4333 California St., San Francisco, CA 94118
 (415) 831-4339


Obesity and Bariatric surgery

Over the past 20 years as a therapist, I have gained extensive experience, providing psychotherapy and counseling for individuals coping with issues concerning obesity and bariatric surgery.  

I find that the emotional aspects of obesity are rarely recognized by the medical community, and thus often fail to be addressed.  If you are coping with obesity, you know that your head is as involved in perpetuating the problem, as is your stomach, if not more so.  If you are post surgery, and in the maintenance stage, you have discovered that "fixing" your stomach is only part of the solution. There is still your mind to contend with, and your mind continues to send old messages such as "I am hungry", "I need food".  Those messages send you back to the fridge and the pantry, despite your best intentions.  

In my work, I assist patients through the process of deciding whether surgery is the right solution for them, by addressing the myriad of trepidations and obstacles many face in the decision process.  With post surgery patients, we focus on "reprogramming" the mind, and replacing the old and unproductive set of statements to which the mind is habituated, with a more effective set, that can support the gains achieved by surgery, and help maintain the weight loss.  For those who are interested in gaining understanding into the causes and roots of the problem, we also examine the family dynamic and the emotional environment which resulted in "choosing" obesity as a coping strategy, to overcome emotional pain and difficulties in interpersonal relationships.

Bariatric surgery is a powerful and highly effective tool, but it is also a complex and challenging path - a path that you do not have to travel on your own.  Therapy may be the ideal complementary tool to secure your goals.


Interfaith and Cross Cultural Couples

Marriage, under the best of circumstances, is a complex and challenging endeavor.   Adding the sensitive ingredient of religion or cross cultural issue to the mix can easily become a deal breaker. 

It is not in vain that people avoid the topic of religion at social gatherings.  It is a topic that can quickly get out of hand, and result in conflict and animosity.  People have strong, uncompromising opinions about it.  For centuries, nations have gone to war over it.  So when a child (yes, an adult child, but a "child" nevertheless), announces that he or she is engaged to be married to someone of another faith, what normally would be a joyous occasion, may quickly escalate to a tense or even tragic event.

While we no longer live in the shtetl of "Fiddler on the Roof", for many, religious affiliation continues to be a strong defining aspect of our identity, or that of our parents.  There is still a strong expectation, whether overtly stated, or not, that we marry within the clan.  It is not only a divine decree (the Bible says so), but also a deeply ingrained emotional and cultural norm, cherished and observed for generations.  Even for the most open minded, tolerant, and liberal, going against it may feel like taking on the whole of Judaism, or Christianity.  And that is no small task.

Interfaith marriages present an array of challenges, both for the couple, as well as frequent opposition from parents and family.  Often, the couple presents a united front, to combat the external opposition, but at a later point questions of differences in values, customs and expectations around religious practices, can cause conflict and discord.  (Do we circumcise our child or do we christen him?  Can't we do both? Why can't we have bacon in the fridge when your parents come over?).

In a way, coping with the challenges of interfaith marriage, is not that different from coping with the challenges of any marriage. To put it simply, it requires the capacity for healthy boundaries and good communication skills.  While the concept is simple, the execution may be far from easy.

For any marriage to succeed, each member of the couple faces the task of psychologically and emotionally separating from their families of origin and realigning their primary allegiance to the newly formed family unit. Then, the couple must define appropriate boundaries within the couple-hood, as well as appropriate vehicles for conflict resolution.  

Depending on the degree of enmeshment and codependency in each family of origin, these fundamental maturational tasks may be more or less difficult to achieve.  If the couple is facing a contentious familial environment, where one or both families oppose the marriage, the objective of separating and individuating from one's family of origin, is farther compounded by a myriad of obstacles.  Depending on the prevalent dynamics in one's family of origin, the couple is likely to find themselves in a high stress, high conflict situation, forced to cope with hostility, hysterics, shaming, guilt, extortion, shunning, and a variety of other highly unhealthy but quite common responses from their families, who, rather than celebrating the good news of their engagement, found themselves, all of a sudden, in the middle of a war.

What was supposed to be one of the happiest times of your life has turned into a stressful and tense situation, or worse yet, a nightmare.  No, this is not a reason to give up on the idea of marriage, or break up with your chosen mate.  It is a reason to get help, to get you through this crisis, as well as acquire skills that would facilitate a happier and healthier relationship with your spouse and, in the long run, with your family as well.



While infertility is a "medical" condition, concerning a physiological problem, coping with the condition inadvertently results in emotional distress.  In fact, when an individual or couple learns of the infliction, the psychological impact overshadows the medical implications.  Feelings shift abruptly from hopeful excitement and anticipation, to fear, helplessness, loss and grief. As the news sink in, other distressing feelings may surface, like anger, jealousy, shame, guilt, and so on.

While trying to contain and cope with the myriad of overwhelming emotions, the couple faces the task of deciding a course of action.  Should you pursue fertility treatments, if so, which ones?  Can you afford it, what are the risks?  Should you consider adoption or a surrogate?  These can be treacherous waters to navigate, require diligent research plus assimilation of a lot of new and complex information that is often confusing and difficult to understand.  

What was supposed to be a simple (and usually pleasurable) task of becoming pregnant, which normally happens naturally and automatically, has now become a logistical nightmare.  For some couples, the shared grief strengthens their bond, and brings them closer together.  More commonly, however, this enormous challenge results in a great deal of stress and tension in the couple, which in some cases may spiral a happy marriage into conflict, mistrust and alienation.

Once a course of action has been chosen, new challenges emerge.  The medical procedures can be grueling, and the hormonal changes often result in mood swings and emotional fragility.  Intimacy and sexuality may be affected.  The emotional roller coaster of anticipating pregnancy and the crushing disappointment with failed treatment, may go on for months.  Some couples may have to face the painful decision of discontinuing treatment.  How does one decide when enough is enough?  

This incredible stress may result in depression, anxiety, disrupted sleep, sexual malfunction, and a myriad of other psychological problems.  While the medical professionals are aware of these emotional byproducts of going through the fertility treatments, they are focused on your reproductive organs.  It is essential, however, to address the psychological aspects of this process, as well, to ultimately facilitate an optimal outcome. 

Additional Expertise

  • Depression  
  • Anxiety and OCD
  • Post Traumatic Stress Disorder (PTSD) 
  • Eating disorders
  • Relationship Issues
  • Marriage therapy and couples counseling
  • Gay and lesbian
  • Psychological support for Cancer Patients and their family members
  • Psychosomatic issues
  • Addiction and codependency
  • Sexual abuse
  • Sexual addiction

                         Serving San Francisco, Marin, Alameda,
                          Contra Costa and San Mateo counties

      Please contact me at rayasmailmft@gmail.com
                        (415) 831-4339

      Website Builder