Clay Cockrell, LCSW practices Walk and Talk Therapy (“taking therapy off the couch”) in New York City.  He talked to WTCI via email about what he does and how he got started with it.

What’s your background?

I am a LCSW in New York state. My MSW is from the University of Kentucky and I received a BA in psychology from Asbury College. Raised in Kentucky, my first professional experiences included adolescent substance abuse treatment in Community Mental Health centers. Eventually I found myself in Cincinnati, OH working for several years in the Psychiatric Emergency Room of University of Cincinnati Hospital. 14 years ago, my wife and I moved to New York City where I began my private practice.

What do you do now?

I am the founder of Walk and Talk Therapy (www.walkandtalk.com).  The inspiration for Walk and Talk Therapy, as does all good things in my life, came from my beautiful wife. Years ago, I had a client who worked on Wall Street and was having a difficult time getting away in the middle of the day to come to his session. He simply didn’t have time to commute back and forth to my office. So my wife suggested that I meet him near his office and walk around the area during the session. My first response was: “Honey, that’s just not possible.”

But the more I thought about it, I really couldn’t come up with a good reason why it couldn’t be done. Confidentiality would not be broken if we walked where people could not hear us–and it’s not as if people who saw us walking would know that we were actually in a therapy session. So I proposed the idea to my client and he immediately thought it was a good idea. We met at Battery Park and had the session while walking along the waterfront. It was liberating. I had never seen him so animated and in touch with what he was saying. We continued the practice for the next two months and he made more progress in that time than in the entire previous year.

So with this kind of response, I began to offer it to my other clients and the results were the same. People who had been stuck in depression began to see their issues from a different perspective. Those that had struggled with anxiety began to incorporate a sense of calm into their lives and were much better able to reduce stress. And I loved it! I loved being outdoors and being active during the day. It completely transformed my practice and my approach to therapy.

I am also beginning to expand my practice to online–using Skype. I am in the process of launching www.counselingformen.com–focusing on the unique set of issues facing men in the 21st century.

What limitations have you encountered with Walk and Talk Therapy? Have there ever been confidentiality problems? What about affect–do clients ever cry in public?

As to date, I have never had any issues with confidentiality being compromised. Prior to taking on a new patient, I do explain the possible risks and I have yet to have anyone express a concern over this. I will say that New York City may be the best place to do this type of therapy. There is a certain anonymity that we take for granted here–and the city is so large, there is really very little risk in running into someone we may know. However, even if that were to happen, there is nothing to say that we are in a counseling session. As far tears, yes that can be an issue. I do most of my work within Central Park, and there are several secluded / private places within the park to process emotions. And my office is very near the park, so if a client would prefer to meet inside due to a particularly difficult issue–that is always an option.

How do you connect with clients? Do people seek you out for this type of therapy? If not, how do you introduce it?

About 90% of my clients come through the Internet. It is my belief that many people, when seeking therapy, don’t know where to turn–so they begin to Google. The choices can be overwhelming. But eventually they stumble upon my site and see something unique. It’s obvious from my website that I approach therapy differently and I think that is attractive to a certain segment of the population. I don’t really think anyone goes out to find a walking therapist – the approach is just not well known. I think people go in search of someone with whom they can connect and the modality is secondary. However, if someone finds me through a directory or some other means, I always direct them to my website and we discuss the options of indoor therapy vs. walking. I offer both.

Are there any clients you won’t see in walk-and-talk mode?  Does it seem contraindicated for some?

When I first started I really thought this would be contraindicated for the ADHD population. (Oh look, a squirrel!) But in actuality, the walking seems to calm and focus them. In my office, the ADHD clients seem to be bouncing off the wall and completely scattered, but I think the action and rhythm of walking allows them to gain control over their symptoms. I really haven’t found a population that is not helped by the process. I even have a few celebrity clients who walk with me. They just keep the sunglasses on and people don’t recognize them. Plus–it’s New York. The city has a leveling effect on everyone.

Are boundaries trickier with this type of therapy–does it seem more like friendship than therapist-client?
It is a more casual interaction–much less formal. So I work very hard at keeping professional boundaries. The therapist/client relationship is sacrosanct and I work to maintain the trust of my clients. Yes, the casualness allows inhibitions to be reduced, but I am always clear that I am with my clients in a professional capacity.

How would you recommend a therapist interested in trying Walk  and Talk Therapy get started?

I get calls about once a week from therapists across the country who would like to add this process to their practices. I have a list of things that I go over with them and I’m always open to coaching others as they begin to offer walking to their clients. To start, I always recommend a conversation with the client about the option of walking. If both therapist and client are on board and aware of what to expect, the only thing left to do is get out there and try it!

Find Clay Cockrell on the web at walkandtalk.com–more articles on Walk and Talk Therapy are posted there.

You may recognize Sherry Gaba, LCSW from VH1’s

I am an LCSW and Recovery/Life Coach in Agoura Hills, CA but do life/recovery coaching all over the world.  I am the author of The Law of Sobriety: Attracting Positive Energy for a Powerful Recovery which takes concepts of Positive Psychology, Dialectical Therapy, and the Law of Attraction and fuses them together for treatment for any and all addictions.  I also am the Psychotherapist and Recovery Coach behind the scenes and on air on Celebrity Rehab on VH1 with Dr. Drew Pinsky.  My background includes working in a psych hospital, hospice, and child custody mediation.

How did you first make the leap from clinical work to books, TV, radio…?

I had always wanted to be a news reporter from the time I graduated with a Journalism major many years ago.  I became a single parent when my daughter was one yrs old and had no choice but to forget that dream and find a job that would pay me to support my child.  I got a job working at the Daily News selling advertising space and about 15 years ago decided to go back to school to become a psychotherapist.  As fate had it, I worked at the famed Promises Treatment Center in Malibu for high profile clients, eventually opened up my own practice, met Dr. Drew Pinsky by fluke, was invited on to his radio show at the time, Dr. Drew Live, and eventually put the law of attraction to work and visualized being on Celebrity Rehab with him and the cast.  He invited me on the show and the rest is history.

What’s it’s like treating people on camera?

Working with cameras rolling has not been an issue for me although I can’t always say that is the same for the cast/clients, especially when material comes up that is of high intensity.  For me, my goal is to stay present with and where the client is–having the cameras in the background is something I have learned to easily ignore.

How has being on the show changed your practice?  And how did the book come to happen?

