San Francisco Counseling Center


A colleague who runs a clinic recently attended a management seminar.  She described one point about passive-aggressiveness in the work place, and the seminar leader's instructions were to ask the employee 5 different ways why that person was behaving in a passive-aggressive manner.  Sounds on the surface like a reasonable plan.

But it's not.  Here's why:

Passive-aggressiveness (PA) is an unconscious process.  The PA person is not aware they are being passive aggressive.  Usually, they wonder why the world treats them so harshly, doesn't cut them any slack, is so rigid.  They don't think coming late to class is passive aggressive, it's just that the instructor is rigid.  They don't think that forgetting to bring money with them to pay for their own dinner is PA towards their friends. "I'm just so spacey." 

How does a person become passive aggressive?

There are probably many roads, but there is one thing in common: it is unsafe to assert oneself.  Because of this, the person needs to see him/herself as a nice person.  "Nice people don't get angry."  "Nice people aren't aggressive."   Instead, the aggression slips out unconsciously.  Co-workers, partners, friends all feel some of the aggression - sometimes ON BEHALF of the PA person.  In other words, the PA person may not be able to experience their own aggression, but people around him/her certainly do.

Why is it unsafe to assert oneself? 

Assertiveness is on the same continuum as aggression.  It takes a certain amount of aggression to stand up for yourself.   In some families, aggression is out of control.  Things feel dangerous.  The PA person has seen how terrifying (and potentially damaging) aggression can be.  In other families, aggression is to be avoided at all costs.  The message, at some level, is the same - aggression is dangerous. 

The inability to assert one's point of view, be heard, feel valued, feel respected can cause a great deal of resentment.  What happens when you have a resentful, angry person who feels it is dangerous to assert him/herself constructively?  You guessed it.  Another part to this, is that people around the PA person become upset.  In a way, this confirms the PA person's world view:" the world is full of angry/aggressive people."  The anger is near by.  "Thank goodness I am not like that person, so angry all the time(!)"

What can you do?

That's actually a pretty hard question.  In some ways, this is one of those situations where the person has to see that things are not working for them.  They may get "written up" at work for perpetual tardiness or low quality work product ("You didn't tell me you wanted me to bring the food to the table IMMEDIATELY".  "I removed the liver, I didn't realize YOU weren't going to stitch him up."

If enough people point out this pattern, perhaps the person will develop some motivation to examine the pattern.  Usually, this is a very slow process.  For the passive-aggressive person, the fear of aggression is pretty strong, and the externalizing defense of projection ("Why are you so mean to me?" ) is a pretty effective one. Unfortunately, for the person with a passive-aggressive style, the world can be a challenging place, filled with "mean" people.

Graduation and other Milestones

    As we are approaching the season for graduations, there are many reasons to pause for reflection.  Typically, milestones such as graduation, certain birthdays (18, 21, 30, 40, 50, etc), life events (birth of a sibling, birth of a child, marriage or partnership commitment, illness, divorce, etc) are all causes for reflection.  Typically, we think about where we have been, what our goals/dreams/aspirations/assumptions were at some time in the past.  We reflect on the future we thought we might have and compare it to the present or future we now think we may have.
    Sometimes these reflections and our evaluations help us to confirm that we are 'on the right track.'  Other times, these reflections are a cause for us to make some changes - ranging from minor to major changes.  Developmental psychologists refer to this as a re-working of one's life structure.  For example, a lifestyle that worked great at 21 may not work very well at 30 or 35 years old.  Maybe a person realizes they need to be more serious and settled (or perhaps they realize they have not allowed for enough closeness, fun, or self-care).  In this case, a person may consciously choose to make some changes.  Perhaps they go for further training in their job or career, decide to save money for the future, or think about taking a relationship to a more serious level.  They could also realize if they don't do some self-care, more time will pass and they will never go fishing, learn to play guitar or lose those 10 lbs.
     If the person assesses that they are on course, they will still be enriched by the experience of this self-reflection.  They will be moving through this part of their life in a more conscious and perhaps more purposeful way. 
     If the person does not consciously go through this type of assessment, it does not mean there is no assessment happening.  Sometimes this happens unconsciously.  This may manifest as the cliched 'mid-life crisis' wherein one day, "I don't know what happened, one day John just left, bought a red sports car and married a younger woman."
     We really cannot (nor should we) avoid the fact that events have meanings in our lives.  If we allow ourselves to be aware of them, these meanings can allow for a deeper, more textured and thoughtful existence.

