When someone says, “She (or he) is just a friend,” this generally means the relationship is not romantic, not sexual and not too intimate. It is also understood to mean, “You need not take this too seriously.”

On the other hand we sometimes hear someone say in a reverent way about a spouse, or a partner, “He (or she) is my best friend.” This is saying, “Yes, lots of people are married, lots of people have sex and live together, but what we share is a special trust, support and a rich love.”

What does it take to have this rich enviable friendship? For a start it takes risking being open about one’s feelings, being gently honest about what one thinks and does, being able to deal with disagreements in a relatively calm manner and being able to negotiate differences.

Unfortunately these skills are rarely taught in childhood. Instead many of us learned not to trust because we found caregivers not safe, not trustworthy and it was not smart to trust. Suspicion and fear are often survival skills in childhood but as an adult they can impede love. To learn how to be a true friend and how to choose someone trustworthy may take relearning in a safe environment.

In effective relationship therapy you may learn techniques, like how to let another person know that you heard what they said by repeating what you think you heard back to them and checking to see if you are correct. You may learn certain "no-no's" like telling someone they "should" do or be a different way. That is a sure way to create distance in a relationship very quickly, almost as fast as by telling someone they are stupid. These things certainly do not gain intimacy.

But most effective may be observing the therapist's style and emotional tone. Or you may notice that the therapist may see things very differently from the way you have seen them and wonder what he sees that you don't. You may explore why your partner's comments are so upsetting to you. What does it remind you of in your history? It can be very helpful to have a wise and experienced guide to do this and feel safe.

Gil Shepard is a licensed Marriage and Family Therapist in Walnut Creek, California

I set my intention for relaxation and peace of mind. I am about to travel almost 3000 miles across the country on a connecting flight. 

Intention is the idea of something made potential through the use of language. Through language, an abstract concept can be transformed into an organized and concrete thought. It is thoughts that inform our emotions and emotions that inform our actions. If what I think informs a healthy feeling, I am more likely to act in ways that are in my best interest. 

At this moment I am feeling anxious. My husband has already been on the West coast for a week on business. I will join him and we will spend 10 days running the coast of Monterey, hiking the hills of Big Sur, and combing the beaches for sea anemones and starfish. So why do I feel anxious? 

When I back up in time, reviewing my actions and the feelings behind them, I find the space where anxiety rose. It was just after thinking that I had successfully packed the big suitcase with 10 days worth of my husband's and my casual clothes for weather ranging in temperature from 55 to 79 degrees. I was feeling very satisfied at the moment of zipping the 50 pound bag shut. And then I thought, "50 pound bag!", and I felt fear. How was I going to carry it down two flights of stairs? What if it weighs over 50 pounds and I am required to pay extra? 

Fear escalates from anxiety to panic. Should I unpack and rethink what I am bringing? Maybe I can empty the suitcase and carry the contents to the car and pack there. How can I know if it is too heavy? Why am I bringing his clothes? I should have never... And so my monkey mind runs. 

Bringing Intention In

This is the perfect place for intention. This everyday space. This moment. A moment in my life. Here and now. I can continue along with my monkey mind and setting off fireworks, dodging land mines, lamenting down memory lane, and pointing ahead to all the ways it will never work. And it is guaranteed that I will feel miserable, defeated, and unhappy as I set out for 10 days alone with the man I love in some of the most beautiful countryside in the world. This is not how I want to start my vacation. 

I center myself. Bringing my attention to my feet, noticing them flat on the floor. Hands on my thighs, I breathe in for the count of four, hold it for two, and exhale for six. I repeat it two more times. And as I bring myself more fully present in my body, I bring my awareness to the expanisve feeling I have created. 

Body relaxed, breath slowed, mind quieted. It is in this space of time that I set my intention for travel. 

What Intention is and How to Set it.

Merriam-Webster's first definition of intention reads: "a determination to act in a certain way." Thoughts inform emotions, emotions inform actions, and actions inform future possibilities. What do I want to make possible? This is important because what I want is not the same as what I don't want. Right now, what I most clearly know is what I don't want. I don't want to start my vacation miserable, defeated, and unhappy.

In setting an intention, I empower an idea that I desire to become a reality. I choose my words to attract what I desire. Watching my words carefully, as they are the directions on my map of reality and I would like to steer myself on the most direct course to the destination of relaxation and peace of mind. Attracting all possibilities for supporting and improving my opportunities to attain relaxation and peace of mind, not misery, defeat, and unhappiness. 

