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Diagnosing for Dollars

Things Are Different Now

May/June 1995
During the late 1960s and early 1970s, when reimbursement for insured outpatient psychotherapy was automatic, unchallenged and comprehensive, it's fair to say that diagnosis was of only fleeting concern to most therapists. Things are different now.

Panning for Gold

Michael White and the Promise of Narrative Therapy

November/December 1994
Australian narrative therapist Michael White captured the imagination of the therapy world by introducing the method of “externalization,” a way of personifying and concretizing clients’ everyday struggles, giving them a larger-than-life, often heroic dimension.
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Body Politics

The Anti-Anorexia League Turns Patients into Activists

November/December 1994
In a barely audible voice, Rose, a 28-year-old woman who had suffered with anorexia for 12 years, was calling for help. She lived in a remote area 600 miles north of our clinic where there were no therapeutic services for "eating disorders."

Turning Down the Temperature

Handling One of Marriage's Most Explosive Crises

September/October 1994
Every therapists know that disclosure of an extramarital affair can create an explosive crisis undermining the foundation of trust necessary to sustain a relationship. In the midst of that turbulence, our job is to help couples find a pathway to a new understanding of themselves and their marriage. But how is the therapist to maintain his or her bearings in such stormy cases? I've found a standard protocol, first developed at the Center for Family Learning, extremely helpful in providing a therapeutic structure for couples facing the crisis of infidelity.

When Same-Sex Couples Divorce

For Gays and Lesbians, Splitting Up Can Create a Crisis of Self-Doubt

May/June 1994
Having never been married in the eyes of the law, no matter how many decades living as spouses, gay and lesbian partners must invent their own forms of matrimony, and negotiate different kinds of separations than straight couples.

The Shadow of a Doubt

The False Memory Debate Strikes at the Heartof Our Belief in a Just World

September/October 1993
For many clinicians, the false memory debate of the 1990s was a chilling experience, rife with accusations that therapists had “implanted” fictitious memories of child sexual abuse in the minds of clients. This piece, part of an issue nominated for a National Magazine Award for General Excellence, plunged us into the many dimensions of this debate—the bizarre, the dreadful, the bewildering, and the deeply sad.
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Ghosts in the Therapy Room

The Systematic Impact of Family Secrets

May/June 1993
Secrets can grow like weeds through the generations, sending unexpected tendrils into every corner of a family's life. They require at least avoidance, at worst outright lies that can become a habit, branching into seemingly innocuous areas until whole dimensions of life are off-limits to spontaneous talk. Secrets shape not only relationships, but inner lives. "If you knew, you would not accept me,"

think the secret-keepers, while those kept in the dark grow worried and confused: "Something's wrong, I'm not supposed to notice, and it must be my fault."

When a family with a secret walks into a therapy session, the heaviness is palpable. The secret haunts the room like a ghost, looking over everyone's shoulder, a tense and hovering presence. Everyone waits for the other shoe to drop. When secrets are skillfully uncovered, the truth can make people free. And yet for years the subject of secrets was almost a secret within family therapy itself.

When I was trained as a family therapist in the early 1970s, nobody taught me much about secrets, beyond a handful of caveats. Effective inquiry into secrets requires a focus on content as well as relationship, and at that time family therapists were in a broad-brush revolt against Freud, who specialized in exca vating secrets. The book-lined offices of the individual therapists who followed him were repositories of secrets, much like the religious confessionals of earlier times. We wanted no part of that old role.

No Hiding Place

Understanding the Liberating Power of Honesty

May/June 1993

What people don't know can hurt them—and what they don't reveal can hurt them even more. Secrets can destroy lives and relationships. When something is kept secret, it can grow in power and significance until it becomes the center of one's identity.

The Open Secret

Affairs Are Usually a Collusion of Mutual Deception

May/June 1993
A secret affair is almost like an oxymoron, like an unmoving earthquake—no matter how much effort is expended on keeping it hidden, its impact severely shakes, and sometimes devastates, the comfortable certainties of marriage.

The Silent Tyranny

Secrets Often Oppress Those They Were Meant to Protect

May/June 1993
When I was 46, I developed an obsessive need to delve into the memories of my grandmother's past. Like a grave robber, I began to search compulsively for answers to questions I couldn't yet form. I didn't know what I sought—I only knew that I felt compelled to learn about my family's genealogy. I didn't yet realize that one secret buries another. The more protectiveness I encountered from family members, the more suspicious I became, and the more passionate to discover the truth.
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