What to Expect

To help demystify the process of psychotherapy, I have provided a thorough explanation of some of the major components of therapy as it typically occurs in my practice. 

• Evaluation
• Explanation of the General Process 
  • Case conceptualization
  • Goal setting
  • Overall therapeutic approach
  • Practice, practice, practice
  • My style
  • Medical Evaluation
• Ending Therapy

EVALUATION

Information gathering

The first session or two will be used as an initial consultation. During the consultation, I will gather information about what brings you into therapy. For those with anxiety, we will specifically identify the triggers, thoughts, physical feelings, and behaviors associated with the distress you are experiencing. I will also ask general questions regarding your social relationships, psychological and physical health history, and social/occupational functioning.

Forms

We will also have to go over forms that explain treatment, payment, and privacy and that release necessary information from relevant providers. Any questions and concerns regarding treatment will be answered fully at this time.

Referrals

In the case that I find that you would benefit most from a treatment approach that I do not provide, I can assist you in finding more appropriate treatment providers.

If requested, I will be able to provide your new provider with information from our consultation session. You are under no obligation to continue therapy at any time.   

EXPLANATION OF THE GENERAL PROCESS

Case Conceptualization/ Treatment Plan

The information I gather during the evaluation will be used to develop a case conceptualization, which is an initial understanding of the problems you are presenting with and factors that may contributing to your distress.

The conceptualization is used to help formulate a treatment plan which will include explanations of the treatment approach and expectations for treatment.

As the therapist, I will provide expertise in psychological strategies, whereas, as the client, you will provide expertise regarding your own psychological functioning, life experiences, preferences, and types of strategies that have worked for you in the past.

The particular treatment approach will be tailored to your own individual needs and will vary depending on your presenting issues and concerns. 

Goal Setting

My perspective is that emotional distress, whether in the form of mild unease or as an occasional anxiety attack, is likely to come and go throughout life and is a normal part of excitement, growth, and change. Therefore, the goal of eliminating emotional distress is not possible nor is it recommended.

Rather than eliminating distress completely, a realistic goal would be to reduce the intensity, frequency, and duration of anxiety attacks or depressive episodes so that even if they do occur, they will not be as severe, will not happen as often, and will not last as long as previous episodes.

To reduce the intensity, frequency, and duration of severe emotional distress involves changing your relationship with your emotions so that you are able to accept, manage, and face moderate levels of distress in a way that it no longer interferes with your valuable life experiences.

Rather than just focusing on reducing emotional distress, the goal should also include being able to approach situations that were previously avoided. The goal is to not allow uncomfortable emotions to limit your ability to live life to its fullest. You can ask yourself, “If I learned to live with these emotions on some level, what would I be able to do?”

For some clients, the goal might be personal growth, which can include being able to manage intense emotional distress, but often focuses on the questions of: Who am I? What factors have shaped who I am today? What type of person do I want to be? What healing needs to be done for me to feel whole? 

As part of setting goals, it is important to identify values that give life meaning. Meaning can come from family, intimate relationships, parenting, social life, work/career, education, leisure activities, spirituality, community life, or heath goals. Identifying those areas that give life meaning can help increase motivation for treatment and give perspective on how emotional distress interferes with living a fuller, more meaningful life.

Overall Therapeutic Approach

I use an insight-guided cognitive behavioral approach with an emphasis on mindfulness and acceptance-based techniques.

Insight-guided:

The therapy is insight-guided in that treatment involves increasing self-awareness of factors that may be contributing to your experience of distress. Contributing factors may be biological vulnerabilities, past experiences, family relationships, personality styles, societal values, spiritual beliefs, or external stressors.

If relevant, I will also provide information about the scientific understanding of the development and maintenance of anxiety disorders (see section on Obsessive Compulsive Disorder for an example of a thorough description of a scientific understanding of a particular disorder) or any specific psychological issue you may be struggling with.

The goal is to develop an understanding what has contributed to your experience of suffering, how it is maintained, and ways you have learned to cope with it. Insight is important because:

• It can help reduce feelings of helplessness that are often associated with intense emotional distress
• It can help prevent the reoccurrence of anxiety or depression by developing awareness of the stressors, situations, and coping behaviors that can lead to problematic anxiety
• It can lead to a sense of relief and hope
• It can lead to self-compassion and understanding which is an important part of the healing process

Insight, though, is often insufficient for reducing ongoing suffering. This is because emotional distress has a self-perpetuating mechanism where, once it is established, it is able to maintain on its own, regardless of how it developed. 

Cognitive behavioral:

My therapeutic approach is also cognitive behavioral, meaning that the focus is on recognizing ways in which thoughts and beliefs and coping responses might be contributing to emotional distress.

For example, with anxiety, your brain perceives danger and becomes rigidly focused on generating thoughts, feelings, and behaviors that are meant to protect you from imminent harm. The problem is that these automatic anxious responses can lead to greater problems and greater distress if there is no flexibility in your responses, such as when there is no immediate danger but your brain continues to behave as if there is.   

Though our brains may generate automatic thoughts and reactive responses to emotional distress, with time and practice, we are also capable of training our brain, changing neural connections or brain activity, so that alternative perspectives and new habits become part of this response system.

