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Challenging The Narcissist

How to Find Pathways to Empathy

July/August 2013
Given their arrogance, condescension, and lack of empathy, narcissists are notoriously difficult clients. The key to working with them is being direct and transparent about the roiling emotions they trigger in us.

Yesterday’s Ethics Vs. Today’s Realities

Boundaries in an Age of Informality

July/August 2012
As the status of therapist has shifted from an oversized figure with Svengali-like powers to an overworked and underpaid service provider at the mercy of the client-consumer...
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Therapist Self-Disclosure

Think Before You Get Personal

July/August 2012
The ways we disclose, read cues from our clients, and dialogue about what’s been divulged are the keys to whether therapist self-disclosure helps clients’ therapeutic goals or gets in the way.

Clinician's Digest

July/August 2009
Cosmetic Neurology * Another look at APA's stance on torture * The effects of internet porn * In praise of older meds * Sexual attraction in couples therapy

Love, Dr. Lagerfeld

Sometimes It's Okay to Trust Your Instincts

March/April 2002
We therapists tend to worry a lot about boundaries, sometimes to the point that we forget that sharing our humanity can be a gift, not a distortion.

A Triple Boundary Crossing

From Client to Friend to Client

March/April 2002
The blanket disapproval of "dual relationships" in some circles draws no distinction between "boundary violations," which can harm a client, and "boundary crossings," which produce no harm and may even enhance the therapeutic connection.

Can We Talk?

Let's End the Conspiracy of Silence About Ethical Dilemas

March/April 2002
One way or another, all therapists face similar questions about therapeutic boundaries: Should we accept the gift? How much do we self-disclose? What do we do when a dual relationship can't be avoided? How do we safely negotiate the currents of sexuality? Moved by our best instincts, our weaknesses or simply by the sheer ambiguity of the situation, we can often find ourselves striking out on our own and coloring outside the lines.

Nightmare in the Aisle

A Therapist Caught in the Act of Being Herself

March/April 2002
After the incident, I came to a decision to consciously bring some of the wisdom and skill of my profession into my life with my children and husband at home. And I started bringing into the office the honesty and imperfection I had once tried to sequester in my personal life.

The Slippery Slope

Violating the Ultimate Therapeutic Taboo

March/April 2002
I doubt that I would fit many people's image of a therapist who would violate sexual boundaries with a client. Before it happened, I certainly did not fit my own. On the day I first met Cara, I was a well-respected social worker at a venerable psychiatric hospital in the Midwest. I viewed myself as a caring and conscientious professional. Yet, over the course of two years, I progressed from sympathizing with Cara, to over-sympathizing with her, buying her groceries, paying her rent and, finally, sleeping with her.

The Crush

Challenging Our Culture of Avoidance

March/April 2002
Before it happened to me, I had never heard even my closest colleague talk about falling in love with a client. In our consultation group, the subject was once broached purely theoretically, and everyone became uncomfortably quiet. Nobody shared a personal experience. The message we gave each other was clear: Whatever you do, don't talk about having a crush on a client! And that may be why I would rather write about being seen naked by a client at the health club, or dealing with anti-Semitic remarks in session, than describe to you what happened.
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