In general
The way I work is called clinical behavior analysis, which means I apply the best available scientific understanding of human behavior to the kinds of problems a psychotherapist can help with. As a behaviorist, my focus is always going to be on helping you achieve the behavior change you want to see in your own life.
What this means is that what I do very often doesn't look much like traditional psychotherapy. The therapy hour isn't (in my opinion) the place where the most important changes happen, because people's problems exist out there, out in the world, out in the other 167 hours of the week. Since the problems are out there, the change has to happen out there too. The therapy hour is where we figure out what you're going to do out there, make a plan, and then cheer you on and/or troubleshoot it, as necessary. Therapy is where we teach skills, practice them, coach them, refine them. Sure, we talk and I listen a lot—therapy is also where we talk about what we don't talk about—but the talk serves action, change, and you getting your life back.
The other big difference between what I do and traditional psychotherapy is that, to a behaviorist, thoughts and feelings aren't problems in themselves. They can be very painful, and they can be very confusing and upsetting, but they'll take our eye off the ball if we let them. People's problems are almost always in what we do under the influence of our worst thoughts and feelings. So we will spend most of our time and attention getting what you do out from under the control of what you think and feel and back under the control of what you choose.
What's it like to be in the room with me?
I was raised by a kindergarten teacher and in a family four generations deep in teachers. So I'm constantly trying to make sure clients understand what we're up to. I try to anchor my explanations and illustrations in clients' own lives and experiences, making them real and immediate to you, rather than stick to a more textbook style of speaking. I tend to be very transparent and genuine: I was trained to be my real self in the room, I truly value that approach, and I think it's important to show up as a whole human being, warts and all, rather than performing an impenetrable "professional" persona. I try to set up the therapy relationship as a safe place to talk about what we don't talk about, be heard, learn new and often scary things, and try them out. If you're happy, relaxed, and engaged, you're likelier to do your best work, which is what matters.
Culturally, I'm a huge lifelong nerd and a very multicultural guy. I love fantasy and science fiction, play video games, watch anime with my family, and spend more time than I should being Extremely Online. I speak English, Spanish, a surprising amount of Japanese and French, and I'm still familiar with Catalan, German, and Mandarin. I've got bits and pieces of a lot of other languages—a few words of Armenian, Hebrew, Arabic, Farsi, Russian, and others. I've done a bit of traveling, mostly to Europe, Mexico, and Canada, but recently to Japan as well. I grew up between cultures, so I'm used to moving between worlds and not being stuck in any one identity. My graduate school research (along with a chunk of my current teaching) focused on sexual orientation and gender identity issues, so I'm comfortable working with people who have a variety of experiences in those spaces. Since I work with young people, my focus there tends to be on identity exploration, rather than assuming any single outcome.
Psychotherapy is talk, of course, and I try to use language in its most powerful possible ways: to bring things into the room that aren't already there, bring you to experiences you haven't had yet, provoke you into looking honestly at your own life and into questioning what seemed unquestionable. I use a lot of anecdotes, humor, passion, and surprise. I work hard to take (and implement!) feedback from clients and own up to my own mistakes and failures.
But—and this is a key thing about a behaviorist approach—I'm not the star of the show. You are. The therapy I do centers the client, and doesn't pedestalize the professional. I know what I know about behavior in general, but it has to be applied successfully to your life—and that has to be rooted in what you know, and what you bring to the conversation.
Scroll down for specifics about how I work with younger children, tweens and teens, and adults.
For young children (0–10ish)
The way I work with younger kids, specifically, is called behavioral-pediatric psychology, which is the application of (no surprise) behavior science to common problems of childhood. My mentor, Dr. Pat Friman at Boys Town, hilariously summed these up as "pooping, peeing, pouting, pushing, pestering, perturbing, poking, procrastinating, picking, and puking." In more technical language, I would say this model is best applied to problems like:
For younger children, strong and consistent parental involvement in therapy is a must. If human behavior is a product of its environment—and I firmly believe that it is—then, for kids, families are the primary vehicle for change. The behavioral-pediatric model centers on helping parents become the place where children succeed. If you're looking for a place to drop off your kid and have someone else fix the problems, I am not your guy. And, similarly, if what you're looking for is "someone for your child to talk to," well, I am a champion listener, and I love kids, but behavior change is the name of the game for me. If we can't agree on how to move from talking to doing, then I won't be able to work with your family.
In working with families, I use a lot of concepts from Acceptance and Commitment Therapy (ACT) and other modern behavioral models like Functional-Analytic Psychotherapy (FAP) and Motivational Interviewing (MI). If you scroll down to the section on how I work with adults, you'll see an intro to those ideas there.
For tweens and teens (11ish–17)
As kids develop toward adulthood, their needs change... a lot. They often end up in a tough push/pull relationship with parents. Sometimes, this means that therapy works best with less parental involvement as the kid figures out how to grow into being the captain of their own ship. These are the kids who need more autonomy and agency (and these are the parents who need to learn to let go, a bit, so that can happen in a healthy way.) Sometimes, though, therapy works best when parents and kids meet each other again there and learn how to have a new kind of relationship with each other. These are the kids who have gotten cut off from their parents (or the parents who have iced out their kids). In these cases, family members need to learn how to trust each other again, how to rely on each other again, and how to be a family again.