My practice is more varied with more Recovery Coaching and clients with addictions more than ever.  Again, the Law of Attraction worked for me with the book coming to me.  I was sending out press releases to write articles and Counselor Magazine who also owns HCI Publishing, asked for a book proposal rather than an article.

[The Law of Sobriety came out in 2010.  A Q&A about the book is here.]

How would you recommend a clinician interested in branching out into media go about making it happen?

To write a book, e-book, or self-publish a book, find a great publicist, do a blog radio show, and have a strong social media campaign.  I write three blogs a week at It’s All in the Journey, Beliefnet.com, LawofSobriety.com, and Counselor Magazine.

What’s next for you?

I am now producing products that compliment my book and my work on Celebrity Rehab such as my audio program. I am now writing a series of e-books that go into more detail about the book The Law of Sobriety for all addictions, plus a workbook.

Find Sherry Gaba on the web at SGabaTherapy.com.

Dr. Rachel Lacy is a Georgia-based Psy.D, P.C. She talked to WTCI via email about her practice and how she built it.

What’s your background? What do you do now?

I am a neuropsychologist, but I also enjoy providing therapy. My background includes a Master’s in Counseling and I worked in community mental health settings for training as well as in a private practice group until I went back to school. At that time, I enjoyed working with people who had depression, anxiety, and chronic pain conditions and I taught a lot of stress management, relaxation training, and assertiveness skills.

I received my doctorate in Clinical Psychology with a specialty in neuropsychology.  I work with brain injuries, learning disabilities, ADHD, dementia, chronic medical conditions, and chronic pain.

I provide assessments for brain disorders, as well as psychological pain evaluations for patients prior to surgery. In terms of therapy, I provide individual and family therapy for people who have a brain injury or chronic medical condition or disability, chronic pain management psychotherapy, cognitive remediation, and traditional psychotherapy for mood disorders including depression, anxiety, and bipolar, as well as personality and relationship issues.

How have you built your practice? What’s worked? What hasn’t?

I started with an old school technique that at first had a small return.  I made some beautiful brochures and mailed them out to the physicians that would likely refer to me and asked to meet them over lunch or dinner. The meetings are what made the difference, and continue to. My assessments are my product and people like them so much, that I became known to other doctors. Now I have a web site that has been very effective, and I have joined LinkedIn and Twitter, making connections there and continuing to invite people to lunch or dinner. Every year, I try to consider a new group of people to connect with.

What did not work was offering to do speaking engagements at schools or churches, connecting with pastoral counselors, or reaching out to doctors who are set on using the same person they have used for years, unless of course they were dissatisfied with their work.

What dos and don’ts of professional lunches and dinners have you discovered over time?

Basic stuff. Know where you are going: I have been late because I can’t find a place, and I find that frustrating. I am habitually five minutes late so I just tell people that up front so they won’t be put off by it. That may sound strange, but admitting something I don’t do well when it could be irritating to someone has kept people from being irritated.

Do dress well, but not stuffy. I don’t do suits–just my general everyday business clothes. I always have cards on hand and direct to my web site. In fact, I may mention my web site on the phone or in a letter prior to meeting someone so they will have a chance to look at it if they want to.

I always try to learn something about a person’s practice before I meet them and I focus on asking them questions more than focusing on what I want to say about mine. I really am there to learn what they do and to get to know them and how I can help them more than selling myself. I figure if I can serve their patients in some way, there is no need to “sell” myself…that will happen naturally. I never promise I’ll work with a population or provide a service that I would feel uncomfortable doing or ill-equipped for just for the referral. If I find the professional’s practice does not fit with my practice in terms of referrals, I don’t worry about it. I still keep their name on file and ask them to do the same, but in the meantime, I’ve had practice in a marketing meeting, I’ve made a new connection that may or may not go anywhere, and my name is out there.

My main message I hope to convey is my practice is not about making money and cranking out the most neuropsychs. It’s about what is best for the patient. I get the most satisfaction with a job well done (meaning I can sleep at night knowing I was ethical and helpful to someone) and the most reward from seeing people get better or providing them with a valuable service. This does not mean I undercharge for my work. I am careful not to do that. But I do not want to be known as a money making machine. I want to be known as that caring doctor who a person can connect with and knows what she is doing.

Anything more…?

I would just add that you have to be flexible and creative in maintaining a practice and that word of mouth still seems to be the most powerful marketing tool out there. It’s important to connect with and collaborate with colleagues who can help you market, refer back and forth with, to help with creativity in your practice, and to serve as sounding boards for you when you have a new idea.

Find Dr. Rachel Lacy on the web at www.dr-rachel-lacy.com or on twitter: @drlacy.

Dr. Susan Giurleo is a psychologist and private practice consultant–the Biz-Savvy Therapist.  She talked to WTCI via email about what she does and how she does it.

What’s your background? What do you do now?

I am trained as a PhD counseling psychologist and focused my research around education and career development. Over time my interests shifted a bit to helping children with developmental issues such as ADHD, autism spectrum and learning disorders. I was a school psychologist for awhile, worked in a group practice and then got tired of working for others and went out on my own. The whole idea of starting a business was overwhelming and scary to me. I had no business background and neither did anyone in my immediate family. But I was motivated to learn because I wanted to create my ideal practice, utilizing evidence-based approaches to help kids and families in distress.

I spent a lot of time learning how business and health care work. Once I got the business fundamentals down, I started to learn how to market my practice. I quickly realized that marketing involves psychology at its core. The best marketing speaks to people’s needs in a way that allows them to understand products and services and make purchasing decisions.

Learning how to market my practice was fun and rewarding. And led me to where I am today.

Now, in addition to my private practice, I write my blog BizSavvyTherapist.com and provide business coaching and consultation to mental health professionals in private practice. My focus is on the marketing of small practices because I feel that is where people can do the work they love and make a very good living at the same time.

All of the business skills I talk about and teach are ethical and promote good mental health. I teach a strategy called “content marketing” (some call it ‘information marketing’). This approach combines valuable psychoeducation to the public,while at the same time promoting a practice and mental health services. Content marketing allows a practitioner to position herself as an expert or the “go to” person in her community for a specific treatment issue or condition. Based on solid, ethical content clients start to self-identify a fit between their needs and a specific practice or provider. At the same time referral sources such as physicians, lawyers and other professionals come to see the provider as a reliable source of information and quality care for their clients.

