FAQ

First, I’ll share my understanding of psychopathology. “Pathology,” refers to the idea that a combination of genetics, environmental factors, and negative experiences can distort our behavior, decision-making processes, and personalities- rendering us dysfunctional in relationships and as participants in society.

A diagnosis can be thought of as a label for the dysfunction, or as a way of talking about a series of behaviors, experiences, and needs, and is given to an individual. Providing a diagnosis for a client is based on criteria outlined in the Diagnostic and Statistical Manual V (DSM-V) which is based on research and evolving understandings of disorders. The idea of a disorder or a mental health condition that may be labeled as such is predicated on the belief that there is something abnormal about a person’s experience, or wrong about how they express their sense of discomfort. It pre-supposes that the experience is inherent to the individual rather than an effect of relational processes in a system.

While diagnoses can help clients qualify for insurance benefits or access various resources, historically and presently, diagnoses also have the potential for others (including the diagnosed person) to tell a story about the client (or themselves); about who they are, and what they are or are not capable of. At times, this can be bureaucratically exploited barring people from ever accessing insurance as companies consider an increase in liability, or can influence bias in legal rulings. They can be exploited in relationships to diminish textured, complex experiences and flatten a partner, spouse, parent, or sibling into a mental illness, rather than a whole person capable of understanding, transformation, and worthy of love, respect for their dignity, and opportunity. While diagnoses can, at once, describe a series of symptoms -which may come as a relief to some clients- it can also function to dehumanize or decontextualize a rich, sensical experience.

In relationships, diagnoses have the potential to run the risk of becoming a foil for accountability and change from clients and partners. They also have the potential to bring a greater sense of understanding, compassion, and way of talking about the problem. The use or exploitation of how a diagnosis functions shapes how we will proceed with assessment and formally documenting it.

For those of whom a diagnosis would be affirming, or for those who are curious about a diagnosis, I will collaborate with you on taking thorough, current assessment measures to create an accurate diagnosis. We will discuss the potential effects and consequences of documenting a diagnosis beforehand. We will also briefly discuss the fact that assessments are developed within the broader context of a pathologizing system, and the inherent limitations of an assessment.

For me, “non-pathologizing,” means that I practice from the stance that behavior, attitudes, choices, and our expression of self, make sense in context. Together we seek to deconstruct the ways a problem, or unwanted beliefs and expressions came to be, and reconstruct new, preferred realities together. “Non-pathologizing” means that I will not reflect a story or perspective back to you which locks you into a limiting way of being, hampering your potential for transformation in our therapeutic relationship, nor which dishonors your inherent dignity. I will continue to stay open to the myriad ways we can talk about your experience. “Non-pathologizing” means I understand and care about the consequences you may experience when seeking and accepting a diagnosis and I will provide you with information about the potential risks and benefits so that you are choosing how your reality is constructed, rather than deciding for you, possibly impacting you beyond our work together.

I am conscious of embodying and practicing therapy from the collaborative-dialogic stance. This is a post-modern, social constructionist, approach to creating conversations and new realities, articulated by Harlene Anderson, PhD., and Harry Goolishian, PhD., in the 80’s and 90’s. [Resources for learning more about the philosophical stance are linked in later questions and answers.]

A major tenet of the practice is to completely suspend assumptions, clearing the way for sincere, thorough curiosity about clients and holding respect for their expertise on their lived experience, their ways of interpreting problems, and their potential for creating something new in conversation together.

In earlier, modernist traditions of systemic therapy, there is an assumption about ‘how things work,’ about what ‘better,’ should look like, and about who’s role it is to bring about change. Within these traditions, it is the therapist’s job to conceptualize a relationship and the problem the members of it are facing, to develop a treatment plan with goals for the family, and to monitor progress through a fairly linear course of reaching objectives towards those goals. Interventions are mechanisms for change which therapists are trained to use to prompt clients to have new experiences based on assumptions of the problem and assumptions about how to “fix,” it. While they can certainly be useful, interventions also carry limitations. They are relevant within models of therapy which were generally developed by white men in the US during the mid 1900’s. This detail is not to discredit them, but to contextualize a lens through which they make sense.

These traditions can be modified to be more collaborative, but the hierarchy between client (sometimes referred to as the ‘patient’) and therapist is skewed with the therapist holding a knowing-betterness about and for the client’s treatment.

