I recently completed training in Eye Movement Desensitization and Reprocessing (EMDR) therapy, and it has already been a game-changer for my clients and many others struggling with trauma, anxiety, depression, and more. However, EMDR is a therapy that often seems mysterious or even confusing. Even as a psychologist, before I received specific training, I had very little understanding of what EMDR was, how it worked, and what it was like to experience it . This post will shed light on what EMDR is all about and how it could help you or someone you know work through trauma, depression, anxiety, and many other struggles. I also provide some resources to find your own EMDR therapist. 
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One fine spring day in the late 1980s, Dr. Francine Shapiro was walking on a sidewalk and thinking intensely about something that was really bothering her. Her mind kept perseverating on it, and she felt strong negative feelings as she focused on it. Oddly, a few moments of walking later, she suddenly realized her negative feelings had vanished and her thoughts had shifted, without any conscious effort on her part. Bewildered, she paused and considered what she had been doing while she was focusing on the distressing situation. In addition to walking, she had also been moving her eyes side to side while focusing on her distress. She became immediately curious about how the side-to-side movement of her eyes (as well as her feet) may have impacted her emotional and cognitive process.

Shapiro's discovery led to series of first informal and then formal clinical trials evaluating the effects of bilateral stimulation (BLS), which is the intentional, repetitive, back-and-forth stimulation of the left and right hemispheres of the brain, on distress. More and more studies,  which originally focused primarily on the veteran population with Post-Traumatic Stress Disorder (PTSD), began to suggest a powerful effect of eye movement BLS on the reduction of PTSD symptoms. From those findings, EMDR was born. Since those early years, EMDR has been found to be effective for a vast range of presenting issues, including:

• Trauma and PTSD
• Anxiety, phobias, panic attacks
• Depression and bipolar disorders
• Grief and loss
• Pain and chronic illness
• Eating disorders
• Personality disorders
• Addiction

EMDR treatment includes a series of stages, and despite being a fairly structured treatment, there are many ways it can vary client-to-client, so this is a very general overview. Before beginning, your clinician should explain EMDR to you in detail, answer any questions you have, and obtain your consent to move forward. Then, the first stage focuses on treatment planning. During this process, your clinician will explore with you what you hope to achieve by completing EMDR. I think of the planning like a funnel - starting with broad areas of concern, and then honing in on a more specific problem along with the core belief you hold about yourself related to the issues at hand. When we start to explore what negative beliefs (e.g., "I am incompetent") underpin the more surface-level symptoms (e.g., performance anxiety), the target for EMDR becomes evident. Once the negative belief is identified, your clinician will help you determine what positive belief you'd like to strive towards that counteracts the negative belief (e.g., "I am competent, regardless"). The last step of the planning process is to then identify specific incidents in the past, more recent present, and/or future, where the negative belief felt especially true to you. This creates an incident map of your negative belief, which will guide the EMDR focus. You typically then select a single incident from the map to focus on first during EMDR processing.

The second stage of EMDR is focused on resourcing. During this stage, your clinician works with you to build up your abilities to cope with and handle strong emotions or triggering memories. EMDR does have the potential to evoke intense emotions, so it is important that you have grounding and soothing skills to help you regulate your emotions if needed. These skills are also valuable outside of the context of EMDR, and can be used during any stressful moment. One of my personal favorites is helping clients develop a peaceful inner place. We use visualization and slow BLS to develop a vivid scene of a place, real or imagined, that produces a sense of tranquility. 

The third stage of EMDR is focused on desensitization and reprocessing. Once the plan and resourcing techniques are set, it is time to begin the application of BLS to work on the incidents and negative beliefs that have been identified. The clinician first takes you through a structured set of questions designed to activate the chosen incident (i.e., turn on your emotional response). Then, the clinician will instruct you to focus on the incident, belief, and associated feelings and sensations, and will apply a set of BLS for typically 20-45 seconds. There are many options for how the BLS can be applied - your clinician will review options with you and together determine the right choice:

1. Eye movement: this is the original BLS mechanism and involves following the clinician's hand as it moves left and right in front of your eyes. Some clinicians also may use a light bar, where the client visually tracks the light back and forth. For virtual meetings, a clinician may use a website or app to create the lateral motion, or they may use their hand on the screen if the client has a wide enough monitor.
2. Tactile: BLS can also be experienced through touch. Clients can self-tap their shoulders or biceps with crossed arms, or tap on their thighs. Some clinicians may also apply tapping on the backs of client hands or knees. Another popular option are "tappers," which are small vibrating electronic paddles that the client holds in either hand. The clinician can alter the speed and intensity of the tappers based on client comfort and need. BLS can even be achieved through movement, such as left-right punching, squeezing stress balls in each hand, walking/jogging, or even stepping the feet while stationary. Tactile BLS is another great option for virtual sessions.
3. Auditory: this option requires the use of headphones. BLS can be applied through auditory tones moving between each ear. 

