Blog Archive

Perfectionism Ruins the Good: For You and Everyone Around You Sep 17th, 2019

As if life isn’t hard enough: who needs perfection to ruin the decent? There is a cruelty to perfectionism. It takes something that could be enjoyed, even celebrated, and turns it into a failure.  See what comes up when you google ”Perfectionism is the enemy of…”? Perfectionism has a lot...

Feeling Depressed isn't Depression, and Other Reasons your Advice is Stupid Sep 10th, 2019

Feeling depressed is a common occurrence. Depression less so. Perhaps the most salient reason many people fail to treat those struggling with Depression with appropriate levels of compassion and concern is because they conflate feeling depressed with having a Depressive Disorder. They are worlds apart. The confusion is understandable, given...

Psychotherapy is a Great Tool Jul 15th, 2019

People compare many things to therapy: hikes in nature, talks with a good friend, meditation, and even confessions to a priest. All those things are great and can be important tools for a good life. But they are not therapy. Let us help you find a therapist. Therapy is a uniquely potent...

But Do I Need Therapy? Jul 15th, 2019

To start, the question shouldn’t be if you need therapy, but if it would benefit you. Few people need therapy, and only in a few circumstances. When a need is an issue, we are usually discussing inpatient residential therapy for a serious crisis or treatment for a person with a...

Anxiety Qualifies for Medical Marijuana Now Jul 11th, 2019

Finally, diagnostic Anxiety qualifies for medical marijuana use. Why finally? Because it should have been one of the first and most obvious of cannabis’ medical uses. Anxiety is as common in our society as Depression, and significantly less successfully treated. Current Medications for Anxiety Suck Unlike Depression, for which we have...

Life Isn’t Easy, or Fair: Idealization Tortures Us Thinking It Should Be Jul 3rd, 2019

I never imagined myself a perfectionist. But in the psychoanalytic lexicon, we are more apt to use the term Ideal, or Idealization. We can get a glimpse of our own brand of idealization right underneath statements like “Life should be fair”, “life should be easy”, “parenting shouldn’t be this hard”...

I Feel Crazy, And It Is Trump’s Fault Jul 2nd, 2019

Trump is making lots of us feel crazy. But if you grew up in a messed up family, with a crazy person anywhere near the helm, Trump’s daily lunacy is particularly disturbing. Falling Apart My friends and I have been falling apart left and right the last couple years. I...

Calling Republicans of Conscience to Speak Up Now, If You Exist Jun 23rd, 2019

You can’t all be bad. Or at a minimum you cant be only bad. We walk in the same streets with you. You are in our families. You have been our friends. You have families you love, jobs you care about, communities and churches you invest time and energy in....

Are My Parents Disappointed in Me? Apr 9th, 2019

Even as adults, we can worry if our parents are disappointed in us. We all seek basic parental approval which can be tough to get if our parents had a very specific image of who they hoped we would be. Sometimes the things we are most proud of in ourselves...

Do I Need to Hate My Parents to Get Better? Apr 7th, 2019

Some folks fear they are going to be asked to hate their parents by their therapist. In a world where we agree it is good to move on, let go of the past, and live in the present, it can seem contradictory that therapists as interested in our childhood. But...

Therapist Client Relationship Mar 25th, 2019

  Therapist client relationship begins best with a good match. A skilled clinician can find ways to connect to all of their clients. But a therapist client match based on personality and style can greatly improve both the early work of therapy and the depth achieved. This video has several...

Philadelphia Psychotherapy Practice Will Match You with a Therapist Mar 14th, 2019

Philadelphia psychotherapy practice Full Living specializes in making thoughtful matches between clients and skilled experienced therapists in the Greater Philadelphia Area. Finding a therapist is a daunting task. Besides identifying a therapist with the right credentials, education, and training you need a way to find our if they are any good. Sometimes...

Finding a Therapist Mar 13th, 2019

Finding a therapist can be daunting. Unless you are a therapist yourself it is hard to know what to look for in a therapist, in terms of their training, education and approach. Even if you know the kind of therapy you are interested in, how would you know if they...

