Peer Reviewed Journal Articles

Published in Psychotherapy, 21, 218-225


This article states a theoretical position that is the outgrowth of 27 years of research into the problem of resistance in psychotherapy. Resistance to change or progress is centered in the patterns of thoughts and behaviors that serve to protect a core defense. The article describes the formation of a “primary fantasy bond” (a delusion of being connected to the mother) which begins in infancy and persists as a defense throughout childhood and into adult life. The hypotheses presented are supported by data gathered from three sources: from schizophrenic patients in a residential setting, from neurotic and “normal” patients in private practice, and from colleagues and friends.

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Published in Psychotherapy, 23(3), 439-447.

Argues that despite the lack of reliable prognostic signs of suicide in the behavior of potential suicide victims, there is clinical evidence that the majority of these people are tortured by a subliminal voice or thought process that is degrading and derisive to the self. This pattern of thoughts is generally accompanied by depression and lowered self-esteem. Under certain conditions, this system of hostile thoughts becomes progressively ascendant until it finally takes precedence over thought processes of rational self-interest. It is suggested that using laboratory procedures, these thoughts can be formulated and brought directly into consciousness when they are put in terms of a “voice.” This voice is described as a core defense that originates in family interactions. The dynamics and probable sources of the voice are analyzed, and the relationship between this destructive thought process and actual suicidal behavior are explored. The case of a 30-yr-old woman who attempted suicide illustrates 3 levels of intensity of the voice in terms of affect. (32 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Published in Psychotherapy, 24, 233-239

Points out the damage caused by the formation of a fantasy bond (FB) in marital and family process. The FB is formed by individuals in early childhood to compensate for emotional deprivation; imaginary fusion attempts to heal the fracture by providing partial gratification of primary needs, thereby reducing tension. The dynamics involved in forming an FB, the resulting symptomatology, and psychological damage both to the relationship and to the individuals involved are described. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Published in American Journal of Psychoanalysis, 47(3), 210-229.


Human beings spend their lives in a restricted range of personal relationships and experiences. Their freedom and initiative are constricted by a self-destructive process. Furthermore, their internal conflict is primarily unconscious, and they are generally unaware of the circle of guilt that limits them.

Guilt reactions are mediated by an internal thought process or dialogue referred to here as the “voice.” The voice is a system of negative thoughts, antithetical to the self, that plays a major part in human suffering and significantly limits an individual’s goal-directed behavior. The voice represents the introjected negative thoughts and hostile attitudes of one’s parents, and it ranges from unconscious or subliminal to fully conscious. The form and substance of experience that people permit themselves is regulated by this system of self-accusatory thoughts and injunctions. To whatever degree these self-critical thoughts remainunconscious, they cause considerable damage, and the individual is unable to break the cycle.

The “voice” of the so-called normal or neurotic individual is directly analogous to the hallucinated voices of the schizophrenic person. The content of these voices, when analyzed, reveals the same regulatory process and is characterized by the same hostility and vindictiveness toward the self.

The concept of guilt refers to an insidious process of self-limitation and self-hatred that seriously restricts people’s lives. Out of a sense of guilt, people become self-denying, self-defeating, self-destructive, and even suicidal. The “voice” represents the thought process underlying the behavior noted above.

Published in Psychotherapy. 24(1), 31-39

Published in Psychotherapy, 26(4), 524-529


Voice therapy (VT) for parents can be used to break the cycle of emotional and physical abuse. During VT, parents (1) work on ambivalent feelings and attitudes toward themselves and their children, (2) recall painful events from their own childhoods, and (3) release the repressed affect associated with negative experiences in growing up. They also gain an understanding of the connections between their present-day limitations and the defensive patterns set up to cope with early trauma. They expose deficiencies in their families, thus breaking the idealization of their parents, and develop more compassionate child-rearing practices. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Published in American Journal of Psychoanalysis, 50(2), 121-135


Regression may be precipitated by significant changes, both positive and negative, in an individual’s life. The author conceptualizes regression as the defense mechanism that is used to heal the fracture in the original bond with the mother caused by events, symbolic or real, that remind one of being separate and vulnerable to death. Guilt reactions, separation anxiety, and fear of death are increased by negative events such as illness, financial loss, failure, rejection, or death of a loved one. Regression may be activated as well by any significant positive experience or unusual achievement indicative of strength, independence, or personal power, that challenges an individual’s image of him/herself in the family. The paper delineates five stages of progressive retreat that characterize regressive episodes catalyzed by an atypical success or accomplishment.

