Let’s talk child development.  This is one of those areas that parents can really get hung up on and also can make situations unnecessarily frustrating or dramatic.  It is interesting how parents tend to approach development.  It begins with babies and some very clear milestones that we want to check off – rolling over, sitting up, walking, running, solid foods.  The list goes on with the behaviors pretty easy to identify and the timeline fairly clear.  Of course, if you actually look more closely, you will find that development varies quite a bit; you can have a very happy, healthy kid that doesn’t follow the proscribed timeline.  In those early months, parents usually do a good job of meeting their kid where they are and have, generally, reasonable expectations for their child.  There are always some parents that draw unreasonable conclusions about their child’s future based on those milestones. (My eldest loved to bang on things – I mean LOVED it, so of course, that must mean that she was going to be a percussionist and we should probably get her enrolled in music lessons to capitalize on her aptitude as soon as possible.)  No, in fact all kids love to bang on things.  Noise is fun.  Relax mom.  Even with those desperate attempts to know who our children will be based upon their earliest days, for the most part, we let them grow at the pace they will grow and try not to force our will or hopes onto them.

      The problem tends to come as the child matures and our expectations of what they can and can’t do simply aren’t as clear.  We know that they won’t jump before they can walk, but we don’t know when they will be able to follow instructions or hold ideas in their little brains beyond two minutes, or when it is reasonable for them to have basic table manners.  Those milestones just aren’t as evident.  Just as you can’t expect your 5 year old to do calculus, you can’t expect your 3 year old to follow more than two instructions at a time or remember what you say from day to day.  They just can’t do it.  Their little brains just can’t. You may as well tell your child to grow taller – they has as much control over that as they does her cognitive capabilities.  So ease up and figure out what are realistic and reasonable expectations. This, of course, is easier said than done.
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     I have found that understanding development and my expectations of my children has been one of the most difficult and confusing pieces of parenting – and I have taken a numerous classes on this topic.  The truth is, every kid is different and will learn and grow in different ways.  As much as I have tried to stay ahead of it, in truth I spend a lot of time catching up and recalibrating.  I can be amazed at how insightful and funny my kid is and then feel shocked and confused that she still hasn’t put her shoes on to go to the park.  I have told her to do it six times, she knows how to put her shoes on, she knows she needs to wear shoes to go to the park, and going to the park was HER IDEA.  Why in the name of Jean Piaget won’t she put on her shoes???  Because she is 5.  That’s the most comprehensive answer I can get or give. She’s only 5.  And to be honest, that answer will often be the most helpful at any age.  So give them a hug. They’re only 5, 14, 22, 38…They’re doing the best they can, just like you.

