IamA Marriage and Family Therapist. AMA! (Rd. II)

What's your position on polyamoury and open relationships?

I think that these relationships can be healthy, and the only reason people think they are not is because of societal norms. However, a person who does not want to be in an open relationship but is doing so at the request of a partner is over-functioning, and that, is not healthy. I think they are fine as long as all partners truly mutually consent to the relationship structure.

What is "over-functioning"?

basically taking on more than your share of the problem, or not getting your own needs met to make sure others get their needs met.

How does one differentiate between over-functioning and the usual compromise/negotiation/adjustment needed for any two people to be able to be in a relationship?

over functioning is when your needs are not met, constantly, over and over again. Usually with compromise, people are still looking out for their own needs... when we overfunction, our own needs get lost.

I've heard that a lot of marriage counselors are relatively sex-negative, anecdotally, anyway. To what extent is this true? Or is that a dated perception (or only true of certain groups)?

Well, I am an extremely liberal guy, and sometimes that is awesome for my clients, and others don't like working with me because I am too open minded. I think that in general, a GOOD therapist will check his or her judgement at the door, and work hard to meet the client where they are at, regardless of their own value systems. I do not get worked about about things like people's attitudes about sex. My clients need to be able to tell me anything and not feel judged. It's really more about not judging and keeping your own opinions out of the therapy room and focusing more on what the client needs... and that goes for everything, not just sexual attitudes.

What about stds? Would that be a concern to a few if not a lot?

Well, one needs to be a responsible sex partner, get tested often, and have a level of trust with the main or central partner. Even in marriages that are not open, if a partner cheats, an STD is a concern. So, being preventative and responsible is necessary in all relationships, not just open ones. (But of course, multiple partners increases risks).

My husband and i went to six weeks of sessions with a marriage councilor at a staggering $200 a session. Two questions: the sessions were completely unproductive, and actually caused more damage (I could go into detail) to our relationship than good. As soon as we stopped seeing her, we were able to mend our relationship issues ourselves - and no, not via implementing any wisdom gleaned from the therapist. Now that half a year has passed, I've thought about writing the therapist and telling her my feelings regarding our experience. Should I? Not in anger, but maybe as one person's evaluation, I suppose.

Second, unlike everything else in the known universe (restaurants, mechanics, maids, dog trainers, you-name-it on Yelp, etc.) there is virtually no way of rating or comparing experiences with other clients. I absolutely understand that in therapy "everyone's experience is different" and "someone might be a good fit for someone else, but not you." however, in my experience, I blindly had to choose someone based on their PsychologyToday profile and commit over a grand and many hours of my and my husband's time to someone whose services, personal outlook, methodology, or satisfaction from previous clients I knew virtually nothing about. She didn't offer a phone call or free evaluation - we gave her a check before the first time meeting. As someone who loves to be an informed consumer (and reads every Amazon review before I buy a thing) do you think this is fair? Thanks for the AMA.

As a therapist, I do not think that is appropriate for there to be reviews of me from clients. This is because I do really feel that some people click and some don't. Sometimes a client may not like me because they reflect their anger from their spouse on to me. So, I don't think reviews are fair. HOWEVER, I have a handful of clients who have agreed to let new clients talk to them. Also, try to get a referral from someone you trust... maybe your doctor or maybe you can ask others who have seen a therapist how they experienced their therapist. I used to give free consults, but I don't any longer. I will, however, answer as many questions by phone that a new client wants to ask me. It doesn't sound like a consultation would have helped anyway, because you saw her six times.... What I tell clients all the time is to please tell me what they need from me as their therapist.... that if we aren't clicking to please let me know so I can help them. Did you ever tell the therapist in session that you didn't think therapy was helping? As a therapist, that frustrates me when a client tells me later that our time wasn't helpful. I would instead want the client to tell me then, so that I can do something about it, or at least give them a referral. If I don't feel like things are working, sometimes I will fire myself. Bottomline, I think clients think we can read their minds, and we can't. We are therapists, but we are not perfect. But, on the flip side, just like any profession, there are good therapists and not so good therapists.....

I think your last line is more important than the first part of what you wrote, especially because a bad therapist can be very destructive. Which is why I think reviews are important. Yes, people might give unfair reviews because the therapist just didn't click with them, but that is true of many other industries that use reviews as well.

I saw a therapist who honestly made my social anxiety much, much worse, and I don't believe it was because we just didn't "click" -- he was just bad. He didn't listen to me; when I told him eventually the sessions weren't working he got annoyed and told me I was wrong and I didn't need cognitive-behavioral therapy because it doesn't work. He brought his baby son to a session once because he couldn't find a babysitter. I had awful social anxiety, and would bring up events that I was anxious (and already obsessing) about and he would tell me why what I said or did was socially inappropriate (for example, snapping at a friend -- I knew it was inappropriate and felt terrible about it, which is why I brought it up in the session. Lecturing me about being inappropriate did nothing but heighten the anxiety).

When you are vulnerable and opening up to someone and the basically confirm all of your fears about yourself and make you feel like you are a deeply disturbed person, it's very damaging.

