What we treat

Anxiety, mood, and emotional problems

• Agoraphobia

  What is agoraphobia?

  Agoraphobia refers to a fear of public, open, or crowded spaces, often where escape is difficult or unavailable (e.g., in a moving airplane.) This fear is usually related to panic attacks and/or otherwise fearing a loss of control in these spaces. Sometimes this fear leads people to avoid these spaces so much that they feel they cannot leave their home.

  How is agoraphobia treated?

  Treatments shown to improve agoraphobia include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure with Response Prevention (ERP), SPACE (Supportive Parenting for Anxious Childhood Emotions), and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Anger Problems

  What are anger problems?

  While there is no current “anger disorder” in the current diagnostic and statistical manual (DSM), there are many individuals who experience chronic, intense anger and have difficulty regulating their behavioral responses that leads to long term consequences in their personal and work relationships. Explosive anger is a learned behavior and therefore, with help, can be “unlearned” through increased awareness of one’s internal (i.e. cognitions, emotions, physiological sensations) and external triggers, development of emotion and behavior regulation strategies, as well as improved psychological flexibility and relationship to one’s thoughts.

  How are anger problems treated?

  Treatments shown to improve anger problems include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), relaxation techniques, and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their anger. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anger. Relaxation techniques teach individuals ways to reduce tension and distress. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Bipolar Disorder

  What is bipolar disorder?

  Individuals with this disorder experience alternating periods of depressed and elated moods, which are dramatic and unpredictable. This disorder is marked by very clear changes in mood, energy and activity levels. There are four basic types of Bipolar Disorder that vary according to type and frequency of manic and depressive episodes (i.e., Bipolar I (manic and depressive episodes), Bipolar II (hypomanic and depressive episodes), Cyclothymia (chronic hypomanic and depressive episodes more mild than those in Bipolar I or II), Other (Bipolar Disorder with Mixed Features, Bipolar Disorder with Seasonal Pattern, and Rapid Cycling Bipolar Disorder.) Periods of extremely “up”, elated, and energized behavior are called manic episodes. Less severe manic periods are called hypomanic episodes. Depressive episodes involve periods of feeling very sad, down, and hopeless.

  How is bipolar disorder treated?

  Treatments shown to improve bipolar disorders include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Interpersonal social rhythm therapy (ISRT), and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Interpersonal social rhythm therapy (ISRT) focuses on establishing daily routines that help regulate mood and manage and resolve interpersonal problems. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy.

• Body-Focused Repetitive Behaviors

  What are Body-focused Repetitive Behaviors?

  Clients suffering from body focused repetitive behaviors experience a strong uncontrollable urge in their body and relieve it by engaging in repetitive body behaviors. One out of 20 people report engaging in repetitive body-focused behaviors including scab picking, nail biting, hair pulling, and knuckle cracking. However, clients with Repetitive Body Focused Disorders (RBFD) report weak control over these urges and behaviors, excessive distress, and significant life interference.

  How are Body-focused Repetitive Behaviors treated?

  Treatments shown to improve body-focused Repetitive Behaviors include Comprehensive Behavioral therapy (ComB), habit reversal training, Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Comprehensive Behavioral therapy (ComB) develops an understanding of the function of BFRBs, specifically in the domains of Sensory, Cognitive, Affective, Motor, and Place (SCAMP), and how to best replace those behaviors and meet needs. Habit reversal training teaches individuals to become aware of their tic triggers, enact a competing response to interrupt the tic, and learn relaxation and stress management techniques to reduce triggers. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people ride out urges to do their BFRB. All of these treatments are effective for both adults and children.

• Coping with Chronic Pain and Medical Illness

  What is chronic pain?

  Chronic pain is a persistent, often debilitating form of pain that can last up to several years. Common forms of chronic pain include headaches, back pain, arthritis, and fibromyalgia. Pain conditions are common among Americans, with as many as 100 million adults experiencing a form of chronic pain. Although pain is experienced physiologically, it involves biological, psychological, and emotional factors and can result in feelings of anger, sadness, hopelessness, and anxiety. Many individuals with pain conditions experience significant impairment in functioning and quality of day-to-day life, with physical discomfort affecting involvement in responsibilities as well as engagement in enjoyable activities. Similarly, other medical conditions can be challenging to cope with and may also benefit from the support of therapy.

  How is therapy used to provide support for chronic pain and medical illness?

  Treatments shown to improve coping with chronic pain and some medical conditions include Cognitive Behavioral Therapy and Cognitive Behavioral Therapy for Chronic Pain (CBT and CBT-CP), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Stress Reduction (MBSR) and can incorporate pacing techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Cognitive Behavioral Therapy for Chronic Pain incorporates content specifically targeting thoughts and beliefs around pain, the source of pain (sometimes an injury or illness), and the way the pain impacts one’s personal life. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with pain and medical conditions. Mindfulness techniques help people find healthy ways to calm themselves. When combined with CBT, Mindfulness-Based Stress Reduction uses meditation and mindfulness practices to aid in minimizing inner conflict and intensity of emotional response to pain and medical conditions. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy.

• Depression and Depressive Disorders

  What are depression and depressive disorders?

  Individuals with Major Depressive Disorder (MDD) experience either loss of interest in pleasurable activities and/or persistent sadness for at least two weeks. Approximately 13% of adults in the U.S. report that they experienced a major depressive episode at some point in their lives. Typical symptoms of MDD include fatigue, concentration difficulties, feelings of hopelessness, thoughts of death or dying, and changes in appetite and sleep patterns. However, individuals with MDD can endorse numerous additional symptoms including anxiety, physical pain, and extreme social sensitivity. It is common to develop depression secondary to a severe anxiety disorder. Common symptoms of depression seen in children are irritability/aggression, social withdrawal, low self-esteem, and poor school performance.

  Dysthymic disorder (also known as Persistent depressive disorder) is a type of depression that lasts for at least 2 years in adulthood, or at least one year in childhood. Some experience dysthymia for many years. This depression is usually mild or moderate, rather than severe. Age of onset varies and can be unclear. Symptoms include difficulties sleeping, eating too much or poor appetite, feelings of fatigue, hopelessness, and low energy.

  Depression is also a symptom of Premenstrual Dysphoric Disorder and can occur at certain times of the year as in Seasonal affective disorder (also known as seasonal depression) or following having a child as in Postpartum Depression.

  How are depression and depressive disorders treated?

  Treatments shown to improve depressive disorders include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Behavioral Activation, Interpersonal Therapy (IPT), Problem Solving Therapy (PST), Dialectical Behavior Therapy (DBT), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with depression. Behavioral Activation involves making time for positive and self-care activities and incorporating healthy routines and some light movement to improve mood. Interpersonal Therapy (IPT) focuses on improving interpersonal problems and communication so that improved relationships and social support can improve your mood. Problem Solving Therapy (PST) is more popular among older individuals and involves approaching problems one at a time and nonjudgmentally to improve mood by incrementally taking practical steps to improve one’s life. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people improve their mood and better handle emotional distress. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle their worries and fears. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and youth.

• Generalized Anxiety Disorder

  What is Generalized Anxiety Disorder (GAD)?

  Individuals with GAD experience excessive worry most of the day, more days than not. The chronic worry creates significant anxiety and physiological sensations (e.g., stomach distress, muscle tension, fatigue, irritability). Individuals with GAD typically worry about topics that are concerns shared by most people but have difficulty “turning off a worry” and often “spiral” to imagining the worst-case scenario. Individuals with GAD often experience sleep difficulties secondary to the physical sensations brought on by worry. In general, most individuals with GAD have trouble trying new experiences (travel, recreational activities) as they have difficulty tolerating the uncertainty. 

  How does Generalized Anxiety Disorder look in children?

  GAD in children presents in a similar way; however, they may not be as aware of the worries as they are of physical problems brought on by worry (e.g., stomachaches). Children can manifest anxiety through agitation and irritability and excessive reassurance seeking from parents, teachers, etc.

  How is Generalized Anxiety Disorder treated?

  Treatments shown to improve Generalized Anxiety Disorder include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), SPACE (Supportive Parenting for Anxious Childhood Emotions), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle their worries and fears. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Grief and Bereavement

  What is grief and bereavement?

  Grief and bereavement refer to individuals’ physiological, emotional, and behavioral responses to loss. Loss can refer to many things. For example, the loss can be of a loved one, pet, job, ability, health status, relationship, pregnancy, or more. While grief is a normal response to loss, some people seek therapy during times of grief to help process feelings and move through the grief process with an added source of support. Prolonged Grief Disorder (also known as complicated grief) refers to intense, persistent grief that exceeds social and cultural norms. It is characterized by ongoing intense emotional pain or numbness, loneliness and difficulty connecting with others, difficulty integrating the loss into life and one’s identity, avoidance of reminders of the lost person or thing, and sometimes searching for things reminiscent of the lost person or thing.

  How is grief and bereavement treated?

