Listed below are some of the treatment modalities I use
Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values. Based on Relational Frame Theory, ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change.
HOW DOES ACT HELP CLIENTS?
ACT for Depression helps clients with depression make changes so that they can have full, rich, and meaningful lives. The focus in ACT is to help you live more closely to your values. It also helps you to be more accepting of yourself. ACT helps clients to have better relationships with themselves, others, and the world. Clients learn to identify and engage in activities that are in line with what they care about. By participating in ACT, the client learns to:
A = Accept C = Choose T = Take Action
By participating in ACT, you will learn to:
- Be more present to the "here-and-now." This focus helps to decrease being caught up in what happened in the past. It also frees clients from worrying too much about the future. Being present helps you to more fully connect to and enjoy the moment.
- Observe thoughts and feelings in such a way that they no longer keep you stuck in life. Learning to observe through openness and acceptance can help you find freedom from negative thoughts and feelings.
- Clarify your values and then take action. Finding what is most meaningful to you and choosing to act on these values are important parts of the therapy. This will be part of the process of building a rich and full life.
ACT for Anxiety
ACT can help you transcend that natural fight-or-flight response that is part of anxiety disorders. At its essence, ACT helps clients accept life’s challenges and problems, big and small, understand and overcome negative thoughts and feelings, choose life directions based on your own desires and values, and take action to shape your life.
When working with ACT, people come to understand their anxiety, their anxiety triggers, and their own anxious thoughts, feelings, and behaviors. Once we can fully recognize what’s going on around us and within us, we can face it and accept it for what it is, often our minds playing tricks and creating fear and worry and anxiety.
With ACT comes control and power. Or rather, anxiety’s control and power is drastically reduced while our own self-control and power over our lives is greatly increased. When we live in the moment and accept ourselves and our lives, we can then decide what it really is that we want for ourselves and our lives. ACT is an approach to anxiety that goes beyond the mere reduction of anxiety and helps us define our values and take purposeful action to live a good life, an anxiety-free life.
Cognitive Behavioral Therapy (CBT) is a time-sensitive, structured, present-oriented psychotherapy directed toward solving current problems and teaching clients skills to modify dysfunctional thinking and behavior. CBT is a psychotherapy that is based on the cognitive model: the way that individuals perceive a situation is more closely connected to their reaction than the situation itself. One important part of CBT is helping clients change their unhelpful thinking and behavior that lead to enduring improvement in their mood and functioning. CBT uses a variety of cognitive and behavioral techniques, but it isn’t defined by its use of these strategies. CBT therapists do lots of problem solving and and incorporate many psychotherapeutic modalities, including dialectical behavior therapy, acceptance and commitment therapy, Gestalt therapy, compassion focused therapy, mindfulness, solution focused therapy, motivational interviewing, positive psychology, interpersonal psychotherapy, and when it comes to personality disorders, psychodynamic psychotherapy.
HOW DOES CBT HELP CLIENTS?
CBT for Depression
The CBT approach to treating depression can be divided into its cognitive and behavioral components. In the cognitive component of treatment, therapist and client learn to identify the distorted negative thinking that causes negative emotions. Then they question the veracity of these thoughts and come up with alternative balanced thoughts. They also learn about the client's core beliefs underlying the daily automatic negative thinking. For example, a depressed client may have the core belief "I am a loser;" when he gets some less than ideal feedback at work he starts having rather drastic thoughts like "I won't be able to finish this task," or "the work I am doing is worthless," or "I'm going to get fired." Almost simultaneously with these negative thinking he starts feeling down, with very low motivation and energy. When he starts undergoing CBT treatment he learns to come up with more balanced thoughts, like "I'm not doing as good a job as I could, but it's not terrible either" or "If I don't improve this level of productivity I could end up getting fired, but I know I can improve it." As a result of this more realistic assessment of the situation, the client will not feel so depressed. Furthermore, therapist and client will have the opportunity to question the underlying core belief "I am a loser." Where did that idea come from? What evidence is there for or against it?
