Clinical Examples

Individual Therapy:

The case I want to discuss is about a woman who was in individual therapy. She entered therapy because of a general malaise in her life. No specific symptoms were formulated by her — only that she felt “stuck” in her life.

I began to see, after obtaining a detailed family history, that the problems this patient was presenting stemmed from the numerous separations she experienced because of the mother’s illness and the final ultimate separation resulting in the death of her mother when she was eleven years old. So a major theme of her treatment was dealing with issues of separation anxiety. It was not safe to leave mother. This got represented by her always breaking off her relationships with men whenever they got serious. At first, we did not understand this connection. After analyzing many dreams and her associations to the dreams what began to emerge is that if she were to marry she would have babies. “Marriage means having babies she said.”  She added, “having babies means that you will die.”  So one might ask, how does her family history connect with what is happening in her present day life?  The history is that her mother became ill after the birth of her brother, seven years her senior. So the mother was sick during the seven years before her birth and throughout her life. The mother finally died eighteen years after she gave birth to her brother when the patient was eleven years old. “Getting married means having babies”, she said again. So we see here how her past family life impacted and was repeated in her present day life.

She is avoiding serious relationships with men so that she won’t have babies and die like her mother did. This, she was not conscious of before she entered treatment.  It was only after analyzing her thoughts, dreams, etc., that we were able to understand what was making her feel stuck.

Much work went on regarding this issue now that she was consciously aware of what she was enacting. She finally reached a stage where she was not frightened to be in a relationship. She did enter a serious relationship.

She is now married and has two children. She worked through her past unconscious fears of getting married and having babies and therefore dying like her mother did. She no longer felt “stuck”.

Child/Adolescent Therapy:

I was seeing an adolescent who was threatening to kill herself. Whenever she was in sessions she cried profusely about how her mom does not spend much time with her and never listens to her complaints to her about relationship with her sister. She also complained that her mother didn’t work but spent so much of her time volunteering her time on Boards and other functions.

Of course, I dealt with the adolescent about the issues she felt about her mom not working but doing other things. We worked on the fact that even though her mother didn’t work that didn’t mean that her mom should stay home at all times. I explained to her that she wasn’t a little girl anymore and needed her mommy there all the time — that her mom also has a life. However, I told her that she was right that her mom should be there for her when she needed her. I asked her permission to discuss this with her mom so that we can improve things. She agreed and I did bring up these issues with the mom. I helped the mother to understand the problems her daughter was having with her and regarding her sister and explained to the mom that she needed to intervene on the adolescents’ behalf. The mother heard me. She was able to make many changes — one, by really being able to be there for her daughter, like, for example, paying closer attention to what the sister was doing to the adolescent and making sure that that wasn’t happening anymore. When it did the mother disciplined the sister and let her other daughter be aware of what she was doing. This provided emotional support for the adolescent.

Let’s remember that her mom is not in the past as it would be for an adult. An adolescent usually still lives with their parents, as, of course, a child does. This adolescent lives with her mom. It is not past family relationships only. My work with parents of children and adolescents involves the here and now of what is going in the family, as well.

Marriage Therapy:

I’d like to give an example of how psychodynamic psychotherapy is applied in marital therapy.

A number of years ago I saw a couple who came into treatment because the woman kept putting up walls and kept withdrawing from the marriage. I worked for a long time pointing that out to the woman. She dealt with the issues of her past and how her mother was not there for her. What she learned from that was to protect herself by putting up a wall. The woman made great efforts to remove the wall between her and her husband. Now that she was much better able to work on her issues she was able to have much less of a wall. Moreover, she was able to point out something about her husband.

Before he met his wife this man had been involved with a woman for three years. He proposed. The next day after he proposed the woman broke off with him.

The point here: It was time for this husband to see that the problem didn’t just lie with his wife. He had to start looking at his own problems that were generated from his past family life. He was choosing women who were not really there. When he began to look at his history and how his issues came from his past the marriage was able to improve a great deal. Each person was able to work on the issues of their past that led to their problems.

ADD/ADHD Coaching Parent and Child:

I would like to give a clinical example of the coaching work I did with a mother and her son. I have given talks to CHADD  (A National Organization dealing with Attention Deficit Disorders in Children, Adolescents  and Adults) NY Chapter – www.chadd.org) where I have discussed my work with this mother.

