Freud, Explained


Of all the figures in shrinkdom, Freud is the most revered and reviled, the most quoted and misquoted, and the most influential and ignored. It used to be that every shrink wanted to be like him, now we want to challenge him and be as different as we can. Perhaps this is what he gets from being first in the field. More than anyone, he broke the ground for what has become modern psychotherapy, turning over centuries of assumptions about human nature. We should not be blamed for wanting to see what we can grow on this plot. However, it pays to sometimes go back to first principles and relearn the basics.

It is said that the great golfer, Arnold Palmer, used to start off every golf season by stopping at a country club, asking to see the golf pro, and taking a lesson. Most pros must have been intimidated to have Arnold Palmer as a student, for he was already a better golfer than all of them. Nonetheless, he would insist on a lesson, going back to basics: the grip, the stance, the swing, before going on with his season. He needed to remind himself of the fundamentals.

In that spirit, let’s return to Freud and re-examine the first principles of psychotherapy, many of which have since been distorted. Continue reading

Relaxation Therapy

shrinbks-links-photo1Bringing you the best of mental health.

Once upon a time, a client came into the community mental health clinic where I worked, checked in with the receptionist, and, instead of sitting in the waiting room till I came to get her, went straight to the lady’s room and slit her wrist. She had slit her wrists many, many times before and had dozens of hospitalizations for suicide attempts. She was the toughest, most frustrating, most hopeless case known to all the therapists in the clinic, given up on by all, and recently transferred to me. When I heard what she had done, I began to believe she was beyond help, too. Continue reading

Therapy and Spirituality

shrinbks-links-photo1Bringing you the best of mental health every week.

I recently read and was asked to review Eastern Wisdom Western Soul by Richard Singer. It got me thinking about how us shrinks handle spirituality. There are basically three ways. We can, a) ignore it and pretend it doesn’t matter; b) help the client work through what

they’ve been taught till they arrive at beliefs and practices that work for them; or c) indoctrinate the client in something new. Eastern Wisdom Western Soul is an example of the choice C. I liked the book, but I’m skeptical that it’s the right way to go. Continue reading

The Shrink’s Links: Book Review: Internal Family Systems Therapy

Bringing you the best of mental health every week.

You are divided. You must have noticed this when you’re trying to decide whether to have that chocolate cake, or stick to your diet; when you rise, groaning from your bed, despite how comfortable that pillow looks; when you want to tell your boss to shove it, but instead say, Yes Sir. It’s like, up there in your mind, you have a boardroom with an array of directors all around the table. Your mother’s voice is heard sometimes. Also your father, your big brother, who called you a spoiled brat, and your little sister, who told everyone you were mean. There’s that coach who said you’d never `mount to nothin’ and that teacher who believed in you. There’s the you that your wife knows, another you that goes to church, and still another that’s not afraid to sing Karaoke when you’ve had enough beers. All your feelings are represented on the Board. There’s a miniature version of your spouse, a trusted friend, and a wise counselor sitting there. You can consult with them, even if the real person is not around. Your Board of Directors is always meeting, always talking, and always making affiliations with each other; vying for dominance at the table and secretly in cloakrooms, backstage.

The relationships between these characters follow the same rules and fall into the same patterns as relationships between actual people. You have some who dominate others. Some who are immature, angry, or caring. Some get really excited and over-react. Polarization is found here, just as in the US Congress; so are triangles, the love variety and otherwise. You have the same splendid complexity within as without. This gives you the same advantages that any group of people have (two heads are better than one), as well as disadvantages (sometimes all you do is go to meetings and never get anything done).

Many psychological theories have recognized this multiplicity, but they all have divided it up differently. Freud had his Id, Ego, and Superego. An updated version of Freud, Transactional Analysis, has Child, Adult, and Parent. There’s the Inner Child of John Bradshaw. Jung had a rich cast of characters. But no theory has done so much with the phenomena of multiplicity as that of Richard Schwartz’s, Internal Family Systems Therapy (IFS).

Schwartz’s special contribution has been the recognition of three classes of inner characters and the relationship between them. First there are the disavowed parts called the Exiles. These are the memories you would rather not think about and the behavior you swore you would never do again. These are the feelings that threaten to take you over. These are the characters that you have wrapped in duct tape, hidden in the attic. Well, they’re getting pissed, and, whenever they get the chance, they bust out of their cells and raise hell.

