Do We Really Need Help?
Developing and maintaining a satisfying couple partnership is perhaps one of the greatest challenges of adulthood. The divorce rate has been falling slightly since 1980, with approximately 40-50% of marriages ending in divorce in 2017 (although there is much debate about the exact number and how to measure the divorce rate). The increase in cohabitation and later first marriages likely contribute to changes in the divorce rate.

The next question is what percentage of married couples are actually happy together? Obviously, there isn't a precise measurement for this, but in general 25-50% of couples who are together report not being happy.

Unhappy Marriages and Partnerships are a Life-Threatening Issue
Being in an unhappy marriage significantly impacts a person's physical and emotional health as well as life expectancy. People in unhappy marriages take longer to heal from simple wounds and illnesses and have higher rates of heart disease, stroke, diabetes, sleep issues, and obesity. They are more likely to die 11 years sooner than those in happier relationships. Rates of mental health issues, such as depression and anxiety, are higher in unhappy relationships.

The Not-So-Good News
When researching the effectiveness of couples therapy models, distressed couples are one of the few types of clients we do not need a control group for. Why? Once distressed, couples rarely if ever get better without treatment. In marked contrast, people with depression and anxiety often get better without treatment. Some research has found that the average couple comes to therapy 7 years too late.

The Good News
The good news is that 70% of couples who participate in an evidence-based couples therapy process, such as emotionally focused therapy (EFT) or integrated behavioral couples therapy (IBCT), get better.

My Approach to Working with Couples

Comprehensive Assessment: I begin with a comprehensive assessment that includes an interview with the couple together and each partner separately to ensure they are ready for couples work. I also conduct an assessment of individual and couple functioning to address key relational issues and rule out psychological or physiological issues that may be a significant factor in the couple's distress. Beginning with a comprehensive understanding of the psychological, relational, and physiological factors ensures that treatment is focused on the right issues.

Early Treatment: In the early phase of treatment, I work with the couple to quickly identify the fundamental interactional patterns and perceptions that generate the conflict and/or distress. I educate the couple on the dynamics of relationships to reduce self- and other-blame and increase compassion and understanding. I draw primarily from EFT and IBCT in my couples work.
Shifting the Negative Patterns and Re-establishing Safety: Once we have identified the communication and behavioral patterns that need to shift, we work in-session to fundamentally shift these so that couples can change how they communicate and behave outside of session as well. Most couples are able to achieve this within 6-12 sessions.

Long-term Relational Wellness: Finally, I work with couples to develop well-established habits, routines, and communication patterns that will enable them to handle the next stressor life throws at them.

For specific issues regarding divorce and remarriage, click here.
If you are in an abusive relationship, click here.
For information on working with me on sexuality issues and sex addiction, click here.

Recommended Reading For Couples

These books should be required reading for anyone wanting a committed romantic relationship and are essential single and coupled adults. Most couples find that reading evidence-based books about the science of couple relationships significantly helps them develop the right focus to resolve their issues.
Written by the developer of one of the only two evidence-based treatments for distressed couples, Hold Me Tight provides an outstanding roadmap for maintaining a health relationship. The first three chapters on adult attachment in romantic relationships should be required reading for everyone who turns 18 years of age. Sue Johnson clearly outlines the underlying emotional and survival role intimate relationships play in our lives and uses this explain why we can behave so badly once committed. She then outlines seven conversations she recommends couples should have to create an emotionally safe relationship for years to come. This book is essential for anyone wanting a stable, long-term relationship.
Written by the developer of one of the only two evidence-based treatments for distressed couples (Sue Johnson’s was the other), Reconcilable Differences is the leading cognitive-behavioral approach to helping couples build long-term, satisfying relationships. The book helps partners to examine their differences and find new ways to understand each other, communicate better, and solve problems effectively. This is another essential read for anyone wanting to improve the quality of their current or future relationships.
Written by a leading relationship researcher, The Seven Principles that Make a Marriage Work provides anyone in a committed relationship with research-based recommendations for what one should focus on to have a successful relationship. Whether beginning a new relationship, in a stable one, or between relationships, this book is a classic for understanding the essential behaviors and attitudes needed to succeed while also correcting many myths about committed relationships.

Divorce and Remarriage

Surviving and Thriving Through Divorce
Although the overall divorce rate is falling, it is rising sharply for those 40 and over, with the decline only for those aged 25-39. Divorce is one of the top three stressors in life, and is often coupled with moving, another of the top three. When divorces become highly conflictual, the psychological, physical, and financial toll are nearly unbearable.

Coping with divorce requires significant emotional-regulation skills and a chance grieve the loss of the most important relationship in a person's life. However, when you thoughtfully and honestly approach divorce with a commitment to learning from this most painful life experience you can ultimately move on to create a more joyful and fulfilling life. But getting through the divorce transition can test even the most resilient of us.

