How important is the therapeutic relationship—the relationship between a person in therapy and his or her therapist—to the change process? Is the relationship itself the primary source of healing or are techniques the mechanisms for positive outcomes? And where does “love” fit in to all of this?

Out with the Old

My career in social work began with a full-time psychotherapy position in a rural town at a small mental health clinic. I was convinced my recent academic instruction had taught me everything under the sun, but also that I was clinically inept to practice as a therapist. Fortunately, the thoughtful, compassionate, and experienced supervisors at the clinic reined in my earnest energy.

I met with a clinical social worker on a weekly basis for supervision. She was a former nun with a wicked proclivity for curse words and an extreme disdain for computers. The topics that arose in the supervision hour varied. We talked about my personal issues, people who got under my skin in the therapy setting, and even her recollection of the days when people in therapy—as well as therapists—smoked cigarettes throughout sessions. What I remember most from our time together was her insistence that the beginning and end-all goal of psychotherapy was the same: you want the people you help in therapy to love you.

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She did not mean love in the romantic sense, nor was she veering from any ethical boundaries. This was not a trick or gimmick. She believed that the person in therapy improved based on the degree of emotional connection, including shared trust and belief in the therapeutic relationship. I immediately dismissed the idea. My graduate school never talked about love, and I didn’t know of any research to back what my supervisor was saying.

I was trained to understand psychology as a series of universal principles. These principles are translated cross-culturally. I was clinically oriented and meticulously uniform with many of the therapeutic modalities I applied. The rigid stance I took on this disallowed vulnerable feelings from surfacing within the therapeutic relationship. It was easier for me to sit back and diagnostically judge than to truly join with people in therapy.

The Role of Therapeutic Alliance

My supervisor at the time was describing (and to some degree going beyond) the concept of the therapeutic alliance. Simon Goldberg of the University of Wisconsin-Madison has conducted research on this concept. It is an emotional bond between the therapist and the person in therapy, which includes a shared agreement regarding the goals to work on as well as the form of psychological intervention used (Goldberg et al., 2013).

Goldberg brought up a related construct—the real relationship (Gelso & Carter, 1994)—which involves the “actual, non-transferential relationship between a client and a therapist” which he feels most accurately reflects what we might call love in therapy. The real relationship is theorized to operate in tandem with the therapeutic alliance, combining the emotional bond of therapist and person in therapy with agreement on the tasks and the goals of where the therapy work is headed. “Love has something major to do with effective therapy,” he adds.

Part of the therapeutic alliance includes a positive attachment contracted around the mutually defined treatment plan for therapy. The role of the therapeutic alliance is central to psychotherapy, and the effect is independent of the type of therapy used. The quality of the therapeutic alliance accounts for approximately 30% of the clinical outcome, while the guiding theory or model used accounts for 15% (Walsh, 2013).

In other words, therapists are all different, but the methods or theories they use are far less important in terms of a person feeling better (Germer et al., 2005). This means that the alphabet soup of therapy acronyms (e.g., EMDR, CBT, DBT, ACT, etc.) are relatively minor ingredients to what really fills the therapeutic bowl: a person’s individual characteristics (participation, motivation, problems, background) and the therapeutic alliance (Walsh, 2013).

However, many therapists swear by their affiliated or credentialed techniques. So, what accounts for the change that occurs in therapy?

Phases of the Therapeutic Alliance

Goldberg states that the theory and technique offer a “rationale on some ritual that the client and therapist engage in.” This collaborative partnership with mutual agreements as to the problem and solution is the predominant factor for change in psychotherapy.

For alliance to build, the therapist needs to be flexible and not hold tightly to an agenda. Priority is placed on collaborating with the person in therapy to establish and maintain the therapeutic relationship.

Past research looked at this alliance as developing from two phases. Phase one sees the person in therapy believing in the therapist as the desirable source of assistance. With warm regard and support from the therapist, the caring relationship commences. Therapy begins on this foundational level. In phase two, the alliance involves the person in therapy buying into the process of therapy via commitment to the procedure (i.e., shared understanding of the problem, value of the examination of the problem) as well as each person’s responsibility for the process (Horvath et al., 2011).

For alliance to build, the therapist needs to be flexible and not hold tightly to an agenda. Priority is placed on collaborating with the person in therapy to establish and maintain the therapeutic relationship (Horvath et al., 2011). The quality of the relationship can be assessed based on the “level of mutual and collaborative commitment to the ‘business of therapy’ by therapist and client” (Horvath et al., 2011; p. 15). This is the “collaborative enterprise” of psychotherapy. Essentially, the question and answer comes down to how well the person in therapy and the therapist work together in sessions.

Collusion Versus Confrontation

Specific variables and behaviors can be assessed for each role of the enterprise. The therapist’s non-reactivity to comments or overall antagonism of the person in therapy is reflected in the therapeutic alliance. My work centers on the conceptual space between collusion and confrontation. It is essential for the therapist to hear—not ignore—criticisms, but this must be done by threading the needle between colluding with the person in therapy or confronting his or her ideas. This perspective requires a dance between total agreement or affirmation and a scared-straight challenge or proverbial wrestling match.

For example, a person might say, “Am I a bad patient?” The therapist’s collusion with this statement might come across as, “Let’s talk about something else,” or, “You can be difficult at times.” The other end of the spectrum is confrontation. A therapist says, “No, no, no. You are not a ‘bad patient.’ ” Or the therapist could say, “Where did you get that idea?” in direct opposition to the statement. A middle-ground response finds the therapist replying, “What would it mean to you to be a ‘bad patient’?” This is the essence of non-defensive but attuned responsiveness.

The therapist does not personalize or absorb any statements, but also does not ignore or avoid emotional comments (Horvath et al., 2011). This is the narrow window or divide between collusion and confrontation that fosters alliance. This is an attuned, appropriate, and nonjudgmental response. Isn’t that love?