The clinician will take you through 20-45 second sets of BLS. Between each set, they will check in with you, often asking, "what did you notice?". There are no "shoulds" or "supposed to's" with what you experience. The goal is to allow your brain, body, and mind to go where it needs to go during the set. The metaphor I tend to use is thinking about EMDR as driving down a highway, except you get off at each exit to check in before resuming your drive. Depending on the scope of the EMDR you agreed on with your clinician, as well as the emotionality and complexity of the focus, this stage may take a single session up to weeks or months to fully process through.

Your clinician will be actively tracking what you notice between sets to gain a picture of the healing process. It is common for clients to first feel their distress more acutely in the earlier sets, as their brains take them into the unhealed memory. However, as the sets progress, clients very often start to notice subtle changes indicating that healing is taking place. This is where your clinician's training and clinician intuition will come into place to guide the process. After it seems the unhealed trauma, negative believe, or incident has been fully addressed, the clinician will then instruct you on installing the new positive belief you had come up with together. Focusing on the positive belief along with BLS helps to deeply instill a new framework for seeing yourself in a more compassionate light.  Once the positive belief is installed, either EMDR is complete, or it is time to move to another incident or negative belief system and start again. 

After sessions, it is common to experience some residual effects of doing EMDR. These effects can vary greatly and may depend on what was addressed in the session, how activating it was, and whether it was resolved. Some clients report feeling more relaxed and present, better OR worse sleep, changes in dreams, body sensations, or in behavior (e.g., suddenly acting more assertive with others). Your clinician will check in with you about anything you may have  experienced between sessions. Once an area of concern is fully processed with EMDR, you should feel a notable shift in your emotional reaction to the incident that was addressed, in that you still remember it, but you don't feel distressing feelings or hold the same negative beliefs related to it. 
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I say think for a reason. Like most forms of therapy, we aren't exactly sure of the specific mechanism of why it helps people feel better. EMDR certainly stands out this way, because it can sometimes feel like magic when a client's strong negative feelings seem to evaporate into thin air. However, there are several compelling theories about why we believe it has such efficacy, and I'll share two of them here: 

1. The REM Theory: I find this theory to be the most fascinating. Brain and sleep research have indicated that Rapid Eye Movement (REM) sleep is integral for memory consolidation. During REM, our bodies and brains are most active, where it is common for eyes to dart around behind their lids and brains to be busy with dreams and memories. There may be an essential link between the back-and-forth eye movement of REM with the processing and storage of memories. However, when we experience something traumatic or even moderately distressing, our brains are not functioning at full human capacity. During times of fight or flight (e.g., in an active warzone), the most human part of the brain, the prefrontal cortex, is largely off-line, while the more mammalian and reptilian parts of our brain take over. In essence, we are governed more by instinct to self-preserve than conscious, rational thought. Perhaps what also takes place is that our memories of those experiences are then not processed, consolidated, and stored due to the shift in our brain functioning in this threatening context. Instead, the memories sit in our brain, wired into our neurons, affecting how we respond to familiar-feeling situations moving forward (e.g., hearing fireworks). BLS may, in effect, be a consciously induced REM stage to help create a processing, healing, and storage function for those memories that have stayed unhealed. 
2. The Distracting Stimuli Theory: A second possible theory for why EMDR works considers the use of distraction through BLS. Rather than enacting a memory processing change, BLS may instead be pairing a neutral distracting stimuli while the client intentionally focuses on a difficult memory. Perhaps the association of the distracting stimuli with the memory aids in soothing or shifting the previous negative emotional association of the event. 