I have realized that all the things that occur to a woman prior to and including giving birth are excellent preparations for the complete lack of privacy that comes with having a child.  Generally, mothers-to-be have nine months of being prodded and measured and contorted into various, vulnerable positions.  Personally, my husband and I had some trouble getting pregnant, so the fertility process introduced a whole new level of invasiveness.  I peed on ovulation test strips for months, was tested in a myriad of ways, and my body felt more like a broken vacuum cleaner than anything personal.  Something to figure out and fix; nothing too precious.  And even though there is not much private about our vacuum cleaner, I still don’t really want anyone analyzing its contents. I think we could probably feed a small village with the number of cheerios and raisins in there.  But when my body became more about function than feeling, I became much less self-conscience about it—that happened when I removed the “self” component of my body.
Eventually, we did get pregnant.  Then came the actual ordeal of giving birth which is a whole new world of exposure.  It was a time to get over any sense of insecurity or embarrassment about my body and its various parts and processes if I was going to get through that.  There just isn’t room for embarrassment. Fortunately, it can also be a very painful at times so I was quite distracted from the fact that my entire body is under the control of some primal force. Is there really space for decorum when stirrups or squatting is involved?  Not at all. 
With my first kid, my water breaking was a mess and it seemed to keep going, which I was not aware was a possibility.  As I sat on the hospital bed, another round of fluid escaped and I told the nurse, “I’m so sorry but I think I just peed on this bed.”  He was wonderful replying, “Oh don’t worry about that.  In fact, don’t you worry about any fluids for a while. We will take care of all of that for you.” Which is about the most wonderful thing a person can say when I was unsure of what is coming out of my body.  So then, regardless of how that baby is born, a body is on display for all to see and not in an artsy kind of way – no, in a purely biological way and you just have to go with it because there really is no turning back now. 
So that is how it starts – this letting go of privacy. 
It continues well past those initial months of checkups, pregnancy, labor and birth.  Breasts can lose all intimacy and desire and become solely functional.  I put a yoga mat in the bathtub next to our shower and just laid our daughter in there while I showered or other performed other bathroom tasks. 
Of course people will say, “Well that is only for a while and then you will start to get more of your autonomy back and have more time to yourself.” Wrong.  My husband has never seen me pee (my thing doesn’t need to be anyone else’s).  But my children have sat on my lap while I’ve done my business.  My 2 year old toddled into the bathroom while I was having a moment. Sitting on the toilet I asked her to “please give mama a little privacy.” “Sure mama,” she said, and promptly closed the door and sat in front of me to tell me about her breakfast. Totally fine, kid, Mama has had an audience for much worse than this.

​Being a parent is hard; being a psychologist and parent comes with its own pressures.  Your kid is walking around like metaphor of your resume – all out there for people to judge your qualifications as a parent as well as your abilities as a psychologist.  Of course, I do not know exactly what others are thinking of my therapeutic abilities- I cannot read minds (despite what others might think it means to be a therapist).  But I do know my mind and it can get very judgmental of me. As for my being a parent, again it is very hard to communicate to others just how much I love my two daughters.
That guise of knowledge and capability that comes with having a PhD was upended quickly when my then 6-month-old daughter was in daycare. When I picked her up one day, I as very gently informed: "Your child bit another kid." Now kids bite – this is a very normal thing.  They are teething, and biting is a way of soothing gums and making sense of the world.  And, in the words of my psychologist friend Rachel, "Sometimes you just like the texture of human flesh." 
