Photo of Kate McNulty, Clinical Social Work/Therapist in Portland, OR
Kate McNulty
Clinical Social Work/Therapist, LCSW
Verified Verified
4 Endorsed
Portland, OR 97214  (Online Only)
Online therapy in OR, WA, ME, NY & FL. I use a down-to-earth approach and provide active, engaged therapy with plenty of feedback. The best help I provide is often through raising thoughtful questions. Clients appreciate the handouts and other suggestions for resources we use. I especially enjoy helping people with relationship improvement and making relationship decisions. I use a systematic approach to these concerns and you can expect results. I'm sorry to say it can be difficult to arrange free phone consultations, but please email me and I will promptly provide details. My books: Love and Asperger's, Parenting Adult Children.
Online therapy in OR, WA, ME, NY & FL. I use a down-to-earth approach and provide active, engaged therapy with plenty of feedback. The best help I provide is often through raising thoughtful questions. Clients appreciate the handouts and other suggestions for resources we use. I especially enjoy helping people with relationship improvement and making relationship decisions. I use a systematic approach to these concerns and you can expect results. I'm sorry to say it can be difficult to arrange free phone consultations, but please email me and I will promptly provide details. My books: Love and Asperger's, Parenting Adult Children.
(503) 295-6265 View (503) 295-6265
Photo of Michelle Butler, Marriage & Family Therapist in Portland, OR
Michelle Butler
Marriage & Family Therapist, MA, LMFT
Verified Verified
Portland, OR 97203  (Online Only)
Waitlist for new clients
I specialize in relationship issues, anxiety, depression, women’s issues, and trauma therapy.
My practice is one of acceptance. My space is a judgement free zone. I am a licensed therapist, driven by a passion for assisting individuals, families, and intimate partners with diverse needs. Regardless of what your needs are, I will always consider how all of the relationships in your life are contributing to the reason you called.
I specialize in relationship issues, anxiety, depression, women’s issues, and trauma therapy.
My practice is one of acceptance. My space is a judgement free zone. I am a licensed therapist, driven by a passion for assisting individuals, families, and intimate partners with diverse needs. Regardless of what your needs are, I will always consider how all of the relationships in your life are contributing to the reason you called.
(971) 257-4582 View (971) 257-4582
Photo of David A Sangster, Clinical Social Work/Therapist in Portland, OR
David A Sangster
Clinical Social Work/Therapist, LCSW
Verified Verified
Portland, OR 97203
From struggling to THRIVING. Become more fully "yourself." Enjoy relationship satisfaction. Strengthen connection to something bigger that is meaningful. Get relief from depression and anxiety (really!). Improve effectiveness at work. Feel more at home in your body, content. Mindful and present. LAUGH. Choosing a therapist that is both really good AND a great fit is important. There is a difference here you will experience from the get go. The office is in a 1930's Cape Cod style house...inviting & comfortable. With warmth and character. David is unusually relational and "real." Sessions are 60, 75 or 90 minutes rather than 50.
From struggling to THRIVING. Become more fully "yourself." Enjoy relationship satisfaction. Strengthen connection to something bigger that is meaningful. Get relief from depression and anxiety (really!). Improve effectiveness at work. Feel more at home in your body, content. Mindful and present. LAUGH. Choosing a therapist that is both really good AND a great fit is important. There is a difference here you will experience from the get go. The office is in a 1930's Cape Cod style house...inviting & comfortable. With warmth and character. David is unusually relational and "real." Sessions are 60, 75 or 90 minutes rather than 50.
(503) 444-8649 View (503) 444-8649
Photo of Josh Wilson, Marriage & Family Therapist Associate in Portland, OR
Josh Wilson
Marriage & Family Therapist Associate, MA, LMFTA
Verified Verified
1 Endorsed
Portland, OR 97209
Finding the right fit in a therapist is essential to forging a healing relationship.
I provide emotionally-focused therapy for couples, families, and adult individuals. My experience, humor, patience, and insight will help you to identify new plot lines in your story, reaffirm your sense of purpose, and strengthen bonds between you and your loved ones. I can help couples increase connection and intimacy; heal from betrayals; and enhance communication. I support my individual clients experiencing depression, anxiety, grief, and midlife transitions through an emotionally-focused and psychodynamic framework. I also love working with families to help parents and adolescents through life's most challenging transitions.
