Last Chance Couples Therapy: How to Break the Systemic Cycle of Fighting and Breathe New Life into Old Relationship Patterns

In this episode, I speak with Peter about his work with “last chance couples” -- couples on the brink of separation who are putting in potentially one final effort in therapy. Peter first gives us a history of how he began specializing in this demographic of couples, the cornucopia of therapeutic models he brings into his work, and the particular challenges these types of couples pose to the therapeutic approach. He speaks about the creative relational movement approach to change which he employs to break a couples’ systemic cycle of fighting. A common issue that these “last chance couples” have, is there is often very little to no internal motivation left to employ a change to their dynamic. Within this creative relational change approach, Peter speaks to the four premises that are important for the couple and therapist alike to understand to get on board with this process, and which of the four premises is most controversial to the field of psychology. He also talks about naming vulnerability as a good way to break the cycle of angry fighting, the challenges of a detached partner, and the often gendered dynamics that can either play into or disrupt the cycle of fighting. Peter shares four research-supported suggestions for couples to increase both the therapeutic credibility and therapeutic outcomes and the five most common “last chance couple” scenarios, including one he discovered after the publication of his book on the subject. Finally, Peter zooms out and leaves us with the big picture concept of how couples can adopt relational values to use as a compass to better guide their relationship on a daily basis. Peter Fraenkel, Ph.D., is an Associate Professor of Psychology at City College of New York; former faculty at the Ackerman Institute for the Family and NYU Medical Center; and is in private practice in New York City. He is the author numerous peer-reviewed articles and chapters, and the books Last Chance Couple Therapy: Bringing Relationships Back from the Brink (2023, Norton); Sync Your Relationship, Save Your Marriage: Four Steps to Getting Back on Track; and is co-author of The Relational Trauma of Incest: A Family-Based Approach to Treatment. Peter lectures and conducts therapist trainings internationally. He received the American Family Therapy Academy’s 2012 award for Innovative Contribution to Family Therapy. He is a former Vice President and former Board Member of AFTA, a Board member of the Minuchin Center for the Family, and a reviewer for several family therapy journals. Peter is also a professional drummer and percussionist, and has performed and recorded worldwide.

In this episode, I speak with Chandra about her path into trauma-informed work with young children and their caregivers. Raised in San Francisco by parents who worked in child welfare, Chandra was exposed early to stories of trauma and healing. Before age 7, several of her friends lost their parents to cancer, which inspired her to become a doctor. In high school, during an internship on a pediatric oncology ward she noticed that while physical health was prioritized, children’s emotional needs were often overlooked. This realization led her to study psychology. After college, Chandra worked at a residential program with children aged 6–12. She found the children often opened up about trauma during informal moments—car rides, bedtime, or watching TV—highlighting the need to involve caregivers in the healing process. In 1998, Chandra interned with Dr. Alicia Lieberman at UCSF’s Child Trauma Research Program, where she trained in Child-Parent Psychotherapy (CPP), an evidence-based treatment for young children under age 6 who have experienced trauma. She later developed the CPP fidelity framework and co-authored the second edition of the manual. Chandra noted a key challenge: although many parents recognize their child’s trauma, few clinicians are trained to work effectively with young children. Many therapists also avoid discussing trauma directly with young children, which can leave them alone with their experiences. CPP begins with the therapist meeting alone with the caregiver to supportively explore the child’s symptoms, experiences of trauma, the caregiver’s own history, including how past experiences may shape the parent's responses. Then the therapist and caregiver gently acknowledge past traumatic experiences to the child—“speaking the unspeakable”—and help the child process their experiences using developmentally attuned pacing and modalities, including play and art. As children process their experiences they sometimes shift topics or activities or seek physical comfort when they begin to move outside their window of tolerance. Therapists help parents understand this process, attune to their child’s needs, and support their child. CPP has a strong evidence base, including five randomized controlled trials. It has shown positive outcomes for preschoolers exposed to violence and infants and toddlers who experienced maltreatment. Notably, a recent study found CPP is associated with lower epigenetic age acceleration in trauma-exposed children aged 2–6—suggesting a measurable impact at the biological level. Chandra Ghosh Ippen, Ph.D. is a child trauma psychologist specializing in working with families with children under age 6. She is co-developer of Child-Parent Psychotherapy, the associate director of the Child Trauma Research Program at the University of California, San Francisco, and a member of the Board of Directors of Zero to Three. She has spent over 30 years conducting clinical work, research, and training in the area of childhood trauma and diversity-informed practice. She is also an award-winning children’s book author and has written 5 children’s books as well as the free Trinka and Sam disaster series, which has been translated and distributed to over 400,000 families around the world.