  Treatments shown to improve prolonged grief include Complicated Grief Therapy (CGT), Acceptance and Commitment Therapy (ACT), Interpersonal Therapy (IPT), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Complicated Grief Therapy (CGT) helps individuals accept and integrate their loss, process emotions, and take steps to re-engage with their lives. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with loss. Interpersonal Therapy (IPT) focuses on improving interpersonal problems and communication so that improved relationships and social support can improve your outlook and engagement with life. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. All of these treatments are effective for both adults and children.

• Health/Illness Anxiety

  What is health (or illness) anxiety?

  Individuals with health anxiety have an excessive fear of illness and/or death. Frequently, these individuals engage in excessive health “safety behaviors” such as scanning their body for “symptoms” or seeking excessive reassurance from loved ones and health professionals regarding their health status. Despite these efforts, they rarely find relief. Some individuals with health anxiety excessively avoid health information and health professionals in belief it will prevent illness. Individuals with health anxiety feel more vulnerable to disease, and, as a result, they have trouble tolerating the uncertainty regarding diseases and illness.

  How is health (or illness) anxiety treated?

  Treatments shown to improve Illness Anxiety Disorder include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), SPACE (Supportive Parenting for Anxious Childhood Emotions), Mindfulness-Based Cognitive Therapy, Inference-based Cognitive Behavioral Therapy (I-CBT), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Mindfulness techniques help people find healthy ways to calm themselves. When combined with CBT, Mindfulness-Based Cognitive Therapy combines meditation and mindfulness practices to aid in letting go of unhelpful thoughts and approach automatic thoughts nonjudgmentally. Inference-based Cognitive Behavioral Therapy (I-CBT) focuses on obsessional doubt and how to stop the process of worry before enacting compulsive behaviors, like checking or avoidance. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Hoarding

  What is Hoarding Disorder?

  Individuals with hoarding disorder struggle with difficulty discarding items, and this significantly interferes with functioning. Individuals who hoard exhibit great difficulty discarding items. They accumulate a large quantity of possessions typically seen by others as useless and not valuable. The saving and acquiring behaviors interfere with the use of the space (e.g., cannot cook in the kitchen or accommodate a guest in spare bedroom). Common reasons for difficulty discarding include attachment or sentimentality, facilitating memories, emotional comfort, and responsibility not to waste. It is usually recommended that this be treated, at least in part, in the home or location in which the items are stored.

  How is Hoarding Disorder treated?

  Treatments shown to improve hoarding disorder include Cognitive Behavioral Therapy (CBT) and Exposure with Response Prevention (ERP.) Treatment may additionally incorporate lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries and challenge thoughts and beliefs they have about their items. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided, like going shopping without buying anything. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Insomnia

  What is insomnia?

  Insomnia is a sleep disorder that makes it hard to fall asleep, stay asleep, or wake up too early. Sleep disruption often co-occurs with anxiety and depression. Common problems include difficulty falling asleep, waking up at night, or waking up early. Over time, many also develop sleep-related anxiety. 

  How is insomnia treated?

  Treatments shown to improve insomnia include CBT-I Cognitive Behavioral Therapy for Insomnia (CBT-I), stimulus control, sleep restriction, and relaxation techniques.

  Cognitive Behavioral Therapy for Insomnia (CBT-I) has been shown to be the most effective treatment for insomnia in several studies. Treatment includes assessment of sleep behaviors and related history, monitoring of sleep habits, alteration of sleep habits and environmental interference, implementation of an individually tailored sleep schedule based on current sleep patterns, and addressing disruptive beliefs about sleep. 

  Cognitive Behavioral Therapy for Insomnia (CBT-I) incorporates elements of cognitive therapy, which helps challenge thoughts and beliefs about sleep; stimulus control, which limits time spent in bed to sleep; relaxation techniques to foster sleepiness; and sleep consolidation, in which sleep is consolidated to only the desired times.

• Misophonia

  What is misophonia?

  Some people experience disproportionate emotional and physiological reactions to noises typically made by others including chewing, slurping, and breathing. These reactions can run the gamut from irritation and anger to panic and a need to flee. Research is relatively new, but some clinical trials suggest that there are neurological underpinnings that make one vulnerable to misophonia. These reactions can be extremely disruptive in social contexts and render the patient isolated (i.e. eating in their room, driving in separate cars, and overall, out of the social loop). 

  How is misophonia treated?

  Treatments shown to improve misophonia include Cognitive Behavioral Therapy (CBT) with elements of Exposure with Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), and mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about these sounds and their aversive reactions to them. Acceptance and Commitment Therapy (ACT) helps create more space and less resistance to life’s uncomfortable experiences and increases one’s sense of control and contentment with these noises. Mindfulness-based interventions including attention training, acceptance and non-judgment, and distress tolerance are shown to be the most effective interventions for misophonia. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. All of these treatments are effective for both adults and children.

• Obsessive Compulsive Disorder

  What is Obsessive Compulsive Disorder?

  People with obsessive-compulsive disorder suffer from persistent beliefs (obsessions) that can come in the form of thoughts, images or urges. These obsessions are unwanted, repetitive, and cause life-interfering distress. Often, people suffering from OCD engage in behaviors (compulsive rituals) that reduce the distress associated with their obsessions for a brief period only to make them more difficult to eliminate. Individuals with OCD often describe feeling as if they have little to no control over these thoughts and behaviors. They also report having difficulty functioning at home or at work. Obsessions can take an infinite number of forms, but common obsessions include:

  • contamination (e.g., HIV/AIDS, dirt/germs, or not-just-right feeling)
  • harm to loved ones/self
  • symmetry/order and exactness
  • unwanted religious or sexual thoughts
  • excessive doubting
  • not-just-right-feeling about numerous (or single) thoughts, objects, emotions, or body sensations

  Corresponding rituals include:

  • hand washing or excessive cleaning
  • excessive checking
  • arranging or ordering
  • praying or mental compulsions like replacing a bad thought with a good thought
  • mentally reviewing situations
  • repeating (e.g., erasing, re-ordering or adjusting, re-reading)

  Individuals with primary obsessional OCD have rituals that are more covert (e.g., mental compulsions, reassurance-seeking). Mental compulsions might include repetition of special words, mental reviewing, and mental “un-doing”. The function of the mental compulsion is to make a thought or feeling go away. Reassurance-seeking may include asking others for reassurance, assuring oneself repeatedly, or frequent confessing to others. Frequent internet searching can be another form of reassurance seeking, as one may seek reassurance in forums, chat rooms, or from information websites.

  How is Obsessive Compulsive Disorder treated?

  Treatments shown to improve obsessive compulsive disorder include Cognitive Behavioral Therapy (CBT) with Exposure with Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), SPACE (Supportive Parenting for Anxious Childhood Emotions), Inference-based Cognitive Behavioral Therapy (I-CBT), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Inference-based Cognitive Behavioral Therapy (I-CBT) focuses on obsessional doubt and how to stop the process of worry before enacting compulsive behaviors, like checking or avoidance. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Outpatient Eating Disorders

  What are outpatient eating disorders?

  Individuals with an eating disorder exhibit unhealthy relationships and behaviors with food and body. Behaviors such as restricting food intake, bingeing, purging, avoiding, over exercising, misuse of laxatives and diuretics can be all consuming and negatively affect one’s thoughts and emotions and overall quality of life. Because eating disorders cause a lot of preoccupation and distress in order to maintain them, they frequently affect an individual’s relationships, cause misalignment with values, and negatively impact one’s mental and physical health. Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder, and avoidant-restrictive food intake disorder (ARFID).

  ‘Outpatient’ refers to the level of treatment for eating disorders. If an individual’s eating disorder has already received primary eating disorder treatment (e.g., they are now stepping down from PHP or residential care) or if the individual has a history of eating disorder, but this is not their main challenge currently they are appropriate for outpatient eating disorder treatment. Chicago CBT Center is not a primary eating disorder clinic or hospital and cannot meet the needs of primary eating disorder treatment.

  How are outpatient eating disorders treated?

  Outpatient treatments shown to improve eating disorders include Cognitive Behavioral Therapy for Eating Disorders (CBT-E), Acceptance and Commitment Therapy (ACT), Family-based Therapy (FBT), and Temperament Based Therapy with Support (TBT-S) for anorexia.

  Cognitive Behavioral Therapy for Eating Disorders (CBT-E) helps individuals create new ways of thinking about their beliefs and thoughts related to eating. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety and distress around eating. Family-based Therapy (FBT) is a family treatment for children and adolescents experiencing anorexia or bulimia that teaches parents to monitor their child’s eating, binging, and purging; reduces conflict and coaches parents in how to support their child by not accommodating eating disorder behaviors with empathy. Temperament Based Therapy with Support (TBT-S) for anorexia uses psychoeducation about one’s neurobiology and natural proclivities in conjunction with developmentally appropriate cognitive and behavioral skills to identify and change unhelpful thought patterns and behaviors. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Oppositional Defiant Disorder

  What is Oppositional Defiant Disorder?

  This refers to a pattern of irritability, argumentativeness, aggressive and/or defiant behavior that lasts more than 6 months and causes significant problems at home or school. Symptoms generally begin in childhood (before age 8) and the pattern of behavior is more extreme than expected as compared to others of the same age or stage.

  How is Oppositional Defiant Disorder treated?

