INDIVIDUAL THERAPY

Relational Psychotherapy focuses on connectedness to others - both past and present. Through the healthy relationship of therapeutic interaction, your sense of self is strengthened and your values are clarified.

Within the therapeutic relationship, you can safely re-experience past relational experiences, and then find freedom to heal the past and bring new skills to present relationships.

Cognitive Behavioral Therapy (CBT) is based on the idea that our thoughts (cognitions) and our actions (behaviors) are related to our emotional experiences. It is an effective treatment for a variety of psychological issues, including depression and anxiety. By identifying problematic ways of thinking and feeling in the context of your life experience, CBT can identify underlying assumptions or core beliefs that are fueling these problems.

The good news of CBT work is that you can change the beliefs you learned, usually due to early life experiences. By practicing thinking, feeling and behaving based on healthier adult beliefs, you can harness the power of neuroplasticity to actually change your brain and central nervous system.

Exposure therapy is a technique that gradually exposes you to the very things you fear. The treatment steps are paired with relaxation and calming techniques so that enduring the exposure to the feared events is more and more tolerable. Through exposure therapy - you can gradually replace the fear you learned with increasing equanimity.

ACT is an empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.

The six core processes of ACT are:

1. Acceptance is an alternative to our instinct to avoid thinking about negative - or potentially negative - experiences.

2. Cognitive Defusion strategies build skill in separating the core of your being - your pure awareness - from physiological events like thoughts, feelings and sensations.

3. Being Present (Mindfulness) is the practice of being aware of the present moment, without judgment.

4. Self as Context helps you find safety inside yourself and increases your capacity to flexibly shift perspective.

5. Values in ACT help people to clarify what is most important to them.

6. Committed Action: ACT aims to help people set goals according to their values and act on them responsibly.

DBT was originally designed to treat interpersonal chaos, intense emotional swings, impulsiveness, confusion about the self (identity), and self-harm/suicidal behavior. However, it is now used for a variety of clinical problems and builds life skills for all people. The term "dialectical" comes from the idea that bringing together two opposites in therapy -- like both acceptance and change -- yields better results than working with either one alone. DBT expands this “both - and” (rather than “either - or”) framework to a variety of common psychological problems.

DBT is appropriate for a range of issues such as depression, anxiety, eating disorders, anger-related problems, and substance use problems. DBT involves extensive and pragmatic skills training to improve our ability to tolerate distress without negative acting-out, and then builds tolerance for strong emotions as they arise.

There are two types of regulation that help us function as skilled adults. One is co-regulation through safe and soothing relationships. The other is self-regulation.

Mindfulness refers to a type of self-regulation practice that focuses on training attention and awareness in order to bring mental processes under greater voluntary control. Mindfulness - when practiced again and again and again - builds stability of mind. People who have practiced this over time experience more calm, clarity and concentration. Through self-acceptance and self-compassion, mindfulness cultivates healthy attitudes toward one’s self and increases one’s self-worth.

It can be hard for people to begin mindfulness work when they just try to sit and focus on their breath. It often helps to start with a moving meditation like slow walking in nature, or focusing on a sensory experience in the moment (like listening to bird song) and when the mind wanders, simply return to listening to the birds - over and over again without any self-criticism.

If you have a history of neglect or abuse as an infant or child, you have what we call “neurodevelopmental trauma.”

As Dr. Bruce Perry, an expert on neurodevelopmental trauma says, “It’s not what’s wrong with you. It’s what happened to you”

Our brains and central nervous systems are developing rapidly from conception through childhood, so adverse events have a particularly strong impact during this time. Children may not have conscious memories, but their bodies remember in the form of a “sensitized nervous system.”

The trauma is childhood is expressed in primarily two ways - 1. Children can become highly reactive (act-out) while vigilantly watching for threats to their safely. 2. Children may cope by dissociating, especially when they have been neglected. If their needs are not met and their cries for help are not heeded, they often detach - as others have not been trustworthy or safe in their experience.

All children do their best to cope with adversity by making “adaptations” to keep themselves as safe as possible. If these adaptations help, they become patterns that can persist into adulthood. And as adults, these old adaptations can become dysfunctional. They lead to mental health problems, relational discord, and self-sabotage.

In my work with trauma, I am informed by polyvagal theory.

This theory teaches us that post traumatic stress symptoms are biologically based and somatically experienced. Three steps are important in the polyvagal approach to treatment of trauma:

1. Self-Compassion: Develop self-compassion for your symptoms. Recognize the physiological, somatic basis of symptoms and why you cannot simply think your way out of your trauma reactions.

2. Develop Somatic Awareness: Learn to mindfully track subtle changes in your body sensations and heart rate. Identify your own personal signs of stress. This will help you respond right away before the stress starts to feel overwhelming or out of your control. We call this staying in the window of tolerance.

3. Practice Attentional Control: Practice focusing your attention on specific cues in your environment that remind you that you are safe now. Relaxation exercises are also important to help you self-regulate.

These three steps improve the physical pathways of your nervous system every time you feel safe. We feel safe when we are connected to trustworthy others or when being compassionate toward ourselves.

EMDR (Eye Movement Desensitization and Reprocessing) therapy is a method for treating trauma.

During EMDR treatment, you will revisit traumatic memories but while remaining in control. You do not need to tell your therapist the details of happened to you, as this can be re-traumatizing. By paring your memories or fragments of images with relaxation techniques to ground you - along with bi-lateral stimulation (eye movements, tapping, etc.) - you will gradually desensitize your nervous system to traumatic events of your past.

Interpersonal and Social Rhythm Therapy was developed as a treatment for mood disorders, including Bipolar Spectrum Disorders. The interpersonal elements of the program are based on Interpersonal Psychotherapy (IPT) for depression, a treatment that focuses on the interaction between mood and life events. IPT emphasizes strategies to improve social support and relationships. The social rhythm elements of this treatment come from both clinical experience and research showing a connection between daily routine or rhythm disruptions and mood destabilization. Sleep is one of the most important routines needed to stabilize moods.

Mood monitoring helps people identify triggers that impair moods. For each person, these triggers are unique. Recognizing the ways in which thoughts, feelings, and behaviors change as moods deregulate in mild, moderate, or severe ways are important for self-awareness. Self-awareness is needed for change to occur. Skilled, active responses can be learned by clients so that they become increasingly able to regulate their own moods and calm their body’s stress response.

Narrative therapy suggests that we create stories throughout our lives as a way to make sense of our experiences. We carry many stories with us at one time - both positive and negative. These stories can influence our self-esteem, abilities, relationships, our work, and so on.

Narrative therapy separates people from their problems. Exploring in this way helps us to widen our view of self, challenge old and unhealthy beliefs, and opens us to new ways of living that reflect a more accurate and healthy set of stories.

Motivational Interviewing (MI) is the most effective way to have conversations with people about making healthy changes in behavior. Simply educating people or telling them what to do - does not lead to change. But helping people resolve their natural ambivalence about change in an open and accepting manner, empathizing with the reasons why people find it very difficult to change, and gradually guiding and collaborating with people to identify realistic step that they choose to make based on their own interests, resources, culture, and values— does predict behavior change. What we as therapists say about change, rarely predicts change. What you say about change can often lead to change.

For many years, Dr. Mary O’Leary was a highly acclaimed national trainer in the field of MI. Her mastery of this therapeutic technique is one of the reasons for the high success rate of her therapy practice and the many positive outcomes for her therapy clients.