Articles

back to November 2024 newsletter 
by Liliana Ramos, LMFT

Gender diversity is one of the most important issues of our time, but Native American cultures have been aware of its presence for centuries. We honor National Native American Heritage month by highlighting the “Two-Spirit” community.

The intersection of Native American heritage and transgender or Two-Spirit identities is deeply significant and rooted in cultural history. Many Native American tribes have long recognized and respected gender diversity through what’s known as the "Two-Spirit" identity.

Historically, in many Native American cultures, Two-Spirit people held respected roles in society, often as healers, storytellers, matchmakers, and caretakers. They were seen as embodying a unique balance of both masculine and feminine energies, a concept that some tribes believe grants them special insights or powers. In tribes where Two-Spirit males and females were referred to with the same term, this status amounted to a third gender. In other cases, Two-Spirit females were referred to with a distinct term and, therefore, constituted a fourth gender.

The arrival of European settlers disrupted these Indigenous views of gender and sexuality. Colonization brought new religious and cultural norms that viewed gender as a binary and imposed restrictions on diverse gender expressions. Despite this, many Two-Spirit individuals continue to reclaim their identities and revitalize traditional understandings, challenging the colonized views of gender, embracing their heritage, and celebrating gender diversity as a meaningful part of their heritage. Among the Lakota, Mohave, Crow, Cheyenne, and others, Two-Spirit people were believed to be lucky in love, and able to bestow this luck on others.

Transgender Native Americans today may identify as Two-Spirit, but not all do, as the term is specific to those who feel it represents their cultural identity. Some trans Native Americans do not identify as Two-Spirit, and instead identify with other terms that align with their specific gender identity within a modern context.

This intersection of trans and Native identity highlights both resilience and a celebration of diversity, encouraging a deeper understanding of gender, spirituality, and identity beyond Western frameworks. Two-Spirit people were often viewed as embodying both masculine and feminine qualities, allowing them a unique role in tribal life as mediators, healers, ceremonial leaders, or caregivers.

Today, attitudes towards transgender people vary within Indigenous communities. While some communities are deeply supportive and affirming, others are still grappling with influences from colonization and the impact of Western views on gender and sexuality. Many Indigenous activists and allies are advocating for acceptance and support for transgender and Two-Spirit individuals, emphasizing respect for traditional values that honor diverse identities.

back to October 2024 newsletter
In order to acknowledge the importance of supporting our clients who have experienced domestic violence, we have compiled resources in both Santa Clara and San Mateo counties that you can provide your clients for further support. Thank you for the work you do!

Santa Clara County Domestic Violence Resources (All numbers are operational 24/7)

AACI Asian Women Home: (408) 975-2739
Offers vital life-saving services to individuals and families affected by domestic violence.​

Community Solutions:
1 (877) 363-7238 (Sexual Assault and Domestic Violence)
1 (408) 683-4118 (Youth and Family)
Offers a variety of programs and services for children, youth, adults, and older adults. Programs include mental health services for all ages, support for survivors of domestic violence, sexual assault, and human trafficking, and housing programs for clients facing mental health and other challenges.

Maitri: 1 (888) 862-4874
If you are facing domestic violence, emotional abuse, cultural alienation, human trafficking or family conflict.

Next Door Solutions: (408) 279-2962
Programs and services are free of charge and designed to empower victims and their families.

YWCA Silicon Valley: Domestic Violence Department Support Network Program: 1 (800) 572-2782
 -- From Santa Clara County

San Mateo County Domestic Violence Resources

Community Overcoming Relationship Abuse (CORA)
(800) 300-1080
CORA provides free and confidential services to victims and survivors of domestic/dating violence and abuse in San Mateo County.

Violence and Abuse Prevention Services in San Mateo County

Keller Center
The Keller Center provides medical, emotional, social, and legal care and support to victims of child abuse, elder abuse, sexual assault, and domestic violence.

California Partnership to End Domestic Violence
Links and resources to dozens of services and organizations throughout California and the nation.