The second class of inner characters is devoted to seeing to it that the Exiles never return. These are the Managers: the parts that, well, manage your life so the horrible things don’t happen. For instance, if you were obese as a child and got picked on a lot for it, then the part of you that gets you to the gym is a manager; so is the part that calls you a fat pig when you have a chocolate sundae.

Then there are the Firemen. This is the class of inner characters who responds to emergencies. What emergency? The Exiles escaping. Like firemen in the real world, who have license to bust down your door with an axe, go to the bed of a sleeping child, carry her out, and soak your living room couch with water, these Firemen go to extremes to keep the Exiles under wraps. In the case of the formerly obese child, every now and then she goes to a bar and sleeps with any man who will sleep with her. She’s looking for affirmation, emergency affirmation. That’s one of her Firemen doing that, so that the Exile, the shame-filled obese child, is kept under control.

You can imagine that when these three classes of characters gets going, the person feels very divided. The morning after the formerly obese woman goes to the bar, there are a whole slew of managers getting into the act, reprimanding her for being such a slut. This threatens to let lose some other Exiles and then, more Firemen to keep them wrapped up and more managers to repair the damage made by the Firemen.

Isn’t there a better way?

Yes, says Schwartz, there is a better way; his Internal Family Systems Therapy is all about finding it.

In Internal Family Systems Therapy, there is one character who is always hidden, but is crucial to the success of the whole. Schwartz confusingly calls this character the Self. Now, many would call the whole system the self, but, to Schwartz, the Self is a special entity.

…everyone has at the core, at the seat of consciousness, a Self that is different from the parts. It is the place from which a person observes, experiences, and interacts with the parts and with other people. It contains the compassion, perspective, confidence, and vision required to lead both internal and external life harmoniously and sensitively. It is not just a passive observing state, but can be an actor in both inner and outer dramas…I cannot see my Self because it is the me that is doing the seeing, and in that sense it is invisible to me. For these reasons, people are likely to be identified with their parts and unaware of their Selves…Once clients become aware that their Selves rather than their parts are at their core, and they experience their differentiated Selves, they feel better about life. One major goal of the model, then, is to help each client differentiate the Self as quickly as possible so that it can regain its leadership status. (Schwartz, Richard C. (2013-10-14). Internal Family Systems Therapy (The Guilford Family Therapy Series) (p. 40). Guilford Publications. Kindle Edition.)

He compares the whole system to an orchestra and the Self is the conductor. You don’t directly hear the conductor. He plays no instrument but his baton, but his role is crucial in bringing all the parts together in harmony. When the parts are in disharmony, they are paying no attention to the conductor. Maybe they don’t know he exists. Maybe awful things have happened that the Self was powerless to stop. Maybe they, consequently, don’t trust its leadership.

A therapist, in Internal Family Systems Therapy, spends a lot of time helping the client take inventory of the parts and identifying them as Exiles, Managers, or Firemen. Special care is accorded to honoring all, especially the Firemen, for their contributions. Managers are respectfully asked to step aside so that the Exiles can be addressed directly. The IFS therapist is always negotiating with the parts on behalf of the Self, so that the Self can be put in charge.

There is a fair amount of resistance to Internal Family Systems Therapy. Clients almost always think that being divided is less desirable than being whole. They worry that, if the therapist recognizes their parts, the parts will take over. There is a fear of Multiple Personality Disorder and the fractured state of Schizophrenia.  Schwartz takes great pains to reassure that is it normal, even desirable, to have multiple parts, as long as they are under the direction of the Self. Multiple Personality Disorder is disunion taken to an extreme, he says, but we all have multiple personalities.

When I started to read Internal Family Systems Therapy, I thought I would like it. My Master’s Thesis started off to be about Multiple Personality Disorder, so, I was familiar with multiplicity. I’ve been comfortable leading clients on role plays with ambivalent parts of themselves and with introjected parents. I know how I am divided. However, the more I read Internal Family Systems Therapy, the more uneasy I got. I attended a workshop on it. Still, something wasn’t right. I watched a number of YouTube videos showing the techniques in action. Something was wrong and I couldn’t put my finger on it. As Schwartz would say, I had parts that were drawn towards it and other parts that were skeptical.

It took me a while to identify the problem, but now I think I understand and am ready to share. I think Schwartz and his followers have lost touch with the obvious.

Multiplicity isn’t real. It is normal. It is desirable to certain point. But it ain’t real.

Yes, that’s right. I didn’t think I would ever say this, but I don’t think people really are multiple. It just looks like they are.