Finding the right fit in a therapist is essential to forging a healing relationship.
I provide emotionally-focused therapy for couples, families, and adult individuals. My experience, humor, patience, and insight will help you to identify new plot lines in your story, reaffirm your sense of purpose, and strengthen bonds between you and your loved ones. I can help couples increase connection and intimacy; heal from betrayals; and enhance communication. I support my individual clients experiencing depression, anxiety, grief, and midlife transitions through an emotionally-focused and psychodynamic framework. I also love working with families to help parents and adolescents through life's most challenging transitions.
(971) 328-3317 View (971) 328-3317
Photo of Daniel Combs, Psychologist in Portland, OR
Daniel Combs
Psychologist, PsyD
Verified Verified
Portland, OR 97201
Waitlist for new clients
Welcome! I am a licensed psychologist who specializes in working with adults and adolescents who are experiencing a wide variety of mental health issues including but not limited to depression, anxiety disorders, behavioral problems, relationship conflict, and trauma recovery. In addition to individual work, I also provide family therapy and parenting consultation, when indicated, to support parents and promote healthy communication and interactions.
Welcome! I am a licensed psychologist who specializes in working with adults and adolescents who are experiencing a wide variety of mental health issues including but not limited to depression, anxiety disorders, behavioral problems, relationship conflict, and trauma recovery. In addition to individual work, I also provide family therapy and parenting consultation, when indicated, to support parents and promote healthy communication and interactions.
(503) 948-7013 View (503) 948-7013
Photo of Sahar L. Jones, Marriage & Family Therapist in Portland, OR
Sahar L. Jones
Marriage & Family Therapist, QMHP, LMFT
Verified Verified
Portland, OR 97215
Feeling isolated, unsure of your purpose, stressed in your relationships, or ashamed or confused about your thoughts, actions or feelings? You are not alone. Mental health, relationship conflict, social/economic stressors, and life during COVID can all make it challenging to feel truly connected. But experiencing connection – whether with yourself, loved ones, pets, or the natural world – is the cornerstone to wellness, and it's worth the vulnerability it takes to get there. Together we'll explore how to support you in building connections and coping skills that nourish you and your relationships for the long term.
Feeling isolated, unsure of your purpose, stressed in your relationships, or ashamed or confused about your thoughts, actions or feelings? You are not alone. Mental health, relationship conflict, social/economic stressors, and life during COVID can all make it challenging to feel truly connected. But experiencing connection – whether with yourself, loved ones, pets, or the natural world – is the cornerstone to wellness, and it's worth the vulnerability it takes to get there. Together we'll explore how to support you in building connections and coping skills that nourish you and your relationships for the long term.
(503) 300-5274 View (503) 300-5274
Photo of Caitlin (Caity) Lynch, Licensed Professional Counselor in Portland, OR
Caitlin (Caity) Lynch
Licensed Professional Counselor, LPC, NCC
Verified Verified
1 Endorsed
Portland, OR 97202
Waitlist for new clients
Our time together may touch on trauma healing/PTSD, depression, anxiety, relationship stress, ADHD, Autism, grief/loss, changes in late adulthood, coming out later in life, spiritual abuse, spiritual growth, improving relationship skills, overcoming infidelity, step-families, and any other areas of interest to you, your family, or your partner(s).
You're here because you need something to shift in yourself, your relationships, or your life. I have ADHD, I am queer and genderqueer and work from a strengths-based perspective, utilizing insight-oriented therapeutic change models (Narrative Therapy, EFIT, IFS) and brain/emotion understanding through psychoeducation, CBT, and DBT and self-in-context understanding (social model of disability, self-compassion work of Drs. Kristin Neff and Tara Brach) to help you imagine and take steps toward a life aligned with who you are. > NOTE: I don't offer ADHD or Autism Assessments, this can be obtained through a psychologist or your PCP. <
Our time together may touch on trauma healing/PTSD, depression, anxiety, relationship stress, ADHD, Autism, grief/loss, changes in late adulthood, coming out later in life, spiritual abuse, spiritual growth, improving relationship skills, overcoming infidelity, step-families, and any other areas of interest to you, your family, or your partner(s).
