I am primarily a generalist, treating a variety of problems and disorders, but do have some particular areas of interests. The best way to determine whether my services will meet your needs is to call me to set up a free phone consultation. To read more about the particular problems and disorders that I treat, click on the links below:
What is anxiety?
Anxiety is a normal feeling of uneasiness, concern, and apprehension that, when carried to an extreme, can become outright fear, panic, and alarm. Some amount of anxiety and worrying is a
normal and necessary part of life. Because we are concerned about our children's safety, we watch them carefully. Because we are concerned about our own well-being, we fasten our
seatbelts to get into a car. These kind of concerns help keep us aware and alert but don't interfere with our daily life in any way. In fact, worry on this level means that our internal
protective systems are doing what they are supposed to do. In some situations, a moderate and even high level of anxiety is appropriate. For example, moderate to high internal stimulation
is necessary for optimal performance in some sports or a high level of anxiety is appropriate and adaptive when a ferocious dog is charging towards us.
How do anxiety disorders differ from normal anxiety?
Anxiety disorders differ from normal anxiety when the anxiety becomes excessive, inappropriate, or uncontrollable and begins to impair functioning in work, family, school, and social
relationships. For example, in an anxiety disorder, worrying and also worrying about worrying cloud most of every day. The worries may not seem to be connected to any specific situation
and rushes of anxiety can seem to happen "out of the blue" and disappear as mysteriously as they started. Sometimes they can become quite chronic (like in Generalized Anxiety Disorder) or they
can be compartmentalized (as with phobias).
What treatments are there for anxiety disorders?
Though anxiety can cause significant impairments, hopes for long-term recovery are very good. Through rigorous research studies, the National Institute of Mental Health has identified cognitive-behavioral therapy as being highly effective in treating anxiety disorders. Cognitive therapy involves identifying and challenging the thoughts that increase anxiety whereas the behavioral component involves gradually confronting and tolerating feared situations while also training individuals in relaxation and deep breathing techniques to calm physiological arousal. Most people experience significant improvements in their anxiety within eight to ten sessions.
Other techniques to calm physiological arousal include biofeedback, mindfulness meditation, and self-hypnosis. Biofeedback can assist you in learning about your body functioning so that you can develop control over seemingly automatic processes such as heart rate and tension. Mindfulness meditation can help increase awareness and appreciation of the present moment, improve clarity of thinking, and calm physiological arousal. Self-hypnosis strengthens the mind's ability to use relaxation and imagery to calm the body. Medications can also be highly effective in treating anxiety symptoms.
I have had significant training and experience in the field of anxiety disorders working with some of the leaders in the field and also publishing research related to the relationship between perfectionism and anxiety. I have found that clients appreciate the cognitive-behavioral approach because the treatment is straight-forward, effective, and empowering. There are many wonderful self-help books out on the market, but most people seem to benefit from the individualized coaching they receive in therapy.
Click here for more information on anxiety disorders from the National Institute of Mental Health
Click Here for more information on anxiety disorders from the Anxiety Disorders Association of America
What are the different types of anxiety?
Social anxiety is characterized by excessive, uncontrollable fear of being judged or embarrassed by others. Since this is true of almost any situation with other human beings, this phobia can have a devastating effect on someone's life. Panic attacks related to social performance are not uncommon. Social situations such as participation in meetings or a class, answering a supervisor's questions, being at a party, meeting someone new, or eating or writing in public can become sources of extreme anxiety. Sweating excessively, blushing, stammering, heart racing, stomach distress, losing the ability to express oneself well, and feeling inferior are often associated with social situations and can lead to more discomfort in social situations. The behavior associated with social anxiety is avoidance of social situations that may trigger anxiety.
Case example: Mike, age 26, has never been able to hold a job for longer than 6 months. Supervisors make him nervous. When asked a question, he's a wreck. Even thinking about participating in a staff meeting puts him into a sweat. Mike is smart, attractive and has a sense of humor. You'd think he would have no problem making friends or getting dates but dealing with the social nature of breaks and the lunch room is pure torture for him. He says he doesn't know how to make small talk and always worries he'll say or do the wrong thing. He is only relaxed when he is alone watching television.
