Second Thoughts on Sliding Scale Payment

While having coffee last week with my friends Christina and Peter, fellow writers from my Thursday afternoon group, we were discussing how a young philanthropist here in Chapel Hill had helped raise funds to rebuild a beauty salon burned during the riots in Ferguson. The young man’s efforts struck me as very personal: he did not donate or solicit money from others for a general fund or cause; instead, he worked on behalf of one particular individual, the salon owner. This prompted me to wonder whether millenials as a whole feel less comfortable than their parents donating to big faceless organizations like the Red Cross and want instead to feel a more immediate connection to the object of their generosity.

A little research the next day confirmed my suspicion. I found several articles discussing a major shift in the patterns of charitable giving, including this one from NRP where a young philanthropist described a pervasive attitude he had encountered among his peers.”They all said, ‘I don’t trust charities. I don’t give. I believe these charities are just these black holes. I don’t even know how much money would actually go to the people who I’m trying to help.'”

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The Role of Intuition (ESP?) in Psychotherapy


While working on an article about virtual psychotherapy for The Atlantic, I began to think about the role of intuition in the work we therapists do: how it functions and what enables us to understand the way a client is feeling without being told. In part, we’re responding to visual cues. Even when clients are silent, we may “pick up” on their feeling states by reading their facial expressions and body language, often without knowing that we’re doing it. When I first began working by Skype, I was relieved to find that my intuition continued to function via video camera and screen.

Another word for intuition in this case would be empathy. When I work by Skype, I’m able to empathize with clients who may be thousands of miles away, thanks to a high definition picture that allows me to absorb the non-verbal cues contained in their posture and facial expressions. But might there something else involved? Is it possible – bear with me! – that a kind of extra-sensory perception is at work?

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My Idea of Friendship

FriendshipOne day many years ago, my friend Ann told me she had scheduled an appointment with a surgeon to discuss whether to undergo a hip replacement. She and her doctor would be evaluating the results of x-rays and a recent MRI. As a candidate for this type of surgery, Ann was young, in her late 30s, but she was in more-or-less constant pain as a result of a car accident many years earlier when her hip joint had been shattered. She walked with a limp. When she told me about the upcoming appointment, Ann seemed quite apprehensive. I knew she was preoccupied with her decision, whether or not to go under the knife.

I fixed the date of Ann’s appointment in my memory and recalled it from time to time as the day approached. Throughout the day itself, I kept her in mind then called that evening to find out the results. She had decided to have the surgery, she told me. We talked at length about what the surgeon had said, the nature of the operation, and how much relief she could expect. A few days later, she left a message on my answering machine: “Know who else called to ask about my surgery? No one.” Besides family members, not one of her other friends had reached out to her. She seemed grateful that I had kept her in mind.

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The Up-Regulation of Joy

My client Ari got married this past weekend. Given his family background, and in light of a gloomy prognosis for his future made by a former therapist, it was a major and moving event. And yet, in our sessions leading up to the ceremony, Ari seemed “dispassionate,” as I expressed it to him. I found no evidence for the joy I expected him to feel. I tried to help him connect with his happiness, while suggesting some reasons why he might find it difficult to rejoice.

During the session, I felt moved on his behalf