You're here because you need something to shift in yourself, your relationships, or your life. I have ADHD, I am queer and genderqueer and work from a strengths-based perspective, utilizing insight-oriented therapeutic change models (Narrative Therapy, EFIT, IFS) and brain/emotion understanding through psychoeducation, CBT, and DBT and self-in-context understanding (social model of disability, self-compassion work of Drs. Kristin Neff and Tara Brach) to help you imagine and take steps toward a life aligned with who you are. > NOTE: I don't offer ADHD or Autism Assessments, this can be obtained through a psychologist or your PCP. <
(971) 257-1636 View (971) 257-1636
Photo of Paula Emerick, Marriage & Family Therapist in Portland, OR
Paula Emerick
Marriage & Family Therapist, LMFT, CADC I
Verified Verified
Portland, OR 97214  (Online Only)
Waitlist for new clients
My specialties include addiction and recovery, relationship dynamics (couples, poly, open, kink), LGBTQIAA identity, family of origin, SPMI, sex work, and healing from trauma.
I believe the most important parts of therapy are trust and collaboration. You'll know immediately if the therapist is right for you. If you don't feel it, keep looking. There's a lot of us therapists out here and your time and self-work are important! Additionally, at our most vulnerable times in life, we need someone who will hold a safe space for us to approach our edges - the parts of us we tend to avoid or neglect. Addressing our 'issues' is intensely brave and can also be terrifying! I commend you for embarking on this journey and invite you to call me if my words resonate with your needs.
My specialties include addiction and recovery, relationship dynamics (couples, poly, open, kink), LGBTQIAA identity, family of origin, SPMI, sex work, and healing from trauma.
I believe the most important parts of therapy are trust and collaboration. You'll know immediately if the therapist is right for you. If you don't feel it, keep looking. There's a lot of us therapists out here and your time and self-work are important! Additionally, at our most vulnerable times in life, we need someone who will hold a safe space for us to approach our edges - the parts of us we tend to avoid or neglect. Addressing our 'issues' is intensely brave and can also be terrifying! I commend you for embarking on this journey and invite you to call me if my words resonate with your needs.
(971) 260-4121 View (971) 260-4121
Photo of Laura La Rosa, Clinical Social Work/Therapist in Portland, OR
Laura La Rosa
Clinical Social Work/Therapist, MA, MSW , LCSW
Verified Verified
Portland, OR 97232  (Online Only)
I believe the therapist/client relationship is the primary inspiration to healing.
You may be an adult who is empowered in some areas but stuck in others or you may be someone struggling to find meaning in your life. Who ever you are, you are the navigator of your life. Your personal narrative is front and center and you decide what isn't working. Together we will dis-empower the stories in your life that no longer serve you and craft the narrative that is most affirming of who you are or who you want to be.
I believe the therapist/client relationship is the primary inspiration to healing.
You may be an adult who is empowered in some areas but stuck in others or you may be someone struggling to find meaning in your life. Who ever you are, you are the navigator of your life. Your personal narrative is front and center and you decide what isn't working. Together we will dis-empower the stories in your life that no longer serve you and craft the narrative that is most affirming of who you are or who you want to be.
(971) 283-7112 View (971) 283-7112
Photo of Kimberlee Dennery, Clinical Social Work/Therapist in Portland, OR
Kimberlee Dennery
Clinical Social Work/Therapist, LCSW, LICSW
Verified Verified
Portland, OR 97239  (Online Only)
Hello, I enjoy working with individuals, couples and families I specialize in treating anxiety and depression. I have experience working with LGBTQ+ and BIPOC communities. I also enjoy working with teenage and younger clients. I see many people who are going through life transitions. When one is going through grief and loss, education challenges, relationship difficulties, a new family member, pain or illness, it can be particularly difficult to cope and particularly beneficial to be in therapy to work through these issues with an unbiased ear. I also specialize in working with individuals who have struggles with chronic pain.
Hello, I enjoy working with individuals, couples and families I specialize in treating anxiety and depression. I have experience working with LGBTQ+ and BIPOC communities. I also enjoy working with teenage and younger clients. I see many people who are going through life transitions. When one is going through grief and loss, education challenges, relationship difficulties, a new family member, pain or illness, it can be particularly difficult to cope and particularly beneficial to be in therapy to work through these issues with an unbiased ear. I also specialize in working with individuals who have struggles with chronic pain.