References:

1. Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Counseling Psychology, 41, 296–306.
2. Germer, C. K., Siegel, R. D., & Fulton, P. R. (2005). Mindfulness and psychotherapy. New York: Guilford Press.
3. Goldberg, S. Personal communication, December 5, 2015.
4. Goldberg, S.B., Davis, J.M., & Hoyt, W.T. (2013). The role of therapeutic alliance in mindfulness interventions: Therapeutic alliance in mindfulness training for smokers. Journal of Clinical Psychology, Vol. 69(9), 936–950.
5. Horvath, A. O., Del Re., A. C., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16.
6. Walsh, J. (2013). Theories for direct social work practice (2^nd). Belmont, CA: Thompson Brooks/Cole.

Not all couples plan for a trip down the aisle. Even couples who have been in a relationship for years may choose to forgo tradition and not get married.

Statistics from the Centers for Disease Control and Prevention (CDC) indicate that over the last decade, adult Americans appeared to be steadily falling out of love with marriage. According to the report, the year 2012 saw an average of 6.8 marriages per 1,000 people, a consistent decrease from 7.5 marriages per 1,000 people in 2006 and 8.2 marriages per 1,000 people in 2000.

A 2011 analysis of United States census data conducted by the Pew Research Center found only about 51% of American adults are currently married—a record low. Compare these statistics to the 72% of American adults who were married in 1960, and some social trends may begin to emerge.

A Shift in Public Attitude About Marriage

With numerous studies suggesting healthy marriages promote physical well-being, boost mental health, and protect children from social and educational problems, the following questions may arise: Why do some couples choose not to get married? And what living arrangements are replacing marriages in 21st century America?

[fat_widget_relationships_right]Data from the Pew Research Center analysis suggests age and public attitudes may play significant roles in the current trend to remain unmarried. Of all Americans ages 18-29, only 20% are currently married, compared with 59% in 1960. Whether young adults are completely abandoning marriage or temporarily delaying it is not yet clear. However, evidence suggests young adults today may be focusing on furthering their education or seeking to establish a social foundation before considering marriage. The analysis reveals an increase in the number of college graduates who decide to marry later in life.

Public attitudes toward marriage are also changing. While marriage may have been expected in the past, the current perception is somewhat mixed, with a growing number of people viewing marriage as unnecessary, said Lori Hollander, LCSW-C, BCD, an expert in relationships and marriage. A 2010 Pew Research survey reports almost 40% of Americans believe marriage is becoming obsolete.

“Marriage is no longer looked up to, and being single is no longer looked down upon,” Lori Hollander said.

What factors have contributed to this public shift in perception? The increasingly sophisticated desires of modern-day adults, coupled with the drive to fulfill these desires with as much freedom as possible, may be influential. Bob Hollander, husband of Lori and a relationship therapist for more than 25 years, suggests people simply want more out of life and love.

“Happiness is no longer just about having a full-time job and keeping the bills paid,” Bob Hollander said. “We now see people who are looking beyond mere survival, and the needs that are being met are simply more sophisticated.”

People in the past may have viewed marriage as an effective way to start a family, build financial stability, or gain happiness, but many modern-day adults are able to meet those needs without a marriage license.

In recent years, single-parent households, single-person households, and cohabitation have all become more popular. Whether the intention to marry is present or not, couples are now moving in together before marriage more than ever before. This trend may be attributed to multiple factors, including:

• A mutual desire to live together
• A desire to experience what marriage to one’s partner may be like
• Financial stress experienced by one or both partners
• A deliberate effort to reduce costs and increase savings
• Proximity to school or place of employment

Tools for a Successful Relationship

According to data from the Pew Research Center, marriage may still be a goal for many Americans, even if it is not among their top priorities. Thirty-six percent of adults report a successful marriage as being one of their most important goals in life, while 48% of Americans say a successful marriage is not most important. A larger portion of adults (53%) view being a good parent as one of their most important goals.

People in the past may have viewed marriage as an effective way to start a family, build financial stability, or gain happiness, but many modern-day adults are able to meet those needs without a marriage license.More than half of Americans surveyed believe marriage does not make a difference in having a fulfilling sex life, being financially secure, feeling happy, reaching a desired social status, or getting ahead in a chosen career.

Stuart B. Fensterheim, LCSW, a specialist in emotionally focused therapy, relationships, and marriage, explains the changing nature of beliefs about healthy relationships.

“For years, people have lived with the idea that relationships are one big guessing game,” Fensterheim said. “On top of that, so many folks now fear that they will have to give up something that they love in order to sustain a marriage. Healthy partnerships are just not that way.”

Married or not, there are many resources available that may help build a healthy, happy, and lasting relationship. Couples counseling can help take the guesswork out of relationships, set realistic expectations, and teach the skills needed to enable love to grow. Individual partners may also seek the assistance of a qualified therapist if they are experiencing specific personal challenges.

References:

1. Centers for Disease Control and Prevention. (2015). National marriage and divorce rate trends. Retrieved from http://www.cdc.gov/nchs/nvss/marriage_divorce_tables.htm
2. Cohn, D. (2013). Love and marriage. Retrieved from http://www.pewsocialtrends.org/2013/02/13/love-and-marriage/
3. Cohn, D., Passel, J. S., Wang, W. & Livingston, G. (2011). Barely half of U.S. adults are married—a record low. Retrieved from http://www.pewsocialtrends.org/2011/12/14/barely-half-of-u-s-adults-are-married-a-record-low/
4. Copen, C. E., Daniels, K. & Mosher, W. D. (2013). First premarital cohabitation in the United States: 2006-2010 national survey of family growth. Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr064.pdf
5. Copen, C. E., Daniels, K., Vespa, J. & Mosher, W. D. (2012). First marriages in the United States: Data from the 2006-2010 national survey of family growth. Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr049.pdf
6. Rosenblum, C. (2013, September 13). Living apart together. The New York Times. Retrieved from http://www.nytimes.com/2013/09/15/realestate/living-apart-together.html?pagewanted=all&_r=1

Clinically trained social workers are the nation’s largest group of mental health service providers. Social work is considered one of the five core mental health professions by federal law and National Institutes of Health. With more than 200,000 in the field, there are more clinical social workers than psychologists, psychiatrists, and psychiatric nurses combined.

