After 22 years, I can still see Amy sitting there, cross-legged, with her arms folded across her chest. This case had been emotionally devastating for me. Amy began calling me at home. Then she began making hang-up phone calls, started cutting her wrists again and threatened suicide. Years after terminating therapy with Amy, she called me again, begging for me to treat her. I agreed. She was caught in the vortex once more and, like a complete fool, so was I.

In previous decades, we came to see sexism and racism as problems we could no longer ignore in our work. I have a nomination for the problem of this decade: for many kids, childhood is becoming a rat race of hyperscheduling, overbusyness, and loss of family time. The problem is all around us, but we haven't noticed how many of our children need daily planners to manage their schedules of soccer, hockey, piano, Boy Scouts and Girl Scouts, baseball, football, karate, gymnastics, dance, violin, band, craft clubs, foreign-language classes, academic-enrichment courses, and religious activities. Parents have become recreation directors on the family cruise ship.

I live in a small city in Upstate New York, and most people in town know somebody who knows me, my husband, or one of our four engaged and energetic sons. Despite all this, I managed, for two decades, to maintain (in my own mind, at least) a fire wall between my personal and professional lives. In the consulting room and the classroom, I worked to present an air of calm worldliness, an expert with the answers to all sorts of painful therapeutic and family dilemmas. Until one day, I was caught being myself, and everything changed.

Marianne Walters didn't invent a brilliant new therapeutic paradigm, publish a large and magisterial body of research, or establish her own unique school of clinical practice. Yet Walters probably had as great an impact on the overall clinical zeitgeist of family therapy as any of the master theory-builders and gurus. Along with her three comrades in arms---Betty Carter, Peggy Papp, and Olga Silverstein---she formed The Women's Project in Family Therapy in 1977, once called "the first, biggest, longest-running feminist road show." It was a combination feminist think tank and SWAT team, which, in public workshops all over the country, challenged the underlying sexism in some of the most basic notions of family therapy.

When someone has been cut off by a family member, he or she often feels immense hurt, incomprehension, rage, rejection, and a sense of injustice. Of course, this can be true for the initiator of a cutoff as well. Even when someone initiates a cutoff for legitimate reasons, the initiator is still likely to experience regret, sadness, and longing for what might have been. Helping families heal cutoffs is painstakingly delicate work, and comes with a high risk for stumbling over buried land mines. But by taking the right steps toward initial reconciliation and properly managing in-session discussions, it's possible to mend broken ties in a way that satisfies everyone.

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.