(503) 300-5309 View (503) 300-5309
Photo of Black On The Couch, LLC, Marriage & Family Therapist in Portland, OR
Black On The Couch, LLC
Marriage & Family Therapist, LMFT
Verified Verified
1 Endorsed
Portland, OR 97227  (Online Only)
Whether you are dealing with relationship issues, navigating life transitions, coping with racial fatigue, or seeking support for anxiety and depression, I am here to walk alongside you in your journey.
Greetings! I am Vyshika M. Willis, a Licensed Marriage and Family Therapist dedicated to fostering healing and growth, with a deep commitment to providing compassionate and culturally sensitive counseling. I understand the significance of finding a safe, inclusive, and understanding space to freely explore your thoughts and emotions. Drawing from systems theory, I help clients uncover patterns, dynamics, and interconnections within their lives. This approach empowers clients to make meaningful changes that extend beyond the therapy room.
Whether you are dealing with relationship issues, navigating life transitions, coping with racial fatigue, or seeking support for anxiety and depression, I am here to walk alongside you in your journey.
Greetings! I am Vyshika M. Willis, a Licensed Marriage and Family Therapist dedicated to fostering healing and growth, with a deep commitment to providing compassionate and culturally sensitive counseling. I understand the significance of finding a safe, inclusive, and understanding space to freely explore your thoughts and emotions. Drawing from systems theory, I help clients uncover patterns, dynamics, and interconnections within their lives. This approach empowers clients to make meaningful changes that extend beyond the therapy room.
(971) 999-3643 View (971) 999-3643
Photo of Joey Ellen Kramer O'Connell, Licensed Professional Counselor in Portland, OR
Joey Ellen Kramer O'Connell
Licensed Professional Counselor, LPC, MFT
Verified Verified
1 Endorsed
Portland, OR 97205
My work with families focuses on the unique challenges of: adoption, involvement with the foster care system, the effect of children on the couples' relationship, co-parenting and shared custody, infertility, blended families, divorce/separation, behavior challenges specific to young children or children with developmental delays.
All families experience transitions, and even positive change can cause stress. I employ an eclectic approach with a strong emphasis on attachment, structural, and solution-focused family therapies. I work with young children and their caregivers to form secure attachments early on. This leads to more effective communication and problem solving patterns and a higher level of resilience down the road. My work tends to be short term and builds on the existing strengths of your family. My work with couples is attachment informed as we look at past and current relationships to elucidate our most fulfilling ways of connecting.
My work with families focuses on the unique challenges of: adoption, involvement with the foster care system, the effect of children on the couples' relationship, co-parenting and shared custody, infertility, blended families, divorce/separation, behavior challenges specific to young children or children with developmental delays.
All families experience transitions, and even positive change can cause stress. I employ an eclectic approach with a strong emphasis on attachment, structural, and solution-focused family therapies. I work with young children and their caregivers to form secure attachments early on. This leads to more effective communication and problem solving patterns and a higher level of resilience down the road. My work tends to be short term and builds on the existing strengths of your family. My work with couples is attachment informed as we look at past and current relationships to elucidate our most fulfilling ways of connecting.
(503) 766-5894 View (503) 766-5894
Photo of Stacey Nixon, Counselor in Portland, OR
Stacey Nixon
Counselor, MS, LPC, LMHC
Verified Verified
2 Endorsed
Portland, OR 97219
We all can get stuck. Trauma, life stressors, uncomfortable emotions, and relationship concerns can throw us off balance. Do you feel constantly stressed, disconnected from your partner, or the impacts of trauma? The weight of these challenges can take a toll on your daily life and overall wellness. You may feel ready to process your trauma and find healing. Or, you may yearn for a closer connection and effective communication in your relationship. You may also desire the capacity to sift through your stressors and cope, calmness in your day-to-day, and fulfillment in life. This is where counseling can offer support and relief.
We all can get stuck. Trauma, life stressors, uncomfortable emotions, and relationship concerns can throw us off balance. Do you feel constantly stressed, disconnected from your partner, or the impacts of trauma? The weight of these challenges can take a toll on your daily life and overall wellness. You may feel ready to process your trauma and find healing. Or, you may yearn for a closer connection and effective communication in your relationship. You may also desire the capacity to sift through your stressors and cope, calmness in your day-to-day, and fulfillment in life. This is where counseling can offer support and relief.