Domestic Violence Self-Help Center, California Courts
Information about safety plans, restraining orders, court processes and other topics

Safe at Home, California Secretary of State
(877) 322-5227
This program helps victims and survivors of domestic violence, stalking or sexual assault start new lives in peace and provides added protections to their overall safety plans.

San Mateo County Child Abuse Hotline
(650) 595-7922
The San Mateo County Human Services Agency provides a 24-hour hotline to report the suspected abuse or neglect of a child.

San Mateo County TIES Line
(800) 675-8437
The San Mateo County Health provides a 24-hour hotline for seniors and vulnerable adults in the community.

Domestic Violence Council of San Mateo County
The County of San Mateo is committed to ending domestic violence and supports a county-based Domestic Violence Council that works to reduce and prevent prevention domestic violence and enhance victims’ services.
  -- From San Mateo County

back to September 2024 newsletter  
By Liliana Ramos, LMFT

Suicide prevention in the Hispanic community requires a culturally sensitive approach that acknowledges the unique challenges, strengths, and needs of this diverse group. A Hispanic person from the Mexico is different from a Hispanic person from Venezuela or anywhere else in the world.

The Hispanic community has strengths such as Familismo, where family comes first. They can also gather strength from religion and spirituality. At the same time, these two strengths can become weaknesses when speaking about suicide prevention. Although family can be a big protective factor against suicide, an individual who is unable to meet the family expectations can hold feelings of guilt or shame that can lead to suicide. Religious beliefs can provide comfort and resilience, but they can also create a barrier if there is a stigma associated with mental health or suicide. Other cultural influences include machismo, which suggests that men are strong, dominant, and don’t show emotions, and marianismo, which suggests women are virtuous, submissive, and care for the family. Both are protective of how the outside world views their family. These can make people reluctant to seek mental health assistance. Other weaknesses are language barrier, stigma, mistrust, and a possible concern about immigration status.

In order to ensure that individuals from the Hispanic community receive suicide prevention material, we need to engage families in discussions about mental health and suicide prevention in their own language. We also need to train religious and community leaders about suicide prevention so that they can assist Hispanic individuals in their community through classes, brochures, bilingual and bicultural providers, and community leaders who speak their language and understand their culture. We can also promote the crisis line at 988 so that they are comfortable calling, texting, or chatting and knowing that they will be able to connect with someone who speaks their language.

What happens when prevention doesn’t work? How do we help the Hispanic family that is left behind? Having someone die from suicide requires a culturally sensitive and compassionate approach because it can have significant stigma in many Hispanic communities, which makes it more challenging for the family to cope with their grief. Again, family loyalty, respect for their family and culture, and incorporating spiritual practices into the grieving process is key.

What’s important when dealing with the topic of suicide and the Hispanic community is to provide compassionate, culturally sensitive support from mental health professionals and community leaders. Hispanic families are used to navigating challenges. A culturally sensitive therapist fostering healing and resilience in the face of tragedy will help the individual and the family navigate through difficult emotions and challenges.

back to September 2024 newsletter  

Back to April newsletter
by Kusum Punjabi, LMFT, DEI Director

This month, we celebrated Autism Day on April 2, and we will commemorate Earth Day on April 22. As Earth Day approaches, it's crucial to recognize that environmental awareness affects all of us. For individuals with autism spectrum disorder (ASD), this connection can be particularly profound.

Autism is a developmental condition characterized by deficits in social communication and interaction as well as restricted or repetitive behaviors, interests, or activities. It affects individuals differently, but many share a deep affinity for nature. Research suggests that spending time outdoors can have calming effects, reducing stress and anxiety often experienced by those with ASD. Research also shows that individuals with autism prefer interactions with animals over humans.

Earth Day serves as a reminder of our responsibility to protect the environment, but it also highlights the importance of inclusion. While some individuals with autism may struggle with social interactions, they often find solace and comfort in the natural world, making them fierce advocates for environmental preservation.

