Theoretical Orientation

Updated 4/28/2007

Lois A. Pessolano Ehrmann PhD, LPC, CAC-Diplomate

Introduction

When I look back on my twenty one years of experience as a professional

counselor, I can see that my professional development intertwined with my personal
development. In the early stages of my professional identity (years one through three), I
was idealistic. I wanted to change the world and fix my clients so they could lead
happier, healthier lives. I was naïve to the fact that much of my agenda stemmed from my
own unfinished business and these issues were rarely addressed in supervision. As
Stoltenberg, McNeill, and Delworth (1998) described in their Integrated Development
Model (IDM) for use in supervising counselors, I was in stage one. I needed a great deal
of direction and the expertise of my supervisors to enhance my knowledge base. I
focused during this time on increasing my skills as a therapist rather then fully
understanding my clients. Thankfully, despite my immaturity, most of my clients’ lives
did improve and they developed healthier ways of coping.
As I continued to work, I found that I ruminated less on my technique
development and looked more deeply toward the development of therapeutic
relationships with my clients and their families. As I experienced this professional growth
shift, transference and countertransference issues became more of a focus. Supervision
helped me to understand both my professional and personal motivations. As I entered
stage two (year four through year nine) of the IDM model (Stoltenberg, McNeill &
Delworth, 1998), I explored my stuck points and how I was reacting to clients’ issues and
feelings about therapy and our alliance. Another round of personal therapy helped me to
stay focused on my client’s needs rather then be distracted by my own. Unlike prior
therapeutic experiences, this intervention was life changing, as my counselor encouraged
me to boldly face my issues. I began to see clearly that I had over-identified with the role
of helper and was beginning to lose my personal self. The therapeutic journey lasted a
few long and hard years but the pay off was great. In the end I decided to stay in the
counseling field but not for the reasons that brought me here in the first place. I decided
that I could not save the world and I found a new sense that a “Higher Power” of some
kind had a purpose for me. This purpose included drawing on the life events I had
experienced in order to show other hurting souls some alternative ways to approach life.
Even though I struggled in this stage, my clients continued to improve and developed
healthier ways of living. I believed that much of the transformation that occurred in both
them and me was of a divine origin.
During year ten of my career as a counseling professional, my family and I moved
to State College, Pennsylvania, and I worked for a private practice agency. My task was
to develop, establish, maintain, supervise and administer a program for troubled children,
adolescents and their families. Through this experience, I clearly moved into stage three
of the IDM model (Stoltenberg, McNeill & Delworth, 1998) where I performed
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autonomously as a professional. I also took on consultant and supervisory

responsibilities. I continued in regular clinical supervision for myself because I believe
that all professional helpers need ongoing supervision for the length of their entire
careers. Ongoing supervision is essential to maintain professional behavior in the best
interests of clients.
During the last ten years of my life as a professional helper, I also took part in
counseling and spiritual direction whenever needed. I felt it was important to practice
what I preach so I worked hard to keep myself as physically, mentally, emotionally and
spiritually as healthy as possible. I also aimed to be the most constructive therapist
possible. I believe that I have evolved as a person to a fairly integrated and actualized
level, and as a professional I have entered into stage three-I of the IDM model
(Stoltenberg, McNeill & Delworth, 1998). This level is the most integrated and
developed in terms of counselor competency and self- awareness. I continue to have
regular clinical supervision at my agency with my colleagues as well as specialized
consultation on some new information processing skills that I have recently developed
through a training program. I am the clinical director at Counseling Alternatives Group,
an agency in State College, PA I started with four other colleagues in 1991. We all
provide ongoing consultation both in individual and group format to younger, less
experienced counselors and I provide regular weekly clinical supervision to our
consultants and other counselors outside of the agency who are pursuing various
certifications and/or state licensure.
In my early development as a counselor, I trained in Person Centered Therapy
(Rogers, 1957; 1961) and Glasser’s Reality Therapy (Glasser, 1975; 1981). I focused on
building up the therapeutic relationship and teaching cognitive and behavioral techniques
to help people improve their lives. As I grew to pay more attention to the relationship
variables in therapy and the important part that emotions play in a person’s life I began to
learn about different theories and techniques that helped people to express their feelings. I
came to realize that cognitive, affective, and behavioral resolution about traumatic
memories or experiences are important for a person to gain or reestablish healthy
fulfilling functioning (Courtois, 1988). I began to see the importance of early childhood
attachments and how those relationships formed a blueprint for the individual about how
other relationships should operate. I saw how early life experiences could form a template
for a person about how his or her world should operate. I began to study Bowlby’s
Attachment Theory (Bowlby, 1969) and the various therapies that have formed from his
ideas (Hughes, 1997; Levy & Orlans, 1995). I also realized that the health of a family
had a great deal to do with the health of the individual. I observed that if a healthy family
existed, an individual within that family seemed to have optimal functioning. If the
family was dysfunctional in some way, then the individual experienced some deficits. I
then began to explore how I could integrate family systems theory (Framo, 1992;
Minuchin & Nichols, 1993; Sherman & Freeman, 1986) attachment therapy, cognitive-
behavioral therapy (Bandura, 1974; Michenbaum, 1992) and gestalt techniques (Latner,
1973) in order to help individuals and their families heal.
The major question I ponder as I begin counseling with an individual or the
family is, “Can I develop a healthy relationship with this person?” If I cannot form a
working relationship, then I will be ineffective in assisting these individuals into healthier
functioning. The major challenge I ask of clients is to form a relationship with me. I ask,
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“Do you think you can take the risks involved? Are you willing to experience all kinds of
feelings with me? Could you imagine yourself getting angry with me and us working it
out? Could you imagine yourself tolerating my frustration with your behavior and us
working it out?”
Clients need to experience a strong healthy relationship with me in order to
develop their own healthy functioning. They need to learn how to get close to me and
how to take risks with me while concurrently experiencing the absence of punishment or
abuse for those vulnerabilities. They need to see that I am not godlike, but human just
like them, and that they are worthy of my, and therefore others’, love. If they can tolerate
their anxiety and move in these directions, then they have a chance of replacing their
unhealthy internal working models with a healthier set of rules, beliefs and paradigms.
Clients can then experience a corrective emotional experience.