Reality is important to me, even though I am aware of how hard it is to grasp. Perhaps, it is because it’s so hard to define, that I don’t want to let it go when I find it.

Also, I have an image of being a practical, no-nonsense, kind of therapist to uphold. A certain kind of underserved clientele flock to me because they think the mental health world is glutted with flakiness. Can I really be telling them that they are inhabited by legions and get them talking to themselves? I, personally, don’t have a problem talking to myself, but I would feel partly responsible if a client left my office saying, “I knew it. They’re all the same. These shrinks are nuttier than their patients,” and went back to drinking and beating his wife.

Still, I understand the value of Internal Family System’s Therapy and want to find a way to make it easy for my clients to swallow and digestible for myself. This is what I came up with.

You know how a meteorologist will program a simulated climate into a computer? She will tweak this and that just to see what the effect might be. She’ll punch a few numbers in that indicate increased carbon emissions, run the program, and see the result on the Arctic ice cap. That’s what’s going on inside you. You have created, based on what you know, a simulated world in your mind. All the people you know are in it; along with all the possible versions of you. Then you run different scenarios.

For example, you’re starting a career in public speaking. You learn pacing, diction, and what to do with your hands. You practice in front of a mirror when no one is around, simulating a performance. Then the day comes and, while you are waiting to go on stage, you experience stage fright. Stage fright is essentially a simulated version of what you think will happen if you get tongue-tied.  You imagine going on stage and not being able to speak, everyone laughing, and you running off in humiliation. That is a simulation of both you and the audience.

The practiced version comes along to counter the stage fright. It says, you’ll be fine, you practiced this. It also says, the audience won’t mind if you trip up on a couple words. The practiced version is a Schwartzian Manager. You decide that, if you back out now, you will be humiliated anyway, so you decide to throw the tongue-tied simulation away. It’s important to realize that the stage fright was there all along, only it wasn’t always problem; it’s what motivated you to prepare. When you’re about to go on stage, it’s not needed anymore. It already did its work by motivating you to be better prepared. It becomes an Exile.

Time goes on and your career as a public speaker grows. You speak in larger venues. You still   have the simulation of being tongue-tied. It continues to motivate you to be better prepared. You write better speeches. You learn to use a teleprompter. Then you get your big break. You’re scheduled to appear in TedTalks. The moment comes and the simulation of being tongue tied is still there; only again, it’s not useful anymore. You can hardly be better prepared. You develop a new simulation, based on how, in the past, when you’ve had a few drinks, you felt calm. Therefore, on your way to your speaking engagement, you stop at a bar and throw back a couple of shots of whiskey. That simulation was your Fireman, in action. Only, I guess I would call it a security guard.

For a simulation to be effective it needs to fulfill certain criteria. It has to be an accurate representation of how you could be in the real world and an accurate simulation of the real world. It has to know whether you can pronounce certain words, for instance, and what the effect of alcohol would be. A simulation also has to seem to have a will of its own so you can accurately project how it will behave. It does you no good, when you run a simulation of the behavior of an audience, to tell it how you want it to behave. You need it to behave as an audience would behave, as if it had a will of its own. Similarly, both the practiced version and the tongue-tied version also seem to have wills of their own. That’s why it can be hard to talk yourself out of stage fright. Simulations do not go away quietly.

Schwartz notes that the behavior of parts of the inner world matches the behavior of an individual within families. You have the same polarization and the same triangularization inside as out. Is it any wonder, if the inner world is meant to be a simulation of the actual one?

Thus, the better a simulation is, the more easily it can also be confused with your actual self and the actual world. If you do confuse them, then that’s because you’re a good author and have developed rich, well-drawn characters that seem real.

You can hear this confusion when you talk. You say, as you’re about to go on stage, “I’m afraid.”

No, you are not afraid. You’re running a simulation that’s afraid. You created a character, meant to resemble you. If you confuse this character with you, then you did a good job creating it; but it’s not you. You are the creator. You are the person directing, watching, and listening to the show.

So, now that I have figured out why I felt so uncomfortable with Internal Family Systems Therapy, where does that leave me? Can I no longer work with clients who believe they are multiple? Do I have to stop conversing with the parts of myself? Can I no longer lead clients in role plays with their parts and introjected parents?

Not at all. In fact, my insight makes me feel a whole lot better about using Internal Family Systems Therapy, or, at least a version of it. You see, Schwartz and I are in agreement with the character of the most important component of the system: the Self. The Self is the meteorologist running the simulated climate program. The Self is the creator of all the simulations. A creator who has made his creation in his own image. An almighty god, who can cast his creations into hell, where they cry and gnash their teeth; or extend grace, mercy, and redemption to a broken inner world that matches the broken actual world.

