Kathleen Kawamura, PhD Clinical Psychologist
Kathleen Kawamura, PhDClinical Psychologist

 

My general approach to psychotherapy can be described as insight-guided cognitive-behavioral therapy and reflects the theories and techniques of mainstream, validated psychotherapies.   

 

The process is insight-guided in that developing self-awareness regarding the sources of distress is an important part of the therapeutic process.  The sources may be early childhood experiences, unresolved emotional issues, biological vulnerabilities, family relationships, or early learning experiences, to name a few.  This insight can help you to develop awareness of the strengths that you already have and to develop compassionate acceptance of those aspects of yourself that you may be struggling with.  In addition, this understanding can provide you with clarity to decide what strategies might be most effective and can also motivate you to make changes in your life, not because of self-hatred or distress but because of self-appreciation.

 

The therapy process is also cognitive-behavioral in that an important component of treatment is the development of strategies that shift and change how you think (cognitive) and how you act (behavioral) to manage how you feel (emotional).  Strategies can involve monitoring and changing your thought processes, developing more effective coping skills, learning effective problem solving skills, developing your communication style, increasing activity, or biofeedback/relaxation training for symptom reduction.  The specific strategies utilized will depend on your unique values, goals, and situation. 

 

***Medications:  As a psychologist in California, I do not have the authority to prescribe medications.  A medical doctor, or psychiatrist, will have to evaluate you for medical treatment.*** Click here for more information regarding medications from the National Institute of Mental Health.

 

To help demystify the process of psychotherapy, I have provided a thorough explanation of some of the major components of therapy. 

  • Evaluation
  • Explanation of the General Process
  • Biofeedback
  • Ending Therapy

 

EVALUATION/INITIAL CONSULTATION

The first session will be used as an initial consultation.  During the consultation, I will gather information on the problems that you would like assistance with, and we can begin to develop a treatment plan.  The particular treatment approach will be tailored to your own individual needs and will vary depending on your presenting issues and concerns.  The treatment plan will include explanations of the treatment approach and expectations for treatment.  Any questions and concerns regarding treatment will be answered fully at this time.  In the case that you would benefit most from a treatment approach that I do not provide, I can assist you in finding more appropriate treatment providers.  You are under no obligation to continue in therapy at any time.   

 

EXPLANATION OF THE GENERAL PROCESS

 

People often come into therapy when they feel blocked in their ability to achieve life satisfaction.  These blocks might be what we call anxiety, depression, stress, low self-esteem, pain, or body image dissatisfaction.  To address and minimize these blocks in the path towards optimal living, I use an insight-guided cognitive-behavioral therapy.  The therapy is insight-guided in that a key component of treatment is developing self-awareness around how past events affect current problems and how problematic patterns of thoughts and behaviors are replayed throughout one’s life.  A problematic pattern of thinking might be, “I can’t handle this anxiety.  This is too much for me. What’s wrong with me?  I shouldn’t get nervous.”  These thoughts are problematic in that they lead to feelings of hopelessness, helplessness, and shame, which are not the most helpful feelings to motivate us to address the situation or the distress we are feeling.  Problematic patterns of behaving might be avoiding fearful situations, isolating oneself from social situations, binge eating, or compulsive cleaning.     

People naturally develop their own unique ways of coping with painful emotions.  These coping styles may have been biologically wired for those preprogrammed to be more sensitive to anxiety or they may have been learned from the family, school, peers, or society in general.  Sometimes these coping styles, which may have been helpful in the past, become less and less effective in minimizing emotional and physical pain.  These coping styles can also become problems of their own.  Old coping styles become problematic when:   

1) They do not directly address the source of the problem

2) They cause more problems in the long-run

3) They no longer work as well in relieving distress for any significant amount of time

In my work, therapy is a collaborative venture where you and I would work together to identify your unique coping styles, understand how you came to develop these particular styles of coping, and understand ways in which certain coping styles may no longer be useful.  Once you understand your past and current styles of coping, we would then work together to develop a more effective and constructive path towards improving your quality of life.  As the therapist, I would provide expertise in psychological strategies whereas, as the client, you would provide expertise regarding your own psychological functioning, life experiences, and what types of strategies have worked for you in the past.   

The one complaint often heard from clients in insight-oriented therapy is, “I understand WHY I act the way I act, now what do I DO?”  This is where cognitive-behavioral strategies become important.  The therapy I do is cognitive-behavioral in that I also use strategies where the focus is on the ways in which how we think and how we act influence the way we feel.  By addressing and shifting the way you think, feel, and act, we can begin to minimize obstacles to achieving life satisfaction. 

