Category: Psychotherapy

Does Couples Counseling Help Relationships?

Does a marital crisis or some very disruptive marital event (e.g., wife discovers husband watches porn) indicate that marriage counseling is indicated? I am often asked this. For many people it seems natural to suppose that a significant and threatening marital conflict indicates marital counseling, but I think the matter requires some thinking through.  Read more

Most Psychotherapy Is Long Hard Work

Perhaps psychotherapy is misleadingly named. What does ‘therapy’ bring to mind? Everyone understands that psychotherapy means treatment. Everyone is familiar with medical treatment and dental treatment. The role of the patient in medical and dental treatment is to bring your body to the treatment site and endure what they do to you. Or take your medication as directed. Either way, you contribute little as an active participant. The success of treatment does not depend on you actively participating. By ‘you’ I mean you the person, not you the body that is being treated. A few years ago I had a hernia operation. Some kind of mesh was used. I have only the vaguest idea what was done. Nevertheless, the operation was a success.

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Facing What Happened | What Lies Beneath Addiction

Karen Horney, a pioneering revisionist of psychoanalytic theory in the 1930s and 1940s, once remarked that in the main what people in analysis wanted was not cure but rather not to be so inconvenienced by their neurosis. In plainer language, and to address this to addiction, what most people want is to ‘eat their cake and have it too,’ to be able to use but for the use to not get so out of hand and produce so much trouble in living day to day. To basically do the same thing and be the same way but a little less.
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Why do people keep on drinking after the first few?

Why do people keep on drinking after the first few? The answer shouldn’t be circular or tautological, as in ‘That’s what alcoholics do.’ The answer should actually shed some light on the matter. I’ve asked myself this question many times in the course of doing therapy with problem drinkers. I’ve asked them, too. This seems to be one of those questions that the person doing the activity in question has a hard time answering. Read more

Why Do People Who Drink Excessively Need Personal Therapy?

Why do people have to be in therapy in order to stop drinking? You’d think that bad outcomes themselves would be reason enough to stop or at least lead to being careful and moderate. Why would a person need therapy in order to stop harming himself and getting himself in trouble? The simple answer is that people are doing the best they can in living’”doing the best they can to cope with the stress and challenges of life as they experience them. Read more

Sex Addiction Treatment

The goal of diagnosis is to formulate a realistic and adequate statement of what is the matter. Treatment has no direction without a grasp of what is ailing an individual. I have discussed my view of what is going on in sex addiction in a companion piece. As with all addictions, what is the matter in the case of sex addiction treatment must refer to what is actually driving the person’s insatiable need for the addictive activity and all the fantasizing, planning, arranging, plotting, and scheming that goes along with it. Read more

Sex Addiction Treatment

The goal of diagnosis is to formulate a realistic and adequate statement of what is the matter. Treatment has no direction without a grasp of what is ailing an individual. I have discussed my view of what is going on in sex addiction in a companion piece. As with all addictions, what is the matter in the case of sex addiction treatment must refer to what is actually driving the person’s insatiable need for the addictive activity and all the fantasizing, planning, arranging, plotting, and scheming that goes along with it. Read more

Knowing How You Feel and Being Less Ashamed

Acting in the moment, what you actually say and do, frequently seems to have a mind of its own, that is, frequently seems to escape your intentions, plans, professed values, rehearsals, strategies, resolutions, cost-benefit analysis, past experiences, etc. Read more

How Does Change Occur in Psychotherapy?

I think it will be helpful to me and to prospective and beginning clients to try to provide an overview of how I think about …

Make-Believe in the Addiction Treatment Industry

Therapists shouldn’t be in the business of make-believe. There is a great deal of make-believe in the addiction treatment …