For Providers

Thank you for your interest. I've prepared this section to give a more in-depth breakdown of the measures and interventions I use in the treatment of behavioral and substance use issues.

Typical Course of Treatment

Screening and Initial Consultation

After initial contact through email, voicemail, etc., my first live interaction with a new client is during a free 10-15 minute phone call in which I gather information about their presenting complaint, a rough subjective estimate of frequency and duration of symptoms,, and then schedule a first session.

Intake

Usually immediately after the initial phone consultation, I will send a digital intake packet to be sent to the new client. Aside from the standard forms I will include one of more measures including the PHQ-9, GAD-7, or PCL-5, depending on the initial complaint. The targeted measure(s) I send, in addition to ICCE's Outcome Rating Scale (ORS), provide a baseline of subjective symptoms and functioning.

First Session

In the first session, I inform the client of client rights and the limits of confidentiality and again take information about presenting complaint and symptoms, and review with the client some of the information that they provided in the intake paperwork. Physical/medical complaints are discussed to determine need for referral. During this first session, we discuss the problem, treatment goals, and begin building rapport.

Virtually every client I work with will end the first session having learned three physical relaxation skills (slow, deep breathing with an extended exhale, full-body muscle relaxation, and reactivation of peripheral vision) for eliciting a parasympathetic nervous system response for stress reduction and self-regulation. I start clients on that skill as early as possible so that it's more familiar to them if we end up doing desensitization work later on. This is also the simplest entry point for exposing the client to the practice of noticing a physical sensation, then changing it. In later sessions, they will build on this by noticing their cognitions and changing them.

Continuing Care

After 6-8 sessions, the client will be sent the ORS and one of the measures I originally sent during intake to track changes in symptoms and functioning. This is also when treatment goals are reviewed, and frequency of treatment is discussed. Many clients will continue to continue with weekly sessions, but others will change to biweekly sessions instead. This measurement, review, and adjustment is made every 6-8 sessions until discharge.

Treatment Approach by Issue

Anxiety/Stress/Worry/Phobia

Anxiety is the most common issue that brings clients to my practice. In simple cases, the client is taught relaxation/self-regulation skills, creates a hierarchy of stressors, and practices exposure to those stressors while in a relaxed state for systematic desensitization. Complex cases involve more in-depth processing of developmental experiences and resulting dysfunctional learning, beliefs, and behaviors. In any case, I help the client conceptually break their experience of anxiety into its parts (physiological stress and mental worry) to address each with the appropriate intervention.

In my experience, I've also learned that it's important to screen for physiological contributors to anxiety such as caffeine intake and thyroid issues. I encourage clients to talk with their PCP to rule these out.

Depression

In treating depression, I work with the client to take a systemic approach, essentially working up through Maslow's Hierarchy of Needs, and referring out as needed, to rule out physiological contributions. Beyond that, behaviorally, I've found depression to frequently co-occur with anxiety and similarly find itself rooted in beliefs, attitudes, and expectations that were taken on as a result of repeated adverse developmental experiences. In these cases, both anxiety and depression treatment will closely resemble the treatment for complex trauma.

Post-Traumatic Stress Disorder (PTSD)

A single-incident trauma that has resulted in PTSD symptoms (intrusive memories, frequent nightmares, and avoidance behaviors persisting over a month) requires reprocessing, desensitization, and cognitive restructuring. Many clients can achieve this through talking about the traumatic experience (exposure) and the chronology of its micro-events (narrative) while maintaining a relaxed state (parasympathetic dominance). I, as the therapist, facilitate this process by providing psychoeducation and skills training, normalization of symptoms, and active monitoring and reminders to maintain parasympathetic dominance during the trauma narrative. In cases that need it, I may also work through the EMDR protocol to help the client complete the same tasks of healing using a different modality.

Complex Trauma / C-PTSD

As opposed to a single-incident trauma, repeated or sustained traumas have the added complexity of being developmentally impactful on the individual. In addition to the more "standard" PTSD treatment described above, "Complex PTSD" presents the additional task of helping the client create or recover a sense of authentic self outside of an often lifelong habit of living in "survival mode". The most impactful or disturbing past events are reprocessed during therapy while outside of therapy, the client practices exposure and desensitization to safe, but triggering, stressors in their daily life.