I’ve been reading a book by Glen O. Gabbard where he outlines some of the goals we work on in psychotherapy. Gabbard is a professor of psychiatry at Baylor College of Medicine and a respected writer in the field of psychodynamic therapy. Below I elaborate on some of his outline in my own language.

Just as each person is unique, so are his/her goals in therapy. So this list is more of a guideline than a prescription. Ideally, a therapist and client work together to figure out the right goals, and they can change over time. Gabbard’s outline helps us think about the overall process of therapy and some of its unique benefits.

Resolving inner conflicts
We all have inner conflicts — parts of ourselves that want different things. For example, one part of us may want a relationship (i.e. love and companionship), while another part doesn’t want to feel tied down. One part of us may want a promotion at work, while another part doesn’t want the new responsibilities. These kinds of conflicts naturally bring up anxiety. In therapy, we can explore and identify these inner wranglings and resolve some of the anxiety. Often we’re not even aware of our mixed feelings until we talk about them. Then we can make more effective and adaptive choices.

Knowing yourself
Therapy is an opportunity to take one hour out of the week and get to know yourself better. Discover more deeply how you think and feel and why certain patterns appear in your life. This is the difference between knowing who you really are, instead of who you’re supposed to be. As Gabbard says, “The outcome of therapy should result in feelings of ‘living in one’s own skin’ and of being authentic.”

Making good relationship choices
We all need people and relationships in our lives. This is about choosing people who treat us well, who we enjoy being with, and who will support our deepest goals and aspirations.

Being self-responsible
It’s easy to blame relationship problems on other people. This is about knowing our own sensitivities and taking responsibility for them. Therapy provides a unique space to learn about our relationship patterns, which may arise in the therapy relationship itself.

During my training years, I worked in a number of community mental health settings and really appreciate the work of these organizations. Listed below are a few good places to know about, whether you’re a health professional or a client.

In future posts I will create a more comprehensive list of resources specific to substance use, sex information, and post-traumatic stress, among other areas. If you know of good, local organizations to include, or would like me to cover a specific health area, please let me know.

San Francisco Suicide Prevention & Crisis Line
www.sfsuicide.org
24-hour crisis line: 415.781.0500
Institute on Aging – Friendship Line for the Elderly
www.ioaging.org
415.752.3778
The Riley Center
www.rileycenter.org
Safe and confidential services for women in abusive relationships and their children.
24-hour crisis line: 415.255.0165
Community United Against Violence (CUAV)
www.cuav.org
The nation’s first LGBTQQ anti-violence organization. Will also provide services to men in straight relationships.
24-hour crisis line: 415.333.HELP (4357)
San Francisco Women Against Rape
www.sfwar.org
Provides direct services and community education for survivors of sexual assault.
24-hour crisis line: 415.647.7273
Ohlhoff Recovery Programs
www.ohlhoff.org
Residential and outpatient programs for chemical dependency and eating disorders.
877-677-4543
Harm Reduction Therapy Center
www.harmreductiontherapy.org
Offers outpatient therapy and treatment services to people interested in an alternative approach to addiction help.
415.863.4282

KQED’s Forum with Michael Krasny had a good program earlier this month on Obsessive Compulsive Disorder. The guests included Dr. Tracy Foose from Langley Porter Hospital at UCSF and the comedian Howie Mandel, who has written a memoir about his struggles with OCD.

The third guest, Jeff Bell, is the author of Rewind, Repeat, Replay and a national spokesperson for the Obsessive Compulsive Foundation.

I thought the program offered a compassionate understanding of the disorder and some good information on how it works and the brain/environment relationship. I always appreciate when people affected by a disorder are willing to speak out about their experience. Both Howie and Jeff were generous and thoughtful in their comments. I think the program is worth listening to if you’ve suffered from OCD, are a family member of someone impacted by the disorder, or just curious about it.

Hearing the program reminded of another memoir that’s been on my list for a long time, Jennifer Traig’s Devil in the Details. Jennifer suffered from OCD, among other things, throughout her childhood. While her illness sounds incredibly painful, she’s a terrific writer and wrote a compassionate, hilarious book.

My colleague, Isadora Alman, has a very good article in her online library called “Saying No Gracefully.” This seems like a good reminder for us all, especially around the holidays. You may recognize Isadora’s name from her “Ask Isadora” columns on sex and relationships.

Why is it so hard to say no? Sometimes we’ve never learned how, or we forget, or we’re with new people in new relationships. In the article, she offers 9 guidelines for saying no with grace. A few of my favorites include using “I” language, such as, “I enjoy your holiday parties, but I can’t make it this year,” and saying no clearly and firmly, such as, “I’m flattered, but no thank you.”

