Blog - Page 3 of 7 - Cognitive Behavioral Therapy

Reasons for Seeing a Psychologist

There are a great many reasons why people seek out the help of a psychologist. As a practicing psychologist for almost 40 years now, I have been consulted for many of them.

The most common reasons people seek out a psychologist is that they are having problems and either want to get help or are referred by others to get help. They may be having problems with their health, work or school, friends or family. They may be overly addicted to bad habits like alcohol, drugs, smoking, food, gambling, etc. The result is they may be overly angry, anxious, fearful, guilty or depressed. They don’t like the way the way they feel or how it is impacting some parts of their life.

Another reason for seeing a psychologist is when an individual wants to increase his/her self-awareness and better understand themselves and why they do the things they do. They are seeking insight and want to know themselves better.

People also see a psychologist when they want help in making a decision. Perhaps it is whether to switch jobs or careers, to marry a particular person or to seek a divorce, or what to do with an aging parent or an acting-out adolescent.

Some individuals see a psychologist as an alternative to getting on medications to control their moods or to get off medications because they don’t like the side effects. Others want to learn to rely on themselves rather than a pill.

Because of my skill in working with athletes, I am often sought out to help them improve their performance, whether it be through helping train their concentration, enhance confidence or aid in coping with pressure situations more effectively.

When seeing a psychologist, individuals enjoy the privacy and confidentiality of sharing important information with a caring, compassionate and objective professional who is highly trained in areas of human behavior, mental health assessment, diagnosis, treatment and behavior change.

I work with children, adolescents, couples and adults in my Boca Raton, Florida location and in some cases, provide telephone and/ or video consultations.

Marriage Counseling

Psychologists often work with couples in marriage counseling. As a psychologist who practices cognitive behavioral therapy, the approach I use is often direct and straightforward.

I meet with the couple for an initial session. And then meet separately with each of the partners. Through both interview and specific questionnaires, I seek to identify and clarify the stated problems and issues along with the resources and strengths of the marriage and each partner.

Sometimes, if an individual’s problems are interfering with the marriage, like a significant alcohol, drug, major depression or anger problem, they are referred out to work with an individual therapist. In most cases marriage counseling proceeds with couples learning how to listen, communicate, assert, relax and often modify their unrealistic expectations of themselves and/ or their spouse. The process is less about changing the other person and more about changing and accepting oneself. At times the spouse must change. For example it is not OK for someone to be physically abusive or to squander the families college fund for the kids on gambling.

In cognitive behavioral marriage counseling, the focus is mostly on the present thoughts, attitudes, feelings and behaviors rather than rehashing the past, early childhood and related issues.

Clients are often given skills to practice between sessions to not only feel better but also get better.

A significant part of cognitive behavioral marriage counseling is psychoeducational. For example, a female might state that she feels badly that her husband is not supportive. The husband denies it and says whenever she complains about something at work he always listens and tells her what she should do. The wife turns around and says, “You see, he is not supportive. He just tells me what to do.” In this common example, the definition of “supportive” needs to be clarified. The wife needs to focus on the intent of the husband to be helpful and the husband needs to be more of a listener prior to jumping into the problem-solving role.

In cognitive behavioral marriage counseling, the psychologist helps both partners identify, recognize, support and reward positive efforts made by the spouse. Rather than focusing on what he or she didn’t do, there is more of an emphasis on what was done. The behavioral goal is to “shape up” the desired behaviors of both partners.

Cognitively, it is important for both partners to become more aware of their thoughts and how these thoughts impact their feelings about their partner. It is tough to feel warm and loving towards a partner in the evening if you have spent most of the day focusing-in on all their faults and mistakes. Changing the way we think helps us change how we feel and act. More often than not, positive behaviors in one partner triggers a reciprocal positive change in the other partner.

With committed couples, cognitive behavioral marriage counseling can be helpful in preserving and improving many marriages and often times in a matter of months rather than years.

Marriage Therapy

Marriage therapy is a service that is growing in demand, sadly due to the large numbers of unhappy and/or dysfunctional marriages. There is an arbitrary distinction sometimes made between marriage counseling and marriage therapy. Counseling usually refers to less serious cases where the couple is having some issues and are looking to make some adjustments or improvements to enhance their overall marriage satisfaction. Marriage therapy usually refers to couples that are having serious issues and in many cases one or both partners are considering divorce.