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If you are wanting to try EMDR for yourself, there are a few places to look to find yourself a trained provider. Because EMDR is a specific form of treatment and often used for traumatic memories, it is important to ensure that your clinician is properly trained in the approach. Here are a few places to begin your search:

1. Directories
   1. Psychology Today: you can filter the search to include EMDR as a specific modality of therapy. https://www.psychologytoday.com/us
   2. EMDR International Association: https://www.emdria.org/find-an-emdr-therapist/
   3. EMDR Institute: https://www.emdr.com/SEARCH/index.php
2. Google search, "EMDR therapist near me"  
3. Word of mouth - consult with your other healthcare providers to inquire
4. Insurance company - check their website or call to get provider referrals

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I hope this post was helpful in demystifying what EMDR therapy is all about. Feel free to submit any questions or comments below, or contact me directly if you'd like to learn more. 

I was recently talking with students in my introduction to counseling graduate class about one of the most unique aspects of learning to be a helper: being your own tool. As a therapist, my "me" is unmistakably present in every moment of the work I do. While my efforts are grounded in science and theory, they are undoubtedly woven together with who I am in the room: which thoughts, emotions, and personal memories come up for me while listening to my clients' narratives, how attentive and present I feel each moment of the session, and how I choose to respond or intervene. The beautiful thing about being my own tool is that I have the honor of lifelong learning and personal growth through this work as I support my clients in their own journeys toward healing. Following are some of the most poignant lessons providing therapy has taught me about myself...so far.

1.  I love to connect. This one may seem like a no-brainer; I must have been drawn to therapy at least in part out of my own innate desire to connect with others. However, the longer I work as a therapist, the more I realize how much joy and enrichment I feel through the connections I form with my clients and colleagues. It is hitting home even more now that I have been working with some clients over the span of years! It is an absolute privilege to experience my clients' lives with them.
2. Diversity energizes me. I've worked in settings where my clients all share very similar identities and presenting issues, and I felt much more fatigued from those settings than I do now in private practice. I love having a wide range of client ages, backgrounds, identities, and presenting concerns and find that it keeps me more engaged and energized.
3. I need balance. Similar to the above point about client diversity, I need balance and change in my professional activities. I love being able to teach and write in addition to my full-time work as a therapist. I am also taking steps toward adding consultation services to my practice and moving toward my ideal workload of therapy vs. other professional activities. I enjoy challenging myself with new experiences, like teaching in the Middle East earlier this year, as it mixes up my routine and sparks new learning.
4. I can't ignore my self-care. I am very emotionally present in my role as a therapist - session to session I may be tearing up with my clients, celebrating their victories, sharing in their disappointments, grieving their losses. My emotional connection guides and supports my work, especially as a relational-psychodynamic clinician, but it also can weigh heavy. I feel a big difference in my weeks if I am not prioritizing my own needs as well. I think about self-care in two ways - replenishment, or bringing things lagging up to baseline, and nourishment, or adding to that baseline for improved well-being. For the former, I feel replenished when I take care of chores, make phone calls, get caught up on notes, or take care of anything else that has been looming over me. For the latter, I feel nourished through exercise, spending time with loved ones, travel, and cooking. If I neglect either front, I feel emotionally heavier and less present as a therapist. 
5. I smile and laugh A LOT. My propensity for smiling and laughing (congruent with American cultural norms) has been both helpful and hindering as a therapist. It has allowed me to inject humor in my work, which has been a great way of building rapport with clients and can pave the way for clients to gain insight and hear feedback in a gentle way. However, I have learned that it can at times be hindering, particularly when smiling and humor are being used to avoid emotional depth. I have been intentionally working recently to gain more control over my instinctive smile so that it is more intentional and conscious. 
   
   

These are only five of many lessons I have learned over the years of being a therapist. As I am still early in my career, I anticipate endless lessons being added as I continue developing personally and professionally. To choose this career is to choose lifelong dynamic growth and learning - and constant honing of yourself as your tool. 

A few months back, I received an email from Lehigh (my PhD program and where I currently work as an adjunct professor) asking if I would be interested in teaching an eight-day course on group counseling for master's students in Kuwait. I paused and took account of my reactions to this question. Isn't it dangerous there? Would I feel uncomfortable as a foreign woman in the Middle East, alone? How would I connect with students from such a different culture, and within a society that has very different views on mental health? My stomach was performing anxious somersaults  imagining this experience. However, I also noted a familial tingle of excitement - a different part of me was reawakening - the part of me that loves a challenge, embraces having my comfort zone stretched, and thirsts for experiencing something new and different, especially related to culture and travel. After a week of pondering, I made the decision to go. 

