Catching up…

I’m back.  I’m here.  I want to catch us up on the past several years.  I took a hiatus from this blog–that’s quite evident.  But if I wasn’t posting, what was I doing?  Most of what I was doing was my usual thing.  Living my life, taking care of myself and my family, working with my clients, managing my office and trying to balance all of it.  I’ve gotten a whole lot better at it and I’ve allowed myself to cut back where I needed and add-on where I wanted.  It just took some doing.  And I did it. 

I’ve focused a lot of my professional energy these past several years on issues around sexuality and gender.  I have always seen a lot of LGBTQ folks but in recent years that work has become the most purposeful and intentional work that I do.  That doesn’t mean I don’t love all the other things I get to do–I am grateful for all my clients, the issues they bring to me, and the lessons they teach me.  The work I do around sexuality and gender, especially gender, has been the some of the most fulfilling and inspirational work I’ve done in a long time.  The big shift came when I decided to attend WPATH’s (World Professional Association of Transgender Health) Symposium in 2011.  Truth be told, most conferences leaves me disappointed or wanting/needing more.  WPATH’s symposium was very different.  I met some of the most amazing people doing incredible work all over the world.  It was fascinating and inspiring and it spurred my commitment to the work. 

I have since created a focus in my private practice on seeing gender-diverse and trans* clients.  I see kids, youth, young adults, adults and families as they unravel and discover the spaces and language and meaning around their gender identity.  Some of my clients are edgy and out-loud, others are quite “average” and low-key.  Some come to explore their gender, others come to deal with all the other sorted issues in life and their gender is a backdrop.  Some are eager for intervention and change, others move slowly or grapple with change altogether.  Some are so excited about what they come to know, others are scared and overwhelmed.  The common thread throughout is the strength and self-devotion it takes to acknowledge their truths, to give voice to those truths, to explore the meaning for them and to decide what they can give and do for themselves to create their most authentic existence.  It’s a complete honor to be a part of such an amazing and personal journey with people.

I love the work so much that I have stretched beyond seeing folks in my office.  I have made several presentations to groups about working with gender-diverse and transgender clients.  I’m not typically excited to present but I have the best time when I get to talk about this issue.  It feels like a calling and I am glad to honor it.  I have also been working to collaborate as much as possible with local folks who share a goal of making St. Louis a place that celebrates, affirms, services and holds up gender diversity.  I have recently started a Gender Consultation group with a few other therapists who share a love for the work.  I also stay closely connected to Transparent, the local parent support group, and am working to help support the amazing work they do in our community. 

I tell you this because I am proud and excited but also as a preface since many of my posts will revolve around these issues.  I hope you find the information I provide here helpful or growth-producing.  Feel free to send me feedback, I’m happy to know you’re out there. 



I’m Coming Back.

I decided I needed to announce this so that 1.) You can look for or forward to it 2.) I will follow up and get back to posting.  I didn’t mean to take such a long break but I spent three years serving on a Board and focusing my attention in other places.  This is my declaration that I would like to get back to the education and connection that I strive for with my blog.  I hope you will stay tuned and will benefit from some of my musings.  I will be back…

It Will Get Better.

Here is a link to a great YouTube project to let LGBT teens know that “it gets better”.  It follows the suicide of a gay teen who was bullied by his peers for being gay.

What an honor to help support and know all my clients who have lived with hard questions and heavy hearts about who they are and who they love.  We must open the door to promise, safety, love and acceptance for EVERYONE.  Bigotry will not win.

What lies behind us and what lies before us are small matters compared to what lies within us. And when we bring what is within us out into the world, miracles happen.
-Ralph Waldo Emerson

I believe we are all strong beyond measure, even when we feel embarrassingly weak, and that we have a natural tendency to rise up to what lies before us.  This power of the human spirit often leaves me in awe.  I bear witness to great tragedies through the stories of my clients and I see (and feel) a full range of raw, gripping emotions.  As a therapist, my hope is to awaken people to their own energy and help them plug into this innate, core strength.  You’ve felt it before, right?  Life will always bring us uncertainty, struggle and pain.  The real power is deciding what to do then.  Lying down is not an option.

