Some stresses arise in the course of normal development.

Others arise from forces outside our control.

And some are the result of inner conflict.

Life brings many stresses to us all, whether we are children, adolescents or grown-ups.

Some of these stresses are the result of normal development. When a child goes off to school for the first time, it is hard for the child . . . and for the parents, too. When an adolescent or young adult moves away from home, the excitement is mixed with sadness and worry. Although these developmental stresses are quite “normal,” they still can be quite painful and sometimes may require outside help.

Other stresses lie outside our control. A hurricane, a life-threatening illness, “down-sizing” . . . each puts us to the test. Most people manage to deal with problems like these pretty effectively, especially if they have family, friends, and neighbors who are willing and able to help. But some people find themselves “stuck” and need help finding ways to get “back on track” after such “external” stresses.

Finally, some stresses arise from within us. Old guilts, problems with authority or competition, feelings of inferiority — these kinds of things can tie people into knots, whether they are 5 or 95 years old.

When problems arise from external sources, their solutions usually require that we do something about the outside world. A child in an inappropriate school placement needs a change. Someone working in a truly hostile environment needs to change that environment or move on to greener pastures.

Likewise, when problems arise from within us, we need to do something about the internal forces that produce these failures and miseries. These kinds of problems require the assistance of someone who is comfortable and experienced in helping people to overcome such inner worries.

How problems grow

Internal conflicts rarely spring up “out of the blue.” They usually germinate over long periods of time. Not surprisingly, we almost always prefer to “not think about” them; after all, they remind us of our weaknesses, not our strengths. Often they are tied to things we feel (rightly or wrongly) to be shameful and therefore secret.

Over time such internal conflicts get incorporated into our very personalities, creating a psychological suit of armor that sometimes may be protective but at other times may be very limiting.

Changing well-established but maladaptive patterns of behavior, thought, and feeling usually takes a lot of work. This is especially true when the roots of the patterns run deep and draw from areas that lie outside our everyday consciousness.

Children, adolescents and adults

I have been working with patients who have “inside worries” since the late 1960s. I see children from the toddler years on (often together with their parents, or involving their parents in other ways). Because many adolescents are quite jealous of their privacy, I always spend time with them sorting out how best to work with both the adolescents and their parents. I also work with adults who find themselves repeating patterns of behavior that they know too well, that they have tried to change, but that persist despite their best efforts.

A safe, private place

Patients have taught me that they tend to do best when they are encouraged to take things one step at a time and are allowed to decide for themselves when they are ready for us to take a look at their private troubles together. I see some patients once each week and others every day. My patients and I decide together what is best for them in terms of the frequency and intensity of our work.

My obligations are to my patients, not to outside “case managers.” I am not on any “managed care” panels and I never release information about my patients to anyone else unless my patients ask me to do so. Experience has taught me that confidentiality is essential if my patients are to be able to face issues and fears that often have troubled them for years.

Unfortunately, the changes in health care that we have seen over the past few years leave people who are wrestling with themselves — in such inner, psychic battles — with some pretty difficult choices. Many health plans now use “gate-keepers;” these tend to discourage subscribers from seeking psychological help. When people do go ahead and seek such help, they often find that the help they are offered focuses on a very narrow piece of the problem. What is worse, they often are required to disclose highly personal information for entry into various computer databases. Once entered, that information is out of their control.

My office, located in a residential area of Chapel Hill, is carefully set up to be both quiet and discreet. I set my fees according to individual circumstances and I adjust them (to the extent that I am able) in ways that help preserve my patients’ privacy and independence.

Areas of specialization

Over the years I have developed a few areas of “specialization” based upon my past clinical work and research. These include:

• psychological issues associated with adoption;
• reactions to bereavement, divorce, and other losses; and
• psychological complications of physical illnesses and disabilities.

Before moving to the Triangle in 1990 I spent more than two decades working in medical centers in San Francisco, London, and Cleveland. These years provided me with experience working alongside medical professionals — especially psychiatrists, pediatricians, family physicians, neurologists and oncologists. I also have consulted frequently with teachers and school administrators around specific children and around issues that may affect many members of a school community (e.g., helping a school to respond thoughtfully to the death of a teacher or student).

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