(Borges and) The Exquisite Vulnerability of Being Known

(Borges and) The Exquisite Vulnerability of Being Known


for Haydee Lange

The garden gate is opened
as easily as a turned page
questioned by a regular devotion
and once inside, our gazes
have no need to fix on objects
that already exist completely in memory.
I am familiar with the customs and the souls
and that dialectic of allusions
which any gathering of humans weaves.
I need not speak
nor claim false privileges;
those who surround me here know me well,
know well my afflictions and my weakness.
That is to attain the highest thing,
what will perhaps be given us by Heaven:
not veneration or victories,
but simply to be accepted
as part of an undeniable Reality,
like stones and trees.  

--translation by Stephen Kessler

Jorge Luis Borges’ beautiful and seemingly simple poem, Simplicity for Haydée Lange captures perhaps the highest human aspiration – to allow oneself to be known.  The beauty of the poem belies the extraordinary achievement such intimate acceptance represents.  Of course, at some level, we all want to “simply be accepted as part of an undeniable Reality.”

Unfortunately, we all have parts that we find troublesome. Most people work hard to deny basic truths about themselves.  These truths are seemingly unbearable.  We all have thoughts, feelings and desires that are not to be spoken in polite company.  When we cannot own and accept these feelings as part of our human endowment, we marshal defenses.  These defenses protect us from “knowing” undesirable things about ourselves, but they also prevent us from knowing ourselves.  We have become (protected, but,) unknowable.

Some people were mistreated early in their lives, perhaps malevolently, perhaps simply out of benign neglect.  In either situation, it is not uncommon, as a child to create a story-line to explain to oneself the behaviors of the caregivers.  Very often, it entails some form of “if I were a better …”.  Here again, develops a sense that ‘to know me is to … (reject me, aggress against me, find me to be unlovable?)  In any case, the smart money is not to let you know me.

In all of the cases noted above (and in many other instances not described here), we develop what Winnicott described as a “false self.”   To some degree, we all need the protection of a false self in order to function in the world.  It offers us a layer of protection not afforded by our genuine or “true self.”  Like calluses or a mask, the false self is a layer between the world, others, and the true self.  Contact is numbed.

Here is the exquisitely painful irony: knowing that we are truly loved and accepted should help us to come to terms with these fears about ourselves, yet, because of our fears we often conceal ourselves.  Instead, to varying degrees, we relate to others through a mask.  We present a “self” which is not completely true.  If they love and accept that self, we do not grow.  Instead, often, we fear that they love this construction, and would reject us (if they really knew us).  Brashly attempting to present the “true self” without coming to terms with ourselves first is unlikely to work.  When we are not comfortable with ourselves, we are likely to present the parts we are afraid of in very skewed ways.  We all have met people who have tried to put on a brave face in some situation, and only came across extremely awkwardly and made everyone else uncomfortable in the process. 

We all have secret selves.  We need some level of privacy within which we can have our fantasies, dreams, fears, etc.  However, gradually finding a safe way to allow a valued other to get to know us, our dreams, our strengths, our foibles and even our downright unlikable parts – and finding that more often than not, they do not run away – helps us to accept those parts of ourselves.  In being accepted by another, we learn to accept ourselves. (In infancy, when the mother smiles at the baby, the baby knows he is loved.  This process is similar.) 

One way to effect this change is through therapy.  In therapy, this is a gradual process, arduous at times, terrifying at times, exciting at times.  Eventually, coming to terms with oneself, reducing the need for excessive reliance on defenses – and grieving unfulfilled wishes and expectations – can free us to be ourselves.  Through this, now more acceptable (accepted by us), we can chance a true encounter with a cherished other.  Chancing an attempt at love requires the exquisite vulnerability of being known.