The BizSavvyTherapist allows me to combine my passions of promoting mental health, education and entrepreneurship. I feel that the more clinicians I can empower to have strong practices, the more people we can help and serve. It feels like a win-win–more clients, more healing and more income for providers.

How do you go about working with clients using content marketing?

My coaching process has evolved over the past few months.

Initially I ask my coaching clients lots of questions about their reasons for becoming a therapist,why they want to build a practice, what their ideal practice looks like and who they want to help.

To build an authentic practice each one of us needs to know our “why.”  Why do what you do? Who do you help others? What drives your decision to work for yourself?

The truth is, it’s not easy to be a small business owner. Yet, so many therapists start their graduate training with this goal in mind, but graduate with no idea how to go about the process of making money in a helping profession. So, we need to get at the heart of our motivations to be in the business of helping.

Once there is clarity on the why, we then explore how that translates into a profitable business. From my client’s core passions and interests we develop a focus, or a specialty from which they can build an authentic, rewarding business. We generate a business plan that incorporates a balance between their business and the lifestyle they desire. I call this “career/life balance.”

Once this base business plan is in place, I can teach and advise how to do the “nuts and bolts” work of building a website/blog, provide services that clients want and will pay for, and multiple income streams and marketing.

Ultimately, the goal is for therapists to have a solid business that helps people with specific needs and generates a good profit.

In this way, helping professionals can do the work they love and get paid well. It’s not hard to do once people are very clear on their motivations and goals.

What are the basic marketing lessons that apply to therapists?

The cornerstone of any success business requires that we offer something specific that solves a problem or addresses a pain point for people. By default, therapists are trained to help people in pain, but we are rarely specific enough about this.

Human beings naturally categorize things, ideas and people. We are hard wired to sort out “what’s in it for me?” Therefore, we pay close attention to the details of a business or service offering. We are willing to invest our resources (time, money, energy) into something that looks like a good fit for our needs.

This means that therapists need to become more specialized and demonstrate an expertise in one treatment area. People don’t work with generalists. They want providers that can meet their specific needs.

Without a focused specialization, all marketing efforts are wasted. No one can successfully market “therapy.” First of all, how do you define that well enough so people see that they need it? And, let’s face it, no one will trust someone who says “I can help you with any problem you may have.” Would you trust a physician who says they can treat any ailment from cancer to schizophrenia? Of course not. So the first basic marketing lesson is to develop a specialty.

After deciding on a focus for your practice, the next step is to develop a marketing “home” where all of your marketing activity comes together. I always suggest this be a website built on a blog platform (WordPress is my preference). Having a robust web presence allows people to access your information 24/7 and eliminates any need for brochures since the website has all the information people will need.

The website becomes the place where you provide information about your specialty, articles that are informational and helpful to clients (and potential clients). You can list services, products, free newsletters, etc. Once these basics are in place you then branch out into social media using Facebook and Twitter to drive traffic back to your site. It really can be quite elegant and efficient once you get a good basic online structure set up.

And the third marketing tip: show yourself online. Put a picture of yourself on your webpage, get rid of those pictures of sunsets, beaches and drops of water (they don’t mean anything to people). When you engage in social media, always have a picture of yourself associated with the account (whether it be Facebook, Twitter, LinkedIn or another networking site). Therapists are essentially marketing themselves. We don’t have a product. If you won’t show your face online, people will not trust you. Our culture increasingly expects to see faces of others online. The internet is the new community center. I know many therapists are uncomfortable with the concept,but we can’t change cultural shifts. If you want to engage in a marketing plan, be ready to show yourself. Nobody will every visit with an anonymous therapist.

Are there marketing ideas that don’t fit for this profession?

The one things many marketers recommend that therapists can’t use is testimonials.

Ethically, we can’t ask clients to give us feedback that we then share with others.
Sometimes business minded clients will offer a testimonial, but I recommend a policy of not using them because our ethics codes are clear that testimonials can be a place of misused power differential. That really is the only area where we need to adjust our marketing efforts.

However, I also want to say that I hear a lot of talk in professional circles about how therapists should not use social media (such as Facebook and Twitter) but that is incorrect advice. There are many ways we can use these platforms ethically and safely to promote mental health and to market our practices. As long as the information shared is factual and never references real client stories or situations, social media is a powerful tool. There is a lot of debate about this, but many of the people engaged in these discussions don’t seem to really understand the flexibility in these platforms. It is absolutely possible to have an ethical social media presence. I recommend therapists learn how to use Facebook and Twitter with their “professional” hat on, rather than approach it as they would as a private person.

I talk about ways to use social media on my blog.

Any final words of wisdom for people building a private practice…?

Start with one thing. Take one action. That could be meeting with a professional colleague for lunch or coffee, writing an article for a local publication (online or off line), heading over to WordPress.org and starting a blog. The process of building and marketing a practice can seem overwhelming, but when we break it down into steps and stick with it, a lot of progress can be made in a short period of time.

I wish every one the best in their practice building efforts!

Find Susan Giurleo, PhD on the web at BizSavvyTherapist.com, ChildDevelopmentPartners.com, and on twitter: @susangiurleo.

John McDargh is an Associate Professor of Theology at Boston College and author of

What’s your background? What do you do now?

I was raised and educated in the South (Georgia and Florida) – thirteen years of Catholic school and an undergraduate degree in English at Emory University (1970). Upon graduation I was awarded a Danforth Foundation Fellowship, and after four years in the U.S. Coast Guard during the Vietnam War, I used the fellowship to pursue a doctorate at Harvard University. I did an interdisciplinary degree in psychology and religious studies under the Committee for the Study of Religion. It allowed me to range over the entire university and put together a committee with faculty from the Psychology and Social Relations Department, the School of Education, and the Divinity School. My particular area of research was on the application of contemporary psychoanalytic theory, in particular psychoanalytic object relations theory (Fairbairn, Guntrip, Bowlby, Winnicott, Rizzuto) to studying the origin and development of the individual’s conscious and unconscious representations of “God.” I have remained interested in this both for its implications for psychotherapy and pastoral counseling as well as its implications for theology.

The book that was based on that research and subsequent writing was recognized with the William Beers Award for outstanding contributions to the field of the psychology of religion by Division 36 (The Division of the Psychology of Religion) of the American Psychological Association in 1995.

