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Individual, Marital and Family Therapy


What will happen in the first meeting?
The first session can take many forms. On rare occasions, I have had a client who came with a very specific issue that we resolved in a single session. Usually, though, the first meeting serves several purposes:

  • I obtain a personal and family history so that I can better place the current problems in context. In the case of a child or teen, this helps me get a sense of whether it will be more effective to work primarily with the entire family, the parents and the child/teen, or predominantly with just the child/teen in individual therapy.
  • It serves as a time to further define just what you want from therapy. A common question I ask takes the form of, "When you have accomplished what you came here to do, how will things be different? What will have changed in your life?" 
  • The session gives both of us a chance to begin to confirm that we are a "good fit." In those rare situations where one or both of us believes it won't be a good fit, I can often suggest names of some other therapists that may be a better match based on what I learned about you in this session.   


What kinds of therapy  do I use?
I once browsed through a textbook that described more than 500 different kinds of psychotherapy!  I find it hard to condense my approaches to a few terms, though there are some common themes that seem to characterize how I work. Here are a few, in no particular order. 

  • I'm a pragmatist: If it works, do it; don't form a committee. 
  • I often look at things from a "family/systems" model. Like two kids on a see-saw, relationships involve balance. Sometimes life may feel as if you're in the one down position, sometimes the other way around. Being stuck is often an illusion.
  • I find it much more useful to look at who can help resolve a problem rather than look at who is to blame for it. 
  • I love using stories and metaphors to teach. This one appeared in Family Circle in late 2001.
  • I'm a linguist - I pay careful attention to the impact of particular words. Many times, disagreements get started from the same few words.  (For a preview, check out my book Great Ways to Sabotage a Good Conversation. You can read the first two chapters here on the web site.) 
  • I value the use of humor as an antidote to many things such as power struggles and tunnel vision. (Click here for one example drawn from the book.)

  • Since many people spend a lot of time in trance anyway (ever watch a child who is watching TV?), I like teaching people how to use self-hypnotic strategies more effectively.

  • Coincidences usually aren't. 

  • I encourage clients to pay very careful attention to intuitive hunches.  Intuition is usually much more reliable than the other senses. Fear, worry and anxiety are never part of an intuition.

  • Lastly, I like to work myself out of a job quickly. In the process, I hope to give you more problem solving tools. To paraphrase from the philosophy at my undergraduate school, Carnegie-Mellon University, my job is not to tell you what to think, but to help you learn strategies for how to think.


How often are sessions scheduled?
Most of my clients choose to meet once a week. When financial or scheduling constraints dictate, sessions are scheduled less often. A few meet twice a week when getting started or during a tough period. Many clients reduce the frequency of their sessions to once every other week for a few sessions before their final appointment. I sometimes joke that if I am staying on top of things well, I'll sense that you're about ready to stop therapy about five minutes before you tell me. 


How long will therapy take?
I keep several wizards on my desk to remind me that while my (clinical) hunches are often on target, I don't read minds. Some presenting concerns lend themselves to brief therapy, defined as 6 - 12 sessions. Acute situations often respond fairly quickly; long-standing problems (e.g., poor self-worth, chronic depression) understandably take longer. How much longer? Ask me again after the fourth session and we'll compare impressions. Those first few sessions usually tell a lot.


What are the limits of confidentiality?
In Georgia, information given to a psychologist is termed "confidential", a legal term providing even more protection than "privileged" information. In essence, I am not allowed to share any information with anyone else without your written consent, with a few important exceptions:

  • suicidal risk -- if I believe that a client is at imminent risk of harming himself or herself, I am legally and ethically required to intervene. In the unlikely event that I thought this applied to you, I would tell you before I contacted anyone else.
  • homicidal risk -- if I believe that a client is at imminent risk of harming someone else, I am required to intervene. Stemming from "duty to warn" legislation, I would have to notify the person whose life I believed was at risk. Again, in the unlikely event that I thought this applied to you, I would tell you before I contacted anyone else.
  • abuse of a minor child or an elderly person -- Psychologists are required to report suspected abuse to DFCS. Again, in the unlikely event that I thought this applied to you, I would tell you before I contacted DFCS. 
  • In very rare cases, a judge can order a psychologist to release records. In 32 years, I have never had this happen.
  • Case law is somewhat ambiguous about confidentiality when two or more people are in the room with a psychologist. For example, assume I am working with a couple. For billing purposes, only one of them is the "client". Can the client waive confidentiality for the case file, including things the spouse told me, without the spouse giving consent? Has confidentiality already been waived because the spouse was present? Different courts have ruled differently.
  • If parents are involved in child custody litigation, the situation can arise where one parent waives confidentiality for the child's psychological records. In such cases, it is important to talk things over with your attorney.
  • For children and teens under age 18, there are two additional exceptions: If I believe a child/teen is either engaged in criminal activity (e.g., breaking into homes, stealing cars) or is involved in drug/alcohol use, it is my policy to tell parents -- after discussing it with the child/teen first. Technically, this is not a violation of confidentiality, because with few exceptions, parents have the legal right to access to their minor children's medical/psychiatric records. 
So what about confidentiality for children and teens? The HIPAA regulations have made some changes that therapists are still sorting out. Historically, I have worked under the assumption that parents have the legal right to access everything in my notes. However, the reality is that teens (and children) are more likely to open up to me if they trust that I will honor their confidence. So I ask that parents trust that I will alert them if any of the above exceptions come into play. In practice, only one parent in 32 years has balked at that. The case involved a change of custody petition. I refused to share the requested information without a court order because of how destructive I thought it would be for his son. Before the case went to court a few weeks later, the boy turned 18, making it a moot point.


What about psychological testing?
For adults, there are several pencil-and-paper questionnaires I frequently use. Several are free. The cost for the other major one I use is usually less than $75. Most of the forms can be completed at home. The information helps me insure I'm not overlooking something important. I'll discuss the results with you. 

For children/teens, I like to have parents complete a couple of questionnaires. If there are concerns about behavior at school or academic performance I like to have the teacher(s) complete a similar questionnaire. I'll discuss the results with you. There is usually no charge for these questionnaires. With some older teens I will administer additional pencil-and-paper tests. Again, the cost is minimal, usually less than $50-75. 

Psychoeducational testing to rule out learning problems falls under a different category. Please see "Evaluation of Learning Disabilities" for more information about this kind of testing. 


For family therapy, who will actually come to the sessions?
Years ago I used to push to have everyone in the family come if a child/teen was the focus of concern. Then I became a parent myself. I'm more pragmatic now. Sometimes I still like to meet everyone, but I often work with subsets of the family. Typically, I mix individual sessions with the child, sessions with the parent(s), and sessions with the child and parent(s). Often I do this within a single session to facilitate getting critical updates from a parent.