Divorce and Children
When handled well, children can thrive after a period of adjustment to their parents' divorce. The key is LOW CONFLICT. In fact, children are at risk for numerous problems, including depression, anxiety, drug use, school dropout, when there is high conflict between their parents—whether divorced or in the same house. In fact, children whose parents argue frequently in the home have the same risks for poor outcomes as children from high-conflict divorced parents.

Remarriage
The majority of households in US are now blended families, surpassing nuclear and single-parent households. However, the blending of two families can be a challenge, and most couples underestimate how long and slow the process should take. Experts estimate that most blended families need 5 years to successful transition to a sense of integration and wholeness.

My Approach to Working with Divorce and Remarriage

Comprehensive Assessment: I begin with a comprehensive assessment that includes not only standard DSM diagnosis, but also consider specific brain-based subtypes of stress; relational dynamics that inform choice of treatment; and other physical factors that may contribute to the symptoms. Beginning with a comprehensive understanding of the psychological, relational, and physiological factors ensures that treatment is focused on the right issues.

Early Treatment: The initial phases of treatment focus on helping clients to emotionally process the divorce and cope with the numerous stressors that are involved in the process. If there are children involved, addressing parenting issues is also critical. Managing the strong emotions involved with divorce is essential to reducing potential damage from unnecessarily hostile legal battles, dragging children into the conflict, or making poor choices as a way to cope.

Recovery Phase: Once the crisis issues are stabilized, I work with clients to identify what happened in their marriage and what they can learn from this. Without 6-12 months of honest reflection on your own role in the dissolved marriage, you are almost always guaranteed to repeat the pattern again in your next relationship. When you do the work to examine your patterns, you are much more likely to enter into a healthier relationship next time.

Moving On to a New Life: In the final phase, I help clients in rebuilding a happier life and improved skills for maintaining health relationships. Although it often did not seem possible at first, my clients invariably emerge from divorce more confident and happier than before, leading a life more closely aligned with their dreams.

Recommended Reading

Most clients find that reading books on related to divorce help support them in coping with the strong emotions, fears, and loss and reduce the sense of failure and isolation.
Rebuilding provides a comprehensive guidebook from the initial shock of divorce to creating a new, vibrant future. The authors provide guidance in coping with the many difficult emotions related to divorce, such as grief, guilt, rejection, loneliness, and trust.
Getting Past Your Break Up provides a non-nonsense guide for recovering from a potentially conflictual breakup by helping you set clear boundaries that allow you to focus on healing. The book also addresses how to make life easier for children during the divorce and strategies for moving on.
The Co-Parenting Handbook guides parents through the separation and divorce process with a focus on minimizing negative effects on the children. It covers common areas of conflict, such as holidays, new partners, public spaces, and finances.
Saving Your Second Marriage Before It Starts guides you through a series of nine questions to reflect on whether you are ready to start again. It educates on essential relationship skills correlated with happy marriages.
The Divorce Workbook for Children has 40 activities to help children discuss their feelings and cope with divorce. It can also be used as a reference for discussing divorce with your children.
Written for younger children, Two Homes is a storybook that helps children adjust to common changes that are part of divorce.

Abusive Relationships

Abusive Relationships
Intimate partner or domestic violence is common with 1% of all women being victims in a given year and 24% being victims of severe abuse at some period in their life. More common but less easily detected, emotional abuse involves specific patterns of isolation, possessiveness, demeaning comments, threats to harm themselves or others, withholding information, controlling finances and major decisions. The crux of emotional abuse is when one partner's repeated control tactics result in the other partner's focus on avoiding the negative, abusive behaviors and comments of the other partner. Emotional abuse is always present with physical and sexual abuse of a partner, and is always the most difficult form of abuse to overcome. Researchers estimate at 35% of women have been emotionally abusive relationships.

Men are also the victims of emotional abuse. Emotionally abusive women use tactics such as insults, false accusations, threats to harm themselves or others, isolation, controlling information, and controlling the finances.

Honeymoon to Abuse
Most abusive relationships start out with very low conflict and high romance. Think Casanova, flowers, gifts, and romantic dinners. The abusive behaviors may take 6-18 months to appear. Then the couple begins to move through a pattern of honeymoon (high romance and promises for change) and tension leading to abuse (whether physical, sexual or psychological). In initially, there are long periods between the honeymoon and abuse phases, but over time the incidents get closer together. The abuser is like two different people in each phase: Dr. Jekyll and Mr. Hyde. This dramatic shift in character makes it difficult for the abused partner to make sense of what is going on.

Personality Disorders and Emotional Abuse: Borderline, Narcissist, and Antisocial
The National Institutes of Health estimate that 9.1% of Americans qualify for personality disorder diagnosis. A personality disorder involves deeply ingrained and maladaptive patterns of behavior that are most apparent in intimate relationships. In recent years, professionals have sought to identify specific patterns of emotional abuse frequently found in three of the most common types of personality disorders: borderline, narcissistic, and antisocial. For some clients, understanding these personality dynamics is useful in recovering from their abusive relationship experience.

