Couples Therapy

stk23562sisThe couple came in and sat at far ends of the couch and I wondered what would come next. Andrea was the first to speak and it was with angry and dismissive tones. They had found me through her therapist and she wanted to know already if I would reduce their fee. I knew the angry and dismissive tones were meant for me as well as her husband. She continued on with why they were there. She felt she was there because he refused to go to therapy and he was a deceitful loser. He had created business after business and they had failed. He had also invested more money than he had told her about. Peter remained quiet as she continued and he seemed a bit afraid to speak up. She kept telling me how better educated she was and she should be the one working but they had a child who needed her at home and she was suppose to be the stay at home mom. Yet she couldn’t relax her vigilant stance, she had caught him in lies about the business and where he was. She wanted him to come clean and start to act in a responsible manner.

Does this sound familiar? In my years of working with couples in private practice as well as in addiction treatment programs I found this similar theme of “They need to change”. I think the hardest part of couples work is often the discrepancy in the emotional growth or availability of each person in the relationship. I will often use the word compassion, how do you find it for yourself and for your mate. With compassion we can find the tolerance and understanding we need to form a collaborative working relationship. Though its not always easy to find. We have to wade through resentments, hurt, disappointments, expectations and lost dreams.  I believe it is an ongoing process we need to adapt since our relationships are always growing and changing. In my own relationships and working with couples I know that communication is a big part of finding that working team. Not just what we say but how we hear it. I have found success with letting people know how I need to be heard this moment.

Some suggestions of how to let the listener know how to listen:

  • I need you to help me problem solve.
  • I need you to let me vent and just be here.
  • I need you to comfort me as I tell you this story.
  • I need you to tell me it will all be ok.
  • I need you to understand my anger and support me.

I used to believe that if we could communicate all would be ok. I have learned through the years its a great place to start but is not always effective. I may need to find another friend or support to talk with because my partner is not able to listen. We all have times when we can’t hear or are frustrated by the topic. It’s important to let the other person know whether now is a good time or they can’t hear the topic. Is this about something of major importance or is this about an argument with a friend, if its about something that is dramatically altering your life I would hope that your partner can listen to you. If not then the problem needs more attention, like couples therapy then this simple exercise. The couple I describe above could not listen or find compassion and their relationship ended in divorce. Many couples that I have treated have been able to learn to listen, communicate and find compassion and rebuild their relationships.

Like any life change it takes work and curiosity.

Licia Ginne, MFT

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Kaiser Permanente Continues to Neglect Mental Health


Kaiser’s administrative offices in Pleasanton, Calif., a 17.8-acre suburban campus that the HMO purchased from computer giant Oracle Corp. The conference rooms are all named after prisons.

It is amazing how Kaiser continues to neglect their mental health programs. For years they have neglected their programs and nobody seemed to care. Now the State has levied the heaviest fines it has every handed out and Kaiser still seems to look down their nose at their mental health programs. They refuse to staff their programs and provide the quality of care they should. Instead it is all about the profit and the executives seem more interested in their profits than in quality of care.

California again slams Kaiser for delays in mental health treatment


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Zak Ebrahim How I chose Peace

This talk by Zak Ebrahim shows how one can change deeply held beliefs when they get challenged within relationships.Whether those relationships are watching Jon Stewart on the Daily Show or meeting people who are different and hold different beliefs in the real world.

As a psychotherapist I often hear “can anybody really change”. As I watch growth happen with those I work with and I see their faces soften as compassion and empathy for themselves and others start to challenge the self-criticism and fear of others, I am moved. It is hard to see it within ourselves and helps to have that mirrored back to us. We start to see the change in how we operate in the world and how our world changes.

Over time change does take place and we often don’t know it. As Zak Ebrahim says in his talk he had gotten to know a Jewish man before he knew he was Jewish and realized that his beliefs had been based upon the dogma that his father had preached. That maybe he wasn’t the same as his father, I am sure he can find traits of his father in himself but he doesn’t have to embrace the hate. But as he says in the end “I am not my Father”. Change is possible and his talk for me was deeply moving and powerful.

