Paula Kirsch

LCSW, LMSW-C

I grew up in a home marked by dysfunction and domestic violence. As an only child I learned early to pay close attention to relationships — to what was said, what wasn't, and what was really happening underneath the surface. Looking back, I was doing the work of a therapist long before I had any language for it. Life took me in other directions first. I married, built a family, and found myself in a relationship that slowly contracted around me — one where my own goals and growth had no room to breathe. During that time I worked with a therapist who was truly remarkable, and that experience showed me from the inside what good therapy can do. Getting out of that relationship was one of the hardest things I've ever done. It was also what finally made everything clear. I went back and finished my degree. A Bachelor of Social Work, then a Master of Social Work. I knew early on that I wanted to work with the complex, layered issues that most people find difficult to talk about — so I sought out the training that would let me do that well. The University of Michigan's Sexual Health Certificate Program gave me a clinical foundation in human sexuality. Gottman Level II training gave me the tools to work with couples navigating the hardest terrain in their relationships. I'm drawn to the work that sits at the intersection of identity, intimacy, and the stories we carry from our earliest experiences of love and safety. That's where the most meaningful change happens — and that's where I've built my practice.

Viktor Frankl's Man's Search for Meaning has stayed with me longer than almost anything else I've read. Frankl was a psychiatrist and Holocaust survivor, and what he observed in the camps was both devastating and profound: the people who survived were not necessarily the strongest or the youngest. They were the ones who had meaning and purpose — something to live for. Those who had lost their "why" were already gone in every way that mattered, still breathing but no longer truly alive. That insight never left me. It shapes how I work with every client. Before I can help someone with what they say brought them to therapy, I want to understand what they're living for. What matters to them. What lights something up. What they're protecting or reaching toward. Because if we can find a big enough "why" — a reason that is genuinely theirs — we can almost always find a "how." This is especially true in sexual health work. So much of what brings people to my office is really about disconnection — from their bodies, their partners, their sense of themselves as vital, desirable, alive. Frankl understood that meaning isn't found, it's made. And helping someone reclaim their sexuality, their intimacy, their joy — that is meaning-making work in the deepest sense.

Collaboration with other providers is something I feel strongly about — particularly when it comes to women experiencing sexual pain or vaginismus. In my experience, women who are working with a pelvic floor physical therapist make significantly more progress when they are also working with a therapist. The reason is straightforward: pelvic floor physical therapy addresses the structural and physical dimensions of the problem — muscle tension, coordination, tissue health. But sexual pain rarely lives in the body alone. Underneath it there is almost always an emotional layer that physical treatment can't reach on its own. Shame. Religious programming around sex and the body. A history of sexual trauma. Anxiety that has taken up residence in the muscles themselves. When only one part of the problem is being treated, results are incomplete — and sometimes women disengage from physical therapy entirely because the emotional piece is too overwhelming to push through without support. The most effective treatment addresses the whole person. That means the physical and the psychological, ideally in parallel, with providers who understand each other's work and communicate when it serves the client. I welcome those relationships with pelvic floor physical therapists and women's health providers — because the clients we share deserve the full picture, not half of it.