So the way I work with kids in this middle period tends to be a mix of family and individual therapy, tailored to the individual case. It would be unusual for me to work only with a teenager and never involving their parents. Minors often don't have the level of influence over their environments that they would need in order to make important behavior changes—and even when they do, their parents are still very powerful sources of support and motivation.
Scroll down to the section on adult clients for more about the hook-and-jab of therapy work with me.
For adult clients (18+)
Of course, that word "adult" covers a huge range of people, often with very different needs and skills. Younger adults may still be living with parents, still building their educations and careers, still needing a lot of support from family. Older adults may not need the same things. So, while the 18th birthday is magical in a legal sense, development into the independent adult role is a gradient that doesn't suddenly complete itself at midnight on the magic birthday. I'm more likely to do more one-on-one work with adults, and of course adult clients are in charge of whether other people are involved in their mental health care, but young adult cases may need at least some consultation and perspective from family. Heck, older adults may too! This gets figured out on a case-by-case basis.
The therapy I do with adults (and parents of younger kids, and older kids, as I mentioned above) centers around Acceptance and Commitment Therapy (ACT), a third-generation behavior-analytic model of understanding problems in human living. Since it's behavior-analytic, it's founded on the understanding that behavior is a natural product of its environment. In other words, all behavior makes sense. Everything we do has a job, a function. There's no such thing as "out-of-control behavior." All behavior is, in fact, pretty strongly under the control of cues and consequences that are right there in the same moment with the behavior. It's not out of control: we just need to figure out what is controlling it, and see whether we can get something else running the show, ideally something you choose.
The ACT model suggests that most of the problems that people show up to therapy for are rooted in avoidance. Specifically, avoidance of painful thoughts, feelings, bodily sensations, memories, and stuff like that. Problems under the skin. The ACT approach notes that those painful thoughts, feelings, etc., aren't actually harmful to us. What harms us is the stuff we do to avoid them. In an attempt to get rid of thoughts and feelings, in attempts not to have them at all, our lives and our behaving become smaller and smaller, more cramped and rigid. So ACT targets that "psychological inflexibility"—that living tightly under the control of avoidance—and seeks to help people liberate themselves into "psychological flexibility"—living freely, under the control of choosing what really, truly matters. ACT uses tools like mindfulness work and exposure to achieve these ends.
One side effect of working in the ACT model is that I'm not interested in a mental-illness understanding of the human world. Of course, mental-illness language—the language of diagnoses and symptoms—is everywhere when we talk about human behavior in our culture. But I can't make much use of that in my therapy. I'll wrap up here by talking a little bit about this, because I think it might be important for deciding whether it makes sense for you to work with me.
The main reason I can't do much with concepts like diagnoses, symptoms, or mental illness is that they don't make sense in a behaviorist world. Illnesses are problems that exist inside a person. But behavior emerges out of a person's interactions with the whole world. A hundred years of boring, nerdy, white-coated, rat-running, pigeon-pestering science has taught us this. If you can move behavior around by fiddling with its world, then behavior just isn't something that works the way COVID or cancer or a cracked shinbone work.
Another reason I'm not interested in a mental-illness account of problems in human living is that the mental-illness idea doesn't work, period. What I mean here is that talking about "mental illness" and "symptoms" and "diagnoses" is a thing that has a specific job inside of medical science, and that job has never been fulfilled and doesn't show any signs of getting fulfilled in the future.
(I'm always afraid I'm going to come across as some kind of conspiracy theorist or supplement-peddling scammer when I say this, but bear with me and understand I don't have any red yarn or weird blurry photos on my wall. Heck, even the people who wrote the DSM agree with me on this, and have agreed about it in very public forums!)
Medical diagnoses ideally point to biological causes that can be targeted for treatment. You show up at your PCP's office with symptoms including a bright red sore throat. She swabs it, you gag, she sends the swab to the lab. With lab results in hand, your PCP diagnoses "strep throat," and those words name a disease by pointing to the presence of a disease agent: a colony of bacteria in your body. Your PCP treats the disease agent (nukes it from orbit with broad-spectrum antibiotics) and the symptoms resolve.
So far so good. But diagnosis is still used even when the causes of symptoms aren't well understood, when there's no known disease agent. When that's the deal, we talk about syndromes (sets of symptoms that show up over and over, but, again, we don't know why.) For example, back in the 1980s, a specific cluster of fatal symptoms was first named AIDS (acquired immune deficiency syndrome), before we discovered (and, thankfully, learned how to treat) the human immunodeficiency virus (HIV) that causes the syndrome.
Mental health diagnosis is stuck at exactly this point: syndromal diagnosis (naming the syndrome, but without knowing what causes it). Now, mental health diagnosis was intended to be a down payment on a huge scientific effort to find the biological causes of problems like the ones we call "depression" and "anxiety" and all those other names! The idea was that we would eventually figure it out the way we figured out epilepsy and heart disease and cancer. The problem is that the investment never paid off. Depending on how you count these things, it's been somewhere between fifty and four hundred years, and none of the names in the DSM point to biological causes. Not one. We haven't even found any reliable biomarkers for any of them, let alone biological causes.