I believe it is necessary, though, to say that these parts are not real. This gives the Self authority over the parts. If the Self knows it has authority, then it has strength. It knows it can afford to be flexible, compassionate, and curious. It can take leadership over its creation and not confuse the real world with the notions of the mind.

Click here to go to Schwartz’s website.

Taming the Pumpkin, or, How to Influence People without Getting Wacked

Once upon a time a traveler hiked down from the mountains into a remote valley to find all the farmers there in a panic. They were running from their vegetable garden into their village, screaming. The women clutched their children close and the men grabbed their hoes, rakes, and pitchforks to defend themselves.

“What’s wrong?” said the traveler.

“There’s a monster out in the field. It’s big and orange and it wants to eat us.”

“Show it to me.”

“Go see it yourself. But be careful, he might eat you.”

The traveler went out to the vegetable garden and there was indeed something big and orange there. He returned to the village. “I saw it. It’s nothing but a pumpkin, you idiots” he laughed. “A bird must’ve dropped a pumpkin seed into your garden and it grew and you think it’s a monster.”

The men of the village looked at each other and attacked the traveler with their hoes, rakes, and pitchforks because they didn’t like to be told they were idiots.

A couple of weeks later a second traveler hiked down from the mountains into the remote valley. By now the vegetable garden had been taken over by weeds and the pumpkin had grown larger and larger. The villagers had constructed a wall protecting their village. They were cowering behind it. The traveler came to the gate and the villagers pulled him inside.

“Come in before the monster gets you.”

“There’s a monster out there?” he said. “I didn’t see it.”

“Yes, there is,” they said. “It’s big and orange and it’s taking over everything.”

The traveler stepped out of the gate and looked at the garden. “Oh, yes, I think I see it. Hand me that hoe and I’ll slay it for you.”

“If you think you can, but be careful, he might eat you.”

The second traveler boldly went to the garden with the hoe and busted the fearsome pumpkin into a million pieces. He held the hoe over his head and shouted. He took a piece of pumpkin in his hands and bit it, the juices ran down his chin.

He marched back into the village expecting the villagers to cheer him, the men to shake his hand, and the women to throw their arms around him and kiss him. However, the men of the village looked at each other and attacked the traveler with their hoes, rakes, and pitchforks because, if he could slay the big orange monster, then this creature who looks like a man must be a monster, too.

A year later a third traveler came down from the mountains into the remote valley. Although the land was well watered and fertile, all the fields were overgrown and neglected. Hundreds of pumpkins grew in the former garden, their orange skin glowering from behind the weeds and volunteer vegetables. The villagers hid behind their wall. They were starving, too weak even to meet him at the gate.

He walked in and said, “Why are you all starving inside these walls when the valley is well watered and fertile?”

“Didn’t you see the big orange monsters?” They took him to the gate and pointed to the pumpkins. “Last year there was only one, but now hundreds have come to eat us.”

This traveler was wiser than the first two. He said, “Oh, no, I didn’t see them when I walked by. They were hiding in the weeds. I’m lucky I made it here.”

The villagers smiled and said, “You better stay with us until they go away.”

The next day the third traveler said to the villagers, “You know, if I’m real careful with those monsters, I may be able to tame them. Hand me that little bit of food you have left and I can see what I can do.”

The villagers were reluctant to hand over the last bit of food. They met and discussed it for hours. At last, they gave it to the third traveler and said, “We discussed your proposal and decided that if nothing was done, we would all starve anyway, so go ahead and take our last bit of food and try to tame the monsters. You’re a very brave man. Be careful out there.”

The traveler took the food and carefully crept out to tame the monsters by luring them nearby with the food. From time to time he would run back and say that the monsters had almost caught him, but he would always have his arms full of volunteer vegetables he had picked. The people of the village ate the vegetables but tried to convince him not to go out again. They all thought he was very brave. One in particular, the finest looking girl in the village, was very impressed, and would hug and kiss him every time he left, expecting never to see him again.

After a few days of this, he returned with a small pumpkin in his arms.

“Isn’t he cute?” he said to the people.

The villagers were amazed to see that he had tamed a monster, even if it was only a small one. One by one, each of the villagers came up to pet the beast and feel its tough, cold skin. The traveler even kept his tamed monster in his hut. Every day he tamed and brought in a new pumpkin and one by one, everyone in the village adopted one until there were none left in the garden. When all the pumpkins were tamed, the people could go out and tend their crops. They never were hungry again.