  Treatments shown to improve oppositional defiant disorder include Parent Management Training (PMT) and Parent-Child Interaction Therapy (PCIT). Parent Management Training (PMT) teaches parents to reinforce desired behavior and minimize less desired behaviors. Parent-Child Interaction Therapy (PCIT) increases positive interactions and secure attachment as a foundation for learning methods of managing challenging behaviors in a calm, consistent manner.

• Panic Disorder

  What is panic disorder?

  Panic attacks are common in all anxiety disorders and in the general public (33% of people have had a panic attack in the past year). However, those who suffer from panic disorder have persistent fear of having a panic attack in a situation in which they cannot escape or get help. A panic attack is defined as the emergence of four or more physiological sensations (e.g., heart race, dizziness, lightheadedness, stomach distress) peaking in intensity within 10 minutes. Those with panic disorder typically fear one of four catastrophic outcomes resulting from panic: “I am going to lose control of myself,” “I am going to die,” “I am going to go crazy,” and “I am going to embarrass myself.” Often, people with Panic Disorder tend to avoid situations that might elicit a panic attack. Some examples of avoided situations include certain foods (caffeine, sugar, alcohol); emotions (excitement, anger, anxiety); and activities (exercise, sex). When individuals avoid locations (airplanes, traffic, large open spaces), this is often referred to as agoraphobia.

  How is panic disorder treated?

  Treatments shown to improve panic disorder include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure with Response Prevention (ERP), SPACE (Supportive Parenting for Anxious Childhood Emotions), and lifestyle tweaks, like improving sleep hygiene, movement, and social support.

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. People with panic disorder tend to use SSRIs, benzodiazepines (e.g., Xanax, Ativan) to control the onset of and recovery from panic sensations.All of these treatments are effective for both adults and children.

• Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

  What is Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)?

  Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a condition that occurs when a streptococcal infection (like strep throat) triggers an abnormal immune response in a child’s body. Instead of targeting the bacteria, the immune system mistakenly attacks healthy cells in the brain, particularly in areas that affect mood, behavior, and motor skills.

  This autoimmune reaction can cause a rapid onset of neuropsychiatric symptoms, including obsessive-compulsive behaviors, anxiety, and even tics. It’s as if a switch flips overnight, leaving parents and children confused and caught off guard.

  How is Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) treated?

  The best treatment for Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is antibiotics for the infection and cognitive behavioral therapy (CBT) to manage the obsessive-compulsive behaviors and anxiety and provide support to parents and child.

• Perfectionism

  What is perfectionism?

  While not a “disorder” in the Diagnostic and Statistical Manual (DSM), perfectionism is more than just wanting to do well. It’s an intense drive to avoid mistakes, meet unrealistically high standards, and achieve flawless results. It’s not about being your best; it’s about feeling like nothing you do is ever good enough.

  There are different types of perfectionism:

  • Self-oriented perfectionism: Setting impossibly high standards for yourself.
  • Other-oriented perfectionism: Expecting others to meet your high standards.
  • Socially prescribed perfectionism: Feeling pressured by others to be perfect.

  While perfectionism might seem like a recipe for success, it often comes with stress, overwork, negative self-talk, procrastination, and burnout.

  How is perfectionism treated?

  Treatments to improve perfectionism include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their perfectionistic tendencies. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to overcome perfectionism. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people improve their ability to hold opposing truths (like something being imperfect and also good) and better handle emotional distress when facing imperfect outcomes, criticism, or pressure. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about why they feel the need to be perfect despite wanting to be free from the pressure of perfection. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. All of these treatments are effective for both adults and children.

• Personality Disorders

  What are personality disorders?

  Personality disorders are mental health conditions where long-term patterns of thinking, feeling, and behaving differ significantly from societal expectations. These patterns can make relationships, work, and daily life more challenging.

  Personality disorders fall into three broad categories: eccentric, emotional, and anxious. In the eccentric category, Paranoid Personality Disorder, Schizoid Personality Disorder, and Schizotypal Personality Disorder are characterized by unusual beliefs and thought patterns and social disconnection. In the emotional category, Borderline Personality Disorder (BPD), Narcissistic Personality Disorder, Antisocial Personality Disorder, and Histrionic Personality Disorder are characterized by extremes of emotional experiences (either intense emotional experiences or emotional numbness or apathy) and difficulty maintaining healthy positive relationships. In the anxious category, Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder (OCPD) are characterized by extreme anxiety (either in intensity or how often they feel extremely anxious) about receiving criticism, abandonment and separation, or about not maintaining order and perfection.

  How are personality disorders treated?

  Treatments shown to improve personality disorders include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with emotional and relationship challenges. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people better handle emotional distress and contradictions in life. It is important to note that we offer individual DBT therapy, not a DBT intensive outpatient program with phone coaching offered by higher levels of care. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle their worries and fears. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy.

• Selective Mutism

  What is selective mutism?

  Individuals with selective mutism consistently do not speak in particular social situations where an expectation for speaking exists, though they may speak without difficulty in other situations. Selective mutism occurs most frequently in children and onset of difficulty speaking often occurs before the age of five. Selective mutism will interfere with the individual’s functioning in educational, occupational, or social settings.

  How is selective mutism treated?

  Treatments shown to improve selective mutism include Cognitive Behavioral Therapy (CBT), Exposure with Response Prevention (ERP), SPACE (Supportive Parenting for Anxious Childhood Emotions), play therapy, and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Play therapy meets children where they developmentally are and uses play to create opportunities to model and build important skills and practice responding differently to challenging situations. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Self-Esteem Challenges

  What are Self-Esteem Challenges?

  Low self-esteem can be brought on by a wide variety of factors: peer victimization, employment difficulties, relationship problems, body image issues, and physical health concerns – to name a few. Unfortunately, self-esteem issues are often linked to mental health disorders and unhealthy coping skills. Those affected can struggle interpersonally, often having difficulty advocating for their needs and creating healthy boundaries. People with low self-esteem also frequently engage in negative self-talk, feel unworthy, avoid new experiences out of fear of failure, have social withdrawal, and have a negative outlook on the future.

  How are Self-Esteem Challenges treated?

  Treatments to improve self-esteem include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to overcome low self-esteem. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about why they feel like they lack self-esteem. Mindfulness techniques help people approach thoughts and experiences nonjudgmentally. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. All of these treatments are effective for both adults and children.

• Separation Anxiety

  What is separation anxiety?

  Children, teens, and adults with separation anxiety typically fear being away from loved ones and/or home. People who struggle with separating tend to worry more about their own well being, the well-being of their loved ones as well as fears of having uncomfortable sensations associated with anxiety (e.g., stomach distress) or illness while away. While the worry of separating can occur during daytime activities, anxiety tends to escalate around nighttime and during extended trips. 

  Children in particular tend to struggle with independently attending birthday parties, new camps, new classrooms, sleepover and older adolescents can fear going away to college. Some children will exhibit oppositional behaviors (e.g., “meltdowns,” tantrums, aggression) in an effort to avoid leaving parents/home. Separation anxiety can interfere with social relationships given reluctance to enter new social situations that require temporary separation from loved ones.

  How is separation anxiety treated?

  Treatments shown to improve Generalized Anxiety Disorder include Cognitive Behavioral Therapy (CBT), SPACE (Supportive Parenting for Anxious Childhood Emotions), play therapy, and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Social Anxiety

  What is social anxiety?

  Individuals with social phobia are excessively concerned with the negative judgment of others. While they remain interested in social connections, they tend to avoid social interactions to reduce their distress and discomfort. The vast majority of adults with social phobia report having experienced this worry “for as long as they could remember,” and typically describe having been shy and quiet during their school years. Physical sensations accompanying anxiety (such as stomach distress, concentration challenges, and blushing) can increase fear and embarrassment in social situations. 

  Most adults and children with social anxiety find it difficult to initiate conversations, express opinions, speak in groups, make eye contact, tell jokes, take risks, and pursue new peer and romantic relationships. In some cases, people with social anxiety avoid social situations and become isolated as a result. In other cases, individuals with social anxiety will overextend themselves socially in order to please everyone. Other people appear socially comfortable and connected, but express very little social enjoyment due to their constant need for impression management and social approval. It is common to overthink or overanalyze social situations, replaying interactions in their mind.

  How is social anxiety treated?

  Treatments shown to improve Social Anxiety Disorder include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure with Response Prevention (ERP), SPACE (Supportive Parenting for Anxious Childhood Emotions), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle their worries and fears. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Specific Phobia

  What is a Specific Phobia?

  A specific phobia refers to the excessive and persistent fear of specific objects or situations that is understood as out of proportion to any actual danger. The fear causes life-interfering distress and/or impairment. Common types include:

  • Animal Type (e.g., dogs, cats, spiders, insects, rats, birds, and snakes)
  • Natural Environment Type (e.g., heights, storms, and water)
  • Blood-Injection-Injury Type (e.g., seeing blood, receiving a blood test or injection, watching medical procedures)
  • Situational Type (e.g., driving, flying, elevators, and enclosed places)
  • Other Type (e.g., choking or vomiting, loud noises, or fears of costumed characters)
  • Emetophobia: This is a specific fear of vomiting. It includes excessive anxiety about feeling nauseous, becoming sick, vomiting in front of others, and/or seeing or watching vomit. People may be anxious about eating certain foods due to fear of vomiting, or be particularly concerned about being near others who are sick or recently vomited. They may ask for frequent reassurance about becoming sick, and engage in repetitive behaviors (e.g., excessive hand-washing) in an effort to prevent becoming sick.