In this episode, Heather discusses her background and how she came to working with couples in therapy. She discussed how usually, when a partner in a couple has significant PTSD, it is recommended that each do individual therapy, but as she discussed, that doesn’t mean the couple doesn’t continue to struggle in their relationship. She shared how in her research with couples, where one person was a child sexual abuse survivor, the Emotionally Focused Couples Therapy approach was helpful, but it was difficult to complete Deescalation Stage, since there was a great deal of emotional dysregulation and difficulty with mentalizing. Heather discussed her conceptualization of Complex PTSD and how she began starting with cognitive-based interventions to help clients understand trauma, their reactions to trauma, and learn skills for emotional regulation and mentalizing, which is being able to reflect on one’s own perceptions of the other, what the other may be experiencing/thinking, and how one might be being perceived. She explained how helping improve these skills helps to couple to address the effects of the trauma together and then allowing for the couple to do the relationship work. She talked about refining her Developmental Couples Therapy for Complex Trauma approaches, trained other clinicians, writing a treatment manual and conducting research. Heather also shared that she had recently published a workbook for clients, “Healing Broken Bonds: A Couple's Workbook for Complex Trauma” which goes through Developmental Couples Therapy for Complex Trauma step-by-step from a client’s perspective. She describes how it’s being used not only alongside treatment, but independently by couples and individuals. It can be paired with episodes of her podcast Healing Broken Bonds that help walk people through the concepts. ​ Heather MacIntosh, Ph.D., CPsych is a clinical psychologist, Associate Professor, and Director of the Couple and Family Therapy Clinic at McGill University where she is the recipient of the H. Noel Fieldhouse Award for Distinguished Teaching. Heather is author of Developmental Couple Therapy for Complex Trauma a Manual for Therapists and Healing Broken Bonds: A Couple's Workbook for Complex Trauma. She is also the developer and host of Healing Broken Bonds, a podcast featuring couples dealing with the impacts of complex trauma in their relationships. Developmental Couple Therapy for Complex Trauma is an evidence based, psychoanalytically informed treatment approach, developed by Heather, for working with couples dealing with the impacts of complex trauma. Heather is the author of over 60 peer reviewed journal articles, book chapters, and treatment manuals. She is in demand as a speaker at international conferences and workshops as well as a resource for local and national media in the areas of trauma, couple and family relationships and issues, and queer and trans wellbeing. She leads an active funded research program having been principal researcher on over $500,000 in peer reviewed research grants and an active co-investigator on over $7,000,000 more with other internationally recognized colleagues. Heather’s research primarily examines the impact of early life trauma on the process and outcome of couple therapy. In addition, she studies the experiences of 2SLGBTQIA+ trauma survivors in therapy, in healing their sexual selves, adapting and integrating models of treatment to ensure accessibility and inclusion of Indigenous, racialized, queer, and trans, graduate student therapist trainees and clients. Heather lives and works on land of the Crawford Purchase Mohawk territory “purchased” for settlement by United Empire Loyalists at the end of the American Revolutionary War. MerryMac Farm is in Eastern Ontario, Canada, where she strives to live with the land in peace, and to bring healing through therapy offered in relation with her Icelandic horses, her retired RCMP Musical Ride Horse, three Ojibwe Spirit Ponies, and a cadre of other creatures who bring joy, hilarity, and love to life.