As a psychologist, I have to evaluate the relationship along with the strengths, weaknesses and concerns of each of the partners. If I determine there is a serious individual problem that is causing or impacting the marriage, I need to refer one or both individuals for individual treatment so that the marriage therapy can be most effective. This can be challenging at times. Not only do both participants need to agree, but they need to have the time, money and commitment to arrange for multiple appointments, sometimes within the same week while juggling work and family responsibilities.

At times, I work with marriage therapy issues from the standpoint of being the individual therapist for one of the participants. I might be working with the female on overcoming early trauma issues which are impacting her mood or ability to relate to her partner effectively. I might be working with a male whose anger is over –the-top or whose drinking, drugging or gambling problem is threatening to topple the marriage.

The success of marriage therapy depends first on the stability of the individuals and then the couple’s overall commitment to the relationship and the skills of the therapist working with the couple as well as any collateral therapy with the individuals.

Another complication is the field of marriage therapy is that there are many specialists who perform it, including, psychologists, social workers, marriage therapists, coaches, Rabbi’s and priests, etc. Their orientation, approaches and skill levels may vary widely.

My own approach to marriage therapy is based on cognitive behavioral therapy, which focuses more on the here-and-now issues and provides clients with practical skills, exercises and homework between sessions to work on improving themselves and the relationship. Cognitive and behavioral therapy tends to be focused, goal oriented and time limited. In general 12-20 visits that start out weekly and then are spread out as progress is made. I have developed a number of psycho-educational guidebooks I use with clients to educate and support the work we do together. Many clients and couples like having these self help guidebooks to refer to between our meetings.

While not all marriage therapy leads to living happily ever after, the quality of most relationships can be improved with skillful help, commitment and hard work. To save clients time and money and to help them see if there is a potential good fit between what they are looking for and myself, I recommend to potential clients to view my website to review educational videos and read some of my articles and blogs. If I am not the right fit, I am happy to make recommendations to other colleagues who might be.

Cognitive Behavior Therapy for Post-Traumatic Stress

Cognitive Behavior Therapy has been used to treat a great many types of conditions and disorders. Among the most devastating emotional conditions is post-traumatic stress disorder, also known as PTSD. When experienced early on in life it can significantly alter the course of emotional development and even impact one’s physical health. In more serious cases it can lead to serious eating disorders, drug abuse, violent behaviors, panic attacks, major depression and even suicide. The extremely high rates of suicide in the military reflect how serious an impact significant trauma can have on a person.

Post-traumatic stress is not limited to military personnel who are exposed to life threatening situations in combat and involved in horrific acts of violence on the battlefield. PTSD can affect anyone: fireman, policeman, ambulance personnel, bystanders, etc.

Post-traumatic stress is also seen in individuals who have been exposed to natural disasters like earthquakes and hurricanes, those who are involved in serious auto accidents, victims of violent crimes, domestic violence and childhood, physical, sexual and emotional abuse.

Cognitive behavior therapy is made up of many types of methods and approaches, several of which are particularly useful in treating PTSD. Psychologists and other mental health professionals undergo specialized training in these methods to be able to work effectively with post-traumatic stress disorder and related conditions.

One method that I have been using for perhaps 20 years now is known as EMDR or eye movement desensitization and reprocessing. I have had some very good results with a number of serious PTSD cases in a relatively short period of time. For some, the therapy is life changing and I am humbled and grateful to have the tools to make such a big difference in people’s lives.

Often times, people with PTSD who have had it for some years have been to many therapists and been on a variety of medications without significant relief. With EMDR, I have seen many clients significantly improve and in a number of cases, rid themselves of their symptoms completely.

EMDR treatment for PTSD is generally short term (3 months to a year). However, in my experience, sessions that are 90 minutes in length and held twice weekly, especially during the active treatment phases, tend to produce the best results.

I am not a scientist or a researcher, but as a psychologist and cognitive behavior therapist, I read and understand the research and much of it, both clinical trials and scientific studies largely support the usefulness of EMDR in the treatment of post traumatic stress.

If you or someone you know is suffering, know that help is available. EMDR trained psychologists and other mental health professionals are available world wide to help you live a trauma free life.

