The major organizing concept of my therapeutic approach is what I call the needed relationship, which is the topic of my first book, Needed Relationships and Psychoanalytic Healing (2017). The central premise is that, while we, as analytic therapists, draw on the rich history of psychoanalytic theories and wisdom, the particular relationship that develops in each treatment is unique, reflecting the unique and always-evolving nature of each patient’s therapeutic needs. The mantra of this approach is the question: What does the patient need from me?—both in the present moment and cumulatively over time. While the question is simple, the answers are always complex. When a patient has suffered emotional trauma as a child their therapeutic needs are complex because they have lost trust in the relational world and have had to develop strategies to protect themselves from further injury and hurt. At the same time, they need a therapist to recognize their unique but injured selves and the debilitating emotions caused by their particular early traumas. Thus, the therapist faces the challenge of winning the patient’s trust—enough trust for the patient to gradually let down their protective defenses and allow the therapist in to witness their most vulnerable selves. Only through this kind of therapeutic trust and connection can a patient begin to let go of their attachments to the internalized “ghosts” who have hurt them in the past and continue to control them in certain ways in the present. The hallmark of the co-creation of a needed relationship in a given treatment is that the patient feels increasingly like the therapist gets it.
The topic of my second book, Airless Worlds and the Restoration of Psychic Breathing (2025), is a particular kind of early relational trauma and resulting clinical syndrome I began to recognize and study during the period of my analytic training. Airless world syndrome, as I call it, is a psychological condition in which a patient’s early attachments and identifications were with parental figures who were negating of their true self and needs, instead imposing their own needs, judgments and requirements on the developing child. These internalized negating messages undermine the adult child’s senses of self and personal agency, and what we might call psychic breathability, leaving them under the control of their now-internalized negating early caregivers. Airless Worlds offers an in-depth study of the kinds of therapeutic processes I have found most helpful in treating patients suffering from this often-disabling condition.
The final chapter in my second book is titled On Management: The Art of Relating to Difficult Parents and Other Family of Origin Members. Unlike the other chapters in this and my first book, this chapter is written in a less academic style that I hope speaks directly to patients as well as the therapists treating them. It describes an approach I have developed over the years for helping patients who are still struggling in their relationships as adults with their parents, and perhaps other family of origin members. The approach involves becoming realistic about one’s parents’ limitations as parents—limitations that may never change. Accepting such limitations involves a kind of grieving—grieving the loss of the parents one never really had to begin with and probably never will have in the future. It requires a shift to what I call a “management” approach in which one realistically seeks to restructure these relationships in ways that protect oneself from re-traumatization while fostering the most positive interactions possible with one’s family of origin members.