Panic attacks are sudden waves of anxiety, and the symptoms of panic attacks can include heart racing, dizziness, shortness of breath, chest pain, trembling fears of having a heart attack or going crazy, nausea, dissociation, sweating, and tingling in the fingers. Those suffering from panic disorder often develop fears about when and where their next panic attacks will occur and will restrict their activities for fear of having another panic attack. Fears might also include losing control, going crazy, or dying.
Case example: Annie is a 20 year old student at a local community college. On several occasions recently she has found herself in absolute panic. Her heart pounds, she trembles, her mouth gets dry, and it feels like the walls are caving in on her. The feelings only last a few minutes but when they happen, the only thing that seems to relieve her fear is walking around her apartment and reminding herself that she is in control. She won't ride in cars any more unless she is driving so she is sure that she can stop if she needs to. She will only go to class if she can find an aisle seat in the back row so she can leave should she have another panic attack. She avoids any situation where she might feel out of control or where she might be embarrassed by having another panic attack.
Panic attacks are so uncomfortable that some people attempt to avoid situations where a person might feel trapped or where help might not be readily available. People who become agoraphobic have become so afraid that they might have a panic attack that they narrow their lives down to places and experiences where they believe they won't be out of control or without the emotional supports they need to get through it. Some people become so afraid that they never leave their own homes or they require the reassurance of having a trusted person with them whenever they venture out.
Case example: Debbie is 36 and lives with her ailing mother. Over the years, her life has become more and more centered on the house and her mother. After having a few panic
attacks, she became so afraid to leave the house that she was unable to keep her job. She can only go out now if her mother or sister go with her. In her efforts to avoid panic attacks,
Debbie has developed agoraphobia.
Chronic Worrying/Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal range of anxiety most people experience. People with this disorder usually expect the worst and worry excessively even when there are no signs of trouble. Worries can be about money, health, family, work, or more mundane issues like chores, car troubles, or being late for appointments. Those with GAD are unable to relax and often suffer from insomnia. Many people with GAD also have physical symptoms such as fatigue, trembling, muscle tension, headaches, diarrhea or constipation, irritability, or hot flashes. Difficulty concentrating, restlessness, fatigue, and difficulty with sleep are often part of the picture. Managing the normal demands of a job, relationships, and every day life become more and more difficult.
Case example: Amy, age 38, is a worrier, She is restless, irritable, and has difficulty concentrating. She doesn't like that she worries so much and isn't always sure what it is that she is worried about. She can't let her husband or children leave the house without making them call her regularly to reassure her that they are okay. Her husband is growing weary of her fretting, and her children can't understand what the fuss is all about. Their impatience with her only makes her worry more.
Many people can relate to superstitious beliefs or being "obsessive" about cleanliness or safety, but obsessive-compulsive disorder (OCD) is when these beliefs and behaviors begin to interfere
with one's life in that it takes up more than an hour each day and causes a significant amount of distress. OCD is characterized by persistent, uncontrollable and unwanted thoughts,
images, or impulses (obsessions) and routines or rituals to prevent or get rid of these disturbing thoughts (compulsions). Obsessions are not the same as everyday worries in that oftentimes
obsessions have little or no basis in terms of realistic probabilities of harm. Fears of contamination, fear of having harmed oneself or another, and immoral thoughts along with the need to
have things "just right," are common obsessions. Common compulsions include washing, checking, repeating, counting, arranging, hoarding, or praying. The compulsions are different from
addictions such as gambling or drinking in that the obsessions do not provide pleasure but rather are performed to provide relief from the obsessions.
OCD differs from the other anxiety disorders in that there is a significant amount of information to suggest that OCD is a brain-related disorder that makes it difficult for the mind to let go of thoughts or urges. Dysfunction in certain brain structures have been implicated in the development of OCD. These structures are responsible for generating normal impulses and urges and also have a built-in mechanism for these thought and urges to go away. In OCD, it seems that the brain is overactive in generating thoughts, images, and impulses, and furthermore, like an itch that won't go away, the mechanism that tells us, "Your hands are clean, you can stop washing," or "The stove is turned off you can go to work now," does not function properly and does not get triggered. Insufficient levels of serotonin also appears to play a significant role in the development of OCD. Therefore, antidepressants that increase levels of serotonin can result in significant improvements in OCD symptoms.