In 1979, I was offered a position on theological faculty at Boston College and have taught here ever since. At the undergraduate level I serve the core curriculum with a year-long comparative theology course on Buddhism, Judaism, and Christianity. At the graduate level I teach courses primarily to serve our joint masters in counseling psychology/social work and masters in Pastoral ministry, though a course like “Spirituality and Psychotherapy” typically draws graduate students from schools across the Boston Theological institute – the consortium of nine seminaries and divinity schools in the Greater Boston area. This past year on my sabbatical I was invited to design and teach a pilot course on “Spiritually Oriented Psychotherapies” for the Massachusetts School of Professional Psychology and have just been invited to chair MSPP’s newly forming Center for Psychotherapy and Spirituality.

How do you suggest a non-clerical therapist integrate spirituality into everyday therapy practice?

There are several different ways to approach this very good question, and a great deal hinges on how you understand “spirituality.”   I find that the simplest practical way to define that is the approach offered in my old friend James Griffith’s book, co-authored with his (then) wife Melissa Elliot Griffith: Encountering the Sacred in Psychotherapy: How to Talk with People About Their Spiritual Lives (Guildford, 2002). They propose to define spirituality as a

“commitment to choose, as the primary context for understanding and acting, one’s relatedness with all that is. With this commitment one attempts to stay focused on relationships between oneself, and other people, the physical environment, one’s heritage and traditions, one’s body, one’s ancestors, saints, Higher Power, or God” (p. 16).

This distinguishes yet relates spirituality to religion, since it is from historical religious or spiritual life ways that a great many people have inherited or appropriated the metaphors, narratives, rituals, and confirming communities that organize those vital relationships over a lifetime. It is also the case that a great many persons will self-identify as “spiritual but not religious” — a self-descriptor that Ken Pargament has shown is usually an index of some degree of alienation or disaffection from what person might term “organized” or “institutional religion” (which nevertheless may play a significant if unconscious or even repressed role in their psychic lives).

The Griffiths argue for therapists inquiring quite directly and yet respectfully about whether a religious or spiritual path has been a significant part of a client’s life if it does not emerge spontaneously in the therapy. Even if that proves not to be the case, there are questions which can be asked, if appropriate, that dive for that level of significance that we may term “spiritual.”  Among the questions they suggest are: “What has sustained you?” “From what sources do you draw strength in order to cope?” “To what or to whom are you most devoted? “Why is it important that you are alive?” Finally, there is the question I find myself wondering about, though it is more often picked up obliquely than asked directly, “Who are you with when you are alone?”

How does the skilled therapist “integrate spirituality into every day therapy practice”? The simplest answer is to listen for ways in which it may already be there – or be conspicuously missing — as a resource and source of meaning in the client’s life. It is then addressed as one would any other vital relationship in the client’s life including the relationship they may carry on with deceased relatives and siblings.

By the way, I think that the “clerical” therapist has both some advantages and some handicaps in attending to this dimension of their clients’ lives. The advantage is that if that identity is known to the client it may be accepted as tacit permission to talk about this aspect of the client’s experience if relevant. Many spiritually or religiously committed clients self censor around these matters out of a sense that it will not be respected and may even be pathologized by the therapist. On the other hand, as my colleague Dr. Nancy Kehoe (who is both a nun and a clinical psychologist) has shown, there are complex transferential dynamics that may be set up when the client perceives the therapist as also a religious professional, and these get particularly sticky when it is a shared tradition.

What are your thoughts about displaying religious iconography in psychotherapy offices?

I think that it is important to ask the question, “For whose benefit is the religious iconography displayed?”  For the therapist’s or the client’s? Many years ago,  when I first saw patients for an intake in an office at a community mental health center, I kept on my desk where I could see it (though it would also have been visible to the client), a small icon of the raising and unbinding of Lazarus, because it was meant to remind me of what has always been for me a metaphor for what good therapy aims to do, to help release persons from the “tombs” or dead places in their lives (and it is a messy, stinky affair, as that story attests; it is also a labor of love). The image was in the first instance there for me…but I think now that is inadequate.

I would be much more thoughtful and intentional today if I were seeing the diverse range of folks who are likely to come to community mental health center. My studies of the history of Jewish-Christian relations, for instance, has taught me that one person’s symbol of hope is another person’s emblem of hate (the cross pre-eminently, as the conflict over the cross erected by the Polish government at Auschwitz poignantly illustrated). My work with survivors of clergy sexual abuse has alerted me to ways in which some religious images are triggers of frightening associations. The priest-clinicians that I know would never, for instance, wear a Roman collar when doing therapy, and most especially with survivors.

It seems to me that the more helpful way of thinking about what is displayed in a space putatively about healing is what images are comforting but open enough to be available to the client’s own projective or imaginative construal. Van Gogh’s Starry Night, or Millet’s The Angelus might offer themselves up to rich associations.

I might add that in recent years I have mainly done spiritual direction, and when I do it at my office in the university the surrounding display gives the message that there are multiple ways in which it is permissable to imagine the sacred since Rublev’s Holy Trinity shares space with a Tankha of the enlightenment of the Buddha and a menorah on the shelf is next to a Hopi kuchina!

How psychotherapy’s relationship to spirituality changed over recent years? What direction do you think we are headed?

For eleven years beginning around 1990 I had the great good fortune to be part of the Agosin Group – a team of psychotherapists begun by the late Dr. Tomas Agosin, a psychiatrist on the faculty of Albert Einstein Medical School, who team taught a summer course, “Psychotherapy and Spirituality,” for the Cape Cod Institute. Initially, and for a good many years, the psychotherapists and counselors who flocked to the seminar from around the country spoke of themselves, sometimes cautiously, as “coming out” as clinicians who took seriously the spiritual dimension of therapeutic practice. It was a daring and still politically marginalized interest, and our work was largely laying out the critical theoretical and methodological groundwork to legitimate an integrative approach. Over these twenty years there has been a veritable flood of literature, much of it published by the American Psychological Association (e.g. books by William Miller, Edward Shafranske, Len Sperry, Ken Pargament, Alan Bergin, and James Jones to cite just a few), that has brought that interest and conversation out of the closet and into something approximating the mainstream – though not without resistance, some of it well-considered and worth taking seriously. All this is to the good and to be grateful for.