Hypnosis and Performance

Hypnosis has been a useful tool for improving performance. Over the past 35 years, I have had the opportunity to work with performing artists, athletes, business persons and students who were looking to either enhance their performance or reduce anxiety, worry and fear associated with performing in front of others.

Hypnosis can often accelerate the progress and improve the effectiveness in treatment . While not everyone can benefit from hypnosis, about 50% can be helped with hypnosis and another 20% can experience powerful results.

Hypnosis is a state of heightened suggestibility based on deep relaxation and specific suggestions developed through careful consultation with a skilled therapist specially trained in clinical hypnosis. While it is not entirely clear exactly how hypnosis works, there is ample evidence from numerous controlled and clinical studies that it can often be highly successful .

With performance issues, I often find direct suggestions around confidence, concentration and calmness are the foundation for enhanced performance. Where negative past experiences are blocking progress, hypnosis can be useful in identifying the blocks and facilitate working through them.

Hypnosis can be used as a sole treatment or as an adjunct to more comprehensive treatment depending on the presenting issues. It is increasingly common for clients coming in with performance issues to have significant co- occurring conditions which magnify there performance issues and make them harder to treat unless they are addressed as well.

Hypnosis treatment tends to be straightforward and short term. Following the education of the client on what hypnosis is and isn’t, a detailed assessment occurs. Then, the therapist develops problem-specific suggestions. Initial relaxation is taught and deepened in a follow-up session. Suggestions combined with relaxation gradually help clients change attitudes, feelings and behaviors. Often times performance issues can be improved or overcome in six to twelve sessions over a 3-4 month period.

Some examples of applications of hypnosis and performance include musicians, dancers and other performers, students taking tests, business people and other professionals needing to speak in public and even some forms of impotence .

The common elements of performance anxieties include basing one’s self worth on the performance, having perfectionistic standards, being overly self critical, fear of the anxiety and caring too much what others think about them.

Hypnosis aids in reducing anxiety, providing an effective method for regulating emotions and assisting in creating a healthier, stronger and positive performance image.

In my work with clients, I often record the sessions and encourage them to practice between visits to strengthen the suggestions. I also teach clients how to develop their own suggestions to maintain their progress in this and other areas of their life.

Hypnosis is a useful tool in the hands of a skilled psychologist or other mental health professional trained in its use. It accelerates treatment and has almost no negative side effects.

How to Select a Psychologist

How to select a psychologist can be a challenging task. Over the past few years, more and more people have been relying on their health insurance benefits or “provider panels” when they have a need for a psychologist. However, if your plan is an HMO, you may be limited to a relatively small number of “qualified” psychologists to choose from. Some HMO’s may not even have psychologists to refer to but rely on lessor trained “mental health professionals”. More experienced and well-established psychologists are increasingly choosing not to be on insurance panels because of the poor reimbursement rates and extreme amount of paperwork and bureaucracy. In addition, individuals are increasingly concerned about their privacy when using their mental health benefits. As a result, more and more people seeking psychotherapy are more willing to pay “out of pocket”.

How to select a psychologist will usually depend on a range of additional important factors. For example, if you have a young child, you may want a “child psychologist”. Not all psychologists are trained or interested in working with all ages and/or types of concerns. For example, although I do “some” career counseling, I am more likely to refer out to a colleague if career planning is the main referral reason.

While most psychologists generally deal with “anxiety and depression issues”, their approach may vary from a non-directive, passive, supportive approach (Rogerian) to a much more active, focused and solution oriented approach (Cognitive-behavioral ). When I sought help for dealing with some of my own issues back in college, I found non-directive approach to be largely unhelpful and frustrating for me.

Depending on the problem, individuals may want to select a psychologist that has specific skills or uses a particular method. For example, people suffering from chronic pain might benefit from a psychologist with expertise in hypnosis, and those suffering from post traumatic stress disorder may want a psychologist who used Eye Movement Desensitization and Reprocessing (EMDR).

A useful method to select a psychologist is a referral from a trusted friend or health care professional that has used or knows of the psychologist’s work first hand.

Another consideration in how to select a psychologist is convenience. When are you most available to see the psychologist and does he or she have openings when you would like to be seen? Since “therapy” may occur weekly for a period of months, this is a more important consideration than seeing a medical doctor or dentist who you might just see once or twice a year.