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Technology Withdrawal and It’s Use in a Private Practice


First computer- Imagine trying to get this to sit on top of your desk.

It wasn’t until I was out of town, and the small town I was in had hit and miss WI-FI and cellular coverage that I went into technology withdrawal. I didn’t realize how much I relied upon these tools. I had planned on my vacation to make several business calls and to follow up on some projects but the irregularity of the service made the task frustrating and not worth it. I had experienced this before where I had gone on vacations and left all the technology behind this time I was not prepared and it woke me up to the limits of technology in how I practice and market my psychotherapy practice.

I am embarrassed to admit this but since I have left Los Angeles and now live in Santa Cruz, CA I am bit surprised at the amount of people who don’t use computers (compulsively). I think the surprise is more related to feeling of Silicon Valley being just over the hill.  I have been talking with a old high school buddy and her last computer crashed a while back and she is waiting to gather the funds to purchase a new one. I have been offering some advice and trying to help her out on how to purchase a computer.  But I am really not talking about the financial aspects I am talking about people who already have a computer but don’t use it very often.  My recent trip to Mendicino, CA also shed some light on what happens to me when my iphone and ipad can’t get access to anything! I started to go through technology withdrawal,  I missed having what we so fondly call the answer machine. Watching a movie ever wonder who that actor is or what other movies they were in, quick reach for the phone, ipad or computer and straight to for the answer. Last night I wasn’t sure if I could freeze roasted chili peppers another quick google to find the answer.

I am currently helping ICP the psychoanalytic institute I belong to strengthen their live streaming program. Now what this means is I helped to find a knowledgeable technician who could evaluate what we need and how to improve our sound quality. The institute offers many of its workshops to long distance participants over a program www., it is actually a very good program for an inexpensive price if you are looking to do live streaming You can use it free but for only 45 minutes at a time, great way to test it out. If you want more information about contemporary psychoanalysis and the programs they offer go to and on the events page you can join their email list and you will be notified of all the programs and most come with continuing education credits.  Working on this project always adds to my knowledge of computers and live streaming, Chris Killen has been helping us and he sent me over a short article on the first things to do when you open a computer, some great tips. I want to offer it to you here.

Also if you’d like to contact Chris for a consult here is his information:
Chris Killen
AMA Pro Racing/

Now how does this all tie into psychotherapy. I promised I would keep you informed of my progress as I continue to grow my psychotherapy practice here in Santa Cruz, and finding technology is as helpful as I’d like. I’ve also known marketing is not one tool its the use of many tools. Like all my consulting clients I too complain there is never enough time to get it all done and patience is required.  Every city has its own rhythm and Santa Cruz has always danced to its own drummer.  So as I have done over the years is to find the middle ground where I feel comfortable. It’s what I teach those that I work with on practice development. You have to push the boundary of comfort for yourself and for me that boundary is I tend to get a bit shy in groups and its hard for me to introduce myself where I don’t know anyone. So I have signed up to speak at the Santa Cruz CAMFT Chapter on Friday, September 12, 2014 on the clinical aspects of working with all types of addictions. I have found the Santa Cruz Psychoanalytic and Psychotherapy Society and look forward to attending and meeting more people. Building a network is so important and slowly I begin to create the network that I need, for people to know my work and me to know theirs. The process is slow and takes a support team, when it gets disappointing it helps to have someone offer support to get you back out there. The biggest lesson I learned is to make sure you are in a supportive environment where you feel comfortable. Now its finding that network.

Licia Ginne, MFT
Individual, Couples and Group Psychotherapy
Private Practice Development
831) 471-8647




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The What’s Underneath Project

This project is amazing and when Jackie O’Shaughnessy says more to herself then the interviewer why, all the time lost feeling never enough. It hits so hard at the point that  we waste so much time not feeling good enough. How many times have you looked back and said if only I could feel now about myself when I was younger. This is just one in the series of short video’s and well worth the time.


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Private Practice Do You Consider Yourself a Business?