“… those who surround me here know me well,
know well my afflictions and my weakness.
That is to attain the highest thing,
what will perhaps be given us by Heaven:
not veneration or victories,
but simply to be accepted
as part of an undeniable Reality,
like stones and trees.  “


Anxiety is a problem which has many faces.  Many times we do not even know we are experiencing anxiety.  To make matters even worse, when we don't know we are anxious, we cannot deal with the problem, respond appropriately, or deal with our mate properly.

What does anxiety look like?  Many of the signs and symptoms are what you would expect. 

  • nervous
  • insecure
  • difficulty sleeping (either falling asleep, staying asleep, or with sleep that does not rejuvenate)
  • difficulty concentrating
  • feeling restless, edgy, keyed up
  • tiring easily
  • irritability
  • increased muscle tension
  • feelings of apprehension or dread
  • anticipating the worst
  • watching for signs of danger
  • headaches
  • pounding heart
  • sweating
  • diarrhea
  • fatigue
Here are some signs or symptoms you may not expect feeling:

  • grouchy
  • gloomy
  • aggressive - sometimes we use aggression to quiet others when we are anxious and something about our interaction with them is increasing our anxiety (think of the parent who threatens the child in the back seat for being too disruptive)
  • lazy (afraid to move forward, also, all one's energy being sapped by anxiety.
  • self-involved (this is not always the only reason, but when one is busy managing a problem - including anxiety - they can look really self-involved)
  • talking:
    • incomplete thoughts
    • dominating conversations, including interrupting
  • procrastination (OK, doesn't seem to make sense, right?  However, for some people, the anxiety about doing a task, being able to do it, being good enough, etc, can make the task daunting.  They end up putting it off until they have no choice.  If it does not turn out as great/good as it 'should', they have the built in excuse that they did not have time to do their best.

How anxiety impacts our lives:

Anxiety often limits us.  It prevents us from living up to our potentials.  One way this happens is that we do not attempt things because of our anxiety.  Fearing feeling anxious, we may limit ourselves and our lives.

Anxiety can affect our relationships in many different ways.  Here are a few of the possible ways:

  • We can look to our partner to help us manage our anxiety.  At times this can be fine, but at times we can expect too much.  Moreover, we often do not even realize we are doing this.  This can have roots in early childhood, for example when a parent (for example, mother) looked at the bruise, kissed and reassured us, and we could forget the problem and return to play.  However, now, sometimes we risk overwhelming our partner by dumping our anxiety onto them.  Now we (a) are both overwhelmed, (b) are seen as the source of THEIR anxiety and possibly (c) end up in a fight (which is probably more about the anxiety rather than whatever SEEMS to be the focus of the fight).
  • We can experience our partner as the cause of our anxiety.  Besides whatever demands our partner really does put on us, we can also experience our partner as putting undo demands on us. These might be ways in which we THINK they expect things from us, and then we react negatively.  One example may be that at some deeper level (perhaps unconsciously) we worry about being abandoned.  We come to think that if we are not perfect, our partner will leave.  Then we can find any number of ways to feel that our partner is putting excessive pressures on us.  We can get angry at our partner; perhaps even feel tyrannized by our partner (without consciously realizing our part).
  • We can try to get our partner to take the anxiety for us.  For some people, or in some situations, we can try to make our partner take our anxiety for us.  In these cases, we induce our partner to feel anxious and we no longer experience the anxiety.  One example may be the backseat driver.  This person keeps "giving helpful feedback" to the driver, until the driver is a nervous wreck.  Peculiarly, the backseat driver is no longer anxious.

What can we do about anxiety?

Some things that may be useful for managing anxiety include:

  • meditation
  • increased exercise
  • discontinue caffeine
  • regulate sugar intake
  • consider other possible lifestyle changes
  • and of course, therapy.
Therapy can be extremely useful for managing anxiety.  Not only for learning skills to manage the symptoms of anxiety, but for getting to the reasons for our anxiety.  What drives YOUR anxiety, not just anxiety in general?  Are there fears that your success will cause problems in your relationship with a parent?  Fear of abandonment?  Getting to understand the underlying causes of your anxiety, and dealing with those causes can be extremely important.   Medication can be an important adjunctive treatment on the way.