(503) 217-6644 View (503) 217-6644
Photo of Esther Berg, Marriage & Family Therapist Associate in Portland, OR
Esther Berg
Marriage & Family Therapist Associate, MA
Verified Verified
2 Endorsed
Portland, OR 97229  (Online Only)
The weight of anxiety, anger, sadness, fear, trauma, and confusion is heavy. Seeking therapy is a brave step towards a happier, healthier life. It's a chance to share your thoughts and feelings, gain valuable insights, and get emotional support for life's challenges. Whether you're dealing with stress, trauma, anxiety, depression, relationship issues, or seeking personal growth, therapy is life changing. It helps you understand yourself, build resilience, and work toward fulfillment. You're not alone, help and hope are here for you.
The weight of anxiety, anger, sadness, fear, trauma, and confusion is heavy. Seeking therapy is a brave step towards a happier, healthier life. It's a chance to share your thoughts and feelings, gain valuable insights, and get emotional support for life's challenges. Whether you're dealing with stress, trauma, anxiety, depression, relationship issues, or seeking personal growth, therapy is life changing. It helps you understand yourself, build resilience, and work toward fulfillment. You're not alone, help and hope are here for you.
(503) 782-6715 View (503) 782-6715
Photo of Janean Vedova, Marriage & Family Therapist in Portland, OR
Janean Vedova
Marriage & Family Therapist, MA, LMFT, #T1945
Verified Verified
Portland, OR 97202
The therapeutic relationship is essential to the process, please feel free to contact me for a free initial consultation to ensure we are a good fit.
Maintaining connection with those close to us can be difficult. I understand the complexities of relationships and how challenging they can be at times. As you know all relationships require maintenance and care, and I can help you navigate the complexities of your unique relationships so those relationships feel healthy for you. I work with individuals, couples and families around what is difficult for them in the moment. I have experience working with people through a variety of issues and with people from all walks of life.
The therapeutic relationship is essential to the process, please feel free to contact me for a free initial consultation to ensure we are a good fit.
Maintaining connection with those close to us can be difficult. I understand the complexities of relationships and how challenging they can be at times. As you know all relationships require maintenance and care, and I can help you navigate the complexities of your unique relationships so those relationships feel healthy for you. I work with individuals, couples and families around what is difficult for them in the moment. I have experience working with people through a variety of issues and with people from all walks of life.
(530) 918-4314 View (530) 918-4314
Photo of Portland Wellness Counseling, LLC, Marriage & Family Therapist in Portland, OR
Portland Wellness Counseling, LLC
Marriage & Family Therapist, LMFT, LPC
Verified Verified
Portland, OR 97229  (Online Only)
I specialize in relationships, assisting individuals and couples to deepen connection and heal the past. Therapy can be a transformational process of self-discovery facilitated by deeper levels of awareness and change. I believe we have an inherent ability to heal ourselves. I offer the experience of mindful observation, acceptance and compassion, so you may offer the same unconditional positive regard toward yourself and others. Sitting in close and conscious relationship with a skilled therapist can be a profound vehicle for this process. I use an integrative approach recognizing the interconnectedness of body, mind, and spirit.
I specialize in relationships, assisting individuals and couples to deepen connection and heal the past. Therapy can be a transformational process of self-discovery facilitated by deeper levels of awareness and change. I believe we have an inherent ability to heal ourselves. I offer the experience of mindful observation, acceptance and compassion, so you may offer the same unconditional positive regard toward yourself and others. Sitting in close and conscious relationship with a skilled therapist can be a profound vehicle for this process. I use an integrative approach recognizing the interconnectedness of body, mind, and spirit.
(503) 743-6404 View (503) 743-6404
Photo of Andie Whittaker, Clinical Social Work/Therapist in Portland, OR
Andie Whittaker
Clinical Social Work/Therapist, BSW , MSW, LCSW
Verified Verified
Portland, OR 97203  (Online Only)
I believe therapy can be many things, and I center the relationship.
Calling neurodivergent people, weirdos, feelers, people who speak to the wind, the ones who are also very logical, people who speak in noises and movement. Queer people, trans people, and all the other magical people who fall under LGBTQIA identities. The ones who seek to understand the wildest and hardest parts of being a human, the philosophers, the ones who speak to plants, etc. AND also humans who just wanna talk to someone who is also a human. I welcome you to reach out.
