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Much of our deepest joy and fulfillment comes from love and closeness and human connection.  Our family relationships, our romantic relationships, and our closest friendships are, for many of us, the most profound and powerful experiences of our lives.   . 

Humans are strongly wired to seek love and attachment. Because we feel so strongly about love and closeness, it can be terribly painful when these things go wrong.  Because the pain of loss or the pain of betrayal can be so intense, human relationships can feel like an area in which the stakes are high, and we have far less control than we would like to have. 

Every relationship involves two people's quirky personalities and complicated histories.  There is a lot happening, most of it deeply emotional, and not terribly rational.  But there is method to the madness, and therapy can play a unique role in making sense of it all, in understanding what gets stirred up in us as we try to be close to other people.

Therapy can work on relationships in many ways, both by understanding the emotions inside you, and by learning to do things differently with those you love:

  • Therapy can help understand the patterns that we learned to play growing up, and how we can now be close to our parents and siblings without continuing to play the roles we learned to play when we were 12. 

  • Therapy can help a person learn new ways to communicate, both ways to be closer to those you love, and ways to have conflicts without doing damage.  

  • Closeness involves knowing another person well, in part by trying to really understand them and their experience.  It also involves letting them know you, by letting them into your experience more deeply.  Therapy can help with both parts of that process, since part of the project of therapy is to understand yourself more deeply, and to understand what seems to be happening between you and other people. 

  • At times therapy involves talking about and understanding the people in your life well enough to understand their limitations.  LIke all of us, they are products of their own life histories, acting out the patterns they have learned.  And like all of us, they may be able to change patterns as they become aware of them, and some patterns may go deep and may not change easily.  As with all of life, the puzzle is in figuring out what to try and change, and what to try and accept. 

  • Therapy can help you understand more of how your heart works, how attachments have worked in your life, and how you have navigated the waters of finding real closeness while managing the vulnerability and the possibility of being hurt. 


Depression is a deep and lasting sadness, a sadness that seems to take on a life of its own. It is both psychological and biological. It is clear that some people are more biologically prone to depression than others. The psychological side of depression is tied to all of the emotionally important aspects of your life.

Even someone who is not all that prone to depression can get depressed during really difficult circumstances. In that case, therapy might focus on how to get through stressful times, how to adjust to new challenges, and perhaps how to deal with painful losses.


If depression comes back over and over, or if it is just under the surface all the time, then therapy will probably involve a deeper exploration of the workings of your life. Therapy for depression can cover a lot of territory, including these things:

  • How you feel about the course of your life, the successes and failures, and whether you are on a path that will be deeply satisfying to you.

  • How you feel about the relationships of your life, about love, closeness, and family, versus isolation or loneliness. Are there people in your life that give you a feeling of having a home?

  • How you feel about yourself, and especially whether you feel that you are someone that others will love, accept, and draw closer to as they get to know you better.

  • Are there negative and hopeless patterns in your thoughts that tend to reinforce your depressed feelings and create a vicious circle?

  • Have there been painful and traumatic events in your life that cast a cloud over how you feel today?


Anxiety is an area in which our human imagination is often torturing us.  Unlike other animals, humans spend a great deal of time thinking about and imagining things which aren't actually happening.  Our minds believe they are keeping us safe by imagining things which might go wrong.  The idea is that by imagining these things, we can take steps to prevent them.

The problem is, for many of us, our minds get stuck in this mode, imaginging bad things happening, and then imagining how we can prevent them.  As this becomes a mental habit, scanning the world for threat and danger can become automatic; it can become what our mind simply does whenever it isn't busy doing something else.

Anxiety typically takes one of two forms:  The more acute form of anxiety is a fear that comes in bursts, a fear that may be tied to certain situations, like public speaking, or social gatherings.  The more chronic form of anxiety involves feeling somewhat anxious all the time.  Sometimes this takes the form of being "a worrier," and constantly thinking of dangers and problems.  Other times it feels like chronic stress, that the demands of your job or your life are unrelenting and force you to be pushing hard all the time.