The grateful villagers elected the third traveler mayor. He married the best looking girl and lived till a ripe old age in the biggest house in the village. The villagers even renamed their remote land Pumpkin Valley and flew a Pumpkin colored flag. To this day, every house keeps a pet pumpkin seated in a place of honor on the mantle.

Everything you need to know about confidentiality

Counseling will work to the degree that you are confident my office is a safe place to bring up sensitive matters, but you will have to take some risks. The things we talk about are confidential. I will not repeat the things we discuss in a way that can be traced back and identified with you. There are some limits and challenges to confidentiality, though. You need to know what they are.

The Counselor

Sometimes the counselor can interfere with the counseling being a safe place. You will not be honest with me if you think I will judge, preach, blame, chew you out, abuse, or criticize you. But I will respond to what you say to me. I would not be human if I did not have a reaction. It would seem weird if I just sat there.

The most frequent complaint I’ve heard from clients about other counselors is that they just sit there, inscrutable, and don’t offer any help. I don’t have this problem, but I am always mindful of giving you the space to talk about what you need to talk about without imposing my own values.

The Office

My office has a parking lot in the back, so it would be hard for anyone to see your car by my building. You can enter through the back, so no one is likely to see you go in. When you step into my waiting room, there will be no one waiting to see other counselors. The radio will be playing and there will be a white noise machine by my door to mask sounds coming from my office. I’ve tested it. Unless people are screaming, it’s impossible for anyone to hear what we talk about in my office. My files are locked and you will not see any private information on my computer screen or on my desk.

In the Community

I will not say hi to you if I see you out in the community. I don’t want you to have to explain to anyone you’re with how you know me if you are not comfortable in doing so. If you are comfortable, then go ahead and approach me.


The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides consumers with important privacy rights and protections with respect to their health information, including  important controls over how their health information is used and disclosed by health plans and health care providers. If you would like to read a government document discussing these rights, click here. If you don’t want to read it, I don’t blame you in the least.


If you choose to use insurance to pay for your sessions, you or I will have to give them some information. If I’m an in-network provider, I will send a claim after each session telling them that you saw me, the date and duration of the session, the type of therapy provided, and a diagnosis code. They seldom ask for anything more, unless we are trying to get approval for more sessions.

If I’m out-of-network, you will have to send them that information if you want to reimbursed. After each session, I will email you a receipt, called a superbill, that contains that information. You pass it on to them.

If you don’t pay your bill

Payment is due at the time of service. If you fail to pay, there is a $5 late fee. If months go by and you still don’t pay, then I refer the bill to a collection agency. They will have your name, demographic information, dates of service, and charges, but I will not pass clinical information onto them.

Release of information

You may want me to pass on information to others. I frequently have clients who are required to attend counseling or get an evaluation by probation, parole, the courts, a parent, or a spouse. If that’s the case, then I’ll ask you to sign a release that states I have permission to share information with others.

I have found that having to report to the authorities may affect the things you will talk to me about. It can be hard to be honest. For that reason, I give them the minimum amount of information they need.

If others are involved in your treatment

If you are seeing someone else, like a doctor, for medication, for instance; it is generally best if I work together with that person. This may necessitate that I share information with them about you. If that’s the case, I will ask you to sign a release. If there is particular information you don’t want me to include, tell me what that is and we will discuss whether I can exclude it.

If you’ve just come from another facility and I need information from them, I might ask you for permission to contact them. If that’s OK, then sign a release.

In an emergency, then no one in the health care field waits around for releases to be obtained before information is shared that is vital to your safety. If I get a call from an emergency room, for example, I will give them whatever information they need to assess and treat you effectively.

Family Therapy

If you’re coming to see me with your spouse or other family member to improve your relationship, most of the time you will be meeting me with them. If there is something you would like to talk about without your family member present, whatever the reason, then please ask to see me individually.

When I work with couples in marriage counseling, I will often set up individual sessions so we can talk privately. I don’t do this because I believe it’s best to have secrets from your spouse; I do it so it can be easier for you to talk. I will regard the things you tell me as confidential and will not repeat them to your spouse when I see them individually or with you.

