Services I offer and Modalities I Utilize
I typically work across several modalities, adapting what is needed for each person. The links below describe the modality from the perspective of addressing depression and anxiety and include links to some key articles demonstrating their evidence base.
Because I cannot be comprehensive and brief at the same time, I limit references to meta-analyses of each approach for treating depressive and anxiety-based illness. If you need more specific references for a specific behavioral health issue, please do not hesitate to contact me.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) focuses on challenging and changing cognitive distortions (thoughts, beliefs, and attitudes) and their associated behaviors in order to improve emotional regulation and help the individual develop coping strategies to address problems. The theory is that thoughts, emotions and behaviors are linked.
What attracted me to CBT was that, rather than looking for the unconscious meaning behind the symptoms, CBT tackles the symptoms themselves. For example, rather than wondering what memory from childhood is associated with depression, CBT tackles depressed mood, not feeling motivated, etc. head-on. It is a problem-focused and action-oriented form of therapy.
CBT is probably the most studied form of psychotherapy:
For more about CBT: Cognitive behavioral therapy
Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy (ACT, typically pronounced as the word "act") came from CBT in the 1980s and came into its own in 1999. Its founder, Steven Hayes, did not like what he called the verbal rules that often went with CBT treatment. He felt that they often made people more rigid whereas he found that more psychological flexibility was needed. After having a panic attack himself, he started testing techniques first on himself and then with others.
ACT can be thought of a couple of elements:
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Dealing with thoughts as they appear. People will contrast it with CBT as not trying to control thoughts. I would say its indirect control rather than the direct control of CBT. This is the acceptance element with its aim of not giving problematic thoughts so much fusion with other thoughts.
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Values clarification. This can be thought of as a stepping back from the busyness of life to find what truly matters to you.
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Taking action, or moving towards. Problematic symptoms or issues often have an avoidance element to them. This element acknowledges the need to take action in the face of a tendency to avoid.
Together, values and action form the commitment element of ACT, as the values form the basis of meaningful action.
ACT is also one of the more studied types of psychotherapy:
For more about ACT: Acceptance and commitment therapy
FOR MY PRACTICE: Nowadays I tend towards ACT therapy and using CBT tools as necessary for specific issues. A meta-analysis confirmed that the results are equivalent to traditional CBT.
(Schefft et al Front Psychiatry. 2023 Oct 5. doi: 10.3389/fpsyt.2023.1189970.)
Positive Psychology
The key to Positive psychology is simple: psychology ought to study not only deficits (disease, disorder, and disability) but also what can help people be happy. A key element is, in positive psychology, ‘what can help people be happy’ is defined by techniques which are then put to the test in scientific experiments.
We usually trace its birth to 1998 when Martin Seligman chose it as the theme for his term as president of the American Psychological Association. Since then, it has developed into domains of happiness ("flourishing", "the good life”, "subjective well-being”, “contentment”, “a meaningful life”, “fulfillment”) and specific, realistic techniques to achieve those ends. Positive psychology offers a good balance for approaches that are too concerned with deficits.
Positive Psychology is one of the more researched schools of psychology, in that its techniques have been studied individually. Note that to date there have been no meta-analyses on the use of Positive Psychology as a whole approach for anxiety disorders.
For more about Positive Psychology: Positive psychology
FOR MY PRACTICE: For some people I start right off with Positive Psychology. Others I either include techniques here and there or transition to a Positive Psychology focus after more pressing issues are addressed. This accords with a recent metaanalysis (Seshadri et.al. Am J Psychother. 2021 Mar 1. doi: 10.1176/appi.psychotherapy.20200006).
Schema Based Therapy
Schema therapy was developed by Jeffrey E. Young when he found that CBT was not as useful for certain people in the clinic he led. He found that the beliefs were deeper, so he called it schema, meaning “a pervasive self-defeating or dysfunctional theme or pattern of memories, emotions, and physical sensations, developed during childhood or adolescence and elaborated throughout one's lifetime”. People learned to structure their lives around avoiding or coping with their schema.
Schema therapy involves helping people change the cognitive patterns connected to the schema and replace maladaptive coping styles and responses with adaptive ones. Over the years, Young and others have developed classifications of common schema and researched ways to address each.
Schema Therapy is one of the harder techniques to study, as the number of schema, their unique expression in individuals and the techniques used form a large umbrella of things to study.
The Effects of Temperament on Depression According to the Schema Model: A Scoping Review
Schema therapy for chronic depression: Results of a multiple single case series - ScienceDirect
For more about Schema-based therapy: Schema therapy
FOR MY PRACTICE: I tell people that usually we only look at your personal history (childhood, early adulthood, etc.) until the point where something ‘clicks’, where you get an ‘aha’ moment where the themes you’ve taken from your past make sense. For some people, they are either interested in further exploration or their issues are such that it makes sense to do further exploration.
Interpersonal
By interpersonal therapy, I mean two things: 1) helping people with their issues involving other people and 2) following a specific guide for doing this. The specific guide is Interpersonal Psychotherapy Of Depression by Gerald Klerman, Myrna M Weissman, Bruce J Rounsaville and Eve S. Chevron (Basic Books 1984 and subsequent editions). The approach is based on the principle that relationships and life events impact mood and vice versa. The authors, from Yale University, developed the approach to systematize four areas of interpersonal issues (grief, interpersonal role disputes, role transitions, or interpersonal training).
One systematic review of interpersonal therapy:
For more about Interpersonal Therapy: Interpersonal psychotherapy
FOR MY PRACTICE: I use these techniques as needed, specifically for people with this need.
Goal Attainment
I call this area “goal attainment”. There’s no specific school, just what works to help people achieve their goals. In this, I rely on the scientific work of two people: 1) John C. Norcross, Ph.D, associated with John Hopkins and SUNY Medical College, and 2) Sean Young, Ph.D, the director of the UCLA Center for Digital Behavior and the UC Institute for Prediction Technology. Both are psychologists who both study and summarize the scientific literature on behavior change.
FOR MY PRACTICE: I let myself be guided by the person I’m working with. Some people like a structured approach whereas others like adding a little here and there to optimize the efforts that they already make.
Existential / Phenomenological / Depth
As mentioned in My History my original training was in existential / phenomenological and depth psychology.
FOR MY PRACTICE: I use as needed. This is not so much an approach as a stance and well of knowledge to take from.