Most therapy manages symptoms. This therapy works with what produces them.

You have probably done therapy before. Maybe it helped for a while. You learned some things about yourself, developed some coping strategies, felt better for a period. Then the old patterns reasserted themselves: the same kinds of relationships, the same reactions under stress, the same ways of getting in your own way. Not because the therapy failed, exactly. But because it was working with the surface of something whose roots go much deeper.

I practice a form of therapy called characterological therapy. It is rarely offered. It comes from a specific lineage within psychoanalysis: from Wilhelm Reich, who understood that personality itself could become a form of resistance; to Hellmuth Kaiser, whose book was simply titled Effective Psychotherapy; to David Shapiro, who mapped the precise ways that a person's style of attention determines what they can and cannot see about themselves. I completed an internship in psychoanalysis, and this tradition is the foundation of everything I do.

What makes this approach different is what it treats. Most therapy works with symptoms: anxiety, depression, relationship conflict, low self-esteem. Characterological therapy works with the person who has the symptoms. It works with the patterns of personality that organize your emotional life, patterns that were built in early relationships and that now run automatically, shaping how you perceive, how you feel, and what you do without your realizing it.

Why therapy sometimes doesn't last

Cognitive-behavioral therapy produces real results. The research is clear on this. If you learn to challenge catastrophic thoughts, your anxiety will decrease. If you activate behaviorally, your depression will lift. If you practice communication skills, your relationships will improve. None of that is in dispute.

But here is what the research also shows: for many people, the gains fade over time. The old patterns reassert themselves. The anxious thoughts come back. The depressive episodes return. The relationship dynamics recur with a new partner. Not because the person didn't try hard enough or the therapist wasn't good enough, but because the therapy was working with the outputs of a system rather than the system itself.

Characterological therapy can explain why CBT works when it does. When a person challenges a catastrophic thought and their anxiety decreases, what actually happened? From within this framework, the person momentarily stepped outside their habitual way of organizing experience and saw something from a different vantage point. That moment of stepping outside is the active ingredient. The specific technique, whether it is a thought record, a behavioral experiment, or a mindfulness exercise, is the vehicle, not the mechanism. The mechanism is the shift in perspective. And the reason the gains sometimes fade is that the underlying character pattern, the habitual way of organizing attention and experience, was never addressed. It reasserts itself, and the old perspective returns.

How this actually works

The psychologist David Shapiro understood personality as a mode of attention. Not what you think, but what you notice. Not what you feel, but what you allow yourself to feel. Your character style is the habitual, largely automatic way your attention is organized: what gets registered, what gets filtered out, and what gets distorted.

In therapy, I pay attention to how your attention works. Not just what you tell me, but how you tell it. What you elaborate and what you skip. What you feel and what you report feeling, which are often not the same thing. Where you go vague at exactly the moment precision would be revealing. The patterns show up in the room, in real time, in the way you relate to me and to the material we are working with.

This is where the most useful work happens. Not in the stories about your week, though those matter. But in the live demonstration of how your mind organizes experience, happening right in front of both of us, available for examination in a way it never is in daily life. I will point out what I see. Not as interpretation delivered from on high, but as observation offered for your consideration. You will always know what I am thinking, because I think clarity is more useful than technique.

Where the patterns come from

The patterns that organize your personality were built in your earliest relationships. This does not mean you had a bad childhood. Many of my clients had parents who loved them and never punished them harshly. But children are adaptive. They read the environment with extraordinary precision and adjust themselves accordingly. A child who senses that a parent is fragile will learn not to make demands. A child who senses that a parent values achievement will learn to perform. A child who senses that emotional expression makes things worse will learn to suppress. None of this requires abuse. It requires only a relational environment with particular contours, and a child intelligent enough to map those contours and adapt.

The adaptation was intelligent. It worked. The problem is that it became permanent. The child who learned not to make demands becomes an adult who cannot ask for what they need. The child who learned to perform becomes an adult who cannot rest. The child who learned to suppress becomes an adult who does not know what they feel. The pattern that was a solution in childhood has become the problem in adult life, and it is running so automatically that the person does not even recognize it as a pattern. It feels like reality. It feels like "just the way I am."

The genetic dimension matters too. Your constitutional temperament, your sensitivity, your threshold for what is tolerable, these set the terms of the adaptation. Two children in the same family can emerge with very different patterns, because they brought different nervous systems to the same environment. This is not an excuse. It is a specification. It helps explain why your particular patterns took the shape they did.

Why the relationship is the mechanism of change

If the patterns were built in a relationship, they have to be revised in a relationship. This is not a metaphor. It is the reason therapy works when it works, and it is the reason self-help books, no matter how insightful, can only take you so far.

The therapeutic relationship is not the background against which therapy happens. It is therapy. The patterns that distort your relationships out in the world will show up between us. The way you manage closeness, the way you handle disagreement, the way you present yourself, the things you hide, the things you perform: all of it will appear in the room. And when it does, we have something to work with that no amount of introspection alone could provide: the pattern, happening live, in a relationship that is honest enough to name it.

Kaiser understood something that most therapists still do not fully appreciate: the therapist's authenticity is not a nice-to-have. It is the active ingredient. A relationship in which the therapist is genuinely present, genuinely honest, and genuinely interested in who you actually are, not who you are performing to be, is a fundamentally different relational experience from what most people have ever had. And it is in that difference that the change happens. The old patterns, which were built to manage a relationship that required performance and concealment, cannot sustain themselves in a relationship that does not.

What lasting change looks like

The goal is not to feel better, though you will. The goal is to be different: to have a different relationship to yourself, to your feelings, to other people. Not a new set of coping skills layered on top of the same patterns, but an actual shift in how you organize your experience. When that shift happens, the symptoms that brought you in, the anxiety, the depression, the relationship problems, resolve not because you learned to manage them but because the thing that was generating them has changed.

This kind of change is durable in a way that symptom management is not. You do not have to keep practicing it. You do not have to remember to use your tools. The change is in the structure of the personality, not in the person's behavioral repertoire. It is the difference between learning to compensate for a limp and actually healing the leg.

What this costs, and why it is worth it

Individual sessions are $200 (€170) for 60 minutes. That is a real investment, and I want to be honest about it rather than apologize for it.

I also offer a brief 15-minute call before we begin. Not because I need to sell you on anything, but because the fit matters more than the method. You will know within fifteen minutes whether the way I think makes sense for you.

About me

I hold a master's in counseling from La Salle University and a master's in sociology from UC Berkeley. I completed an internship in psychoanalysis. I have been in personal therapy for roughly twenty years, and that has shaped my work as much as my training has. I know what it is like to sit in the other chair.

I work exclusively online, with adults, in English. Many of my clients are English speakers living abroad: expats, international professionals, people in cross-cultural relationships. Others live in English-speaking countries but want a therapist whose approach is different from what is available locally. Working online means continuity: if you move, you keep your therapist. More about my background here.

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