Topics of Human Development

I believe that people are born good and by virtue of possessing life energy are
worthwhile and sacred. Unfortunately, the world not only holds millions of people upon
its surface but also holds upon it the human condition (Keating, 1992; 1992; 1999). The
human condition comprises all the action states of being and environmental conditions
that human beings find themselves in the world. Sometimes the human condition takes on
characteristics which move people toward a destructive direction. Famine, war, poverty,
discrimination, drug abuse, sexual abuse, and oppression are all part of our human
condition and when these things happen to an individual, that person is cut off from the
knowledge of him or herself as good, worthy, and sacred. Much of the therapeutic work I
do with individuals and families tries to get the person back in touch with the sacredness
and worthwhile nature of his or her being.
Clients enter therapy with me for various reasons. The addicted client decides
that his or her program for happiness, using drugs, (Keating, 1992) is no longer working
and is in fact causing more pain then relief and thus enters treatment. Other clients may
find that their perfectionism or control issues are out of control, or their symptoms of
depression are no longer minimal. Persons who have experienced trauma such as sexual
abuse or disasters come in because those feelings and memories have exhausted their
coping resources and they need resolution. I work with traumatized adopted children
because their parents are searching for a professional helper who will not sabotage their
parental power. These parents want to reach and influence their wounded children in a
positive way. They want my assistance to intervene upon their children’s negative
internal working models. Parents hope through therapy that their children will risk a
relationship with them despite the abuse of previous caretakers. They hope their children
will allow themselves to be children who have the right to have their vulnerabilities
protected by non-abusive parents. Generally speaking when the misery of not
resolving interpersonal problems becomes larger then the anxiety of facing them,
individuals wind up walking into my office.
The definition of the problem is unique in every client situation. I take time to
listen to the person’s life story and to discover what makes sense to the client and what
does not. Due to different cultural experiences and internalized culturally based belief
systems, something that might be a problem for one person and family is not a problem
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for another. For example, I have counseled families where a child’s enuresis has caused
major difficulties, some of which is due to societal injunctions and norms. Other families
have had children who also engage in bed-wetting, but see it as a very understandable
behavior given the child’s level of trauma. Thus, the bed-wetting becomes a non-issue. I
work in team fashion so everyone involved in the therapy has important input into
problem identification.
In work with traumatized individuals and their families, I focus on both nature
and nurture issues. We explore and often celebrate the positive aspects of the individual
that came with birth. I stress the importance of one’s culture of origin in the healthy
development of personal identity and in finding the solutions to internally and externally
based conflicts. In adoptive families, I look toward the environments (nurturance) that are
in the individual’s present experience as the bridge for the person to integrate and/or
transform his or her nature (what one is born with) in order to bring about optimal health
and functioning. With adults, much of the focus is on building the nurturing environment
that was not experienced as a child but which can be safely constructed as an adult.