Some people will ask, "If OCD is a brain-disorder, then is medication the only treatment?" The answer is a pretty solid, "No." Studies have consistently found that cognitive-behavioral therapy can lead to significant reductions in OCD-related symptoms, similar to improvements with medications. More compelling is the evidence through brain scans that show that improvements with cognitive-behavioral therapy lead to similar brain changes as improvements with medications. Therefore, regardless of whether it is in the body or the mind (and I would argue there is no distinction between the two since the mind is the brain which is the body), both therapy AND medications are equally effective. I believe that psychotherapy is important in that it teaches the individual specific ways of coping with the OCD especially as the symptoms often wax and wane throughout life.
The OCD foundation provides thorough information on OCD, its causes, and its treatments. Click here for the OCD Foundation website.
Case example: Bert is 40 years old and works on an assembly line in a brush factory. He is terribly afraid of being contaminated with germs. He avoids shaking hands with others, he won't eat in the cafeteria, and he has trouble leaving the bathroom because he isn't sure he has washed his hands well enough. His hands are often cracked and bleeding from the excessive washing and excessive use of antibacterial solutions.
Specific phobias refer to intense fears about particular objects or situations where the fear is so great that it interferes with an individual's life functioning. For example, a fear of
airplanes is not a problem unless you are compromising your own happiness or your job functioning because of this fear. Common fears include fears of natural environment (storms, high cliffs,
ocean), animals (dogs, insects, horses, etc.), blood and injections (usually triggered by seeing blood or an injury or thought about getting an injection or having a medical procedure), or situations
(tunnels, bridges, elevators, flying, enclosed places, etc.).
Case example: Hannah, age 55, was in a major car accident 20 years ago during a cross country trip. Ever since, she has been unable to drive on major highways. Although she does drive, she goes to great lengths to travel only on back roads and scenic routes. She is able to go where she wants to go but it often takes much longer to get there than it has to.
What external situations cause stress?
People often become aware of stress when they begin to experience the physical symptoms associated with excessive stress such as muscle tension, headaches, insomnia, or high blood pressure. Certain situations can make people vulnerable to stress such as major life events (death of family member, marriage, retirement, pregnancy, loss of job, divorce, etc.) and daily hassles (traffic, bad weather, relationship conflict, job stress). There is some research evidence that suggests that the cumulative effect of minor daily hassles can have a greater impact on our physical and emotional well-being than even major life events.
What internal situations cause stress?
Though external situations can leave us vulnerable to stress, it is ultimately our interpretations of events that create the experience of stress. For example, when confronted with an abrasive co-worker, Jim might think to himself, "I can't handle this. This always happens to me. Nobody understands me," whereas Sally might think to herself, "Developing a way to work with abrasive co-workers is a good interpersonal challenge. How should I approach this situation? At least I know it's only that one co-worker and that most of my other co-workers are fun and supportive. I'll talk to my friend Kerry and see what she thinks would be a good approach."
What's the difference? Sally feels a sense of challenge from this even whereas Jim feels a sense of threat. Sally also has a sense of having control over effecting change in this situation, is optimistic about her ability to confront this challenge, puts the event into perspective and sees it as a specific event rather than a global situation, and feels a sense of social support. These factors are just some examples of how our interpretations of events can affect how much stress we experience.
Why is it important to manage stress?
Stress can produce uncomfortable physical symptoms such as headaches, muscle tension, insomnia, or stomach distress. Stress can compromise your immune system functioning leaving you vulnerable to illness and infection. Stress can lead to high blood pressure which can lead to heart problems. Stress can lead to unhealthy behaviors such as not eating or sleeping well or increased alcohol or cigarette use.
How can therapy help?
Cognitive-behavioral therapy can help you build resilience to stressors. Resilience refers to the body and mind's ability to withstand stress. By targeting the thoughts and interpretations that lead to stress, you can build resilience of mind. By targeting maladaptive behaviors and developing the ability to calm your body, you can build resilience of body. Biofeedback can assist you in learning about your body functioning so that you can develop control over seemingly automatic processes such as heart rate and tension. Mindfulness meditation can help increase awareness and appreciation of the present moment, improve clarity of thinking, and calm physiological arousal. Self-hypnosis strengthens the mind's ability to use relaxation and imagery to calm the body.