I am currently on my fifth day here in Kuwait. I am curled up on a couch in the lobby of my hotel, sunlight and warmth streaming in from the big windows overlooking the city. I am feeling utterly fulfilled and refreshed as a professor of these brilliant, brave, and complex students. I am also feeling enriched and enamored with this country, the beauty of Kuwait City, and the vibrancy of the culture around me.

I felt some culture shock when I first arrived here. Kuwait does not have a big focus on tourism - and it shows. The airport had minimal signage for people new to Kuwait. The public transportation system is also limited and difficult to grasp if you don't speak Arabic. There is no hop-on-hop-off bus or tourism offices to plan your visit. Thankfully, I had some help with a meet and greet service at the airport to help me get my visa sorted and to transport me to my hotel. Lehigh also made sure I had contacts both at home and here in Kuwait to make sure things ran smoothly. Upon arrival, I was immediately struck by how urban it is here - the city is packed with tall apartment buildings, endless high-end shopping malls, busy roadways, and enough honking to rival NYC. The buildings are varying shades of sandy beiges and browns, bedecked with the visages of the Emir, smiling and waving. While the city is, in theory, walkable, it is not always pedestrian friendly, and crossing streets can be an extreme sport. 

On my second day, I got to meet two of my students who offered to take me out for coffee and dinner, and to show me around the city. While sipping on an iced matcha latte, I could already feel the warmth and generosity of the social climate. My students answered all of my questions about Kuwaiti culture, expressed curiosity about how it felt for me being here, and gave me great pointers on everything from how to cross streets without having my life flash before my eyes, to where to find top-notch knock-off perfumes at the Mubarakiya Souk (Arabic market).

My class includes nine students who represent as vast an array of cultural, religious, and lingual backgrounds as Kuwait City overall. Some hold very traditional and deeply held religious beliefs; others embrace more liberal and modern attitudes. Mental health here is in its infancy - there is deeply held stigma about mental illness and treatment for mental health problems. And yet, my students are defying stigma and opening themselves to learning about a topic that is not widely embraced within their culture. That takes courage. 

A significant aspect of our course is having an hour long experiential group that takes place during each class meeting. Students rotate being group leaders, and student members are themselves - no role playing or acting. I led the first group, but since that initial meeting I have been a group member as well. As each meeting has occurred, I have been able to see my students learn how to let go of their anxiety about the unknowns of what will happen in group, embrace the beauty of organic conversation and connection, and dig deep to share parts of themselves that they tend to keep hidden. Due to their diverse identities, this means something different for each student - however each one has taken courageous steps to find and embrace those common threads that hold us all together. These common threads are woven through sharing laughter, speaking in our home languages and explaining cultural sayings, discussing cultural values that shape our experiences and perspectives, and holding together shared emotions of anxiety, sadness, isolation, joy, empowerment, and connection that reflect a universal language. We are creating a tapestry as a group that is intricately textured, patterned, and infinitely colorful. 

I am already mourning the impending end of this teaching experience as it is already halfway to completion. However, I remain excited about where this journey will continue to go, and what other common threads will emerge along the way. 

Psychodynamic therapy is a style that is typically deep and insight-oriented, as it focuses not only on symptom reduction but also on the development of client self-awareness and self-understanding of who they are, how they got to be the way they are, and ways in which they can change. It maintains focus on both the past as well as the present/future and involves the exploration of how the unconscious mind and past experiences manifest in  behaviors and relational patterns. A psychodynamic clinician is curious about their client's childhood experiences and memories, their early and current attachment figures, and how they make meaning of the world around them.  Through exploring the past and the unconscious mind, the therapeutic process can aid clients in challenging old patterns, learning more about themselves on a deeper level, understanding how they function in intimate relationships, and developing tools for change.

Psychodynamic therapy is often integrated with other styles, such as Cognitive Behavior Therapy (CBT), as it can address deep-rooted and unresolved struggles, providing a rich foundation and motivation for behavioral change through CBT or other interventions. In fact, psychodynamic therapy is an evolution of psychoanalysis, which is the original talk therapy (think: Freud). Many of the more "skill-focused" therapies which get a great deal of press today, including CBT, originated from psychodynamic approaches and remain embedded in psychodynamic therapy. Indeed, empirical research has supported the effectiveness of psychodynamic treatment for a range of mental health issues, and clients tend to continue improving even after their treatment has finished (Shedler, 2010).