Now as I see it the problem we face is perhaps rather different. My colleague in the Agosin Group, Mark Finn referred to it as the “commodification of spirituality.” There is, I sometimes fear, a growing tendency for psychotherapists to reify “spirituality” as simply one more pragmatically useful resource to enhance the psychological well-being of individuals in therapy. Spiritual practices like meditation are deracinated from their traditional ethical, ritual, theological,  and social contexts, and offered as value-free (but financially costly) technologies for personal self-improvement. To describe this process in terms of traditional Buddhism (since it is the practices adapted from that spiritual path which have been perhaps most often appropriated in this uncritical fashion): it is like trying to extract Right Mindfulness from the total context of the Eightfold Path and offer it without attention to the ethical practices (right speech, right mindfulness etc.) or the accompanying ontological vision of reality (right view). Or to put it another way, this approach ignores the crucial role of the “sangha” (in other terms, community, synagogue, church, haverot, fellowship) in the process of individual and social transformation. Sociologist Robert Bellah in Habits of the Heart was critical of this long running and very American tendency to a privatized “expressive individualism” that ignored the common good. For all that we may rightly criticize traditional “institutional” religion, it maintained at its best the bracing vision of the human person as ultimately made for and by a common life in relationship to transcendent meanings and values that overcome the isolating centrifugal forces of solitary self-cultivation.

Bibiliography

James Griffith and Melissa Elliott Griffith. Encountering the Sacred in Psychotherapy (Guilford Press, 2001)

Nancy Kehoe, RSCJ, Ph.D. Wrestling With Our Inner Angels: Faith, Mental Illness and the Journey to Wholeness (Jossey-Bass), 2010.

William R. Miller (ed) , Integrating Spirituality into Treatment: Resources for Practitioners (American Psychological Association) 1999.

P. Scott Richards & Allen E. Bergin (eds), Handbook of Psychotherapy and Religious Diversity (American Psychological Association), 2000.

Edward Shafranske, Religion and the Clinical Practice of Psychology (American Psychological Association, 1996)

Len Sperry & Edward Shafranske (eds), Spiritually Oriented Psychotherapies. (American Psychological Association ), 2005.

Froma Walsh (ed), Spirituality in Families and Family Therapy (Guilford Press), 1998

Find John McDargh on the web at bc.edu. Find the above books along with others on the subject at the Where the Client Is/Amazon Bookstore.

What’s your background? What do you do now?

My background is originally in Family Practice. When I started off, I wanted to be a primary care provider, and so I started down the Family Practice path. Over time, it became increasingly clear that I showed a special talent for Psychiatry, so I chose to specialize in that area. Flash forward ten years, and now I am serving in a bunch of different roles. Clinically, I split my time between my private practice and my clinic practices. Additionally, I teach and supervise Psychiatrists in training, serve on the Executive Council of the APA in New York City, and serve on clinical advisory boards for two top rehabilitation programs. In my private practice, I get to provide high-end patients with psychiatric care that is nonjudgmental and considers their specific needs. In my clinic practices, I get to provide top-quality care to those who will benefit from it the most. The two clinic practices are a HIV/AIDS community program and a community addiction treatment program. In the HIV/AIDS program, I am the sole psychiatrist in a multidisciplinary medical practice, and in the addiction program I am Medical Director. In both clinic programs, patients have not been able to achieve success in their lives for one reason or another. Through closely coordinated care, my colleagues and I assist the patients to lift themselves up to the next level and, hopefully, start to put their lives together. It’s an incredibly rewarding and satisfying experience. My involvement with the APA and the advisory boards is my attempt to help modernize psychiatry. More and more psychiatry is developing a scientific foundation that is helping to destigmatize the various mental health disorders. I am hoping to help increase awareness, acceptance, and support for the various mental health disorders.

How did you first build your psychiatric practice? What worked? What didn’t?

I have to say that I was very surprised by what worked and what didn’t in the process of building my practice. Following advice from peers and friends, I reached out to the psychiatric community and to therapists in my neighborhood with announcement notes. Additionally, I posted a couple of small ads in hobby journals to which I subscribe. From all of this effort, I may have received maybe one referral. What eventually did work was face-to-face contact: I invited colleagues out to lunch or dinner, I attended every professional function I could find, and I made brief visits to neighborhood treatment centers to introduce myself. Within a few weeks of changing my tactics, the phone started ringing with referrals. Once my roster started to grow, I made a point to meet with patients’ psychotherapists. Thereafter, a network for cross-referral began to grow and business started to boom.

As a psychiatrist, what do you most value in psychotherapists with whom you share patients? Which are the therapists you are most likely to refer to?

That’s a question I’m very happy to answer because I am quite fond of the therapists with whom I share patients. They all have three things in common: collegiality, great communication, and a longitudinal approach for each patient. First off, in private practice, our colleagues are the people in our network with whom we interact; therefore, it really pays off to have good working relationships with one another. This is usually reflected by how easily we ask each other questions and tell each other our ideas. I never hesitate to speak with one of my colleagues because I know that the conversation will be easy and I may even learn something! The next thing I look for is great communication regarding my patients. What makes the therapists in my network stand out above the rest is that they give me updates on how my patients are doing — even if I don’t ask. I refer patients for therapy not because I want to deflect that part of the treatment but because I believe my patients will benefit from the additional modality. Therefore, hearing about how my patients are doing enables me to create more comprehensive formulations and thereby provide better care. Finally, and this may be a personal preference, but I like to work with therapists who take a longitudinal approach to formulation. I like to hear what they think in terms of where the patient has been, where the patient is now, and a few projections as to where they think the patient might be headed. Ideally, I’d also like to hear what approaches they would take given the possible outcomes that they suggested. This comprehensive approach to formulation let’s me know that my patients are in the hands of a therapist who has paid attention, has formed an opinion, and is thinking about the repercussions of their various interventions. This is the type of therapist into whose hands I would like to place the care of my patients.

Do you have any additional wisdom you’d like add for therapists starting out in private practice?

Do what’s right for your patients and the universe will do what’s right for you. I know it’s scary to pass a patient on to a colleague when you’re trying to build up your practice and make a living; but refer when appropriate and you will earn a reputation as a practitioner who puts their patients first. When the recession hit and patients decreased their frequency of visits, I felt the familiar pangs of wanting to fill up my practice. An exercise I found helpful in these situations was to imagine my practice full again and the patient in front of me (or on the phone, or being referred to me) as a patient that I would have to go through some machinations to accommodate. In that situation, would I really be the best provider for this patient? If so, then I would take the patient on. If not, then I would discuss referring the patient to a colleague. You’re here to help so do what’s right for the patient and everything else will fall into place for you.

