By Annie Wright, LMFT · Licensed Marriage & Family Therapist (#95719)Clinically reviewed May 2026This article guides adult children through the painful reality of a parent who refuses to engage in hospice or end-of-life conversations. It names the emotional, ethical, and systemic complexities of denial, patient autonomy, and medical communication barriers, offering compassionate strategies for preparation and connection despite silence.
Last reviewed: June 2026 by Annie Wright, LMFT
- The Brochure Is Bent Against Her Ribs
- Why End-of-Life Conversations Are Often Refused (And Why the Refusal Is Sometimes the Right Compass)
- The Three Refusal Patterns. Denial, Dignity-Defense, and Punishment-by-Silence
- What “Patient Autonomy” Actually Allows You to Insist On (And Where It Stops)
- The Specific Hazard of the Doctor Who Will Not Tell the Truth
- Both/And: He Has the Right to Refuse AND You Have the Right to Prepare
- The Conversations You Can Have Even When the Hospice Conversation Is Off the Table
- The Adult Children Who Honored the Refusal. What Their Parents’ Deaths Looked Like
- Frequently Asked Questions
The Brochure Is Bent Against Her Ribs
Jordan’s fingers brushed the worn corner of the hospice brochure tucked deep inside the leather pocket of her tote. The drive over had bent its edges, the paper now soft and creased beneath her palm. She shifted in her seat, feeling the brochure press against her ribs, a quiet reminder of the conversation she was desperate to start but knew she could not.
Her father stood by the stove, warming canned soup, the same brand she remembered from her childhood but which he hadn’t touched in decades. Forty years of marriage had meant her mother’s cooking filled this kitchen, but now, this Friday evening ritual was a stark departure. The faint smell of the soup mingled with the hum of the stovetop.
He turned slowly, eyes meeting hers, and said, “Sit down. Eat. We don’t need to talk about anything tonight.” His voice was low but firm, a barrier Jordan had encountered three Fridays in a row now.
She swallowed the lump in her throat, repeating silently, “He has terminal cancer. He does not want to know he has terminal cancer.” The hospice nurse had told her gently that someone had to start the conversation. But here, in this kitchen, with the bent brochure against her ribs, the conversation was still waiting to be spoken.
In moments like these, the physical weight of that brochure is more than paper, it is a symbol of the unspoken, the fears, and the love tangled in silence. Jordan’s experience mirrors a common reality for adult children caught between their parent’s denial and their own longing for clarity. The kitchen’s quiet hum feels like a fragile thread holding together a family’s fragile equilibrium.
Such scenes are often charged with complex emotions: grief, hope, frustration, and a deep yearning to honor the parent’s wishes while preparing for what is inevitable. The hospice brochure, bent and folded, becomes a quiet witness to this delicate dance.
Why End-of-Life Conversations Are Often Refused (And Why the Refusal Is Sometimes the Right Compass)
End-of-life conversations can feel like a betrayal to someone facing their mortality. The refusal to discuss hospice care or dying may seem like denial, but it often functions as a protective mechanism. The emotional weight of acknowledging the final chapter can overwhelm not only the patient but the family as well.
Dr. Atul Gawande, whose work in end-of-life care has reshaped how physicians and families approach these delicate moments, points out that many patients need time to psychologically prepare for death. For some, the refusal to talk is a boundary-setting act, an expression of autonomy in a life increasingly defined by illness and loss.
This refusal can sometimes be a compass pointing towards what the patient still values: control, dignity, or a semblance of normalcy. For a driven parent who spent decades as a provider and protector, admitting vulnerability through these conversations can feel like surrender.
Adult children often wrestle with this silence, caught between honoring their parent’s boundaries and their own urgent need to prepare. Recognizing that refusal is not simply obstruction but may be a form of self-preservation can shift the emotional landscape, allowing space for compassionate acceptance of the parent’s pace and readiness.