This can feel overwhelming.  On a physical level, anxiety and stress produce a mild version of the "fight or flight" response.  All of the stress hormones are released in a slow, but continuous way.  Blood pressure and muscle tension rise, digestion is altered, and the entire system runs in a state of over-arousal.  As you might expect, our bodies aren't built to do this.

In the same way that depression is tied to all of your life experiences related to sadness, anxiety can be connected to all of your life experiences related to fear, including those related to not feeling safe, and to fears of failure or of not being good enough. 

Therapy for anxiety often works on both how to manage external circumstances and stressors, and how to respond to your deeper internal fears.

The "external" part of therapy for anxiety can be about getting through stressful circumstances, making careful choices, figuring out how to calm yourself when anxious, how to delegate, to pace yourself, and to avoid getting yourself into situations in which too much is expected.  The "internal" part of therapy for anxiety goes deeper because it usually involves fears that are strongly held. It might include these:

  • The sense that success and performance are all that counts. The feeling that you can't keep performing forever, and that no amount of success makes the fear of failure go away.

  • The fear that others won't love you. Often this turns into the sense that you can be wanted if you take care of of everything and everyone, and the fear that you'll be unwanted if you are ever weak or needy.

  • A sense that the world is an unkind and unsafe place, and that any feeling of safety is temporary and unreliable.  This can often develop if you did not feel safe or did not feel as if things were under control during your upbringing.

Family of Origin

Each one of us was powerfully shaped by the family and the environment of our developing years. Our family was the place where we first learned about every important part of human life and human relationships.  We learned our first sense of whether we are lovable, whether others will be there for us.  We learned a sense of whether we should share our feelings or keep them to ourselves.  We learned whether it was OK to be vulnerable, to apologize to admit to being wrong.  We learned what it takes to be admired and desirable.  Is it our appearance?  Our smarts?  Our kindness? 

And we don't learn all of these things in a dry, cognitive way.  All of these things are tied to our deepest emotions.  They are tied to the question of, am I good enough?  Will people want me?  Can I trust people?  Is it safe to be really vulnerable a close to someone?

The lessons from our family of origin aren't just ideas that we have, they are deeply coded emotional beliefs and assumptions about how the world works.  And some of them may be partly conscious, but many of them are so deeply learned and automatic that they are beliefs we hold without being aware of them. 

Freud and his followers believed that we keep things out of our consciousness when we are conflicted about them.  That may be true of certain kinds of issues.  But learning theorists also point out that there are things that we are not conscious of simply because it is a view we hold that we have never questioned. 

 A part of the point of looking at your development in your family of origin is to become more aware of who you are and how you came to be who you are.  This often gives a person a much greater sense of self-understanding and self-acceptance. Exploring these things is a powerful way to change the way your life works now, especially by understanding and changing some of the habits and patterns that you may act out without realizing it.

Alcohol and Drugs
Alcohol and Drugs

When people come to therapy to address alcohol or drug problems, there are typically two very important and distinct parts to the project.  The first part involves changing the pattern of substance use, either by striving for abstinence, or by shifting toward truly healthy moderation.  The second part of the project involves repairing one's life and one's relationships once the substance use itself is under control.  This might involve some of these things:

  • Exploring and resolving the underlying emotional and psychological issues that fueled the addiction. This is the process that allows the recovery to be solid and enduring. Often when people have been using substances as an escape, or as "self-medication" for emotional pain, getting sober means feeling more of the depression or the anxiety. The danger is that unless these things are dealt with, they will make it all the more tempting to go back to using, especially during difficult emotional times.

  • Repairing the damage done to your life and your relationships while the addiction was going on.

  • Dealing with the after effects of growing up with an addiction in the family. There are a number of tragic experiences that are often part of growing up in an alcoholic family. Inconsistency and neglect can be very hard on the child's self esteem, and can make it very hard for a person to feel secure and trusting, even toward loved ones. Often children never learn the skills of talking through family problems, talking about painful emotions, or handling conflicts in appropriate ways.

  • Therapy can help spouse or family member figure out how to deal with addiction in a loved one.

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