what is your general approach?
My focus is on helping you figure out what really matters to you and what you want to include as part of a meaningful, fulfilling life. I want to help you enact changes in your everyday life—this means trying things out, taking some healthy risks, and viewing the between-session process as a bit of a lab experiment in the real world.
What's the process for online sessions? can I use Skype or FaceTime?
For sessions I use Doxy.me HIPAA-protected video chat. It's free for you to use and I simply send you a link. As a backup I use VSee (also HIPAA-protected). I don’t use Skype or FaceTime because they are not compliant with healthcare-delivery requirements.
What happens in the free 20-minute consult?
A few things. First, I want us to work through the nuts and bolts of ensuring a good video session. Next, I want to understand what it is that you’re hoping to get out of our meetings, and answer any questions that you have. Also, you may want further explanation of the therapy process, and I’m happy to provide that.
Most important to me is that you have enough time to explain what’s going on with you. You can schedule your consult, a session or the discounted package of sessions directly through the Booking tab, and of course you can just reach out to me via my contact info if you prefer doing that.
What are the advantages and disadvantages of online therapy?
The main advantages are convenience, greater privacy, and the online “disinhibition effect” which has shown that people often feel more open and able to disclose personal concerns while interacting online.
The main disadvantage is the lack of full non-verbal communication, since I am not sitting in the room with you. Also, online therapy is not appropriate for people with a poor-quality internet connection.
What do I need to ensure a good-Quality online appointment?
A private space. It will be difficult for us to focus if you’re getting interrupted a lot during the sessions.
A good internet connection of broadband (wifi or ethernet) or 4G phone data.
Headphones/earbuds with a microphone are recommended, as they block out other noise and help with clarity.
do you take insurance?
No, but I can provide an out-of-network superbill you can take to your insurance. Better is a company that takes 10% of insurance reimbursement you get, but does all the legwork for you (no, I'm not sponsored by them or anything, it just seems worth exploring).
what interventions do you use in therapy?
At my core, I am a brief therapist with a specialization in Solution Focused Therapy. This orientation influences all of my work, in that I trust in our process of co-creating solutions that fit your life.
Solution Focused Brief Therapy (SFBT): This brief intervention focuses on constructing the life you want to be living, while simultaneously looking for clues in your present and past that show instances of your preferred future. SFBT involves, at first, understanding what your hopes are from therapy, and what would make it worthwhile for you. After that, we use some unusual questions that will engage your ability to view multiple perspectives, explore exceptions to the problems you are having, and build solutions that are doable and self-sustaining.
In addition to SFBT, the below interventions are flexible, creative, practical and engaging, and we may incorporate them as needed:
Assertiveness: I view assertiveness as a key skill in living well. Having assertiveness as a default style of communication is the goal, in that passive, aggressive or passive-aggressive communications come with pitfalls and are usually not the proper tool to use. A flexible, mindful approach to assertiveness is simply to view it as being present and willing to express your opinions and desires, while having no expectation of a particular response. This opens up a fluid, genuine way of communicating that will improve relationships and increase your ability to reach your potential. To help accomplish this, we look at the influences—good and bad—on your ability to be assertive through your beliefs, social roles and how you manage stress.
Mindfulness: Like assertiveness, mindfulness is another key skill in living well. The ability to be present, without judgement, and act in a way that overcomes the stress response or bypasses ingrained, unhelpful thinking is clearly useful for many situations. A further benefit of mindfulness is that, just like true assertiveness, it fosters a way of living that is more open and genuine, and you will find that you are happier, with the ability to be more comfortable in your own skin across a variety of circumstances. The skill of mindfulness comes from the practice of bringing yourself back to the present moment, and there are different ways to do this, based on what fits best for you.
Exposure: Exposure is a technique that cuts across various interventions. Simply put, it means taking part in activities or experiences that you may be avoiding due to anxiety or other reasons. Our work with exposure involves understanding avoidance strategies and safety behaviors, such as being overprotective, overcompensating for perceived deficits, and excessively seeking reassurance. We create an exposure plan and construct a hierarchy of difficulty to help tackle the issues step by step, so that your successes can build on each other.
Behavioral Activation (BA): BA focuses on behavioral change, by growing your ability to choose behaviors that are healthy and helpful. Positive reinforcement is the goal, specifically “diverse and stable” activities and relationships that are pleasurable and/or satisfying and naturally encourage repeated action. These helpful behaviors would ideally be diverse in that there are multiple sources of positive reinforcement (friendships, a respected coworker, dodgeball team, etc), and stable in that they can be done consistently and are repeatable (going to the gym or a class 2x a week versus a once-in-a-lifetime trip to Bora Bora). It’s also important to combat avoidance behaviors, which provide temporary relief and “negative reinforcement” in that they help you in the short term to get rid of an unwanted feeling, but do not help you construct a vibrant, connected life.
Acceptance and Commitment Therapy (ACT): This intervention focuses on changing the relationship you have to something that is bothering you, whether it’s some form of negative thinking, physical pain or other troublesome stimuli. To do this, we develop the ability to accept the undesired thought or feeling without judgement, by building awareness, mindfulness and what ACT calls “psychological flexibility.” From there, the goal is to make choices that are consistent with your values in the real world, not some abstract version of values. This is the “commitment” part, in that we want to build the ability to act in a way that honors your values such that you can make choices that are better for you in the long term, as opposed to making short-term, avoidance-oriented choices.
Cognitive Behavioral Therapy (CBT): This set of interventions is very flexible, and at its core examines the relationship among thoughts, feelings and behaviors. Any part of that trio can be the area of focus in CBT, but probably what most differentiates it from other treatments is the analysis of “unhelpful” versus “helpful” thinking, and examining evidence that supports or contradicts specific thoughts and interpretations. Examples of unhelpful thinking would be “all or nothing” thinking or saying you “should” or “must” do something when that’s not really the case. A good overview of unhelpful thinking styles is presented here.