Notice for yourself. Place your feet flat on the floor, hands on your thighs, and practice three breaths in this way: In for four, hold for two, and exhale for six. Now say, "I don't want to be stressed out." Notice how you feel. Bring your awareness to your feet, your stomach, your chest, and your head. What do you notice? Now, do it again and say, "let me be free to experience relaxation and peace of mind." Any difference? You might notice a calmer stomach, lighter chest, and more expansive feeling in your head. You might experience more positive sensations. 

When I am present in this moment, I find myself afraid about my 50 pound suitcase. I notice that my monkey mind takes me off to the races. Here and there. Back and forth. I breathe. Feet flat on the floor, hands on my thighs, and I breathe. I see that in this moment I am reliant on my environment. There is no other way. I am dependent on the airline to transport me, their scale to weigh my bag, and my own brain and brawn to get the darn thing down the stairs. I realize that this interdependency or oneness means a relinquishing of control. I can't possibly know all the things that might happen at any moment and all the things that are interdependent of those things. To be honest, I can't know anything for certain. And if I attempt to control that which is outside my influence, I will feel more anxious. It is at this juncture, when I am willing, that I can shift my focus from control to cooperation. This is the "aha" moment. I let go and welcome the "I don't know mind." I don't know how I will get my 50 pound suitcase down the stairs, but with some curiosity and my intention set for an expansive mind, I am sure I will figure it out. And I will feel good doing it. 

This January, when you sit down to write your New Year's resolution, carefully choose words to attract what you desire and to empower you to think, feel, and act on it. And then support it with everyday intention.

***

Tami Boehle-Satterfield, LGSW, NBCCH, HTA is a licensed professional therapist, certified hypnotherapist, and practitioner of Healing Touch energy medicine. She practices therapy from a solution oriented approach called Attention to Living Therapy. She utilizes many treatment techniques that facilitate shifts to increase motivation, creativity, and self confidence. www.attentiontoliving.com

How much do your personal feelings about animals affect the way in which you are authentically able to be with someone grieving the loss of their pet? How does your past inform your present? Whether it be a sibling's allergies, cultural beliefs, or perhaps fond memories of your own childhood pet, they all help to inform our view today. 

As therapists, we have a rare opportunity to learn from our clients, as our clients learn from us. Over the course of nearly three decades, I continue to bear witness to clients' pain, whether it be buried, projected, internalized, or stuck! However, one thing remains the same: when it comes to the loss of one's pet, there is nothing stuck about the deep and expressed/experienced pain! Quite often, it is this pain that brings someone into therapy. If we, as therapists, dismiss the pain experienced by our client, they will leave feeling empty, misunderstood, and could possibly experience a sense of shame! 

Pet loss has become an important topic, even more so during natural disasters and a down economy. Most people will tell you how sorry they are, some may even send a card, but there does remain a discomfort or stigma around grieving too long or too deeply (i.e., "it was only a cat", or "she should be over it by now").

Therapy can truly be a place to grive and heal in a helpful and healthy environment. 

As a client, whether you are seeking help from a new therapist or are already working with someone, you need to feel comfortable expressing your pain over the loss of your pet. Working collaboratively with a therapist, you are entitled to feel understood, respected, and supported through this tremendously painful time. 

The following are some suggestions for clients to work collaboratively with a therapist and feel empowered in the process: 

1. Be clear and direct around what you need, how you are feeling, and how your therapist might help you in regard to your loss.
2. Pay close attention to how you feel. Does it feel like a safe space? Are you given the time to share, grieve, and process without there being a different agenda or the topic being changed? 
3. Does your therapist respond in a kind, caring, and empathic way? Do you feel heard and understood by him/her? 
4. One way to include your therapist in your grieving process is to bring in photos and memorabilia, as well as share stories about your pet. 

There is no time limit to grief and grieving. Take the time you need! Hopefully your therapist will ask a lot of questions, remain engaged, and empathize with your pain. 

The darkest hours of a client's pain around the death of their pet can also help to create a new and healthy beginning of a relationship! For some people, the loss of their pet is as important and painful as anyone's loss of a family member, friend, or partner/spouse. 

Grieving the loss of your animal is both extremely personal and profound. It is an experience that far too many people dismiss or can't understand. It is my hope that we all can find that safe place and person to help us grieve, heal, and bond/love again. 