Psychiatrist Bessel van der Kolk, MD, author of The Body Keeps the Score, reminds us that trauma and stress imprint on the body and mind in ways that shape how individuals face life-threatening illness. The refusal to engage with end-of-life discussions may echo past traumas or deeply ingrained survival strategies, especially when vulnerability threatens a lifetime of resilience.
Understanding refusal as a nuanced response rather than a barrier opens the door to empathy and patience. It invites adult children to attune to their parent’s emotional state and to seek support that honors the parent’s coping style without sacrificing their own need for preparation.
Advance care planning is the process by which individuals consider and communicate their wishes for medical care in the event they become unable to make decisions. It often involves legal documents like living wills and healthcare proxies. (Clinician-informed definition)
In plain terms: It means thinking ahead and letting people know what kind of medical treatments you want or don’t want if you can’t speak for yourself later.
In SG-S26, the section called The Brochure Is Bent Against Her Ribs needs to be read as more than advice about time management. For a reader searching for hospice-conversation-parent-refuses-end-of-life, the pressure has already moved from the calendar into the body: she may be answering a parent’s call while rehearsing a work conversation, watching a teenager’s face for signs of disappointment, and scanning her own body for the moment she can safely stop performing competence. Pauline Boss, PhD gives language for ambiguous loss, but the clinical meaning becomes most visible in these ordinary moments, when the woman’s private life asks for tenderness at the same time her public life asks for precision.
The practical implication for The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial is that the solution cannot be reduced to a better list. For SG-S26, a list can still be useful, but the more important repair begins when the reader of The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial can separate present-day caregiving duties from inherited family training, identify which responsibilities require her adult consent, and notice where love has been confused with disappearance. In therapy or coaching, this distinction often becomes the first place the nervous system receives new information: she can remain devoted without consenting to be erased, and she can be responsible without becoming the only adult allowed to have no limits.
In SG-S26, the section called Why End-of-Life Conversations Are Often Refused (And Why the Refusal Is Sometimes the Right Compass) needs to be read as more than advice about time management. For a reader searching for hospice-conversation-parent-refuses-end-of-life, the pressure has already moved from the calendar into the family system: she may be answering a parent’s call while rehearsing a work conversation, watching a teenager’s face for signs of disappointment, and scanning her own body for the moment she can safely stop performing competence. Bruce McEwen, PhD gives language for allostatic load, but the clinical meaning becomes most visible in these ordinary moments, when the woman’s private life asks for tenderness at the same time her public life asks for precision.
The practical implication for The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial is that the solution cannot be reduced to a better list. For SG-S26, a list can still be useful, but the more important repair begins when the reader of The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial can separate present-day caregiving duties from inherited family training, identify which responsibilities require her adult consent, and notice where love has been confused with disappearance. In therapy or coaching, this distinction often becomes the first place the nervous system receives new information: she can remain devoted without consenting to be erased, and she can be responsible without becoming the only adult allowed to have no limits.
In SG-S26, the section called The Three Refusal Patterns. Denial, Dignity-Defense, and Punishment-by-Silence needs to be read as more than advice about time management. For a reader searching for hospice-conversation-parent-refuses-end-of-life, the pressure has already moved from the calendar into the work identity: she may be answering a parent’s call while rehearsing a work conversation, watching a teenager’s face for signs of disappointment, and scanning her own body for the moment she can safely stop performing competence. Steven Zarit, PhD gives language for caregiver burden, but the clinical meaning becomes most visible in these ordinary moments, when the woman’s private life asks for tenderness at the same time her public life asks for precision.
The practical implication for The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial is that the solution cannot be reduced to a better list. For SG-S26, a list can still be useful, but the more important repair begins when the reader of The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial can separate present-day caregiving duties from inherited family training, identify which responsibilities require her adult consent, and notice where love has been confused with disappearance. In therapy or coaching, this distinction often becomes the first place the nervous system receives new information: she can remain devoted without consenting to be erased, and she can be responsible without becoming the only adult allowed to have no limits.