In this episode, I speak with Karen Sprinkel Ancelet about her path to integrating trauma-informed, psychedelic-assisted therapy into her clinical practice. Karen shares how, early in her career, she worked with families whose loved ones had been murdered by a serial killer. She found that the models she had been trained in were not enough to address the profound spiritual trauma her clients experienced as they struggled to make sense of such horrific loss. This realization led Karen to begin practicing Buddhism and eventually to live in Asia, where she deepened her understanding of human suffering. While working with people from Thailand and Tibet who had endured trauma, she witnessed how cultural perspectives shape the ways we make meaning out of tragedy and resilience. She also facilitated group therapy for child sexual abuse survivors, where she discovered that while some approaches were effective for certain individuals, they were not universally helpful. From these experiences, Karen came to conceptualize trauma as impacting the mind, body, and spirit, all of which must be addressed in healing. She describes her initial skepticism toward psychedelic therapies, coming from a place of purism, but shares how her perspective shifted as she learned more about their effectiveness. Immersing herself in advanced training and certification, Karen began working with clients using psychedelics in therapeutic contexts. Karen also discusses the breadth of her training across multiple trauma-healing approaches. She highlights Somatic modalities such as Somatic Experiencing, Hakomi, and Sensorimotor Psychotherapy; Desensitization-based methods like Eye Movement Desensitization and Reprocessing (EMDR) and Brainspotting; and Parts models including Internal Family Systems (IFS), Voice Dialogue, and Ego State Therapy. She explains how client factors often determine which approach is the best fit for a given individual. Throughout our conversation, Karen emphasizes her commitment to helping clients heal from PTSD as efficiently as possible. This integrative vision inspired her book, The Thriving Self: A New Paradigm for Healing the Mind, Body and Spirit and Moving Beyond It, which offers clients a framework to move toward healing without spending years in therapy. Karen Sprinkel Ancelet, LMFT is a licensed psychotherapist with more than 30 years of clinical experience, practicing in California, Colorado, Oregon, Washington, and Michigan. She specializes in trauma-informed care and integrates a broad range of evidence-based modalities, including EMDR, Brainspotting, Somatic Experiencing, Internal Family Systems (Level 3), and HeartMath. Karen is also a Ketamine-Assisted Psychotherapy (KAP) provider with advanced psychedelic training through MAPS, Fluence, and Three Cups. She graduated with a Certificate in Psychedelic-Assisted Therapies and Research from CIIS. In addition to her clinical practice, she serves as a consultant, educator, Certified Clinical Trauma Professional, and Continuing Education provider. A pivotal chapter in Karen’s life was her time living in Asia, where she conducted her master’s research on trauma healing following violent crimes in Tibet, Southeast Asia, and the United States. Deeply impacted by these findings, she returned to Asia for several years to further her exploration. Today, Karen weaves together the ancient wisdom of meditation and mindfulness with contemporary approaches such as EMDR, Brainspotting, Flash, EFT, IFS, and Somatic Experiencing to guide and support her clients in their healing journey.

In this episode, I speak with Sam about his career and what lead him to become an Emotionally Focused Couple Therapy trainer, teaching EFT in The United States and throughout Latin America, S​pain and the Caribbean. Sam discussed how his clients lead him to EFT when, although he had trained in multiple models of couples therapy, his clients were saying they felt like the therapy wasn’t going deep enough for them. He shared that he had been reading about attachment theory and John Bowlby’s work, and then took a workshop in EFT from Sue Johnson, Ph.D. He said he fell in love with the model and explained how it helped him see the struggles of couples he was working within a different light, and through the lens of attachment, he could see beyond their conflicts and struggles and see their protests at disconnection as longing for connection. We discussed how Sue asked him to become a trainer in EFT, and asked him to bring EFT to Spanish-speaking countries, as he was originally from Mexico City and spoke Spanish fluently. Sam shares about the countries he has provided trainings in and we discussed cultural nuances that he has found in Latin American cultures and with other cultures. He discussed how the expression of love and the expectations of closeness are influenced by culture, and also how all human beings, regardless of culture, have the fundamental need for connection and safety. We discussed dynamics in Latin American culture that relate to gender, socioeconomic status, relation to family, collectivism and individualism, and how these may appear in couples therapy. In addition to Sam’s cross cultural work, we also discussed his work on Forgiveness, and a training he had first done with Dr. Michelle Gannon on apologies and how important they are to healing Attachment Injuries. Sam now teaches Master Classes on Attachment Injuries and Forgiveness with fellow Argentinean Trainer Natalia Gilabert. We left off commenting on the book Sam coauthored for the APA called Deliberate Practice in Emotionally Focused Couple Therapy, and trainings he is offering in-person this September in San Diego with Dr. Lisa Palmer Olsen, and online in 2026. Sam Jinich, Ph.D. is a Clinical Psychologist in private practice, licensed in California since 1995, and currently based in Buenos Aires, Argentina. He is an internationally recognized Emotionally Focused Therapy (EFT) Trainer, Supervisor, and Certified Couple Therapist, endorsed by the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT). Sam teaches EFT to therapists across the globe in English and Spanish. In North America, his trainings feature English-language didactic presentations with the option of bilingual experiential role plays—reflecting his belief that Latinx bilingual therapists should learn in the language they are most comfortable with, while deliberately practicing in the language they use clinically. A respected leader in the EFT community, Sam co-founded the Northern California Community for EFT (NCCEFT) and served as its EFT Trainer until 2025. He is also a past president of the San Francisco Psychological Association. Over nearly three decades, he has trained thousands of therapists, taught at multiple universities, published scientific research on trauma and family dynamics, and coauthored the APA book Deliberate Practice in Emotionally Focused Couple Therapy. Sam is the Clinical Director of the San Francisco Consultancy in Emotionally Focused Therapy (SFCEFT). Sam will be co-leading an EFT Externship in San Diego in September 2025, and an online EFT Externship in May 2026. Learn more at www.drsamjinich.com or on the ICEEFT website.

