Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an evidence-based goal-oriented approach that helps identify and change destructive or disturbing thought patterns that affect our emotions and behavior. Sometimes described as rewiring the brain, CBT uses a range of both cognitive and behavioral strategies to overcome negative thinking, develop healthy habits, and create new ways of thinking that improve quality of life.
Theoretical Basis for CBT
Cognitive theory suggests we filter experience through our existing thoughts, which affects how we make meaning of our lives. Therefore, our thoughts and feelings play a fundamental role in how we act. CBT is based on the theoretical understanding that some forms of emotional distress stem from core beliefs we developed about ourselves due to our life experiences. These core beliefs, especially negative ones, can churn out negative, hurtful self-talk about ourselves and others.
By working to understand where these thought patterns come from, we can learn strategies to replace harmful thoughts with more realistic or positive ones. When our thoughts improve, our behaviors are more likely to improve, and so are our feelings. In fact, these three processes are closely linked in what is referred to in CBT as the cognitive triangle.
Session Expectations
CBT gets down to the root of what stresses us out by focusing on and reframing the way we think. When we accept that we can’t control the world around us, we can change how we interpret and deal with things in our environment.
In a CBT session, clients learn to discriminate between their own thoughts and reality. They discover the influence their thinking has on their emotions and actions, and how to recognize, observe, and monitor their thoughts.
CBT can be an umbrella term for the many different therapies that challenge limiting beliefs and change negative thought patterns, so a session can include strategies like guided discovery, cognitive reframing, activity scheduling, behavioral experiments, exposure therapy, role playing, relaxation and stress management techniques. Therapists may also encourage patients to keep a journal of limiting thoughts and track the progress/effects of healthy new habits.
What about ERP (Exposure and Response Prevention)?
Exposure and response prevention is a subtype of CBT that can be used to treat obsessive-compulsive disorder (OCD). Because OCD is a highly specific type of anxiety, ERP was created to help treat symptoms, manage anxiety and regain a healthy sense of control. Specifically, ERP focuses on helping clients return to their previous daily functioning without feeling burdened or controlled by their obsessive thoughts and/or compulsive behaviors.
ERP works by strategically setting goals, developing healthy ways to manage symptoms of anxiety, and setting up an exposure hierarchy which helps the client resist engaging with their obsessions or compulsions.
ERP is often used in conjunction with other treatments including but not limited to traditional CBT, medication management, safety and risk planning, and mindfulness skills.
Why Choose CBT?
When a person suffers with psychological distress, the way they interpret situations becomes skewed, which has a negative impact on the actions they take. CBT helps break these patterns and can be used to help treat addiction, anger issues, anxiety, bipolar disorder, depression, eating disorders, panic attacks, personality disorders, phobias, problems with stress, and more.
EMDR
Eye Movement Desensitization and Reprocessing therapy is a research based, proven method to help people recover from trauma. EMDR uses bilateral stimulation to help patients reprocess trauma and stress by improving communication between the amygdala (where we process fear and emotion), the hippocampus (learning, memory) and the prefrontal cortex (analyzes and controls emotion and behavior).
Theoretical Basis for EMDR
Our brains are built to respond to stress as part of our natural fight, flight or freeze instincts, but adverse life experiences and traumatic events lead to disruptions in our neural networks that affect how we process and store memories. This is why people often feel “frozen” in time, continuing to re-live painful memories, cognitions, and emotions, feeling haunted in the present by what has happened in their past. EMDR can be used to treat a range of challenges including PTSD, depression, anxiety and grief.
Session Expectations & Why Choose EMDR Therapy
EMDR does not require talking about the distressing issue in detail like other models of therapy. In an EMDR session, the therapist works with you to identify events in the past that have created the problem, present situations that cause distress to continue, and key skills or behaviors that will improve well being in the future. When the client brings to mind emotionally disturbing memories, the therapist encourages the biological brain to reprocess memories through stimuli like eye movements, auditory tones, and tactile taps. Instead of relying on therapist interpretations, EMDR restores the body’s natural mechanisms for healing, similar to the way the body is physiologically organized to repair itself when injured. The memory of trauma or stress doesn’t go away, but EMDR improves our ability to manage our fight, flight or freeze response, increasing healthy integration and reducing distress.
Gottman Method – Couples Counseling
The Gottman Method is an approach to couples therapy that addresses frequent conflict and poor communication. This approach can help emotionally distanced couples on the verge of separation, and can provide specific skills for challenges related to parenting, finances, and sexuality.
The Gottman Approach includes a thorough assessment of the couple’s interactions and integrates research-based interventions as part of relationship coaching. Practitioners help couples strengthen their relationships in three primary areas: friendship, conflict management, and creation of shared meaning and values. Couples learn to replace negative conflict patterns with positive interactions and to repair past hurts by strengthening closeness and deepening emotional connections.
Theoretical Basis for The Gottman Method
Gottman and Levenson did decades of research on relationships and discovered that couples tend to have the same conflict discussions about 80% of the time. They also found that 69% of relationship problems are perpetual and never get resolved due to personality differences between partners, but individuals can improve their ability to disagree effectively and manage conflict in ways that increase intimacy. After numerous replications of their studies, they were able to predict divorce with an average of 90% accuracy.
Keeping these statistics in mind, The Gottman Method was founded on the idea that if we can predict with great reliability the factors that would lead to a divorce, we should be able to tailor treatment to address those crucial factors and how they show up in relationship dynamics.