Published in  Psychotherapy, 27(4), 627-635


A systematic approach to therapy based on a comprehensive theory of psychopathology and a comparative model of mental health is set forth. Humans are conceptualized as in conflict between the active pursuit of goals in the real world, and an inward, self-protective defense system. The resolution of this conflict has a profound effect on an individual’s overall functioning. A case study illustrates a therapeutic process utilizing methods based on this theory.

Published in Journal of Sex and Marital Therapy,16(4), 258-274


Negative cognitions are capable of interfering with the natural flow of excitement and sexual desire at any point prior to, during, or following a sexual encounter. The source of these inimical thought patterns can be found in internalized parental attitudes that are transmitted intergenerationally and that also form the basis of sexual stereotyping. This paper describes the application of Voice Therapy methods to the resulting sexual problems manifested in many couple relationships. Clinical material excerpted from group sessions illustrate the content of the “voice” process–the negative cognitions–and demonstrate the angry affect that accompanies the verbalization of such thoughts and attitudes. Exposing self-attacks and critical thoughts about one’s partner has proved to have positive results in terms of improved sexual relationships. Also discussed are those prevailing cultural views that function to reinforce each individual’s “voice,” thereby contributing to much of the sexual distress experienced in personal relationships.

Published in Journal of College Student Psychotherapy, 4(3-4), 101-123

Published in Journal of American College Health, 38(5), 207-213

Published in American Journal of Psychoanalysis, 53, 335-352


Elucidates the relationship between fantasy and addiction and describes addiction as a primary function of the self-parenting process. In presenting a comparative model of mental health vs psychopathology in terms of the self-parenting process, the author discusses 3 categories of individuals: the person with extreme propensities for fantasy and isolation; the person who uses elements of reality primarily to reinforce and support an ongoing fantasy process rather than really investing in relationships and career; and the person who lives a realistic committed life whose actions match aspirations and capabilities. Three groups of addictive reactions associated with a self-nourishing lifestyle are discussed. A therapeutic approach (1) challenges and disrupts the addictive patterns and (2) encourages movement toward real gratification and autonomy in the external environment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Published in ERIC


Emotional child abuse is virtually inevitable in the context of the traditional nuclear family and often has a more detrimental effect on children than other, more widely publicized forms of maltreatment. This paper documents clinical, statistical, and empirical evidence showing that “normative” child-rearing practices in our culture have pathogenic properties and effects. Manifestations of emotional child abuse include: (1) behaviors based on parental hostility such as verbal abuse, sadistic socialization measures, lack of respect for the child’s personal boundaries, threat of abandonment, and stifling a child’s spontaneity; (2) destructive practices based on indifference and neglect, including excessive permissiveness and inconsistency; (3) behaviors based on ignorance, including dishonest role-playing, overprotection, and isolation; (4) overly restrictive or harsh moral codes; and (5) parents’ defenses and addictive patterns that are transmitted to their children. A number of factors are involved in the psychodynamics of emotional maltreatment: parents’ ambivalent feelings, the projection of parents’ negative traits onto children, the confusion between emotional hunger and genuine love, the exclusivity of traditional coupling, and the utilization of the child as a symbol of immortality. It is mandatory that we examine dehumanizing child-rearing practices delineated here in order to help future generations of children.

Published in ERIC


This paper describes the essential difference between two modes of sexual relating: (1) a personal, outward style of interaction that is the natural extension of affection, tenderness, and companionship between two people; and (2) an impersonal, inward, more masturbatory expression in which sex is used primarily as a narcotic. The origins of self-gratifying modes of sexuality can be traced to the “self-parenting” process: a core, psychological defense formed early in childhood in which children learn to “parent” themselves, both internally in fantasy and externally by utilizing objects and persons. This adaptation later becomes externalized in an adult’s intimate relationships. This manner of sexual relating is characterized by elements of sexual withholding and control, a reliance on fantasy with corresponding emotional distancing, and the intrusion of negative cognitions during sex. The major distinction between self-gratifying modes of sexuality and more spontaneous, free sexual expressions is that the former represents the utilization of another person as an instrument to assuage primitive needs and longings. The only hope for a couple trapped in such a framework is for them to break out of the imprisonment of their defensive posture of self-parenting, and free themselves to move toward individuation and the possibility for genuine love.

