Research shows that the right match of therapist and patient is critical to success. I believe it is my ethical obligation to make an effort to match you to a therapist who has the greatest likelihood of being able to help you. I may not be that person. I only work with people who I believe I am likely to be able to help over time.

I determine my suitability for you based on a combination of factors:

1) my expertise with the type of problem you have or the type of situation you are in;
2) the type of person that you are with your particular needs or preferences;
3) whether my therapeutic approach and style is likely to be helpful for you.

~ If you want a therapist who gives clear answers to questions and has interactive discussions.

~ If you are uncomfortable with therapists who are silent or emotionally distant.

~ If you’ve never had a therapist before and are afraid of going to a therapist or aren't sure how therapy can be helpful to you.

~ If your family and/or friends fail to be objective or cannot provide helpful advice.

~ If you have a history of surviving some kind of traumatic experience from which you never fully recovered.

~ If you have a history of achievement and have demonstrated abilities but lack confidence, are shy, insecure, highly sensitive, or easily overwhelmed.

~ If you've been thinking about your problems on your own for a long time and have figured out a certain amount, but are now stuck and need professional help to reach new levels of understanding.

~ If you are self-taught, highly independent, were socially isolated as a child, and/or had a lack of emotional support from family members.

~ If you are overly self-critical, often feel misunderstood by others, or find it difficult to cope with situations in which others do not value or appreciate you. If you wonder "Am I normal?", or ask yourself questions like "Is there something wrong with me?".

~ If you want a therapist who listens carefully, pays close attention to what you say, and focuses on sensing how you really feel inside and what is important to you.

~ If you want a therapist who respects your own knowledge of yourself, recognizes your inner strengths, and helps you to build upon that foundation.

~ If you want a therapist who is emotionally supportive and encouraging, who has empathy for your experience.

~ If you want a therapist who has a strong yet gentle presence that puts you at ease.

~ If you want a therapist who can provide structure and guidance to meet set goals.

~ If you want a private confidential consultation about your mental health that is not part of your medical record.

~If you have mental health issues that need to be discussed with your physician and you want a psychologist to speak to your physician on your behalf.

~ If you are originally from New York or other East Coast locations, or are new to San Francisco from other areas.

~ Traumatic Experiences and Major Life Changes
When traumatic events or major life changes occur, we can be thrown off balance and severely shaken by the effects. It is normal to be overwhelmed and need a supportive therapist to guide you through the recovery process.
           
I have a particular interest in working with people who are survivors of rape or sexual abuse. When your personal space has been violated, you may lose the ability to concentrate or accomplish anything, lose faith and confidence in yourself and others, have major trust issues, ongoing sexual difficulties, etc.

I worked on the Stanford University research team studying the benefits of therapy for survivors of rape and childhood sexual abuse. I also have my own personal experience as a rape survivor. You can download my poem "Ready or Not" here.

You can download my article Review of Research on Post-Traumatic Stress and Current Treatments. originally published in The San Francisco Psychologist, June 2005 issue, pp 6-7.

~ Stress Management
Ordinary life can sometimes present challenges that are more intense than we feel we can handle comfortably, or there may be an unfortunate timing of events, or particularly difficult situations that increase stress to an intolerable level. I can help you learn to manage stress that is unavoidable, teach you relaxation techniques or healthy stress reduction methods, and help you cope with emotional reactions to the situation that may be making you feel worse.

~ Anxiety and/or Depression
Symptoms of these conditions frequently overlap. For each person, the particular feelings and circumstances are unique. You may have panic attacks, many fears and worries, feel hopeless, demoralized, pessimistic, easily discouraged, or overwhelmed in other ways. You may feel you need to always be in control, may have high standards and feel you must be perfect to be accepted, may have low self-esteem, may be indecisive and procrastinate.

You may have trouble sleeping or find it difficult to calm yourself down when you get upset. You may be in a perpetually bad mood or frequently irritable and critical. You may lack confidence, feel insecure and shy, and/or avoid social situations. There are many forms of this experience.

If any of this sounds familiar to you or even close to your experience, I may be able to help you feel better. You may be interested in my review of the documentary film "Learning to Swallow", about a failed suicide attempt by a woman diagnosed with bipolar disorder, originally published in The San Francisco Psychologist, June 2005, pp. 6-7, which you can download here.

~ Individual Sex and Gender Issues
I am interested in helping people with all issues of sexual orientation (including bisexuality, homosexuality, and heterosexuality), and concerns about sexual fantasies, sex-play activities, or sexual arousal. I am comfortable working with people who have a history of rape or sexual abuse (see more under Traumatic Experiences)
           
I am also interested in issues of gender orientation including how it feels to be male, female, feminine, masculine, transgendered, bigendered, or other terms you may prefer. Sometimes your internal sense of gendered self differs from your external image, or your internal sense does not match society's expectations or assumptions.

~ Relationship Issues
I may be helpful for any of the following types of problems:            

1. Communication issues: problems feeling understood by partner, inability to resolve problems or prevent repeated arguments, inability to get reconnected after arguments or separations.

