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Individual Therapy Sessions

Anxiety Disorders

I have treated many people who have a variety of different types of anxiety including generalized anxiety disorders, social anxiety, panic disorders, phobias and obsessive-compulsive disorders. The symptoms for each type of anxiety disorder are different but may include overwhelming fears and debilitating dread and can affect all aspects of a person’s life.


Generalized Anxiety

People suffering from Generalized Anxiety Disorder (GAD) can’t stop worrying even though they often understand their concerns are way more intense than the situation that they are in. Often there are physical symptoms that accompany their worry such as headaches, irritability and trembling. They tend to have difficulty concentrating, and often have issues with sleeping.


Social Anxiety

Of the various anxiety disorders, social anxiety is the most frequently encountered. Those with social anxiety have problems with severe anxiety in everyday social situations. In many cases, interacting socially becomes very stressful and even emotionally painful. Some people have the feeling that they are constantly being judged by others. Sometimes feelings like this become so problematic that someone may completely avoid almost all social interactions with others. For example, teenagers who struggle with social anxiety avoid or refuse to attend school altogether.  Social anxiety can interfere with enjoyment of school, work or other activities that involve other people. Sufferers typically say they are really worried about being embarrassed or humiliated.


Panic

People with panic disorder have sudden and repeated attacks of fear that last for several minutes or even longer. These episodes are called panic attacks. Panic attacks typically include a fear of disaster or of losing control even when there is no real danger. Panic attacks may include sweating, shaking, heart palpitations and shortness of breath.


Obsessive Compulsive Disorder (OCD)

Obsessions are intrusive, unwelcome, distressing thoughts and mental images. Unlike other unpleasant thoughts, they do not fade away, but keep intruding into your mind over and over against your will. Because obsessions do not go away, they are extremely difficult to ignore. Compulsions are behaviors that people perform in an attempt to get rid of the fears and anxieties caused by their obsessions. Unfortunately, performing these behaviors tend to set off a vicious cycle. While it may bring momentary relief, the more compulsions are performed the obsessive thoughts and feelings become stronger and more demanding.

Common Obsessions

  • Obsessions about dirt and contamination
  • Obsessive need for order and symmetry
  • Obsessions about hoarding and saving
  • Obsessions with sexual content
  • Repetitive rituals
  • Nonsensical doubts
  • Religious obsessions (scrupulosity)
  • Obsessions with aggressive content
  • Superstitious fears

Common Compulsions

  • Compulsions about having things “just right”
  • Hoarding or collecting compulsions
  • Checking compulsions
  • Other compulsions (asking over and over for reassurance; slowness in carrying out the most routine activities; blinking or staring rituals; behaviors based on superstitious beliefs; feeling of dread if some arbitrary act is not performed; the overpowering need to tell someone something or ask someone something or to confess something; the need to touch, tap or rub certain objects repetitively; counting compulsions; mental rituals such as reciting silent prayers in an effort to make bad thoughts go away, and excessive list making).

Science of OCD

OCD is related to a biochemical problem in the brain, where four key structures of the brain become locked together, and the brain sends false messages that the person cannot readily identify as false. One of the main signal-producing centers of the brain, made up of two structures called the caudate nucleus and the putamen, can be thought of as similar to a gearshift in a car. The caudate nucleus works like an automatic transmission for the front, thinking part of the brain. Working with the putamen, which is the automatic transmission for the part of the brain that controls body movements, the caudate nucleus allows for the extremely efficient coordination of thought and movement during everyday activities. In a person with OCD, however, the caudate nucleus is not shifting the gears properly, and messages from the front part of the brain get stuck there. Essentially, the brain’s automatic transmission has a glitch and the brain gets “stuck in gear” and can’t shift to the next thought. When the brain gets stuck, it might tell you things like “You must wash your hands again”, and you will wash, even though there is no real reason to do so. Or the brain may say, “You better check that lock again”, and you will check it again and again, unable to shake off that feeling the door may be unlocked.


Phobias

One of the more well-known of the psychological disorders is phobias. There are all kinds of phobias and some of them are more common than others. Generally speaking, phobias are irrational and unrealistic fears that can interfere with your daily life. Common phobias include fear of blood, insects or flying. Modern research has led to therapies that will reduce the anxiety caused by phobias and take away the fear.