Therapist Credentials, Education, Training and Approach Mar 12th, 2019

Therapist credentials, education, training and approach to the work of psychotherapy vary widely in the field. Full Living director Karen L Smith offers information about her background and approach to therapy. Her work is analytically oriented psychotherapy, often referred to as psychoanalytic psychotherapy. Smith is and analytically oriented psychotherapist with 25...

In Defense of Long Term Psychotherapy Mar 12th, 2019

Long term psychotherapy gets a bad rap in the age of managed care and evidenced based concrete treatments. But long term therapy offers transformation, of the way we see ourselves, our relationships and our world. In the video, eating disorders are used an example to compare approaches. Smith is and analytically...

Up-selling Psychotherapy: Are Therapists Even Allowed To Do That? Mar 6th, 2019

Up-selling is a term borrowed from the business world. While the concept seems counter-intuitive to a therapist salary, many of us are additionally small business owners. The fact that we are in a helping profession, doesn’t mean our psychotherapist salary doesn’t matter to us. We use our work in the...

Does My Therapist Care About Me? Is That What I Pay Them For? Mar 6th, 2019

It is a reasonable question. “Does my therapist like me”? In the bizarre, boundaried, prescribed therapist/client relationship, where clients can come to have such potent feelings about their therapists, it is fair for the client to wonder where they stand. Such a Prescribed Relationship For some of our clients, having...

Liam Neeson’s Comments and Racist Impulses is all of Us Feb 7th, 2019

Liam Neeson recently revealed that some 40 years ago, after a friend was raped, he found himself entering predominantly black neighborhoods, seeking out black men, hoping for an altercation in order to channel his rage. In the original interview where he revealed this, he made clear that he understood this was...

CEU Education: Fees, Slides and Cancellation Ethics Dec 26th, 2018

Some basic policy questions: How do you or your agency determine service fees? Do you or your organization offer a sliding scale? If, so, to whom, under what circumstances? What is your or your agency’s late cancellation policy? Some harder questions: Do you ever feel guilty, or under-appreciated based on...

Defending Lena Dunham, Kind Of: Being Messed Up Dec 10th, 2018

Lena Dunham didn’t get it just a little wrong. She got it massively wrong. She did a truly horrible thing. She protected a man accused of sexual harassment because she didn’t want to believe he did it. Even worse, she implied she had confidential information on her side, which made...

The Epitome of Psychological Health: Sabrina the Teenage Witch Nov 10th, 2018

While there are lots of ways to describe and define emotional, mental, and psychological health, there is one consistent theme; Integration. Integration of body, mind and soul. Integration of left and right brain hemisphere. Integration of all the many parts of our psychological and emotional selves. We are not one...

Kavanaugh Believes Himself. He Has Disavowed His Shadow Twin Sep 28th, 2018

Kavanaugh’s tears were real. He was devastated that his good boy, church-going, sports and beer loving, devoted son, persona was being brought down. It is part of his true self. A part of himself he is very proud of. But he has another true self. Kavanaugh’s alter ego is a...

Kavanaugh and Defending Sexual Assault Sep 18th, 2018

Boys will be boys. Rough-housing. What happens in (fill in the boys club activity) stays in (the boys club), and locker-room talk. This is some of the language used to defend behaviors in boys, and men, to describe otherwise reprehensible behavior. But now, in the aftermath of the #MeToo movement,...

Rules of (couples) Engagement: Strike When the Iron is Cold Aug 18th, 2018

I know I know…the motto is “strike when the iron is hot”. There are quite a few situations in life where I believe that is sound advice. But between couples, with difficult issues between them, your best bet for fair fighting is addressing issues when no one is mobilized is...

Surviving Trump’s America as it Turns Toward Hate: Chop Wood, Carry Water, and Laugh with Friends Aug 12th, 2018

It isn’t sustainable. The ongoing shock, panic, horror and emotional devastation resulting from the daily barrage of thoroughly unbelievable atrocities and absurdities promulgated by Trump and his administration. Besides having to somehow try to metabolize the insanity of policy and tweets coming from the white house, congress and house, there is...

Anthony Bourdain, and Why I Talk to My 10 Year Old about Suicide Jun 11th, 2018

When I woke to the reports of Anthony Bourdain’s death by suicide Friday morning, I was visibly upset. My 10 year old asked me what was up. I told him Bourdain had killed himself. He asked what we all ask when someone takes their own life. “Why”, “he is rich, and famous,...

