Clinical Practice

Psychotherapy and Consulting Practice: Relationship, Systems, Recovery     

At the same time that my community interests were in the fields of HIV/AIDS and how people with serious mental illnesses are treated, my clinical practice from the late 1980’s through to the present day evolved along two intersecting lines of understanding. One followed liberally the psycho-dynamic thinking that I “grew up” with, examining intra-psychic conflicts and the therapy relationship itself as a way to help people. This provided the basis for a kind of discipline drift into the field of psychiatric rehabilitation, which places the quality of relationship between provider and consumer of services as central in people’s recovery process. The other line followed the family systems approach which I had come to find so very useful in helping people recognize and understand the forces at work around them–in the myriad of different social settings in which we are embedded, not just our families. This also pointed me towards psychiatric rehabilitation and the recovery model, as it identifies the critical role which social integration and community play in people achieving their fullest human potential.

I think of these together as encompassing the space within us and the space around us. By helping people to explore both of these worlds, I believe that we are giving them at least some of the tools necessary to determine what aspects of their lives they can influence, and how.

In reviewing the kinds of situations which people have presented to me over the years and the kinds of training that I’ve both received and provided, the following issues–other than HIV and SMI–have been the most prevalent in my therapy and consulting work:

• parenting challenges
• adolescence
• sexual orientation
• work and career changes
• disabilities
• chronic and terminal illnesses
• bereavement and loss
• aging
• dying
• acculturation
• stress and burnout
• boundaries and helping relationships
• intergroup relations
• lay-professional collaboration
• clinical supervision
• engaging difficult clients

As described in my Psychology Today profile, my style tends to be active and straightforward. I encourage clients/patients to think about therapy as an educational process in which they are hiring me–and potentially firing me–as a consultant to help them understand better what’s happening in their lives and how they can have more control over it. I aspire to work collaboratively, trying to minimize the power differential that often exists between “doctor and patient,” and I focus on values and strengths, hopefully helping people to recognize what might be preventing them from becoming more who they want to be.