Warm, direct, and genuinely collaborative

Insight alone changes very little. Some of the most self-aware people I have met have been repeating the same relationship for fifteen years and can explain exactly why. Understanding a pattern is necessary and it is not sufficient. Change happens when understanding meets repetition — the same new response, practiced on unremarkable days, long enough that it becomes available on a bad one.

Most of therapy is boring. The transformative sessions are real, and there are perhaps four of them a year. The rest is steady, repetitive, occasionally tedious work: tracking a week, rehearsing a sentence, noticing the same thing for the ninth time. Anyone promising you a series of breakthroughs is describing a film about therapy rather than therapy.

Symptoms usually make sense. The behavior that is currently costing you the most probably started as an intelligent solution to a situation where it was the best available option. I am not interested in pathologizing an adaptation. I am interested in whether it is still earning its keep.

Neutrality is often just withholding. I have opinions and I will tell you what they are. You are welcome to disagree with me, out loud, in the room. Some of the best work I have done has come immediately after a client told me I had it wrong.

Why I do this. I work with a diagnostic group that a great deal of the field quietly avoids and describes badly. People with intense emotions and unstable relationships are frequently the most perceptive, loyal, and alive people in the room, and they are routinely handed language that makes them sound like a hazard. Doing this work well, with people who have been written off before, is the part of the job I would not trade.