Sharyn Rose is a Psychotherapist and Clinical Hypnotherapist in Davis Square, Somerville, MA. To learn more, visit her websites at: www.sharynrosetherapy.com and www.srosehypnotherapy.com

Most of us were raised in a culture where asking for help was not easy and even downright terrifying! 

It takes a leap of faith to make that initial contact with a therapist and hope this person may be able to help mitigate the discomfort or pain we present with. People are told to "listen to their gut" or "trust their instincts" in finding a therapist. A problem with that is, as a potential client coming in for help, the degree of pain you are in will most certainly be stronger than your ability to tune into your instincts or listen to your gut.

The following is an outline of questions and observatins for you to make and ask, most especially for clients who are new to the process: 

Initial Contact

1. Did the therapist return your call or email in a timely manner? 
2. Were they able to schedule an appointment to meet with you within a reasonable timeframe? 
3. Were they willing to spend a brief time on the phone, willing to answer questions you may have?
4. Lastly, does their manner/voice sound pleasant and/or warm? 

Initial Appointment 

1. Is the therapist's office clean, comfortable, and inviting? 
2. If your appointment is scheduled for 10:00, does he or she greet you at 10:00? 
3. Is he or she attentive, engaging and engaged with you throughout the session? Although therapists need to take notes, does he or she make good eye contact with you? 
4. Do you feel heard? Does the therapist appear open and non-judgmental? Do you feel spoken to with respect and dignity? 
5. Does the therapist talk too much or too little? We all respond to people's styles differently, but the focus should remain on the client! 
6. Does he or she review what you have shared with them and give you a sense of their approach and how they hope to help you? 
7. Lastly, do you find yourself feeling a bit less frightened or confused, the same, or worse at the end of the session? 

The therapeutic relationship is just that - a relationship. Although you are seeking help from an "expert", your working relationship needs to feel like a collaborative partnership. 

Is there something you would like to add? Let us know what you think in comments. 

Sharyn Rose is a Psychotherapist and Clinical Hypnotherapist in Davis Square, Somerville, MA. To learn more, visit her websites at www.sharynrosetherapy.com or www.srosehypnotherapy.com. 

Long before I chose counseling as my profession, I dealt with my own personal mental disorder; social anxiety. The disorder had taken over my life when I was in high school. It got so bad that I missed several days of school due to anxiety attacks; including the first day of my senior year. After many years of suffering, my mother took me to our family physician to discuss the issue. My doctor asked me a few questions about my anxious feelings and wrote me a prescription for a relatively new drug called Fluoxetine (a.k.a. Prozac). 

After a few months on the drug, I noticed that my anxious feelings had changed, but not necessarily for the better. I had lost my fear of social situations, but I had not lost the anxiety. It was almost like living two lives at once. I now enjoyed going out with friends and meeting new people, but I still had excessive sweating, heart palpitations, racing thoughts and shaky hands. The drug was masking my fear but not addressing the reasons behind my anxiety. 

When I went to college, I was told about the student clinic that offered free counseling. Over time, I had become more knowledgeable about my disorder and realized that I needed to see a therapist, so I booked and appointment. What ensued was an amazing transformation in my outlook on life. 

Seeing a therapist to supplement the medication was the best decision I could have ever made. Before, I was taking a pill every day and ignoring all the anxious thoughts that still went through my mind. For three months I went to see the school therapist once a week. We would discuss the reasoning behind my anxiety and different ways to look at things. During these sessions, I learned a great deal about myself and about other people. I learned that everyone experienced anxiety every now and then and that most people were too worried about themselves to notice me (my biggest fear was that other people were staring at me). 

Talking through and accepting these simple truths was what eventually brought me out of my fear of social situations. By the end of my college years, I add successfully weaned off the medication. It took me years, but I finally felt comfortable in my own skin. I don't think this would have been possible had I not paired medication with counseling. 

Due to my own personal experience, I firmly believe that anyone who has been prescribed an antidepressant or other mental illness medication should seek counseling from a therapist. Yes, medical doctors can diagnose patients with mental disorders and prescribe the appropriate medications, but using a medication without taking part in therapy is like trying to lose weight through diet only and no exercise; they supplement one another and increase your chances of success.

Lindsey Webster has been a rehabilitation counselor for 15 years and also owns the site Masters in Counseling. She likes to write about different topics related to counseling and careers.