Who Are Social Workers?

Social workers are highly trained professionals working to improve the quality of life and well-being of others through direct practice, crisis intervention, research, community organizing, policy change, advocacy, and educational programs. Social workers are dedicated to the pursuit of social justice and strive to help those affected by poverty, disabilities, illnesses, divorce, unemployment, and other personal problems and social disadvantages.

Being a social worker requires extensive knowledge of human behavior and development, as well as social, cultural, and economic institutions and the ways in which they interact. Most social workers will hold at least a bachelor’s degree in social work or related field, though many (especially clinicians) will hold a master’s degree and valid license to practice.

A good social worker will often possess a high degree of compassion and empathy, a passion for helping others, strong interpersonal and problem-solving skills, and good listening and organizational skills.

What Do Social Workers Do?

Social workers fight for social justice, equality, and the overall well-being of people in need. Social workers are responsible for many of the liberties we have today. These include:

• Civil rights for all citizens regardless of race, sexual orientation, gender, faith, etc.
• Medicaid and Medicare programs that provide disadvantaged groups access to health care
• Child abuse and neglect prevention programs
• Unemployment insurance, disability pay, worker’s compensation, and social security
• Humane treatment for those with mental health conditions and developmental issues

[fat_widget_right]In addition to advocacy work, social workers also help people solve problems in their daily lives. They may assist those who are adopting a child, fighting an illness, or facing an addiction. They help protect abused or neglected children, deal with behavioral problems in schools, and help hospice patients adjust.

Clinical social workers diagnose and treat mental health conditions as well. They provide individual, family, and couples therapy, and they assist with depression, anxiety, family problems, and other mental health or behavioral issues. They may work in private practice or at a mental health or therapeutic facility. Social workers host support groups, create treatment plans, and facilitate interventions when necessary.

Some common duties of a social worker include:

• Identifying and reaching out to those in need.
• Assessing people’s needs and implementing a plan of action.
• Helping people adjust to major life changes.
• Responding to crisis situations.
• Connecting people with important resources and support.
• Evaluating social services and support programs.
• Providing advocacy for people when needed.
• Following up with people to ensure circumstances are improving.

Where Do Social Workers Work?

There are several common areas of focus in the social work industry:

• Administration/supervision
• Aging
• Alcohol, tobacco, and other drugs
• Children, adolescents, and young adults
• Child welfare
• Physical health
• Mental health
• Private practice
• School social work
• Social and economic justice and peace
• Social work and the courts

A good social worker will often possess a high degree of compassion and empathy, a passion for helping others, strong interpersonal and problem-solving skills, as well as good listening and organizational skills.Social work is unique in the way it can be found in most aspects of community life. Social workers are employed in schools, hospitals, rehabilitation facilities, hospices and nursing homes, private practices, government institutions, correctional facilities, law offices, military organizations, public welfare agencies, nonprofit organizations, and some private businesses and corporations.

Even when social workers are employed in office, they may spend time traveling to visit with people in need. School social workers may also travel from school to school or hospital social workers from hospital to hospital.

Why Social Work Is in Demand

According to the United States Bureau of Labor and Statistics, overall employment of social workers is expected to grow at a rate of 19% between 2012 and 2022. The demand for health care social workers is expected to grow by as much as 27% during this same time period—a rate much higher than the average growth rate for all occupations. One reason for the increase in demand is due to the aging of the baby boomers, who will soon need long-term care and assistance.

Social workers in the mental health and substance abuse fields will also be in high demand, with a 23% increase in employment expected by 2022. More people are expected to seek mental health treatment, and people who have a substance addiction are increasingly sent to treatment programs rather than jails or prisons.

How to Become a Social Worker

Those interested in entering the social work profession should first prepare for admission to the program of their choice by gaining valuable volunteer experience and obtaining professional references in the field.

A bachelor’s degree is the minimum requirement for an entry-level social work position, but most employers prefer a graduate degree. A master’s level education in social work is a requirement for clinical licensure in most states.

An undergraduate degree in social work is not necessary to gain admittance to a master’s program; virtually any bachelor’s degrees will suffice. Upon graduation, a few years of supervised work is necessary to gain licensure.

When to Reach Out to a Social Worker

• You’re seeking therapy or treatment for depression, anxiety, or another mental health condition.
• You’ve recently undergone a major life change (divorce, death of a loved one, etc.) and need support.
• You have witnessed child abuse or neglect.
• You need geriatric assistance for an elderly family member.
• You are coping with a drug or alcohol addiction.
• You are finding it difficult to cover the costs of basic needs (food, shelter, water, or others).
• You or a loved one is battling a major illness.
• You have recently become unemployed or disabled.
• Your child is experiencing behavior problems at school.

References:

1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Social Workers. Retrieved from http://www.bls.gov/ooh/community-and-social-service/social-workers.htm
2. National Association of Social Workers. (NASW). Social Work Profession. Retrieved from https://www.socialworkers.org/pressroom/features/general/profession.asp
3. National Association of Social Workers (NASW). Social Work History. Retrieved from http://socialworkers.org/pressroom/features/general/history.asp
4. National Association of Social Workers (NASW). Who are Social Workers? We Help. Retrieved from http://www.naswdc.org/pressroom/2011/HSH-FactSheet2011.pdf

It has been more than 30 years since Dr. Patrick Carnes published his book, Out of the Shadows: Understanding Sexual Addiction, which introduced the concept of sexual addiction. One working definition of sexual addiction is a pathological attachment to a mood-altering experience of sex.

At that time, the focus was almost entirely on males who were addicted to sex. But new ground was already being broken. When I first met Jennifer Schneider—an Arizona psychiatrist—in the early 90s, she and a colleague had recently completed a book about couples recovering from sexual addiction.

Schneider and her colleague obtained detailed information about married females who were addicted to sex. Twenty-four women and 17 husbands were interviewed by telephone; 7 of the male spouses declined to take part in the survey. The findings were provocative back then, but they are confirmed by my own clinical observations over the years.

