Q: Sometimes I feel like I’m not earning my money. I mean I’m not doing very much. The client is working and maybe even resolving something but I’m not doing very much besides just sitting there watching.
A: What you are being paid for is to provide an environment of unconditional positive regard. That is worth about a million dollars an hour. It is my perspective that an hour in such an environment is a respite from the culture and is therapeutic all by itself.

Q: I often feel afraid when I intervene in certain ways. However, if I don’t try out different interventions, I won’t learn what I’m supposed to be learning.
A: In session try following this credo: If you hear a train coming, get off the tracks. In other words, if you feel afraid, then there is danger; so protect yourself. Your internal alarm system does not differentiate between internal or external jeopardy. When there is danger, it goes into alert mode and signals, “Red light! Change activities!” by pumping fear-producing (fight or flight) biochemicals into your bloodstream. Over time, should you mostly not pay attention, your automatic system, in order to insist you protect yourself, has to up the ante, either by starting earlier or by increasing the amount of fear.

Q: He is fragile and threatened. If I guess something about him out loud, he plays dodgeball with me. He will crack jokes and get very concrete. He is so defended, that guessing is the really the only enactment I can do with him.
A: Hear your assessment of him. Perhaps you are right. Perhaps he is fragile and threatened. Perhaps he feels attacked by you. Perhaps the adherence to concreteness and the jokes are ways he protects himself from you.

Q: 16 y.o. recently began living with his mother again, this time with her new husband. His mother wants me to see him to help him adjust. The boy seems fairly normal and clearly is comfortable with his choice. I’d like to do step-family work with the family instead. You know, exploring and adjusting to new roles and rules, etc.
A: I often opt to see parents and adolescents in pairs.

Q: They are so enmeshed. I’ve done everything I know from teaching I-messages and using the session to practice negotiating, to directing them to use language that takes responsibility. Nothing changes.
A: Some pairs of people are too enmeshed to work with as a couple. They are so intertwined, that one can’t raise an eyebrow without a reaction from the other. Each brings their partner into therapy as a representative of their shadow-side, refuses to own it, and asks you to fix it. If this is the case here, do not be seduced into working within the ordinary couple’s frame of communi-cation skills and conflict resolution. In order to do couple’s work, you need to think of the two of them as one thing in order to work with their process but they need to perceive themselves as two individuals.

Q: An eight-year-old draws houses with huge roofs. If I can just figure out what her symbolism is, I’ll be able to understand her.
A: Nearly every person on this planet has had parents, friends, relatives, neighbors and total strangers trying to figure them out since the person was born. The probability that a psychologically sophisticated observer such as yourself would be able to correctly interpret drawings, behaviors, speech, and body language, might be as high as seventy to ninety percent. Suppose that you have managed to break this girl’s symbolism code. Now you know stuff about her that she does not even know herself. This may be intellectually satisfying for you and alleviate some of your existential anxiety about not knowing what do to next, but it does not directly do anything for the girl at all.

Q: I thought she was so easy to work with; she does everything I suggest. But I wonder lately why nothing ever gets resolved.
A: You suspect this person has been playing please-the-therapist and stockpiling resentment every time she agrees to do what you suggest. This is quite possible. The habitual placater is nice to be with, but too often the niceness is at their own expense. Consequently, they are usually angry underneath that pleasant demeanor.

Q: She is twelve. She won’t cooperate at home and does the minimum she has to do in session, too. She is passive-aggressive. For example, I’ll ask her to do a drawing or ask her a question and she’ll draw a stick figure or shrug. Her attitude is, “I don’t want to do much, I’d rather sit home and watch t.v.”
A: Angry twelve-year-olds are supposed to be passive-aggressive. Not only is it the law, it is part of the human genetic structure. The down side is, of course, that depressive behavior can become habitual.

Q: She is low functioning, low fee and wants only to discuss a particular book. Although she is delighted when I invite her to connect with her responses to the book’s passages, I still find myself dreading sessions.
A: After exploring the matter a while, you agreed that if you were being paid a thousand dollars per hour, you would not dread seeing this client at all!

Q: He resists working in metaphors. He is intelligent but insists he has no imagination.
A: Think to yourself some version of, “Oh, goody, now I get to use my imagination. One thing you might try is to make a sandtray while he is talking, resisting, and insisting.