In the behavioral component of treatment, the therapist helps the client assess how the different daily activities have an impact on the client's mood and how some of them can improve symptoms of depression. Therapists usually help clients develop an action plan, based on the behavioral activation approach. In this approach the therapist and client create a list of activities and then they order them from less to more difficult to achieve. As the client goes from easier to harder activity his feeling of mastery improves as depression lessens.
Dialectical Behavior Therapy (DBT) developed by Marsha Linehan, a Professor of Psychology, Psychiatry and Behavioral Sciences at the University of Washington.
HOW DOES DBT HELP CLIENTS?
DBT focuses on four major skill areas: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. The core of DBT begins with an analysis of each client’s behavior through chain analysis, and missing-links analysis to find the causes of the behaviors and come up with a plan for problem-solving around these causes. Chain Analysis addresses when we engage in the ineffective behavior, while Missing-Link Analysis addresses when we fail to use effective behaviors. This allows my clients to be aware of their struggles and plan accordingly in a proactive way.
Mindfulness is paying attention. It is noticing what you are doing, feeling and thinking at the time you are actually doing, feeling and thinking it. Mindfulness skills help clients reduce suffering and increase happiness and control of their own mind. Linehan is a Zen Master and incorporates mindfulness into DBT throughout. However, because I am a therapist of Christian faith, I use Christian Mindfulness rather than a Buddhist or secular approach to meditation. Christian mindfulness is designed to fill the mind with just one thing: seeking God’s kingdom and His righteousness. From this perspective, Christian mindfulness and meditation don’t aim to detach our selves from suffering, but to attach our deepest selves to God. Because God is part of our everyday lives, paying attention to God and focusing on God’s kingdom is a fundamental practice of Christian mindfulness.
Using Interpersonal Effectiveness skills can help clients develop new relationships, improve current ones and deal with conflict. Many of us struggle with asking for what we want or need in relationships, as well as struggling with how to say no to things we need to. Effective relationships is a core need for all of us in building our support systems and our resilience.
The goal of Emotion Regulation Skills is to reduce emotional suffering. I'm not saying you should try to get rid of emotions because emotions play a very important role in our lives. Rather, I emphasize working on skills and ability to manage, regulate, and change emotions when we have a desire or need to.
Distress Tolerance is described by Linehan as having the skills to tolerate and survive a crisis situation without making the situation worse. This is important for two primary reasons: pain is a part of life that we cannot avoid, and the ability to tolerate distress is a necessary step in making any changes in our lives. Without distress tolerance skills, the stress of making changes will circumvent our attempts to move forward in a different way. Through Crisis Survival Skills and Reality Acceptance Skills, clients learn to tolerate their distress and make lasting changes in their lives.
DBT for Anxiety
DBT gives my clients skills to live in the present moment and to observe, alter the intensity of, and change feeling states. Clients with anxiety benefit from being able to tolerate intense feelings and modify behaviors in order to create new emotional experiences. Mindfulness skills in DBT give my clients with anxiety the tools to set aside worries about the past or future in order to address what is happening in their lives right now.
DBT for Depression
DBT offers skills specifically designed for clients dealing with depressive feelings. DBT empowers clients with depression to add positive emotional experiences to their lives in order to have better relationships and experience more joy. DBT includes evidence-based behavior activation skills to give clients concrete tools to use when feeling depressed. By knowing what works, clients with depression can take charge of their lives and do what they need to feel better.
DBT for Bipolar
Clients with bipolar often benefit from therapy to help them learn skills for tolerating distress and managing intense emotions. Clients with bipolar often benefit from help managing stressors that can increase vulnerability to depression and mania.
While DBT was originally developed to help highly suicidal clients, and those meeting the criteria for Borderline Personality Disorder, DBT is also able to help with other issues. For those struggling with Depression, Anxiety, Trauma, Stress Management, Anger Management, Conflictual Relationships, DBT can be a good choice. If you’re struggling with any of the above issues, using these four core skills of DBT can help you build the core mindfulness skills necessary to remain present in our lives. DBT helps you better manage your emotions and reactions to situations, be more effective in your interpersonal relationships, and tolerate the distress involved in making changes in your life. If you’re dealing with any of these issues, I hope this gives you hope. DBT is not the only solution, but it is a proven, effective solution that produces results!