My Approach to Abusive Relationships

Comprehensive Assessment: I begin with a comprehensive assessment that includes not only standard DSM diagnosis, but also consider specific brain-based understanding of human behavior; relational dynamics that inform choice of treatment; and other physical factors that may contribute to the symptoms. Beginning with a comprehensive understanding of the psychological, relational, and physiological factors ensures that treatment is focused on the right issues.

Early Treatment:
When working with women and men who have been in abusive relationship, I begin with education about abuse to help them better understand their experience and reduce self doubt. Many of these clients are also struggling with PTSD, depression, and anxiety, and so I also address these issues to increase their ability cope.

Resolving the Abuse:
Once clients are more emotionally stable, I work with them to examine the abuse dynamic, explore why they responded as they did, and identify early life events that may explain their response. We then begin to identify specific behaviors that the person needs to change to ensure that they don't end up in a similar relationship in the future. Most of my clients find that certain behaviors, such as not asserting their needs, that lead them to tolerate abusive behavior are also present to a lesser extent in other relationships.

Moving On:
Finally, I help clients rebuild their lives, including helping them through the dating process, which is where old patterns are most likely to repeat themselves.

Recommended Reading

Why Does He Do That? examines the psychology of men who are verbally abusive. Bancroft argue that the underlying belief that leads to such abuse is male privilege. He also identifies several different types of male abusers. This book can be helpful for those trying to make sense of a psychologically abusive relationship.
The Dating Radar guides you in identifying common personality disorder types early in the dating process.
A Harvard psychologist, Stout radically proposes that most sociopaths are not serial kills, but rather charming yet manipulative people that not only lack empathy but a conscience. She estimates that 1 in 25 Americans fits this profile, who manipulate others for not only financial gain but also a personal sense of power and fulfillment. This book can be helpful in understanding some of your most challenging relationships.
Sociopath Free helps anyone recovering from a toxic relationship with an emotionally abusive partner. MacKenzie explains how anyone can initially get pulled into such a relationship, helping to alleviate nagging questions, such as “how did I not see this?” He also outlines a path to recovery and wholeness.

Sexuality

The age of the internet, social media, and non-stop external stimulation has made navigating our sexuality increasingly complex. Sexual dysfunction is highly prevalent, with 43% of women and 31% of men reporting these concerns. Low sex drive is on the rise, with 30% of women and 15% of men reporting git as an issue. Sexual arousal disorders, such as erectile dysfunction, is an issue with 10% of men 20% of women, while 30% of men report premature ejaculation issues. There is also an increase in delayed ejaculation, which is correlated with pornography use. In 2017, 42.7% of internet users reported viewing internet pornography, with 6-8% of Americans struggling with sexual addiction.

At the same time, neuroscience is providing a whole new understanding of the psychological and physiological mechanisms of sexual response and desire. Although a delicate topic, sexual concerns are a concern for individuals and couples alike.

My Approach

Comprehensive Assessment: I begin with a comprehensive assessment that considers individual and couple (if partnered) functioning to address key relational issues and rule out psychological or physiological issues that may be a significant factor in the dysfunction. Beginning with a comprehensive understanding of the psychological, relational, and physiological factors ensures that treatment is focused on the right issues.

Early Treatment: Early treatment of sexual addiction focuses on addressing the psychological, emotional, relational and biological underlying the compulsive behavior and taking concrete steps to get it under control. With other sexual concerns, we explore beliefs, expectations, relational dynamics, and attitudes that relate and typically underlie the sexual concerns.

Cultivating Healthy Sexuality and Intimacy: Once compulsive behaviors are better under control, new attitudes towards sex are established, and/or relational dynamics are improved, I work with individuals and couples to develop a healthy approach to sexuality and increased ability to experience emotional intimacy in couple relationships.

Recommended Reading

Come as You Are reveals the latest science on the why and how women's sexuality works, radically changing how you understand and approach sex.
Mating in Captivity offers a bold new perspective on intimacy and sex in committed relationships by carefully examining the paradox of sustaining desire in monogamous relationships.
In State of Affairs, Perel offers new insights into affairs and the modern marriage, examining personal and cultural attitudes about love, lust, and commitment. Her insights offer couples struggling with infidelity with a new and hopeful perspective for understanding their situation.
Breaking the Cycle helps you end the cycle of sex addiction by examining your unique story and then providing practical guidance for taking back control of your sexual choices to preparing you to experience true intimacy.
An essential book for parents and their boys, Your Brain on Porn reveals the many unexpected outcomes and symptoms of the internet pornography use. Scientists are learning that this specific form of pornography is resulting in a dramatic increase in sexual dysfunction in young men, including premature ejaculation, delayed ejaculation, and erectile dysfunction.