Caroline Russell Smith, LCSW-R

PACT Level 2 Therapist

I was voted “Most Likely to Become the Next Dr. Ruth” in my high school yearbook, but not until 16 years into my career as an individual therapist did I finally complete sex therapy certification. I had virtually no experience with couples therapy (let alone the PACT approach), but I would soon know a lot about sex! What could possibly go wrong?

I nailed my framed certified sex therapist diploma to the wall and got to work. The first three couples who sought my services were kind, collaborative souls, more reticent than fiery, whose secure functioning gifted me a false sense of clinical competence. Psychoeducation did the heavy lifting, and the couples happily headed off into the sunset with improved sexual functioning. 

My fourth couple continued chatting with each other on their way to my office from the waiting area, hardly acknowledging me, then sat on my couch (no PACT set-up then) and stared at me in stony...