), psychophysiological (somaticized tension), paradoxical ("sleep-state misperception") childhood ("limit-setting sleep disorder"—parents don't enforce bedtime), food-allergy related, environmental, periodic (internal clock problem), altitude related, hypnotic, stimulant-dependent, alcohol-dependent, toxin-induced, menopausal, and age-related, among others.

Chronic insomnia is linked to a multitude of physical and psychological ills: increased risk of cancer, hypertension, heart disease, obesity, diabetes, infertility, miscarriage, depression, anxiety, irritability, dementia, impaired cognitive and reasoning skills, lowered immune-system function, heightened awareness of pain, and who knows what else? Probably bunions, dandruff, and pinkeye. But while insomnia apparently contributes to, results from, or is comorbid with the ailments on this laundry list, why we get insomnia, which parts of the brain are most implicated, and how it actually hurts us, even what it is exactly, all remain largely a mystery, as does sleep itself. Thus researchers summed up a lengthy 2005 National Institutes of Health report on insomnia with deadpan succinctness: "Little is known about the mechanisms, causes, clinical course, co-morbidities, and consequences of chronic insomnia."

What's undisputed, however, is that sleep is as necessary to physical and mental health as air and water, and that, without it, we suffer—often severely. So, those annoying world-beaters, who brag about needing only four hours of sleep a night (the better to forge multimillion-dollar start-ups and do their Nobel Prize–winning research) are perhaps not being entirely candid. According to sleep expert Thomas Roth of the Henry Ford Sleep Disorders Center in Detroit, "The percentage of the population who need less than five hours of sleep per night, rounded to a whole number, is zero."

From Psychotherapy Networker magazine, March/April 2008

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