Moreover, fostering a connection between individuals with ASD and the environment can offer opportunities for growth and understanding. Nature-based therapies and outdoor activities tailored to accommodate sensory sensitivities can promote well-being and enhance quality of life.

As we celebrate Earth Day, let's remember to embrace diversity and inclusion within the environmental movement. By recognizing and harnessing the unique perspectives and passions of individuals with autism, we can work together towards a more sustainable and inclusive future for all.

back to March 2024 newsletter
By Marty Klein, PhD, LMFT

Sex therapy, first developed by Masters & Johnson back in the early 1960s, can be wonderful—life-changing, cost-effective, marriage- (and therefore family-) saving. Refined over the years by professionals such as Sandy Leiblum, Lonnie Barbach, Leonore Tiefer, Michael Perelman, and Steve Snyder, there are today about 1,000 credentialled practitioners in the U.S.

We can do wonders, which makes this work life-affirming. We can’t do everything that people want or need, which also makes this work painful. Here are some things I’m asked to do periodically, which I just don’t know how to do—and I doubt that my colleagues, can, either:

* Increase the sexual desire of someone for whom sex usually hurts

We all stub our toe or bang our elbow occasionally. And sex can hurt momentarily for many reasons—accidentally pulling her hair, accidentally elbowing his balls, a leg cramp, someone moaning too loudly, miscalculating how wet your vagina or anus actually is before insertion, nipple-squeezing that’s too enthusiastic, and so on.

That’s different from chronic pain during sex, whether that pain is around the vulva, the lower back, or anywhere else. Enjoyable sex involves focusing our attention on how our body feels. When this involves pain, who would want more of it over and over?

I do see couples where one or both just shrug and think “sex just hurts me or my partner, and that’s how it is.” There’s often—not always—ways to reduce the frequency or intensity of the pain. Sex therapy can be very helpful with this, with specific exercises or explanations, and possibly directing people to sexually-informed health care providers (including pelvic floor therapists).

But when sex hurts, most people simply want to do it less. I don’t blame them, and I don’t really want to change that.

* Persuade your partner that non-monogamy is great

Consensual non-monogamy is great for couples who, well, think it’s great.

But when one partner wants it and the other doesn’t, persuasion is rarely a good idea. Neither is nagging. Pressure or threats? Never a good idea.

Most of the couples I see in conflict about this don’t have a great sex life together. Whether one partner wants sex more than the other, or one partner wants activities the other doesn’t want, it’s usually the higher-desire partner who suggests an open relationship.

My frustrated thought about this is often “great, your sex life doesn’t work, so let’s add more people. That should clear things up.”

Instead of saying that, I tell people that successful and enjoyable non-monogamy requires a level of communication that many couples (including theirs?) don’t quite have. If the center of a couple’s unsatisfying sex life is poor communication, how can non-monogamy work? It won’t.

If couples can’t clean up their communication—which typically requires resolving lingering resentments, a power imbalance, or lack of trust—there’s no magic way to make non-monogamy work. In such a case, it isn’t fair to just blame the partner who doesn’t want an open relationship. In fact, that person may simply be more realistic about the dead-end that a couple has reached.

* Help your spouse understand that your disrespectful behavior is not actually disrespectful

Practically every couple who comes into my office says they have “communication problems.” But not everybody does. Some couples communicate fairly well—with messages that they don’t like each other, don’t trust each other, or don’t enjoy each other’s company.

Sometimes it’s mostly one-sided—one partner regularly being sarcastic, dismissive, critical, bossy, while the other person alternately begs for relief, nags back, or withdraws.

And then one or both want to improve their sex lives.

In most relationships, when A is chronically disrespectful to B, B typically knows it. When B has run out of energy for saying “please stop” yet again, they often shut down sexually. When they come to sex therapy, A will complain that B is too sensitive, takes things too seriously, or is unmoved by apologies.

In such cases, how do I persuade B to “lighten up?”

I don’t. If couples let me, I’ll help them increase mutual respect, resolve specific old wounds, and rebalance their power dynamic. But gaslight someone and urge them to ignore their partner’s hostility and disrespect? No.

