Therapy with Aubry Koehler, PhD

Aubry Koehler is a therapist in Winston-Salem, NC specializing in couples counseling, divorce & separation, and family issues. We asked Dr. Koehler more about her work with clients and her guiding philosophies on therapy.

Dr. Koehler’s background and personal life

How did you decide to become a therapist?

In my early schooling, I gravitated toward the social sciences and health care. In college this manifested as a major in medical anthropology -- how different cultures (including mainstream US culture, and the culture of biomedicine) understand health and healing as well as death and disease.

I soon discovered that I was not only passionate about understanding peoples' stories, but I also wanted to provide clinical care to help people shift their lives in meaningful ways. Working with couples and families, who have their own unique cultures of shared stories/beliefs/values, was an early calling in my therapy training.

What was your previous work before going into private practice?

Before moving into private practice, I trained and then worked in integrated care in which therapeutic intervention was delivered to primary care patients in a medical settings. My systems training as a licensed marriage and family therapist was foundational in these settings to managing the multiple agendas of the patient, family members, as well as the medical care team with emotions often running high around issues related to new diagnoses or chronic illness management.

I also had the privilege of leading a behavioral health team, and training medical residents on physician-patient relationships and medical management of behavioral health needs at the primary care level.

What do you enjoy doing in your free time?

I love time spent outdoors in the fresh air, walking, hiking, and running. As a native New Englander, I find the cold (most of the time) invigorating and relish opportunities to enjoy snow, a North Carolina rarity! I am an avid reader (a mix of fiction and non-fiction, paper and audiobook) and writer (mostly poetry).

Dr. Koehler’s specialties and therapy philosophies

What guiding principles inform your work?

I believe all clients bring strengths and resourcefulness to their lives and therapy, even if they don't feel that way! It is my job to guide them in expanding these strengths, developing new ones, and connecting them to resources to support their healing.

With regard to couples and families, I believe that all people want to be seen, heard, and understood and that most (if not all) of the presenting problems that bring people to therapy orbit around feeling invisible, hurt, and/or misunderstood. In the therapy room, when couples and families are able to join in this shared and basic human needs for love and belonging, I can help them remove barriers and repair emotional wounds that stand in the way of healthy bonds and interactions.

What clientele do you work with most frequently?

I work exclusively with couples and families. I work with children of all ages when they are a part of families seeking family therapy.

What do you find most rewarding about your work?

Being a therapeutic support to a couple or family is truly an honor. People who come to therapy are inviting me into many of their most vulnerable conversations -- I can think of few other roles that require that level of transparency and trust from the client. In many ways, the interactions between therapist and couple/family members serves as a model for the kind of vulnerable and nonjudgemental conversations clients will eventually be able to have together, without the help of a therapist.

Showing a couple and family what is possible in terms of authentic communication and understanding of one another and then seeing them learn to interact this way on their own is extremely rewarding.

Therapy sessions with Dr. Koehler

What will our first session together be like? What happens in ongoing sessions?

In the first and/or second session, I like to get an opportunity to hear from couple/family members individually (in the case of families, I often meet individually with those in the parenting role and then individually with the child or siblings). This allows me to better understand the dynamics at play between the "sides" or "camps" that may have developed.

It is also often helpful to complete a genogram together early on, as I find this assists with identifying relevant family patterns and/or events that the couple/family otherwise may not have thought to share with me. In subsequent sessions, I assist the couple/family in shifting their way of communicating/interacting especially around issues they have identified as impasses.

When I offer guidance in real time, couples/families experience the corrective experience of being heard and understood and, now from a place of emotional safety, are able develop alternatives to falling into the patterns of behavior that brought them to therapy in the first place.

How long do clients typically see you for?