Photo Credit: Steve Snodgrass Flickr

Therapy is a special place. A relationship is created in order to help you feel better, or at least that's the hope. When you start therapy you have all these feelings swirling around that control your life and you want the therapist to fix it. That is understandable. However, it is a false expectation. First of all, a therapist has no magic wand to make all the pain go away in an instant. We would if we could. It is a process of small changes and insights that build to create a better, calmer, more fulfilling life. 

As you build the relationship with the therapist and start trusting (oooh bad word) them, you start revealing deeper more painful things. These things often seem scary, embarrassing, and they can hurt. The irony is the more you hold onto these feelings and negative thoughts (that are hurting you) the more you are scared to face them. When you start revealing those tender, inner parts to a trusted professional, it does seem to hurt a little more for a while. However, you find out you are strong and courageous by facing those inner struggles and the emotions start to decrease. You win. You become more confident and able to make choices that benefit you and help you reach your full potential. 

Therapy is a place to be vulnerable and take risks. Speak up. Say what you need to say. Trust yourself. You will be better off in the end for finding your voice. What a precious gift to have a place to share the depths of who you are with someone you know cares for you no matter what.

Shelley Quinones is a Licensed Therapist in San Dimas, California. She has been in the field in various roles for over 20 years. She is trained in EMDR which helps process minor daily traumas that accumulate, or major traumas that influence daily choices, or even allows for performance enhancement. She is a Christian and believes faith plays an important part in healing. Her website is www.shelleyqmft.com.

Neuropsychological evaluations are used to gain a better understanding of a range of problems that involve the brain. For instance, people who have had a head injury, a stroke, or brain tumor may be referred for a neuropsychological evaluation to assess the impact of the injury on cognition, memory, language, and motor coordination. Neuropsychological evaluations are also performed with children or adults to gain more information about problems such as learning issues, attentional problems, autism, and even emotional conditions such as anxiety or mood disorders. Referrals for neuropsychological evaluations come from primary care doctors as well as neurologists; primary care physicians; mental health providers such as psychiatrists, psychologists, and social workers; speech/language therapists; and educational tutors. 

Neuropsychologists use indirect methods to study brain functions and their relationship to behavior. The "tools" of the neuropsychological evalauation look like puzzles, drawings, language activities, checklists and computer games. However, these tasks have been carefully designed to measure some function that is important in learning and problem solving, and then administered to a large number of people. The results are transformed into standardized scores that allow for the direct comparison of people of different ages and backgrounds. Using the pattern of strengths and weaknesses revealed by these scores, the neuropsychologist can then identify problems, make recommendations for needed services and even design interventions to improve functioning in key areas of a person's life, such as school, work, and interpersonal relationships. 

A neuropsychologist is a licensed psychologist who has completed two years of additional training in the administration and interpretation of neuropsychological measures and the development of treatment regimes to address areas of concern. Neuropsychologists may work in a hospital setting as part of an interdisciplinary team of medical doctors, physical therapists, speech and language therapists and other specialists. They may also work independently in private practices. Some neuropsychologists work in research settings where they use technology such as brain imaging to learn more about brain structure and functioning. 

Neuropsychological evaluations can vary in length and complexity, depnding on the setting and the referral questions. The actual testing time can range from less than an hour in an inpatient unit for someone who has suffered a stroke, to five hours or more in an outpatient unit if the question involves learning issues. The cost of evaluation can also vary widely depending on the amount of testing, scoring, provision of feedback and extensiveness of the written report. Insurance coverage for neuropsychological evaluations varies between insurance companies and plans, and it is important to check with your company to ascertain benefits for different conditions. 

Stephanie Monaghan-Blout, Psy.D. Formerly an adolescent and family therapist, Dr. Monaghan-Blout specializes in the assessment of children and adolescents with complex learning and emotional issues. She has a particular interest in working with adoptive children and their families as well as those contending with the impact of traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with the Harvard Law Project, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations. 

Dr. Monaghan-Blout obtained her doctoral degree at Antioch New England Graduate School. She completed an internship in pediatric neuropsychology and child psychology at North Shore University Hospital in New York and a postdoctoral fellowship at HealthSouth/Braintree Rehabilitation Hospital. She joined Children's Evaluation Center in 2003, and NESCA at its inception in 2007. Dr. Monaghan-Blout is currently a member of the Board of Directors of the Massachusetts Neuropsychological Society. 

Dr. Monaghan-Blout is the mother and stepmother of four children, and the grandmother of four (and counting). She is also an avid ice hockey player. 

