About the Treatment
We work with adults and sometimes with older adolescents. We provide individualized psychotherapy, tailored to your specific needs. We do not conduct relationship or family therapy, but we welcome you to invite partners and / or family members into sessions to support you in your therapy process. Sometimes we might ask you to include a partner or family member in a session so that we might gather further information about your situation, and/or provide education to your loved ones about your condition and its treatment.
Cognitive-Behavioral Therapy (CBT)
CBT typically focuses primarily on thoughts, feelings, and issues in the present and how to cope effectively. The “cognitive” portion of the therapy refers to discussion of thoughts and how to challenge, modify, or ignore unhelpful, upsetting thoughts. The behavioral portion of the treatment addresses how a person’s activities (or avoidance), interactions, and environment might be contributing to distress. Treatment strategies include education about the nature of thoughts, feelings, and body sensations; problem-solving; assertiveness practice; acceptance of one’s feelings and internal experience; and often something called “exposure” (see below).
CBT usually requires “homework” to be completed between therapy sessions. The therapist and client work together to design useful homework exercises for practice. Sometimes the treatment involves reading or using a workbook in conjunction with the therapy sessions.
Exposure and Exposure with Response Prevention (ERP)
Exposure is a strategy used to help a person “face fears.” Often this involves constructing a hierarchy of situations or experiences that trigger feelings of anxiety in the client. Starting with the least anxiety-producing tasks, the client gradually practices “facing” the situation (that’s the “exposure”) until the anxiety decreases. For example, someone with high social anxiety might practice walking through a mall and making brief eye contact with strangers at first, until this feels easy; later, s/he might practice starting conversations with others. Someone having panic attacks might practice driving in different settings, or doing exercises that produce uncomfortable (but nondangerous) body sensations.
The goal of exposures is two-fold: 1) To experientially demonstrate that the feared consequences either do not occur, or are manageable to the extent that they do occur. 2) To build confidence that one can tolerate and accept the body sensations and general experience of feeling afraid, which is a normal, inevitable, and temporary (but recurrent) part of living.
In the case of Obsessive Compulsive Disorder (OCD), exposure is accompanied by "response prevention." This means refraining from compulsions (rituals) that interfere with being able to learn that a situation is not dangerous (or that the level of risk is tolerable) and that anxiety will pass without the need for compulsive behaviors.