Anyway I very much disagree with you that reviews aren't "fair." I think it is like anything else -- some people are turned off by any bad review, but many people know to read the substance of the reviews and make a fair judgment based on what is written. It frustrates me that I can't do anything to warn people away from this man because he really messed me up for awhile.

your fault the burger was bad... you had nothing to do with it. However, in therapy... yes, sometimes the therapist is not good.... but sometimes the client has something to do with that process... that is, they were court ordered to come... or they were forced by a spouse or whatever.... so here is what I'm really trying to say.... I would be COMPLETELY FINE with my clients being able to post reviews about me.... as long as I was also able to post a review of the client's willingness to work hard on their issues. Or if the client ALSO had to review themselves when reviewing me. Sometimes, like in the above examples, therapists really are just not doing good work... but sometimes, the client has a part in the failure of the therapy.. and not noting that in a review is the part that I don't think is fair. It's like not brushing your teeth and eating candy everyday, and then saying it's your dentist fault that you needed a filling.

What I tell clients all the time is to please tell me what they need from me as their therapist.... that if we aren't clicking to please let me know so I can help them. Did you ever tell the therapist in session that you didn't think therapy was helping? As a therapist, that frustrates me when a client tells me later that our time wasn't helpful. I would instead want the client to tell me then, so that I can do something about it, or at least give them a referral.

Your first line may have already answered this question, but I just wanted to give feedback on this - how difficult/unrealistic it is to expect a client to voice their concerns/frustrations with you, unasked. The thing is, a whole lot of the therapeutic relationship is based on a client seeking the therapist's approval. It is hard if not impossible to confront or challenge the very therapist whose approval you wish to seek.

I've been in therapy for half a year, with a woman who I feel is, overall, a very good therapist. There is one thing she did, though, that I felt was damaging. I still, honestly, resent her for it - I just recognize that it relates to an issue from the past and that it isn't affecting the work we're currently doing, and I feel she is still able to help me with my present circumstances.

When it first came up, I remember trying to discuss it with her. I stumbled a lot. What it looked like, was me asking her why she made the choice she did to handle things the way she did, and me asking for clarification on her reasoning. She took my question at face value, and told me why she chose the approach she did. I couldn't bring myself to push the issue any further than that. I think she thought it was resolved - I asked a question I had about the therapy process, and she answered it. I couldn't bring myself to say "Ok, I get it that you had your reasons, but it still hurt me, and I am having a hard time letting go of the resentment I feel that a very difficult time in my life might not have been so difficult if you'd given me what I needed, and that I might have had more success finding closure if it wasn't for you." I can't say that to her. I still want her to approve of me, and I still overall respect her skills as a therapist even if she made a mistake.

It would have been different if she asked. If she asked me how I was feeling about our therapy or if there was any ways that she wasn't meeting my needs, then, I'd easily tell her. It feels much less confrontational to me, to simply answer a question I'm asked, as opposed to bringing it up.

So I guess that's the second thing I resent her for a bit - the fact that she never asks.

This brings up another point- I always ask clients after the 1st, 5th, 9th, and 13th session how they feel therapy is going. So, I do ask directly, and if they still don't tell me, I'm not sure what else I'm expected to do. Also, it concerns me if a client is so concerned about me approving if them that they can't honestly answer my questions. That, in itself, is something to work on in therapy. Why you need your therapist to approve of you? In fact, I also smile inside when I client tells me, "no, I disagree with you" or "that doesn't fit for me" because I know they are getting more confident in solving their own problems- and that's exactly what I want them to do. What other job in the world is based off of your customer firing you because they don't need you- and that's a good thing. That's what makes being a therapist so awesome. To see people be able to tell you to piss off, I'll do what I want.... Makes me proud! :-)

I've read that clients can go through a NUMBER of counselors before finding someone they can be comfortable with. This is healthy. Find someone that suits you and your issues!!

yep, I agree. And sometimes, it has taken clients months and months before they are finally ready to start working on what they really need to work on.

How long have you been working as a therapist?

Have you identified any tell-tale signs of success or incompatibility when doing marriage or pre-marital counseling? I don't mean signs that 100% indicate either one, of course, but things you notice that usually correlate to either success or failure.

Yes.... relationships need to be void of defensiveness, criticism of each other, stonewalling (not talking about problems), and contempt (as in, being mean to be mean... name calling, emotional abuse, etc). Also, sex is an important part of a relationship as well, and lack of sex can be replaced with conflict, and that conflict can drive the four traits I mentioned above. When people are turning towards each other, and are all-in to make a marriage work, most of the time, they will be okay.... it's when they begin to turn away and stop caring that they could be in trouble.

How important would you say sex actually is? Is there some fundamental part of it that can be satisfied in another fashion?

I have been with my partner for 7 years and we haven't had any sexual contact in 18 months. Yet… our relationship is getting stronger. It's a great relationship. We did go to a couple's councilor once but he couldn't find anything wrong (turns out I was having a mental break). We're quite emotionally intimate. I suppose I just end up being curious as to how we're thriving without sex.

Lack of sex is a problem when one partner wants sex more than the other. If both of you are TRULY okay without a sex life, then I suppose there really isn't any need to worry. However, if I were your therapist, I would explore and dig deeper, as we are relational creatures... us humans... and it might be worth exploring why you make the decision not to be sexual. I'm not saying I don't believe you... I would just ensure that you both genuinely dont have an issue with the lack of frequency. Your genders, age, and past sexual experience are factors here as well.

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Yes, I also like EFT models as well.

I came up with a metaphor recently and I'd be curious to know if you agree: If a relationship is a body, the sex is the skin. In that, whatever you put into your body (healthy/unhealthy food, smoking, water or lack thereof) will be visible in your skin. So, depending how a relationship functions, it is visible in the sex, be it a lack of communication, intimacy, trust, comfort, confidence....anything. Thoughts?

yes, that's pretty cool. Sometimes the sex life is better than relational life.. and therefore the sex life can be used as a strength or metaphor to solve other problems.

