About Karena
Karena Franses brings 28 years of clinical social work to her practice in California. She is a Licensed Clinical Social Worker (LCSW) who has spent decades helping people navigate addiction, depression, anxiety, grief, relationship struggles, and other painful life changes. Her style is steady and compassionate, with attention to what feels most urgent for each person.
She spent many years supervising social work at a county hospital outpatient HIV clinic and later maintained a personal psychotherapy practice in San Francisco.
Background and approach
Those settings shaped her approach to addiction, trauma, serious medical concerns, and the stresses of stigma and marginalization. She draws on those long-term clinical experiences when supporting people now. Karena weaves mindfulness and a personal Buddhist practice into her work.
She values simple kindness and encourages small steps that build clearer thinking and gentler self-care. Sessions tend to focus on understanding what keeps problems active and on identifying practical next steps clients can try between meetings. Her methods include motivational interviewing to support change and psychodynamic ideas to look at patterns that repeat over time.
She uses these approaches to address issues such as codependency, body image, intimacy concerns, and coping during serious illness or caregiving stress. People who connect well with Karena often want a reflective but action-oriented therapy. She welcomes conversations about life purpose, guilt and shame, relationship communication, and recovery from substance use.
The work is collaborative and paced to each person’s readiness to change.
How Karena’s approaches translate to online therapy
Karena uses motivational interviewing to help people clarify what they want to change and to build motivation for those changes. This method is helpful for substance use concerns, ambivalence about treatment, and steps toward healthier routines.She also draws on psychodynamic therapy to look at recurring patterns and how past experiences shape present relationships. That work can help with relationship struggles, intimacy issues, and persistent patterns that cause distress.
Choosing a therapeutic approach is a collaborative process. Karena will talk with each person about their goals and try different methods until a good fit emerges. She tailors sessions to the client’s needs and adjusts pace and focus as progress unfolds.
Online formats - video calls, phone sessions, live chat, and text messaging - make it easier to fit therapy into a busy life. Video lets people read facial cues during deeper conversations. Phone can be a simpler option when bandwidth is limited or when someone prefers not to use video. Live chat and text messaging work well for brief check-ins, ongoing support, or when clients want a written record of thoughts between sessions. These options offer flexibility while keeping the focus on practical steps and emotional work.
Frequently asked questions
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Specialties and expertise
Top specialties
- Addictions
- LGBT
- Relationship issues
Also works with
- Bipolar disorder
- Body image
- Cancer
- Caregiver issues and stress
- Codependency
- Commitment issues
- Communication problems
- Coping with life changes
- Depression
- Drug and alcohol addiction
- Eating and food-related issues
- Grief
- Guilt and shame
- HIV / AIDS
- Hospice and end-of-life counseling
- Intimacy-related issues
- Isolation / loneliness
- Jealousy
- Life purpose
- Self esteem
- Stress, Anxiety
Therapeutic approaches
- Experience
- 28 years
- Licensed
- California
- Languages
- English