Psychotherapy Q&A

What are the different psychological approaches/methodologies in your toolbox? Can you talk a bit about each?
In Session uses an eclectic approach to psychotherapy that draws from: Cognitive Behavioral Therapy (CBT), Psychodynamic Therapy, Acceptance and Commitment Therapy (ACT), Emotionally Focused Therapy (EFT), Mindfulness, and Motivational Interviewing.

Cognitive Behavioral Therapy (CBT) for example and Rational Emotive Behavioral Therapy (REBT) as evidence-based methods provide a more immediate symptom relief and therefore they tend to be the first line of treatment. The premises are that there’s a connection between thoughts, feelings/emotions and behaviors/actions that people have as a reaction to an event/situation. Usually, people keep a thought record log that after a while identifies certain thinking patterns. The identified irrational or unhelpful thoughts are challenged and reframed into rational and helpful ones. To be noted that therapy acts at the level of thoughts and behaviors as people can’t directly change what they feel and many times events aren’t under their control. Changing how we think about an event will change how we feel about it. Depending on the clinical presentation, there are different techniques used like thought stopping, desensitization, flooding and breathing relaxation when dealing with anxiety or behavioral activation when treating depression.

Mindfulness is a great approach to be used along with CBT. People spend a lot of time thinking about the past or the future. When the nature of these past and future related thoughts is negative the result is depression and anxiety. Mindfulness requires the person to bring their focus into the present and to observe their thoughts instead of judging them which only perpetuates the symptoms.

Psychodynamic therapy is a more modern and engaging form of psychoanalysis that focuses on certain aspects of the past that are influencing the patient’s present, it targets defenses and it changes interpersonal patterns. As people find relief from their symptoms, it is necessary for treatment to go deeper in order to achieve long lasting results. People develop defenses early on in their lives and these defenses are needed for the human mind to adapt to its new reality and to cope with unwanted changes. However, defenses that were once helpful can start acting against the best interest of the person using them. Psychodynamic therapy brings defenses to consciousness, examines the roles of id, ego and superego in a patient’s clinical presentation, uses interpretations to identify themes related to symptoms, and includes transference and countertransference as means to facilitate an emotional corrective experience that will trigger change.

How do you know what sort of approach to take with a particular individual? What is your process of getting to know a new patient and understanding the issues that he/she is having?
We believe that all forms of therapy work but they don’t all work for one particular patient because one size doesn’t fit all.

The approach taken with a particular patient depends on the clinical condition, patient’s current psychological insight, their personality, and their previous therapy experience.

We view patients as the experts in themselves, meaning that there’s no one else who knows them better at the time when we first meet than themselves. Therefore, we spend the first several sessions getting to know the person by asking them questions and by carefully listening to their personal narratives. We steer away from diagnoses and labels. We want to see the person who’s hidden behind their symptoms and issues. It’s also important to know what is the patient’s own perception of what is going on with them and their level of hope. Hope is essential in treatment because sometimes it is the last helpful pillar standing. Once we gain an understanding of their presenting problem including what has been contributing to their symptoms and what might be helpful in addressing them, we collaboratively create a treatment plan that covers estimated length of treatment and methods to be used.

What are the consequences of leaving psychological issues untreated? What could happen?

A proverb states: “Pain is inevitable. Suffering is optional.” We all face different challenges and hardships. The difference between people is that some have developed healthy coping mechanisms to preserve their physical and mental health and others didn’t. Untreated psychological issues have people end up in unhappy relationships, estranged from loved ones, on wrong career paths, using damaging coping methods like substance abuse, or developing eating disorders. It’s just a matter of time until people lose their life meaning and purpose.

How do you go about putting a patient at ease?

We acknowledge that usually when we first meet a new patient they are in a vulnerable state, perhaps tired of trying to make things work out on their own, scared and even hopeless about their situation being able to change. We try to normalize their experience without minimizing it either. It’s important to create a safe emotional space especially that the therapeutic relationship can feel uneven given that the patient offers so much personal information while they don’t know anything personal about their therapist. We are open to patients’ questions, of course within professional boundaries, if that allows for them to see the human side of their therapist. We strive to be friendly and approachable.

What kinds of results can a patient expect to see after starting counseling? Will they see immediate benefits?
A lot of people report feeling better right after the first session and that is attributed to them having a safe space to give voice to their thoughts and feelings which reliefs the burden that they feel. Throughout the course of therapy, patients alternately feel better and worse. The fluctuation is part of the process. It’s important for patients to feel some discomfort because that signals that they are working through some sensitive issues that are crucial to the outcomes of their treatment. To be noted that most of the work is done by the patient in-between sessions. Sessions are used to explore certain issues and to create a plan of action for between sessions. Progress in therapy is personal. People move towards change at different paces depending on their psychological make up and everything that it entails. Let’s take a 30-year-old person with their own schemas, thought processes, and defenses, how soon do you think we’re going to undo or redo what was done for three decades? It definitely won’t take another three decades but it takes some time. 

What should a new patient know about therapy and counseling? Or what do they frequently misunderstand before coming in?
The most important thing patients should know is that therapy is a major commitment and an investment in themselves. Therapy is a collaborative working alliance, a professional but at he same time personal relationship that is designed to change the patient’s perspective on themselves and on the world with the purpose of achieving optimal mental health. A new patient should also know that time and patience are essential elements in their recovery and that the insights they gain during sessions need to be actionable in order to create change.

During the course of our practice we noticed that most people, regardless of their previous therapy experience, feel anxious during that first session. They are concerned with what being in therapy says about themselves, about being defective, with how much or little they should disclose, whether therapy will work for them, etc. It’s perfectly normal and we are here to answer any question they might have at any point in treatment.

Another notable observation pertains to patients who were never in therapy before. They might view therapy as more of a medical treatment where they come in, talk to you, you give them something, and they’re good to come back in a month or two. It’s important to know hat therapy is a process that requires regular attendance at least once a week to start with. As people reach their mental health goals we scale back.

Why might someone be hesitant to seek therapy? What do you say to individuals who might have reservations?
Some common causes of hesitation are: time and financial commitment, insurance related frustrations, stigma associated with therapy that still exists within certain cultures, fear of judgment from friends and family, and patients’ own perceptions of themselves as being weak and defective if they seek mental health treatment.

Freud stated:” Out of your vulnerabilities will come your strength.” Seeking help is actually a sign of responsibility, strength, and emotional maturity.

We see the time and financial commitment as a worthy investment in yourself. All life areas are dependent on our mental health. Regarding insurance coverage, although we are not in network, we can work together to maximize your out of network benefits. We learned over the course of years that many times there’s a negligible difference between the in network and out of network benefits. We are trying to make the administrative side of therapy as painless as possible. Patients pay the session fee at the time of their visit, our office verifies their benefits and submits the claims on the patient’s behalf, and patients get reimbursed directly by their insurance.