The techniques utilized for anxiety disorders are similar to those used in stress management, and therefore, my training and experience in the cognitive-behavioral treatment of anxiety disorders is also applicable to stress management. Furthermore, I have been running a highly successful stress management group at UC Irvine for the past four years and received additional training at Harvard Medical School in the use of biofeedback, relaxation, and hypnosis (along with cognitive-behavioral treatment) for stress management. As with anxiety treatment, the techniques and strategies that I use are straight-forward and effective strategies that can be found in self-help books, but clients have found the personal coaching of therapy to be effective in helping them fully incorporate these strategies into their life for long-term changes.
Click here for more information on stress management.
WEIGHT MANAGEMENT/BODY IMAGE SATISFACTION
What is body image satisfaction?
Body image satisfaction refers to the way in which you feel about your body, whether it be related to weight or physical appearances in general. American society places great importance on physical appearances, especially for women, especially for weight. Sometimes by changing your physical appearance, you can change your body image. Other times, no matter how much makeup you put on, how much weight you lose, or how much surgery you get, you might continue to struggle with feeling good about yourself.
What are the causes and effects of a negative body image?
Body image is influenced by a myriad of factors such as self-esteem, cultural ideals of beauty, peer influence, media images, and parents. Positive body image refers to feeling comfortable and confident in your body, whereas a negative body image refers to a distorted body image (e.g., feeling overweight despite being medically underweight), self-consciousness, feeling awkward in your body, and feelings of shame related to your body. Negative body image can lead to unhealthy dieting, anxiety, depression, low self-esteem, and eating disorders.
How can therapy help?
Having worked in college counseling centers, I have had much experience helping women develop healthier body images and healthier lifestyles. I also wrote two chapters on the body image attitudes of Asian Americans for the Body Images Handbook, a comprehensive review of the broad topic of body image and a textbook for Asian American Psychology. In addition, my fellowship at Harvard Medical School's Behavioral Medicine Program offered opportunities to treat eating disorders and run weight-management groups.
Therapy does not offer any magic solutions but can offer new strategies, new information, and a source of motivation and support. Cognitive-behavioral therapy can help shift your perspective on food, weight, and your body. Developing a positive body image requires shifting the focus of attention to those aspects of your body that you do appreciate, accepting the way your body is for now, and challenging unhealthy social and cultural messages regarding your body. In weight management, changing your eating and exercise patterns is much easier when you do it because you love and appreciate your body, rather than because you loathe and are ashamed of your body. Negative self-criticism is just not helpful in motivating people to change.
Shifting your behaviors is also an important component of treatment. Learning about healthy eating and healthy exercise and then incorporating it into your daily living is another challenge in developing a healthy body and body image. There are many different strategies that can be personalized to you and your situation, and we would work together to develop what would be the best course of action for you.
What is depression?
Experiencing ups and downs in your mood and activity level are part of the natural fluctuations of the life process. In depression, though, the intensity and duration of sadness may seem out of proportion to the external situation. The symptoms of depression can be:
* Emotional: Sadness, hopelessness, helplessness, guilt, emptiness, worthlessness, feeling disconnected from others
* Cognitive: Difficulty thinking or concentrating, global negativity, suicidal thoughts
* Behavioral: Crying, loss of interest or pleasure in usual activities, withdrawal from social activities
* Physical: Changes in appetite, insomnia or oversleeping, vague but chronic aches and pains, lack of sexual interest, fatigue, restlessness
Depression is often referred to as the "common cold" of psychological problems because it is the most common psychological disorder. As many as 1 in 4 women and 1 in 8 men experience depression at one point in their lives. Therefore, most mental health professionals will have had some experience working with depression.
How is a mood swing different from bipolar disorder?
Many people who experience symptoms of depression can have moments where things seem okay, but then they find themselves falling into a depressed mood again. This cycle between feeling "okay" and feeling depressed can be experienced as a mood swing. These types of mood swings are different from the the extreme fluctuations seen in bipolar disorder. During the "up" period, those suffering from bipolar disorder do not just feel "okay" but rather experience manic episodes which are characterized by extreme euphoria, excitement, physical energy, inflated self-esteem, and rapid thoughts and speech. Manic episodes are often followed by incapacitating depressive episodes.