I had been working with Annie for 3 months. Her symptoms of anxiety, insomnia, and frequent bouts of crying had improved, but not to the extent either of us would have liked. Annie began to wonder whether difficulties in her marriage were implicated in her symptoms, and she decided to invite her husband Matt to join her in therapy. Matt agreed, but reluctantly. After the introduction he said, "I'm here, but I don't believe in psychotherapy". 

As I said to Matt that evening, I don't believe in psychotherapy either. Psychotherapy involves a knowledge base, a skill set, and a relationship, and hence is not something to "believe in". It requires knowledge of human behavior, interpersonal and family dynamics, emotional wellness and illness, and an awareness of the impact of culture and economic systems on people. It requires communication skills, along with a capacity for insight, intuitive understanding, the ability to suspend judgment, and a knack for making connections between seemingly unrelated events, behaviors, and feelings. The knowledge and the skills needed for the practice of psychotherapy qualify it as a science. 

As a relationship, psychotherapy is also an art. While certain principles underlie therapy as a particular kind of professional relationship, like boundaries, ethics, and non-reciprocity, it can't be learned from a book or even by imitating other therapists. Relationships must be experienced and felt, and too many rules or road maps diminish them. 

When I sit down with Annie and Matt, I can't forget what I've learned or the skills I've developed. Paradoxically, however, I have to bracket them time and again to e receptive to these unique human beings, and to open myself to a brand new relationship. Empathy, which is the ability to walk a bit in someone else's shoes, so that they might possibly walk farther or more easily, involves both a  commitment and an aptitude. 

I suggested Annie and Matt think of therapy like a house, a house being important, even essential, but not something to believe in. The foundation, the framing, the siding, and the roof make up the science of psychotherapy. Everything else is art. 

Susan Donnelly has been a practicing psychotherapist for over 30 years, and presently maintains a private practice in Ridgewood, NJ. she has held clinical and administrative positions in public and private agencies and has recently completed a term as Chair of the Bergen Country Mental Health Board. You can visit her website and blog at www.ridgewoodtherapy.com. 

Question: My general practitioner can prescribe anti-depressants...why bother also seeing a psychiatrist? 

Most psychiatric medication in the United States is prescribed by General Practitioners. This is probably the result of at least two factors: 1) most visits to General Practitioners are motivated by physical symptoms which at least in part are caused by emotional problems; and 2) most people feel less likely to be stigmatized if they tell their General Practitioner that they are depressed, or anxious, or overwhelmed, because expressing these concerns in the primary care setting doesn't suggest you are mentally ill. In our society, even going to see a psychiatrist for help with emotional symptoms is often seen as 'proof' that a person is mentally ill. 

Unfortunately, this often leads to people not getting the specialized help they need.  It has been shown that more than half of anti-depressants given in a primary care setting are not given at the right dosage, are not monitored carefully, and do not result in ongoing treatment or resolution of patients' emotional symptoms.  Patients have side effects to anti-depressants given at incorrectly high starting dosages, and stop their medicine prematurely.  Alternately, if the starting dose is too low, patients won't feel like the medicine is helpful, and will simply stop taking it, rather than taking higher doses of the medicine until their symptoms resolve.  Without close monitoring, people don't know what to expect and how to cope with side effects.  This leads to a situation where more than 75% of the prescriptions written by General Practitioners for anti-depressants and anti-anxiety medications are never filled at a pharmacy.  People have reached out for help, but most often they do not receive the kind of help that will end their emotional problems, and related loss of normal functioning.

For this reason, seeking help from a Psychiatrist for depression (or any other emotional problems that are interfering with normal functioning) is much more likely to lead to these problems being properly treated so that patients will regain normal functioning. Psychiatrists are able to understand both the biologic, psychological, and social/family components of emotional illness. They can order diagnostic laboratory tests and prescribe medications at the proper dose and monitor closely for side-effects, increasing the chances that you will be able to continue taking the medication. They can also assess whether the emotional symptoms might be caused by an underlying physical or hormonal problem, such as thyroid disease, diabetes, or anemia. They can provide a wide range of different kinds of psychotherapies to help change feelings and behavior.