A Thought from the Universe

An email sent to me by a wise woman…
The slate’s been wiped clean, the past has released its grip, and before you sparkles eternity, yearning for direction. All that lies between you and the life of your dreams is just one teeny, tiny, gentle, little rule. Only one condition, prerequisite, principle that matters.
It’s not love. It’s not God. It’s not fate, or luck, or karma. It’s not complicated or esoteric, and you needn’t sacrifice, plead, or pray to invoke it. It’s the only rule that’s ever existed, and it’s the only one that will ever exist. No reality can exist in its absence. For its mere existence, you are. With its existence, the power, the light, and the way are revealed. It’s your purpose to discover it, and it’s your destiny to master it. It’s the beginning, the middle, and the end. The Alpha and the Omega. The be-all and end-all of every wish, desire, and dream, and you are its keeper.
This caveat of all caveats is that absolutely nothing can be anything until it is first imagined. Thoughts become things, nothing else does. And so, it’s the thoughts you choose from here on out that will become the things and events of your life, forevermore. It is written in stone. There’s no other way. It’s your ticket to anywhere you can dream of. Your passport to abundance, health, and friendships. The key to the palace of your wildest dreams.
Your thoughts, and your thoughts alone, will set you in motion. Your thoughts will yield the inspiration, creativity, and determination you need. Your thoughts will orchestrate the magic and inspire the Universe. Your thoughts will carry you to the finish line if you just keep thinking them. Never give up. Never waiver, doubt, or ask.
Aim high.
That you’ve even received this Note, that you’re able to read it through, means you are so close. So extraordinarily close. The hardest work has been done. The wars have already been waged. The lessons have already been learned. The journey, now, is for home.

Therapy Works and You Don’t Just Have to Take My Word For It!

January 25, 2010

Psychodynamic Psychotherapy Brings Lasting Benefits through Self-Knowledge

Patients Continue to Improve After Treatment Ends, New Study Finds

WASHINGTON—Psychodynamic psychotherapy is effective for a wide range of mental health symptoms, including depression, anxiety, panic and stress-related physical ailments, and the benefits of the therapy grow after treatment has ended, according to new research published by the American Psychological Association. Psychodynamic therapy focuses on the psychological roots of emotional suffering. Its hallmarks are self-reflection and self-examination, and the use of the relationship between therapist and patient as a window into problematic relationship patterns in the patient’s life. Its goal is not only to alleviate the most obvious symptoms but to help people lead healthier lives. “The American public has been told that only newer, symptom-focused treatments like cognitive behavior therapy or medication have scientific support,” said study author Jonathan Shedler, PhD, of the University of Colorado Denver School of Medicine. “The actual scientific evidence shows that psychodynamic therapy is highly effective. The benefits are at least as large as those of other psychotherapies, and they last.” To reach these conclusions, Shedler reviewed eight meta-analyses comprising 160 studies of psychodynamic therapy, plus nine meta-analyses of other psychological treatments and antidepressant medications. Shedler focused on effect size, which measures the amount of change produced by each treatment. An effect size of 0.80 is considered a large effect in psychological and medical research. One major meta-analysis of psychodynamic therapy included 1,431 patients with a range of mental health problems and found an effect size of 0.97 for overall symptom improvement (the therapy was typically once per week and lasted less than a year). The effect size increased by 50 percent, to 1.51, when patients were re-evaluated nine or more months after therapy ended. The effect size for the most widely used antidepressant medications is a more modest 0.31. The findings are published in the February issue of American Psychologist, the flagship journal of the American Psychological Association.

The eight meta-analyses, representing the best available scientific evidence on psychodynamic therapy, all showed substantial treatment benefits, according to Shedler. Effect sizes were impressive even for personality disorders—deeply ingrained maladaptive traits that are notoriously difficult to treat, he said. “The consistent trend toward larger effect sizes at follow-up suggests that psychodynamic psychotherapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended,” Shedler said. “In contrast, the benefits of other ‘empirically supported’ therapies tend to diminish over time for the most common conditions, like depression and generalized anxiety.” “Pharmaceutical companies and health insurance companies have a financial incentive to promote the view that mental suffering can be reduced to lists of symptoms, and that treatment means managing those symptoms and little else. For some specific psychiatric conditions, this makes sense,” he added. “But more often, emotional suffering is woven into the fabric of the person’s life and rooted in relationship patterns, inner contradictions and emotional blind spots. This is what psychodynamic therapy is designed to address.” Shedler acknowledged that there are many more studies of other psychological treatments (other than psychodynamic), and that the developers of other therapies took the lead in recognizing the importance of rigorous scientific evaluation. “Accountability is crucial,” said Shedler. “But now that research is putting psychodynamic therapy to the test, we are not seeing evidence that the newer therapies are more effective.” Shedler also noted that existing research does not adequately capture the benefits that psychodynamic therapy aims to achieve. “It is easy to measure change in acute symptoms, harder to measure deeper personality changes. But it can be done.” The research also suggests that when other psychotherapies are effective, it may be because they include unacknowledged psychodynamic elements. “When you look past therapy ‘brand names’ and look at what the effective therapists are actually doing, it turns out they are doing what psychodynamic therapists have always done—facilitating self-exploration, examining emotional blind spots, understanding relationship patterns.” Four studies of therapy for depression used actual recordings of therapy sessions to study what therapists said and did that was effective or ineffective. The more the therapists acted like psychodynamic therapists, the better the outcome, Shedler said. “This was true regardless of the kind of therapy the therapists believed they were providing.” Article: “The Efficacy of Psychodynamic Psychotherapy,” Jonathan K. Shedler, PhD, University of Colorado Denver School of Medicine; American Psychologist, Vol. 65. No.2. The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.