Gender Differences in Sex Addiction

Unlike the majority of men with sex addiction, most women are aware of their codependency when they initially begin therapy with me—either alone or with a partner. Codependency can be briefly described as looking outside oneself to other people in order to define self-worth.

[fat_widget_sex_right]This makes the early stages of recovery particularly difficult for women who are sexually compulsive. Initially, a period of abstinence is important in order to learn to maintain sexual boundaries. But that requires being able to say no without it affecting self-worth. As one woman in therapy put it, “I don’t want to deprive him or drive him to look elsewhere for sex!”

I find that is rarely a problem for a man choosing a period of abstinence. Unfortunately, this culturally learned gender difference makes it much more difficult to rebuild marriages in which the wife is sexually compulsive. Females with sex addiction often feel alone and unsupported as they work toward recovery.

Steps for Women in Recovery

In order to appreciate the complicated nature of sex addiction for women, it’s important to recognize how terrifying psychological isolation can be. One woman told me, “I feel ashamed that I feel lonely even in my marriage, like something in me is broken and defective.”

Consequently, women in recovery benefit most from a combination of supportive individual therapy and group experience, both 12-step and therapist-led. In 12-step meetings such as Sex and Love Addicts Anonymous (SLAA), participants share experiences, strength, and hope. In her book, Ready to Heal: Women Facing Love, Sex, and Relationship Addiction, author Kelly McDaniel lists some of the numerous benefits:

• A sense of belonging
• Seeing and being seen
• Having a voice
• Supporting others when they have a turn to speak
• Giving and receiving comfort when life is painful

You may not be able to heal your brain alone, and the brain usually doesn’t function at its best capacity when you are isolated. Therapy can provide a trusting relationship and a healthy context for healing.Healing relationships requires healing the mind and the lifelong patterns that have shaped responses to the people closest to you. When your mind is fearful, you may have problems trusting or acting outside of your truest morals and values. Women with sex addiction may have difficulty being their best selves, and many of their sexual behaviors may have fallen outside their value system.

Healing your life also means healing your brain, and this may require professional support. Sexual addiction thrives in isolation. You may not be able to heal your brain alone, and the brain usually doesn’t function at its best capacity when you are isolated. Therapy can provide a trusting relationship and a healthy context for healing. McDaniel makes these suggestions for being a careful consumer when you’re ready to find a therapist:

• Consider finding a professional who understands brain chemistry, the effects of trauma, and the subsequent need for an addiction.
• Look for a therapist who understands sex addiction and can guide you through the process of designing a treatment plan that will best address your particular situation.
• Most important, your therapist must be able to facilitate a relationship with you that is collaborative and respectful. If you feel awkward in your first session, listen to your intuition. Trust your heart to be your guide in finding the right professional.

Women experiencing sex addiction today have a much greater chance of finding a caring and well-trained professional than their mothers may have had. You owe it to yourself to find the best help possible.

References:

1. Carnes, P. (2001). Out of the shadows: Understanding sexual addiction (3rd ed.). Center City, MN: Hazelden.
2. McDaniel, K. (2008). Ready to heal: Women facing love, sex, and relationship addiction (2nd ed.). Carefree AZ: Gentle Path Press.
3. Schneider, J., & Schneider, B. (1989). Rebuilding trust: For couples committed to recovery. Center City, MN: Hazelden.

Confidentiality in therapy is vital to the therapeutic process. Confidentiality also means outside observers cannot weigh in on the quality of therapy. In search of a reliable way to evaluate therapy quality, a study published this month in PLOS One proposes one potential model: a computer that can evaluate therapists’ empathy.

Evaluating Empathy with a Computer

Researchers from University of Southern California, University of Washington, and University of Utah say methods for evaluating therapy that require an outside observer can potentially alter the therapeutic process and undermine confidentiality. As an alternative, they developed a program that listens to therapy sessions, then rates the therapist as either “high empathy” or “low empathy” based on a speech analysis.

Using therapist training sessions, the team taught the program to detect empathy cues in language. Phrases that signal the highest amounts of empathy include “it sounds like,” “do you think,” and “what I’m hearing.”

Kathy Hardie-Williams, MEd, MS, NCC, LPC, LMFT, said such phrases measure the extent to which a therapist hears and mirrors the emotions of people in therapy.

[fat_widget_right]“Not to be confused with sympathy, empathy is a person’s ability to recognize and share the emotions of another while seeing the situation from the other person’s perspective,” Hardie-Williams said. “Sympathy is a feeling of care or concern for another, but does not have the component of a shared perspective or shared emotions.”

The University of Southern California’s Signal Analysis and Interpretation Lab continues to improve upon the model. Researchers are now working to help the program analyze tone of voice, diction, and the extent to which a therapist mirrors the speech patterns of people in therapy.

The Role of Empathy in Therapy

Empathy is just one component of quality therapy, but Hardie-Williams said it is vital to people’s willingness to openly share with their therapists.

“I believe genuine empathy is important in therapy because in order to maintain the therapeutic alliance, [people] need to be able to perceive that the therapist can share [their] emotions and experiences,” Hardie-Williams said. “[People] who come in for therapy often have a deep shame core that gets in their way, and in order to process it, they need to share their shame with someone they feel emotionally safe with.”

Choosing a Therapist

Everyone may seek something different from a therapist, but in general it can be important to recognize some guidelines for effective therapy. People seeking a therapist should also be attuned to warning signs of bad or ineffective therapy.

Reference:

Blumenthal, A. (2015, December 2). Can you tell if your therapist has empathy? Retrieved from https://news.usc.edu/89274/can-you-tell-if-your-therapist-has-empathy/

In our fast-paced society, more and more people find it challenging to juggle unrealistic work and home life demands. We frequently have to deal with high levels of daily stress, which negatively affects our physical and mental health. Many of our most common physical ailments, such as headaches, digestive problems, high blood pressure, insomnia, and an impaired immune system, can in many cases be attributed to stress. The same is true for many of our psychological issues, including anger, irritability, depression, and anxiety.