Old patterns of responding are not necessarily bad and do not necessarily have to be eliminated, but rather you are developing a wider range of possibilities from which to choose from. 

The ultimate goal of therapy is to enhance flexibility in thoughts and behaviors to create a more flexible emotional system. There are many different cognitive behavioral strategies to help with this process (See section on CBT).

Mindfulness and acceptance-based: 

My therapeutic approach is mindfulness and acceptance-based in that throughout the therapy there is an emphasis on observing your emotional response as it unfolds without judgment and without immediately reacting. The reality is that the more you to try to “control” or “destroy” your painful emotions, oftentimes, the stronger it will become, leading to greater suffering

Mindfulness refers to observing what you are seeing, feeling, and thinking in the present moment, observing with compassion and without judgment, which can help keep you from being swept away by your powerful and automatic emotional response. Being accepting and understanding of your emotions does not mean enjoying the experience or wanting it but rather seeing it for what it is in the moment, coming to terms with it, and riding the waves of emotion so as to soften its impact.

Mindfulness is an attitude that can be cultivated with time and practice and there are many exercises to help with the process of shifting your attitude and approach towards emotions.

Practice, Practice, Practice

An important component of treatment for long lasting change will be practice. Practice can mean reading more about topics related to your struggles, journaling and exploring your thoughts and feelings, or trying out suggestions meant to help you with your healing process.

Especially with anxiety, practice is necessary for rewiring the circuitry of the brain to make it more resistant to intense emotional distress, and some parts of the brain seem to learn best through experience, not logic or debate.

Emotion management is not meant to be a temporary change, but rather it is meant to be a life style change for life long change, and therefore, regardless of the strategy you decide to focus on, a more important aspect of treatment will be to consistently engage with the process of therapy. I firmly believe that it is what you do in between sessions that creates more lasting and effective change.

To help you with this, I will provide you with notes after each session that review the content of the session and include readings, exercises, journal prompts, and other suggestions that can help you engage with the therapy in between sessions. This can help transfer the content of the therapy session into your daily life.

My Style

Because there are specific strategies to be taught and practiced, my style in therapy tends to be active. This means that I will come to each session with a plan based on our last meeting while also taking into consideration your needs for the session. With anxiety in particular, there is a strong educational component where I will try to transfer my knowledge and skills to make you an expert on emotions.

Being active also means asking exploratory questions, providing feedback, and offering validation, support, and encouragement. I try to model for my clients the process of leaning into emotions with curiosity and compassion, minimizing judgment, and moving towards acceptance. 

Such an active approach may lead to a temporary increase in distress at the beginning, but with time, knowledge, support, and practice, your distress should begin to subside in the long run.

Therapy can be quite a challenge, but my job is to motivate, support, and coach you through the process. Do not worry if you do not feel prepared for such an active therapy, have doubts about the therapy, or have confusion over how to proceed. Part of therapy is addressing these concerns.

If at any time, you find that therapy is not progressing to your satisfaction or I feel that I am not the best therapist for your needs, I will do my best to provide you with referrals to other providers.    

Medical Evaluation

A medical evaluation is important to rule out any medical issues that may be contributing to psychological symptoms. A medical evaluation with a physician or a psychiatrist is also important for those with a complicated medical history, neurological problems, or an acute medical illness.

Consultation with a physician or psychiatrist may also help you decide whether medications would be helpful. Medications have been shown to be an important part of treatment for severe mental health problems such as schizophrenia, bipolar disorder, and psychosis, but other problems such as anxiety or depression may be effectively treated with or without medications.

Therefore, consultation with a medical or mental health professional who can discuss with you the costs and benefits of specific medications may help you decide whether medication is the right choice for you. A psychiatrist or physician will be the provider who ultimately decides whether a prescription is warranted. 

Click here for information regarding the use of medications for the treatment of anxiety

Click here for information regarding the use of medications for specific anxiety disorders. 

ENDING THERAPY    

After you have started to develop effective coping strategies and have begun to experience a decrease in your distress, we will discuss the next step in therapy. Some clients find that the initial course of therapy is sufficient and are comfortable ending therapy so that they may continue to develop their skills on their own.

For others, therapy sessions can be spread out to once every other week or as needed. Many clients use their notes and the suggestions contained within to help carry the therapy over between sessions. Your needs will be assessed regularly to determine what is the best decision for you.

By the end of treatment, the hope is that you 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 old problems resurface or when life events present new obstacles, then all you need to do is call me to set up another appointment and continue to use therapy “as needed.”    

Some clients find that after the immediate crisis is resolved, there are other issues in their lives that they would like to address (relationships, communication, life goals, self-esteem, fitness, assertiveness, family issues, etc.) As the intensity of distress decreases, clients may find they are better able to tolerate other emotions that begin to emerge, can explore a wider range of their emotional lives, and are more confident in their ability to handle other challenges in life.

If you feel a good relationship has been established in therapy, it makes it a natural decision to continue working on different issues that will help you achieve an optimal quality of life. If therapy is continued in this fashion, reevaluation of treatment objectives will occur on a consistent basis. 

I do not see therapy as providing an easy “cure” for “sick” patients, but rather as a way of motivating and coaching individuals on how to use their own resources to the best of their abilities to grow, gain insight, and solve specific problems.