Knowing you can transform your clients lives must be a great feeling, but who's life have you changed the most and what was there story?

I had a guy in his 20s that saw me for a year, and then discharged. About a week later, I got a letter from him in the mail that said if it wasn't for me, he would have killed himself. He said he was planning to kill himself the day that he came for his first appointment, but because I gave him some hope, he changed his mind. He never told me about it in therapy, but told me about it later. That was a pretty awesome feeling to know I had impacted him so much and didn't even know it.

So you're a hero!

well, I don't know about that. But it was rewarding to feel so helpful.

What was it you did that gave him hope? I have trouble finding the right words when my friends tell me their troubles, so I'd love to know what you said.

I don't think it is what I said... I think it was more about that he thought he was crazy and no one could help him... and instead, I accepted him and made him feel understood. He put in the letter... "You told me it we could work on this together and it would be alright... and that was the first time anyone said they could help." I can't speak for him... For me, it was eye opening because even as a therapist, we sometimes never really know where someone is emotionally, and it is very dangerous to assume we do.

When couples come to you for help, is it too late?

Sometimes, couples will come for help, but what they really want is for the therapist to give them permission to get divorced or break up. They want to be able to say, "I tried therapy and it didn't work. I did all I could do." For those couples, yes, it is too late if they have stopped caring and are just going to therapy to prove a point. However, as long as people still feel something, even if it is anger, then it's not too late. It's when people become indifferent or stop caring that they are in trouble.

What's the craziest thing someone has come to you with? Or are you not allowed to talk about that?

I can talk about things as long as they are De-identified. I had a client that would bark at me like a dog when he would get uncomfortable. I had another client that would swallow Barbie Dolls heads as a sexual fetish.

I've been in a relationship for 8 years with my man. We have lived together for 2 years and we get along very well, we don't have arguments often, if we do, it's never about money or jealousy, it's usually small things like chores. We pan to get married in a year.

Anyway what I'm trying to ask is, do you feel it is necessary for a couple to get therapy if there is no major problems in the relationship? What benefits would there be?

I tell my cients that sometimes people do their best therapy when they don't feel like they need it. This is a time to work on love-mapping (i.e. learning things about each other you don't know) and about rehearsing (i.e. practicing what to do when there is a problem). You may find that you don't need to go every week. Maybe once a month would be your speed. I think people think therapy only has to be about problems, and that is not the case. You have to be wiling to be open minded, and to contribute to the session, though. Most of the time, people don't come see therapists unless there is a problem. However, there are several therapists that do pre-martial work... some of it is faith based, but if that is not your style, there are also secular approaches.

I remember reading in one of Malcolm Gladwell's books about a therapist who could guess with high accuracy if a marriage is going to make it within a short period of time. The key was if there was contempt express on the partner's face when the other partner talked.

I was wondering if you agree with this? Are there tell tale signs that couples exhibit that almost guarantee the relationship will fail?

You are probably talking about John Gottman. Gottman notes: Defensiveness, Criticism, Contempt, and Stone Walling as signs that a marriage will fail if they are not reduced and treated.

I am certainly no John Gottman, but I don't like the idea of telling anyone their marriage WILL fail. I think success of people comes from the notion that someone believes in them. If you believe your marriage can work, and will put in the effort, then it will work. I think people are in charge of making a marriage work, not research. I think what tells me that a marriage is in trouble is when the people just don't care anymore. That is, they feel indifferent about their marriage or relationship.

Is it ever appropriate for a therapist to talk about his personal life to a client? For example, my friend is cheating on his wife and thinking about leaving her. His therapist told him about his divorce and how his wife had cheated on him. Are there rules or best practices about such things?

Yes, it is appropriate. Disclosure is actually an intervention or technique that therapists use to show empathy and normalize feelings of the client. Here is the rule of thumb.... if my personal disclosure is intended to help the client and does not benefit me, it is okay. BUT... if my disclosure is to get something off my chest and vent, or to get a client to lean towards my agenda, or for me to somehow benefit from the disclosure, then it is not appropriate. The first question a good therapist will ask himself is... "How does me telling the client this information help him reach his goals." If the therapist can't really answer that, then it is not appropriate. Again, usually disclosure is used to normalize the clients feelings.

I guess my thought would be: if the therapist was cheated ON, and the client is doing the cheating, it doesn't seem like that would normalize his feelings. But then again I wasn't there so of course I only have a snippet of context.

Right, I agree. But disclosure there might have been being used to help the client understand the position of his wife, and the reality of what was happening...... or it might have just been inappropriate disclosure. Who knows?! I only have your snippet of context as well. :-)

Counselor here, self disclosure is very tricky. It can be helpful if it is first and foremost about the client, but from what you're writing here that doesn't sound like appropriate self-disclosure.

I think it is risky to tell someone a therapist is not being appropriate without context. Just an opinion. The therapist may have had some counter-transference going on here, but he also may have been attempting to get the man to consider the feelings of his wife and the reality of his behaviors.

That's definitely what it sounded like to me. If it were me, I'd feel really weird talking about my other relationship, like the therapist is judging.

I disagree. Again, context is important. This may have been the therapists way of attempting to get the client to self-examine his behaviors. We have to be careful to judge an intervention without the context.

I have no real family at this moment. My father died when I was eight years old, my mother is an abusive alcoholic and my sister rarely speaks to me.