How can therapy help?
My work in community mental health clinics, substance abuse treatment centers, medical hospitals, and college counseling centers has certainly exposed me to many levels of depression due to many different causes. My postdoctoral fellowship at Harvard Medical School's Behavioral Medicine program focused on combining cognitive-behavioral therapy with psychodynamic therapy in treating depressive disorders. Research consistently shows that cognitive-behavioral therapy can be just as effective as medications and can also lead to longer lasting improvements. Cognitive-behavioral therapy focuses on shifting maladaptive and negative thinking patterns and developing meaning in one's life. Behaviors that are targeted may be increasing the number of pleasurable events in one's life, mild exercise, improving social supports, or meditation. The psychodynamic components focus on understanding what situations or emotional experiences may have left one vulnerable to depression. Insight into the causal factors can also lead to symptom improvement.
Click here for more information on depression from the National Institute of Mental Health
What to call it exactly? Some people come into therapy, not because of specific problems or specific disorders, but because they are seeking to understand themselves better, perhaps so that they can lead a more meaningful life, build healthier relationships, feel better about themselves, or make better choices in their future. For some clients, they start therapy for specific problems or specific disorders, but once those issues are manageable and since we've already developed a therapeutic relationship, we agree to shift the focus of therapy to more global issues such as self-development, self-esteem, self-understanding, self-identity, self-improvement....call it what you will. This often entails a more thorough understanding of family dynamics past and present, family patterns passed on through generations, childhood experiences, the impact of cultural values that are imposed on us, clarification of goals and values, or prioritizing commitments to create a more meaningful life. The process and goals for therapy are mutually determined by both client and therapist.
Habit change refers to changing any maladaptive, intrusive habit such as nail biting, skin picking, hair pulling, overspending, procrastination, unhealthy eating, or other unhealthy habits. Habits to be changed are those habits that interfere with your emotional and physical well-being or cause problems in your relationships, school, or work.
How can therapy help?
Cognitive-therapy can be an effective way to change a habit. The cognitive component entails identifying the thoughts and emotions that often precede an episode of nail biting, skin picking, hair pulling, etc. By managing these thoughts and emotions in a more effective way, the need to engage in the habit decreases. A typical thoughts might be, "I just NEED to pick at my skin," or sometimes people are not even aware of having any thoughts at all and only become aware of their thoughts afterwards ("Why did I do this again? I'm so ashamed of myself.") Becoming aware of the thoughts and emotions that actually come before the habit takes much time and practice. Behaviors might include learning to tolerate that feeling of discomfort or distress that comes with wanting to engage in the habit and not being able to. Other behaviors may include limiting contact with triggers that seem to precipitate the habit or rewarding oneself for not engaging in the habit. Another strategy that is often important are stress management techniques. Stress is a common trigger for many different habits, and therefore, lowering overall levels of stress can help decrease the need to engage in the habit. As with any program for change, combating long-standing habits, becoming aware of automatic thoughts and emotions, and implementing an effective program of change takes time and effort. Therapy does not provide magical solutions but rather provides practical solutions that you may already be aware of but have been unable to put into practice. Therapy can also support you as you embark on this challenge, help you deal with the emotions related to the habit, and motivate you to change.
Perfectionism refers to having excessively, unreasonably high standards that, when not met, lead to harsh self-criticism and feelings of failure. Those suffering from perfectionism find that their perfectionistic standards lead to significant distress leading to stress, anxiety, physical symptoms (ulcers, headaches, aches and pains, etc.), or depression. In addition, perfectionistic standards tend to be debilitating, discouraging, or counterproductive. Perfectionism is markedly different from having healthy high standards. With healthy high standards, an individual does not feel distress but rather feels a sense of challenge or excitement because reasonable standards are set and the probability of meeting those standards are pretty good. In addition, with healthy high standards, an individual feels motivated to achieve their best rather than debilitated by the pressure to be perfect.
How does perfectionism develop?
Perfectionism is not necessarily bad, but rather, it is a strategy often developed early in life that was once effective but eventually begins to cause too much distress and impairment. Some theorists believe that perfectionistic standards are developed via harsh and critical standards set by parents that are then internalized by the children. Perfectionistic behaviors may also be modeled by parents and picked up by children. In addition, our society rewards those who strive for perfection while criticizing those who feel that good enough is good enough. Perfectionistic behaviors are maintained because sometimes it can lead to powerful rewards such as the admiration of others, high scores on exams, landing a business contract, or more money.
