I’ve begun to put aside my idealized view that unless people overcome their difficulties once and for all, therapy is somehow a failure. More and more, that perspective seems simplistic and disconnected from the realities of what psychotherapy, no matter how skillful the clinician may be, can actually provide. So what if we start to think differently about this? What if we view anxiety and depression—especially generalized anxiety and dysphoric states of mild and moderate depressions—not as disorders that will be cured, but as chronic, relapsing, remitting disorders?

Many therapists define the type of therapy they practice by taking a head count: if one person is present, they're practicing individual therapy; if two or more people are present, it's couples or family therapy. I believe this is misguided the key to determining which brand of therapy is in use at any given point lies in the therapist's orientation and focus, not the number of people occupying space in the room. In contrast to therapists who question the value of doing couples therapy with individuals, this approach is often my method of choice for a variety of reasons. I find it can empower people by showing them that they no longer have to play the waiting game of "I'll change if you change first." Instead, they find themselves back in the driver's seat of their own lives.

Over the years, I've worked with many couples who complain bitterly that the other kisses or touches, fondles, caresses, strokes the "wrong" way. I used to take these complaints at face value, trying to help the couple solve their problems through various forms of marital bargaining, until I realized that their sexual dissatisfactions didn't stem from ignorance, ineptitude, or a "failure to communicate." Instead of trying to spackle over these normal and typical "dysfunctional" sexual patterns with a heavy coat of how-to lessons, I have learned that it makes much more sense to help the couple analyze their behavior, to look for the meaning of what they were already doing before they focused on changing the mechanics.

While at first glance, 21st-century adolescents appear impossibly cool--cooler than we could have ever been ourselves--teens today are running hot. They're not just hormonally hot, but hot with cultural forces that have redefined the nature of their consciousness and experience of selfhood. Millennium kids live in a context that spawns fragmentation, what I call a "divided-self" experience: cool and often cruel on the surface, they hide surprisingly healthy passions beneath.

Most therapists learn couples therapy after they get licensed--through workshops and by trial and error. Most specialize in individual therapy, and work with couples on the side. So it's not surprising that the only form of therapy that received low ratings in a famous national survey of therapy clients, published in 1996 by Consumer Reports, was couples therapy. The state of the art in couples therapy isn't very artful. I'll start with beginners' mistakes and then describe how couples therapy can go south, even in the hands of experienced therapists.

While not all overprotective parents are as extreme in their behaviors as Shyam (indeed, few experience themselves as being obsessive at all), many middle-class families are struggling to decide how much protection is the right amount, even when their children are showing signs of anxiety and rebellion as a result. Whether these families are my clients or my neighbors, overprotective parenting appears to have become the rule, rather than the exception, in today’s world.

Has the time come to consider the whether modern families lack some of the intimate connections they used to have? And, if so, what can we as therapists do about it?

As we move slowly beyond the great recession, today’s young people are the first American generation in a long while expected to be less well off than their parents. So we have a paradoxical situation, in which the pressure to produce successful kids has never been more relentless or harder to achieve, especially with mass culture suggesting that if kids do fail, it must be because mom and dad failed in some way. Thus, it’s easy to understand how parental focus can shift from the child to the child-as-product, underlining a kind of premeditated parenting with calculated ends in mind. So we have earnest, committed, caring parents trying their best to follow an almost infinite number of often contradictory prescriptions to produce a perfect commodity with greater market potential. What could possibly be wrong with that? A lot!

Schools and physicians don’t seem to understand the ways in which trauma leads to symptoms that resemble ADHD. Thus, we all need to ask the right questions and dig a little deeper in creative ways to find out what may be troubling the child, so that our treatment is effective and not just a surface remedy for a misdiagnosis.

Seven-year-old Emily is continually nervous and her anxiety is keeping her from enjoying summer camp, sleepovers with friends, and after-school activities. Her parents don’t know what to do, and even her therapist is worried that Emily’s anxiety is starting to define too much her integral sense of self. Treating anxiety in kids takes a creative, often playful approach, says Lynn Lyons, author of Anxious Kids, Anxious Parents.