One of the things I value most in this work is collaboration.
As a couples and family therapist, I spend a lot of time coordinating care with other clinicians. I consult with individual therapists, psychiatrists, treatment teams, and other providers because I believe that good collaboration often leads to better outcomes. Most of the time, these conversations are thoughtful, helpful, and deeply enriching. They allow us to pool our knowledge, see blind spots in our thinking, and support clients from multiple angles. I have learned an enormous amount from my colleagues over the years, and I genuinely believe that collaboration has made me a better therapist.
At the same time, one of the hardest parts of collaboration is encountering fundamentally different ways of understanding human behavior.
These moments are relatively rare, but they tend to stay with me. Occasionally, I will find myself on a consultation call listening to another clinician describe a client in a way that feels very different from how I understand them. The conversation may focus heavily on poor choices, maladaptive behaviors, resistance, manipulation, attention-seeking, self-sabotage, or a client’s unwillingness to change. Sometimes there is an underlying assumption that the client is choosing these patterns despite knowing better.
To be clear, I am not writing this because I think there is only one correct way to practice therapy. There are many therapeutic approaches that help people. There are clinicians whose work looks very different from mine who have helped countless clients. I also believe accountability is important, and I do not think trauma-informed care means excusing harmful behavior or removing personal responsibility from the equation.
And yet, the longer I do trauma work, the harder it becomes for me to understand people primarily through a lens of pathology, blame, or choice alone.
One of the biggest shifts in my own development as a therapist has been learning to become curious about function and releasing judgment. Rather than stating, “This person is making really terrible life choices” I often find myself asking, “What purpose is this serving?” or “What is this behavior protecting them from?” or even, “What happened that made this adaptation necessary in the first place?”
Working with trauma survivors has fundamentally changed the way I understand human behavior. Once you spend enough time sitting with people who have experienced abuse, neglect, attachment wounds, chronic invalidation, discrimination, loss, or relational trauma, it becomes difficult to view their coping strategies as “irrational.” More often than not, the behavior that is causing problems today was once a brilliant solution to a very real problem.
The person who struggles to trust may have learned through experience that trust was dangerous.
The person who avoids conflict may have grown up in an environment where conflict led to emotional or physical harm.
The person who shuts down during difficult conversations may have discovered long ago that vulnerability came at a cost.
The person who appears controlling may be trying to create predictability in a world that once felt frighteningly unpredictable.
This does not mean these strategies are still helping them. In fact, many of the protective mechanisms that allow people to survive become the very things that create suffering later in life. But empathizing with the origin of a behavior is not the same thing as condoning it.
For me, this distinction matters deeply.
Sometimes when I collaborate with clinicians who have not had extensive trauma training, I notice how quickly the conversation can move toward what the client is doing wrong. There may be an emphasis on the behavior itself rather than the context that gave rise to it. The focus can become the symptom, the pattern, or the problem without spending as much time understanding the adaptation underneath.
Those moments are difficult for me because I know how much shame many of our clients are already carrying.
Most people who come to therapy are not looking for ways to make their lives harder. They are not waking up in the morning hoping to sabotage their relationships, destroy their sense of self-worth, or repeat painful patterns. In my experience, people are usually doing the best they can with the tools, experiences, nervous systems, and attachment histories they have.
That does not mean those tools are effective, nor does it mean people should not be accountable for the ways they impact or harm others. It simply means that I have become less interested in asking whether someone is choosing a behavior and more interested in understanding why that behavior feels necessary.
This is especially true when working with children and adolescents. In fact, one of the reasons I moved away from working primarily with children is that parents would sometimes come into my office with an underlying message of, “Fix my broken and problematic child.” And yet, even with acute behavioral challenges, there are often real systemic, relational, familial, developmental, or environmental contexts that have shaped why a child has moved toward certain protective behaviors. That does not mean parents are bad, or that caregivers are solely responsible for every struggle a child has. But it does mean that children’s behaviors rarely emerge in a vacuum, and healing often requires us to look beyond the child as “the problem.”
In many ways, this is one of the core values that guides my work as a therapist. I believe shame reduction and systemic insight creates the conditions for change. When people feel judged, defective, uniquely problematic, or fundamentally broken, they tend to become more defended and less flexible. When people feel understood, they often become more curious about themselves. That curiosity creates space for accountability, growth, and healing in a way that shame rarely does.
Perhaps that is why these consultation conversations rattle and stay with me. They remind me that therapy is not just a collection of interventions or techniques, but a way of understanding human beings. Even among skilled and caring clinicians, we can look at the exact same client and arrive at very different conclusions about what is happening. And unfortunately, these underlying philosophical differences can sometimes negatively impact treatment outcomes and reinforce the very challenges that parts of the client are desperately trying to change.
The longer I do this work, the more I find myself returning to the same belief: beneath nearly every behavior is a story. Beneath nearly every coping strategy is an adaptation. And beneath nearly every adaptation is a human being trying, in the best way they know how, to navigate pain, seek connection, and protect themselves from further harm.
That perspective has changed not only how I work with clients, but also how I understand collaboration with other clinicians. I continue to value consultation deeply, and I have learned so much from colleagues who think differently than I do.
But I also want to be honest: there are certain clinical frameworks I find difficult to collaborate with because I believe they can cause real harm, especially when clients are already carrying trauma, shame, or long histories of being misunderstood. When a client’s protective strategies are repeatedly framed as manipulation, toxicity, resistance, or poor choices without enough attention to the pain and adaptation underneath, therapy can unintentionally reinforce the very shame the client is trying to heal from.
Warmly,
