Therapy is a journey my clients and I take together discovering and building upon your strengths while identifying and meeting your needs.
Focusing on the here and now is preferred over digging up events from the past.
I’m an excellent listener and motivator. Together we can conquer your greatest challenges.
Proficiencies & Specialties
Mood & Anxiety Disorders
Most clients are motivated to seek therapy when they are out of balance in their own lives. The majority of them do not know what their clinical diagnosis is, but typically they are either experiencing feeling depressed, feeling anxious, or both.
This is a serious disorder characterized by despondent mood, feeling sad much of the time, crying spells, loss of pleasure in usual activities, hypersomnia (oversleeping), fatigue and loss of energy, lethargy (inability to move or function), morbid thoughts (wish they had never been born, thinking of dying), and suicidal ideation (thoughts of killing themselves). Psychiatric medication and psychotherapy are usually indicated. I require collateral consultation with a board-certified psychiatrist when I treat clients with Major Depression.
More moderate forms of depression are also quite common, without the severity of the above features, and usually lacking suicidal ideation and morbidity. When I treat these clients, I prefer that clients collaterally meet with a psychiatrist to manage medication, when indicated.
This is a milder depressive disorder characterized by chronic low-grade depression. In layman terms, clients with Dysthymic Disorder usually lack energy and motivation. They can will themselves into action in order to function normally, but they tire easily, and often retreat early. Sedentary behaviors, social isolation, moodiness and irritability are common. Dysthymic disordered clients often have collateral mood-altering behaviors, e.g. alcohol use, cannabis use, stimulant use, or binge-eating disorder.
Clients with Cyclothymic Disorder often present with a mixture of dysthymic mood and hypomanic mood. The mood swings accompanying cyclothymia are mild compared to the mood lability of bipolar disorder. In fact, many people do not even realize they are cyclothymic because of the beneficial features which accompany hypomania. Hypomania is characterized by quick-thinking, being quick-witted, having a high level of energy with a decreased need for sleep, accomplishing tasks with bursts of energy, and spikes in creativity. Because these are seemingly positive, clients do not make a connection to hypomanic mood. By contrast, the hypomania which accompanies Bipolar Disorder is quite dysfunctional and easily identified. Typically, in my practice, Cyclothymic disordered clients present with collateral substance use issues. Clients often self-medicate their mood. The most common substances include alcohol and cannabis. I prefer clients being treated for Cyclothymia to meet collaterally with a psychiatric practitioner for medical evaluation/treatment.
Bipolar I and Bipolar II
Bipolar Disorder is commonly referred to as Manic-Depression. This is because the two primary components of this major mood disorder are both Major Depression, and Hypomanic mood. The Major Depression symptoms are consistent with the characteristics written about it above. But hypomanic mood and how that presents, can vary in terms of the severity of the illness. Sometimes the mania is so severe that thinking and behavior are disorganized, and hospitalization is required. Rapid-cycling refers to the degree to which the mood flip-flops from agitated, angry, and/or manic to tearful, lethargic, depressive episodes. New clients are required to initiate treatment with a psychiatrist prior to initiating therapy with me; or to seek treatment with a psychiatrist before returning to begin psychotherapy with me.
Anxiety disorders are too numerous to list. In layman’s terms, anxiety disorders are those which are characterized by feelings of worry and fear and the physiological manifestations of those feelings. Typically, anxiety disordered clients have strong ruminations – distorted thoughts that they often replay mentally which account for amplified reactive anxious feelings. Frequently, anxiety disordered clients present with a range of issues which may include fears, phobias, panic attacks, nightmares, dissociation, avoidance, post-traumatic stress, psychomotor agitation, increased startle response, hypervigilant behaviors, profuse sweating, and other somatic issues. Collateral psychiatric care is preferred, but not necessarily required.