I want to stop talking to my mother and end our relationship as family. I hate her, really. She has ruined my life and I have panic attacks every day because of her. She have beaten me and told everybody when I used to hit her back (as a really young child) that I was a monster and she couldn't handle me. The only reason I hit her back was in self defence because she taught me that hurting each other was okay, since she hit me every day. Everybody that I knew, relatives, neighbours, teachers, friends, were scared of me. I haven't had a real education because of her. At one point she starved me because she ran off and got drunk for months. I am 19 years old and she never calls me because finally she understands that she only makes things worse.

I want to end our relationship. I never want to see her face again or hear her voice again. But everyone I've spoken to about this says I shouldn't do that and "she's still my mother". But she haven't been my mother since my father died. She have hurt me in so many ways and I don't want to build up a stong confidence in myself and then let her ruin it once more. Pshychiatrists at school, friends and grown ups I've trusted have all said that I will regret it and that she is an important part of my life. But the days when I practically forget that she exists is the best days of my life..

Is it wrong of me that I never want to see her again? I feel that it's the only way to let me become my own person and not her slave and punching bag.

Well, this question is one that I have to carefully answer, as it is not appropriate to give you therapeutic direction in this setting. Instead, let me offer this: It is important to try to salvage relationships that are only difficult... that is, we have to manage our emotions, and not give up too easily. However, it is also important that when a relationship is toxic, as it, it is not difficult, but rather, it is dangerous.... this is when we should cut it off, almost like a cancer. I would encourage you to work with a professional to help you decide if your relationship is difficult, or if it is dangerous. But, no matter what, no one has the right to hurt you.

If you're absolutely sure you don't want to talk to her, let her know. Have you ever told her that you feel like breaking contact? This might make her realize the fact that she's screwed up a lot. She may change, she may not. If you don't feel like she has tried to make things right, just tell her you don't see any type of contact needed.

I have told her several times that I don't want to speak to her and that she doesn't belong in my life. But before I moved to the other side of the country I had to meet her on different occations to pick up stuff from her apartment. She always asked if we could do things, maybe have a cup of tea or go to the movies. But every time I said yes she'd cancel last minute and end up going to some random guys' place instead. The last time we met she cried and said she hasn't been a good mother. But that wasn't the first time. Every single time "we" had a fight she did the same. But she never stopped.

I feel like it's the right thing to do, not to have contact anymore. But since all of the people I've asked had said that I shouldn't break it with her I get more scared that they are right and I should just forgive her. But I feel like they don't understand most of the time. They aren't the ones that have had their whole childhood and life taked away and destroyed by that one single person..

I think it is important to listen to what you just said there.... " I don't think they understand." Trust yourself. You don't have to continue to be hurt by anyone, even your mother. Just being your mother isn't a good rationale for continuing a relationship that is toxic. Trust yourself.

When you see a family, do you ever think one parent is doing a worse job than the other, and do you share what the kids say privately to you with the parents?

I guess maybe I have thought that, but then I remember that a family works together as a system. The under functioning parent, for example, might be under functioning because the over functioning parent is functioning too much. So, it is important to really explore that dynamic before making any judgement calls. As far as sharing what kids say, legally, kids have no right to confidentiality with their parents. However, I also know that if I blab everything a kid tells me to their parent, then the kid won't tell me anything. So, a lot of the time, I will ask the kid first... is there anything we talked about today that you don't want your parent to know? And, if there is something that I feel a parent really needs to know, I will tell the kid and first ask for permission. If it is a safety issue, I won't give the kid a choice, but i will still tell them in advance to try to salvage some trust.

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you mean, as in, how to relax during sex or something different?

Leading into it , I get anxiety with someone I've been dating , a few drinks and I'm ok but I would to not resort to alcohol .

Are you male or female? Is this about performance anxiety, body image, something else. Understanding the root of the anxiety is really the first step in lowering it. You have to have insight into why you are anxious before you can do anything about it.

Hey there fellow MFT, just wanted to say I think you're doing a fantastic job representing the field. My questions are: where did you do your training? Also, did you decide to certify in any particular model? I saw some hints that you might be Gottman oriented.

Thanks for the compliment. In regard to models, I am all over the place, but I like to do EFT & Gottman with couples... Narrative, DBT, and use EMDR when appropriate for trauma....I like pieces of structural and strategic for families, and used to use a lot of Bowen, but not as much any more. So... like I said, I'm all over the place. I don't use a lot of CBT because I think it's boring. I also don't really use too much solution focused. I have recently been into DBT. I also love using sandtray as well... that and EMDR just amaze me.

I don't understand this but it sounds awesome.

Haha, here let me help out a bit. This is obviously going to be super simplified though. Remember, basics here.

EFT (Emotionally focused therapy) is brief therapy (brief therapy generally means 8-20 sessions) that works on reframing the emotions that one feels so that they are not victims of it, but allies against it. It also focuses on being able to identify and tap into one's emotions.

Gottman, well, read the AMAer's responses, really. You look at the various aspects of the relationship (e.g. communication (or lack thereof), conflict management, etc.) and attempt to reframe it. Haven't been taught it, so he'd be a better answerer than me on this.

Narrative. It's a person's story expressed with more detail than one might normally tell. It also allows for the narrator (the client) to externalize problems. In this, I mean that the problem is given a name (such as "Angry Man" (yes, it can be that simple)) and then the narrator chooses how to interact with that problem. Admittedly, I am not the best person to talk about this one as I haven't dabbled enough into it.

DBT (Dialectical Behavior Therapy) is something I have not been in contact with before and so this is Wikipedia'd. It sounds like its used for those who are harming themselves, such as suicidal patients and substance users (yes, this ALWAYS includes alcohol). It attempts to help the person find inner strength (e.g. self-soothing, ACCEPT) to capitalize on.