  How is it specific phobia treated?

  Treatments shown to improve specific phobias include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure with Response Prevention (ERP), SPACE (Supportive Parenting for Anxious Childhood Emotions), and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Tourette’s/Tic Disorder

  What are Tourette’s and tic disorders?

  Individuals with Tourette’s disorder exhibit a range of sudden movements and vocalizations known as tics. These behaviors are brief, but recur frequently, especially during times of heightened stress, excitement, anxiety, or fatigue. It’s also common for tics to decrease during times of focused activity, such as while a child is working on homework. Tics are classified based on the type (motor or vocal) and complexity (simple or complex) of the behavior. As a result, tics can take a variety of forms and their presentation can vary even within an individual from moment-to-moment. Two of the most common tics are eye blinking (simple motor) and throat clearing (simple vocal). Because transient tics are common in childhood, individuals with Tourette’s disorder must have a pattern of recurrent tics for at least a year and the individual must have experienced multiple motor tics and at least one vocal tic. Tics are often experienced as involuntary; however, some individuals experience an urge prior to a tic’s occurrence and individuals are able to suppress these movements at times.

  How are Tourette’s and tic disorders treated?

  Treatments shown to improve specific phobias include Comprehensive Behavioral Intervention for Tics (CBIT) and habit reversal training.

  Habit reversal training teaches individuals to become aware of their tic triggers, enact a competing response to interrupt the tic, and learn relaxation and stress management techniques to reduce triggers. Comprehensive Behavioral Intervention for Tics (CBIT) type of behavioral therapy that combines habit reversal training, relaxation and stress management, and psychoeducation about Tourette’s and tic disorders. All of these treatments are effective for both adults and children.

• Trauma and Post-Traumatic Stress Disorder

  What is Trauma and Post-traumatic Stress Disorder (PTSD)?

  PTSD is a trauma and stress related disorder that can develop following a traumatic event (i.e., exposure to a threat to the physical integrity of self or others). The traumatic event is experienced with a sense of intense fear, horror, or helplessness. In children, the reaction involves disorganized or agitated behavior. Symptoms of PTSD include:

  • re-experiencing the trauma (i.e., flashbacks, nightmares, recurrent intrusive thoughts)
  • hyperarousal (i.e., feeling jumpy or easily startled, difficulty sleeping and restlessness, irritability, difficulty concentrating, and hypervigilance or feeling on guard)
  • avoidance (i.e., avoiding places, people, events, or objects that remind a person of his or her trauma, emotional numbness, loss of interest in previously-enjoyed activities, difficulty remembering important aspects of the trauma, feeling cut-off from people)
  • negative feelings and thoughts (i.e., persistent and distorted thoughts such as blaming yourself or others, or persistent negative feelings like depression and anxiety)

  Many individuals experience a few of the symptoms described above following a trauma. However, a person develops PTSD when these symptoms last more than one month and become life interfering. In some cases, it can be months or years following a trauma before symptoms emerge.

  PTSD symptoms can arise in people of all ages who have experienced a traumatic event; however, symptoms may appear differently in children compared to adults. Younger children may develop the following symptoms: repetitively acting out the event during play, separation anxiety, decrease in speech, bedwetting, and/or stomachaches and headaches. Symptoms in teenagers are more likely to resemble those of adults but may also include disruptive and destructive behaviors. In addition to the symptoms described above, those with PTSD often have emotional reactions such as anger, guilt and shame as well as disruption in sleep, diet, and exercise habits.

  How is Trauma and Post-traumatic Stress Disorder treated?

  Treatments shown to improve post-traumatic stress disorder (PTSD) include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Acceptance and Commitment Therapy (ACT), Trauma-focused cognitive behavioral therapy (TF-CBT), SPACE (Supportive Parenting for Anxious Childhood Emotions), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Processing Therapy (CPT) targets beliefs and thoughts related to the trauma that may have been protective in the traumatic moment, but hold someone back outside of that moment. Prolonged Exposure (PE) gradually exposes individuals to traumatic memories, feelings, and situations they might be avoiding, allowing them to process and reduce their anxious response. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Trauma-focused cognitive behavioral therapy (TF-CBT) helps children, adolescents, and families create new ways of thinking about the trauma and begin to approach things the traumatized person finds aversive. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle trauma and fears. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Trichotillomania/Hair Pulling & Excoriation/Skin Picking

  What is Hair Pulling Disorder (Formerly Trichotillomania)?

  Trichotillomania, or hair pulling, is a very common Repetitive Body Focused Disorder. Clients with trichotillomania will pull hair from any site on their body, but the most common sites include eyelashes, eyebrows, scalp hair, underarm and pubic regions, and arm and leg. Individuals with trichotillomania have noticeable gaps or patches in hair growth. Pulling behavior can be focused (with awareness) or automatic (without awareness). The behavior can be experienced as soothing in the moment but can lead to feelings of shame and anxiety. For some people, the pulling ritual includes examination of hair and root, as well as root chewing. Pulling behavior may be triggered by a variety of emotions (e.g., stress, anxiety, anger, boredom), situations (e.g., work, T.V., driving, falling asleep), or contexts (e.g., seclusion, mirrors, grooming).

  What is Skin Excoriation (Skin Picking)?

  Skin Picking is a body focused repetitive behavior in which people excessively pick or scratch at their blemishes, scabs/sores, etc. Individuals with skin picking often pick to accelerate the healing of a blemish, achieve symmetry, or soothe an uncomfortable urge. Most individuals will describe feeling out of control or “once I start, I can’t stop.” The damage to skin is often noticeable and leads to embarrassment and shame. As a result, individuals with skin picking will typically attempt to conceal the skin picking sites.

  How is Hair Pulling Disorder and Excoriation treated?

  Treatments shown to improve Body-focused Repetitive Behaviors like hair pulling and excoriation include Comprehensive Behavioral therapy (ComB), habit reversal training, Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Comprehensive Behavioral therapy (ComB) develops an understanding of the function of BFRBs, specifically in the domains of Sensory, Cognitive, Affective, Motor, and Place (SCAMP), and how to best replace those behaviors and meet needs. Habit reversal training teaches individuals to become aware of their tic triggers, enact a competing response to interrupt the tic, and learn relaxation and stress management techniques to reduce triggers. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people ride out urges to do their BFRB. All of these treatments are effective for both adults and children.

Interpersonal & relationship issues

• Attachment Concerns

  What are attachment concerns?

  Attachment concerns arise when the natural process of forming secure emotional connections is disrupted. These issues can show up in childhood or adulthood and may include insecure attachment styles (patterns like anxious, avoidant, or disorganized attachment), difficulty trusting others, fear of abandonment or rejection or worry about being unworthy of love, and/or over-dependence or avoiding relationships altogether.

  Some parent and child relationships can feel extra challenging. This can be due to traumatic or stressful events in the child or parents life or more simply differences in temperament and personality.  Attachment concerns in children can show up in a variety of ways including patterns of avoidance toward parental nurturing, oppositional behavior, poor emotion regulation skills, over familiarity with strangers, and a pattern of nurture seeking followed quickly by rejection toward parents.

  Attachment concerns can impact all kinds of relationships—romantic, familial, or friendships. They can impact people through emotional highs and lows, communication struggles, conflict and/or self-esteem issues. Understanding these effects can help you recognize and address patterns in your own relationships.

  How are attachment concerns treated?

  Depending on who in the relationship is coming to therapy, the nature of the relationship, the ages of those involved, and the needs and goals of those involved, therapy for attachment concerns may involve individual therapy, couples therapy, parent training, family therapy, or a combination of these. 

  Family treatments shown to improve attachment include Structural Family Therapy (SFT), Multisystemic Therapy (MST), Parent Management Training (PMT), and Parent Child Interaction Therapy.

  Structural Family Therapy (SFT) focuses on identifying and changing dysfunctional family patterns through improved communication and reduced conflict. Multisystemic Therapy (MST) approaches treatment from the perspective of addressing the multiple systems (e.g., school, family, friends, neighborhood, etc.) that impact youth behavior. Tapping into your family’s “village” can improve overall support, functioning, and improve family dynamics. Parent Management Training (PMT) teaches parents to reinforce desired behavior and minimize less desired behaviors. Parent-Child Interaction Therapy (PCIT) increases positive interactions and secure attachment as a foundation for learning methods of managing challenging behaviors in a calm, consistent manner.

  Individual therapy for attachment concerns may involve Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Internal Family Systems Therapy (IFS, also known as “parts work”.)

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their interactions and relationships. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to re-establish or establish new attachment patterns. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people improve the way they relate to others and better handle emotional distress. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how they think about and act on attachments. 