 

Depending on your own individual needs, the most effective strategy may be problem-solving, shifting thinking patterns, developing more effective behavioral strategies, becoming more physically active, exploring family and childhood history, developing communication skills, learning to cope with problems that cannot be easily “fixed,” relaxation training, biofeedback, mindfulness meditation, or further assessment.  These techniques often provide a significant amount of symptom relief within 6-8 sessions.    

 

After we have identified the blocks in your path, you have started to develop effective coping strategies, and you have begun to experience a decrease in your distress I will provide consultation regarding the next step in therapy.  Oftentimes, clients who have presented for treatment of a specific problem such as chronic pain, depression, or anxiety choose to continue in therapy to explore ways in which they can further enhance their quality of life.  Issues that may come up include self-esteem, relationship concerns, cultural issues, reassessment of life values, career goals, or developing effective communication styles.  If we decide to continue together in therapy, we will reassess our goals at regular intervals.  
 
Other clients find that the initial sessions are sufficient, and they are comfortable ending therapy at that time or spreading out sessions to every other week.  Part of ending therapy would be coaching you to be able to identify your unique vulnerabilities so that when you see yourself falling back into old maladaptive patterns, you can readily utilize the strategies you learned in therapy.  By the end of treatment, you will have developed a sense of independence and confidence to be able to continue to implement on your own the strategies you have learned.  If at a future time, you find that you are again blocked in your path towards optimal living, then all you need to do is call me to set up another appointment and continue to use therapy “as needed.”   

Whether or not therapy is effective depends on the person, the type of therapy, the length of therapy, the type of problem, and the skills of the therapist (See Choosing Your Psychotherapy).  I do not see therapy as providing an easy “cure” for “sick” folks, but rather as motivating and challenging individuals to use their own resources to the best of their abilities to grow, improve, gain insight, or solve specific problems.  

 

BIOFEEDBACK

Biofeedback is a therapeutic technique that can be used to help manage symptoms related to anxiety, stress, insomnia, and chronic pain.  By using a specialized heart rate monitor, you will be able to see a visual representation of your heart rhythm patterns and learn how to create heart rhythms associated with focused attention, calm relaxation, and positive emotions.  Biofeedback is not a cure or a treatment but rather a training technique that is, in a sense, a short-cut to learning deep relaxation and meditation.  By getting immediate feedback on a computer monitor, you will quickly learn how your body responds to stress so that in the future you are more aware of your internal sensations association with stress so that you can catch it earlier in the cycle.  In addition, you will be able to learn how to implement various relaxation techniques and get feedback that it is having a positive impact on your body system.

 

 

 

 

 

Heart rhythm patterns associated with stress, anxiety, and anger are jagged and irregular whereas heart rhythm patterns associated with calmness, focused attention, and positive emotions are smooth and wave-like.  These smooth waves appear when your breathing and your heart rate (two powerful systems in your body) are in coherence with each other.  This in turn, leads to more coherence in your other physiological systems, particularly the autonomic system that is associated with the stress and relaxation responses.

 

The smooth waves have also been found to be an indication of health and wellness, particularly cardiac functioning.  In my practice, I combine both psychotherapy and biofeedback to achieve optimal functioning in both mind and body.

Click here for research publications on the relationship between heart rate variability and both physical and mental health.

 

RELAXATION: UNDER CONSTRUCTION

 

ENDING THERAPY    

The length of therapy is mutually determined by both the therapist and client.  Often times what occurs is that brief psychotherapy (6-8 sessions) will decrease psychological distress, instill hope for change, and teach new effective coping strategies.  Some clients find that this is sufficient.  An assessment is made after this initial course of therapy.  Some clients find that they are having difficulty consistently implementing strategies learned in therapy and thus will continue for several more sessions.  In this situation, therapy sessions can be spread out to once every other week at this time to help generalize the treatment to day-to-day life.  Some clients find that after the immediate crisis is resolved, there are other issues in their life that they would like to address (relationships, communication, life goals, self-esteem, fitness, assertiveness, family issues, etc.).  If they feel they have established a good relationship with the therapist, it makes it a natural decision to continue working with the same therapist on different issues that will help them to achieve an optimal quality of life.  If therapy is continued in this fashion, reevaluation of treatment objectives will occur on a consistent basis.  For those clients who terminate therapy after the initial course of therapy, they may choose to use therapy “as needed” and return when old problems resurface or when life events present new obstacles.