EMDR (looked this one up too) is used for PTSD. First, history of the traumatic events (and related ones) are taken down. Then, techniques are identified or taught to the client to combat the negative emotions, behaviors, etc. that one experiences because of the event. Then, the person's imagination is used to relive the event and use these techniques to calm themselves and self-soothe. Progress is tracked until the next session and then analyzed at the next session.

Structural therapy is a huge believer in hierarchy. So, parents are the authority ALWAYS, children listen to the parents, older children listen to younger children. Parents are not 'friends' with their children - that's blending dynamics and causes confusion to the children and allows them to manipulate the parents further. By establishing rules (that do have consequences to them and are not empty threats), hierarchy can be re-established.

Strategic therapy is super brief therapy (usually less than 10 sessions). Clients identify problem, therapist gathers necessary data about it, clients and therapist come up with solution to problem, problem is solved and therapy is over until a new problem arises and you tackle that one. Basically, one problem at a time. (It's assumed that the solution found would change this one dynamic and that it would have a domino effect on others.)

Bowenian (Bow-in-e-en) therapy is all about differentiation. Families have triangles. This triangulation is used to the benefit of one party and the detriment of another. The prime example is one parent (let's say father) and the other (the mother) are fighting. The father, wanting to prove he's right, calls their son in to settle the argument. The son will side with whomever will end the argument or create a disturbance that focuses on him instead ("I failed Math"). Differentiating oneself from this triangle allows for one not to be pulled in and take a better view and stance for the argument.

CBT (Cognitive Behavioral Therapy) is where one changes the thoughts and behaviors one has about the problem. 'Boring', sure, but extremely effective. It does not have the bells and whistles like other theories here, it's a simple let's identify your thoughts and feelings about this, stop them when they occur, and replace them with something else.

Solution focused brief therapy (SBFT, for short) is all about positive. Look to the future, not the past, unless it directly helps in some way. It has the miracle question. Basically, tonight you go to bed and while asleep the problem magically goes away but you don't know it. What is the first thing when you wake up that tells you, something is different? "What next?" is usually asked to continue the story. Then, you have scaling questions ("How was this previous week?" "6" "6? That's great! That's up from the 5 from last week. What changed?"). SFBT looks for exceptions and highlights them (you aren't always feeling depressed, so when were you happy, angry, not thinking, etc.), to identify for the person their strengths.

Sandtray therapy is AMAZING. Basically, you put sand in a tray, have HUNDREDS of toys, people (different ages, sizes, color, etc.), superheroes and villains (and I mean a lot of them, too), animals, buildings, cars, etc. etc. etc. You literally cannot have enough, ever. The client starts using/playing in the box and usually creates a story that is then told to the counselor. Usually done with kids, it allows them to express through others the words they are unable to say and tell (without actually 'telling') others what's going on.

Basically, this guy is eclectic to a T. In that, I mean, he doesn't ascribe to one model exclusively and tends to use what he deems fit for the situation at hand. Sounds harsh, I know, but it's been driven into me that I should not be eclectic and stick to one theory of choice. I can borrow assessments and tools from other fields (such as the Bowenian genogram, which is a detailed family tree, or Structural's triangulation for hierarchical needs, and the sandtray), but only if it's still through the lens of my theory. Again, not saying he's wrong, but that's what I've been taught.

If there's one thing you should take from all of this, Jotebe, it's that there are seemingly numerous ways to help another person help themselves. Each has their merits, and each has their pitfalls. None of them are perfect, but they do what they can to help this person in need. And, yes, counselors help clients help themselves. Counselors are not a perpetual crutch to their clients. They are there to pick you up when you're down (because, let's be honest, you don't go to therapy when you're feeling good about your life) and help you on your way.

Thanks for taking the time to answer this question. Interesting what you said about being eclectic... because I learned exactly the opposite... that it is important to pull from multiple models to suit the needs of the client best... and to not stick to any one theory. Not saying you're wrong either.... but we have obviously been taught differently.

My wife and I changed our communication style last night. For the past 9 years, we have a very typical style of communication - with a lot of how and why questions. But, as I discovered, it lead to a lot of miscommunication.

So now we're using yes/ no questions.

Is this a healthy style of communication? Are there better techniques for clearer communication?

Starting questions with "why" can create a defensive/critical response, so it is a good idea to get rid of that. I like to encourage couples to use scaling..."On a scale of 1 to 10 how much to you want to go out for dinner?" to help them express ideas safely. These all are just band-aids though until the couple can tolerate distress a bit better. There are lots of techniques for better communication, but that is too difficult to really explain all that here. Bottom line, if what you are doing is working for you, then, don't try to fix things that aren't broken.... but at the same time, it's always important to be attempting to grow and improve.

I know you said that techniques for better education are too difficult to explain here, but could you possibly elaborate a little on communication in long distance relationships? My husband is stationed overseas without me, and I am always looking for good ways to continue strengthening our relationship, especially while we have to be apart from each other, especially when it comes to communication. I love the "scaling" idea!

this is where love mapping comes into play.... sometimes objects help. For example... instead of email or phone calls, a handwritten postcard sent weekly or even daily can give you something to hold on to, literally, in your hand... knowing that he wrote the note, he touched the paper you're touching.. etc. Technology was taken away romance. Sending care packages, remembering inside jokes, sending photos.... all of those things make connection stronger over distances.

What is your opinion of staying together for the kids?

