Cognitive behavioral therapy
Your mental state and sense of yourself in any given moment depends on the interplay of a) your thoughts, b) your feelings, and c) your behavior. Change one, and the others change as well. Really learning and integrating this into your life can be a powerful way of taking responsibility for your own mental health.
Cognitive behavioral therapy operates from this theory: if your emotions are causing you problems, for example in the form of anxiety or depression, you have the power to change the situation by changing your thoughts and behaviors.
Thoughts. We are inclined to trust the input of our brains. What we feel, hear, see, and smell, our knowledge of who and where we are…all of these are indisputable facts provided to us by our sensory organs and our brains. Thus, we are inclined to accept our thoughts as truthful and factual. When someone struggles with anxiety or depression, however, the input from the brain may not be accurate, and this may negatively impact your sense of self, your hope for the future, your current mood, and even your expectations for the future. Instead, cognitive therapy teaches clients to evaluate thoughts for their accuracy and helpfulness. Like any skill, it requires practice, support, and patience, but learning to separate yourself from your thoughts is one of the most valuable skills you can acquire over the course of your life.
Behaviors. Anxiety and depression are systems that maintain themselves and grow through changing your behavior. An anxious person may begin to avoid anxiety-causing situations, restricting his or her environment and creating more anxiety about pushing these self-imposed boundaries. A depressed person may give up on previous enjoyable activities, relinquishing things like hobbies and time with friends which might actually improve their mental health. Changing your behavior is a matter of “fake it ‘til you make it.” Dialectical behavior therapy calls it “opposite action.” If your thoughts are unhelpful, then what your mind is ordering you to do might be the opposite of what you need to do. Any success in therapy depends on your willingness to identify and change unhelpful behaviors. Its hard, but, with support, it can be done.
Recommended books for clients:
- Daniel Amen. Change Your Brain, Change Your Life.
- David Burns. Feeling Good.
- Jonathan Haidt. The Happiness Hypothesis.
- Matthew Walker. Why We Sleep.
Interpersonal neurobiology/interpersonal process method
These are not the same thing, but they overlap, so I’ve lumped them together. Interpersonal neurobiology, developed by psychiatrist Dan Siegel, teaches us that the mind grows within the context of our relationships. Healthy relationships, including a strong therapeutic alliance in mental health treatment, encourages the brain in its natural inclination towards “integration.” A lack of integration leads to symptoms of chaos or rigidity.
Some of this chaos or rigidity comes from early life experiences in relationships, especially with our caregivers. Our attachment to our primary caregivers in early life lays down a foundation upon which we build both our own self-concept and our ability to connect with others. Someone with a secure attachment recovers more easily from upsetting experiences and handles stress better. Someone with an insecure attachment struggles more with building healthy relationships and a strong and positive sense of self.
Fortunately, we are never locked into poorer mental health by a less-than-ideal childhood. In fact, according to research, our brains continue growing and changing and moving more towards integration throughout our lives. It’s not the severity of early life adversity that determines your current functioning, it’s instead your ability to make sense of it and move past it. Work with a therapist, of any theoretical orientation, is one way of improving functioning and integration in the brain.
Recommended books for clients:
- Brene Brown. Daring Greatly.
- Viktor Frankl. Man’s Search for Meaning.
- Laurie Gottlieb. Maybe You Should Talk to Someone.
- David Richo. How to Be an Adult.
- Daniel Siegel. Mindsight, plus The Whole-Brain Child for parents.
- Irvin Yalom. The Gift of Therapy and Love’s Executioner
Mindfulness
I’m sure you’ve heard this term before. Perhaps you’ve tried it yourself. Mindfulness, itself a form of meditation, is the process of bringing nonjudgmental awareness to the present moment. Most of us spend our time slightly out of sync with the present—we’re thinking ahead (sometimes with anxiety) to the future or thinking back (sometimes with sadness or shame) to the past. The thoughts and judgments that emerge from being out-of-sync like this are sometimes unhelpful and can even be harmful. Mindfulness isn’t about getting rid of these judgments—that’s impossible. Instead, mindfulness is the process of choosing to notice these thoughts and judgments, let them go, and return to the experience of the present.
It’s a common misconception that practicing mindfulness means sticking to a rigid schedule of formal meditation practice. This is not necessary. While many people find it helpful to set aside time to meditate every day, mindfulness is a practice that can be built into your day to day activities and utilized when needed. It is a powerful tool to help free us from the judgments that stick to us and hold us down.
Recommended books for clients:
- Jon Kabat-Zinn. Wherever You Go, There You Are and Full Catastrophe Living
- Gabi Garcia. Listening to My Body (for kids)
- Thich Nhat Hanh. Any, especially The Miracle of Mindfulness
- Mark Williams, et al. The Mindful Way Through Depression.
Mindfulness book recommendations and discussion here: https://fivebooks.com/best-books/mindfulness-tessa-watt/
Eye movement desensitization and reprocessing (EMDR)
EMDR is a method of encouraging the brain to appropriately process traumatic memories, which will reduce the symptoms of post-traumatic stress. While it was developed for use with PTSD, it can also be used to treat any “emotionally charged” memories that contribute to emotional or physical distress.