2. Mixed Matches: Major differences in personality style, family backgrounds, cultures, religions, beliefs, lifestyle choices, etc.

3. Major differences in plans for the future such as living together, marriage, whether to raise children, where to live, etc.

4. Sexual difficulties, differences in sexual desires or preferences, issues of arousal and sex-play or fantasies, etc.

5. Issues of monogamy and faithfulness, or non-monogamy and polyamory

6. Trust issues, history of secrets, lies, betrayal, abandonment, history of traumatization (for example, rape or sexual abuse) or anything that has created fear of intimacy and/or commitment.

7. General patterns of thought and behavior that make it difficult for the relationship to succeed. General uncertainty about staying in a relationship, or wanting to improve the overall quality of the relationship.

8. Before living together or getting married, make sure you are both prepared and ready for your future together.

9. Before you become a parent or bring a child into this world, make sure you are both prepared and ready to raise that child together.

10. Before you get divorced, make sure you have done everything possible to save the marriage and if it must end, develop a plan for the changes in your relationship.

In collaboration with Robert S. Badame, Ph.D., I have been working on a book titled "Kindredness, Kinships, and Soulmate Relationships". You can download an excerpt here.

~ Aging and Eldercare
I did a two-year postdoctoral fellowship at the Institute on Aging and gained experience with changes that occur in the aging process, such as memory loss, dementia, illness, grief and loss, death and dying. I am also familiar with the concerns of caregivers and family members of the elderly. I can help people understand the changes that their parents may be experiencing and what is involved if they need in-home healthcare, assisted living facilities, conservators, or have other special needs of the elderly.

At the American Psychological Association annual meeting in San Francisco in 2007, I presented my work on doing psychotherapy with the elderly in home visits. You can download a copy here.

~ Living with Chronic Medical Conditions, Illnesses, Disabilities:
I have worked with people who have chronic pain, multiple sclerosis, heart disease, cancer, stroke, diabetes, traumatic brain injury, and dementia. I am familiar with issues of physical and emotional suffering, learning to manage medication regimens, learning how to live with lifestyle restrictions, dealing with feeling deprived of ordinary activities and pleasures, feeling socially stigmatized or isolated, depressed, angry, and easily exhausted.

I have written an article on the Stress of Living with Chronic Illness that can be downloaded here

I did my Ph.D. dissertation on my work with people who have atopic dermatitis (aka eczema), allergies, and/or asthma. A summary of my dissertation, titled "The Development of Expertise in Self-Management of Chronic Illness: Narratives of Older Adults Living with Atopic Dermatitis, Allergies, and/or Asthma", can be downloaded here. If you want to order a copy of the entire dissertation, call Proquest/UMI Dissertation Services at 1-800-521-0600, extension 7020. My dissertation is catalog #3159992. You can also ask for it by title or my name as author.

I presented my work on psychological aspects of chronic itching at the Fourth International Workshop for the Study of Itch in San Francisco in September 2007. You can download a copy here.

I also published an essay on my personal experience with atopic eczema in the medical journal Making the Rounds in Health, Faith, and Ethics, September 23, 1996, Volume 2, Number 2, pp. 1-4. This journal is no longer in publication. You can download the article Case Story: Lifelong Effects of Chronic Atopic Eczema. Included is the journal's editorial opinion about my essay, titled "Commentary: Heeding the Call of Suffering, by S. Kay Toombs. Download here

~ Artists with Creative Blocks
Artistic expression depends upon the ability to stay in flow with the creative process. Sometimes there are stuck places that are not just natural temporary pauses but pits or traps from which you cannot escape on your own. Each artist has their own reasons for this which we will explore.

Some artists find it useful to have a goal for our sessions, such as finishing a project upon which they were already working or creating a new artwork representing the block itself or the transformative process of finding new inspiration. Other artists prefer to have no specific end-product as a goal. The choice is yours. Come as you are. Leave as no one yet knows you will be.

~ Business Owner Issues:
I may be helpful to people who are struggling with the stress of starting a new business, feeling isolated as a sole proprietor, having conflicts with business partners, are trying to change careers or get out of a business.

I do not work with patients who have ADD or ADHD, anger management problems, bipolar disorder, child custody disputes in divorce, drug addiction, eating disorders, learning disabilities, or any personality disorder.  I will refer you to other therapists for these problems.

I do not work with children or adolescents under the age of 18. I will refer you to other therapists for these populations.

I do not do EMDR or hypnosis. I will refer you to other therapists for these methods.

I do not do psychological testing, neuropsychological assessment, fitness for duty evaluations, or workmen’s compensation cases. I will refer you to other therapists for these services.

I take referrals very seriously. I maintain a referral network for different specialties so that I can make the best possible referrals. I am a member of the San Francisco Psychological Association and only refer to licensed professionals.

After our first consultation, even if we decide not to work together, you are at least likely to walk away with new information and emotional support. Research shows that people often feel a sense of relief after just one consultation with a psychologist.