Monthly Archives: July 2014

Problems

Individual, Couples, and Group Therapy

At the Bay Area CBT Center, we help you to identify and overcome the obstacles that prevent you from living the kind of life you desire. To assist you in this process, we offer therapy for individuals and couples as well as twelve-week group therapy sessions that focus on particular issues and concerns. For your convenience, we have offices in San Francisco and Oakland.

Because we believe that the client-therapist relationship is crucial for progress to be made, we offer initial free consultation sessions to prospective clients. We want to be certain that you find the therapist who is right for you.

Individual Therapy

Do you struggle with feelings of inadequacy, anger, or depression? Do you feel ill-equipped to deal with conflict, the challenges of personal or professional relationships? Are you seeking ways to cope with trauma or illness? Individual therapy can help you with these and related concerns. Depending on your needs, sessions can be conducted in person or by phone or Skype. When appropriate, we also offer out-of-office sessions. (See “Types of Therapy Sessions” below for more information.) Individual therapy sessions are fifty minutes long.

What We Offer Individuals

As part of individual therapy, we offer a variety of self-awareness and skill-building opportunities. Although the list below is not exhaustive, it will give you an idea of the ways we can help you. Depending on your needs and desires, any one or combination of these can be incorporated into your therapy:

  • Assertiveness training
  • Dating coaching
  • Anger management
  • Tools for overcoming perfectionism
  • Sexual identity exploration
  • Career Assessment
  • Non-violent communication skills
  • Motivational techniques
  • Sex Therapy
  • Schema Identification
  • Exposure
  • Mindfulness
  • Anxiety/chronic worry
  • Bipolar Disorder
  • Body Image Issues
  • Career/life transitions
  • Communication problems/relationship difficulties
  • Depression
  • Emotional Dysregulation/Impulse control
  • Grief/Loss
  • Hair pulling/skin picking
  • Low Self-Esteem/Self Doubt
  • Obsessive Compulsive Disorder
  • Panic Disorder/Anxiety Attacks
  • Procrastination/Indecision
  • Social Anxiety
  • Specific Phobias
  • Trauma
  • Work-related Stress/Job Burnout

 

Couples Therapy

Do you feel like you and your partner have the same arguments over and over? Do you feel stuck, hopeless, and alone in your relationship? Is it difficult for you to get your needs met? Does it feel like you give more than you get in return? Do you struggle to communicate your needs and feelings to your partner? You are not alone. Despite the fact that we all yearn and long for intimacy and connection, many of us have difficulties with interpersonal relationships.

By the time partners seek out couples counseling, they often feel so overwhelmed that they start believing that their problems are impossible to manage or repair. Couples get stuck in lose/lose communication when they focus on the immediate conflict rather than their underlying needs. Often their conflicts grow out of core beliefs or main themes in relationships, which we call “schemas.” You may be totally unaware of your schemas, but they shape not only your thoughts, actions, and life choices but also your relationships. Once we identify these themes or schemas in your relationship, your problems don’t seem so large. We can help you recognize and break these painful patterns in your relationship and learn new skills to resolve conflict and build intimacy.

These challenges stymie all types of couples—same-sex and heterosexual as well as couples where one partner (or both) is transgendered. We have ample experience working with a wide variety of couples, and are dedicated to helping you rebuild and maintain a healthy relationship.Couples therapy is conducted in person. All sessions are one hour long.

What We Offer Couples

As part of couples therapy, we offer a variety of self-awareness and skill-building opportunities. Although the list below is not exhaustive, it will give you an idea of the many ways we can help you. Depending on your needs and desires, any one or combination of these can be incorporated into your therapy:

  • Anger management
  • Assertiveness training
  • Assistance with divorce or separation
  • Codependency issues
  • Dating coaching
  • Emotional intimacy building
  • LGBTQ
  • Negotiation skills training
  • New baby preparation
  • Nonviolent communication
  • Parenting skills
  • Premarital counseling
  • Setting limits and making boundaries
  • Sex Therapy
  • Sexual identity exploration
  • Trust development after betrayal

 

Group Therapy

Groups are offered on an ongoing basis. The following groups begin in November 2014.

Getting Off the relationship Fence with Schema Awareness:

Group for individuals who are experiencing a breakup, contemplating ending a relationship, having relationship concerns, currently or recently in the process of ending a romantic relationship, going through a divorce, or feeling ambivalent about their current relationship.

Dates and times:Wednesdays 6:00 p.m.–7:30 p.m. or Sundays 3:00 p.m.–4:30 p.m.
Duration: 12 weeks
Cost: $65 per session
Description: Sometimes when one partner is feeling extremely unhappy and unsatisfied in a relationship, the other partner may not be as motivated to take steps towards improving the relationship or may be unwilling to participate in therapy. The decision regarding what is tolerable or intolerable for you and whether or not to end the relationship is on you. You can still take steps towards improving your relationship on your own and you can also learn to monitor and track whether your needs are getting met in your current relationship, whether the relationship is consistent with your values, and gain clarity regarding whether or not the relationship is working for you.

This group is designed to help you get off the fence and make decisions regarding your relationship. This group can also help you improve your relationship without your partner.

You will learn specific tools and strategies for monitoring whether your needs are being met in your current relationship, whether you are making your needs clear, whether this relationship is consistent with your values and the kind of relationship you want, and what behaviors you are engaging in that are contributing to the problem and that are damaging your relationship. We will help you parse out what you can work on in your relationship and what is out of your control. We will assess the patterns and themes that have occurred throughout your relationships and the ways you’ve maintained these patterns in your current relationships.