  Couples therapy may include Emotionally Focused Therapy (EFT), Gottman Method, Acceptance and Commitment Therapy (ACT), and Integrative Behavioral Couples Therapy (IBCT.)

  Emotionally Focused Therapy (EFT) focuses on emotional bonding by helping couples create a closer connection and increase trust between partners. The Gottman Method  emphasizes communication skills and conflict resolution as well as recognizing bids for closeness and attention and how one’s response to these bids impacts overall relationship functioning. Acceptance and Commitment Therapy (ACT) focuses on using shared values to bond and guide couples toward more meaningful interactions and activities. Integrative Behavioral Couples Therapy (IBCT) emphasizes increasing feelings of acceptance and feeling seen and heard in relationships as a “home base” for when couples choose to address problematic patterns or work toward deeper change.

• Codependency

  What is Codependency?

  Codependency is not a psychological disorder, but a relationship dynamic where one person’s happiness or stability heavily depends on the other. It’s common in relationships with people struggling with addiction, mental health issues, or other challenges, but it can also happen in any close relationship—romantic, familial, or platonic.

  Key traits of codependency include an excessive need to care for or control others; difficulty setting boundaries; feeling responsible for someone else’s emotions or actions; and neglecting your own needs, desires, or goals.

  Codependency may be especially relevant to those who engage in people-pleasing, have a sense of over-responsibility for others, who have a fear of abandonment, low self-esteem, or who struggle to set and enforce boundaries.

  How is Codependency treated?

  Treatments shown to improve codependency include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Problem Solving Therapy (PST), Dialectical Behavior Therapy (DBT), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their relationship worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to guide how they choose to interact with others. Problem Solving Therapy (PST) is involves approaching problems one at a time and nonjudgmentally to improve mood by incrementally taking practical steps to improve one’s life. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people improve their social effectiveness and better handle emotional distress. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle their worries and the way they interact with others. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

• Couples and Marital Problems

  What are couples and marital problems?

  Communication breakdowns, financial disagreements, intimacy issues, difficulty balancing responsibilities, and trust concerns are common contributors to couples and marital challenges. Couples may face challenges for various reasons. Life changes like moving, career shifts, or having kids can disrupt routines and dynamics. Unrealistic relationship expectations and personal stress from work, health concerns, or unresolved individual issues can impinge upon the relationship. Busy schedules may limit quality time and lead to feeling disconnected from each other. Understanding these underlying factors can help you address issues with empathy and teamwork.

  How are couples and marital problems treated?

  Couples therapy may include Emotionally Focused Therapy (EFT), Gottman Method, Acceptance and Commitment Therapy (ACT), and Integrative Behavioral Couples Therapy (IBCT.)

  Emotionally Focused Therapy (EFT) focuses on emotional bonding by helping couples create a closer connection and increase trust between partners. The Gottman Method  emphasizes communication skills and conflict resolution as well as recognizing bids for closeness and attention and how one’s response to these bids impacts overall relationship functioning. Acceptance and Commitment Therapy (ACT) focuses on using shared values to bond and guide couples toward more meaningful interactions and activities. Integrative Behavioral Couples Therapy (IBCT) emphasizes increasing feelings of acceptance and feeling seen and heard in relationships as a “home base” for when couples choose to address problematic patterns or work toward deeper change.

• Dating Issues

  What are dating issues?

  From navigating dating apps to figuring out where you stand with someone, modern romance comes with its own set of challenges. Some common dating challenges include miscommunication, fear of vulnerability, unrealistic expectations, and simply fitting it in alongside work, family, and the rest of one’s life. Past experiences, societal pressures (e.g., feeling like you’re “behind” or should be at a certain stage in life), and fear of rejection.

  Understanding these factors can help you approach dating with more compassion for yourself and others.

  How are dating issues treated?

  How dating issues are treated in therapy depends a lot on the source of the issues. For some people, social anxiety and other social difficulties contribute to their dating issues. For others, past relationship trauma may be at work and require treating the trauma in order to feel comfortable letting others in in dating and relationships. Attachment concerns may prompt some people to address their attachment style and approach new ways to interact with others. People pleasing may contribute to unhealthy interpersonal patterns and require practice setting boundaries and honoring one’s values. Some people have relationship OCD, which may require OCD treatment. For others, couples therapy may be better suited to address relationship dynamics. There is no one-size-fits-all solution to dating issues, but there are many options across a variety of dating issue themes.

• Divorce, co-parenting, & single-parenting support

  What are divorce, co-parenting, & single-parenting challenges?

  Navigating life after a divorce isn’t easy. Add co-parenting or single-parenting into the mix, and the challenges can feel even more overwhelming. But here’s the thing—you’re not alone, and with the right tools and mindset, this journey can be one of growth, resilience, and connection.

  Divorce is a significant life change, and it’s natural to feel a mix of emotions—grief, relief, anger, hope. Nonetheless, it can be challenging to adjusting to a new normal, establishing co-parenting dynamics as individuals who are no longer a couple, and coping with the financial stress of paying for divorce proceedings or managing expenses on a single income.

  How is divorce, co-parenting, & single-parenting supported?

  How divorce, co-parenting, and single-parenting is supported depends a lot on the specifics of each person’s situation. If divorce has contributed to attachment concerns or prompts one to want to address unresolved patterns of interacting with others or causes anxiety at the thought of putting oneself out there again returning to dating, treatment will reflect the specific needs of the individual. Click into the relevant topics for what divorce may have brought to the front of your mind for specific treatment and support ideas. 

  Learning to parent in a new way and supporting their children is another common concern at these times. In this case, support may involve individual or both parents participating in parent training sessions to learn ways to work together to support their children through family changes and help find a positive new normal.

• Elder-Care Stress

  What is elder-care stress?

  Caring for an aging loved one can be one of the most rewarding experiences, but it can also be incredibly stressful. Whether you’re coordinating doctor’s appointments, managing medications, or simply trying to provide emotional support, elder-care responsibilities can feel overwhelming at times. Time management is a challenge, while trying to balance caregiving responsibilities with work, family, and personal time. Watching a loved one’s health decline can be heartbreaking and emotionally exhausting. Financial stress is often inherent in medical bills, home care, or assisted living costs. Helping with mobility, hygiene, and daily tasks can take a physical toll on your body. Elder care situations can also lend themselves to family disagreements due to differing opinions on care decisions can lead to tension among relatives.

  These stressors can be even more intense among sandwich generation individuals, or people who are simultaneously tasked with caring for young children and the elderly.

  How is elder-care stress treated?

  Support for elder-care stress depends a lot on the specifics of each person’s situation and sources of stress. Elder-care stress often arises from the unique dynamics of caring for someone who once cared for you. Role reversal wherein one becomes the caregiver for a parent or older relative can feel emotionally complex. Trying to do it all without help can lead to burnout. Finding ways to deal with the guilt of feeling like you’re not doing enough, even when you’re giving your all can also be a treatment target.

  Some therapy treatments that can improve these common issues related to elder care are Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about life events and relationships. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to guide behavior and set priorities for how to balance self-care and elder care. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people improve the way they relate to others and better handle emotional distress. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how they think about and act on family obligations.

  Couples or family therapy may also be helpful in instances involving family conflict.

• Family Conflict

  What is family conflict?

  Family conflict often stems from a mix of personalities, values, and circumstances. Some common triggers of family conflict include communication problems, differing values or priorities (often generational and/or cultural), stress and external pressures (e.g., financial strain, work stress), unresolved past issues, and disagreements about role expectations.

  Conflict within a family takes an emotional toll on family members, strains relationships, impacts children and others caught in the middle of conflict, and can impact family members’ physical health. 

  How is family conflict treated?

  Family treatments shown to improve family conflict include Structural Family Therapy (SFT), Multisystemic Therapy (MST), Parent Management Training (PMT), and Parent Child Interaction Therapy.

  Depending on who in the family is coming to therapy, the ages of those involved, and the needs and goals of those involved, therapy for family conflict may involve individual therapy, parent training, family therapy, or a combination of these. 

  Structural Family Therapy (SFT) focuses on identifying and changing dysfunctional family patterns through improved communication and reduced conflict. Multisystemic Therapy (MST) approaches treatment from the perspective of addressing the multiple systems (e.g., school, family, friends, neighborhood, etc.) that impact youth behavior. Tapping into your family’s “village” can improve overall support, functioning, and improve family dynamics. Parent Management Training (PMT) teaches parents to reinforce desired behavior and minimize less desired behaviors. Parent-Child Interaction Therapy (PCIT) increases positive interactions and secure attachment as a foundation for learning methods of managing challenging behaviors in a calm, consistent manner.

• Open Relationships & Non-Monogamy

  What is an open relationship & non-monogamy?

  Not all relationships are monogamous. Open and non-monogamous relationships exist in endless ways. Some people have a primary relationship that allows for partners to engage in dates or outside relationships secondary to their main partner. Others have less of a hierarchical approach to multiple relationships and multiple partners are more seamlessly involved with one another. Everyone has different sexual and emotional boundaries and priorities that are reflected in the way they handle their relationships.