Finding ways to lower our stress levels is therefore extremely important for our overall health. Eating right, exercising, getting enough sleep, and meditating on a regular basis are all factors that can contribute to a more balanced lifestyle. When these self-care techniques fail to help us to feel better, seeking help from a third party may be beneficial.

Some of the signs that might indicate counseling could be helpful in your situation include the following:

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1. Feeling sad and unmotivated. If you have had feelings of hopelessness, decreased energy, sadness, irritability, thoughts of suicide, feel overwhelmed and unable to cope, or are no longer finding pleasure in activities you used to enjoy, you may be dealing with depression and may benefit from talking to a professional.
2. Excessive worry. If you feel as though your anxiety is interfering with your ability to do normal activities and/or you are unable to sleep at night due to ongoing rumination about your difficulties, you may want to consider seeking help.
3. Trauma or abuse. If you have experienced any type of traumatic event or abusive relationship, coming to terms with your experience by talking to an empathic other can be extremely helpful. Trauma and abuse can leave long-term scars that, if left untreated, can negatively impact your life, relationships, and ability to experience joy or happiness.
4. Relationship problems. If your relationship has become unfulfilling and you feel you are no longer able to communicate effectively with your significant other, seeking out couples counseling can be a helpful step in getting your relationship back on track.
5. Difficult life transitions. We all face difficult life situations at times–the loss of a job, a move to a new city, a divorce, or the loss of a loved one. When difficulties such as these arise and you find it difficult to move on, talking with a counselor can be an effective way to process your feelings and work through any lingering grief.
6. Addictions. If you are struggling with any type of addiction—substance abuse, an eating disorder, gambling, or sex addiction—this could be a sign you are trying to cope with unresolved issues or feelings in unhealthy and inappropriate ways and may obtain benefit from professional help.
7. Obsessive or compulsive behaviors. If you are spending too much time double checking to make sure you have turned off the stove, obsessively washing your hands, or are consumed by compulsive thoughts, receiving counseling could be extremely beneficial in getting your life in order.
8. Children excessively acting out. If your child or children have been misbehaving and you are at your wit’s end trying to figure out what to do, talking with a professional who has experience with children’s issues can be helpful. A counselor or therapist can frequently provide you with some additional parenting tools to make your life easier.

In addition to helping with the issues above and others, obtaining professional help may provide you with more insight and awareness. Although it can sometimes feel scary to take the first step to reach out, reducing your symptoms and learning to cope in healthier ways can make doing so more than worthwhile.

There is something special and unique about the relationship between a person in therapy and his or her therapist. It is a professional relationship, one in which the therapist is providing a service. However, it is also an intimate relationship, one in which secrets are shared, tears are shed, and moments of joy are celebrated. It is an open relationship in that, with consent, your therapist will communicate with other health professionals on your behalf. But it is also a very private relationship, as your confidentiality is held sacred.

A bond and trust are formed in therapy, yet the therapeutic relationship is a bit one-sided; while your therapist learns a great deal about you, he or she is less likely to engage in reciprocal sharing. This is different from a friendship, in which both parties mutually share who they are.

The complexities of the therapeutic relationship are distinct from other relationships, but it is these same complexities that make psychotherapy work. For therapy to be successful, your therapist must maintain healthy boundaries in the relationship and cannot develop a friendship with you.

Because of this, it could seem like your therapist is being fake or disingenuous with you. There have been multiple occasions in which a person in therapy has stated to me, “You don’t care about me, you are only here because this is your job.” It is true that your therapist is doing a job, but this does not mean he or she does not care about you. I rather like and enjoy the people I help. I have had the pleasure of meeting funny, intelligent, successful, and down-to-earth women and men who, had we met outside of therapy, likely would have made good friends. But for therapy to do what it’s supposed to do, your therapist simply can’t be your friend.

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One of the first rules therapists learn is they cannot provide therapy to friends or family. It is too challenging to remain unbiased in friend and family relationships, which is why many people have great difficulty staying objective when it comes to those closest to them. Your therapist developing a friendship with you would ultimately serve to interfere with your therapeutic relationship. Additionally, therapists who become over-involved in the lives of those they help experience higher rates of burnout and decreased efficiency.

This does not mean a deep connection isn’t developed between you and your therapist. Authenticity, warmth, and support are desirable characteristics for any therapeutic relationship. In fact, the relationship between you and your therapist is one of the most important factors in creating a successful therapy experience. The better the fit between you and your therapist, the more likely you are to reach your therapy goals. It just so happens that the relationship remains safely protected from a level of personal involvement that would distract from your therapy goals and success.

Admittedly, it’s odd to share great detail about your life and get little in return from the other person. Fortunately, your therapist (hopefully) is not robotic or an emotionless blank slate. Although you do not have a friendship with your therapist, he or she does not have to be a mystery to you.

This is also not to say you cannot have a friendly relationship with your therapist outside of counseling. Your therapist is unlikely to accept your social media requests or attend social functions you invite them to; however, there are many cases where therapists and the people they help have more than one relationship. For example, a therapist working at a college counseling center could be an adviser for a campus organization in which a person they help is a member. Or a therapist and person in therapy could attend the same church and see one another at church functions. But even though friendly exchanges occur, your therapist is still operating within boundaries to protect your confidentiality and maintain the therapeutic relationship.

Admittedly, it’s odd to share great detail about your life and get little in return from the other person. Fortunately, your therapist (hopefully) is not robotic or an emotionless blank slate. Although you do not have a friendship with your therapist, he or she does not have to be a mystery to you.

As mentioned earlier, your relationship with your therapist is a predictor of therapy’s success; therefore, you and your therapist need to be a good fit. When appropriate, your therapist can voluntarily share personal information, but it is also fair to ask your therapist certain questions. You can ask professional questions about your therapist’s educational background or style of therapy. You can ask personal questions that seem relevant to you. Your therapist has the right to decline to answer any question. There are times when I refrain from answering questions if I believe that, regardless of my response, any answer I give will have some sort of unnecessary impact on the relationship. But often I answer personal questions, as they are not generally meant to be invasive—people are just curious about people sitting across from them.