Kids are much more resilient than we give them credit for. A divorce can actually help kids feel better because the constant fighting stops and their parents are less stressed (after a while, of course). Kids can handle divorce if it is done is careful and healthy way. Kids can adapt easier than adults can. However, when the adults use their kids as pawns to hurt each other, talk about about the ex-spouse, or get their kids in adult business, that is unhealthy. But, if the couple really takes the time to do divorce "the right way", with the help of a professional if needed, kids will be okay.

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What advice would you have for an ACOD who was used as a pawn, and has trouble talking to his parents about this?

That's a tough one. Of course, working through that in therapy would be a good start. Perhaps helping the person to be able to exonerate his parents, and learn to "let go" of trauma through EMDR or trauma focused therapy to develop a stronger sense of self would be a start. This question is too complex to be answered in this sort of setting... and it is dangerous as there isn't enough context to be helpful. So, I guess I'd tell him to make an appointment! (sorry that wasn't very helpful).

Are you married? If so, does your spouse feel that you are constantly evaluating them? Or is it beneficial? I've always wondered about the personal life behind a therapist.

I am not married, but I have been in significant relationships. Honestly, therapists are humans. I can "put on my therapist hat" at work, but we have problems, get depressed, get angry, etc. just like everyone else. Therapists don't let on to that with clients, though, because it is important the client doesn't feel a need to "take care of their therapist". For example, if a client knew I was feeling sad, he or she might be less likely to tell me about sad things in their own life because they care about me and want me to not be sad.... so we have to work very hard to keep our own feelings and life experiences out of the therapy room.

what are some patient's issues that you think you have to deal with more frequently because you're in Kansas, as opposed to, say, Massachusetts?

Hmmm... well, since I don't have anything to compare it to, I wouldn't know how therapy would be different there. I would say people are much more conservative here, so there are probably issues regarding gender roles or expectations in relationships, that more liberal parts of the county wouldn't address. That is a great question, but it's hard to answer. I'd have to do therapy somewhere else to really know.

My husband had a major panic attack the other day but he refuses to talk to anyone or seek counseling.

What would you say to someone who is very weary about visiting a therapist? Could you briefly describe a typical first meeting?

If I know that a client is weary, I usually move very slowly. Your husband probably is expecting someone to challenge him, or dive right in, like the therapy you see on T.v. That is not what real therapy is like. The first sessions are really joining with the client and building trust. With the right therapist, if he could make it through the first session or two, he would be okay. The first 1 or 2 sessions are often the hardest. It is important the therapist not move too quickly for him, and that he or she is aware off the bat that he doesn't want to be there. Remind him that we do not have Jedi-mind tricks, and he will be the one in control. At the same time, I am not willing to work harder than my clients are willing to work at getting better. If he doesn't want to seek help, he just may not be ready.

Do you ever follow up with your past clients to see if the sessions resulted in a positive outcome or divorce down the road?

I don't formally do that, mainly because it would take a lot of time. I often wonder how people are doing. Sometimes, past clients will send me a note or email, but not often.

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A few things... Start by deciding before hand what qualities you are looking for in a therapist. I will ask my clients what is important to them, and I am always surprised about how many don't know how to answer that question.

Ask people you trust if they have had experiences with therapists, or if they know people who have. Finding the right therapist is so subjective, so what you're looking for are things like, Does the therapist keep appointments? Is the office and staff professional? Is it easy to schedule appointments? Those sorts of things....

Ask your family doctor. A lot of times, PCPs have therapists they refer out to...

And finally... don't be afriad to call around and ask a few questions, maybe meet more than one before deciding. If a therapist isn't willing to chat with you on the phone for at least a few minutes to see if you click, that therapist probably doesn't have time to take new patients anyway.

What is a subtle way for a poly family to ask if their potential therapist is poly-friendly? It's hard to find a list of providers in my area.

If you don't feel comfortable disclosing, then this is probably something to be worked through first. Honestly, if the therapist doesn't respect your value system, then you might want to consider a new therapist. If trust is there, tell your therapist. He or She should do the right thing and refer you out if they are that emotionally charged by you being poly. Remember, your therapy is about you, not what the therapist thinks. I have had clients that have made decisions or had value systems that I disagree with, but a good therapist can still do therapy anyway, because therapy isn't about the therapist. It is about meeting the client where he or she is at and making the therapy about what the client needs. You pay us too much for our time to not be about you!!! :-)

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maybe you could be the one to start therapy yourself, and invite your mother to attend with you when you are ready... and frame this as more about you and less about her. You can't control what she does, but you can control how you feel about it, and a therapist can help you with that.

Any advice for dealing with your parents separating? I'm in my mid-20s so at least it's not the same trauma I'd be experiencing as a kid, but it came very out of the blue - my dad just ended it one night. He's not having an affair but it's hurt my mum pretty bad, and I feel like I'm kinda caught between being emotional support for my mum and still trying to keep a relationship with my dad. I'm single and an only child, so it sort of feels like my entire family has disintegrated. I sometimes wonder whether I should see a counselor about it but it feels, I dunno, almost selfish when it really is their problem to sort through and they're experiencing it so much more intensely than I am.

Seeing a therapist is never selfish.... and honestly, as an only child, and now an adult, that situation would be stressful for anyone. You probably feel a need to take care of both of them, and when one talks badly about the other, what a double bind you are in. (Google what a double bind is, and you'll see it's enough to drive you crazy). You're not selfish to want to work with a therapist. This would be hard for anyone in your situation. Be kinder to yourself, and accept that is okay to seek out some support during this time.

Throw-away for obvious reasons.