Perversity and Power in Sex Isn’t a Problem, in Fantasy or With Consent Nov 27th, 2017

We are currently involved in a national dialogue about sexual harassment, abuse, rape, and molestation, of young people, employees, job applicants, and others who are vulnerable to the abuses of power. Many of us are reading horrifying stories daily about perversity, and the ways people in power have put others...

Treating Nazis: Analytic Considerations on Racism Aug 28th, 2017

The events and dialogue surrounding this month’s march by white supremacists, KKK, skin heads and neo Nazi’s in Charlottesville have left many of us shocked by the display of such blind hatred and aggression towards whole populations of people. Even for those who feel very aware of both systemic and...

An Impactful Change You Can Successfully Make Aug 11th, 2017

Making this one change prepares the foundation for all kinds of growth and change. It is something you already do, all day long, that you just have to learn how to do differently. And you really must, because it is highly likely that how you are doing it now is...

It’s Not the Glass That’s Half Full/Empty; It’s the Breast Apr 25th, 2017

We judge each other as dispositioned towards negativity or positivity, scarcity or abundance, as if it is a chosen disposition. We imagine the concept of a glass half full or half empty as a perspective that people choose. We access people as being negative or being positive.  We go so far...

Psychotherapist as a Dance Archeologist Apr 3rd, 2017

An element of a good psychotherapy, the one which requires the most skill and psychological strength from the therapist, is our work at uncovering early childhood dynamics (archeology) impacting our daily patterns (dances). Whatever brings folks to therapy, eventually, patterns from childhood become a centrally relevant part of the therapy....

Confessions of a Popaholic: An Erotic Fetish Mar 22nd, 2017

Ok. So you may not be used to hearing the words erotic or fetish in a sentence with zits and popping, but that is surprising. In the world of psychoanalytic theory, where it is quite normative to consider all the ways the body eliminates and evacuates its contents, zit and...

Thinking About Divorce or Suicide? Stop it! For 6 Months Mar 14th, 2017

When we are considering giving up, on our relationship, or on life itself, our thoughts become narrowed to whether or not we are going to give up, and how we would leave if we decide we are done. From thoughts in divorce about how we would afford moving out, what...

When your Client is Racist; In 3 Not So Easy Steps Feb 22nd, 2017

When your Client is Racist (or Homophobic, or Anti-Muslim/Semitic, Sexist, or otherwise hating/afraid of an entire segment of the population. Of all the many bridges we cross in our work to join our clients, isms can not only significantly compromise our ability to empathize, sympathize, and understand where are clients...

Run, Don’t Walk into Therapy Nov 5th, 2016

A blog about therapy;and how you should run, not walk, to begin your therapy journey. Folks compare a lot of things to psychotherapy, like hikes in nature, talks with a good friend, meditation, and even confessions to a priest. All those things are great, and can be great tools for...

Eye Rolls, Shrugs, and Why Trump Is So Provocative Oct 3rd, 2016

It is both hard to turn away and unbearable to watch. Trump has garnered more blind love and searing hate than any political figure in memory. For those who love him, watching him speak, and gesticulate, is cathartically satisfying like a good vent, or cry, or scream, with a feeling...

Colin Kaepernick, Beyoncé, Chappelle and the Protest of Black Lives Matter Sep 4th, 2016

As during most weeks of this past year, social media has been rife with commentary related to issues of race, justice and protest. Many folks reacted with rage at the form some of the protest took, in particular Colin Kaepernick’s decision to remain seated during the National Anthem. Beyoncé engaged in an...

What “Make America Great Again aka MAGA” Means Aug 27th, 2016

Current national political debate is so divided and contentious that most of us aren’t listening to one another’s points, or concerns. We listen to each other only enough to mock or debunk. We hear the worst possible version, or implication, of what someone is saying, and give no thought to the...

Clinical Study and Supervision Group (16 CE’s) Learning from our Mistakes Aug 10th, 2016

For both seasoned clinicians and beginners alike, getting unknowingly sucked into enactments with clients is par for the course of long-term work traversing the world of the unconscious. Regardless of our clinical orientation, we can find ourselves in near and/or actualized re-enactments with our clients paralleling key dynamics in their...