In SG-S26, the section called What “Patient Autonomy” Actually Allows You to Insist On (And Where It Stops) needs to be read as more than advice about time management. For a reader searching for hospice-conversation-parent-refuses-end-of-life, the pressure has already moved from the calendar into the boundary: she may be answering a parent’s call while rehearsing a work conversation, watching a teenager’s face for signs of disappointment, and scanning her own body for the moment she can safely stop performing competence. Judith Herman, MD gives language for traumatic stress and recovery, but the clinical meaning becomes most visible in these ordinary moments, when the woman’s private life asks for tenderness at the same time her public life asks for precision.
The practical implication for The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial is that the solution cannot be reduced to a better list. For SG-S26, a list can still be useful, but the more important repair begins when the reader of The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial can separate present-day caregiving duties from inherited family training, identify which responsibilities require her adult consent, and notice where love has been confused with disappearance. In therapy or coaching, this distinction often becomes the first place the nervous system receives new information: she can remain devoted without consenting to be erased, and she can be responsible without becoming the only adult allowed to have no limits.
In SG-S26, the section called The Specific Hazard of the Doctor Who Will Not Tell the Truth needs to be read as more than advice about time management. For a reader searching for hospice-conversation-parent-refuses-end-of-life, the pressure has already moved from the calendar into the grief: she may be answering a parent’s call while rehearsing a work conversation, watching a teenager’s face for signs of disappointment, and scanning her own body for the moment she can safely stop performing competence. Bessel van der Kolk, MD gives language for the body holding unresolved threat, but the clinical meaning becomes most visible in these ordinary moments, when the woman’s private life asks for tenderness at the same time her public life asks for precision.
The practical implication for The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial is that the solution cannot be reduced to a better list. For SG-S26, a list can still be useful, but the more important repair begins when the reader of The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial can separate present-day caregiving duties from inherited family training, identify which responsibilities require her adult consent, and notice where love has been confused with disappearance. In therapy or coaching, this distinction often becomes the first place the nervous system receives new information: she can remain devoted without consenting to be erased, and she can be responsible without becoming the only adult allowed to have no limits.
In SG-S26, the section called Both/And: He Has the Right to Refuse AND You Have the Right to Prepare needs to be read as more than advice about time management. For a reader searching for hospice-conversation-parent-refuses-end-of-life, the pressure has already moved from the calendar into the repair: she may be answering a parent’s call while rehearsing a work conversation, watching a teenager’s face for signs of disappointment, and scanning her own body for the moment she can safely stop performing competence. Tara Brach, PhD gives language for the pause between stimulus and response, but the clinical meaning becomes most visible in these ordinary moments, when the woman’s private life asks for tenderness at the same time her public life asks for precision.
The practical implication for The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial is that the solution cannot be reduced to a better list. For SG-S26, a list can still be useful, but the more important repair begins when the reader of The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial can separate present-day caregiving duties from inherited family training, identify which responsibilities require her adult consent, and notice where love has been confused with disappearance. In therapy or coaching, this distinction often becomes the first place the nervous system receives new information: she can remain devoted without consenting to be erased, and she can be responsible without becoming the only adult allowed to have no limits.
The Three Refusal Patterns. Denial, Dignity-Defense, and Punishment-by-Silence
Clinicians and researchers have identified three common patterns in how patients refuse end-of-life conversations, each with distinct emotional and relational dynamics.
Denial is the most recognized pattern, where the patient rejects the reality of their prognosis. This is not mere stubbornness but often a psychological shield against unbearable pain or loss. Therapeutic wisdom urges patience here, as pushing too hard risks fracturing trust.
Denial may manifest as minimizing symptoms, avoiding medical appointments, or redirecting conversations. Psychiatrist Judith Herman, MD, author of Trauma and Recovery, discusses how denial can serve as a temporary refuge from overwhelming emotions, a critical stage in the complex process of integrating difficult realities.