  While any relationship may face challenges, communication, jealousy, and resolving conflict in open and non-monogamous relationships must extend to more people. It can be rewarding, yet demanding to meet everyone’s needs.

  How are open relationships & non-monogamy supported?

  Open and non-monogamous partners have a number of effective therapy options that can be adjusted and applied to this type of relationship. Psychoeducation and an affirming and well-informed therapist can help all partners improve their relationships. 

  Therapy may draw from Emotionally Focused Therapy (EFT), Gottman Method, Acceptance and Commitment Therapy (ACT), and Integrative Behavioral Couples Therapy (IBCT.)

  Emotionally Focused Therapy (EFT) focuses on emotional bonding by helping partners create a closer connection and increase trust. The Gottman Method  emphasizes communication skills and conflict resolution as well as recognizing bids for closeness and attention and how one’s response to these bids impacts overall relationship functioning. Acceptance and Commitment Therapy (ACT) focuses on using shared values to bond and guide partners toward more meaningful interactions and activities. Integrative Behavioral Couples Therapy (IBCT) emphasizes increasing feelings of acceptance and feeling seen and heard in relationships as a “home base” for when partners choose to address problematic patterns or work toward deeper change.

• People Pleasing and Setting Boundaries

  What is people pleasing and setting boundaries?

  People pleasing goes beyond being nice. It often involves overcommitting; avoiding conflict, even when you end up agreeing to things you do not want; seeking validation from others to feel good about yourself; putting others first and ignoring your own needs. While these behaviors may stem from good intentions, they can lead to feeling overwhelmed and unappreciated. Lack of boundaries and difficulty setting boundaries goes hand in hand with this type of relationship dynamic and prioritizing others’ needs.

  Boundaries define what you’re comfortable with and what you’re not. They’re essential because they protect your energy, encourage healthier and more respectful interactions, improve self-esteem, and reduce resentment. Setting boundaries isn’t selfish—it’s a way to take care of yourself while still showing up for others.

  There are many reasons people fall into the habit of people pleasing. Fear of rejection, desire to be liked, believing that being agreeable is the only way to maintain relationships, past experiences where your needs weren’t prioritized, and cultural or societal pressures often contribute to people pleasing. Understanding why you people please is the first step to changing the pattern.

  How is people pleasing and setting boundaries treated?

  Treatments shown to improve people pleasing and help individuals learn to set and enforce boundaries include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their relationship concerns. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to guide how they choose to interact with others. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people improve their social effectiveness and better handle emotional distress. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle their worries and the way they interact with others. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

• Social Difficulties

  What are social difficulties?

  Social difficulties refer to challenges in interacting and communicating effectively with others. These challenges can range from mild awkwardness to more significant barriers that impact daily life. Common difficulties include difficulty reading social cues, social anxiety, trouble initiating or maintaining conversations, fear of judgment or rejection by others, worrying excessively about how others perceive you and image management, and avoidance of social situations.

  Social difficulties can stem from a variety of factors. Some examples include personality traits such as being introverted or shy. Negative past social encounters, bullying, or rejection. Social anxiety disorder, autism spectrum disorder, or other conditions that impact relationships. Lack of practice: Limited opportunities to develop social skills. Recognizing the root causes of social difficulties is the first step in addressing them.

  How are social difficulties treated?

  How social difficulties are treated depends largely on the cause of those difficulties. Depending on the cause of social difficulties, treatment may involve Cognitive Behavioral Therapy (CBT) wherein one challenges unhelpful thoughts and beliefs about social situations and may incorporate Behavioral Experiments (gradually practicing new social behaviors to build confidence.) If anxiety plays a role, Exposure Therapy (similar to behavioral experiments, but working from situations the individual rates as less anxiety-inducing to more anxiety-inducing) may help. Acceptance and Commitment Therapy (ACT) allows people to use their values to guide the actions they take in social situations. If social difficulties are family based, treatment may involve family therapy.

• Supporting adult-children of alcoholics & drug users

  What is unique about the experience of being the adult-child of an alcoholic and/or drug user?

  Growing up in a household where addiction was present can leave a lasting mark. As an adult child of an alcoholic (ACOA) or drug user, you might find yourself dealing with unique challenges, from strained family dynamics to emotional scars.

  Every family’s story is different, but there are shared experiences many ACOAs or adult children of drug users face. Walking on eggshells, parentification or taking on adult responsibilities early, difficulty trusting others, people-pleasing tendencies, and feeling unseen or unimportant in childhood can affect your self-worth and confidence as an adult.

  What is support for adult-children of alcoholics and/or drug users?

  While many adult-children of alcoholics and drug users find support groups through AA and NA helpful, sometimes people want to do individual work that prioritizes their own experience instead of the group’s experience.

  Depending on the needs of the individual and the specifics of their family situation, individual therapy is tailored to how a parent’s alcohol or drug use impacted them. For example, if an individual developed an anxiety disorder as part of their experience, treatment may target the anxiety disorder. If someone has attachment concerns or people pleasing habits, these may serve as treatment targets. 

  Treatments shown to improve some of the common challenges of adult children of alcoholics and drug users Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about themselves and create new narratives to understand their story. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to guide how they choose to interact with others. Dialectical Behavior Therapy (DBT) teaches emotion regulation and distress tolerance skills to help people improve their social effectiveness and better handle emotional distress. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle their worries and the way they interact with others. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

Identity development & challenges

• Gender & Sexuality (LGBTQ+ Affirming Care)

  What is gender and sexuality and LGBTQ+ affirming care?

  Gender and sexuality exist on a spectrum, and everyone’s experience is unique. Gender identity refers to how someone personally experiences and identifies their gender (e.g., genderqueer, female, male, nonbinary,). A cisgender person’s gender identity matches the sex they were assigned at birth, while a transgender person’s identity does not. Sexual orientation refers to how someone is attracted to romantically, emotionally, or physically (e.g., lesbian, gay, bisexual, pansexual). Gender expression is how someone presents their gender through clothing, behavior, or appearance.

  It’s okay if you’re still learning, questioning, or making moves to better understand your identity and how to express yourself. One’s identity is always evolving. 

  How is gender and sexuality and LGBTQ+ affirming care supported?

  How gender and sexuality concerns are supported depends a lot on the specifics of each person’s situation. Some people benefit from having a dedicated time and space to think through these issues and discuss them with a supportive professional. Other people may seek support in coping with dysphoric symptoms and pursuing gender affirming care more broadly in their life. Some people develop anxiety and mood disorders secondary to their struggles with gender and sexuality, like social anxiety or sexual orientation OCD. There is no one-size-fits-all approach to gender and sexuality affirming care.

  Treatments to improve the psychological impact of a variety of identity concerns include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, Internal Family Systems Therapy (IFS, also known as “parts work”), narrative therapy, and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image and life changes. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change and take meaningful action on the things they can change. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about oneself and life stage. Narrative therapy helps people create a coherent story of their life and provides an opportunity to create new versions and interpretations of that story to facilitate moving forward and finding new meaning. Mindfulness techniques help people approach thoughts and experiences nonjudgmentally. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. These psychotherapeutic approaches are often applied as part of a larger multidisciplinary approach to gender affirming healthcare.

• Men's Issues, Role Transitions and Social Expectations

  What are men’s issues?

  Men’s issues involve the intersection of gender identity – or what it means to a person to be a man – and social expectations and role transitions in life. Advancing phases in life from adolescence to adulthood or into parenthood and aging can challenge one’s idea of who they are as a man and how they can best express their identity.

  How are men’s issues treated?

  The way men’s issues are treated depends on the nature of the issue at hand. Anxiety, mood, and body image struggles have a variety of dedicated treatment options that can be added to a larger approach to building a strong sense of self and life satisfaction.

  Treatments to improve the psychological impact of a variety of men’s issues include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support.

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image and life changes. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change, like the effects of aging, and take meaningful action on the things they can change, like approach to anxiety or relationships. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves and has been shown to be especially helpful for post-partum parents. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about oneself and what they want from life. Mindfulness techniques help people approach thoughts and experiences nonjudgmentally. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

• New Parent Transition

  What is the transition to being a new parent?

  The post-partum and post-adoption or foster experience can be challenging for new parents of every stripe. Adjusting to the needs of a child and the impact this has on everyone’s routines, social and family roles, relationships, and overall lifestyle is a major task. Moreover, post-partum anxiety, depression, and obsessive compulsive disorders can affect birthing and non-birthing parents.

  How is the new parent transition supported?

  How the new parent transition is supported depends a lot on the specifics of each person’s situation. Anxiety and mood disorders have a variety of dedicated treatment options that can be added to a larger approach to learn more about the effects of this major life transition, how they may impact body image and beliefs about oneself.

  Learning to parent and supporting the child is another common concern at these times. In this case, support may involve individual or both parents participating in parent training sessions to learn ways to work together to support their children and help find a positive new normal.

• Religious Trauma, Guilt, & OCD

  What is religious trauma, religious guilt, and religious obsessive compulsive disorder (scrupulosity)?