Typically every other week for about 6 months and then monthly sessions until clients have comfort and competence in noticing and interrupting negative relational patterns at home, and replacing these with communication and patterns of interaction that foster emotional safety and healthy bonds. It is not unusual for individuals to finish a course of therapy and then return for a check in or tune up when facing a new challenge, often connected to a family life cycle change (e.g., birth of a child, launch of a child, or other changes to household composition).

Do you assign “homework” between sessions?

At the end of each session, the couple/family and I develop a plan together on what will be attended to in between sessions. This might be a noticing exercise (noticing when the unhelpful relational pattern comes up) or a behavioral shift (making time to check in or share a mutually enjoyable outing). The corrective experience of improved communication and connection in the therapy room is the intervention; eventually, couples and families learn how to shift their interactions at home to match the new dynamic they are experiencing in therapy and some home tasks can support this process.

How do you help ensure I'm making progress in therapy?

I ask couple/family members to subjectively rate their satisfaction in their relationship(s) and to identify the areas that are most dissatisfying or distressing to them. Through ongoing conversation, I revisit these ratings and challenging areas. I also observe the way in which couple/family members interact in therapy and highlight when positive shifts occur or when there has been a lapse into previous unhelpful patterns.

When couples/families say things are better, I believe them! But I also like to be able to see evidence of those healthier patterns in the therapy room when clients demonstrate ability to work through previously contentious areas or relational blocks with sensitivity and understanding.

How do I know that it’s time to start seeking therapy?

It's certainly time to start seeking therapy when you notice feelings of stuckness, resentment, or hopelessness/helplessness. As a couple and family therapist, I would say the sooner the better. The longer you live with negative patterns of interaction, the harder it can be to make shifts to those patterns, so as soon as you start noticing a pattern that isn't responsive to your attempts to change it, consider seeking therapy.

The particularly proactive may consider coming to therapy to foster healthy relationship patterns before negative ones take hold (as is the case for couples/families who wish to avoid "repeating family patterns", or for couples/families who seek therapy before marrying/cohabiting/blending families).

How can I prepare for our first session?

Completing the intake questionnaire will help to get your thoughts/feeling ordered around your priorities for change. Remember that you don't have to share anything (on the intake forms or in therapy) that you are uncomfortable sharing; however, be mindful that when your therapist understands the context the that brought you to therapy, they can more readily guide you toward healing. Other than that, come to therapy (as much as possible, given you are likely hurting) with an open mind and heart for change.

How will I know it’s time to end my time in therapy with you or reduce session frequency?

It's time to end therapy or reduce sessions when you feel like you can breathe in your relationships again. This means time around (or thinking about) your partner/family members is no longer dominated by feelings of hurt or anticipation of negative interactions.

Love and sense of belonging are basic human needs, so it's no wonder that threats to these sends us into fight, flight, or freeze. When connection has been restored, a sense of being on high alert or numb/shutdown is replaced with an increased sense of engagement, playfulness, curiosity, and trust.

Why should I seek therapy, rather than turning to my partner, friends, or other loved ones?

Turning to your partner, friends, and loved ones is adaptive and healthy -- we need our communities and social support networks! However, there are times when this isn't sufficient either because these individuals haven't had training in couple/family therapy modalities and/or they are carrying their own (and often biased) interest/agenda.

A therapist is not only licensed in psychotherapy, they have been trained to hold each partner's/family member's emotional experience and needs in awareness without taking sides so all clients can feel seen, heard, and understood. This shared experience of understanding creates the emotional safety essential for shifting problematic patterns of interaction into healthy and helpful ones.

What advice would you share with therapy seekers?

Take your time finding your good fit by browsing profiles and engaging in brief consultation calls, but also give your selected therapist a chance across at least two sessions before seeking a different one. That said, if it's not a fit, keep on moving to find someone who gets you and your partner/family member's.

You should have a sense not only of your therapist's competence and comfort level with you needs but also of their belief in/advocacy for your envisioned future. The right therapist for you is out there.

Visit Dr. Koehler’s profile to watch her introductory video, read more about her, and book an initial call!