There is great variation in length of treatment for psychodynamic therapy, depending on presenting issue and therapist style. This approach tends to have less structure than CBT-based therapy to facilitate client spontaneity and insight. If you are looking not only to feel better in the present but to also learn about yourself, work through struggles from past relationships or your family-of-origin, and work on a deeper level with a therapist, this style could be a great fit for your treatment goals. 

Do you have questions about this style of therapy? Share them in the comments!

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. 

It can be tough to make the decision to get help. There are many factors which can hold people back from beginning (or returning to) therapy. Some common hesitations I have heard clients struggle with prior to making that call include:

1. Are my problems really that bad?
2. There are plenty of people worse off than I am...so why should I go to therapy?
3. I really don't feel like spilling my life story to a stranger.
4. I've felt worse than this before - I'll be fine. 
5. How on earth can I fit therapy sessions into my already hectic week?

Why the hesitation? Well, it certainly can relate to the ongoing stigma regarding mental health and psychotherapy. There are deeply set stereotypes about therapy from well over a century ago that still persist today, including therapy being for "crazy people," viewing help seeking as a sign of emotional weakness, or that receiving therapy is something to be ashamed of. In addition to stigma, others may have a hard time recognizing their pain AND seeing it as valid, often undermining the importance of their own self-care and well-being. Still other sources of hesitation may reflect a lack of prioritizing individual needs, tendencies toward being more of a private person, or skepticism about psychotherapy. Let's unpack some of those hesitations. 

1. Are my problems really that bad? Psychotherapy is effective for all sorts of struggles regardless of type or severity. It is flexible, client-directed, and can be customized to fit your needs. It has utility for everything from time management skills, to understanding yourself better, to managing mood, anxiety, substance use, or schizophrenia. There is no required level of severity to warrant therapy; rather, if you are even asking that question, it's a good sign that you could benefit from it. Some of the many signs that it is a good idea to go include: your normal sources of joy and stress relief are no longer doing the trick; you're in a major life transition that is causing you discomfort; you're noticing symptoms of lasting sadness, anxiety, or lack of energy that are impairing your normal routines; you're falling into destructive habits; you're having problems in your relationships; or, you experienced a trauma or loss and are struggling to bounce back. Your pain is valid, and you are deserving of help. 
2. There are plenty of people worse off than I am...so why should I go to therapy? Similar to the first point, there is no required level of severity for therapy to be indicated. To be human is to struggle, and emotional distress is universal regardless of its cause. Depression, anxiety, and distress do not discriminate. 
3. I really don't feel like spilling my life story to a stranger. Yup, I get that. It can feel overwhelming and intimidating to be vulnerable with someone you've never met before. You may come from a family or cultural background in which privacy is a major value, or you may just be a more shy or private person. It can help to be informed about what to expect at your first session to dispel some anxiety about starting therapy. Also, know that your therapist is aware of how hard it can be to get started and can help you ease in at a pace that feels comfortable for you. 
4. I've felt worse than this before - I'll be fine. It is common for those who have experienced emotional struggles once to experience them again. Depression and anxiety often ebbs and flows with our environmental stressors, time of year, etc., and some may be biologically predisposed to experience mood symptoms. Many find it beneficial to revisit therapy for a short-term "booster" course of treatment if they have already done counseling before. Additionally, just because you have felt worse doesn't mean you need to keep suffering. Notice the patterns of your distress and seek help to find ways to intervene.
5. How on earth can I fit therapy sessions into my already hectic week? Yup, I get that, too. It can be hard to make space for therapy, whether from a financial perspective or carving out time in your schedule. We typically don't hesitate too much to get to the doctor's office for a physical complaint - why don't we value attending to our mental health to the same degree? Your emotional pain is just as important as physical discomfort, and seeking help can improve your well-being drastically. Many therapists may offer evening or weekend availability to meet the needs of busy schedules. There are also options for making therapy more affordable, so don't foreclose on seeking help too soon. Here are some strategies for finding a therapist. 

What other hesitations might you have before seeking help? Other stigmas you want to debunk? Share them below!