  The Religious Trauma Institute defines religious trauma as, “The physical, emotional, or psychological response to religious beliefs, practices, or structures that is experienced by an individual as overwhelming or disruptive and has lasting adverse effects on a person’s physical, mental, social, emotional, or spiritual well-being.” Many people experience religious guilt when transitioning to new eras of their spirituality. Religious obsessive compulsive disorder (sometimes called scrupulosity) refers to a subtype of obsessive compulsive disorder involving religious or moral obsessions and compulsions and significant distress around beliefs and religious practice.

  How are religious trauma, religious guilt, and religious obsessive compulsive disorder (scrupulosity) treated?

  Religious trauma may incorporate spiritual ways of coping (like prayer or meditation) and/or consultation or collaboration with religious leaders alongside trauma treatment. Treatments shown to improve post-traumatic stress disorder include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Acceptance and Commitment Therapy (ACT), Trauma-focused cognitive behavioral therapy (TF-CBT), SPACE (Supportive Parenting for Anxious Childhood Emotions), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Processing Therapy (CPT) targets beliefs and thoughts related to the trauma that may have been protective in the traumatic moment, but hold someone back outside of that moment. Prolonged Exposure (PE) gradually exposes individuals to traumatic memories, feelings, and situations they might be avoiding, allowing them to process and reduce their anxious response. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Trauma-focused cognitive behavioral therapy (TF-CBT) helps children, adolescents, and families create new ways of thinking about the trauma and begin to approach things the traumatized person finds aversive. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to handle trauma and fears. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

  Religious guilt is more often treated by targeting the beliefs and thoughts underlying the guilt and the emotional experience of guilt itself. Specifically, Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, Internal Family Systems Therapy (IFS, also known as “parts work”), narrative therapy can help people overcome religious guilt. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image and spirituality. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change and take meaningful action on the things they can change. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves rather than self-blame. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about oneself and one’s spiritual journey. Narrative therapy helps people create a coherent story of their life and provides an opportunity to create new versions and interpretations of that story to facilitate moving forward and finding new meaning. Additionally, mindfulness techniques help people approach thoughts and experiences nonjudgmentally.

  Religious obsessive compulsive disorder (scrupulosity) may incorporate spiritual ways of coping (like prayer or meditation) and/or consultation or collaboration with religious leaders alongside OCD treatment. Treatments shown to improve obsessive compulsive disorder include Cognitive Behavioral Therapy (CBT) with Exposure with Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), SPACE (Supportive Parenting for Anxious Childhood Emotions), Inference-based Cognitive Behavioral Therapy (I-CBT), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Inference-based Cognitive Behavioral Therapy (I-CBT) focuses on obsessional doubt and how to stop the process of worry before enacting compulsive behaviors, like checking or avoidance. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. All of these treatments are effective for both adults and children.

• Women's Issues, Perimenopause and Menopause, Fertility, Pregnancy, and Post-Partum Stress and Mood Disorders

  What are women’s issues?

  Women’s issues include perimenopause and menopause, fertility, pregnancy, and post-partum stress and mood disorders. Perimenopause and menopause often involve symptoms of anxiety, trouble sleeping, irritable mood, feelings of overwhelm, brain fog and difficulty focusing. Fertility struggles can contribute to feelings of depression, anxiety, impact relationships, and fertility treatments can be physically and emotionally stressful to endure. Similarly, the hormonal, physical, emotional, and life changes involved in pregnancy can present adjustment and emotional challenges. Post-partum stress and mood disorders (e.g., post-partum anxiety, post-partum depression, post-partum obsessive compulsive disorder) can bring a host of psychological symptoms that prompt new parents to seek help. 

  How are women’s issues treated?

  The way women’s issues are treated depends on the nature of the issue at hand. Anxiety, mood, and sleep disorders have a variety of dedicated treatment options that can be added to a larger approach to learn more about the effects of perimenopause and menopause, fertility, pregnancy, and post-partum experiences, how they may impact body image and beliefs about oneself and their physical condition and changing phases of life.

  Treatments to improve the psychological impact of a variety of women’s issues  include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about self-image and life changes. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change, like the effects of aging, and take meaningful action on the things they can change, like approach to anxiety or insomnia. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves and has been shown to be especially helpful for post-partum people. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about oneself and life stage. Mindfulness techniques help people approach thoughts and experiences nonjudgmentally. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

• Young Adult Transitional Challenges

  What are young adult transitional challenges?

  Young adulthood often comes with some major soul-searching, existential, and practical questions. What do I want to do with my life? How do I balance independence and support? Am I making the right choices?

  Transitioning to adulthood can bring plenty of challenges. Choosing a career path or landing your first job can feel overwhelming. Friendships and family dynamics often change as you grow. Healthy communication and setting boundaries can make these transitions smoother. Balancing newfound independence with adult responsibilities is a new task. Anxiety, self-doubt, and imposter syndrome are common during this phase. Seeking support from friends, mentors, or therapists can make a big difference. 

  How are young adult transitional challenges treated?

  The way young adult transitional challenges are treated depends on the nature of the issue at hand. Anxiety, mood, and sleep disorders have a variety of dedicated treatment options that can be added to a larger approach to learn more about the effects of relationship changes, life skills, and beliefs about oneself and changing phases of life.

  Treatments to improve the psychological impact of a variety of young adult transitional challenges include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, SPACE (Supportive Parenting for Anxious Childhood Emotions), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about self-image and life changes. Acceptance and Commitment Therapy (ACT) helps individuals better tap into values as a way to cope better with things one cannot change, like the effects of aging, and take meaningful action on the things one can change, like approach to anxiety or insomnia. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves and has been shown to be especially helpful for young adults and college students. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and young people to teach parents ways to help their child reduce or overcome anxiety and increase independence. SPACE can be a parent or a family intervention. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about oneself and life stage. Mindfulness techniques help people approach thoughts and experiences nonjudgmentally. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

Artistic, athletic, academic and professional stress & performance enhancement & personal growth

• Academic Pressure & Test Anxiety

  What is academic pressure and test anxiety?

  Academic success often feels tied to everything–one’s future, self-worth, even happiness. Parents, teachers, or students themselves all often have high expectations. Thanks to social media, it’s easier than ever to compare yourself to others, which can add to the stress. Overloaded schedules can also contribute to feelings of pressure and overwhelm between classes, extracurriculars, and part-time jobs, finding time to breathe can feel impossible. Additionally, the fear of failure – the thought of messing up or not meeting expectations – can make the stakes feel high.

  Related to academic pressure is test anxiety. Test anxiety is more than just feeling nervous before an exam. It’s a type of performance anxiety that can cause racing thoughts or trouble concentrating; physical symptoms like sweating, a rapid heartbeat, or nausea; and a mental block, where you forget what you’ve studied. It’s not a reflection of one’s abilities. It’s a natural response to stress that you can learn to manage.

  How are academic pressure and test anxiety treated?

  The way academic pressure and test anxiety treated are treated depends on the nature of the issue at hand. Anxiety and mood disorders and school refusal have a variety of dedicated treatment options that can be added to a larger approach to address academic concerns.

  Treatments to improve academic pressure and test anxiety include Cognitive Behavioral Therapy (CBT), Exposure with Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, SPACE (Supportive Parenting for Anxious Childhood Emotions), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image and life changes. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change, like the effects of aging, and take meaningful action on the things they can change, like approach to anxiety or insomnia. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves and has been shown to be especially helpful for young adults and college students. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and young people to teach parents ways to help their child reduce or overcome anxiety and increase independence. SPACE can be a parent or a family intervention. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about oneself and achievement. Mindfulness techniques help people approach thoughts and experiences nonjudgmentally. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

• Coping with Career Transitions and Stressful Work Environments

  What is coping with career transitions and stressful work environments?

  Whether you’re starting a new job, changing industries, or just trying to survive a toxic workplace, the challenges are real. Career transitions often come with a mix of excitement and anxiety. The uncertainty of not knowing what’s next, starting something new might leave you questioning whether you’re truly qualified and result in imposter syndrome. Concerns about income stability can add extra weight to the process. And change fatigue can accompany even positive work changes. Adjusting to new routines, expectations, and environments can take a toll on your energy.

  A difficult work environment can have a significant impact on quality of life and mental health. Toxic work culture – Gossip, favoritism, or lack of support can make work unbearable. Unrealistic deadlines or workloads can lead to burnout. Poor leadership involving a lack of clear direction or empathy from management creates unnecessary stress. Strained relationships and interpersonal conflict with colleagues can make every day feel like a battle. It’s not always so simple as leaving a bad job and finding a better one, and for that in-between time, many people seek additional support.

  How is coping with career transitions and stressful work environments supported?

  The way career transitions and stressful work environments are treated depends on the nature of the issue at hand. Anxiety, mood, and sleep disorders have a variety of dedicated treatment options that can be added to a larger approach to coping with career transitions and work stress.