Find Samuel Sharmat, MD on the web at samuelsharmatmd.com.

Tom Corboy is the founder and director of the OCD Center of Los Angeles

What’s your background? What do you do now?

I received my master’s degree from the Department of Counseling Psychology at the University of Southern California (USC) in 1993. My USC graduate thesis was a study comparing various treatments for Obsessive Compulsive Disorder (OCD). In conducting my research, I learned that numerous controlled studies had consistently found a specific type of Cognitive Behavioral Therapy called Exposure and Response Prevention (ERP) to be the most effective treatment for OCD. Much of my post-graduate training was focused on CBT and various exposure therapies like ERP for the treatment of OCD, Panic Disorder, and related Obsessive Compulsive Spectrum Disorders. During my post-graduate training, I also started a weekly, CBT-based, OCD therapy/support group for adults that has been running continuously since 1997.

I am currently the director of the OCD Center of Los Angeles (OCDLA), which I founded in 1999. OCDLA is a private, outpatient treatment center dedicated exclusively to the treatment of OCD and related OC Spectrum Disorders, including Panic Disorder, Social Anxiety, Body Dysmorphic Disorder (BDD), Health Anxiety (Hypochondria), Phobias, Trichotillomania (compulsive hair pulling), and Dermatillomania (compulsive skin picking, or CSP). We have four therapists on staff, all of whom specialize in CBT for these conditions. We treat adults, adolescents, and children, and offer services in both English and Spanish.

Our program primarily focuses on weekly, outpatient, individual CBT sessions, but may also include intensive daily sessions, family sessions, home visits, or couples sessions. Individual sessions often includes “in-vivo” field therapy, during which our staff therapists help clients face their anxiety in real-life situations. We also have ten structured CBT therapy/support groups–six for adults and four for children and adolescents.

How did you go about growing from one person with a specialty into a center with multiple therapists?

Even while doing my post-graduate hours, I knew that I wanted to have a niche practice focused exclusively on OCD and related anxiety-based disorders. After I completed my hours and passed the California state licensing exams, I subleased a small office and opened the center, which was originally just a solo private practice.

Since then, the growth of the center has been very gradual and based on increased client demand for services. After a couple of years of solo private practice, my client base had grown to the point that I hired a post-graduate MFT intern to see additional clients. After another year or so, we both had full schedules, so I hired a second MFT intern, and took over the lease of the entire suite that housed my original subleased office. And a year after that, I hired a post-graduate MSW associate.

For the past five years or so, the center has consistently had 3-4 therapists on staff. Most of the interns and associates have stayed on after receiving their licenses. One staff therapist, Danielle Lieb-Foley, eventually moved to Oregon after getting licensed and opened a similar clinic called the Portland OCD and Anxiety Center.  As I said, the growth of the center has been very gradual – we have only expanded when it has been clear that our client load warranted hiring additional staff and renting more space.

How do you choose staff? How do you recommend people get trained in ERP?

Choosing staff is a critical issue for a niche center like ours. Our treatment program is very structured and extremely specialized. Unfortunately, the vast majority of graduate programs provide only minimal training in CBT, and no training in ERP. When hiring, I look for people who have had some additional education and training in CBT and ERP, and ideally, some experience with using CBT and ERP to treat anxiety disorders.

The OCD Center is fortunate in that we are now established to the point where young therapists with a specific interest in the conditions we treat frequently contact us looking for internships. The first thing that happens upon being hired is that they go through an extensive training in the various CBT modalities we use – specifically ERP, but also Imaginal Exposure, Interoceptive Exposure, Habit Reversal Training, and Cognitive Restructuring. Our training also includes a strong emphasis on mindfulness-based approaches such as Acceptance and Commitment Therapy (ACT), which we have found to be particularly valuable with clients experiencing anxiety.

Upon completion of this initial training, new staff therapists start with 1-2 clients, and increase their client load only as they become more adept in using these techniques effectively. They receive face-to-face supervision on a weekly basis, which continues in the form of weekly staff meetings even after they have received licensing.

Where do your referrals tend to come from?

Our referrals come from a wide array of sources. After ten years, the center is fairly well-known in the local mental health community. As a result, we get referrals from psychiatrists who want to add CBT to the pharmacotherapy of their patients. We also frequently receive referrals from other local psychologists, MFTs and social workers who want their clients to get into a CBT group to augment their individual therapy. And we get referrals from former clients who recommend us to friends and family.

Another major source of referrals for us is our website. We have made a concerted effort to build a strong web presence, with a lot of time and energy put into ongoing search engine optimization. I think a lot of therapists make the mistake of putting up fairly simple websites which they never update. Our site has grown significantly over the years to include over forty pages of information and online tests. It also includes a blog specifically about OCD and related anxiety conditions.

Find Tom Corboy and the OCD Center of Los Angeles online at OCDLA.com and blogging at OCDLA.com/blog.  For recommended reading about OCD, take a look at the Center’s OCD Readings page or at the WTCI Bookstore’s OCD section.

Keely Kolmes (Photo by Thomas Roche)

What’s your background? What do you do now?

Before becoming a psychologist, I was doing computer consulting and had been fairly immersed in online culture since the early 90′s. I also had interests in sexual health and behavior and had worked previously at the National AIDS Hotline. I went to graduate school for my Psy.D. in 1996 with the dream of working in college mental health and working with students around issues of sexual behavior and identity. I’ve spent eight years working in college mental health, and started my private practice two years ago. Now, I’m doing private practice full-time and I work with a lot of sexual minority clients (LGBT, poly-identified, kink-identified) on a variety of issues including anxiety, depression, relationship concerns, and sometimes sexual issues. I see individuals and couples in my practice. I also offer consultation and trainings to other mental health professionals on managing a professional presence on social media and also in working with sexual minority clients.

What’s been your approach to managing your social media presence?

After starting my private practice in 2008, I wanted to use social media for marketing purposes, but I found it problematic to use my personal accounts to do this since I did not want to lead clients back towards my personal life. In February of 2009, I created my professional Twitter account which felt like a big relief. I was able to take up space online in a completely professional way and keep my personal tweets confined to a locked and private account. Shortly after this, I also created a Facebook Fan page for the purpose of experimenting with Facebook ads. I have opted to keep my LinkedIn profile non-public since I would prefer for people not to be able to browse my contact list. But I do participate in LinkedIn discussions and groups.