I saw a woman in consultation who was very upset about her child. At the time of this initial consultation she described her child as extremely bright. He was in nursery school at a private school in Manhattan. She was concerned because he couldn’t write his name, whereas, other children in his class were able to write theirs. His was a simple three letter name — Dan.

After meeting with her and hearing the different issues that she was concerned about  I recommended that she bring her son to be tested by a neuropsychologist. I recommended someone to her. When the mother told the Head of Nursery Years and the School Psychologist that she was going to have her child tested, the Head of School told her that she was an over-anxious mother. Of course, she came in and told me about this. I told her, given what she has told me that, I, too, was concerned about her son and that she should ignore what they were saying and that she should trust her instincts and go ahead with the testing. I told her that the worst thing that could happen is that we were in error and that there is nothing wrong with him. But if there is she will be giving her son the treatment that he needs.

Fast forward, the child was diagnosed with dysgraphia and ADD/ADHD. The mother brought her son to the tutor who worked with him for his dysgraphia. When the mother told me that the tutor just kept having the child write Aa, Bb, Cc, etc., etc., at every session I told the mother that she needed to find someone else. I asked around and helped her find a wonderful tutor. This tutor took the time to find out what this little boy was interested in. They began writing stories on what the tutor found captured the little boy’s interest. Fast forward again, by the time he got to grade one he was able to write.

As for the ADD/ADHD, of course, he was put on medication for that. But in addition to the medication, I worked with the mother. I coached her on how to handle him when he got home from school. “Have him get a snack and then go do his homework”, I said.  Every day, the mom or the babysitter would sit in his room and make sure that all his homework got done.

The mother and/or the babysitter did this right up until the time he went away to college. As he got older, the door to his room had to stay open when homework needed to get done, so that either the mom or babysitter could make sure his homework was indeed getting finished. For some years I did not see this mother because her son was doing very well at the same prestigious private school that he attended since nursery years. She was in a panic about what would happen when he went away to college. I assured her that he probably has internalized what has gone on all these years in his family. Of course, if he begins to have problems we’ll deal with it then, I told her. Off he went to college. Sure enough when he got to Harvard, not only did he follow the pattern he did all his school life about doing his school work but he went off his medicine and took it only during exam time. He was able to do this on his own because of what he had internalized growing up. He graduated from Harvard and then went on to Medical School and then a Residency in paediatrics. He is a successful paediatrician today.

Because of my experience with this mother over the years I have begun offering ADD/ADHD Coaching groups. I run groups for parents of ADD/ADHD children and adolescents and also ADD/ADHD groups for people who have ADD/ADHD.

Marriage Mediator:

I have training in family and couples therapy, child and adolescent therapy, adult therapy and group therapy. I also teach students how to do therapy in all these modalities.

I have a plethora of experience dealing with people in conflict. I work with people to resolve their issues, whether it be for couples working through things to come together or to help couples arrive at an amicable divorce. This is, of course, important for the couple but, needless to say, when there are children involved it is important to help the couple prepare their children (no matter what their ages) for the parents’ divorce. I also work with couples helping them make child custody arrangements and how to tell their children about their impending divorce. In addition I also work with people individually who may want to seek out professional help but have not yet discussed the prospect of divorce with their spouse. I work with people who have already undergone a divorce and would like some follow-up help to deal with the aftermath of a divorce.  In other words, if you are just contemplating a divorce, or planning a divorce, or are in the aftermath of a divorce, I will help you work through the various stages in which you find yourself.

For those clients that stay in therapy after a divorce I work with them to look at how they chose their spouse — so that they do not repeat the same mistakes. That is, I help clients work through the issues of their past that influence their present life. Therapy can help you not repeat the past.

I, not only, specialize in divorce mediation and negotiating child custody arrangements but also deal with people presenting problems such as depression, anxiety disorders, sexual problems, relationship problems and work problems.

If, after working together, the couple have agreed upon a divorce, I refer them to a divorce attorney to navigate the legal aspects of a divorce.

I also work directly with Divorce and Mediation lawyers to help the lawyers with their clients who have emotional problems and/or who need help with child custody arrangements.