  Treatments to improve the psychological impact of a variety of young adult transitional challenges include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassion-focused therapy, Mindfulness-Based Stress Reduction (MBSR), Internal Family Systems Therapy (IFS, also known as “parts work”), and can incorporate mindfulness techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image and life changes. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change, like the wait to find a new job, and take meaningful action on the things they can change, like approach to anxiety or insomnia. Compassion-focused therapy helps individuals build a practice of thinking and acting with kindness and compassion toward themselves. Mindfulness techniques help people find healthy ways to calm themselves. When combined with CBT, Mindfulness-Based Stress Reduction (MBSR) uses meditation and mindfulness practices to aid in minimizing inner conflict and intensity of emotional response to hostile work conditions. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about oneself and the direction one wants to take in life. Mindfulness techniques help people approach thoughts and experiences nonjudgmentally. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports.

• Performance and Audition Anxiety

  What is performance anxiety?

  Performance anxiety is the fear or worry around opportunities to perform in front of others. This is common among athletes, musicians and those who are frequently in performance situations. Performance anxiety may lead to avoidance of feared situations, participation with significant stress, compromised performance, or less fulfilling experiences than one might otherwise expect. 

  How is performance anxiety treated?

  Treatments shown to improve performance anxiety include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure with Response Prevention (ERP), and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. People will often use some type of medication like a beta-blocker or benzodiazepine to help medicate the physical sensations in order to perform. All of these treatments are effective for both adults and children.

• School Refusal

  What is school refusal?

  Some children experience significant anxiety about going to school. This can be the result of social stressors, perfectionism, separation anxiety or mood disorders. This anxiety often gets worse during the start of the school year in the fall, after long holiday breaks, or even after weekends. Children may exhibit oppositional behavior as early as weeks before school begins and report physical symptoms in an effort to remain at home. Often, children will negotiate with parents to get out of going to school, promising to go the following day or later in the day. Parents commonly feel conflicted about sending their child to school with complaints of illness and extreme distress, and often give in to their child’s pleadings.

  How is school refusal treated?

  Every child who has difficulty attending school has their own unique set of factors contributing to this challenge that are specific to that child and their school. We tailor treatment to each child and family’s needs. Depending on the needs of each child and family, we have served as step-down care after a child completes a residential program, PHP, or IOP. We have also created individualized intensive treatments in-house involving our own team members, student, and their parents. And sometimes treatment looks like parent training and/or child or adolescent individual therapy.

  Treatments shown to address some of the concerns and conditions that contribute to school refusal include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure with Response Prevention (ERP), SPACE (Supportive Parenting for Anxious Childhood Emotions), and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with anxiety and take valued actions. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. SPACE (Supportive Parenting for Anxious Childhood Emotions) is a treatment for families and youth to teach parents ways to help their child reduce or overcome anxiety. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy.

• Sports Psychology & Athletic Performance

  What is sports psychology?

  Sports psychology is the science of how your mind influences your athletic performance. It’s about understanding the mental side of the game and learning strategies to enhance focus, motivation, and resilience. Think of it as training for your brain, just like you train your body.

  Athletes—whether weekend warriors or professionals—often deal with mental hurdles that can impact their performance. Performance anxiety is the fear of messing up and can feel paralyzing, especially during high-stakes moments. Slumps and plateaus can negatively impact motivation. Injury recovery often poses a barrier to resilience and getting back into the game. Bouncing back physically is one thing, but overcoming the mental barriers after an injury is another story. Managing team dynamics and communication within a team can be as challenging as the game itself. Balancing expectations from coaches, teammates, or yourself can sometimes feel overwhelming. 

  How is athletic performance supported?

  Athletic performance is supported by a combination of evidence based practices including imagery or visualization, goal-setting, self-talk, and mindfulness relaxation/arousal regulation. Athletes learn to visualize successful performance, set measurable and attainable goals to track progress and hone healthy self-talk during games and practice/training. 

  Athletes may use mindfulness techniques to regulate physiological arousal. When combined with CBT, Mindfulness-Based Stress Reduction (MBSR) uses meditation and mindfulness practices to aid in minimizing inner conflict and intensity of emotional response to physical pain and reactions to unexpected or disappointing moments.

  Sometimes athletes may also have life circumstances or psychological conditions that impact their performance. They way these are treated depends on the nature of the issue at hand. Anxiety, mood, and sleep disorders have a variety of dedicated treatment options that can be added to a larger approach to athletic performance.

Neurodiversity-related challenges

• Attention Deficit Hyperactivity Disorder (ADHD)

  What is attention deficit hyperactivity disorder (ADHD)?

  Individuals with ADHD have symptoms of inattention, hyperactivity/impulsivity, or a combination of both. Children and adults with inattention can often be easily distracted, have difficulty with organizational skills, make careless mistakes, be forgetful, or have trouble following through with directions or completing tasks. Those with symptoms of hyperactivity and impulsivity may fidget, talk excessively, have difficulty sitting still, interrupt others, or feel restless or “on the go.” Inattention, hyperactivity, and impulsivity often impair an individual’s everyday functioning, such as a teen struggling with school performance, a child having difficulty with making friends, or an adult staying on task at work.

  How is attention deficit hyperactivity disorder (ADHD) supported?

  While the only direct intervention on the neurological aspects of ADHD is medication, there are a number of psychosocial options to support behavior change and coping with the emotional impact of ADHD. Treatments shown to help coping with ADHD include Parent Management Training (PMT), Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT) and can incorporate pacing techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Parent Management Training (PMT) teaches parents to reinforce desired behavior and minimize less desired behaviors. Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image and organize their thoughts to better process emotions and life events. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change, like atypical executive function, and take meaningful action on the things they can change, like approach to anxiety or insomnia. 

• Autism Spectrum Disorder

  What is autism spectrum disorder (ASD)?

  Autism Spectrum Disorder (ASD) is a neurodevelopmental difference that can lead to differences with social interaction and communication. It can involve repetitive behaviors related to finding comfort in routine, stimming behaviors, or special interests. It often also involves sensory differences and differences in experiencing and processing emotions and other kinds of information. Sometimes these differences can become impairing or unduly stressful to manage and cope with, especially in school, work, and social settings. While ASD is not an illness to be “cured,” it can be helpful to seek support in learning how one’s mind works and how to best support oneself in the world.

  How is autism spectrum disorder (ASD) supported?

  There is no one way autism spectrum disorder (ASD) presents in a person, therefore all treatment is tailored to the specific needs of each person. Treatment often involves psychoeducation on autism spectrum disorder (ASD) and related issues, such as managing sensory sensitivities, coping with masking, unmasking, and disability. 

  Depending on the nature of each individual’s challenges and age, treatment may incorporate Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure with Response Prevention (ERP), Parent Management Training (PMT), Theraplay, Internal Family Systems Therapy (IFS, also known as “parts work”), and may incorporate pacing techniques and lifestyle tweaks, like improving sleep hygiene, movement, and social support.

  Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their worries. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope with challenges and engage in valued action. Exposure with Response Prevention (ERP) is a useful framework for building confidence and working toward taking actions an individual previously avoided due to anxiety. Parent Management Training (PMT) teaches parents to reinforce desired behavior and minimize less desired behaviors. Theraplay is a child-guided play therapy for parents and children that uses play as an opportunity to build secure attachment and develop child coping skills and parenting skills. Internal Family Systems Therapy (IFS) is particularly helpful for resolving inner conflict about how to make sense of past experiences and ongoing behavior. Mindfulness techniques help people find healthy ways to calm themselves. Adjusting lifestyle factors can address sources of stress outside the individual and improve supports. Pharmacotherapy can also be helpful both as its own treatment and in conjunction with therapy. 

• Executive Functioning Challenges

  What are Executive functioning challenges?

  At its core, executive dysfunction is a struggle with the brain’s executive functions—the mental skills that help you plan, organize, focus, and regulate emotions. Executive dysfunction is common in conditions like ADHD, depression, anxiety, and autism, but it can also happen to anyone during times of stress, fatigue, or overwhelm.

  Common signs of executive dysfunction include difficulty starting tasks; procrastination; forgetting important dates, to-dos, or even why you walked into a room. Another sign is time blindness, or losing track of time or underestimating how long tasks will take. Overwhelm at the thought of breaking down big projects into steps feels daunting, so you avoid them altogether can also be part of this experience.

  How are executive functioning challenges supported?

  Treatments shown to help coping with executive functioning challenges include Parent Management Training (PMT), Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT) and can incorporate mindfulness, behavioral, and pacing techniques, lifestyle tweaks, like improving sleep hygiene, movement, and social support. 

  Psychoeducation and Parent Management Training (PMT) teaches parents to reinforce desired behavior and minimize less desired behaviors related to executive dysfunction. Cognitive Behavioral Therapy (CBT) helps individuals create new ways of thinking about their self-image and organize their thoughts to better process emotions and life events. Acceptance and Commitment Therapy (ACT) helps individuals better tap into their values as a way to cope better with things they cannot change, like atypical executive function, and take meaningful action on the things they can change, like approach to anxiety or insomnia. Mindfulness exercises, which can be adapted to play to one’s need for more or less stimulation, can help improve focus and reduce distractions. Behavioral techniques may incorporate organizational and goal-setting strategies and ways to break down tasks into manageable parts. Pacing techniques involve attending to one’s energy level and pacing work and activity to make effective use of the finite energy we have and minimize burnout.