Three Key Fathers Parenting Jobs, Analytically Speaking Jun 21st, 2016

Psychoanalytic theory pays plentiful attention to the role mothers play in early childhood development. The first weeks of life are dominated by the mother-infant relationship, often referred to in the analytic world as the nursing couple*. (To be clear; the nursing couple might be a father and child, and/or might include a bottle...

Let’s Profile Brock Turner, More Accurately Than His Father Jun 10th, 2016

In a letter penned in defense of a light sentencing for his son, Brock Turner’s father described him as “happy go lucky” prior to the events one night in January 2015. Even after accepting his son had sexually assaulted an unconscious woman, he still believed it could be true that...

A Snarky Size Activist and 3 Benefits of My Stupid Fitbit May 25th, 2016

I am a large woman, who worked for a decade on size-activism. My work included helping women both love their bodies more, regardless of size or appearance, but also on reducing the importance they place on their appearance. More controversial, I also suggest that people needn’t bow down to the...

Client Irritating You? Boring You? It is Useful Counter-Transference May 21st, 2016

When we tell someone at a party that we are a psychotherapist, they inevitable ask “Don’t you get bored hearing about everyone’s problems”? Or “Doesn’t it get irritating listen to people complain about their problems all day”? Most therapists would agree that our work is hardly irritating or boring. It is more...

6 Openings for Talking to Kids About Sex and Gender May 19th, 2016

As parents, a lot of us have our fingers crossed. We hope our kids won’t have sex until they are grown. And that they will land on the easiest and least controversial path possible. It is a reasonable wish, but can’t be turned into a parenting goal without shutting down...

Your Client Wishes You Were Friends; Its Oedipal May 13th, 2016

Sometimes clients express their wish that we could be friends. Sometimes the feeling is even mutual. There may be practical reasons, such as aspects of our personalities that align in such a way that we imagine a friendship would be viable. But this is not why our client, or we,...

Psychoanalytic Mother Lovers: 3 Theories for Mom’s Day May 7th, 2016

It is true that no analyst or analytically oriented psychotherapist worth seeing is interested in anything else as attentively as our moms*. But really, who can deny it: moms are centrally key in all our lives. *Moms are sometimes Dads, or Aunts, or Guardians. Sometimes an infant has more than...

5 Reasons to Treat Dating Like an Internship May 6th, 2016

Internships rock. They are a great way to test out a type of work without the commitment of a job. That is what dating should be…a great way to check out a person and a relationship, to see if it is a good fit, without the commitment of partnership. The...

Attending to the Unconscious in a Psychotherapy Session May 1st, 2016

Sigmund Freud postulated that for psychoanalysis to be effective, the client must share with the analyst all that crosses their mind during the course of the clinical hour. Whether their thoughts are deemed by them to be relevant and consequential or completely tangential and random, that the analyst needed access...

“Why Would I Do Something So Stupid?!” 3 Tools for Answers Apr 17th, 2016

“What is wrong with me”? “Why do I do this to myself”? “Why do I keep making the same mistakes”? These are common questions clients have when talking with a psychotherapist. Or a friend about an incident we are upset about. Or to our journals or the universe. It is...

Made Your New Year’s Resolution? Read This Jan 3rd, 2016

Most folks make New Years resolutions about their most core issues. With or without our own awareness of the links, the issues that plague us year after year are entrenched because they deeply rooted in themes from childhood. We love to think that if we just leverage some sound, rational...

Want to Raise a Diversity-Savvy Kid? 3 Traps, 2 Solutions Nov 6th, 2015

If you want a future for you kids that reflects a fantasized “good ole days”, filled with white, heterosexual, legally married couples, with 2.3 kids, living behind picket fences in suburbia, with a bunch of people just like you, this post isn’t going to help you. If you want your...

Sometimes I Give in to my Kid, and I Am OK With That Oct 12th, 2015

Parenting is hard. I know parents are supposed to be consistent. Once we say “no,” we aren’t supposed to let them convince us otherwise. We are supposed to mean what we say and say what we mean. Really, I know, I’ve read all the discipline and parenting books. I even...

5 Reasons Suffering People Don’t Want to Try Medication Oct 4th, 2015

When folks struggle with ongoing depression, anxiety or bi-polar symptoms, serious action is required. Mood disorders are no joke and can suck the joy out of a well-built life. While psychotropic medication is hardly the first order of business, depression meds and anxiety meds are key tools in our arsenal,...