Assessment

To be helpful, I need to understand as much as possible the history, current

functioning, relationship aspects, culture and worldview of the person. To do this I take
the first five sessions of a therapeutic intervention to do assessment. I inform the client
about this up front and say that at the end of five sessions, I should be able to help
identify and prioritize key problems. After this assessment phase is completed, I tell
clients that together we will do treatment planning and begin actual therapy. If I feel that
I cannot help them, I make a commitment to refer the client and his or her family to the
professional helper that is most qualified to assist them. I use a structured psychosocial
format that includes the following information areas: presenting issues, history of current
issues, family of origin history, current family history, religious/spirituality history, social
relationships history, sexual history, educational history, physical health history,
substance abuse family and individual history, abuse (sexual, physical, emotional,
psychological, religious) history, prior treatment history, mental status exam, and
affective processes information. During this assessment phase of therapy, I may use
some paper and pencil tests but only to see if my professional hunches based on the
interview sessions are valid. I have used the following measure instruments fairly
regularly: Achenbach CBCL, Reynolds Adolescent Depression Scale, Beck Depression
Scale, Dyadic Adjustment Scale, Family Environment Scales or FACES, Taylor Manifest
Anxiety Scale, Randolph Attachment Disorder Questionnaire, House- Tree- Person
Drawings, ADHD Rating Scale, Parenting Stress Index, Connors Adult ADHD
Screenings, SASSI Adult and Adolescent scales. I also have additional demographic
questionnaires and symptom check lists for clients to fill out as well. I consider these
survey or projective type instruments additional tools that give the client or family
members a chance to tell me something in writing that they did not disclose verbally. If I
suspect some organic brain damage or cognitive deficits, I will refer clients to specialists
in the community for additional diagnostic and assessment services.
Assessment in therapy helps me to understand the client better and helps the client
get to know me as well and how I respond to different and difficult information.
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Assessment also has a part in relationship building and therefore I do not ever rush this
process. Even though assessment is important, it never takes a priority over the
personhood of the client. I rarely do assessments for assessments’ sake and I always take
into consideration the cultural background of clients and how these factors can affect the
process and results of assessment (Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000).
When requested by a Court, Children and Youth Services or the Department of Juvenile
Probation to do just assessment, I mandate the assessment take place over at least five
sessions as usual. I do this because I see it as my responsibility to assist the client in using
the assessment information for his or her benefit in order to get the services that have the
best chance of helping the individual. Occasionally, the assessment phase of therapy
helps me to discover that I cannot help a particular client or his or her family. I use the
assessment information then to make an appropriate referral.
Additional relationship building results from assessment in the form of debriefing
sessions for clients and then problem identification and prioritizing occur. I then work
with the client and or family to develop an operationalized treatment plan with clearly
stated goals, objectives, strategy steps, and dates for reevaluation. The treatment plan is a
contract I have with my clients and I work hard for them to see that improvements are
because of the effort they expend and not because of anything magical about me. I often
say that I am a guide that will hold the flashlight and if they wish their hand while we
explore different directions but their legs have to do the walking.

Essential Conditions for Good Therapy

In my opinion the essential conditions for effective therapy are the following:

1. I function at an optimal level. I am rested and sufficiently nourished by food,

attention, and love. As I experience healthy needs fulfillment, I am able to support
and hold the client’s pain in order to be a healing agent.
2. The client sees that that his or her risk taking with me will pay off.
3. The relationship is one of caring and closeness. It is my job to establish an
environment that promotes such a relationship.

I work best with individuals and families who are acutely aware of their own pain
and despair. I have the gift of being able to be in close contact with another person and
his or her pain in a supportive manner. By staying present to the client, I help to facilitate
their resolution of that trauma and despair. I enjoy the challenge of helping children and
adolescents who are both survivors of severe abuse and who are offending and acting out.
A typical client profile for me is the 13 year old male or female who was abused in all
ways in the birth home, lived through five to six foster homes and is now in a foster to
adopt family situation but has begun to sexually offend on the younger siblings in the
home. Additionally, often substance abuse, fire setting, or self-mutilation is present.
I also treat severely traumatized adults who may be addicted but I have a difficult
time treating adults who are perpetrators. I find that I cannot give these adult clients a
fair chance in therapy because I tend to get impatient and frustrated with them. Many of
the clients that I work with are resistant and in truth they should be. They have
experienced oppression from multiple societal systems as well as abuse. They have been
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discounted, pathologized, and dehumanized. I usually welcome their resistance and