I carry training and experience which inform various ways of talking about a problem with you and offering more or less structure depending on your needs and preferences. However, I do not know better than you about your experience and what change means for you. I will never patronize you into treatment. In fact, the approach I use honors your agentic, creative potential as a person engaging in a conversation that is important to you. I have been experientially trained to understand that we are our own best instruments for transformation.* **

You are not a problem to be intervened. You carry a lens, often several, for understanding, and knowing anew. You are a powerful collaborator in your experience. Far be it from me to alienate you from your ability to hear yourself and to construct your life and ways of being in the world.

When we trust our curiosity, we can turn towards ourselves and one another with more compassion, more capacity for connection, more awe towards our contradictions and complexities, and feel more resourced to participate in transforming our experiences.

I will work with you in deepening trust in your curiosity and knowingness rather than insulting or interrupting your process.

*(J. Fountas, personal communication, Spring 2022-Summer 2023)

**(M. Twist, personal communication, Fall 2022-Spring 2024)

Most often, the individuals that I work with are women, mothers, and caregivers. Most often the couples I work with are becoming parents, navigating (in)fertility, pregnancy, traumatic birth experiences, miscarriage and stillbirth, perinatal mood and anxiety disorders, and changes to their individual and family identities as they become parents (sometimes known as matrescece and patresence). I work with broader kinship networks as caregivers to newborns.

Most Pennsylvania clients are located in Greater Philadelphia, Montgomery County, Bucks County. Most Connecticut clients are located in Greater New Haven and Fairfield County.

Most clients that I work with self-identify as creatives, artists, or academics. Many are also therapists, nurses, and students.

I also work with couples experiencing other life transitions like marriage and death, high conflict, and those wanting to increase sexual intimacy and satisfaction with one another (sometimes this includes members of a polycule).

I work with adults (18+). I do not work with children and do not provide child custody evaluations or recommendations.

I facilitate open dialogue with clients and other adult members of their kinship networks. I also facilitate open dialogue with medical providers relevant to therapy and client goals.

You may find definitions and references for some of the terms by accessing this SHEET. Phrases like “conversational partner,” “generative,” “non-interventive,” “dialogue,” and “transformation,” refer to specific concepts in collaborative therapy and are used by Harlene Anderson in her book, Conversations, Language, and Possibilties: A Postmodern Approach to Therapy. Words and phrases like “reciprocity,” “mutuality,” and “Circle of Care,” refer to specific concepts which are part of Socio-Emotional Relationship Therapy (SERT) and have been articulated by Carmen Knudson-Martin. You may read more in her book: A Step-by-Step Guide to Socio-Emotional Relationship Therapy: A Socially Responsible Approach to Clinical Practice.

Additionally, the intentional use of words mirrors the attention and critical interpretation of language to practicing collaborative therapy.

As you poke around my site, you may be considering whether to reach out and start therapy with me. Getting a sense-albeit, limited-for who I am and how I show up to my work, gives you some insight about who and how I will be in conversation with you. So I am here in earnest.

With that said, the “self” is relationally constructed. If we begin our dialogue, your use of words and language will become part of our shared conversation. They will shape me and the way we talk, as the way I am using language may shape you and the way we talk.

Trust in our relationship and in our process makes all of the difference in how therapy progresses.

Sometimes, we come to conversations with doubts about our own ability to use our voice, leading to breakdowns in trust with ourselves. Sometimes, our conversational partner has absolutely done or said something that we can’t make sense of, dislike, are offended, or are harmed by.

It can, at once, be liberating and terrifying to make your inner thoughts known to another person. However, this is practice for being in productive conflict, for self-expression, and to be held and understood by another person.

I’ve seen tattoo artists leave an anonymous feedback box on their websites before, and I considered offering this here. I have chosen against this because I cannot guarantee your anonymity from myself or from potential hacks, and because it would not allow me the opportunity to properly respond to you and your very real concern.

If you have a concern about how we are talking, about how therapy is progressing, about something I have said or done, I invite you with tenderness to bring this to our conversation.

I will thank you for sharing your concern or hurt with me. I may ask more questions to understand you. I will respect any decision or stance you hold about what is to be done about it. I will respond with accountability and open-heartedness. If you are interested in my opinion, intention, or stance I will be discerningly forthcoming.