Overview of Therapy Style

My work in therapy is strength based, and highly flexible. Approaches used will depend greatly on the individual client or family, presenting issues, and desires of the client.

I prefer not to put people in boxes or diagnose, although that is a skill that is well developed, and may be necessary for insurance purposes, or because a person wants to have a handle on the problem they, or a child is experiencing.

Many clients may have no interest at all in the models I use, but will trust in my skill, compassion, experience as a father and husband, or long experience. Others may just like my dry sense of humor, acceptance, and experience with parenting issues.

Others however may be interested in my theoretical orientation and the tools I use. A brief summary follows.

Specific therapy models I may use, with very brief descriptions follow. You may read more about each of these in more detail under the Therapy menu. If there is a particular approach you would like, or if something I am doing is not comfortable, please feel free to let me know.

Mentalization Based Therapy

Peter Fonagy Anthony Bateman and Jon Allen describe mentalizing as “a form of (mostly preconscious) imaginative mental activity that enables us to perceive and interpret human behavior in terms of intentional mental states (e.g. needs, desires, feelings, beliefs, goals, purposes and reasons”. (Mentalizing in Clinical Practice, 2008).  The term itself is a little awkward, and can be confusing since mentalizing is not just about thoughts, but largely about feelings and emotions.

Mentalizing is a natural human process occurring all the time, often implicitly spontaneously. When we mentalize we may focus on ourselves, or others, on affect or cognition, on inside or outside, automatically, or more deliberately controlled. Good mentalizing allows functioning at all of these polarities in a flexible way appropriate to the context.  When mentalizing is functioning well individuals have a good sense of themselves, have appropriate trust, understand reasonably well how others see them, and families and groups can cooperate and function as a “we” with shared intentions and goals.  Mentalizing can become impaired due to attachment challenges, trauma, or learned ineffective family communication patterns and strategies. When this happens confusion, conflict, and miscommunication can occur. In more extreme situations there may be a breakdown of the internalized sense of self which can lead to extreme behaviors including chronically unstable relationships, risk taking, substance use, self-harm and suicidality.

 Mentalization-based therapy is an evidence-based treatment for people with borderline personality disorder and other mental health conditions. It draws on many different psychotherapeutic approaches and shares common elements and techniques with psychodynamic, systemic, DBT, CBT, attachment based work and other therapies.

Mentalization-based treatment was originally developed in the 1990s by Anthony Bateman and Peter Fonagy specifically for people with borderline personalities. Enhancement of mentalizing and improved emotional regulation are at the core of MBT treatment.

Mentalization-based Therapy can be an effective and evidenced based treatment for increasing the capacity to mentalize in people with personality disorder, addiction, eating disorders, and depression.  In some cases it ha other treatments have been unsuccessful.

Difficulty mentalizing often stems from or is exacerbated by insecure attachment. If you lack an understanding of your own and other people's feelings, you may have difficulty both regulating your own problematic emotions and behavior and correctly identifying the thoughts and feelings of others. You may not understand the intent behind other people’s behavior and respond impulsively and inappropriately in ways that can disrupt your relationships. Family therapy may incorporate aspects of mentalization to help heal relationships between parents and their children.

MBT may allow you to work in a safe environment in which you and your family can begin an exploration of your own feelings and those of others, ultimately developing your capacity for mentalizing. Work is very much focused on the present situation as opposed to psychodynamic work that may focus more on the past.

I have received training from Peter Fonagy, Anthony Bateman and others through Mass General, McClean Hospital and Anna Freud Centers, and am receiving supervision and training through the Mentalizing Initiative in Los Angeles.

(adapted in part from a Psychology Today description and writings by Fonagy and Bateman)

Milton Erickson

Unlike Freud and others, the view of Milton Erickson takes a highly positive and strength based view of the unconscious. Erickson was deeply respectful of his patients, and trusted deeply that they, and not he, would ultimately be the source of solutions to stuck patterns and difficulties. Erickson, using metaphor, indirection, and hypnotherapy, worked with the unconscious and was able to effect rapid and at times seemingly magical transformations. While I do note hope to aspire to his level of finesse, subtlety and skill, my work is deeply influenced by his views and technique.

Family Systems Theory

My work is strongly influenced by Family Systems theorists, including Salvador Minuchin, Jay Haley, Virginia Satir, Gregory Bateson and others. I also have studied Neurolinguistic Programming, an approach that attempted to model some of the most successful practices of Erickson and Family Systems practitioners.