Domestic Violence

I, and most other counselors, will not meet with couples for marriage counseling when there is an ongoing threat of domestic violence. It may seem that marriage counseling would make sense in cases like that, but the situation is often not safe enough for marriage counseling. I don’t want you to bring up something up in my office, thinking it’s a safe place, and pay for it when you get home. When there is domestic violence, I will work with one or both people individually on whatever issues are relevant.


If I learn in our conversations that you are planning harm to yourself or others, I am obligated to take action towards safety. This may mean that I get you to the hospital. It may mean I call the police. It may mean that I warn the person threatened. If you have physically or sexually abused a child and are that child’s caretaker, I will have to report this so it can be investigated.


You may have heard that the Safe Act in New York requires that mental health professionals report any client to the authorities who possesses a gun and is likely engage in conduct that puts people or themselves at risk. The authorities would then revoke that person’s permit to possess a firearm.

That is true, but, when they wrote the law, they defined mental health professionals as psychologists, psychiatrists, registered nurses, and social workers. In their haste, they left out licensed mental health counselors and certified alcohol and substance abuse counselors, which is what I am. This leaves me in a very ambiguous position. On one hand, the intent of the law was clearly to include me and my colleagues, on the other hand, they could have, and didn’t.

The way I have settled this for myself is to do what I have always done. If I learn you are planning harm to yourself or others, I take action towards safety. This may mean that I get you to the hospital. It may mean I call the police. Confidentiality is important, but saving lives is more important.

Things You Have Done in the Past

If you confide in me about things you have done in the past, I am under no obligation to report them to anyone. You could have killed someone and I won’t report it. However, things you are planning on  doing in the future is a different matter. If you are planning on killing someone, for instance, I would have to take steps to prevent it.

Court Order

Theoretically, a judge can order me to testify or submit my records to court. However, in thirty years, I have only had one subpoena to do this and, in that case, I evoked privileged communication and the request was withdrawn. I would do the same if it ever happened again.

Consultation and Training

Being able to consult with and learn from other professionals is vital to me as a therapist. Every two weeks I host a peer supervision group with colleagues. I sometimes work with an intern who sees me for supervision. I also attend training and conferences where cases are discussed. If I ever bring up your case in those settings, I will not share identifying information.

My Writing

I do a lot of writing. I have a blog: Madness 101, in which I post twice a week. Currently, I’m working on three books: a self help book about relationships and two novels. Under a pseudonym, I also have written a blog of fiction called The Narrative Imperative.

Certainly, my work as a therapist enters into the things I write about. I seldom write case studies. I don’t like them aesthetically, and I also wouldn’t want my clients shocked to find themselves written up in entirety as an example. If I ever am interested in writing about your case in detail, I will get your permission first.

My fictional work is sometimes inspired by my own experiences and stories I’ve heard, but it is still fiction. Any resemblance to actual people and events is purely coincidental.

Social Media

I’m not on Twitter. Call me a dinosaur, but I don’t tweet.

I’m on Facebook, but, if you’re a client and send me a friend request, I will decline. Not because I don’t like you, it’s just that it crosses boundaries into the personal. If you are already one of my Facebook friends, I will refer you to someone else for counseling. I won’t ask you to like my business Facebook page, because I haven’t created one. I don’t believe it really helps any business but Facebook.

LinkedIn is a different matter. I have a page on LinkedIn and, because it deals with my professional life, I will accept invitations to connect there. However, please don’t expect me to endorse you for a skill I know nothing about.

Electronic Medical Record

I keep your records electronically on an encrypted cloud server provided by I use this software for online appointment scheduling, appointment reminders, charting, emailing, billing, insurance claims, and business management. I selected because it is HIPAA and HITECH compliant. I believe it is more secure than keeping paper records. Click here to read a government assessment of the security of electronic medical records.

Patient Portal

I also selected because it enables me to involve you in every aspect of your treatment. You can look up, schedule or change appointments, view and download account balances, pay your bill online, and exchange secure, encrypted messages with me. I send you a summary after each session to remind you what we talked about.

Any messages I send through this service self destructs after two weeks, like in Mission Impossible. You will have to cut and paste if you want to save it.

To take advantage of this, you will need to set up a patient portal and keep your password safe. If we have never met and have not yet set up an appointment, then you can click here to register as a new client. If we have met any time since December 2013 or have an appointment in the future, then I already registered you. Click here to log in. Call me at 585-732-1970 if you don’t know your username or password.

Phone and Texts

You may call or text me at 585-732-1970. This is my cell number, both business and personal. If I don’t pick up it’s because it’s not a good time to talk. If you leave me a voice mail message or text, I will try to get back to you by 9 pm at the latest.