Treatment for Anxiety

When it comes to treating anxiety disorders, there are many tools and options at our disposal. I use a variety of methods including psychotherapy, stress management training and relaxation training to help alleviate the pain and suffering caused by this family of disorders. Often the people I for anxiety also have other areas of their life that they would like to improve as well, so there are many factors that influence which methods are used. Treatment for anxiety begins with a full evaluation to determine what type of anxiety you are suffering from and where it is coming from. This allows me to recognize that you are someone who would benefit just by considering the anxiety in a supportive and therapeutic environment, or if you are someone who would benefit from a more structured approach and intervention.

Rational Emotive Behavioral Therapy (REBT)

Rational Emotive Behavioral Therapy (REBT) is an evidence-based cognitive behavioral therapy for anxiety. REBT is a practical, action-oriented approach to coping with problems and enhancing personal growth and places a good deal of its focus on the present: on currently held attitudes, painful emotions and maladaptive behaviors that can sabotage a fuller experience of life. REBT also provides people with an individualized set of proven techniques for helping to solve problems.

In therapy, my role is to help uncover your individual sets of beliefs (attitudes, expectations and personal rules) that frequently lead to emotional distress. You will learn the ABC model of REBT and how to use it to understand the real source of your anxiety and beliefs about them. You will eventually come to realize that (A) Activating Event does not directly cause your feelings at (C) Consequence but that your beliefs or (B) play an important role, you will begin to have hope.

REBT provides a variety of methods to help people reformulate their irrational beliefs into more sensible, realistic and helpful ones by employing the powerful REBT technique called “disputing.” Ultimately, REBT helps individuals to develop a philosophy and approach to living that can increase their effectiveness and satisfaction at work, in living successfully with others, in parenting and educational settings, in making our community and environment healthier, and in enhancing their own emotional health and personal welfare.

Exposure and Response Prevention

Exposure and response prevention (EX/RP) is considered the gold-standard for treating OCD. EX/RP involves two components: 1) provoking obsessions and experiencing subsequent anxiety while 2) refraining from engaging in rituals. The purpose of this process is to gradually extinguish your obsession-related anxiety by having you ‘learn by doing’. When you repeatedly test your predictions of your feared outcome (e.g., “I will get sick and die”) by exposing yourself to your anxiety triggers (e.g., dirt on your hands) and resisting the urge to perform rituals (e.g., washing your hands 3 times), the paired association between the obsessions and compulsions gets weaker. Crucially, by preventing rituals, you learn that (1) despite your anxiety and compulsive urge, the feared outcome likely will not occur (or at least not nearly as bad as you imagined); and (2) the anxiety itself will habituate on its own as long as compulsions aren’t performed. Plus, as a byproduct, many people also feel a sense of control and empowerment over their anxiety for the first time, instead of remaining crippled by obsessions and compulsions. The actual exposure occurs gradually and systematically, so you start with the least feared situation and move onto the most feared. These exercises can be done during session (and assigned to you as homework) through guided in-vivo (out in the world) or imaginal scripts in my office.

Biofeedback

Biofeedback is a technique you can use to learn to control some of your body’s functions, such as your heart rate. Typically, I will ask clients to track and measure physiological changes in their body through their heart rate by wearing a Fit Bit or Apple Watch. In the event one of the aforementioned devices is not available, a pulse oximeter device that attaches to your finger can be used and purchased for a nominal fee through Amazon. Using feedback from the device about your physiology, in conjunction with other coping skills and psychological strategies can help pace your breathing, relax and avoid a panic attack altogether.


Depressive Disorders

There are several different types of depression: major depression, dysthymia (chronic low-grade depression), seasonal affective disorder, and adjustment disorders. In more serious cases, some individuals have suicidal thoughts or engage in self-injurious behaviors. Whether you consider your symptoms mild, moderate or severe, I have experience and training in assessing and treating all levels of depressive disorders and associated symptoms.