10 easy tips to help you improve your relationship

Here is a "Top 10" list of tips that can help you improve your relationship.  These tips come from our experience with individual, couples and group therapy.  Here goes:

1. Don't blame your partner.
         Often times we expect our partner to be perfect (despite the fact that we are not!).  We often hold our partner to unreasonably high standards.  Think of how much more you expect from your partner than almost anyone else, (including patience).
2. Your partner is not your parent.
         This one may not be readily apparent.  Often times we expect our partner to 'fix' problems that really belong to our relationship with our parents.  One example could be insecurity.  This usually develops in childhood, however, we typically look to our partner to make us feel perfectly secure.  This often puts extra pressure on the relationship, and can often have a negative effect.

3. Remember to keep courting your partner.
          We often pull a "bait and switch" in relationships.  When we are first dating, we present ourselves as the 'perfect mate.'  However, once we get a commitment from the other, we often stop being as gentle, thoughtful, etc.

4. Appreciate what you have.
           We often overlook the good things in our relationship.  Notice the good times, be aware that it feels good just to hang out together or do an errand together.

5. Listen!
           Often times we worry that we won't be heard, and we end up trying to make our point(s).  We often spend much less effort and time really trying to listen to our partner's feedback (instead, we often fend it off).  How can we make improvements to the relationship without listening to what our partner wants?  How can we expect them to feel valued if we don't listen?

6. Your partner needs you to say what you want or expect.
           How often have you heard, "If I have to tell (him/her) it means .... s/he doesn't care/love me/know me?"  Unless your partner is a fortune-teller, this is unreasonable, and puts a lot of pressure on the relationship.  The fact that your partner doesn't always know what's on your mind simply means she or he is human.  The other problem with this situation, is that you can convince yourself that he or she does not love you, rather than they don't have special powers.

7.  Re-examine the expectations you have for your partner.
          We typically expect more from our partners than we do from any other person.  Often, our expectations are even unreasonable.  Sometimes, we expect our partner to make the world right for us.  They can't.  Often we regress in our relationships, and unresolved childhood issues get played out.  One way this happens is expecting perfection, like we expected from our parents (see also #2).

8.  Make some special time.
          It is too easy in our busy lives to keep running at full speed.  Even if you are in school and/or working a lot, set aside some time.  Quality time goes a long way.  Maybe it's just a meal, a walk or even going to the store together.  Find ways to make the found time together quality time.  Really listen to your partner, hold hands.  Tell yourself this time is for the both of you, and that you will get back to the other things.  Focus on this time together.

9.  Don't use global statements.
         Many times in arguments we say things like, "You always ..."  "You never ..."  Generally these are over-statements, and they have an insidious effect.  First, your partner is forced to defend him- or herself rather than listen to your complaint.  This will most often escalate the fight.  The other problem, is that we often begin to believe these over-statements.   At some level we think to ourselves, "Yeah, that's right ... she NEVER ...."

10. The Golden Rule.
         You know, "Do unto others as you would have them do unto you."  It's golden for a reason.  If you want your partner to think well of you, do things that will promote those feelings. 

11.  (Bonus point!)  Be mindful.
          We spend a great deal of time just going through our days.  However, when we approach our partner in a mindful state, we usually are more prepared to respond in ways that are more consistent with who we want to be, rather than just acting out of reflex.

Sibling Rivalry

"I lost my job the other day.  Well, it's not that I lost my job, but when I got there, there was some other guy doing it.  (pause).  I lost my girlfriend the other day.  Well, it's not that I lost my girlfriend ..."    Comedian Bob "Bobcat" Goldthwait.

This is something of the experience of the older sibling.  It was his/her place, to be the prince/princess, the center of attention.  Suddenly, there is someone else in his/her position.  And, by the way, this person seems to be getting an undue amount of attention, especially for someone/something that only eats, cries and poops!

The birth of a sibling is the first developmental "crisis" many people face. For the younger sibling(s), "living up to" the older sibling has its difficulties.  In both cases, there is some combination of love, resentment, competition and camaraderie (along with potentially innumerable other feelings) that characterize this situation.  Undoubtedly, many of these feelings shift from time to time, and change over time.  However, in some cases, how this 'crisis' is dealt with can have a lasting impact for both (all) the siblings.   As parents, how we help the child negotiate this time can have a lasting impact on his or her life, sibling and peer relations, and sense of self.