I work by myself in a private practice and it is impossible for me to always be available for emergencies. If you’re in crisis, nearly anywhere, you can get help by calling 911. If you’re in the Rochester area, dial 211 to call Lifeline at any time.


You can email me at, but it is not an encrypted form of communication, so I prefer to use the email service provided in the patient portal.

Feedback and Complaints

The best way for me to get better at counseling is to get accurate, constructive feedback from my clients. I try to do this in a way that doesn’t overwhelm you with surveys or detract from the reason you see me. Please let me know, by email or when we meet, any reactions you have to our sessions or the summaries I send, positive or negative. This feedback helps me improve.

I try to follow the ethics guidelines set forth by the American Counseling Association and the New York State Office of Alcoholism and Substance Abuse Services. Click on the links if you want to read them.

I am licensed by New York State as a Mental Health Counselor (LMHC) and a Certified Alcohol and Substance Abuse Counselor (CASAC). (Click on the links to verify) You can contact those offices if you have a complaint.


So, that’s it. I’ve tried to think of everything to enable you to trust me. If you still have trouble trusting, that’s not unusual. Maybe you were hurt in the past. Tell me about it and we will work through it together.

The Shrink’s Links: A Consequential, Niggling Detail

Bringing you the best of mental health every week.


Today I’m going to write about something that should be irrelevant and of no concern to you, but may affect you, nonetheless: the licensing of people who perform psychotherapy.

Licenses exist so the consumer can know who to trust and who has the necessary training and experience to do what they say they are doing. Professions usually welcome licensure for the same reason that restaurant might welcome a critic’s review. It endorses and affirms their work and guides customers to their doorstep.

Licensing laws also serve to shut out the competition. New York City releases a limited number of taxi medallions, for instance, so that taxi operators can be assured plenty of business. This, of course, drives up prices and makes it hard to get a cab. Consumers complain and often find undesirable alternatives.

We often hear about how it is difficult to access mental health care. It’s expensive. It can take months to get an appointment at a community clinic. Our prisons are filled with the mentally ill. When people can’t get mental health care, they chose alternatives: alcohol and drugs, violence, anything that gives them short term relief, and it ain’t pretty. Remember that the next time you hear about a school shooting, an overdose, a suicide, a fatal DWI, domestic violence, or pass homeless people on the street. Clearly, there are not enough people providing mental health care. Obama Care and other laws will not help if there are not enough therapists to see all those who need help.

A few years ago, the New York State legislature overhauled the laws concerning licensing of psychotherapy. Licenses had been very hard to come by. You had to go through a social work school, get a doctorate in psychology, or complete medical school and a residency. There weren’t too many of these opportunities in Western New York. Folks, like myself, learned the same material in other settings and got plenty of experience working in non-profit clinics where licenses had not been necessary. The legislature recognized that there were alternative paths to the same level of competency and created several new licenses with rigorous requirements: the LMHC, or Licensed Mental Health Counselor, for one. The legislature got all that right. The trouble is, they screwed up one little detail.

They wrote in the law that we would be doing “assessments”, not making “diagnoses”. There is absolutely no practical difference between making an assessment versus a diagnoses; they both result in the same thing: a brief summary of the problem. However, when insurance contracts are written that patients require a diagnosis, all the lawyers and bean counters in the insurance company (and there are quite a few) insist that diagnosis is what they need to have.
The result of this gaff is that today we have more competent people in the profession, but many of the insurance companies will not pay them. This limits the availability of mental health care.

I’ve been told that the other professions that had previously been licensed: the doctors and social workers, lobbied against using the word “diagnosis” in the language, thus inserting a poison pill into the legislation and ensuring they would get plenty of business. However, I would like to not believe doctors and social workers could be so evil.

I’ve been told that it’s going to take another act of congress (the New York State legislature, to be precise) to correct the problem. We all know what that’s like. Try to get a politician interested in this.

If you are still reading at the end of this post, you must still be interested. So, do one more thing. Contact your state senator or member of the legislature and ask him or her to support A.7608 and S.4977.

The links:



A New Development: The After Visit Summary

The latest good idea I’ve had about counseling I got from visiting my allergist.

I have allergies. If you ever sat with me in a counseling session and I had tears in my eyes, it might have been due to what you were saying; sometimes I am deeply moved. But probably my allergies were responsible. I went to see an allergist to determine if there was something I could do about it. He gave me a bunch of tests and told me there was. All I had to do was…

“Got it?” the allergist asked.