Family Systems models assume that much in human behavior is social, and that patterns of behavior are not simply intrapsychic and a problem with an individual psyche, but may result from patterns between family members (or other systems). These patterns can become reciprocally reinforced. It may be very difficult for an individual in a family system (or couple) to change because patterns in the relationship or family relationships evoke and maintain a stable pattern. Family systems work attempts to loosen these patterns and support a family in reorienting around more flexible and healthy ways of relating.

Interpersonal Neurobiology, Attachment, and Infant Mental Health

Relationships and affect in learning form the basis of most human development, including the development of abstract reasoning and other cognitive processes which are often assumed to be rational and not affectively based.

These models grew initially out of work with young children (0 to 5) and work of neurobiologists seeking to understand cognitive processes adn development. The infant mental health model is an interdisciplinary approach originally developed by Selma Fraiberg. Work with children focuses on the importance of emotional connection and relationship, particularly the attachment relationship between a baby and the mother and father. Research has shown that healthy early attachment and good early relationships are very strongly correlated with adult mental health.

Stanley Greenspan, and others, have developed a model for addressing early learning difficulties (including autism spectrum and others) that addresses developmental stages, individual differences (of sensory processing, development, etc), and affective relationship. While this model is primarily used in addressing early learning, developmental, and relationship difficulties, it is clear that for some children (and adults) these principles may be effectively used to resolve learning and behavior problems, including attention deficit hyperactivity disorder, sensory sensitivities, and other learning problems. Greenspan and others note the enormous importance in the development of "circles of communication" in learning. The importance of these patterns (and of gaps in learning at an early age) in adult life cannot be underestimated.

Interpersonal Neurobiology (Daniel Siegel and others), takes the view that neurobiology, which in the past was assumed to be an internal process, is in fact highly relational, and that interpersonal processes are key to the development of nearly all processes of mind. The understanding of various brain systems is best understood not in isolated brains, but in understanding the extraordinary degree to which human brains are "designed" to respond and develop with social input.

The importance of reflection and reciprocity in relationships, and the emotional mirroring, sensitivity and responsiveness between individuals, especially in close relationships, cannot be underestimated, and applies to people of all ages. Those who had difficulty in developing secure relationships can, at any age, make progress in developing more secure and satisfying relationships.

Sensory Motor Psychotherapy

Sensory Motor Psychotherapy is an approach, developed principally by Pat Ogden. It is used principally to address trauma. Based in part on neurobiology, and related to some of the developmental and relational models in Infant Mental Health, it looks at the normal response to threat, and at how, under specific circumstances (principally a perception of helplessness or repeated trauma) patterns of avoidance or hyperarousal may result from triggering situations. Very specific interventions are used to help a client safely reexperience events surrounding the trauma (without triggering the traumatic hyper (or hypo-) arousal that typically is associated with trauma. The goal is to expand the "window of tolerance" that the traumatized individual can tolerate, and eliminate or decrease the intensity of the response to events that may trigger the trauma response. This approach is most useful in addressing anxiety, phobias, obsessions and  compulsions, some forms of depression, and of course, Post-Traumatic Stress Disorder.,

ACT (Acceptance and Commitment Therapy)

ACT is one of a number of Mindfulness based therapies. Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.

Based on Relational Frame Theory, ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change. (See http://contextualpsychology.org/act)

While I have some differences of opinion with ACT regarding aspects of the philosophical framework, and some differences regarding how ACT views values, I otherwise find the techniques to be wonderfully useful, particularly in working with clients with Anxiety, depression and phobias, or whose defensive style is primarily avoidance.

DBT (Dialectical Behavioral Therapy)

DBT is also an outgrowth of Cognitive Behavioral Therapy. DBT was developed initially to work with clients with very challenging personality disorders, including borderline personality disorder. However it can be used effectively with others. DBT enhances behavioral and cognitive techniques with mindfulness based practices, and also focuses strongly of the importance of both therapist and client maintaining and repairing the therapeutic relationship. With clients who can easily become angry and alienated from others, or who easily feel others are working against them, DBT can provide valuable tools. DBT also offers a wide variety of self help tools which some clients feel are very helpful.

DBT Skills include Mindfulness, Distress Tolerance (Ability to tolerate uncomfortable emotions), Emotional Regulation (practices to help stabilize emotions), and Interpersonal Effectiveness (learning specific interpersonal skills to be more successful in interacting with others).

See http://www.dbtselfhelp.com/