Suicidal Thoughts

Having many years of assessing risk and suicide in high-pressure situations and teaching other mental health professionals how to assess and treat an individual suffering from suicidal thoughts, I am comfortable with seeing clients struggling with this. While some people who consider suicide do so fleetingly or only once in their lives, others experience these thoughts ongoing or off and on over time. Suicidal thoughts can burden people and hold them hostage. Experiencing these thoughts is to experience absolute darkness, hopelessness, pain, and nothing matters but stopping that pain. The first step in therapy for someone struggling with suicidal thoughts is to help develop the skills they need to stay alive. This typically involves creating a safety plan, which is a document that support and guides someone experiencing thoughts of suicide in an effort to help avoid a state of intense suicidal crisis.

A safety plan is an assets-based approach designed to focus on a person’s strengths. Safety plans typically involve identifying personal warning signs; coping strategies that have worked in the past or strategies that may work in the future; identifying people who are sources of support in their lives; how means of suicide can be removed from the environment; and personal reasons for living or what has helped the individual stay alive.

A safety plan is NOT a no-suicide contract, as there is lack of evidence to support such contracts as clinically effective tools. After focusing the initial intervention on staying alive and building the skills to be able to do so, we then move forward in working on other psychological troubles the individual may be facing. If you are reading this and are in immediate crisis or have attempted suicide, you should contact your local emergency room or call 911.


Non-Suicidal Self-Injury

Having many years of assessing risk of non-suicidal self-injury (NSSI) as it relates to suicide, treating individuals with suicidal thoughts and NSSI, and teaching other mental health professionals how to do the same, I am comfortable with seeing clients struggling in this area.

Non-suicidal self-injury (NSSI) is the direct injuring of body tissue without suicidal intent. The first step in therapy for someone struggling with NSSI is to conduct an assessment of risk and suicide.

Should a safety plan be appropriate (as described above in the suicidal thoughts section), then we create a safety plan. The next step in therapy includes learning the function of the NSSI, meaning, what is the behavior of NSSI achieving? Current literature in this area indicates there are 7 proposed psychological theories, that once uncovered in therapy, will help me determine which treatment may be the most effective.


Treatment for Depression

I have specific advanced training in Rational Emotive Behavioral Therapy (REBT), which has been established as an evidence-based treatment for depression. I am also well-versed in Interpersonal Therapy, another treatment for depression that is also an evidence-based treatment for depression. Treatment for depression begins with a full evaluation to determine what type of depression you are suffering from and where it is coming from.

When it comes to treating depression, there are many tools and options at our disposal. I may use a variety of methods to help alleviate the pain and suffering caused by this family of disorders. Often the people I treat for depression also have other areas of their life that they would like to improve as well, so there are many factors that influence which methods are used.

Rational Emotive Behavioral Therapy

Rational Emotive Behavioral Therapy (REBT) is an evidence-based cognitive behavioral therapy for depression. REBT is a practical, action-oriented approach to coping with problems and enhancing personal growth and places a good deal of its focus on the present: on currently held attitudes, painful emotions and maladaptive behaviors that can sabotage a fuller experience of life. REBT also provides people with an individualized set of proven techniques for helping to solve problems.

In therapy, my role is to help uncover your individual sets of beliefs (attitudes, expectations and personal rules) that frequently lead to emotional distress. You will learn the ABC model of REBT and how to use it to understand the real source of your depression and beliefs about them. You will eventually come to realize that (A) Activating Event does not directly cause your feelings at (C) Consequence but that your beliefs or (B) play an important role, you will begin to have hope.

REBT provides a variety of methods to help people reformulate their irrational beliefs into more sensible, realistic and helpful ones by employing the powerful REBT technique called “disputing.” Ultimately, REBT helps individuals to develop a philosophy and approach to living that can increase their effectiveness and satisfaction at work, in living successfully with others, in parenting and educational settings, in making our community and environment healthier, and in enhancing their own emotional health and personal welfare.

Interpersonal Therapy

Another form of therapy I may use for depression is interpersonal therapy. This therapy deals with relationships in your life and how they can contribute to depression. Ultimately, it helps clients improve the relationships in their lives in order to relieve potential causes for depression. Areas where social problems are occurring are explored in depth.