So, my kid was a biter.  My first thought (and I am not proud of this) was – did the other kid have it coming?  That's what I thought. But what I said to her teacher was “Can you talk to me about the context of this behavior?”  Apparently, a kid had taken the toy she was playing with, so she ran him down, tackled him and bit him on the arm.  I can respect that.  It was a reaction to an injustice (my kid). On the other hand, biting is not ok – biting hurts.  Teeth are not for biting other people (read that book; it spells things out clearly).  So, there was some behavioral modification to do and my husband and I talked to her a lot about not biting.  We sang songs about it; I did puppet shows.  I was very desperate to curb this behavior, because not only does biting hurts and that is not ok, but also, I really did not want my kid to get kicked out of daycare.  Six months seemed very early for academic expulsion and I certainly did not want to set a tone.
A few weeks later, while giving our daughter a bath, I reiterated to her that we do not bite.  We do not bite our mom, we do not bite our dad, we do not bite our friends, we only bite our enemies.  – At this point her father interrupted my lesson with a very dramatic – “NO we do not bite ANYONE” – and a stern look at me.  Right – we do not bite anyone.  Sure.  For now. 
She did stop biting mostly.  There was one more incident when, again at daycare, she bit the kid in the highchair next to her and took his Goldfish crackers from off his tray, shoved a fistful into her mouth and then promptly threw them up all over herself. To my knowledge this was the last time that she bit another human. To be honest, I’m not entirely sure what was the key to stopping her chomp response.  For my own piece of mind, I’m going to assume it was the puppet shows, as they were the most entertaining for me, but it also might have been that human flesh just didn’t do it for her anymore.  Not after she discovered Goldfish.
When our younger daughter, (then age 13 months) bit her friend, it was not in response to any type of provocation.  The kid just liked arms.  Chomping on arms.  To be fair, when she was an infant, she also like biting my boob, which was a horrible thing and gave me a panic response when nursing that kept us both a little on edge. I didn’t know when she would bite, she didn’t know when I would throw her away from her food source with a yelp and an “Ouch biting hurts!”  This biting was going to take a different approach to quell as it was internally driven, and not triggered by an external prompt.  How do we make her not want to bite.
My Ph.D. education assured me that it is very difficult to appeal to a 13-month old’s moral compass. So, I tried the puppet shows (as I believe they were very successful with our eldest) with a slightly different narrative.  Instead of the “ouch- biting hurts” narrative, it was more “yuck- biting-tastes icky” narrative.  Unfortunately, as you can imagine, this really wasn’t effective.  What was?  Now this is going to be controversial and I would not recommend this tactic to anyone else.  She stopped biting when her friend bit her back.  I mean really gnashed her arm.  Daycare does this wonderful thing where they send you pictures of your children in their activities – as well as the injuries they inflict or receive.  The photos showed this was a full mouth chomp on her arm.  I could see every tooth’s indentation.  Apparently, this experience was a painful surprise and a turning point in my daughter’s understanding of biting.  Turns out ‘Ouch Biting Hurts” did work for her, when she was the one saying "Ouch." 
It was through the experience of having two biters that I came to take a step back from the expectations I was putting on myself to have beautifully behaved children all the time, through every developmental stage and in every situation.  That somehow, because of my knowledge of child development and behavioral modification techniques, I would be able to create these perfect little children.  That expectation completely disregarded the possibility that I would have a child that just liked to bite.  Or a child that was going to be more "physical" in her pursuit of justice and sustenance. Turns out, I was going to have HUMAN children.  Unpredictable, inconsistent, impulsive, reactive, loving, kind, hilarious, human children.  My educational knowledge gave me strategies to understand them, but it was love that was going to have to lead the way in how I parent them. Love and puppet shows with a side of Goldfish.  