* Increase your partner’s personal hygiene if they refuse to do so

Kiss someone who forgets to brush their teeth? Lick a penis that doesn’t get showered regularly? Cuddle up with someone who wears a shirt way beyond its “wash-me” date? Almost nobody wants to do that.

And if you can’t get a partner to clean up their act (literally), I probably can’t. For some of these dirtier-than-thou folks, it’s a juvenile assertion of autonomy—‘I’ll do what I please.’ For others, it reflects the neglectful way they were raised. And for some, they just don’t relate to their body very much—they don’t get a periodic health checkup, don’t believe in taking vitamins, and think exercise is a waste of time.

And then they don’t understand why their partner doesn’t desire them more. Or their partner doesn’t understand their own low desire. I can’t enhance desire for something that someone finds undesirable. In fact, I’d call that common sense, not something to fix.

Originally published as: https://www.martyklein.com/what-sex-therapy-cant-do/

Dr. Marty Klein has been an MFT and Certified Sex Therapist working with couples & individuals for 42 years. His books include Sexual Intelligence and His Porn, Her Pain.

back to March 2024 newsletter

Back to Fall 2023 Newsletter
by Mark Mouro, LMFT

Almost one year ago I was sitting in my office with a couple and I had noticed the wife was making significant progress and change. I asked her about it and she briefly mentioned her unconventional work with another local therapist named Nick. After the session I immediately reached out to him to find out more. We got together for coffee and then continued to meet since I was so fascinated with what he was doing. I think its important work so I asked him for an interview. Here is my interview with Nick Sanchez, LMFT.

What is your education, training, and experience with psychedelics and psychedelic-assisted therapy?

For formal education/training, I received my certificate in Psychedelic-Assisted Therapies and Research from the California Institute of Integral Studies a few years ago. They partner with MAPS (Multidisciplinary Association for Psychedelic Studies) to ensure alignment across certification.

On a more intimate level, I have worked with numerous licensed and spiritually rooted practitioners to have my own psychedelic experiences to truly understand each compound's impact on mental health challenges and overall life fulfillment.

Which psychedelics do you work with in your practice and what is most common?

With the current legal landscape of psychedelics, I provide preparatory and integrative sessions for clients. Many clients use the preparatory sessions to explore what compound suits their needs before seeking it out. It depends on many individual components to find what compound will give the client the result they are looking for. When people initially reach out for a preparatory session, they most often initially inquire about MDMA and Psilocybin.

I also receive clients looking for "coaching" around how they may use the compounds in microdosing to have smaller experiences.

As you say on your website, psychedelic-assisted therapy is illegal in the US. But California Senate Bill 58 would decriminalize personal possession and cultivation of plant-based psychedelics and the bill also aims to establish “community-based healing” practices that promote group therapeutic use of psychedelics. As of last week, it is now on the governor's desk for signature and if he signs it, S.B. 58 is set to go into effect on Jan. 1, 2025. In addition, the Zide Door church in Oakland will be providing DMT to its members next month. Will LMFTs be able to do this work legally?

The last I heard, MAPS has just won its efforts in lobbying with the FDA to allow LMFTs that have received substantial training/certification in psychedelic-assisted therapy to receive direct access to the compounds once they are legal. Their lobbying efforts are a huge win, as the FDA originally planned only to allow psychiatrists (whether or not they received training in psychedelic-assisted therapy) access to the compounds. One of the reasons that I attended CIIS is that it allows me to take 1-2 more courses from MAPS, which would allow legal access to the compounds that can be provided by licensed/certified professionals in a therapeutic setting.

Can you say more about your belief in the power of these substances to change people's relationship with themselves and the universe.

I believe the mental health landscape will change drastically once psychedelics are legalized. My first experience with psychedelics felt like eight years of therapy within 7 hours, even after doing my therapy for over a decade and completing graduate school. I believe it provides a much more experiential approach to working with your mental health challenges that leave a far more lasting impact and desire to implement change after having an experience. You also are unable to hide from yourself. You can easily manage what you tell a therapist, whereas psychedelics allow you to confront areas of your consciousness in an intense and loving way.