Unlike General Practitioners, Psychiatrists are specially trained in understanding the causes and treatment of emotional problems, and are more knowledgeable about the use of anti-depressants and other medications used to treat these emotional problems.  They are also trained more extensively than other therapists to take primary responsibility for their patients' total care, which can include providing both medication and therapy, making sure that underlying medical problems are adequately treated, and they can provide long-term follow-up.  They can more completely distinguish the different kinds of emotional problems and how to treat them:  is the problem only depression? is there both depression and anxiety?  is the depression part of a manic-depression cycle?  is the depression or anxiety a normal reaction to stress or grief?  In clarifying the nature of the problem, Psychiatrists are more able to choose the correct treatment,  in terms of medications and also with psychotherapy.  They can carefully monitor the patient's response to treatment and therefore minimize side-effects, allowing patients to remain on medicine that could lead to the resumption of normal functioning.

For all these reasons, getting help from a Psychiatrist rather than a General Practitioner is the best way to be sure that emotional problems don't continue to interfere with normal functioning and having normal relationships, at work as well as with family and friends.

About the author: Irene Kitzman MD has been practicing general adult Psychiatry since 1984. She graduated from the Yale University Department of Psychiatry, where she was a Chief Resident at the West Haven Veterans' Administration Hospital. Most recently, she was appointed Clinicial Associate Professor at the University of AZ and was Director of the Outpatient Clinic at Kino-UPH hospital, where she taught doctors in training to be Psychiatrists. She evaluates and treats adults, couples, and families for a number of issues including depression, anxiety, post-traumatic stress disorder, and psychiatric symptoms of Lyme disease. Dr. Kitzman received the honor of being named one of "America's Top Psychiatrists 2006" by the Consumer Research Council of America. For more information, visit her website. 

*Top photo credit: Amada Hatfield 

More than one colleague or client has asked me how I came to work with children. I used to work mostly with adults and when time, after time, these adults turned to me in session and said, "Steve, I wish someone had recognized the amount of emotional pain I was in when I was a child--then maybe I wouldn't be 40 years old and sitting in your office now!" When I reflected upon what those adults were saying to me, then I decided to do something about the emotional pain of children. 

I like to think of my work with children as preventive medicine--i.e. treat the child before their emotional difficulties become a chronic condition. Some people are concerned about the meta-message being sent to children who are brought to counseling. I've been asked, "What does this do to their self-esteem--especially if siblings or peers find out?" In my experience is rarely a problem. I think the much bigger problem is what it does to a child's self-esteem to leave depression or anxiety or other disorders untreated. When a child has had difficulties for months or years and is brought to me, one of my first interventions is to counter their sense of worthlessness and guilt for having problems. The earlier the child is treated, the less their self-esteem is eroded. 

Some researchers think that a large number of children with childhood disorders have a genetic predisposition to the disorder, then this predisposition is activated by environmental problems or other stressors. The following case illustrates this paradigm: A six year old was brought to me with feelings of sadness, isolation and withdrawal following the death of a loved one, continued for four months, and was accompanied by school and social problems. Both parents had a history of multiple losses and depression. After a month of psychotherapy the client's depression was greatly reduced and the client's grief was on track to being resolved. It appears that the stress of losing a loved one had triggered in the client a depression stemming from a biological predisposition toward depression that was inherited. 

Children come to counseling with a need to be listened to and respond positively to attention, encouragement, empowerment, and assistance with their emotional and practical difficulties. Research shows that children have a high need for sharing personal experiences and feelings, which they do with relatively few reservations. I create a safe, friendly environment so the child feels free to express her/his stress and concerns. I find the child responds openly to suggestions for change when presented in a caring manner. 

When providing counseling to children, I use imaginative play, games, books, puppets, various toys and art therapy to facilitate self-expressiveness and empathy to connect them to their inner feelings and to develop insight. After a therapeutic alliance is formed, even young children are quite capable of clearly talking about their thoughts and feelings. I find an easy give and take between play therapy and talk therapy facilitates the healing process. 

The goals of counseling are to improve the child's immediate adaptation to her or his life situation, build ego strength and teach problem-solving skills. Sometimes what a child needs is more structure, discipline and attention from parents and that involves family therapy, but that is a topic for another article.

*Photo "India Whistling" by apdk

ABOUT THE AUTHOR: Mr. Knezek is a clinical social worker in private practice in New Haven, CT. His practice consists of 50% children/adolescents and 50% adults. In addition to his clinical work, Mr Knezek is a Practice Building Consultant who helps clinicians realize their dream of a thriving private practice, and a clinical supervisor. www.stephenknezek.com