Session Expectations
Relationship Coaching encourages individuals to tune in with themselves and each other so that shared values and goals can be identified and nurtured through better conflict management and conversational techniques. Couples can expect:
- Comprehensive questionnaires at the beginning of therapy to assess specific areas of relationship strengths, areas for growth, and shared goals
- Feedback about current status of relationship based on assessment and a plan for addressing areas that need improvement
- Guided readings, exercises and homework assignments in between sessions
- Communication coaching. The therapist will observe communication dynamics in session while intervening as needed to model effective communication skills. These conversations will help you as a couple understand why and how certain patterns have developed in your relationship.
Keep in mind that couples sessions will also focus on attachment styles and the role that attachment plays in relationship dynamics. Learn more about attachment theory below.
Attachment Theory
Attachment theory is based on observational research that indicates a parent’s treatment of their child affects that child’s development, feelings of security, and ability to form healthy habits and relationships when that child becomes an adult. Types of attachment include:
- Secure
- Anxious
- Avoidant
- Disorganized
Theoretical Basis for Attachment Theory
Attachment theory stems from decades of research and experiments on the connections and behavior between a mother and child, across species. Research suggests that failure to form secure attachments early in life can have a negative impact on behavior throughout life, whereas children who are securely attached as infants tend to develop stronger self-esteem and better self-reliance as they grow older. These children also tend to be more independent, perform better in school, have successful social relationships, and experience less depression and anxiety.
How Attachment Theory Therapy Works
In therapy, working from an attachment framework allows the therapist to carefully assess the type of attachment style, engage the client in discussing how this style shows up in their life, and apply behavioral and emotionally focused techniques to prevent the attachment style from interfering with intimacy in a harmful or negative way.
Learning about our attachment style in therapy can help us understand how we form relationships in intimate situations such as:
- Friendships
- Casual dating scenarios
- Polyamory
- Committed romantic partnerships and marriage
For instance, someone with an anxious attachment who is trying to date, may unconsciously seek out avoidant partners who activate their attachment system. Therapy can help you learn how to cope with your anxiety while also seeking out a secure partner who is able to meet your needs and not trigger your attachment system in an unhealthy way.
Mindfulness Strategies
Mindfulness is often used as an umbrella term that encompasses practices of stress reduction, relaxation, body scans, and meditation. At its core is the skill of observing our thoughts, feelings and behaviors. When we become skilled at observing, we are able to reduce our tendency to over-identify with them and become less attached to our negative or self-critical thoughts.
In taking an observer stance, we can transform the way we interact with our bodies, our minds and our surroundings. Through mindfulness, we learn skills to help us drop into the present moment, become more centered, and learn to give less weight to negative thoughts and sensations.
Theoretical Basis for Mindfulness
The basis of all mindfulness practice is acceptance. Many of us push away uncomfortable feelings, thoughts or experiences due to the belief that we cannot tolerate them. But by practicing skills such as observing, describing and participating, we can finally learn to let go of what we cannot control and embrace what is. When we master the art of being nonjudgmental, we are able to feel safer in our bodies, at peace with our wide range of emotions and, most importantly, more connected to other people.
The benefits of mindfulness are most evident in Dr. Jon Kabat Zinn‘s research and widespread library of meditations. As the founder of mindfulness-based stress reduction and a renowned teacher and author, Zinn has widely popularized and demonstrated efficacy in using this practice to cope with stress and physical ailments. In one of his studies, 22 people diagnosed with anxiety disorders participated in an 8-week outpatient mindfulness meditation group for stress reduction. They showed clinically and statistically significant improvements in their symptoms of anxiety and panic. The 3 year follow up for the study concluded that intensive and time-limited group mindfulness meditation yields long-term beneficial effects for anxiety.
Session Expectations
Because the center focus of mindfulness is becoming an observer, skills focus on non-judgmentally paying attention to thoughts and feelings while learning how to keep from over-identifying with them. Sessions may include a combination of traditional meditations, walking meditations in nature, body scans, breath-work, noting thoughts and feelings as they come and go, and perhaps visualization. Mindfulness can help enhance any state of being, and it can be tailored to the individual.
Internal Family Systems – Parts/Inner-child Work
Internal family systems, parts work, and inner child work refers to therapeutic conversations to help people get in touch with the subconscious parts of themselves that may be influencing emotions and behavior. We know that self love should help us feel better, but it can be hard for many to experience self love in an authentic way. If you’ve ever felt torn about a difficult decision, or felt like you have a harsh internal critic, or found yourself behaving differently with colleagues and friends than you would with your parents, IFS may be a helpful approach for you.
Theoretical Basis for IFS
The Internal Family Systems Model or IFS, is an integrated, evidence-based approach to therapy developed by Richard Schwartz in the 1980s. This approach uses systems thinking and visualization to determine the discrete sub-personalities, viewpoints, and responses to stress that exist within us. Schwartz’ philosophy is that each of our inner parts contains valuable insights and qualities, and that our core Self knows how to heal and act from compassion to self and other when the mind is in harmony.
Session Expectations
In this work, we’ll create greater understanding about the root causes of tension that you may experience emotionally due to memories associated with previous experiences. During a session, I’ll invite you to close your eyes and focus inward on the parts of your personality that may be hurting. We’ll work toward a state of inner clarity that will help you build understanding of what drives reactivity toward other people and experiences based on your history. The goal of our sessions will be to develop a strong sense of self that helps calm and transform troubling inner voices to more effectively process feelings of vulnerability or inadequacy.
How IFS Therapy Works
This work helps with trauma, self esteem, and negotiating the inner critic.