So when did marketing become a dirty word?TMCprofile5

I have been consulting with private practice practitioners for over 7 years and what I find most common is the struggle to think of a healthcare practice as also a business.  We are in the helping service and feel we must help others before we help ourselves. Most of us came into the world of therapy because we had been helped by it and wanted to help others. We all went through long and costly years of school, but most of us never had a class or internship that taught the business of psychotherapy. We struggle with networking, knowing our value, how to set our fee and whether or not to be on managed care or insurance panels. I think most of us just followed the mentors we trusted. Our caseloads can be enough to handle without having to try and do the paperwork, insurance billing, collecting and marketing.

Major first step start to think of yourself as a small business owner and that means thinking about how much you make, how much you want to make and what it costs to run your practice. Running a practice includes your office, phones, etc. but also your marketing budget, which frightens many of us. Your investment in your therapy practice is an investment in yourself. I have made it my business to learn how to do things with as small an investment as possible. The initial outlay may seem overwhelming but there are ways to do things on the less expensive side and remember this is an investment that over the years will keep giving you a return on your dollar. I work with people with all kinds of budgets but what I have found is if I have to spend money to make something look professional it is worth the investment because it represents me in the world. You can have a designer create a website from $500 – $15,000. You can use wordpress and get templates but I have always found even with templates it helps to have a professional do some final tweaking so it looks professional. You can manage the costs by doing as much of the work as you can.

Some of the people I talk with seem afraid of marketing. Most often you are marketing and don’t even know it. When I opened my first office, I shared space with a friend of mine, neither one of us had any clients but we had a lovely office all ready to go. It was a risk and we knew we needed to take the risks to get started. There are lots of ways to get going that minimize the costs and risks, like renting space part-time. I think many of us have a hard time networking and feel uncomfortable attending group events. Think about your school or training programs and start networking with the people you met there. Wherever you are in your career start networking, start developing a referral network. Let people know where you are, what you specialize in and how you can help people. I’ve spent time, money and energy going to school, interned for next to nothing, studied for my license and now I have to go out and sell myself?

Well, the brief answer is yes

The longer answer – You are not selling goods. You are investing in yourself and I will not hide the unpleasant truth you are selling your expertise, skills and experience. The good news is it can be done with creativity, beauty, grace and a tremendous amount of professionalism and ethics.

Licia Ginne, MFT

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Kelly McGonigal – Making Stress your friend

I loved this talk and felt inspired by her and wanted to share it with you. I was hoping I could place it directly on my site, but it’s too big a file for my website. What I love about this is her thinking about how we need to embrace our experience and not it see it as something we need to get rid of but more that our body is giving us information. Kelly McGonigal – How to make stress your friend

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Does Avoiding Conflict Really Work?

Man must evolve for all human conflict a method which rejects revenge, aggression and retaliation. The foundation of such a method is love.

Martin Luther King, Jr.


Man must evolve for all human conflict a method which rejects revenge, aggression and retaliation. The foundation of such a method is love.

Martin Luther King, Jr.


carlyungDoes avoiding conflict really work. I don’t like conflict, it makes me uncomfortable. I can nervous, sweaty and start to shake if I have to speak up about something uncomfortable. Though I have also found that people that try the hardest to avoid conflict are the ones that create the most. These are the people pleasers who have a hard time setting boundaries and letting you know what they really want. In relationships I find that feeling that your friend, partner, spouse or family is there for you to lean on and provide input is one of the most important elements to a successful relationship. You want to feel that those people closest to you are going to tell you the truth without harm or meanness. You know when you are trying to make a decision and you feel the other person is just trying to please and doesn’t take a stand, it doesn’t feel like you have a separate person with you, they have blended into you. We need to feel that people can be kind and have their own opinion and this is someone that you feel is separate from you that you can lean on and you feel that you can sink your weight on them and they won’t collapse. Those that try to avoid conflict seem to be the ones that you never know where you stand with. They don’t often tell you to your face what is going on, you might hear it by accident, you may never hear it or  it may come from someone else they complained to you about you. I am not saying that you should take on every fight or upset and that fighting is OK,  It is as Carl Jung says that what comes from conflict is growth. Learning how to resolve issues, fight fairly and state your thoughts and emotions is what brings intimacy. Whether it is in your personal relationships, work relationships or being in the world. It is important to stand up for yourself but just as important as to learn how and when to get the best results. Conflict resolution, learning to listen and communicate is what improves any relationship and not every fight can be won but when we feel that we have been heard than it is easier to find the compromise.
Licia Ginne, MFT

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What is Codependency?