Mostly my approach to social media is to participate when I’m moved to do so. I blog when I have a topic I feel passionate about. I tweet when I read things that interest me. And I try to interact a reasonable amount without it pulling me away from other activities. I share things when they excite me and I love finding other people’s resources that are valuable to pass along.

How did you get to 16,000 twitter followers and how does your Twitter/social media presence affect your practice?

Twitter lists categories of suggested users and I found myself listed in their Health category this year. After that, my follower count jumped up a great deal. It’s hard to say how Twitter alone affects my practice. I have never had a new client say they found me through Twitter. Most of my followers on Twitter live in different cities or different countries. I think Twitter expands my reach globally, rather than locally, which is good for helping to establish my reputation and letting other people know about me, but I’m not sure it translates directly into referrals.

However, Twitter has enabled me to connect with other mental health professionals who are passionate about technology and social media. It’s greatly enriched my professional life by leading me to professional collaborations with clinicians in other states and countries who I would not have met before Twitter. Since I love research, writing, and collaboration, this has been of great value to me. I see Twitter as a place for me to engage in professional exchanges with other folks in mental health, although occasionally students and consumers of therapy ask me questions there.

What’s the story behind the Social Media Policy posted on your site?

Last March, I first began to consider therapists encountering client information on the Internet and how that might affect treatment. At that time, it seemed there was a lot of worry from therapists about clients searching for information about them online, but very little being written about what impact it might have on therapy when therapists found client information online. I started developing my research instrument to explore this subject.

In my research proposal I acknowledged that future therapists might need to include items in informed consent such as whether or not they Google their clients and how they respond to interactions with clients online. Through my research and my consultations with other professionals, I began to hear of how many different boundary crossings were occurring via the Internet. This helped me to shape my ideas about what to include in my Social Media Policy.

I saw the Social Media Policy as an opportunity for me to think through my policies and consider why I had adopted them and to articulate this in a language that was understandable to clients. Demystifying the therapy process for consumers has always been of interest to me. I also know that clients might not otherwise know what to expect unless they intentionally or accidentally crossed paths with me online. I believe that in a number of years, all therapists with Internet access are going to have to start including Social Media information in informed consent, and I would not be surprised if the APA addresses this in the near future. I just consider myself an early adopter of the Social Media Policy. But since I think a lot of professionals may not even know where to start, I also wanted to offer this document as a gift to the profession for people to copy, share, or modify to fit their own approaches to clinical care.

Find Keely Kolmes at her website, drkkolmes.com, and on twitter: @drkkolmes.  Her Social Media Policy is here.

Tamarisk Saunders-Davies is a British marketing-professional-turned-psychotherapist. She talked to WCTI via email about her work with female entrepreneurs and the state of therapy in the United Kingdom.

What’s your background? What do you do now?

I did my first degree in Psychology at the University of Newcastle-upon-Tyne, in the north of England. As a teenager I actually dreamed of being a actor but i started to realise what i loved about acting was getting to understand the character and why they did what they did…fairly quickly I realised what I really wanted to do was study human behaviour so I enrolled in the psychology programme.

On leaving university, I pursued a career in marketing and public relations in London, hoping to put my knowledge of human behaviour to good use. I didn’t, but it was great fun if high pressured and very results driven. Eight years into my marketing career, I got to wondering if I still wanted to be doing it 30 years from now and I couldn’t escape the niggling doubt that no, I really couldn’t see myself doing it for my entire working life. So I took a pay cut, carried on working part time and went back to university to get my post graduate in Counselling and Psychotherapy. It was tough juggling the high pressured job, the blinking Blackberry and essay deadlines but I really felt excited about moving towards my new career as a psychotherapist.

Now I’m running a fantastic London based practice working with ambitious, go-getting women who are struggling with issues around work, relationships or both and who are looking to find some clarity in their lives. I also offer consulting services to other therapists looking to get a better handle on their marketing…so maybe I will be doing a marketing job until I retire!

What’s your approach to working with your “go-getting” clients?  How have you marketed yourself to them?

While my training was integrative, I’ve been continuing my development as a psychotherapist by learning more and more about the existential way of working. I’ve been avidly reading works by the likes of Irvin Yalom, Rollo May, Emmy Van Dursen and Freddie Strasser.

It seems to me that a lot of people have the notion, gleaned from movies, television and glossy magazines that life is perfectable. The idea that other people out there somewhere have achieved the perfect life, when in fact no one has, it’s not possible. So they feel dissatisfied with the life they do have or even cheated out of the life they think they deserve. They yearn for for a life of perfect happiness, while failing to take control of the life they do have.

My role as therapist is to help my clients find their own unique meaning for their life, I assist them in recognising that they are free to create themselves and make something worthwhile of themselves, making it more rewarding by taking decisive, realistic action.

The type of clients I work with–career orientated women who are struggling with issues of self-confidence and self-esteem–respond really well to this approach as it’s quite an active and dynamic questioning process. They feel I’m with them, that I’m curious and that I’m not just sitting there saying “hmmmmm” a lot!

How have I marketed myself to them:  What’s really important for me is to get out there, meet people and tell them about who I help and how. I’m very fortunate in that I really enjoy networking and living in London you’re really not short of opportunities to do that! I’ve also got much more comfortable networking online, connecting with people through social networking sites like Twitter. With a little bit of hunting I’ve found loads of people doing exciting things out there and so wonderful opportunities to collaborate with them have cropped up. I’m contributing to newsletters, websites and all sorts.

The health care system also runs very differently in the UK to how it does in the States, so for me it’s also been key to get on the radar of GP’s. They tend to be the first port of call when people are struggling emotionally. The National Health Service is doing a lot more to create greater access to talking therapies through a programme called IAPT, but demand is still much, much higher than supply.

The clients I work with are used to having a choice of service provider and are prepared to pay to access good therapy quickly rather than wait. In some cases waiting lists to access NHS counselling and therapy runs into years.

Working within the NHS, are you restricted to evidence-based therapy (CBT and the like)?  If so, how do you fit the search for “unique meaning in client’s lives” within that framework?  It seems like the U.S. is slowly heading in a British-ish direction.