affirm its worth and functionality. I often put the decision to hold onto the resistance or to
let it go even for just a few minutes back onto the client. If they shift out of the resistance,
I affirm their courage in taking the risk. If they hold onto their resistance, I affirm their
decisions and say, “This is so understandable given all that you have been through.” In
this way, the client and I can work through power struggles about resistance issues.
Therapy ends for my clients and I for various reasons. Sometimes clients
themselves decide to terminate even though I feel they have unresolved issues. I talk
frankly about this with them but I also identify the strides they have made and the
challenges they have overcome. I usually leave the door open for them to return should
they desire. Sometimes it becomes apparent that what looked liked a manageable
problem appropriate for outpatient therapy is actually a problem that needs more
intensive program strategies. In this situation, I work with clients and their families to
find the most appropriate setting for treatment and intervention. On an outpatient basis, I
cannot treat individuals whose addictions (be they substance abuse, sexual offending
behaviors, foods etc.) are totally out of control. This would be like attempting to treat a
sprained ankle in a doctor’s office when the person actually had a broken leg and hip and
needed to have surgery in the hospital to repair the bones. Also at times, I need to keep
individuals and other people in the community safe. When my clients have the real
potential to be violent to themselves and others I have had to refer to hospitals or criminal
justice treatment facilities. Occasionally I have had to initiate commitment proceedings
for court ordered hospitalization for their own or others’ safety.
I do know my limits and refer to other professional helpers and inpatient facilities
when I cannot help a person. Regular ongoing supervision helps to be a check and
balance process for me in recognizing my strengths and acknowledging my limitations.

Reasons for Change

Change for the good in a client’s life happens because I have been able to develop
a healthy honest relationship with the client where a number of interpersonal relationship
events take place. They are:

1. The client feels he or she can share most anything with me and not face rejection,
although unhealthy behaviors will be challenged.
2. The client feels he or she can confront me about the ways I relate to him or her
that are frustrating.
3. The client can accept from me appropriate comments and gestures of affirmation,
appreciation, and care including in some cases appropriate ethical touch (Hunter
& Struve, 1998).
4. The client has an appreciation for me and thus becomes attached and begins to
care about what I think about him or her and the behaviors of concern.
5. In experiencing from me healthy caring, support, understanding, and affirmation,
the client begins to challenge his or her own irrational beliefs. Eventually the
client begins to internalize healthier ways of viewing the self and others and
engages in healthy self- nurturance.
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I do not know if change for the bad ever happens because I am very careful about not
intentionally hurting or abusing my clients. Certainly, the state of ‘no change’ has
occurred and the reasons for this has been:

1. I have not been able to adequately communicate to the client that a relationship
with me, although painful in the developing stages, would be well worth the
client’s time and energy and would promote the client’s healing as a person.
2. The client has been so abused and shattered by previous caretakers early in life
that there is brain damage and severe immobilizing anxiety that has produced
extraordinary guardedness.

Some behavioral changes with certain techniques can happen relatively quickly,
especially if there is an external reward to influence the client. For example the client
who is told, “Stop using drugs or else you will be incarcerated for two years,” is more
likely to change those behaviors relatively quickly. The reward is continued freedom. The
question is whether the change in the client is for the right reasons. If drug use is a
problem, the client should desire to quit using because doing so would increase the
individual’s overall level of healthy functioning and improve interpersonal relationships.
These reasons are considered internalized motivations to work in therapy as opposed to
the externalized reason of avoidance of jail. In the latter situation, the client’s external
behavior is abstinence from drugs, but the internal motivations for doing so are not there.
Treatment is part of the game to try to outsmart the judicial and other systems that are
impinging on the client’s life because of his or her irresponsible behavior. The danger in
accepting change due to external motivations is that when the carrot or external reward is
gone, the original problematic behaviors may return. Facilitating a client to change his or
her behavior so that internally his or her thoughts and feelings match up with behavioral
outcomes takes a great deal of time. Changes in self and other concept, internal working
model and issues of self-esteem, self-worth and personality changes require long-term
therapy. Although the treatment I do with most of my clients is long- term therapy, those
who put forth the effort to internalize needed changes find that a new healthier style of
living in the world emerges and endures.