Despite the phrase “eye movement” in the name, EMDR may not involve eye movement at all. It uses some form of bilateral stimulation – auditory, visual, or tactile stimulation on alternating sides of your body – while you notice and report what comes up as you think about the distressing memory. It sounds a bit silly and overly simple – but often it works. I’ve been an EMDR provider for eight years, and I’ve seen people make amazing progress with a few sessions of EMDR.
EMDR is not a magic tool that works for everything. Even if your primary interest is in EMDR, expect to first spend some sessions on standard talk therapy. We will explore in session your suitability for EMDR work and what we might need to do first in therapy before beginning the processing of traumatic memory. Please see the sections on this website for trauma and somatic trauma therapy.
Recommended books for clients:
- Francine Shapiro. Getting Past Your Past.
More information about EMDR is available through the EMDR International Association at https://www.emdria.org.
Dialectical behavior therapy (DBT)
Should I stay or should I go now?
Should I stay or should I go now?
If I go, there will be trouble
And if I stay it will be double
– The Clash
Originally a treatment for borderline personality disorder, DBT has grown into a great set of techniques for helping clients with any difficulty in regulating strong emotions and communicating their needs in intense moments. I do not do strict, “official” dialectical behavior therapy, which requires participation in a DBT skills group and a particular form of collaboration with other therapists. However, I am formally trained in DBT and familiar with all aspects of the typical DBT program.
DBT deals with the difficulty of dialectics – the struggle between two opposites. To accept or change a difficult situation, to respect a partner’s needs or advocate for your own, to move forward on a difficult goal or change your objective, to find ourselves wanting two contradictory things – we often find ourselves stuck in these dilemmas. Often the answer is not one or the other but to choose how to move between both options. DBT integrates elements of cognitive behavioral therapy and of mindfulness.
My favorite part of DBT is its set of “skills.” DBT provides a great set of coping skills designed to be taught, shared, and reinforced as part of regular talk therapy. They’re easy to learn and easy to begin using right away to handle stressors. DBT is extremely popular in therapy right now, so DBT skills handouts and worksheets are available for free online in many different formats.
Recommended books for clients:
- Marsha Linehan. DBT Skills Training Handouts and Worksheets.
- Matthew McKay. The Dialectical Behavior Therapy Skills Workbook.
- Lane Pederson. The Expanded Dialectical Behavior Therapy Skills Training Manual.
Somatic trauma therapy
Somatic trauma therapy is an eclectic approach to the treatment of post-traumatic stress. Effective treatment of trauma needs to engage the body and the autonomic nervous system (see this website’s page on trauma). Somatic trauma therapy is a three-stage method that first establishes safety and stability for the person struggling with trauma through both talk-therapy methods and body-based work. Only after someone is able to handle the intense stress and anxiety brought up by trauma triggers will we engage with the traumatic memory itself. It’s a myth that the best way to deal with trauma is to go to therapy to “process” it. That comes later. This is a flexible method aimed at reducing the impact of trauma from the first session onward.
STT is similar to other body-based trauma therapy methods, such as Peter Levine’s and Pat Ogden’s. I’m familiar with these methods as well and pull in a lot of what I’ve learned from my own reading and research into these methods. I am currently involved in a two-year certification in somatic trauma therapy involving multiple trainings with Babette Rothschild and case consultation/supervision.
Recommended books for clients:
- Judith Herman. Trauma and Recovery.
- Peter Levine. Waking the Tiger.
- Babette Rothschild. Eight Keys to Safe Trauma Recovery.
- Bessel Van der Kolk. The Body Keeps the Score
Gottman method couples therapy
I’ve been seeing couples for as long as I’ve been a therapist—ten years now. Couples therapy is a brave choice—not only do you have to be honest and vulnerable in front of a therapist, you also have to be honest and vulnerable with your partner when things haven’t been at their best between the two of you, perhaps for a long time. Couples often delay seeking therapy until their relationship has begun to fall apart. It’s okay to reach out for therapy then, but it’s even more helpful to seek support when you notice that conflict has become unproductive, that there is more distance between yourself and your partner, or that it feels like you’ve hit a brick wall when discussing sensitive topics.
Couples therapy requires participation from both partners. There is no such thing as couples therapy in which one partner is 100% at fault (the exception being when one partner is abusive, in which case I do not recommend couples therapy). We’re doing hard work to change the relationship, and that requires both partners to work and change.
I draw from Gottman-method couples therapy, which views the love, friendship, and respect between partners as the foundation of a relationship. If this foundation is shaky, it needs to be repaired. The next step is making conflict both safe and productive for each partner. The conflict needs to pause if one or both partners become overwhelmed (“flooded”} with emotion, but it needs to be addressed rather than avoided after that. Make no mistake; couples therapy is very hard work. But it’s very rewarding work when both partners are willing to commit to change.
Recommended books for clients:
- David Burns. Feeling Good Together.
- John and Julie Gottman. Any of their books.
- Sue Johnson. Hold Me Tight.
- Thich Nhat Hanh. How to Love. David Richo. How to Be an Adult in Relationships.