Curiosity, about ourselves and about our relationships with others, is an important element of therapy. Honoring that curiosity is a good thing. Your therapist is there to help guide that curiosity where it is most needed. So, while you and your therapist can’t be friends, you can be part of a rewarding relationship!

I was at a party chatting with a stranger when he asked me what sort of work I do. I told him I am a marriage and family therapist who specializes in group therapy. “Group therapy!” he said. “I thought that went away after the ’60s.”

I’m happy to report that group therapy did not, in fact, go away in the 1960s. However, many people, like the guy at the party, don’t realize that group therapy exists as a powerful therapeutic option to consider instead of, or in addition to, individual therapy.

People may dismiss group therapy because it’s a therapeutic approach more often utilized in hospitals and treatment centers than in private practices. It can be difficult to find private practice therapists who run groups. Sometimes, it requires a lot of research and phone calls to find a group. However, plenty of therapists do run groups in their private practices, and this unique experience is worth the effort it might take to find it.

So, what’s so special about group therapy?

• It provides community and connection. Challenges tend to be harder when there is no one to share them with. In group therapy, individuals find relief through sharing their thoughts and feelings. Personal sharing creates connection and emotional support.

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• It’s an opportunity to learn from others. In group therapy, members learn from the other members. They see others successfully coping with depression; hear multiple perspectives on problems; observe others take emotional risks and be rewarded; and discover things about themselves by seeing those things in someone else. For example, seeing a fellow group member judging themselves can help a person understand the injustice and cruelty of his or her own self-criticism.
• It can bring about shame reduction. Receiving acceptance and understanding from fellow group members about something that feels shameful and uncomfortable may reduce shame and promote self-growth.
• It cultivates honest input from multiple sources. Defense mechanisms prevent people from receiving the insight they seek from therapy. Defenses ignore what a therapist might say because that’s just one person’s opinion, but when a group of people say the same thing, it’s not so easy to ignore. Helpful input breaks through the defenses, increases insight, and facilitates therapeutic change.
• It’s a safe space for interpersonal learning. One of the greatest benefits of group therapy is interpersonal learning. In individual therapy, people talk about their relationships; in group therapy, people engage in relationships with the other members of the group. If a person is very passive in his or her relationships—never asking for things, never saying “no”—he or she is likely to be passive in relationships with the other group members. Whatever a person’s relationship style, it will eventually be reenacted in the group. This reenactment allows all parties to become aware of this relationship dynamic. Once a person is aware of his or her typical way of interacting with others, the group provides a safe laboratory in which the person can try behaving differently. Standing up for oneself, setting boundaries, and expressing intimate feelings are the types of healthy relationship behaviors that can be developed in group therapy.
• It’s generally a more affordable option. Although cost varies from setting to setting and from therapist to therapist, group therapy rates tend to be more affordable—in some cases, roughly half the cost of individual therapy. This allows people to stay in therapy longer than their financial situation might otherwise allow them to.

No, group therapy is not dead. All around the country, people are gathering in groups to be more truthful, more engaged in relationships, and more open to insight than they are the rest of the time. Group therapy is very much alive! Are you ready to give it a try?

Psychotherapy can be about more than treating symptoms; it can be a path to living a more fulfilling life.

People often begin therapy to alleviate symptoms—a worthy goal, to be sure. But perhaps even more compelling is the ability of psychotherapy to help us counter our tendencies to stay in our comfort zones, and to challenge us to open ourselves to the aliveness and dynamism of the ever-evolving now. It can help us tap into our potential and live happier, more meaningful lives.

Yet it’s not uncommon to hear people say that therapy is like using a crutch, or that therapy makes people dependent on their therapists. In some cases, such claims may indeed be true. However, good therapy is meant to empower us, to help us mature, to stand on our two feet and face whatever comes our way.

Furthermore, therapy is not an easy process. If your therapist is doing his or her job, you will feel uncomfortable at times as you examine uncomfortable feelings and the reasons they exist. Whoever thinks that therapy is a crutch or an easy process clearly has not gone to therapy.

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Therapy Takes Courage

Engaging in the process of therapy is a courageous endeavor that is not for the faint of heart. Successful therapy demands that you see what you do not want to see within yourself. We all have parts that we don’t want to see, parts that scare us and that we have carefully hidden deep inside.

Good therapy is meant to help us uncover those parts. Even in the safety of a strong therapeutic relationship, that is no walk in the park. It requires commitment, emotional stamina, capacity to tolerate difficult emotions, capacity to shift attention to different aspects of ourselves at the right moments, and compassion—lots and lots of compassion. It requires dedication and a willingness to be in (inner) places that we haven’t been before, a willingness to be vulnerable.

Vulnerability Is True Strength

Allowing ourselves to be touched and open to experience in a non-defensive way is a very vulnerable thing to do. The idea that this is a weakness is a delusion; nothing takes more courage than to meet the parts of us that are scared and hidden. As long as we try to force our way into seeing our depths, we will not have access; the way in is through vulnerability and allowing our experience be exactly what is.

Allowing ourselves to be touched and open to experience in a non-defensive way is a very vulnerable thing to do. The idea that this is a weakness is a delusion; nothing takes more courage than to meet the parts of us that are scared and hidden.

This is no easy task. Our culture advances a belief that we need to “pull ourselves up by our own bootstraps,” but that belief is based in unconscious fear that dominates our experience—in fact, it is an act of violence toward ourselves.

If instead of beating ourselves into action we learned to invite the shaky, scared parts of us to show up, and we hold them with openness and let ourselves directly feel all of their uncomfortable sensations, we are being as courageous as we can possibly be. We are willing to meet ourselves without hesitation.

If we allow ourselves to feel the sense of deficiency (or whatever we are resisting), without defending against it, in time we can begin to experience a palpable sense of strength, courage, and determination that is not based on ideas of what should be, but are actual, felt experiences. Good therapy can help us with this.