Dignity-defense emerges when patients resist conversations about death not because they ignore the facts but because such discussions threaten their sense of self-worth. Maintaining control over their narrative preserves dignity in the face of vulnerability.
For example, a parent who has been a pillar of strength may refuse hospice conversations to avoid appearing weak or dependent. This defense can be a form of self-protection that preserves identity and agency. As family therapist Pauline Boss, PhD, highlights in her work on ambiguous loss, maintaining dignity is a central human need in the face of loss and uncertainty.
Punishment-by-silence can occur when a parent uses silence to communicate unresolved anger, grief, or betrayal within family dynamics. This pattern is complex and entwined with relational trauma, often requiring sensitive therapeutic approaches to untangle.
In these situations, silence may feel like a weapon or a cry for acknowledgment of wounds that have never healed. bell hooks wrote poignantly about the wounded inner child that many women carry, shaped by years of denying true feelings to please others. This inner child’s voice can influence the refusal patterns we see, making the conversation not just about illness but about identity and history.
“The wounded child inside many females is a girl who was taught from early childhood on that she must become something other than herself, deny her true feelings, in order to attract and please others.”
bell hooks, cultural critic and author, All About Love: New Visions
Patient autonomy is a foundational bioethical principle affirming the patient’s right to make informed decisions about their own medical care, including the right to refuse treatment or information. (Bioethics consensus definition)
In plain terms: You have the right to decide what happens to your body and health, even when others want you to do something different.
What “Patient Autonomy” Actually Allows You to Insist On (And Where It Stops)
Respecting patient autonomy means recognizing your parent’s right to refuse information or care, even if it is painful or confusing for you. This autonomy extends to their right not to have the hospice conversation on their terms and timeline.
However, autonomy is not absolute in cases where the patient’s capacity is compromised or when decisions might involve others’ safety or legal obligations. Adult children who have legal authority through power of attorney or healthcare proxy can intervene, but only within those boundaries.
The challenge lies in balancing respect for autonomy with the practical and emotional responsibilities of caregiving. You cannot force your parent to accept hospice, but you can insist on clarity about their wishes, as much as they are willing to share, and prepare yourself accordingly.
Often, the tension between honoring autonomy and preparing for the inevitable can be the hardest terrain to navigate, especially when medical professionals provide mixed messages or avoid candid conversations themselves.
Ethically, the principle of autonomy sits alongside beneficence and nonmaleficence, the duty to do good and avoid harm. When a parent refuses hospice conversations, adult children must weigh the respect for autonomy against potential risks of unpreparedness. This delicate balance requires sensitivity, legal awareness, and often external support.
The Physician (or Medical) Orders for Life-Sustaining Treatment form is a medical order indicating a seriously ill patient’s preferences for treatments like resuscitation or intubation. It translates wishes into actionable medical directives. (Statutory medical definition)
In plain terms: It’s a doctor’s note that tells emergency responders and hospital staff exactly what kind of life-saving care you want or don’t want.
The Specific Hazard of the Doctor Who Will Not Tell the Truth
One of the greatest obstacles adult children face is when the doctor either withholds the full truth or softens the prognosis to spare the patient’s feelings. While this may seem compassionate, it often leaves families unprepared and undermines trust.
Dr. Susan Block, who specializes in serious-illness communication, notes that patients and families deserve transparency balanced with empathy. When doctors avoid clarity, the silence can become a barrier to meaningful end-of-life planning.
The harm of withholding truth extends beyond logistics; it can perpetuate ambiguous loss and freeze families in grief before the death occurs. This kind of ambiguous loss, as described by clinician Therese Rando, is a grief without closure that complicates emotional processing.
Adult children like Jordan may find themselves trapped between a father who refuses the hospice conversation and a medical team that won’t fully confirm what is known. This liminal space can heighten anxiety and isolation.