Dialectical Behavior Therapy (DBT) is a specialized type of Cognitive Behavioral Therapy (CBT) that maintains a focus on interpersonal dynamics and relational distress. It was created in the 1980s by psychologist Marsha Linehan as a specialized treatment for those grappling with Borderline Personality Disorder (BPD). Growing up, Linehan was given a range of inaccurate psychiatric diagnoses and extreme forms of "treatment" to try to cure what she now believes was BPD.  BPD only became an official diagnosis in 1980, though references to it in psychological literature are present decades prior. Linehan's own struggles with mental illness and eventual success in managing her mental state to become a thriving and high-functioning professor of psychology served as her inspiration for developing the DBT approach.

DBT is a great treatment approach for those who have intense reactions to emotional situations, especially situations related to interpersonal relationships. For some, changes in relationships, whether it be movement towards OR away from intimacy with another, can elicit very strong and overwhelming emotional responses. DBT is especially designed to aid in managing strong emotional reactions through building skills for mood regulation, distress tolerance, mindfulness (e.g., meditation, staying present), and strategies to improve interpersonal effectiveness and relationships. It is designed to help people find balance between dialectics (e.g., opposites), and practice sitting in grey areas rather than black-and-white thinking (e.g., recognizing and tolerating ebbs and flows in relationships vs. believing that getting in an argument with a partner means the relationship is doomed). 

DBT capitalizes on the individual's strengths to aid in symptom reduction and progress. It utilizes similar components of CBT, with an effort towards identifying and challenging unhelpful thinking patterns, as well as relaxation training and mindfulness practices to re-learn how it feels to be at peace. DBT sessions are typically structured, time-limited, and present-focused. It is administered in individual, group, or a combination of group and individual modalities. While it was developed originally for and remains the top choice treatment for BPD, it has also been successful in treating post-traumatic stress disorder, some eating disorders, depression, and substance abuse.

Interested in finding a DBT therapist for yourself? Check this post for ways to get connected with a therapist.

Some other helpful resources on DBT:
Overview and Applications of DBT Therapy 
DBT Skills and Worksheets 
DBT Skills Workbook

Cognitive-Behavioral Therapy (CBT) is a widely utilized therapeutic orientation and has grown tremendously over the last few decades. Aaron Beck, MD is considered the father of modern CBT and its structured, scientific, and organized approach to problem-solving. CBT involves an emphasis on education to improve self-awareness and develop coping strategies for achieving behavioral change and more positive feelings. CBT tends to focus not on HOW your struggles came to be, but more exclusively on understanding how these struggles manifest and what you can do to change -- it is heavily goal-oriented. Many clinicians integrate CBT with other therapeutic approaches, as it is a great framework for short-term symptom reduction within the context of a deeper insight-oriented therapy. ​

CBT techniques focus on the links among thoughts, feelings, and behavior; at its core, CBT hones in on irrational, negative, and distorted thinking patterns (see: "thinking traps"), which connect to low mood and unhelpful behavioral patterns. The therapist first works with the client to identify unhelpful thinking patterns that support low mood and maladaptive behaviors. Next, the clinician provides a model of ways to effectively challenge and alter those cognitive patterns to achieve reduction of anxiety, depression, or other mental health struggles. Importantly, clients are encouraged to adapt and continue using CBT strategies to help maintain their well-being even after the therapy is finished.

In CBT, structure is important both within therapy sessions as well as during the days between in the form of homework assignments. A typical session of CBT involves completing an objective questionnaire to assess the client's mood, setting an agenda to determine what issues will be discussed, review of prior session, joint problem-solving and discussion of agenda topics, followed by a review of how the session went. CBT ranges from as few as 6 weekly appointments up to 20 depending on need, with follow up booster sessions after the course of therapy is complete. CBT has been found to be effective with many presenting problems, and it is especially well-suited (and researched backed) for anxiety disorders, somatoform disorders (psychological problems manifesting in physical symptoms), bulimia, anger problems, and general stress (Hofmann et al., 2012).

If you are looking for quick symptom reduction, coping skill development, and a straightforward, structured therapy approach, CBT is an excellent option for your treatment. If you like the principles of CBT but also want a deeper, insight-oriented approach, keep an eye out for clinicians who integrate CBT with other forms of therapy, such as psychodynamic, interpersonal, and existential. CBT is quite user-friendly; if you are experiencing more mild to moderate symptoms or can't access a CBT therapist, you can find a number of self-help books based in CBT principles that may offer you some relief (see resource list). 