Published in Psychotherapy, 31, 342-351


Presents clinical material using voice therapy, to elicit, identify, and counteract negative thought patterns. The case of a 38-yr-old man, who experienced suicidal impulses in competitive situations, illustrates the concept of “identification with the aggressor” in relation to a father’s angry, rivalrous feelings toward his son. The author discusses the dynamics operating in families where immature or insecure parents compete with and show resentment toward the child of the same sex and direct overt or covert aggression toward him/her. Later, the internalized aggression emerges as a negative thought process when the individual strives to achieve personal or vocational goals. An exploration of the theoretical implications of the case contributes to an understanding of unresolved Oedipal issues that can affect young people at risk for suicide, particularly high-achieving adolescents who seemingly have everything to live for. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Published in Mind and Human Interaction, 7, 167-180


Group identification is a major cause of religious, racial, and international conflict. Many forms of group identification are fantasy bonds, imagined connections with others offering security at the expense of individual self-realization. The fantasy bond forms in childhood in response to inadequate parenting. Human beings are not inherently aggressive, but interpersonal tension in families leads to hostile and defensive behaviors first acted out on family members and later extended to outsiders. These bonds become reinforced as the child becomes aware of death’s inevitability. Social systems represent a pooling and projection of individual defense mechanisms into a cultural framework as mores, traditions, and secular religious beliefs. These traditions and beliefs become imaginary survival mechanisms for the individual, a way to deny death’s finality. Since they represent immortality, these world views are strongly defended by their adherents, who feel threatened by groups with other beliefs, and will fight to defend their point of view. The outgroup is seen as peculiar, impure, or evil. Outbreaks of violence will continue to be a problem until destructive child-rearing practices and social processes fostering aggression change, and death is accepted as the natural end of life. (Contains 109 references.)

Published in Psychotherapy: Theory/Research/Practice/Training, 39 (3), 223-232


Notes that numerous attempts have been made to explain the demise of psychoanalysis and depth psychotherapy, placing blame on secularism among analysts, insufficient empirical research, prolonged treatment time, monetary considerations, and managed care. The author considers the primary cause to be an implicit cultural movement to squelch serious inquiry into family dynamics and interpersonal relationships, particularly the physical, sexual, and emotional abuse of children. To revive the humane practice of depth psychotherapy, therapists must support research that emphasizes the importance of early psychosocial environmental influences on personality development. Clinicians must also challenge restrictive societal pressure, sacred illusions concerning family life, and their own psychological defenses in order to reestablish a legitimate practice of depth therapy that moves away from the medical model. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Published in Journal of Humanistic Psychology


Although resistance takes many forms, this article elucidates the primary source of resistance in psychotherapy as well as the fundamental resistance to leading a fulfilling life. The ultimate resistance to change, in both cases, originates in the anticipatory fear of arousing existential angst. To varying degrees, most individuals retreat from life and adopt defense mechanisms in an attempt to avoid reawakening suppressed feelings of terror and dread they experienced as children in early separation experiences, and, in particular, when they first learned about death. As clients dismantle their defenses during therapy and move toward increased individuation and self-fulfillment, these unconscious fears threaten to emerge into conscious awareness, and core resistances come into play. Certain events and circumstances, both positive and negative, arouse or intensify latent death anxiety, whereas other circumstances and defenses relieve it. There are numerous defenses that help ameliorate the core anxiety including the fantasy bond—an illusion of connection or fusion with another person, persons, groups, or causes—addictions, microsuicidal behavior, and literal and symbolic methods of denying one’s eventual demise. Although these defenses provide a measure of security and a sense of immortality, they adversely affect one’s psychological adjustment, emotional well-being, and interpersonal relationships.

Invited Chapters

Published in What is Psychotherapy? Contemporary Perspectives (pp.68-74)

This book draws on the expertise of eighty-eight psychotherapists who have contributed significantly to the development of their field. It offers an in-depth look at each contributor’s therapeutic approach, detailing the way they practice psychotherapy, the theories on which they base their techniques, and their analysis of the strengths and weaknesss of their approach.