Real Therapy Has Results Beyond the Reduction of Symptoms

There are real, tangible benefits to engaging in this process, including an increased sense of freedom. By understanding and unwinding the inner structures we have hidden inside, we are also recovering a great deal of previously frozen aliveness. By learning to see through our emotional and mental defenses, we also gain openness, awareness, and responsiveness. We become more finely attuned to what we need and to what is needed at any given moment.

A simple way to measure psychological well-being is by how responsive we are to the immediate environment without our old filters getting in the way as much. Neither reactive nor passive, we become able to appropriately act in a way that supports our continuous development.

This is not a mental exercise; it includes all of our being. It includes awareness of our mental, emotional, and somatic (physical) states. It requires uncovering our past beliefs and ideas about reality. It also requires getting to know our limitations and our capacities. And it requires us to not be defended—or at least not extremely defended. In a way, therapy can be an adventure into our inner landscapes, a process in which we are willing to be transformed by self-discovery.

By becoming aware of the parts of us that we didn’t know existed, we can begin to know ourselves in a more intimate way. In turn, our satisfaction in life increases, because our actions, emotions, and thoughts come into greater alignment. Furthermore, by understanding our unconscious inner conflicts and relational patterning, we begin to lessen their impact on our well-being and our capacity to respond appropriately to life.

Why Feeling Unheard Hurts So Deeply

Feeling unheard in your relationship can be frustrating, isolating, and exhausting. You might try to talk about your needs, only to be met with defensiveness, distraction, or silence. This is one of the most common challenges couples face—and it’s one you can change.

I once received a call from a woman who wanted to start couples therapy with her husband of 10 years. When they tried to talk, the conversation often became heated, ending in arguments. She hoped therapy could help them improve their communication skills.

In my practice, about eight out of ten couples seek therapy for communication concerns. Most relationship experts — and countless self-help books — emphasize that the key to a better relationship is good communication. But here’s the truth: communication isn’t just about talking. It’s equally about listening.

Why Good Communication Requires Good Listening

Healthy communication builds trust and intimacy. When we talk and share our feelings, we feel closer to others and are more likely to have our needs met.

But without the capacity to truly listen, even the most heartfelt words can be lost. Talking without listening is like sending a letter with no address — it never reaches the person it was meant for.

As human beings, we have a deep need to be heard. This begins in infancy, when caregivers respond to our cries. The important part isn’t just what they say or do in response — it’s that we feel heard, period.

When partners dismiss, deflect, or respond defensively, they can leave the other feeling rejected or even abandoned. Over time, this erodes trust and connection. Anyone can talk, but not everyone can listen.

Signs You’re Not Being Heard by Your Partner

When you communicate with your partner, notice if any of these signs appear:

• They flip the topic so you become the problem.

• They tell you you’re being “ridiculous” or “overreacting.”

• Their focus is on proving why they feel the same way.

• They walk out or leave the room.

• It seems like they’ve heard you, but the same issue keeps coming back.

If you recognize these patterns, it’s worth exploring why they happen. Often, listening problems stem from deeper emotional or relational dynamics.

Why Some People Struggle to Listen

Poor listening skills can come from deeper issues — not just unwillingness to hear. Common reasons include:

• Emotional overwhelm – Some people feel swamped by their own emotions or by the emotions of others.

• Poor timing – Trying to talk when your partner is distracted, tired, or stressed can block listening.

• Unresolved resentment – Lingering hurt feelings can create mental barriers to hearing your partner.

• Mental health challenges – Conditions such as anxiety, stress, or attention-deficit issues can make listening more difficult.

Understanding why your partner struggles to listen — and practicing compassion — can help you address the problem more effectively.

How to Improve Listening Skills in Your Relationship

On a practical level, Imago therapy offers a helpful technique for couples called “mirroring.” This involves one partner speaking while the other repeats back exactly what they heard, without judgment or defensiveness.

Here’s how to try it in a calm, safe moment:

1. Ask first – “Is now a good time to talk?” If not, set a time that works for both of you.

2. Speak concisely – Stay on topic and share the most important points.

3. Pause and reflect – Ask your partner to repeat back what they heard.

4. Switch roles – Once you feel heard, let your partner share while you listen.

If your partner becomes defensive or is unable to do this, it may be time to find a therapist who can guide you through the process.

When to Seek Professional Support

If you’ve tried multiple strategies but still feel unheard, professional help can make a big difference. A couple’s therapist can:

• Identify underlying patterns blocking communication

• Teach tools for better listening and empathy

• Provide a safe space for honest dialogue

Questions to Ask a Couples Therapist

• How do you help couples improve their listening skills?

• What therapeutic approaches do you use for communication issues?

• How will we know we’re making progress?

The GoodTherapy Commitment

For over 17 years, GoodTherapy has connected people with ethical, qualified therapists who respect client autonomy and dignity. Our directory includes professionals specializing in communication and relationship concerns — helping couples feel heard, valued, and connected.

Remember: Listening is a skill that can be strengthened with awareness, patience, and support. You and your partner can learn to hear and be heard — and doing so can transform the quality of your connection. Communication challenges are common, but you don’t have to face them alone. A skilled couples therapist can help you and your partner develop listening habits that build trust, empathy, and connection.

Find a qualified therapist near you and take the next step toward better communication today.

The key to tasty pizza is for each part—the crust, the sauce, the cheese, and the toppings—to be unique and distinct, but to blend into a well-balanced and delicious whole. Live life as though you and your family were a delicious pizza. This is the goal of family systems theory, though it’s probably not quite how founder Murray Bowen would phrase it.

Bowen was likely too academic to associate his work with a pizza, but it really helps explain his concept of good relationships. He used the term self-differentiation and taught that families and other groups function best when we are connected and in good relationships with other people. But at the same time, we are able to form our own opinions, feel emotions that are different from those around us, and choose our own responses to situations rather than simply following expectations.

Simply put, this means that if you are the crust on the metaphoric pizza of your family, your role is to be a sturdy foundation for the rest of the pizza. Regardless of the specific ingredients, you hold the rest of the pie together. If you are spread unevenly or have a big hole in the center, this will make it hard for the sauce and cheese to stay on top and not stick to the pan.