Client: I don't need corporate America to tell me when to buy flowers for my wife. That is manipulative and I'm not buying into it.
Me: I can see your point. When was the last time that you bought flowers for your wife?
Client: Last Valentine's Day. I bought into their scheme.
Me: So you didn't get her flowers at any other time during the year?
Client: no.
Me: and your wife loves getting flowers.
Client: yes.
Me: Well it sounds like you might need a push from the Valentine's Day corporation to get flowers to your wife.
Client, thinking it over....considering....: ah hell doc, do you think Giant has sold out of roses by now?
Me: I think you can probably figure something out.

n the spirit of Valentine’s Day and a more heightened awareness of romance; I thought that a few words on this elusive concept would be appropriate.
So, here are 5 thoughts on romance

1.  Romance looks different to everyone.  For some, putting gas in her car is as romantic as buying flowers.  For others, cooking a meal at home in your pajamas is as intimate as a candlelit dinner.  The important thing is to know what romance means to you and to your partner and step up accordingly.  There is no need to roll your eyes at him when he gets you a card with a sweet, perhaps, cheesy sentiment inside.  No need to act bothered when she requests that you go to a restaurant that requires a tie.  This is a time to be responsive to the romantic requests of others-go for it.
2. Romance isn’t for just one day a year.  The beautiful thing about romance is that it includes effort and desire.  Two things that everyone wants to feel they are worth.  It does not need to be grand gestures all the time, but small gestures for your partner that remind him or her that you care about them and desire them are necessary throughout the year.
3. Romance is about intimacy  -- this can include sex but doesn’t have to.  Intimacy is that feeling you have when you are seen by another person in the most accepting and honest way possible.  It is to be known by someone, understood and embraced.  The embodiment of intimacy can range from laughing with each other until it hurts, holding each other, a simple touch, seeing each other across a room and knowing what the other is thinking, cooking a meal together, sex (in whatever form you enjoy), pulling her close while waiting in line at the market…whatever it looks like it involves engagement with another person –it is dynamic.
4. Passion and romance are two separate things.  Romance is deliberate, an effort to elicit a desired emotional response in someone.  Passion is less organized.  Both are important and both take different types of motivation to maintain.  Passion can be cultivated by having an openness and willingness to take advantage of opportunities to engage with each other in a heightened level of arousal.  Romance can be nurtured through efforts to send a clear message of desire and love.  It is has a layer beyond affection-a hint of vulnerability in revealing your desire for another person.
5. Every relationship needs some romance – it does not matter if you have been together for 5 years or 50.  What romance in your relationship will look like will evolve and change – this is vital.  Romance can be familiar gestures or surprising efforts – all of it is good.  The most profound impact of romance is that it makes you feel wanted.  That loving you is a choice that your partner is making over and over again.  It is feeling wanted and desired that keeps a relationship alive.  So if you know what your partner finds romantic, do that. If you don’t, ask.  Romance does not lose its meaning because you talk about it.  I have told many many of my clients that you can either be surprised or satisfied when it comes to romance, but rarely both.  So ask for what you want.  Don’t expect for your partner to read your mind and don’t expect that his desires from 4 years ago are the same now.  Make the effort and recognize when an effort is made.  Show your partner they are worth it.  

 
 

First, let me note how exceptional the person is who seeks counseling.  It can be a daunting and frightening thing to do and above all the amazing qualities my clients possess - it is their courage in making that first appointment and coming into my office that I admire most.  Knowing, both personally and professionally, how difficult it can be to initiate therapy, I wanted to give a few ideas about how to find a good match in a therapist.  This list is by no means complete, but I feel that it is a good start when entering into a therapeutic relationship.

The Initial Preparations:
Identify your needs:  It is important to be able to first identify what you are looking for in therapy. To do that, here are a few questions to consider when looking at what you want to gain from therapy.

• What are three areas in my life that I would like to change?  
• How will I know that things are better? - What would I see/feel/experience?
• When did I notice things starting to slip in my life and become more difficult?  What was happening at that time?
• What is my push to seek help now?  
• Am I willing to give therapy a chance to help?  How much effort do I feel I can put into therapy?
• What behavioral changes do I think will be important to make to move toward my goals?

Personal Preferences:
It is good to consider if there are particular attributes you would like in your therapist.  Some people feel more comfortable talking to one gender over the other.  Some would like their therapist to share their same religious views or at least be able to converse about religion and/or spirituality.  Some are looking for a particular therapeutic technique or approach.  Cost, location and availability are also important considerations.  

The Office Space:
There are a few things to keep in mind when you arrive at your appointment - do you feel safe in the neighborhood? Is the waiting area neat and orderly?  Is the clinician's office comfortable?  I check out the books on the shelves to see where their interests are -- I like to see up-to-date psychology journals or a few newer looking books in the office--this makes me feel that they are invested in continuing to build on their skills and keep abreast of changes in the field.

THE IMPORTANT STUFF

1.  The RELATIONSHIP between client and therapist
If you look at all the research on what makes therapy effective it all points to the quality of the therapeutic relationship.  More than technique or style.  More than any therapist attributes.  More than cost of treatment or years in practice.  This is what makes therapy work or not.  The connection you feel with your clinician will be the most important aspect in treatment.  Here are some statements that should resonate with you regarding your therapist.