Another factor that needs to be addressed is location. The closer and more convenient the location, the greater chances you will be able to make your appointments on a regular basis.

Finally, a key factor is how to select a psychologist is “comfort and fit”. How comfortable do you feel in talking with the psychologist? Do you feel safe in the location? Do you feel understood? Does the psychologist explain the assessment and treatment approach that will be used? Do you leave the session with a sense of rapport and a degree of hopefulness?

I hope these factors will be useful to you in your search for a psychologist, if and when you have the need for one.

How to Succeed at Therapy

After 40 years in practice, I have made some observations of some of the ingredients that result in success in therapy.

What do you want to be different as a result of your work in therapy?
Be clear and specific about your goals and what you want to achieve.

2. Come to your appointments on time.
Therapy sessions are usually 45-50 minutes in length. Time passes very quickly so get the most of your session by coming on time, being prepared and focused.

3. Be consistent. Don’t miss scheduled appointments.
Most clients are usually seen once a week. Missing sessions can seriously interfere with the assessment process as well as the flow of treatment. Make the commitment.

4. Do your homework!
Reaching your goals, getting better and feeling better require effort, work and practice. Strengthening and reinforcing what you learn within the session is valuable but you increase your chances of success by the work you do between the sessions.

5. Be honest and open.
Success is strongly related to a good relationship based on trust, communication, raising any questions or concerns you may have and providing full and complete details of your experiences, efforts and results.

6. Keep a log or journal.
Recording your efforts and response to guided suggestions, readings ,and/or experiential exercises.is highly related to successful outcomes.

7. Silence your cell phone.
Your therapy hour should be the most important focus. Stay in the present moment. Avoid all distractions.

Brain Training

I recently heard a story of a young man that dropped his cell phone while crossing a busy intersection of traffic. He instinctively raced back into the traffic to retrieve it and was almost hit by a car. While he didn’t want to lose his valuable phone, he almost lost something that was irreplaceable, his life.

Many people are killed or injured by all sorts of impulsive actions. While in retrospect they would likely admit that it was a bad decision and they might even commit to not doing it again, the truth is their brain is trained to react impulsively and to ACT before they think. Making split second decisions requires training to rewire the brain to make the best decision in a particular situation. That is why special forces has drills to practice “shoot” or “don’t shoot” in life threatening situations.

If you want to change your behavior, you must have the intention of doing it and then practice it systematically each day for 30 days to help the brain react differently in the future.

So, our young man who leaped into the street to retrieve his cellphone would need to rehearse a new response. Perhaps, seeing his FIRST reaction to LOOK before he LEAPED and perhaps deciding to risk losing the cell phone rather than his life”. So, his first reaction becomes looking both ways and DECIDING rather than REACTING. Imagining the same situation but reacting differently is the key to being able to make better split second decisions. It might save a life: yours or someone you love.

Virtual Life Coaching

There are a great many reasons for the popularity of Life coaching. Here are several of the main ones:

Reason 1. Life Coaching is perceived to benefit highly functioning, generally stable individuals who are stuck, struggling with a difficult life decision or a looking for more expert advice or skills training to help them perform better in some areas of their life.

Reason 2. Life coaching focuses more on the present and the future.

Reason 3. Life coaching is goal oriented, solution focused and tends to conclude over months rather than years and often with measurable results.

Reason 4. Life coaching is more direct, interactive and often involve the coach teaching the client new skills to accomplish their goals.

Reason 5. Life coaching can be virtual via the phone or a video platform. As such, Life coaching allows great flexibility and convenience for the client and coach alike.

Reason 6. Because of the focus on resolving current issues and or teaching new skills, clients reach goals in a shorter period of time.

If you think life coaching may be something you might want to experience, contact Dr. Robert Heller for a free mini-consultation to see if you are a good fit for this approach.

Peak Performance Strategies

I recently came across an article on “9 ways Olympians develop resilience” and whether these attributes can be taught to the average person to perform better at the gym, tennis court, job and life in general. As a practicing psychologist, who has worked with lots of athletes and non-athletes for over 40 years, I do believe many of these attributes can be learned and/or improved upon. Here are my top five.