In this episode, I sit down with Zenobia Morrill, Ph.D., who shares her journey into psychotherapy—from a personal confrontation with existential truth to navigating her family’s intergenerational pain. Dr. Morrill reflects on her early experiences as a therapy client, where she encountered traditional frameworks that often fell short, approaches that pathologized pain while ignoring the broader systemic and historical forces at play. Grounded in liberation psychology and critical theory, Dr. Morrill offers a compelling critique of mainstream psychological models that individualize suffering and overlook the impact of power, politics, and culture. We explore how psychotherapy can become a tool for liberation, not by reinforcing institutional norms, but by creating space to challenge and reimagine them in service of opening up possibilities for personhood. Dr. Morrill shares how critical-liberation psychotherapy offers practitioners a framework to question how therapeutic practices may either reinforce alienation or open new paths toward freedom, healing, and fuller participation in society. She reflects on the importance of broadening our range of being, reclaiming repressed parts of the self, and bridging individual pain to collective emancipation. Therapy, she argues, must move beyond static formulations and recognize that social, political, and cultural forces are already present in the room—they are not “add-ons” but essential to the client’s lived experience. This approach does not suggest liberation occurs solely within the therapy room, but asks how the institution of therapy itself—its theories, method, and practices—can be used to support liberatory outcomes. Ultimately, Dr. Morrill calls on therapists to resist objectification of clients and of therapy itself—and to reimagine psychotherapy as a dynamic, relational, and contextually grounded space for transformation. Zenobia Morrill, Ph.D., is a critical-liberation psychologist and psychology professor at William James College. She received her doctorate from the University of Massachusetts Boston and completed her pre- and post-doctoral fellowship at the Yale School of Medicine and at Yale Health, Mental Health & Counseling, respectively. Inspired by her personal and professional experiences with the mental health system, Dr. Morrill emphasizes the power in psychological frameworks as the stories we use to understand ourselves, and the risks presented when these frameworks cannot capture the complex existential, sociocultural, familial, physiological, and tacit dimensions of humanity. Her work centers on the belief that psychological healing must account for these broader meaning systems and political structures that shape individual experience. Her research and clinical interests include psychotherapy process, global mental health, qualitative methodology, theory and philosophy, and critical and liberation psychologies. A recipient of the American Psychological Association’s Sigmund Koch Award for Early Career Contribution to Psychology, Dr. Morrill’s work and Critical-Liberation Psychotherapy model have been recognized and presented internationally.