Many want to feel a greater sense of meaning and purpose within their lives. We want to feel "a part" of the "bigger picture". I believe psychedelics are one way of very strongly coming in contact with these ideas and allow individuals to experience a profound sense of meaning and purpose while also reminding us of how beautiful life is when our societal thought norms are stripped away.

Many individuals will continue to use psychedelics to peel back the onion further after they have experienced relief from their mental health challenges. It becomes a powerful tool for finding direction and purpose in life.

I work with many clients about their mortality and how we can ultimately use our death anxiety to allow us to live our most fulfilling lives. Often, psychedelics bring the experience of your mortality to the top of your mind and let you ask yourself the more significant existential questions about your existence within the universe. I have found that this alone causes individuals to experience tremendous relief from their mental health challenges while guiding them toward their true calling in life.

I'm very interested in the selection of substance. Can you talk about the process of how you decide which substance is best for each client and their personal goals.

It truly depends on the experience a client is looking for. We can also think about the different compounds as different intensities of the experience we want to have. Some people seek a gentler introduction to consciousness, whereas some want to dive off the highest cliff and confront the deepest and darkest parts of themselves. I work from an existential-integrative approach, which works beautifully with helping clients identify what they want from the experience, which informs the compound they would like to use.

I think about it like a toolbox. We have different tools to apply to different scenarios. Like creating a toolbox for clients around CBT skills, I believe the same can be done with each compound.

Much like traditional therapy, we often receive much more from the process in a slow ramp-up versus going straight into the infinite abyss. Some clients can have a traumatic experience if not approached correctly.

You've mentioned that there are rituals, outcomes and processes surrounding the use of these substances. Can you elaborate on how the substances differ in this respect and what that means for the client.

I would think about it like preparing for a competition. You will prepare differently depending on the type of competition you are competing in. If you are going to be running, you will not be spending time swimming, and if you are trying to prepare to pass a licensure exam for your career, you will not spend most of your time mountain biking. The compounds would be similar. We want to prepare for the experience depending on the compound. Someone who is going to be using Ayahuasca is going to have a much different experience than using MDMA. The rituals, outcomes, and processes will be generally similar, with some fine-tuning depending on what compound a client wants to experience.

I see that preparatory, experience and integration are the main facets of your approach. Can you give an example of how many sessions and how much time each of these take on average?

Usually, a client does about three preparatory sessions. I conduct these as traditional sessions that run 50 minutes in length. The focus is a mixture of getting a landscape of how to prepare for a journey, identifying material that could show up, and how they could effectively work with it while on the journey. Some clients may need more if they have never been to therapy before and it is their first time unpacking some life experiences.

For integration, it depends on the experience that the individual has. I often do one integration session and will have another a month later. Integration sessions are more around how to incorporate the material and realizations that came up in their journey, and the length of ongoing sessions will depend on a client's ability to follow through with their identified action steps.

Integration is vital as that is where the "work" is. The compounds themselves do not "fix" clients. It is the integration they do after that changes their mental health and overall quality of life. The idea of psychedelics "fixing" clients is a common area to address with clients. Many operate from the concept of current psychiatric approaches that believe the medication is where we will see the most significant impact of change.

Why do you think it’s so difficult for most people to integrate the findings from their experience into everyday life?

I have found that many individuals like to stay asleep in life. When we have significant experiences with psychedelics, we become awake. We see the areas we are unhappy with and confront the places we have not been paying attention to. Many individuals will have new realizations and understandings in their journeys that can feel daunting to take the first step in creating the change.

Preparatory sessions are setting the stage for us to be ready to take action directly after an experience. We want to be proactive instead of being reactive to the material that comes up. Many people (especially in Silicon Valley) are comfortable in the rat race. Change takes effort; many of us are tired, sick, and checked out. Getting started always takes more effort than maintaining. We also want to honor the protections many clients have been walking around with for YEARS that have brought them this far in life. It takes a lot of effort, commitment, and action to get a different outcome from the life we have settled into for decades.

Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel, and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

Back to Fall 2023 Newsletter

Back to Spring 2023 Newsletter
by Mark Mouro, LMFT

We are now in the last three months of the two year program at PAPPTP and have just completed a case conference course. This class has been very different from all the others and has given a glimpse into the vast possibilities of psychoanalytic psychotherapy treatment. I was amazed by the variety of interpretations my classmates would make reading from the same transcript of a session. And it had me thinking about how different a session can be depending on the unique characteristics of the therapist and the relationship they have with the client. 

In times like this, I am reminded of the parable of the blind men and the elephant. Then therapists listening to a session and each one giving their own perspective based on personal experience, emotional reactions, and clinical desires. Only when taken as a sum do you really get a more complete picture of the client and a more in-depth understanding of the case.

I should note that this is not uncommon and I, like most of you I imagine, have participated in similar groups in the past. Before getting licensed, I was in numerous supervision groups with other associates discussing each other’s cases; after getting licensed I enjoyed being a part of consultation groups with colleagues. But this one was different. There were a handful of guidelines that I believe made it possible to benefit from this one in a much different way.

For six weeks, one classmate was chosen to present an ongoing case each week. Right before class she sent out a transcript of one session that week and then she read it out loud during class. The professor would have her pause every once-in-a-while and ask mainly two things from the students. What thoughts do you have on the nature of the transference and what feelings and reactions does the client evoke in you in this moment? In addition, the rule was no asking the presenter questions and she would hold off on any of her own comments about our discussion.

Following these principles allowed the discussion to be more about the client and how each one of us can see things differently rather than it being a critique on how the therapist is doing in session and what we think she can do better. The collaboration of each person sharing their observation and insights helped us to identify factors that may have been overlooked as well as potential barriers to treatment. This provided a more rich and nuanced understanding of the numerous dynamics constantly at play that we most likely are not aware of. In particular, how the transference and distinct countertransference in each of us can potentially facilitate the treatment in its own unique way.

Betty Joseph (1985) defines transference as “everything that the patient brings into the relationship… gauged by our focusing our attention on what is going on within the relationship, how (the patient) is using the analyst, alongside and beyond what (the patient) is saying”. She goes on, “Much of our understanding of the transference comes through our understanding of how our patients act on us to feel things for many varied reasons; how they try to draw us into their defensive systems; how they unconsciously act out with us in the transference, trying to get us to act out with them; how they convey aspects of their inner world built up from infancy—elaborated in childhood and adulthood experiences often beyond the use of words, which we can often only capture through the feelings aroused in us, through our countertransference, used in the broad sense of the word” (p. 447).

And for the therapist presenting her case and how this class affected the relationship with her client? I recently spoke to her after the course finished and she confirmed that the classes notes subtly affected the direction of her sessions. She also remarked that there were things she never would have noticed about the client and the sessions before this exercise. But it was an intense and rigorous experience for her because she thought about the client so much due to notes after session, reading what her client said, and hearing the client being talked about in class. In the end, though she felt it was a massive amount of learning for her, this wasn't really a process for her as much as for everyone to learn from each other. This collage pieced together illustrated how complex the process of therapy can be.  And it humbled me by showing the expansiveness of the human spirit that we are not always cognizant of.  

As mental health professionals, it is not uncommon to experience tunnel vision or become overly focused on one aspect of a client’s case. Sharing with a group of professionals with diverse backgrounds and experiences can help to broaden and deepen the understanding of a case; it allows to create fresh insights and ideas to the table. When we can work together to develop a more comprehensive understanding of the patient's condition, then we all benefit from it.

Reference
Joseph, B. (1985) Transference: The total situation. International Journal of Psychoanalysis 66, 447-454.

Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel, and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons.

