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Keeping Kids Out Of The Middle (Garber, 2008)

"Clinical" refers to those services
which individuals, couples and families seek voluntarily
in the interest of improving functioning, comfort,
the quality of performance in a particular setting
(e.g., grades at school)
and/or the quality of relationships.

By contrast, Dr. Garber's court-related or "forensic" services
are usually engaged under court-order and may serve the court's needs
rather than the individual's needs. Read more

Developmental Psychology For Family Law Professionals (Garber, 2009)

How does Dr. Garber approach psychotherapy?

There are almost as many approaches to the process of change and growth that we call psychotherapy as there are therapists. The media (á la Woody Allen) has suggested that at least some psychotherapies require that the "patient" recline on a couch and talk endlessly to a quiet, expensive listener in the background. This is Freudian or dynamic psychotherapy.

Others require that psychotherapy be very task-driven. The "client" is given homework and the therapy itself is base upon very concrete goals. This is "behavioral" or "cognitive behavioral" therapy (CBT).

Research studying the effectiveness of scores of different types of therapy agrees on only one thing: Therapy can only be effective when the client (or patient) and therapist have an open, trusting and well-bounded relationship. "Open" and "trusting" may be self-explanatory. "Well-bounded" means that the relationship is mutually understood and accepted as a non-reciprocal, professional helping relationship.

Dr. Garber is trained in dynamic, CBT, systems and related therapies. The approach that is chosen, the tools that are used, the goals and the pace of the therapy are the result of a mutually determined, client-centered process. Impulsive five year olds may need a very directed, task-driven behavioral intervention while the depressed and fearful 35 year old struggling with a failing marriage may need more supportive listening and constructive direction to area resources.

Dr. Garber's job as psychotherapist is to recommend the best path between the concerns that prompt your first call and your end-goals. Your job is to collaborate in the process, to trust, to try new options and to be open and honest at all times.

What age groups does Dr. Garber work with?

Dr. Garber is trained in developmental psychology as a child and family therapist. He has experience working with individuals, couples and families from 3 to 93.

Certain special conditions may be relevant to accepting individuals of specific age ranges. For example, psychotherapy with young children (e.g., 3 to 6) can be a very slow and gradual process, investing a great deal of time helping the child to feel safe and comfortable. Parents are often closely involved. Psychotherapy for young children is an expressive process, as it is for anyone, but expression in childhood often occurs most comfortably in pretend play, drawing and crafts.

Psychotherapy with teens has its own unique conditions. Establishing trust, safety and a willingness to engage in a change process with a 12-17 year old can be quite challenging. This work is further complicated by the teen's expectable exposure to drugs and alcohol, sexual behavior and all that accompanies these topics. In addition, concerned caregivers are reminded that federal law allows teens to keep certain matters of reproductive health, HIV/AIDS status and substance abuse private with a therapist from a parent. Learn more here

Link to an interesting 2003 article on the political history of these laws

The role of medication in psychotherapy.

Dr. Garber will advise you about the possible benefit of medication and will refer you for medication evaluation, as appropriate to your needs. However, Dr. Garber will recommend that all other avenues be pursued (e.g., individual and/or group psychotherapy, education, changes in diet and exercise) before medication is considered, within the limits of safety and pragmatics.

As a matter of safety, consider this non-scientific measure:

On a scale of 0-10 (where 0=none and 10=overwhelming), how much distress are you experiencing? Distress is your internal of subjective state of pain. On the same scale, how much dysfunction are you managing? Dysfunction is the external, objective measure of your success managing the reasonable functions of your world (e.g., eating, sleeping, dressing, schooling or working, friending). Dr. Garber has taken the position that if either number is 8 or greater or their sum is 13 or greater, medication consultation may be an important next step.

As a pragmatic issue, keep in mind that in non-emergency situations, it may take several weeks to schedule a first appointment with a prescribing physician (i.e.., psychiatrist) or nurse practitioner (i.e., ARNP) and then, if you decide to start a medication, it may still be 6 or more weeks until you know whether the medication is helpful and achieve the right dosage level. With this in mind, its important to try to anticipate your needs so as to plan ahead.

Learn about psychiatric medications

Depression and psychotherapy

Many people mistake depression for sadness. In fact, depression can quietly erode the quality of an individual's life and impact the lives of caring others with no obvious sadness or apparent reason.

Depression is a medical illness which can impact anyone, anywhere at any time of life.

Read more about depression

For practical purposes, think of depression as the pervasive and debilitating experience of hopelessness ("there's nothing ahead for me"), helplessness ("there's nothing I can do to help") and/or wothlessness ("I feel like garbage.") These experiences often interfere with sleep, appetite, sexual interest and the enjoyment of previously preferred activities.

Individual psychotherapy is often one necessary part of a constructive response to depression. The less pervasive nad debilitating the symptoms, the briefer the duration of the symptoms, the more likely psychotherapy is to be sufficient for relief.

More intense, longer standing and more debilitating symptoms can require additional supports via family and/or group therapies and/or medication consultation.

Dr. Garber provides outpatient individual, family and (as the need arises) group psychotherapy
for children and teens with depression. Learn more

Anxiety and psychotherapy

Everyone has anxiety. Anxiety is the tension that keeps you alert and aware and responsive. Anxiety reasonably peaks when you're threatened or in danger and diminishes when you're tanning on a beach or cuddled up with a trusted friend.

Anxiety grows out of proportion for some people due to genetic predisposition, trauma history, limited or impaired coping mechanisms, medication side effects, illness and/or toxic exposure.

Ask your prescribing doctor or pharmacist if your routine medication
might contribute to anxiety and/or depression!

Anxiety can appear in a wide variety of forms, from a specific phobia (e.g., terror of spiders) to obsessive and compulsive rituals; from normal and expectable separation anxiety to a crippling inability to communicate with others, to leave the home or to manage relationships.

Untreated, anxiety quickly develops secondary, complicating problems including depression, physical illness and academic or occupational failure.

Many forms of anxiety are very responsive to cognitive-behavioral therapies. Some of these therapy tricks and techniques are summarized in a very useful book

Dr. Garber provides skilled, incisive and efficient psychotherapy services to individuals struggling with anxiety, particularly children with separation difficulties associated with family transition, loss and conflict.

Parenting/co-parenting clinical services

No matter which hat he wears, no matter the service provided, Dr. Garber's commitment is to serve the best interests of children.

Although skilled providing psychotherapy and court-related services directly to children, it is always far more time and cost efficient and far less stressful to kids when a child-centered concern can be addressed by helping the parent or parents to change so that the child benefits.

Parenting and co-parenting services both intend to help children by helping their caregivers. Both are supportive/educational processes largely focused on developing healthier caregiving structures within one or between two (or more) homes.

Children are healthier, happier and more successful when their caregivers provide clear and consistent limits, consequences emphasizing positives, boundaries which define space and routines which define time. Parenting and co-parenting services both help caregivers achieve these outcomes in their children's best interests.

Parenting services include assessment and intervention with one or more caregivers committed to better serving the needs of a specific child or sibling group. Dr. Garber will routinely ask a parent seeking such services whether his or her co-parents can participate in the process (regardless of the legal relationships among the adults or between the adults and the child) so that change is consistent for the child across caregiving environments.

Co-parenting services are commonly accessed by caregivers who share a commitment to one child or sibling group but who live apart, are divorcing or divorced or who are struggling to agree on parenting structures (e.g., bedtime, rules and consequences).

Co-parenting therapy is quite different than Parent Coordination