Angry Young Feminists Sep 29th, 2015

Here is my current contribution to the perennial debate about why some folks hate feminists, the concept of feminism, and consistently see them as “angry feminists”. I am going to “blame” it on angry young feminists. Okay, I don’t really mean I am going to blame it on them, but I...

8 Things You Have to Remember When You Fight With a Partner Sep 25th, 2015

Couples fight. And when we do, partners expose our most vulnerable, panicky, hateful selves. Nothing else can open an abyss of confusion and madness like a stalemate half an hour into a fight with our partner. We can find ourselves treating our partner, even when we’re not still in the...

Love is Lovely, but Hate Gives Love its Teeth Sep 24th, 2015

Hate gets a bad rap. Yet real love doesn’t exist without it. Hate and love always live next to each other. Lots of folks don’t like to think about the moments in their lives when they hate their children, their partners, their parents, much less to talk about it. But people...

Catch the New (School) Year Wave and Get Back to Work Sep 8th, 2015

It is not just Jews and school-bound kids that are gearing up for the new year. It is in the air. Or ingrained in our bones from our school years. Summer is over. The fun, or the chaos, of the season is over, and it is time to get back to...

Turning 50 Alison Bechdel’s Success and Mine Sep 5th, 2015

My big celesbian sighting (that is a celebrity lesbian-sighting), was in a hotel lobby in upstate New York, and Alison Bechdel was in her sweatpants version of pajamas. It didn’t stop  me from walking right up to her and introducing myself. I then furiously texted back and forth with all my friends,...

Blue? Lost? Uncertain? Read this book as a pick-you-up. Jul 24th, 2015

Often given as a graduation gift, Dr. Seuss’s Oh’ The Places You’ll Go is a masterpiece reminding us of the natural ups and downs of life and the dangers life entails. While hardly a cure for diagnostic depression or anxiety, it is a comfort to the soul. I read it routinely to...

Anger Matters Jul 14th, 2015

This is a text I received from my 7 year old son one morning upon realizing I wasn’t going to the zoo with his class that day. Note the sadness descending into violent rage.   This is jack you better be come to the feeld trip Keran smith!!!???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? Clearly, the...

Why I absolutely adore the gruesome TV show Hannibal Jun 5th, 2015

The tv show Hannibal is the most internally consistent psychological drama on TV. Sure, its characters are quite fantastical, but they are crafted intelligently, with sophisticated comprehension of the disturbed psyche. Shows with criminal profilers allow psychologists to be relatively smart, but still, they offer the most simplistic of analyses, aren’t...

“I don’t want to talk about Rwanda” Mar 15th, 2015

I have a client who sometimes starts a session saying “I don’t want to talk about Rwanda”.  What he means is he wants to be able to talk about his pain and suffering, and the unfairness of life, without having to think about people who have it worse. The extremes...

Coupledom is great; But Singlehood ain’t too shabby either Feb 22nd, 2015

As an analytically oriented psychotherapist, I am always thrown a bit by “attachment theory” and “attachment parenting”. What about the other side of the coin, separation? Both attachment and separation are capacities that must be achieved. They are accomplishments that need to be nurtured in our children, because both entail losses. Let...

Who is going to Win; You, or your Relationship? Feb 9th, 2015

When couples fight, the need to be right can easily distracts us from the damage that insistence does to our relationship. Unfortunately we really have to chose who is going to win, you or your relationship. Most folks come upon it honestly. In childhood we need to build up a...

Time is my Higher Power Jan 13th, 2015

When I first entered 12 Step recovery in my early 20’s I was faced with the daunting task of identifying a “Higher Power”. I came to the program anti-religious, not particularly spiritual, and very committed to rational thought. I was also un-trusting enough to make relying on my sponsor or...

ADD – Don’t Subtract Foods for your Weight Loss Resolutions for the New Year Jan 4th, 2015

I am a large, body-positive, feminist, who worked with in the Eating Disorder field as both a clinician and educator. And still, this time of year I always find myself hyper aware of my size. And while I think societally we are continually inundated with propaganda about weight loss resolutions,...