I may be downvoted but I sincerely hope that you answer this.

I am a diagnosed sociopath. My SO is aware. I've never been with someone that brought such value to my life. We've been together 4 months. That is really quite a long relationship for me. She is bipolar, but well controlled with meds.

I'm excellent at maintaining my social mask for days or maybe even weeks at a time, but I have a terrible tendency to get bored of people, see them as play things, and then play with them. It's fun for me, but not for them. An example from earlier today, is that she made some small mistake, and I dug into her. I forced her into a situation, linguistically, where she'd have to admit to being a genuine moron, and then pressed the issue harder and harder, making her feel even more stupid for not seeing it, until she admitted it. I could attempt to salvage some semblance of purpose other than my own amusement by saying that I was attempting to train her to comply sooner rather than later -- indeed, I do train her to comply, but usually not so harshly, since I've learned that people tend to go away if you're consistently so harsh with them. Unfortunately, I'm fully aware that I was only playing with her to amuse myself by causing her to admit defeat, and that she is a moron. I enjoy making people say and do things contrary to their nature.

As I get more and more bored with a person, I more and more frequently find myself doing things like this to entertain myself.

If the build-up is slow, they stick around a lot longer than if I were suddenly a perpetual asshole, but they do eventually leave or cheat or something as I become vicious more and more often.

So, I suppose what I'm interested to know is... How do I make her not leave? I realize that there are some things I'm going to have to change, so perhaps the question might be... how do I control this urge (it's almost a subconscious thing that I don't know I've done until it's over) to toy with people once I get bored of them? Or perhaps, how can I find other ways to toy with people that might entertain me for longer, besides doing things which might incidentally and unfortunately, hurt them?

EDIT: I should also mention... rather crucially, we are in a D/s relationship. I'm curious how this impacts your potential response, and out of curiosity, I wonder how you feel about D/s relationships in general.

for the record: Ostensibly, I believe that a D/s relationships require mutual respect, and require that the "D" ("Master" in my case) must be the most rational person they can be. In my case, that's easy enough. Rationality (when not sinking my teeth into a "toy") is automatic.

It sounds like you are being emotionally abusive to your partner. If you are indeed anti-social and have formally been diagnosed as such, and that diagnosis is correct.... then you are aware that you have a personality disorder. Just by posting this is not typical of someone that is anti-social, so you are already on the right track. I encourage you to seek therapy from someone that is well-versed in working with personality disorders. You will need to take responsibility for your behavior with your partner before couples therapy would be safe, but that is something you might consider as well.

Your need to "mess with people" comes from somewhere... family of origin, organic disorders, past trauma, or something of that sort... work with a professional that can help you work through that.

I am out college with my bachelors in psych and thinking about a doctorate in psych to become a therapist or getting a masters in MSW. After four years of school however, I feel a fair amount of hesitation going back to school. Did you absolutely knew what you wanted to do after your bachelors? Any advice you might have for me?

I was actually a teacher before a became a therapist. If you just want to do therapy, and you aren't interested in research or teaching, a PhD isn't really necessary. And, in my opinion, an MSW is not the way to go either if you want to do therapy only. A master's like MFT or to be a professional counselor (LPC) is much more limiting in jobs than social work, but I do not feel an MSW is as trained to do therapy as an MFT or LPC would be. I really enjoyed graduate school, because unlike a bachelors, all my classes were very focused on my degree field and I was excited to learn. You may find that you enjoy your graduate work in a much different way than when you did your undergrad. Just make sure you pick a graduate degree that makes sense for what you want to do.

As a guy in his early 20's who hopes to be married someday. What are some of the biggest pre-marriage things I should work on?

Learn that when you feel criticized by others, to instead be curious about why they might be having those experiences. Sharpen your empathy skills (google for help).

Hi! I'm really actually a little surprised to see someone like you on here doing an AMA! I hope you'll answer a question, even though it's more of a personal question rather than something about your profession..... My husband and I have been married a little over a year, but we've been basically long distance since the beginning. He is in the military and is stationed overseas (I have to continue living in the states due to medical reasons). I try to go see him as often as we can and we've been blessed with the ability to do so every 8-10 weeks or so. My question is about sex drive... I happen to have a much higher sex drive than he does. Do you have any advice for a relatively newlywed, moderately long distance couple who have drastically different sex drives? Sex is an incredibly important to me in our marriage, I feel like it's not even all about pleasure, but being close and intimate with each other. Sometimes it seems like there just isn't enough of it when we do get to be with eachother (I just had a 2 week visit and we only made love twice). I feel like being a female, having a higher sex drive is a little more unusual, should I take a step back and just take what I can get? Or is there something else we can do that might help satisfy my cravings for that intimacy, when he's really not in the mood?

I wrote a long response to you, but it didn't save. So here is the jist: I would encourage you not to set your own needs off to the side and settle. Doing so will lead to resentment. With sexual problems, we always want to start medical.... your husband might want to have his testosterone checked. After that, consider things like depression, anxiety, body image issues that might be creating distance. If all that checks out, then look at the intimacy issues. Rather than finding just a way to deal with it, I would encourage you to find a way to fix it.

Thanks for your reply, it's too bad it didn't save, I would have loved to read it! I've wondered about the physical/hormonal aspects of it (I'm not even sure military medical would be able to check on that or help), but I'm not sure he's ready for me to bring that sort of thing up. I'm concerned that me openly questioning his testosterone might make him even more sensitive on the subject and just make things worse. He usually tells me that he's "never really had a really strong drive, and it's always been like that". Of course he tries to do what he can, but nothing I know of can really replace the intimacy of actual intercourse.. We're hoping it might change once we actually get to live together. He had to go overseas 3 days after we wed, so that doesn't help with the whole quality time thing.

