Before beginning therapy, we conduct a thorough assessment of your goals and values, as well as your history and the current difficulties you are encountering. This helps us together form a conceptualization or hypothesis about why you are stuck, and a treatment plan as to how we can effectively work together to achieve the client’s goals. Some type of progress monitoring is used, and if the desired changes are not occurring, the conceptualization and plan are revised. Therapy sessions are typically structured, involve active collaboration, and includes homework (between-session practice of skills, experimenting and developing new behaviors). We integrate a number of evidence-based therapy approaches and techniques, including CBT, ACT and DBT (see below). Therapy also involves intense emotional work; a warm, safe, collaborative client-therapist relationship is foundational for this process. See Home for "What is Evidence-based Psychotherapy?"
Cognitive-behavioral therapy (CBT)
CBT is an approach to treatment that focuses on identifying current problems that a client is having, examining the historic causes and current beliefs and behaviors that maintain these difficulties, and generating alternative strategies to break unhelpful cycles. CBT tends to be short-term, active and collaborative, and focused on specific goals. The “cognitive” part of CBT is focused on identifying your automatic thoughts (and underlying beliefs) that may be driving emotional distress and problematic behavior (for example, the tendency to overpredict negative outcomes, creating anxiety and avoidance). Techniques are taught to gather evidence in order to challenge these beliefs and replace them with more adaptive, helpful ways of seeing yourself, others and the world. Behaviorally, CBT seeks to identify and change maladaptive behaviors (often avoidance, acting out, controlling or self-defeating behaviors) in order to develop new, more adaptive choices and skills. New behaviors are not only the goal; they also create new experiences (data), which can help change old beliefs and feelings.
Dialectical behavior therapy (DBT)
DBT weds Zen philosophy and behavioral science to create a central "dialectic" of acceptance and change. This is an active, skill-based therapy developed and researched by Dr. Marsha Linehan and her colleagues. DBT strives to decrease interpersonal chaos, unpredictable moods, and impulsive behavior. One foundational element is mindfulness--the ability to observe in an open and non-judgmental way our internal experience, and thus to focus our attention where we choose. DBT also teaches skills related to distress tolerance (how to manage anxiety and get through crises without making things worse); emotion regulation (how to identify and manage powerful emotional states while reducing vulnerability); and interpersonal effectiveness (how to maintain strong bonds with others, preserve self-respect, and achieve one's own needs).
Acceptance & Commitment Therapy (ACT)
ACT uses mindfulness techniques to help clients accept what is out of their control (both internal experiences and external circumstances) in order to focus on what we do control: taking committed action to create a rich and meaningful life. Like CBT, ACT helps clients become aware of the negative self-talk and painful feelings that keep them stuck in old patterns; but, instead of battling, buying in or obeying them, it uses mindfulness to “defuse” or disengage from the negative stories. Mindfulness is similarly used to make peace with unpleasant emotions and frustrating situations in our lives, so that we can free up energy from worrying and ruminating about them. Instead, we can focus on our core values – the parts of ourselves we want to bring alive and express more in the world (such as being creative, generous, open-minded, kind, playful, loving, etc.). ACT teaches skills for clarifying values and skills for effectively putting them into action. Thus ACT challenges a common notion of “happiness” in our society: Instead of chasing after the illusory idea of “happy” as some state to be achieved in the future (once we lose weight, make more money, and find the love of our life), ACT is about bringing yourself alive in the present, and each day doing what is most meaningful to you.