Goals for Treatment

My goals for myself in the treatment of my clients are the following:

1. Be the healthiest I can be in order to role model this for the client and to have the
energy needed to support the client in his or her transformation.
2. Use whatever knowledge and techniques I know to (a) facilitate a healthy
relationship with the client and (b) help the client to make healthy life changes.

My goal for my client is that he or she experiences a transforming union with me so

that he or she can find the resources between us and within the self to make changes for
optimum growth and functioning.
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Techniques

During assessment and the early phases of therapy, I focus on relationships

and use the techniques that stem from Person Centered Therapy (Rogers, 1957; 1974).
I try to show the client empathic understanding, unconditional positive regard, and
genuineness on my part. In addition I tell clients that our early work together is like a
partnership where they tell me the stories of their lives and I record and write the words
down in a coherent fashion. This narrative therapy technique helps me to understand the
various meanings a person ascribes to joys and disappointments, successes and failures,
celebrations and losses in life. As a result most of the time a healthy therapeutic alliance is
formed and I believe that this relationship is primary. All other interventions build upon
the relationship.
As we proceed into treatment planning and intervention strategies, the techniques
I use are chosen specifically to meet the client’s needs and they vary considerably. For
children I may use a combination of art, sand tray play, and structured and unstructured
play therapy (Einon, 1985; Jernberg & Booth, 1999; Malchiodi, 1998) as well as family
therapy sessions where parents gently snuggle and hold their children as we work through
hard issues to promote parent-child attachment (Cline, 1992; Federaci, 1998; Hughes,
1997; James, 1994; Keck & Kupeckny, 1995). At times I will facilitate the creation of the
child’s important life story in a book form that all of the helpers (me, parents, sometimes
grandparents, mobile therapists or therapeutic staff support personnel) also take part in.
Sometimes I find it helpful to use workbooks with children that deal specifically
with issues pertinent to them. When the anxiety in a child is so high the structure of a
workbook keeps the discussion of the topic contained and safer for the child. I have used
workbooks with children when dealing with sexual abuse (Bean & Bennett, 1993;
Loiselle & Wright, 1992; Spinal-Robinson & Wickham, 1992; Stowell & Dietzel, 1982;
Wright & Loiselle, 1997), anger and rage (Garbarino, 1993; Hage, 1999; Murray &
Wright, 1996), sexual offending behaviors (Freeman-Longo, Bays & Bear, 1996;
MacFarlene & Cunningham, 1990) and various interpersonal skill development issues
(William Gladding Foundation, 1996). In 2005 I began studying and training in Eye
Movement Desensitization Reprocessing (EMDR) (Shapiro, F., 2001; Shapiro, R.,2005;
Shapiro, F., & Forrest, 1997) which is a specific way of working with trauma material so
that the memories, feelings, and sensations associated with traumatic events are
assimilated throughout the whole brain for better understanding and resolution rather then
staying stuck in the limbic or emotional base of the brain. I use this technique in creative
and fun ways with children to help them process and integrate past traumatic material
(Tinker & Wilson, 1999). EMDR efficacy in treatment has been studied prolifically with
the adult population but studies on treatment effects for children are just now beginning
to be conducted. For more information on EMDR, its purposes and strategies for work
with persons across the life span go to www.emdria.com.
I do parenting education with the caretakers or parents of the children who are my
clients. Often I have to teach caretakers to stretch their regular parenting skills. I
encourage and teach the use of therapeutic parenting skills and positive disciplinary
strategies. I do that using a number of books and videos as well as having parent only
sessions (Cline & Fay, 1990; 1992; Dinkmeyer & McKay, 1990; Hage, 1997; Phelan,
1995; Thomas, 1997). At my agency, periodically we run an eight-week
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psychoeducational group program called Parent-to-Parent 2000 (The Passage Group,