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Here’s a real-life example of a family or workplace picnic that gives a variety of possible responses to one tricky situation. Each response results in a different balance between holding onto your own integrity and responding to the needs and expectations of others. Each possible response corresponds to a “relationship pizza quality score” rated from zero to five, with zero showing no self-differentiation and five indicating a high level of self-differentiation.

This scene takes place at either a picnic with extended family, a workplace outing, or a gathering of friends.

You arrive at the gathering and greet everyone. One particular family member or friend leads you toward the food table and piles a rich and savory dish onto a plate. They hand the plate to you and says, “You are going to love this!”

You look at the food and realize that you can’t eat it because you are on a new diet and this is not the kind of food you can eat right now.

Response One

You reluctantly take the plate and eat it without saying anything. You feel guilty and bad about yourself, but you don’t want to offend the other person.

Pizza Quality Score: 0

If you were the crust on this metaphoric pizza, you have holes in your dough. This represents a poorly differentiated response because you are letting go of your values and your needs and focusing only on the other person.

Response Two

You say, “No, thank you. It looks really good, but I’m on a new diet.” The other person responds by saying, “You are always on a diet. One taste won’t hurt you. I worked really hard cooking this.” This time you respond, “Oh, OK. Just one bite.”

Pizza Quality Score: 2

You start out with a response that defines yourself and sets your personal limits, but when the other person rejects that response and pressures you to eat, you let go of your own values and allow the other person to define you. If you were the sauce on this metaphoric pizza, you would be oozing off the edge of the crust.

Response Three

This time, when the other person complains about your diet and pressures you to eat a bite, you respond differently. You say, “No, I’m not going to eat that. That is just the way it is, so get over yourself.”

Pizza Quality Score: 3

Frequently, when one person changes their usual behavior, other people resist. Self-differentiation often takes hard work, but it can have life-changing benefits.You have taken a stand, but you are doing it by pushing the other person away and not showing any respect for their feelings.

Good self-differentiation involves both standing up for yourself and your values while simultaneously remaining connected to others. If you were the sauce on our metaphoric pizza, you have added a large amount of a spice that clashes with the cheese and the crust. The result is unappetizing, but edible. Let’s try again.

Response Four

The other person says the same thing, but you take a different approach. This time, you say, “I really appreciate all the work you put into that dish; it shows how much you care about me. I am sorry, though, I’m really not going to be able to eat any today. I need to stick to my diet.”

Pizza Quality Score: 4

You have held onto your values while also staying positive and appreciative of the other person.

Response Five

You can perfect your differentiated response by adding something to encourage a connection with the person in a way that doesn’t compromise your integrity. For example, after using something similar to response four, you could add: “How about if we take a walk together?” or, “I want to tell you a funny story about this new diet.”

Pizza Quality Score: 5

This response shows excellent self-differentiation because you are holding onto yourself and your values while fostering a relationship with the other person.

Finally, good self-differentiation does NOT depend on the other person’s response. Reaching out to foster connection is a self-differentiated move even if the other person responds by turning away. Frequently, when one person changes their usual behavior, other people resist.

Self-differentiation often takes hard work, but it can have life-changing benefits.

It’s that feeling down in your belly that wiggles and burns, then jumps into your chest as you check your phone for the 10th time for a text from the object of your interest. Fireworks. Electricity. A burning flame. These are all descriptors that often describe passionate, romantic love.

We often hear people say they love someone so much it hurts or that a person can give them “butterflies” in the stomach if they’re in the same room. We think to ourselves, “This person works them up so much. They must really be into them!” The reality, however, is that pain and anxiety are not signs of passion. They are just pain and anxiety. Authentic love should not feel that way.

The Mixed Signals of Romance

In the beginning of a developing relationship, you may feel preoccupied with powerful feelings. Anxiety and excitement feel very similar. However, as a relationship builds, those unnerving feelings can be indicators the relationship is not truly serving you.

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Anxiety can show up in a number of ways in relationships. Perhaps you worry excessively about what your significant other thinks or feel like you need to be perfect when they are around. You may have irrational thoughts that they might be angry or leave you. You may feel self-conscious around this person, or even panic when things go wrong. This is not how a person should feel in a secure, loving, and supportive relationship.

Are Your Needs Being Met?

It’s not uncommon for someone to become anxious about a relationship when a partner is not meeting their needs. When we feel ignored or not prioritized, it can be unsettling.

You probably have a friend who texts their significant other relentlessly every time they fail to answer the phone, asking where they are, what they’re doing, or instructing the person to call back right away. Your friend may be coming from a place of anxiety and might not feel secure about their partnership. Maybe your friend has reason not to trust their partner. Maybe they are carrying hurt and suspicion from a past breakup. Either way, those rapid-fire texts are not a sign of undying love—they may, instead, indicate anxiousness.

All that angst may feel like over-the-moon passion, but remember: above anything else, your relationship should feel calm and safe.Some degree of anxiety in a relationship is normal. But if you frequently feel nervous about where things stand with your significant other, you may want to pause and think about what’s causing you to feel that way.

Does your partner ignore you for long periods of time? Are they hypercritical or jealous? Maybe they make you feel guilty, give you ultimatums, or become passive-aggressive and irritable. Does your partner act overly flirtatious with others? These are all examples of unhealthy relationship dynamics that can leave people feeling panicky and unnerved. If any of these are behaviors are commonplace in your relationship, you may want to reach out to a couples counselor or rethink your commitment.

From Infatuation to Meaningful Connection

As a relationship develops and moves past the honeymoon phase, lust and novelty should be replaced by trust, commitment, and dependability. These are the true qualifiers of an authentic, long-term connection. A loving relationship should feel secure, reliable, and supportive. You should be able to feel relaxed and open about being accepted as your true self. You should be able to trust your partner to be loyal. You should feel like a priority. Everyone deserves this type of relationship.

All that angst may feel like over-the-moon passion, but remember: above anything else, your relationship should feel calm and safe.