Do you think he has any issues with his body? Is he shy? Is he in good shape? Sometimes men are more self-conscious then people know.... also, and I realize this is quite personal... some men have performance anxiety or can internalize their "size"... those can also be issues that are very difficult to talk about.

Don't suppose this is just a chance to get free therapy, is it?

not at this hour of night. LOL (Not to mention that would be unethical).

I feel jealous of my s/o's qualities quite frequently. I watched him graduate uni with great distinction just a few months ago and felt heart wrenched because I don't feel up to his standard. He doesn't possess many other qualities other than grades, and I'm chock full of extra curriculars/ contacts from years of volunteering etc. My grades aren't bad, I'm just having so much trouble trying to calm down and not compare each other constantly. At the same time, he knows how I feel and is very supportive.

In short, I feel like my constant regression of self doubt is hurting him. I don't want to feel this way anymore, and at the same time give him relief. What could my first steps be?

I would consider perhaps your own past trauma with family of origin. Where did you learn to not have confidence in yourself? What is the root of that.... where does that come from. Once you figure that out, then work on reversing that negative self talk. It sounds like this is more about you and less about him, and that you know that already.

Ok so here is the deal, been with my current girl for about 7 years now (first real relationship out of high school) and I am debating on breaking up with her. The reason's why are she threatened if I don't marry her soon she will leave me and also threatened if we don't buy a house she will do it herself and leave me. She is a year younger than me and we are in early 20's. We both have decent jobs but are living paycheck to paycheck. I really have not been happy in the relationship for the past few years but thought it is just a rough patch. I have a potential new place to move into but just want some opinions to help try and weigh the pros/cons if anyone have any. Tried talking to her about it and she of course said she didn't mean it but the fighting that followed after she said both statements seemed pretty real to me. I feel like if I stay with her I will just be dragging her along for who knows how long. Any advice you can give?

tl;dr: thinking about ending relationship and moving out very soon and need help doing so or not.

Well, of course, I'm going to tell you that you might benefit from seeing a therapist as a couple, or on your own. Second, you are stonewalling, ie... not expressing to your partner that you want out, so she can't read your mind to address that. Third, it probably isn't helping you by feeling pressured to marry her and buy a house. It probably isnt about the money... it's about not feeling connected. So, I would encourage you to get honest with yourself about that. If you want the relationship you will work on it, but if you don't.... and you truly are done and don't even feel like you want to try, then it's only fair to disclose this so you can both move forward. I am uneasy, though, about giving you such a simple answer, so again, maybe working with a therapist could help.

What is your opinion on a cheating spouse? Why is that they cheat?

It might be because it's late, and I'm running out of steam, but I can't even attempt to answer that question in this setting. I could write for hours and hours about that.

However, this is a great book about that very subject:

After the Affair: Healing the Pain and Rebuilding Trust When a Partner Has Been Unfaithful by Janis A. Spring

Malcolm Gladwell stated in the book Blink that the easiest way to assess if a marriage will break down is if they talk to each other with contempt. Would you agree?

This same question was answered above:

You are probably talking about John Gottman. Gottman notes: Defensiveness, Criticism, Contempt, and Stone Walling as signs that a marriage will fail if they are not reduced and treated.

I am certainly no John Gottman, but I don't like the idea of telling anyone their marriage WILL fail. I think success of people comes from the notion that someone believes in them. If you believe your marriage can work, and will put in the effort, then it will work. I think people are in charge of making a marriage work, not research. I think what tells me that a marriage is in trouble is when the people just don't care anymore. That is, they feel indifferent about their marriage or relationship.

Hi, and thanks for the AMA! I was wondering if there's a definitive answer to this age-old question: should a couple stay together for the kids, or it is it better for the kids if you were to separate?

This question was also asked above... here was my response...

Kids are much more resilient than we give them credit for. A divorce can actually help kids feel better because the constant fighting stops and their parents are less stressed (after a while, of course). Kids can handle divorce if it is done is careful and healthy way. Kids can adapt easier than adults can. However, when the adults use their kids as pawns to hurt each other, talk about about the ex-spouse, or get their kids in adult business, that is unhealthy. But, if the couple really takes the time to do divorce "the right way", with the help of a professional if needed, kids will be okay.

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Like some of the others here, this question is really too deep and complex to be answered in this setting. I am sorry you are experiencing this. Have you considered your own therapy? You also may want to establish a relationship with a therapist and then invite them to come. I'm sorry that I didn't give you a straight answer, but I don't want to do any harm to you, and I'm afraid without really knowing you, it's not safe for me to answer. :-( Hang in there, and seek out services to work through this. Believe in yourself and know that you are important.

What's your view on incest?

Not sure what you mean. Obviously, it is not healthy. Incest usually occurs with enmeshment within the family system. It is usually a pattern that is maladaptive of the system, and just like any sexual abuse, and be traumatic. I'm not really sure what you are asking.... maybe be more specific?

not sexual abuse, but romance and love between brother/sister from both sides. And I'm talking about 1/2 years age difference between siblings.

again, this kind of dynamic can come from enmeshment of the family. Are these step-siblings, half- siblings? Since there is only 6 months difference, I assume they are not bio siblings.

Are you married?

what is the purpose of that question?

Don't you think it has a purpose?

If I asked the purpose, then wouldn't that mean that I thought it had one?