1999). This program teaches parents various skills such as behavioral reversals, I
messages, contracting, appropriate limit setting, and healthy self and other nurturance.
With adults in therapy, after a relationship is established, I tend to use cognitive
behavioral techniques identified by Linehan (1993) in her work with individuals suffering
with borderline personality disorder and histories of severe trauma. Linehan’s model has
been systematically evaluated on a multitude of client populations and is considered a
strongly empirically validated approach to depression, PTSD, and borderline personality
disorder. I use techniques that construct safe containment for the client and engage in
resource development in preparation to use EMDR for trauma resolution. I also use some
gestalt techniques (Latner, 1973) such as empty chair, and parts work to help the client
get at affective conflicts and processes that need resolution. While I have always done
ego state work (inner child nurturing) with traumatized clients more recently I have been
using a model called Internal Family Systems developed by Richard Swartz (1995). I
particularly like this model because it normalizes the fact that all of us, regardless of
where we dance on the unhealthy to healthy continuum, have internal parts that make up
our personalities. One only has to think of the various roles the individual engages in on a
daily basis to see this concept in action. An example is the mother who gets up at 6:30
AM in the morning to get herself ready for work and then rouses the children to feed and
clothe them in preparation for school. Already she has presented the role of working
woman and then mother. At work all day she may move into her role as an administrator,
teacher, business analyst, or limitless other job categories and then she leaves at the end
of the day to return to her family as mother and wife. She may also be a loving and caring
daughter when her elderly mother calls for help with some errands later that evening. If
she is planning to help the children with their homework but her mother is in need of her
driving abilities to pick up medication, a conflict between her two roles (mother and
daughter) or two parts of her ensues. This is but one example of the typical internal
conflicts that all of us run through on a day to day basis. Traumatic experiences result in a
further splitting of a person’s internal parts because being in continual conflict within one
self significantly reduces functionality.
Additional techniques that I use stem out of the empirically validated model of
Emotion Focused Therapy (EFT) (Johnson, 1996; 2005; Johnson & Whiffen, 2003).
Helping a client to learn how to pay attention to feelings and body sensations is a goal of
mine because attention to feelings and sensations can provide important messages to us
about our conflicts, lives, meaning, and about the relationships we have with the people
within our world. Lately I have also been reading and studying some body centered or
sensorimotor approaches (Ogdin, Minton, & Pain, 2006; Rothschild, 2000; Scaer, 2001;
2005) to resolution of life’s difficulties as well as the abusive struggles and double binds
that many clients bring with them into the therapy office.
When techniques do not work, it is usually because the intervention was not
sufficiently matched with the specific area of need in the client. The client and I
or the family and I then regroup and evaluate, refocus and re-strategize. I consider every
member of the family including the client as part of the team in identification of the
issues and in the brainstorming of the solutions. When working with individuals apart
from their external families, the internal parts (called their internal family) also become
important team members in working on the solutions.
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I conceptualize the process of therapy for my client’s within Bowlby’s theory of

attachment (Bowlby, 1969). Therefore, I continuously review the following:

1. What is the status of the client’s attachment to me (or to the parents if a child)?
2. How am I promoting or pushing for the attachment or this relationship? What
strategies can I implement to promote a stronger relationship (i.e. non-directive
sessions so the client can have more control over session contact, increased
physical touch or proximity, interactive games that build or promote teamwork
etc.)? What am I personally doing within the therapeutic relationship that could
be hampering the client’s growth?
3. When I think about different strategies, what cultural issues for this particular
client do I need to consider? Are there cultural differences between this client and
me about the use of touch or affection, the expression of feelings etc? How
should I adjust or adapt to these cultural issues and differences?
4. What are the client’s affective, cognitive, behavioral stuck points that are
interfering within our relationship, within his or her relationships with others?
Are these stuck points due to reactions on the part of the client to external
oppressive forces such as discrimination and oppression? What appropriate
interventions can I implement to assist this client to get unstuck (i.e. journaling,
disputing of irrational beliefs, empty chair work, parts work, EMDR coaching
etc.)?
5. How is this client generalizing session learning to his or her greater community
and life outside of therapy? If generalization is happening to a high degree is the
client ready to approach termination? If generalization is happening to a low
degree, what still needs to be worked through?

Where do I want to go from here?

My personal and professional journeys have resulted in a place and space where I
find that I am an expert on the treatment of trauma and attachment difficulties in the lives
of individuals whose ages travel across the life span. Being an expert though does not
mean that I have ‘arrived’. No one ever fully arrives in his or her lifetime because growth
and development never stops. Our lives just take on new pathways and we move in new
directions possibly just a tad bit bolder then before. I find of course, that I am still
growing. My plan is to keep doing what I have been in the way of providing services as a
clinician to clients and families who for whatever reason walk into my office. I also want
to do more research and outcome study trials so that I can provide some clarity as to what
is really helpful to children who have been so terrorized and battered in their young lives
that their spirits seem crushed and they have no effective energy to struggle once more to
build relationship. Finally I see myself someday training and supervising other
professional helpers who have the same goal as me of facilitating the attachments
between traumatized children and their adoptive families.
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