In clinical practice, such withholding can stem from cultural taboos around death, clinicians’ discomfort with delivering bad news, or systemic pressures. Yet, research shows that honest, compassionate communication improves patient and family outcomes, enabling better psychological adjustment and decision-making.
Anticipatory grief is the mourning experienced prior to an expected loss, encompassing emotional, cognitive, and behavioral responses to the impending death of a loved one. (Therese Rando, PhD)
In plain terms: It’s the sadness and adjustment you feel while someone you love is still alive but seriously ill and likely to die.
Both/And: He Has the Right to Refuse AND You Have the Right to Prepare
It can feel like a paradox: your parent has the unequivocal right to refuse end-of-life conversations, yet you also have the right. And responsibility. To prepare. This both/and reality requires holding two truths without collapsing into guilt or control struggles.
Jordan felt this tension deeply on that Friday night, the bent brochure pressing into her side, her father’s canned soup a quiet metaphor for what was left unsaid. She knew she could not force the conversation, but she could gather information, consult with hospice professionals, and plan contingencies.
Parallel planning is a strategy that acknowledges the parent’s refusal while simultaneously building safety nets and support for the family’s practical and emotional needs. This approach honors autonomy but prevents paralysis.
Both/and thinking invites adult children to hold space for their parent’s process while creating their own pathways to readiness, whether that means legal preparations, emotional support, or self-care.
Clinical wisdom suggests that embracing paradox reduces anxiety and fosters resilience. Tara Brach, PhD, psychologist and meditation teacher, emphasizes the power of “radical acceptance”. Embracing reality as it is while nurturing the hope and agency within it.
In practical terms, this may look like keeping the hospice brochure folded but close, quietly organizing paperwork, or seeking counseling to process anticipatory grief. It means acknowledging the parent’s right to refuse while affirming your right to prepare and care.
Parallel planning refers to preparing for multiple possible outcomes simultaneously, especially in cases where a patient refuses to discuss prognosis or hospice care. It balances respect for autonomy with pragmatic readiness. (Clinical practice term)
In plain terms: You get ready for what might happen, even if your loved one isn’t ready to talk about it yet.
The Conversations You Can Have Even When the Hospice Conversation Is Off the Table
When the hospice conversation is refused, not all communication is lost. Adult children can find other ways to connect and prepare emotionally and practically.
Topics like legacy stories, life reflections, or practical memories can open doors to connection without triggering denial defenses. These conversations honor the whole person beyond illness, preserving dignity and relational continuity.
Jordan remembered Nadia, another adult daughter who once shared how she found a way to talk about “what matters most” with her mother, sidestepping direct discussions about dying but building a foundation of love and acceptance nonetheless.
Such conversations are acts of care that soften the edges of silence, allowing anticipatory grief to unfold in ways that are bearable and meaningful.
These moments often arise unexpectedly, a shared laugh over a cherished recipe, a quiet reminiscence about childhood adventures, or a gentle question about favorite memories. They weave threads of presence and meaning that transcend the unspoken fears around death.
Emily Dickinson’s poem captures the fracturing and healing of the mind in grief: “I felt a Cleaving in my Mind. / As if my Brain had split. / I tried to match it. Seam by Seam. / But could not make them fit.” In these conversations, the seams begin to align, if only briefly, offering solace and connection.
“I felt a Cleaving in my Mind. / As if my Brain had split. / I tried to match it. Seam by Seam. / But could not make them fit.”
Emily Dickinson, “I felt a Cleaving in my Mind”
The Adult Children Who Honored the Refusal. What Their Parents’ Deaths Looked Like
Honoring a parent’s refusal to engage in hospice or end-of-life talks does not mean abandoning preparation or love. Many adult children describe a bittersweet peace in respecting boundaries while quietly doing the work behind the scenes.
These children became steady witnesses to their parents’ final months, learning to read the unspoken cues and holding space for grief that was as ambiguous as it was real. Their stories often include moments of grace amid pain, acceptance amid resistance.