​In this episode, Laney discusses her experience learning about eye movements from taking a training in Eye Movement Desensitization Reprocessing (EMDR). After trying it one time she then found a way to be as direct and quick as possible, which she called Accelerated Resolution Therapy (ART). She discusses her approach to utilizing ART to help clients rescript past negative images and narratives. With a background in Gestalt therapy, Laney incorporates rapid eye movements and guided associations to support clients in transforming adverse cognitions into more positive, empowering perspectives. She discovered a way to have the clients brain erase negative images, which cause triggers. Laney has developed this accelerated, directive therapeutic method to address conditions such as ADHD, OCD, eating disorders, generalized anxiety, and depression. She emphasizes the efficiency of ART, noting that clients often experience significant breakthroughs in just a few sessions—sometimes even in a single session. Laney likens the process to a dental procedure: identifying and removing emotional “decay” and replacing it with a metaphorical filling. When clients become emotionally stuck, therapists may employ a technique called Scene Matching, which connects current emotions to past experiences with similar emotional tones, facilitating healing and insight. Much like Fritz Perls’ empty chair technique in Gestalt therapy, ART utilizes metaphorical visualization to allow clients to process unresolved experiences internally. Laney distinguishes ART from EMDR by highlighting its structured, therapist-directed approach, as opposed to EMDR’s emphasis on building a longer-term client-therapist relationship and a free association approach. ART’s clinical precision and efficiency are key to its growing popularity. She explained how today, over 16,000 clinicians have been trained in ART. She discussed research in ART and how in July 2025, Laney and a team of professionals from Yale will begin training clinicians in Kenya. Laney Rosenzweig, MS, LMFT is a Licensed Marriage and Family Therapist who has been in the mental health field since 1989. Laney is the Founder/Developer of Accelerated Resolution Therapy (ART) developed in 2008. She is the CEO of Rosenzweig Center for Rapid Recovery, which trains clinicians in ART. ART has a treatment protocol that is directive, standardized and easy to apply using. It is an eye movement therapy. Her introduction of the Voluntary Image Replacement (VIR), which guides clients to erase negative images from view in their mind, is a unique and powerful way to quickly eliminate triggers and eradicate symptoms. Laney has traveled the globe training licensed mental health professionals in ART and has over 65 ART trainers. Yale University has trained clinicians and in the process of doing a study as well as Mayo Clinic and the Canadian Military. She is available for presentations to civilian and military groups who are seeking an alternative to longer, less effective treatments for trauma and other mental health problems. The website is www.ARTworksNOW.com. There is an intro to ART every 4th Wednesday of the month at 6 pm Eastern and the link can be found on the top of the website.

In this episode, I speak with Alex about his career working with addiction. While there are countless resources for substance-related issues—such as drug, alcohol, and sex addiction—he noticed a striking lack of support when it came to process addictions related to technology use. He shared how he connected with and learned from Dr. Hilarie Cash, founder of reSTART, a pioneering treatment program for technology addiction. Alex discusses his work with parents, helping them implement comprehensive behavioral strategies to support children and adolescents in developing a healthy relationship with technology. In an age where digital exposure is unavoidable and children grow up as digital natives, he explains how we can encourage balance and moderation from an early age to prevent problematic or addictive behaviors from forming. He delves into the unique challenges of treating process or behavioral addictions, which can involve greater complexity than substance-related ones. Alex emphasizes the difficulty of establishing structures that foster intrinsic motivation for self-regulation in children and young adults. He highlights the importance of helping young people connect with their values, become more intentional with their screen time, and take a holistic approach to balance—not just with technology, but across all areas of life. The conversation also explores how parents can coordinate across households to create consistent expectations around technology use and how they can impose meaningful limits even when school-issued laptops have minimal built-in safeguards. Alex concludes by discussing how screen use can become a mechanism for emotional avoidance, which can significantly block personal growth. He underscores the need to prioritize self-care and emotional awareness to prevent this from becoming a long-term negative coping strategy. Alex Basche, LMFT is a psychotherapist based in the SF Bay Area. He works mainly with adolescents and young adults, specializing in the treatment of tech-related behavioral addictions such as gaming, social media, pornography, online gambling & shopping in addition to substance use disorders, as well as frequently co-occurring conditions such as anxiety disorders, ADHD, depressive disorders, OCD, Autism Spectrum, and identity formation issues. In 2017, Alex helped create and found the first in-network Intensive Outpatient Program in the state of California treating technology addiction in adolescents. He has written many therapy groups’ curricula and leads trainings and workshops on topics related to Assessment & Treatment for Process Addictions, Parenting in the Digital Age, Adolescent Anxiety & Depression Treatment and more. Alex serves as a Subject Matter Expert (SME) on the Mental Health Workgroup Advisory Board for Fairplay’s Children’s Screentime Action Network and on the Board of Directors for local nonprofit Adolescent Counseling Services. He continues to co-author and present research on digital addictions and related topics.