The Improving Access to Psychological Therapies (IAPT) has evolved from a paper originally tabled by a very influential health economist called Lord Layard in 2005.

Layard reasoned that funding by the Department of Health (DH) to improve provision of psychological therapies in the treatment of depression and anxiety, would positively impact on the number of people who are ready, willing and able to get back into work. This increase would consequently reduce the cost of Incapacity Benefit (Welfare I think is the US version) for this section of the population, leading to potential savings for the government. By bringing together prevalence statistics for depression and anxiety, costs of training and employing therapists, potential cost savings in reducing the amount of people claiming welfare, and the benefits to individuals and society of improved mental health and wellbeing, Layard was able to make a strong case for investment by central government.

Layard strengthened this economic argument with a moral and clinical one highlighting the inequitable and patchy nature of current psychological therapy provision, long waiting times, and lack of consistency in implementing NICE (National Institute for Clinical Excellence) guidelines for depression and anxiety.

Based on the NICE guidelines (2004), Layard’s proposed solution was for the provision of treatment centres offering evidence based psychological therapies and psychological support. This proposal achieved £3.7million funding to set up demonstration sites in two different areas of the UK, and saw the launch of the Improving Access to Psychological Therapies Programme (IAPT) in England.

The IAPT programme is absolutely about CBT and therapists currently being trained and working within that programme are using that way of working, but there are lots of different types of practitioners who work within the NHS. CBT certainly has a majority share but there are more traditionally trained psychotherapists working within the NHS. The world famous Tavistock Centre for instance, is orientated towards the psychoanalytic tradition.

A full explanation of all the different ways of working within the NHS would take more space than I have here, because provision changes from borough to borough, council to council.

I will say this -  while I believe an increase in access to talking therapies is a good thing, above everything else I believe that a successful therapeutic encounter can only happen if the client has that elusive chemistry with their therapist. I really believe that choosing your therapist, rather being referred to whoever has a free slot for you, is what will lead to that happening. It’s when that happens that good therapy happens.

Find Tamarisk Saunders-Davies on the web at twochairscounselling.co.uk.  For authors mentioned in the interview, go to the Where the Client Is Bookstore.

Will Meek, PhD is a Vancouver, Washington-based therapist who has carved out a niche working with “The Psychology of Men.” He talked to WTCI via email about what that means and what he does.

I am currently employed full time as a psychologist at Washington State University Vancouver, where I run our small counseling center. This essentially means I run the training program, the outreach program, see a full case load of clients, and work on our students of concern committee and am part of the campus Diversity Council. I also teach at Portland State University in the Masters in counseling program. Additionally, I have a private practice in Vancouver, Washington, which I feel quite passionate about. As of this interview the practice is still in its infancy, but I am quite excited about the direction it is going.

Right now I am putting a lot of time into developing my new blog: Vancouver Psychologist. I have written online in some form or another for the past 10 years, and I think this is my best yet. I am also in the process of beginning a research program on psychology of men, which will be centered on another site I have: Psychology of Men. Working with male clients is a specialty of mine, and I think I have some fresh ideas on the subject to share.

What was the biggest surprise in going into private practice?
Insurance! Despite being pretty educated as a consumer of health insurance, being on the provider side was quite a surprise. I heard horror stories from supervisors and mentors during my training, but the reality of dealing with insurance is unbelievable. It takes a very diligent clinician to keep track of all the money he is owed, how the deductibles work for each client, and follow up with session authorizations.

How did you first get interested in the psychology of men?
My first spark of interest came when I realized in my mid-20s that I had never really thought about what it meant to be a “Man.” This was likely the result of some form of privilege, and I soon realized that most of my colleagues, friends, and clients had not considered this aspect of their identities either. So I decided during my post-doc year that I would focus on men’s issues, and I did a lot of reading, personal exploration, and learning about the psychology of men.

The biggest surprise to me was how splintered the literature on this subject was. The were two distinct threads; one from a male empowerment perspective, and another as a compliment to the feminist movement. Not once did I come across something that felt like a balance or integration of both of these perspectives, which is when I decided that I needed to get some of my ideas out there.

You have just started doing research on something you refer to as “Gender Role Advantage”–can you tell us what that is?
Most people studying masculinity have read about Gender Role Conflict (GRC), which is Jim Oneil’s concept about problems that arise when our gender role becomes limiting or harmful to ourselves or others. In working with clients on GRC, I realized that there were major forces keeping men in place with their gender roles and identities, which prevented any change and continued the GRC. These factors amounted to two levels of benefits: (1) acceptance from other men, and success at professions traditionally held by men; (2) increased money/resources, self-esteem, social status, and interest from mates. So gender role advantage is “the benefits from maintaining a particular gender role and identity.” I think that these things must be examined in working with male clients.

Many of my clients feel like they will appear insensitive if they feel good about being a man or explore this aspect of their identity. I think that cautiousness shows some of the awareness of how charged this stuff can be, but once the fear is lifted, it is amazing how powerful and transforming connecting to this part of self can be.

What’s next for you?
I am going to really get some steam behind my research on Gender Role Advantage and hopefully establish that idea in the professional consciousness, since I think that attention to this by clinicians will be very helpful for men going to counseling. I am also going to continue my work in my private practice, writing my blog, working at WSU Vancouver, and teaching at PSU.

Recommended Reading

(All titles available at the WTCI-Amazon Bookstore)

King Warrior Magician Lover
Robert Moore & Douglas Gilette (1991) – HarperOne

The Masculine Self
Christopher Kilmartin (2009) – McGraw Hill

Fire in the Belly: On Being a Man
Sam Keen (1992) – Random House

In the Room With Men
Matt Englar Carlson & Mark Stevens (2006) – APA

Iron John: A Book About Men
Robert Bly (1990) – Da Capo Press

New Psychology of Men
Ron Levant & William Pollack (1995) – Basic Books

Manhood in America: A Cultural History
Michael Kimmel (2005) – Oxford University Press

Under Saturn’s Shadow: The Wounding & Healing of Men
James Hollis (1994) – Inner City Books

Masculinities
RW Connell (2005) – Univ of California Press

Manhood in the Making
David Gilmore (1991) – Yale Univ Press

Castration & Male Rage
Eugene Monick (1991) – Inner City Books

He: Understanding Masculine Psychology
Robert Johnson (1989) – HarperOne

Find Will Meek on the web at willmeekphd.com and psychologyofmen.org.