What are your thoughts about CBT? Share any questions or comments below!

Some other resources to learn more about CBT:
More About CBT
Socratic Questioning in CBT
Self-Help CBT Book List

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. http://doi.org/10.1007/s10608-012-9476-1

 Making the decision to seek help is often the hardest part of beginning therapy. However, it can also be an overwhelming process to know where to look to find nearby therapists, how to find providers that take your insurance, AND find a provider who fits your schedule and price range! Not to mention, demand for high quality mental health care is at an all-time high, and many therapists are at their client capacity. This post offers strategies to guide your search and get your treatment up and running as soon as possible.

Before you start the search process, you'll want to determine whether you are going to use health insurance for therapy and what your mental health benefits are. To do this, you can either call your insurance company and ask what your coverage is, or you can log into your health insurance account online and get the same information. The perk of calling is that you can ask follow-up questions if there is anything unclear about your coverage (and let's be honest, pretty much everything is unclear when it comes to health insurance). However, calling can be time consuming and frustrating to get a live person on the other end. Either way, you'll want to have this information before calling therapists. 
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Thanks to the internet, there are many easy ways to locate providers in your area. Before you immediately pull up Google Maps, I'd first check out Psychology Today, which has a massive directory of therapists. You can even sort the listings by location, specialty area, gender, and, most helpfully, which insurance the provider accepts. This is often your best first stop for finding a therapist who matches what you are looking for. However, not every provider has a listing on Psychology Today, especially if they are a part of a larger group practice or clinic. Another strategy to find a therapist would be to log into your health insurance account (if you are using it) and find in-network providers through the provider search option. This is a fail-safe option to ensure that the therapist is in-network so you can use your healthcare benefits.

Google can also come in handy for finding any practices that are not listed in Psychology Today or if confirming health insurance coverage is not your top priority. Additionally, be sure to consider any alternative sources of mental health care you may be able to access. College students, check your school website to see if you have a counseling center on campus - this can be a great way to get short-term *free* therapy. Employees, you may have an Employee Assistance Program which often provides a few free sessions with a local provider to aid in clarifying your needs and setting you up with services.

Depending on where you live and what the demand is like, it may take some time to find an available therapist who fits your needs, so prepare for a bit of a process to get there. When you do call, if you are using health insurance, be sure to have your card in front of you so the provider can verify your benefits. Additionally, your availability makes a big difference in getting in the door -- challenge yourself to prioritize your mental health and make space for therapy in your week. 

Have any strategies that have worked for you? Share them below!

How important is a strong client-therapist match for effective psychotherapy treatment? Pretty important, but maybe not in the ways you would expect. 

No therapist is a one-size-fits-all clinician; each provider brings their personality, worldview, cultural identities, and unique approach to therapy to the table at every session. Some clients may have a strong preference for a therapist of a particular gender due to their past experiences or presenting concerns. Some may look for a therapist with a particular specialty, like trauma work, LGBT issues, ADHD, parenting, etc. You may also consider the therapist's education and degree - what kind of specialization did they pursue in graduate school? Are they at the master's- or doctoral level?

What is even more vital, though, is how connected you feel to your provider. Research has taught us that the emotional bond within the therapeutic relationship is the biggest predictor of therapy success, regardless of therapeutic approach (Lambert & Barley, 2001). Did you leave session feeling heard and supported? Was there warmth and empathy? Do you feel more hopeful about your situation? These factors trump the therapist's education level, specialization, or gender; even if you are convinced you can only see a young female therapist who uses CBT techniques, you may end up with a better match with someone entirely different who is able to connect with you in a more authentic and meaningful way. 

If you end up with a strong match from the start, wonderful! Sometimes, though, it may take a some time to feel connected and trusting. I encourage clients to give therapy a few weeks before making a decision about continuing or looking for a different provider. Be open with your provider and communicate what is working and not working in therapy. Don't worry - your therapist will not take it personally if you give them feedback about your sessions. Be an empowered consumer and use assertiveness to talk about what works for you. If it's not a good fit, let your therapist know and cancel out your appointments. A clean ending is much better than "ghosting" your therapist and never coming back -- trust me, they will appreciate it. 