“I understand,” I claimed.

Then he showed me the printed after visit summary where he had written out the instructions. I learned that I had not understood. Not at all. I had them all screwed up.

The incident got me thinking about all the times I’ve had people in my office and watched them arrive at an important insight, only to forget about it as soon as they leave. I might prevent that from happening simply by writing an After Visit Summary just as my allergist had.

In this document, he summarized the things I had said about my allergies. He gave the test results. He listed the steps I could take to treat them. It seemed easy enough. I could do it, too.

After each session is complete, I write a summary note it anyway. All I had to do was share it with the client. Maybe I can’t produce it on the spot as my allergist had; I don’t want to have to write during the session, but I could send it later.

It proved to not be as easy as it sounds. First of all, a clinical note is a highly technical document, full of mysterious jargon, alienating, and objectifying of the patient. When I worked in a community mental health clinic, the lawyers and the insurance companies had inserted themselves into our note writing and forced us to fill the records with so much legal mumbo jumbo that it was impossible to find the point. I could never simply share a clinical note with a client and have it be helpful and understandable. It would have to be written respectfully, clearly, simply, and concisely; not because clients are idiots, far from it, but because the point of writing an After Visit Summary is to communicate.

Ordinary clinical notes are not written to communicate. No one ever reads them.

To be honest, I have not been the first to share notes with clients. Writing therapeutic letters reflecting on sessions is a pretty standard technique in narrative therapy. I tried doing this years ago, writing thoughtful letters to each client after every session. I might have continued, but it was time consuming. The clinic where I worked also required the usual clinical note. Then there was all the fuss and expense of stamps, envelopes, and printing. I soon abandoned the practice and forgot all about it until that day at the allergist.

Conditions are different now. I’m in private practice and I can adopt practices that suit me and my clients. Also, I don’t have to rely on the post office. We have the internet.

Getting the internet to work towards the objective of communicating with clients is another story, a long, involved one, with which I will not bore you. Suffice it to say that ordinary email is not secure enough to send summaries of sessions by. I had to enroll in an electronic medical record system that included an encrypted patient portal, but, luckily the technology is out there.

So, there you have it, my new development. We’ll have to see if it helps people progress faster in therapy or if it just causes new problems.

Here’s one. Just how do you summarize, organize, and interpret fifty minutes of conflict, fears, and angst? How do you pack it away in a manageable bundle?

That’s what therapy is anyway.

The Shrink’s Links: Crucible® Therapy

The Shrink’s Links

Bringing you the best of mental health on the internet every week.

Today’s Shrink’s link of the week is

Crucible® Therapy

I recently began a new series on relationships. I should say that I haven’t come up with these ideas solely out of my own head. I have my sources. The first is David Schnarch and what he calls Crucible® Therapy. The second is Gottman. More on Gottman later. For me, Schnarch provides much of the theoretical framework of how I work with couples; Gottman helps with the application.

Schnarch didn’t come up with these ideas solely out of his own head, either. He built on a foundation first laid by Murray Bowen, one of the pioneers of family therapy. While Bowen is not a household name, even in households comprised of shrinks, such as my own; he gave us such widely used concepts as boundaries, triangles, ideas about the influence of sibling position, and the differentiation of the self. Alright, maybe you never heard of the differentiation of the self, but you will when you read my series; again and again and again. I believe the concept is fundamental.

I’ve never been one to hand myself over completely to a guru and make his or her ideas and methods my own without adding many idiosyncratic twists. And, in case you were thinking of making me your guru, I don’t think you should either. I only keep the parts that work for me and seem to resonate with the couples who come to me for counseling.

There are two more things about Schnarch that I want to say. Yes, he has a funny name. Let’s get that out of the way first. Although, I must admit that, as a person with a very ordinary name, Wilson, I feel a little jealous of him. It’s distinctive, at least.

The second is this. You’ll see it if you go to his website. He has taken Bowen’s ideas, given them his own clever turns of phrase, and trademarked them so no one else can use them.

I understand why he does it. He’s protecting his investment. I think it’s outrageous. Science (and, yes, counseling psychology is a science, as well as an art) requires that there be a free exchange of ideas. Trademarking one’s expression of them just gets in the way.

So, in my series, I will respect the trademark law even though I don’t respect Schnarch’s use of it. When I use his, and Bowen’s ideas, I use my own phrases. Please feel free to pass them on and use them yourself.

Click here to go to the link

Click here to go to the entire Relationships series.

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