I believe therapy can be many things, and I center the relationship.
Calling neurodivergent people, weirdos, feelers, people who speak to the wind, the ones who are also very logical, people who speak in noises and movement. Queer people, trans people, and all the other magical people who fall under LGBTQIA identities. The ones who seek to understand the wildest and hardest parts of being a human, the philosophers, the ones who speak to plants, etc. AND also humans who just wanna talk to someone who is also a human. I welcome you to reach out.
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Photo of Gayle M. Waitches, Marriage & Family Therapist Intern in Portland, OR
Gayle M. Waitches
Marriage & Family Therapist Intern, LPC, NCC, DO
Verified Verified
Portland, OR 97215
Your experience is so important; research shows that the most significant factor in a positive outcome is the relationship with the therapist.
I am both a physician and a marriage, couple and family therapist intern. My training gives me a unique awareness of the interconnectedness of neuroscience and the tender yet resilient human psyche.
Your experience is so important; research shows that the most significant factor in a positive outcome is the relationship with the therapist.
I am both a physician and a marriage, couple and family therapist intern. My training gives me a unique awareness of the interconnectedness of neuroscience and the tender yet resilient human psyche.
(503) 705-8489 View (503) 705-8489
Photo of Helloship, LLC (Marie Duff), Licensed Professional Counselor in Portland, OR
Helloship, LLC (Marie Duff)
Licensed Professional Counselor, LPC
Verified Verified
1 Endorsed
Portland, OR 97236  (Online Only)
Waitlist (as of 3/31/24): You’re doing your best given your circumstances, awareness, & resources. Growth, and a fulfilling, meaningful life is possible when the conditions work for your unique needs. If you have ADHD/Autism, relationship, medical, or identity issues, anxiety, depression, or trauma, you may want your life back- or to feel "normal” for once. From the heavy depths of despair to the bubbly heights of playfulness, what makes life absurd, beautiful, & tragic will be acknowledged, not ignored. “Weird” celebrated, not shamed. I’ll help you embrace the unknown, adapt to change, & move forward.
Waitlist (as of 3/31/24): You’re doing your best given your circumstances, awareness, & resources. Growth, and a fulfilling, meaningful life is possible when the conditions work for your unique needs. If you have ADHD/Autism, relationship, medical, or identity issues, anxiety, depression, or trauma, you may want your life back- or to feel "normal” for once. From the heavy depths of despair to the bubbly heights of playfulness, what makes life absurd, beautiful, & tragic will be acknowledged, not ignored. “Weird” celebrated, not shamed. I’ll help you embrace the unknown, adapt to change, & move forward.
(541) 588-5378 View (541) 588-5378
Photo of Kylar Batten, Marriage & Family Therapist Associate in Portland, OR
Kylar Batten
Marriage & Family Therapist Associate, MA, MAT
Verified Verified
Portland, OR 97202
I am a therapist who enjoys working with couples, individuals, and youth ages 11-17 . Marginalized folx are my specialty: Queer / GNC / Neurodivergent, POC. My goal is to help you find a better understanding of who you are and who you want to become and then together we will chart a path forward. When I work with couples, I consider your relationship the client. My couples therapy work is from an emotionally focused, trauma informed, and attachment style lens. With all of my clients I find it helpful to examine how your historical and present contexts impact your relationship with yourself and others.
I am a therapist who enjoys working with couples, individuals, and youth ages 11-17 . Marginalized folx are my specialty: Queer / GNC / Neurodivergent, POC. My goal is to help you find a better understanding of who you are and who you want to become and then together we will chart a path forward. When I work with couples, I consider your relationship the client. My couples therapy work is from an emotionally focused, trauma informed, and attachment style lens. With all of my clients I find it helpful to examine how your historical and present contexts impact your relationship with yourself and others.
(503) 832-4876 View (503) 832-4876
Relationship Issues Therapists
While need for human connection appears to be innate, the ability to form healthy, loving relationships is learned. Some evidence suggests that the ability to form a stable relationship starts to form in infancy, in a child's earliest experiences with a caregiver who reliably meets the infant's needs for food, care, warmth, protection, stimulation, and social contact. Such relationships are not destiny, but they are theorized to establish deeply ingrained patterns of relating to others. The end of a relationship, however, is often a source of great psychological anguish.