Have any tips of your own for finding a strong client-therapist match? Share them in the comments.

Lambert, M. J. & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357-361.

Considering taking the plunge and beginning a course of therapy? It is common to have some questions about what to expect when you have your first appointment. It is an emotional and often difficult decision to finally make the call and set up that appointment. Let's break down five things you can expect.

1. Anticipatory Anxiety: Whether you've been a client several times before, or if this is your very first time meeting with a therapist, it's absolutely normal and expected to be feeling a bit nervous / ambivalent / guarded / avoidant / panicked / excited / freaking-out / oh-my-god-I-want-to-cancel. Therapy is simultaneously steeped in stigma and stereotypes, while also shrouded in mystery and confidentiality, leaving you, a new client, feeling lots of feelings about getting started. I encourage all new clients to ride that wave of anxiety and doubt; don't let it prevent you from seeking the care and support you need, but notice what it IS bringing up for you, as that will be helpful to talk about with your therapist. And believe me, they will be understanding and willing to talk about any concerns or questions you have about the therapy process to help you engage fully in the work.

2. Paperwork: Yup, you'll have to fill out some paperwork. There are certain documents required by law for clients to complete before beginning a course of treatment, including a confidentiality agreement, consent to treatment, and the disclosure of some personal information, including address, phone number, insurance information (if needed), etc. Your therapist may also ask for information about your past mental health, family history, medications, physical health, and any other doctors or providers you wish your therapist to contact (only with written consent). Some therapists also include a questionnaire to assess for depression and/or anxiety to get a baseline score at the start of treatment. It's generally a good rule of thumb to show up for your appointment a bit early to allow time to complete your paperwork. 

3. Orientation to Therapy: Before diving into your reasons for coming in, your therapist will often take some time to orient you to the therapeutic process. This "spiel" generally includes a review of confidentiality, which is the core of effective therapy. While there are some variations in limits of confidentiality depending on state, typically, everything you share in session remains between you and your therapist unless your therapist believes you are in imminent danger of suicide or homicide.  Your therapist will review these limits with you and answer any questions you may have. The therapist will also likely disclose to you their credentials and background and logistical information about session timing, contact information, fee rates, etc. They may also discuss their approach to therapy, including theories they use (e.g., CBT, psychodynamic, mindfulness) and what to expect during initial and future sessions. This is an excellent time to ask any questions you may have about the process of therapy or your therapist's approach. 

4. Information Gathering: Therapists are great contextualizers. While much of the conversation may be focused on sharing your current concerns and stressors, your therapist will want to be able to put those issues in the context of your life as a whole. Take anxiety, for example; though the symptoms may be similar for many people, it has vastly different triggers, sources, and appropriate interventions depending on the bigger context of the client's life. As a result, your therapist may ask about the history of your family and social systems, mental health, substance use, experiences of trauma, hobbies and interests, self-care practices, physical health, self-harm/suicidality, etc. If it becomes overwhelming or too difficult, it is okay to tell your therapist that you need to slow things down. You can also share general things without going into detail, or not share certain things until you feel ready to do so. It is important to remain empowered in what you choose to disclose, especially at the beginning -- which leads us to...

5. Post-Session Emotions: Initial sessions can bring up a lot. Think about it -- you just spilled a whole bunch of very intimate, personal information about yourself! Not to mention, many people don't often share this sort of information with other people in their life, and especially not to strangers. Talking about your struggles with your therapist for the first time can lead to some very positive feelings of relief, connection, and feeling heard and understood. However, it can also lead to some negative feelings of vulnerability, anxiety, or a sense of "unraveling" of things you may not have talked about or even thought about for a long time. You may be revisiting some of your ambivalence about beginning therapy in the first place (see #1) and feeling some hesitance to return for your next appointment. These reactions are expected for the first couple of sessions as you delve into your background and current struggles. As therapy continues, though, you'll notice the negative reactions will lessen as your therapy relationship becomes stronger and more trusting. Plus, you should hopefully feel some relief and improvement in your well-being as you continue in the therapy work. 

If you've gotten this far, you should be in pretty good shape for knowing what to expect during your first session. It is a big decision and can elicit some difficult emotions, but the journey of therapy is worth it. Approach it with openness and curiosity, and don't hesitate to ask questions and be empowered!