What is Codependency and does it matter

Codependency is a word that has lost some of its original meaning from overuse. Codependency originated in the recovery movement and was used to describe the behaviors of people who were in a relationship with an alcoholic or substance abuser. Codependency has come to mean addiction to relationships, relationships that do not have healthy boundaries and relationships where the codependent has not been able to protect themselves.

Over the years, however, codependency has expanded into a definition that describes a dysfunctional pattern of living and problem solving, developed during childhood by dysfunctional family rules. These families suffer from poor boundaries (to understand these boundaries and definitions of abuse) and produce adults who have been abused as children. This abuse may come in the form of neglect, physical abuse, sexual abuse, verbal abuse and/or emotional abuse. Abuse will be have found in families who suffer from mental health issues, problems with addictions and compulsivity, in families where for whatever reason parents don’t have time for children, and in families where the parents were abused as children.

Pia Melody in her book, Facing Codependency, defines the Five Core Symptoms of Codependence:

• Having low self-esteem
• Difficulty setting boundaries
• Knowing yourself, knowing what you want
• Taking care of adult needs and wants
• Difficulty experiencing and expressing reality moderately.

In any family there are elements of accommodation that we have to make, for some these accommodations are little for others it can be a form of abuse. We adapt so we can survive. You couldn’t wake up each day and say “This is hell”; you have to go into some type of denial to survive. Those tools we used to adapt were the tools available to children and as adults we may find that we still rely upon them and they don’t work as well as they did before. Remember: as a child your choices are limited. They are pretty much limited to your thoughts and fantasy, these are the tools of children. “How can I think about what is happening to me in a way that I don’t feel like a victim?” Children blame themselves for the problem: “If I were better, maybe my parents wouldn’t fight or I wouldn’t be hurt.” “If I brought more joy to my family than they wouldn’t be so unhappy.” As children we don’t even usually think things this clearly its not until we are far removed from the situation that we can really allow ourselves to think about it. As a child to feel the problem might be in  our parents often makes us feel helpless and hopeless — we do not have the power to change how others respond and as children we don’t have the power to leave or protect ourselves.  So to feel a sense of mastery in the world, we become the problem. “This is something I can work on and fix. I can change me and I can’t change them.” But we constantly fail because we are not the problem.

Psychotherapy has been a good setting for learning that you are not the problem. It can be a good environment for learning how you accommodated and how to put yourself first. How to grow, develop insight and understanding so you will have more options and choices in your life.

As we grow our tools for protecting ourselves should grow, but remember we must be taught coping and problem solving skills. Without this education we still use the tools our child’s mind came up with and often continue to blame ourselves for other peoples behaviors. As adults we need to expand our resources, we have not been taught good problem solving skills or good self care.

Recovery from codependency is learning how to meet and identify our own needs, to learn that putting ourselves first is not always selfish. When we set boundaries and factor in our needs we become a better friend, spouse/partner in any type of relationship. I always use the example when you are on an airplane and the flight crew is giving you the instructions most of us ignore they always tell you if the oxygen mask comes down first place it over your mouth and then if someone needs assistance help them. If you can’t breath you are little help to the next person. This isn’t a hall pass to always have it your way it is an opportunity to start looking at your relationships and consider how they can become collaborative. It is an opportunity to challenge some of the beliefs you have learned about yourself and find that some of them may not be accurate or maybe were but no longer fit.  We learn ways of communicating,we learn to honor and respect our needs and wants and the needs and wants of others. We learn what a reciprocal relationship is and how we deserve to be in them. We learn how to problem-solve and look for the win-win solutions. How to set health boundaries, how to compromise and accept others limitations and not take it personally. We learn to tolerate differences and know there is not always one way to do something. We learn we are not damaged and doomed to repeat the same mistakes. We discover our self-worth and self-esteem. We learn that we are loveable.

By Licia Ginne, MFT

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