Published in Death Anxiety Handbook: Research, Instrumentation, and Application (pp. 217-241)

Published in Favorite Counseling and Therapy Techniques: 51 Therapists Share Their Most Creative Strategies (pp. 82-85)

In the new edition of this highly popular book, Howard Rosenthal once again brings together a group of prominent therapists who share their insightful, pioneering, and favorite therapeutic techniques. These therapists include such well-known figures as Albert Ellis, Arnold Lazarus, William Glasser, Raymond Corsini, and Allen E. Ivey. Many of the classic entries in the previous edition are once again included, some unaltered and others updated, while several new chapters have been added to reflect the newest advancements in the counseling field. For practitioners wondering what methods to use when working with clients and what they can prescribe for them between sessions, or for those who simply are interested in gaining insight into the thoughts and minds of such eminent therapists, the more than 50 entries in this text are sure to be both highly useful and exciting reads.

Published in Death Attitudes and the Older Adult: Theories, Concepts, and Applications (pp. 65-84)

Death and ageing are two topics not often discussed together in the present literature. This text bridges the fields of gerontology and thanatology. Death attitudes – defined as attitudes towards the dying process, end-of-life decision making, and death itself – are explored. Those contributing to this volume hail from several specialized backgrounds including gerontology, death, education, and general psychology. This mix of contributors adds to the interdisciplinary perspective of the text.

Published in Favorite Counseling and Therapy Homework Assignments: Leading Therapists Share Their Most Creative Strategies (pp. 85-90)

This companion to Favorite Counseling and Therapy Techniques contains more than fifty handouts and homework assignments used by some of the finest and most renowned therapists in the world, such as Albert Ellis, William Glasser, Richard B. Bolles, Alan E. Ivey, Marianne Schneider Corey, Gerald Corey, Maxie C. Maultsby, Jr., and Peter R. Breggin. Several new entries have been added to reflect the newest advancements in the counseling field. This is sure to be a highly useful and insightful read for any practitioner wishing to learn new techniques to benefit their practice and patients.

Published in What’s the Good of Counseling & Psychotherapy? (pp. 48-80)

Published in The Handbook of Closeness and Intimacy (pp. 375-395)

This handbook brings together the latest thinking on the scientific study of closeness and intimacy from some of the most active and widely recognized relationship scholars in social and clinical psychology, communication studies, and related disciplines. Each contributing author defines their understanding of the meaning of closeness and intimacy; summarizes existing research and provides an overview of a theoretical framework; presents new ideas, applications, and previously unstated theoretical connections; and provides cross-references to other chapters to further integrate the material.

Published in Therapy’s Best: Practical Advice and Gems of Wisdom from Twenty Accomplished Counselors and Therapists (pp. 113-149)

Therapy’s Best is a lively and entertaining collection of one-on-one interviews with some of the top therapists and counselors in the world. Educator and psychotherapist Dr. Howard G. Rosenthal talks with twenty of therapy’s legends, including Albert Ellis, arguably the greatest clinical psychologist and therapist of our time; assertiveness training pioneer Robert Alberti; experiential psychotherapist Al Mahrer; and William Glasser, the father of reality therapy and choice theory. Each interview reveals insights into the therapists’ personal lives, their observations on counseling, and the helping profession in general, and their thoughts on what really works when dealing with clients in need.

Published in Meaning, Mortality, and Choice; The  Social Psychology of Existential Concerns


fundamental aspect of being human is knowing that one day we will die. Efforts to contend with this knowledge are at the root of a great many social behaviors across a variety of domains. These behavior include, on the one hand, the development of symbolic language, the creation of art and music, and efforts to transcend the human body. On the other hand, awareness of mortality has spawned acts of aggression against enemies, real or perceived, and extreme reactions such as terrorism and suicide.
In this thought-provoking addition to the Herzliya Series on Personality and Social Psychology, Shaver and Mikulincer have gathered a distinguished group of thinkers to investigate these existential concerns within a framework that is both philosophical and practical. Theorists examine the nature of universal themes such as the importance of personal choice and human autonomy in an arbitrary world and the vital roles of parenthood and religion in providing solace against the threat of meaninglessness. Clinicians discuss the use of various psychodynamic and cognitive behavioral therapies, emphasizing the mind’s propensity to assign value in ways that can be either maladaptive or liberating. The result is a cohesive, well prepared book filled with cutting-edge research.