Building Resolve for New Years Dec 26th, 2014

New Year’s Resolve Most of us start thinking about New Year Resolutions the morning after Christmas. It is a natural response to weeks of over indulgence, gluttony and greed…all good motivators. The problem with New Year’s Resolutions though is that making change is hard, and it requires a fair amount...

Managing Christmas Expectations Dec 24th, 2014

What could possibly compare to the expectations for Christmas? Certainly not Christmas. The buildup is so massive, that it typically serves to diminish the day itself. One of my favorite X-files episodes starred Ed Asner and Lily Tomlin as Maurice and Lyda, married ghosts who had killed each other on...

Communication Skills for Couples: Headline Your Needs! Dec 15th, 2014

Communication skills are key to turning couples fighting into vehicles for relationship growth and change or just increasing injury and disconnection. You are radically more likely to get your basic needs meet when you communicate needs clearly to your partner/friend/boss/parent. Examples: “I could use for you to hear me out before...

Should I go to Psychotherapy? Dec 9th, 2014

The short answer to if you should go to psychotherapy is Yes! To start, the question shouldn’t be if you need therapy, but would it benefit you. Very few people need therapy, and only in a few circumstances. When need is the issue, we are usually discussing inpatient residential therapy for a serious crises or...

What Should I Talk about in Therapy Today? Dec 6th, 2014

Most clients know that some of their best sessions happen when they don’t know what their therapy topic is going to be. In the absence of an external event to report, the unconscious manages to insert itself into what feels like random meanderings of thoughts in the first few minutes...

Listen to your Unconscious Dec 5th, 2014

Our unconscious minds are filed with truths about our history, hopes, fears, struggles and triumphs. Freudian slips, dreams, songs that get stuck in your head: they are all efforts by your unconscious to direct you to issues burdening your mind that part of you is resistant to addressing. Smith is and...

On Kissing, Tickling and Being Bored Dec 3rd, 2014

“On Kissing, Tickiling and Being Bored: Psychoanalytic Essays on the Unexamined Life” by Adam Phillips. Here is a new feature of my blog…book recommendations. I wanted to start with one of my favorite analytic books of all time.  It is a great read for clinicians and non-clinicians alike, offering an...

Thanksgiving Gluttony, Gratitude, and Black Friday Greed Nov 29th, 2014

I want to be thankful on Thanksgiving; I really do. It is just that the build up is so big, the expectations so high, the demand for joy, and gratitude so relentless.  We have designed the holiday as essentially antithetical. Gratitude is characterized by that moment when you taste the...

Anxiety, Medication and Lost Decades Nov 25th, 2014

Both my client and I sat with such a strange mixture of feelings tonight. In the past 2 weeks his life has radically changed for the better. A burden that has been eating him alive for over 30 years has been lifted. After having spent 20 years of his adult...

Quarantine Your Business Nov 20th, 2014

S: “I have been thinking about maybe going away for a three day weekend” L: “Me too! Where should we go”? S: “Remember when we stayed at the cabin? That is still one of my favorite vacations we have taken. It was so relaxing”. L: “But it took so long to get...

Psychotherapy Myths Nov 18th, 2014

Psychotherapy myths about therapists, clients, why people go to therapy, and the therapy itself prevent some folks from using this uniquely potent tool for crafting a better life. Don’t let fear and misinformation keep you from finding a therapist and a therapy that can help you change your life. Smith is...

Counseling Isn’t Psychotherapy Nov 17th, 2014

Many folks, including some clinicians, use the terms counseling and therapy as if they are interchangeable. Many clinicians engage almost exclusively in the use of counseling techniques and mistakenly call what they do as psychotherapy. This is a serious pet peeve of mine. Okay, not really a pet peeve as much as...

No Arguing in Bed Nov 17th, 2014

I don’t mean arguing right before we go to sleep. While it sucks when that happens, sometimes it happens and makes most sense to have the fight then. But sit up! Get out of bed!Bed is for a lot of things, but not for fighting. It is important to keep it...

Go To Psychotherapy Now Nov 16th, 2014

A blog about psychotherapy Folks compare a lot of things to psychotherapy, like hikes in nature, talks with a good friend, meditation, and even confessions to a priest. All those things are great, and can be great tools for a good life. But they are not therapy. Therapy is a...