This path requires courage, patience, and the willingness to grieve losses that are both present and anticipated. The experience can deepen resilience and compassion, inviting adult children to reframe what it means to “do right” by a parent who refuses the hospice conversation.
For example, one adult daughter shared how her father’s refusal to discuss hospice led her to focus on creating joyful, present moments: music evenings, shared photo albums, and quiet companionship. Though the hospice conversation never happened, the family found their own rituals of care and farewell.
Another adult child described the challenge of balancing respect with advocacy, eventually securing a POLST form with her father’s reluctant consent. This allowed the family to honor his wishes while feeling prepared for emergencies.
For those walking this difficult road, community, therapy, and trusted resources can provide crucial support. As always, the goal is to balance respect for the parent’s wishes with the adult child’s need to prepare and find meaning.
For more on navigating complex family dynamics and anticipatory grief in caregiving, explore our Sandwich Generation Resource Hub and our clinical guides on therapy for driven women.
Readers who recognize themselves in The Hospice Conversation Your Parent Refuses to Have. Navigating End-of-Life Care With a Parent in Denial may also want the adjacent Annie Wright resources on betrayal trauma and relational shock, relational trauma patterns, individual therapy with Annie, executive coaching for ambitious women, and Fixing the Foundations™. These are not detours from the caregiving question; they are often the surrounding terrain that explains why this particular load lands so deeply in the body.
Q: Can I force my parent to have the hospice conversation?
A: No. Patient autonomy protects your parent’s right to refuse medical conversations, including hospice discussions. Forcing the conversation can damage trust and cause emotional harm. Instead, focus on gentle invitations and preparing yourself in parallel, respecting their pace and boundaries.
Q: What’s “parallel planning” and is it the answer when he refuses?
A: Parallel planning means preparing for multiple outcomes at once, honoring your parent’s refusal to engage while also making practical and emotional preparations for end-of-life. It helps you manage uncertainty without pushing your parent prematurely.
Q: Should I override his denial?
A: Overriding denial is rarely helpful and can cause relational damage. Denial often serves an important emotional function. Instead, work on building trust, offering support, and preparing yourself for when your parent is ready.
Q: Why won’t his doctor tell him the truth?
A: Some doctors avoid full disclosure to protect the patient from distress or because of cultural discomfort with death. This can lead to ambiguous loss and complicate family preparation. Advocating for clear, compassionate communication can help.
Q: What documents do I need before he loses capacity?
A: Key documents include advance directives, power of attorney for healthcare and finances, and POLST forms. These clarify your parent’s wishes and give you legal authority to advocate on their behalf when they can no longer speak for themselves.
Q: Can I respect his autonomy and still prepare for his death?
A: Yes. Respecting autonomy means honoring his choices while also taking steps to prepare yourself and your family. Parallel planning allows you to do both simultaneously, balancing care with readiness.
Q: Does therapy help with anticipatory grief when the parent is in denial?
A: Absolutely. Therapy provides a safe space for processing complex emotions like anticipatory grief, ambiguous loss, and frustration. It supports your emotional resilience so you can care for your parent without losing yourself.
References
Peer-Reviewed Research (Vancouver)
- Cloitre M, Stolbach BC, Herman JL, van der Kolk B, Pynoos R, Wang J, et al. A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress. 2009;22(5):399-408. doi:10.1002/jts.20444. PMID: 19795402.
- van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, et al. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One. 2024;19(1):e0295926. doi:10.1371/journal.pone.0295926. PMID: 38198456.
Books & Cultural Sources (Chicago Author-Date)
- Brach, Tara. Radical acceptance. Bantam Books, 2003.
- Dickinson, Emily. The complete poems of Emily Dickinson. Little, Brown, 1960.
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Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven, ambitious women. Including Silicon Valley leaders, physicians, and entrepreneurs. In repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
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