She also talks about allowing the asker to retain his or her dignity. She advises that we acknowledge the other person took a risk, saying something nice about them or the encounter, while maintaining our stance. For example, “I can’t make plans for next week right now, but I’ve enjoyed spending this time with you. Thanks for asking.”

The full copy of Isadora’s article is available in her online library — it’s the fourth one down from the top.

Earlier this year I wrote an article for Bridge, a local journal for therapists and other health professionals, on helpful practices for couples to build and strengthen their relationship. The three practices I wrote about are mindfulness, cultivating wise mind, and sharing appreciations.

You are welcome to download a copy of the full journal with my article.

Practicing mindfulness allows us to become more aware of our own sensitivities. Knowing our sensitivities, or triggers, can help explain why we get so upset with our partner, and why certain things he/she does drives us crazy. This also helps regain some presence of mind in heated moments.

Cultivating wise mind allows us to bring both our emotional mind and our logical mind to the situation. Sometimes we get in trouble when we rely too heavily on one or the other. The integration of these two states of mind is known as wise mind.

Sharing appreciations is another good practice. In the article, I describe how it works — basically, each partner takes a turn sharing something he/she admires or appreciates about the other. This brings both people into the present moment and really increases honesty and intimacy.

Again, here’s the full journal with my article, and please let me know if you’d like to join the Bridge mailing list for future issues.

“There is not one kind of healthy self — there are many kinds.”
— Heinz Kohut

In the past couple of years, I’ve started teaching graduate students and providing informal consultation to MFT Interns. This work has inspired me to revisit some of the foundational literature in our field, including self psychology.

In my practice, I use a variety of approaches and work with many different kinds of clients, including adults, couples and children. Self psychology provides a helpful starting place for all of this work. Basically, self psychology says that a healing therapeutic relationship is based on empathy, understanding and repairing any ruptures that may occur. This provides a foundation for clients to address the deeper concerns that bring them in to therapy.

I recently wrote a two-part article on self psychology in the San Francisco-based professional journal, Bridge. If you’d like to see a copy of the journal, please drop me a line and I’d be happy to send one to you.

Two important Town Hall Meetings concerning CAMFT and marriage equality are happening on August 21st in Berkeley and on August 23rd in San Francisco. All therapists are invited. CAMFT, the California Association of Marriage and Family Therapists, in a recent discussion of marriage equality in its magazine, published non-scientific articles that perpetuated derogatory stereotypes of LGBTQQ people. These meetings will address their response to the membership and their stance on marriage equality as an ethical and professional issue.

The website of California Therapists for Marriage Equality offers more info and background.

Town Meeting Sponsored by East Bay CAMFT
All practitioners are invited.
Friday, August 21, 2009 6:15-8:45 PM
GAIA Arts Center
2120 Allston Way
Berkeley, CA

Town Meeting Sponsored by Gaylesta
All practioners are invited.
Sunday, August 23, 2009 10 AM- 1 PM
The Hotel Whitcomb / Grand Ball Room (SF’s old Municpal Court)
1231 Market Street
San Francisco, CA

The New York Times published an article today on the mysterious connection between our sense of self and our physical brain, referencing stories and research from traumatic brain injury cases. The sense of self is an area that psychotherapy has been investigating for some time, and it’s fascinating to see how brain science approaches this material.

The New York Times article is part of an ongoing series in that paper called The Science of Identity.

Locally we have had some recent collaborations between the fields of psychotherapy and neuroscience at the Psychoanalytic Institute of Northern California. Their Spring 09 events, Crossing the Synapse, offered discussions of neuroplasticity, relational trauma and neuroanatomy.

Authors who address these topics in interesting ways include Antonio Damasio, Dan Siegel, Oliver Sacks, and Louis Cozolino.

Weddings can be playful, fun and meaningful — in addition to the all the requisite stress and planning. When I see couples for premarriage counseling, I always like to find out about their own unique “magic” — what makes their relationship special — and help couples incorporate this into the planning. Here are a few wedding videos that totally illustrate the playful concept.

(By the way, these are not couples I’ve worked with, just videos I’ve loved watching.)

Vicki Santillano, a writer at DivineCaroline, an online magazine for women, called to ask for my thoughts on a recent study about relationships and obesity. She was kind enough to include my comments in her article, “Do Women Gain More Weight in Relationships?”

For me, some of the questions raised by the study and article include: How do women’s priorities change when they’re in committed partnerships, for better and worse? How do women take care of themselves while they also attend to others?

While the study investigated whether women in relationships put on more weight than single women, I’m curious about the other effects of close partnership. For example, how does being deeply accepted by a partner affect a woman’s sense of self-acceptance? What unfolds with a woman’s sexual identity in monogamous partnership, if she’s no longer in the dating pool?

Lots of interesting questions here, and lots of variety in the conversation to follow. I’m curious to hear your thoughts.