In this episode, I speak with Matt about his evolution as a therapist, researcher, and founder of New Harbinger Publications. Originally trained in Gestalt therapy, Matt transitioned to Cognitive Behavioral Therapy (CBT) after discovering its effectiveness in addressing his own anxiety—and its ability to offer more structured tools for change. From there, his work expanded into third-wave CBTs like Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), especially as he sought to support clients experiencing complex emotional challenges, trauma, and persistent distress that weren’t always responsive to traditional CBT protocols. We discuss the development of a transdiagnostic and precision-based approach to therapy, centered on identifying specific mechanisms such as emotional and cognitive avoidance. Matt explains how treatment can be tailored using interventions like emotion exposure, mindfulness, and cognitive diffusion to address each client’s unique coping profile—an approach supported by his work on the Comprehensive Coping Inventory. Matt also talks about the founding and mission of New Harbinger Publications, which pioneered the self-help workbook format grounded in evidence-based therapies. He shares insight into their newest tool, Therapy Assist, a digital resource for therapists to assign skills-based, diagnostic-specific homework. We delve into his clinic’s current research on trauma treatment, including the effectiveness of combining ACT with EMDR and written exposure therapy. We also explore how trauma manifests physiologically and emotionally, and why traditional approaches often fall short when addressing complex PTSD, dissociation, or early attachment trauma. Matt reflects on integrating coping skills into ACT—an often debated topic—and describes his efforts to bridge therapeutic models like Schema Therapy and ACT. We explore how these integrations can support trauma clients in choosing value-based responses over automatic, schema-driven reactions. Throughout the conversation, we reflect on the growing movement toward precision therapy—individualized, mechanism-targeted, and empirically grounded. Dr. McKay’s work continues to shape how therapists understand suffering and resilience, and how they can empower clients with the tools to navigate both. Dr. Matthew McKay is a clinical psychologist, professor at the Wright Institute, founder of New Harbinger Publications, and author of research and over 40 books on CBT, ACT, trauma, and emotional healing, including Mind and Emotions, The Relaxation and Stress Reduction Workbook, and Emotion Efficacy Therapy. He cofounded the Haight Ashbury Psychological Services agency in 1979 and served as its Clinical Director for 25 years and is currently the co-director of the Bay Area Trauma Recovery Clinical Services (BATRCS). Matt's interests extend to writing poetry, fiction, and music, and he has a published novel and two books of poetry.

In this episode, I speak with Bill Miller about his road to developing Motivational Interviewing. Bill explained that he started off heading into pastoral ministry but instead chose to be trained as a clinical psychologist. His behavioral PhD program required a two-semester course on how to work with clients before engaging in behavior therapy, and that's where he was introduced to Carl Rogers and a person-centered approach, which significantly influenced his career. He mentioned watching Gerald Patterson doing behavior therapy with families and seeing how he was with clients: warm, engaging, empathic, and funny, which was not covered in published descriptions of the method. On a sabbatical leave in Norway, Bill was asked to demonstrate his own therapeutic approach through role plays in which the clinicians would stop him and ask good questions: "What are you thinking just now? "Why did you ask that particular question?" "How did you decide what tor reflect from all that the client said?" These interactions helped him reflect on what he was doing and why he was doing it, and he wrote down a description that became the first description of motivational interviewing. Seven years later, on sabbatical leave in Australia, he found himself officed next to Stephan Rollnick who would become his career-long co-author. Rollnick had already been teaching motivational interviewing based on Bill's first article and they decided to write together the first book about motivational interviewing that was published in 1991. When they began teaching the method they noticed that some trainees seemed to be using MI techniques “on” rather than “with” clients. What had they left out? They began writing and teaching about the underlying spirit or attitude with which MI is to be practiced. Therapists also shared with them that this way of practicing seems to prevent burnout. In a later book with Theresa Moyers, Bill discussed eight clinical skills that characterize more effective therapists, which are: accurate empathy, genuineness, positive regard, acceptance, hope, evocation, giving advice, and having shared goals or direction. Bill and I explored the term “resistance” and how it is something that happens between people yet is often attributed to client pathology. In yet another book he argued that ambivalence is natural human nature and even a virtue, as it means the person is weighing the options. He and Rollnick reformulated "resistance" as sustain talk (a natural part of ambivalence) and/or discord in the therapeutic relationship. We discussed how in motivational interviewing the therapist is a guide rather than an expert-director. Lastly, he touched on his work on quantum change, which is transformational change that that can occur within a matter of moments or hours and tends to be both permanent and benevolent. Dr. William R. (Bill) Miller, Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. He is the author of 67 books including four editions of Motivational Interviewing, Effective Psychotherapists: Clinical Skills That Improve Client Outcomes, Listening Well: The Art of Empathic Understanding , and On Second Thought: How Ambivalence Shapes Your Life. He has been teaching the skill of accurate empathy for over 50 years.