The problem is that perfectionism may begin to interfere with life happiness, social relationships, educational attaintment, or job performance. With perfectionism, people inevitably hit a wall where their perfectionistic standards become more debiltating than facilitating. A common phenomenon associatied with perfectionism is procrastination. The pressure to be perfect generates so much anxiety that people often choose to avoid the situation rather than confront the possibility of failure. At this point, people begin to recognize that their healthy high standards have somewhere along the way turned into debilitating or distressing perfectionism.
How can therapy help?
Perfectionism can be seen as a habit. In therapy, we can begin to generate an understanding of how this habit developed and how it can be both helpful and harmful and decide which components to keep and which to change. In addition, cognitive therapy techniques have been found to be helpful in shifting perfectionistic attitudes. This entails monitoring perfectionistic thoughts and then developing alternative perspectives. For example, a typical perfectionistic thought might be, "I have to get this proposal right before I present it at the meeting tomorrow," which is followed by the behavior of writing and re-writing the proposal over and over again throughout the night. A strategy may be to develop an alternative thought such as, "I've been working on this proposal in some form over the last week. I'm sure I've done a pretty good job. If there's any mistake, I'm certain there won't be any serious consequence. I've done propsoals like this before and they were well recieved." Changing perfectionistic attitudes may also require changing one's priority, for example, prioritizing your physical health and happiness over a perfect proposal. This all may sound easy enough, but if you suffer from perfectionism, you probably already can tell that change will take much effort and time. Therapy may not offer you anything magical or new, but it may offer you support, motivation, and a systematic program for change.
One of the most wonderful aspects of living in Southern California is the cultural diversity. Many people from countries around the world immigrate and settle in the area so that by now some ethnic communities have been firmly established in California for several generations. Many people from ethnic minority groups, at some time or another, go through a process of ethnic identity development. This process is characterized by thoughts, feelings, and behaviors related to the question, "Who am I?" For individuals from ethnic minority groups, this question often involves how they feel about their own ethnic identity.
There are many different reasons why one might start thinking about their ethnic identity. Perhaps it was a racial comment another person made, perhaps it is a gradual understanding that ethnicity and how you look may at times impact how others react to you (whether positive or negative or neutral), or perhaps it is triggered by life changes such as separating from parents, starting a family, or moving to a community with a different ethnic composition than one you're used to. Ethnic identity development does not necessarily have to be a confusing or torturous process and there is no one right way of feeling about your ethnic identity. Instead, it is a process of understanding more fully who you are and what that means to you.
Cross-cultural issues do not necessarily have to be the focus of one's thinking but can still impact one's life decisions and psychological functioning. For example, general life issues (transitioning to college, changing jobs, getting married, raising children, etc.) may be influenced by cultural factors such as cultural values, parental values and expectations, expectations of the ethnic community, balancing your needs and values with the family's needs and values.
How can therapy help?
Therapy can help you develop a better understanding of yourself, the influences in your life, and how that impacts your future choices. Therapy can also help you through experiences related to racism and discrimination by providing a place of support and by also helping you to develop strategies to be able to make decisions and attain life goals without feeling constrained.
For some individuals, value conflicts contribute to distress around life decisions. Parents may have been raised with different cultural values, they may want their children to follow their values, and the children may be torn because a part of them wants to follow the cultural values of their traditional ethnic group and another part of them wants to follow the cultural values they developed as Americans or American residents. Therapy can help clarify these issues so that these individuals feel they are making more informed decisions about your life.
Even if cultural issues are not the focus of therapy, it will be important to have a counselor with cultural sensitivty. Cultural sensitivity has been identified as an important component of effective psychotherapy. According the the U.S. Department of Education, a culturally sensitive individual is one who understands each individual has unique value system based on upbringing and culture, values diversity (in ethnicity, sexual orientation, religions, etc.), is aware of her own cultural biases, can work effectively in different cultural contexts, and does not assign values (better or worse/right or wrong) to cultural differences. For ethnic minority or international clients, these qualities can be quite important.