Karen Shay, MFT

Psychotherapy and Counseling for Adults, Adolescents and Couples

1330 Lincoln Avenue, Suite #107c 
San Rafael, CA 94901 map

Telephone: (415) 259-9669
E-mail: karenlshay@gmail.com

Treatment Issues


Depression, when it has firmly taken residence in your mind and heart is a very effective kidnapper.  Depression can hold you hostage to all your negative self talk, make you withdraw from loved ones and can make just getting through the day or trying to perform at work feel like an overwhelming task.  We all have "down" days, bad moods and rough patches in life, but when your depressive thinking lasts for more than two weeks and your "old self" seems like a distant memory, then seeking some support and guidance through therapy may be advised.  I will work with you to understand the source of your depression, develop some healthy coping skills while you are working through the depression, intervene to stop any self destructive behaviors and help you establish a good support system outside therapy as well.


I believe many anxiety disorders come from three possible sources:  (1) reliving or fear of a past trauma;  (2) constant rumination/guilt over the past; and (3) obsessive worry about the unknown future.  Two of the sources--the guilt or regret over past behaviors or unrelenting worry about the future are both arenas in which we have absolutely no control or power.  We can truly only control or affect things in the present.  In therapy I will work with you to disassemble the negative power of the past and to stop fearful futurizing.  In therapy we will work to identify and disarm your fears/phobias and to develop a healthy arsenal to combat anxiety (relaxation techniques, physical exercise, midfulness/meditation, avoidance of destructive self medication/alcohol and correcting cognitive distortions).

Relationship Problems?

Developing and maintaining a loving and healthy relationship can be an ongoing and sometimes difficult task.  Much of how we relate to our partners is grounded in how we experienced our first real intimate relationship, i.e., the maternal and paternal bonds of our childhoods.  We come to relationships with many expectations, assumptions and hopes that our partner will complete us somehow and guarantee our happiness.  We often find ourselves operating under unconscious and "unspoken agreements" that neither partner realizes they have signed on for.  In therapy with couples in conflict, I work first to stop any destructive behaviors between the couple (physical abuse, substance abuse, affairs) so that there is a safe environment for the couple therapy.  Next I coach them in more respectfiul communication and explore with them how often much of their negative interactions has a basis in their families of origin.

I also work with divorced families who are trying to adapt to issues resulting from divorce such as blended families, stepfamilies and the difficulties of shared custody.

Destructive Behaviors/Addictions?

Though I do see alcoholism and most all other addictions from the medical model of a physical disease with a genetic predisposition as well, I also see addictions as primarily a person's futile attempt to medicate away either intolerable depressive or anxious states (see above).  Most very depressed or anxious people want desperately to not feel the very uncomfortable emotions they are experiencing and alcohol (and all other addictive substances) are mistakenly used to try to escape those feelings.  Any of you who have suffered from major depression or severe anxiety know that whatever escape or "fix" the addictive substance gives, it is of a very short duration and usually only tends to compound your troubles.  In working with addictive behaviors I primarily address the underlying depression and/or anxiety beneath the addiction as well as support and promote your recovery program (12 step programs as well as secular sobriety).


It is important for you to get a sense of the therapist before you commit so I offer a free initial consultation session to determine is this will be a "good fit" for you.


Get In Touch
phone (415) 259-9669