• I feel my therapist works hard to understand me
• My therapist is on my side
• I trust my therapist
• I feel that my therapist cares about me and my well-being
• I feel challenged by my therapist
• I feel that my therapist has a plan for my treatment
• My therapist checks in with me about how I feel treatment is progressing
• I feel that I can talk to my therapist about our relationship

Note:  The relationship between client and clinician does not form instantly.  It is important to give the relationship a chance to develop.  Personally, I feel that you can get a pretty good gauge about a therapist within the first three sessions. You should at least feel some sort of connection at the initial session.  
Fallibility: Alas, therapists are not perfect.  We mess up.  We misread things, we have bad days, we get distracted, we have 'stuff' like anyone else and sometimes we don't do our jobs as well as we can or should.  Your therapist may fall victim to being human and it may impact your relationship.  That is a good thing!  Trust me, having a therapist that messes up can be amazing because you get to practice 'working through the rupture.' You get a chance to talk about the mess-up, how it felt and what you need and how to move forward.  So, I invite you to give your very human therapist a chance to make things better -- a good therapist is open to their own humanity and should willingly step into an open conversation about where things went wrong and how it impacted your relationship.
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2.  Safety
You should feel safe with your therapist - both physically and emotionally. The space you are in should feel comforting, the dynamic with your therapist should feel caring and compassionate.  You need to be able to trust your therapist -- that is the only way that you can be vulnerable.  Most important, you should feel that your therapist is always working toward your best interests.  This is not to say that you should always like your therapist - because sometimes therapy is hard--and it should be. Beware of feeling too comfortable - therapy should present challenges.  Challenges to how you think and behave.  Challenges to how you view the world and yourself.  Challenges that push you out of your comfort zone - where growth happens. A good therapist can help you feel safe; a great therapist helps you feel safe taking risks.

3.  Feedback
A good clinician will always ask for feedback regarding your experience, progress and treatment planning.  You should feel comfortable asking questions about you treatment and the treatment process and your clinician should be able to answer your questions clearly.  A therapist should not get defensive if you speak up about something that you would like to change or address about therapy- it is YOUR therapy and a good therapist knows the benefits of client feedback.  

4.  Logistics
All of the logistics should be discussed at the initial session or within the first two sessions of treatment. You should know your therapist's policies around after hours contact, how to re-schedule, emergency procedures and attendance policies. You should know what your rights are as a client, what limits to confidentiality are in place, your therapist's theory and approach to treatment, costs and payment practices as well as what the clinician's expectations of his or her clients are.  Some clinicians ask that clients do 'homework' between sessions or try different behavioral experiments.  I am a big fan of between-session activities because it is very difficult for change to happen when you only devote an hour a week to it. However, it is also very important that you are honest with your clinician about what you are and are not willing to do. For example, I had a client who hated the idea of tracking her feelings every day in a journal but was willing to download an app to help her track her moods. Another client preferred to keep a music journal and downloaded songs to make a playlist of her emotions for the week.  Work with your therapist to find what fits for you.
Ethics:  A good therapist knows his or her limits.  It is unethical to 'practice outside your scope' - so, it is ok to ask your therapist what experience they have working with your types of concerns. You have every right to ask about any part of treatment from a specific intervention to a therapist's training in providing services for a particular disorder.  Your therapist should be able to provide you with their reasons for pursuing a particular type of treatment.Your therapist should be licensed - you can check on their license history through your state's board of professions. 

5.  Humor
This element is often left of the lists of important traits in the therapy room but I think it is vastly important.  
It is important to laugh.  It is important that your therapist be able to present ideas to you in a way that is engaging.  Humor should never be used at the expense of a client or their experience but it can be an excellent tool for finding insight, release and perspective.  Tears can be a means of catharsis but so can laughter.  
Finding the humor in one's situation is vital - not as a means of invalidating or dismissing the experience - but as a way to see it in its most whole form. I have found that using humor and laughter with my clients is a way to finding peace with difficult things.  While holding their experiences with compassion, laughter allows experiences to take on a new form. A form that can be easier to approach, to talk about, to understand and to accept. 

So there you have a quick guide for what to look for and look out for when choosing a therapist.  Remember, it is YOUR treatment and your comfort is important.  Trust your instincts and give therapy a chance to work for you--I absolutely believe that it can.