- Generalized Anxiety Disorder
- Post-traumatic Stress Disorder
- Panic Disorder
- Acute Stress Disorder
- Performance Anxiety
- Irrational fears
- Obsessive Compulsive Disorder
Substance Use Disorders
Counseling and psychotherapy for Substance Use Disordered clients should not be confused with Drug & Alcohol Rehabilitation. Clients who have serious alcohol and drug dependencies often need inpatient detoxification and partial hospitalization versus intensive outpatient treatment modalities in order for treatment to be successful.
I often see clients in the advent of their drug rehab experience. I use a family systems model to intervene into the disease of addiction. Sometimes substance abusing clients who are not addicted to mind altering chemicals can benefit from identifying adaptive self-soothing strategies to cope with stress in lieu of the maladaptive mood-altering behaviors they seek, which can account for their presenting substance abuse issues. Other times, such harm reduction strategies can prove insufficient, and a greater continuum of care is needed. At this juncture, the client would be referred to an appropriate treatment program.
The psychotherapy I prefer to do with Substance Use Disordered clients takes place after they have achieved meaningful sobriety (for those with abstinence-based recovery), or meaningful stability (for those with medication-assisted therapy, such as Suboxone maintenance). I engage these clients in a therapeutic journey to identify the factors which drive their addiction by deconstructing their addicted life stories, and by using a person-in-environment paradigm to make important behavioral changes and interpersonal connections in order to achieve equilibrium.
Family members of chemically dependent people often have their own myriad issues. Many family members attempt to control addicted behavior through their own set of dysfunctional behaviors known as enabling. Therapy with family members focuses on individuation, power and powerlessness, and adaptive positive supportive behavior versus maladaptive enabling behavior.
- Alcohol & Drug Intervention Training
- Early stage alcohol & drug abuse issues
- Codependent Relationship Issues (Enabling behaviors)
Addictive Spectrum Disorders
Addictive spectrum issues are called “process addictions” because they are very similar in some respects to Substance Use Disorders, while also being distinctly different.
Clients who present for therapy either have spent far too much money with gambling/gaming than they had intended, or a family member, in outrage, discovers large sums of money missing. Frequently, clients who present with Gambling Disorder have an embedded co-occurring mood disorder, e.g. Cyclothymia.
Paraphilia, Sexual Addiction, & Sexual Compulsivity
Sexual addiction and sexual compulsivity are dysfunctional sexual behavior disorders whose names are often used interchangeably even by professionals in the field, but they are distinctly different. Paraphilia is considered to be a form of sexual addiction, but is also distinctly different.
The Paraphilias constitute the most severely disordered sexual behaviors. In layman’s terms, paraphilias refer to sexual behaviors that are perpetrated against nonconsensual partners. Examples of paraphilias include Exhibitionism, Voyeurism, Frotteurism, Sadomasochism, and Pedophilia.
Sexual addiction involves sexual behaviors which are not ordered toward intimacy with a partner. Sexual anorexia and sexual addiction mimic the binge-purge cycle of addiction; and sex addicts are more often than not, lonely, lacking in intimacy, and plagued by stormy relationships. Sex addicts spend a disproportionate amount of time thinking about sex and acting out sexually, and are usually male. They often lack boundaries in relationships, and their addictions are driven by shame and inadequacy.
Sexual compulsivity refers to a pattern of frequent sexual activity. Sexual compulsives seem to think about sex a lot, and they are usually in the hunt for sexual partners versus masturbating compulsively. Sexually compulsives use sexual behavior as a maladaptive coping mechanism to cope with stress. Internet pornography is often employed to achieve arousal and to heighten the experience. Sexually compulsive behavior in males tends to focus more on performing a sexual behavior to achieve orgasm; where sexually compulsive behavior in females tends to include chat rooms, and face to face encounters that seem on their face to be more relational.
Because of the sexual nature of these disorders and transferences inherent in the client-therapist therapeutic relationship, as a matter of boundaries, I will decline to accept female sexually addicted, sexually compulsive, or paraphiliac clients.
- Life-Stage Transition issues
- Gay & Lesbian issues
- Stress Management
- Impending or post-divorce issues