Not to over-simplify, but let's start with "what do kids need?"  Obviously, they need food, clothing and shelter.  But what else?  Well, all kids need to know that they are safe.  One of the main ways kids know they will be safe, is that they know their parents' are very invested in them (see where I'm going?).  Attachment research shows us that children are much less anxious when they know the parent has a strong bond/investment in them.  Making sure the child knows they are special, finding ways to have 'special time' with each child alone, and with the children together.  The latter can be an opportunity to show the children that you value both of them, and show them how to share (your attention).  Helping the child to know they are special to you, and that you are very invested in them will help to reduce their anxiety, improve their sibling (and peer) relationships and help them maintain good self-esteem.

Premarital Counseling

Marriage/commitment can be a wonderful thing.  We all hope to find the perfect person, to live “happily ever after.”   In our culture, we have few examples of happy couples.  If we are lucky, we have encountered some growing up.  Sometimes, not.

What happens after ‘the big day’?  The excitement of moving from being a single person to a committed couple can be an all-encompassing focus.  What about the day after?  What does it mean to call the other your spouse?

Often times, the day after the big day can involve a let-down.  The party is over, and now what?  Well, there is some internal work to do.  We have to begin to understand ourself , and our partner, in new ways.  What does it mean to be married/committed?  What internal models come to the fore?  Well, what did you see growing up?  What were the models in your life?  How did your parents relate to each other?  How about your grandparents, aunts/uncles, your parents’ friends, your friend’s parents?  Anytime we make (or have) a significant change in our lives, we have to create new internal representations – new internal models.  These models are based, in large part, on what we experienced.

There are many internal changes as we move into this new stage of our lives.  In addition to changing our internal representation of ourselves from single to married, there is also this new representation of our partner as a spouse.   We may also have to learn to share our space, our time, our socks, to be accountable, and to be patient.

Growing up in this culture, we often (perhaps unconsciously) expect things to be easy and for things/people to be perfect.  We might idealize what marriage means/feels like – and then realize that things are not perfect.  One morning, you realize that your spouse has bad breath!  (By the way, so do you!).   We have to learn to incorporate the little disappointments, and learn to cherish the simple things that work well together.  Maybe she takes all the covers, but it is a special feeling knowing that you wake up next to her. 

Marriage poses a paradox.  We really do best in a marriage when we can be mature, understand our limitations and foibles and learn to be patient/mature with our spouse.  However, there are strong regressive pulls in marriage.  We often look to our partner to make up for things in our family of origin.  We can benefit from appreciating the wonderful qualities of our partner, even from a dreamy perspective – however, we really do need to balance the dreaminess with the patience that comes from mature love.

The idea of premarital counseling can be frightening.  However, there is something very special about developing new understandings about yourself and your relationship in the presence of your partner.

These are just a few thoughts on this very rich topic. If you have any questions, want more information or would like to explore premarital counseling, please contact us at or 415.440.0500.



              Welcome to the San Francisco Counseling Center Blog.  We are a group of psychotherapists  dedicated to providing high quality therapy.  We have in common some basic beliefs about how the mind works, the importance of past experiences and a real passion for doing this work.  We also have very different backgrounds/experiences and we plan to bring our strengths to providing informative, thoughtful (and perhaps thought-provoking) topics.  Some of us teach or have taught graduate school, have run internships, several of us have extensive work with children and adolescents.  Some of us have  extensive experience in working with couples (one of our therapists teaches couples therapy at a local graduate school).

                In the future we will touch on topics relevant to family life, couples concerns, parenting issues, cultural and cross-cultural concerns, and some of the basic concerns of just being a person,  as well as the standard topics such as depression and anxiety.  In all likelihood, you will find that we are not presenting a party-line.  We expect that (in at least some of our postings) you will find a creative and unique point of view.  We hope you will check back with us, or perhaps subscribe through RSS.   You are always welcome to contact us through email or the phone.  415.440.0500.  SS.

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