Back to Spring 2023 Newsletter

Back to Winter 2022 Newsletter 
by Mark Mouro, LMFT

I can recall being a grad student and hearing a teacher explain that the job of a Marriage and Family Therapist is to help people with their relationships. Soon after that, I will never forget working as an intern and experiencing the push and pull of transference in relation to my clients. And now, most of my training and experience is focused on the relationship between partners in couples therapy. Perhaps, then, it is no surprise that what has inspired and excited me most about being in the Palo Alto Psychoanalytic Psychotherapy Training Program (PAPPTP) is learning about the relational perspective of psychoanalysis.

Relational psychoanalysis has been defined by the APA as “a psychoanalytic approach incorporating aspects of several theoretical perspectives, such as object relations theory and interpersonal theory. It focuses on an individual’s sense of self and patterns of relating to others as developed in early relationships and in treatment it emphasizes the importance of the relationship between a patient and analyst or therapist in helping the patient understand those patterns and form new ones.”

This description really did not match up with my image of psychoanalysis: the therapist in the chair behind the patient, the patient on the couch, and never shall their eyes meet. It seems to put the interactions between the therapist and patient front and center with the various forms of communication being expressed. This shift away from the intrasubjective (our inner experiences) to focus on the intersubjective (the space between two persons or the impact of relationships) really appealed to me.

I had to ask myself why this approach speaks to me personally. In my teenage years, play was a huge part of my life through sports. I expressed a lot of emotions and made close connections through athletics. Upon entering college, I discovered the theater and fell in love with improvisation and co-creation of a new reality. It was both in play and spontaneity that I felt most alive. Both gave me a sense of risk, adventure, and reward. Now, as a professional, I find that vitality exists more often when these elements are present in session.

In many of these sessions, when the client’s level of trust in me is good enough, improvisation can lead the way. The two of us can play with ideas and feelings. This spirit produces a dynamic space where we build on each other’s contributions. They tell me their version of reality while I add some elements to it that I experience. They acknowledge and disclose additional details that they are aware of. Only together, can we both understand what is really going on. It becomes a sort of negotiation of different perspectives.

In relational psychoanalysis, interpersonal relationships are seen as the basis of human development. The emphasis is added on the role of relationships in both creating and healing suffering. Therefore, the therapeutic process is seen as a reciprocal system. The relationship between client therapist provides the best opportunity for intervention since the organization of mind is most accessible in the room between two people.

This two-person psychological model is built on mutual influence and equality. A definite shift away from the expert dictating to the sick person who they are and what they want. Less interpretation and more self-disclosure here. There is not one person in charge of the truth. This approach to psychotherapy demands authenticity on the part of the therapist. A real showing up, coming to the table, and being available in many ways to engage. This makes sense to me given that mutual regulation and mutual influence are always happening at some level or another. I can definitely say that I am a different version of myself with each client and that is due to who the client is and the unique way we connect.

The difficulty I encounter most often is disrupting the universe. Just like my clients, I have a hard time changing the dynamics of the relationship after the gel has solidified. There are various clients with whom I feel we are locked into certain roles at some point. From the get-go, the client uses me as an object, and over time I start to feel the sessions becoming narrow in scope. My participation feels contained to a rigid frame. As a result, the client restricts themself to cursory explanations. There is no mutual give and take, no openness to exploration, right or wrong. There is no discovery. The sessions have become flat. There is no wondering and much less, any wandering.

From a relational perspective then, my stretch would be to face it head on with questions that give context to the mutuality of our experience. This means frequently asking my clients what they imagine I am thinking or feeling in reaction to them. Or “I think you think I am feeling….” or “I think you have the impression that I…..”. Taking it even further might be when I tear up and they have a blank face I ask them if they have any thoughts about why I am tearing up and it does not look like they are being affected emotionally. Or even “I wonder why I said that as a therapist, why do you think?”

This co-creation of interpretations is something I am still struggling with. It feels like a big risk. Yet, I know that most of the time when I venture out there, a big reward is awaiting. And isn’t that part of our work? Leading by example with vulnerability. It is the glue that binds us all together.

Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

Back to Winter 2022 Newsletter