This group is both a skills-based group and a process group. This means that each session will introduce a new skill or tool, and include an open group discussion, weekly assignments, and feedback from group members. You will understand patterns in their relationships and recognize the core beliefs that are getting in the way of changing interpersonal behaviors. You will also learn to recognize your core beliefs in relationships, identify the behaviors that hurt your relationships, and break painful relationship patterns. Group members will take an interpersonal schemas questionnaire in order to identify their schemas. The group will consist of identifying your schemas, schema coping behaviors, and values as well as exploring alternative behavioral responses in relationships. Members will be asked to practice new skills and behaviors outside of session and monitor their behaviors.

Building Intimacy and Improving Communication with Schema Awareness: A group for couples.

Dates and times:Mondays Sundays 5:00 p.m.–6:30 p.m.
Duration: 12 weeks
Cost:$65 per session
Participants: Limited to four couples.
Description: This is a unique group psychotherapy experience for couples who have a desire to learn new coping skills and communication strategies. Group members will take an interpersonal schemas questionnaire to identify their schemas (core beliefs) in relationships. You will learn to identify your triggers, schemas that you have in your relationship, and gain an understanding of your behavioral responses and how they contribute to a negative cycle in your relationship. This group is both a skills-based group and a process group. This means that each session will include learning new skills, practicing new behaviors, and exploring feedback from other couples in the group. You will learn to recognize themes and patterns in your relationship and identify the core beliefs that are getting in the way of changing your behaviors and being the kind of partner you want to be. In order to break painful relationship patterns, you will learn mindfulness skills to observe your negative thoughts and identify the behaviors that hurt your relationships.

All groups are based on the protocol that Dr. Lev developed and provided in the two books she has coauthored. This approach offers a new and innovative treatment for individuals and couples who want to improve their communication and break negative patterns in relationships. The protocol is based on research that has shown significant improvement in the quality of relationships for participants.

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Values Are The Journey

Values

Values represent and define the kind of person you want to be and what is important to you. One strategy for starting to clarify your values is to imagine witnessing your own funeral. Ask yourself if you were observing your own funeral, what would you want the people you love to say about you?

  • What would you want your life to be about?
  • What do you want to stand for?
  • In an ideal situation, what would you want most to hear about yourself?
  • What kind of partner do you want to be? (For example: being spontaneous, appreciative, affectionate, accepting, emotionally available, expressive, assertive)
  • What kind of friend? (For example: being loyal, consistent, reliable, genuine, supportive, honest)
  • What kind of coworker/boss/colleague? (For example: being fair, open, flexible, curious)
  • What kind of parent do you want to be? (For example: being nurturing, patient, accepting, supportive, loving, non-judgmental)
  • What kind of person do you want to be when you feel angry, with your partner, with your parent, with your friend? (compassionate, assertive, expressive, vulnerable, kind)
  • What kind of person do you want to be when you feel sad?
  • How do you want to be with yourself and with others when you feel inadequate or insecure?  (persistent, self-disciplined, compassionate, productive, kind)

Values are like a compass they guide your direction, but they are not the destination.

Values are freely chosen: This means that your 1values are not based on rules that you have about yourself, others, the world, relationships, or about how you “should be”, but rather they are freely chosen and represent your deeply held beliefs. They reflect the kind of person you want to be, what you want to stand for and what you find important in life.

Values are not emotions or thoughts. Feeling less anxious, feeling happier, or more confident is not a value. These are emotional states. Emotional states come and go just like the weather in the sky changes. Values are a way of being in the world. Thoughts and feelings come and go just like the whether changes, but values are consistent. They are not contingent on external circumstances and limitations.

Our values are not contingent on a particular outcome. For example if your value is to be assertive and you set a limit with a friend, your friend’s’ reaction to you setting a boundary may not feel good and might not be an ideal reaction, but you still took a step that brought you closer to being more assertive.

  • Thoughts, feelings, sensations are out of your control.
  • Other people’s responses are out of your control.
  • Your behaviors and your values are always under your control.

Taking deliberate steps that bring you closer to the kind of person you want to be is always under your control. This means staying connected in the present moment and in the process. Values are not a means to an end they are the end. They are not the destination they are the journey. Remembering that it’s not just the end goal, but the process of how you approach it. Did you reach your goal while staying consistent with your values and the kind of person you want to be?  If you were unable to reach your goal, were you able to stay consistent with the kind of person you want to be?

values and cognitive therapy, Oakland

Taking this path is not easy. Sometimes taking steps in a particular direction will bring up intense and uncomfortable thoughts and feelings about ourselves. These thoughts and feelings about ourselves will try to stop us from doing new behaviors and taking the steps that bring you towards your values.

Values motivate us towards behavioral change. The clearer we are about our values and what we want to stand for in our life, the better informed choices we are able to make in the present moment.

Values are not tangible and they are not achievable. Meaning you can never be 100% honest, authentic, loving, kind. You can only be taking steps that bring you closer or further away honesty. Every moment is a choice that brings us further away or closer to the kind of person we want to be. We will never be that person 100%, but sometimes we can be 95% closer, or 80% closer, or 75% closer. Values guide our present moment choices and guide us in the direction we want to go.

Values vs. goals: goals are tangible you can reach a goal, but values are a constant work in progress – every moment in life provides you with an opportunity to engage in a behavior that brings you closer to particular value or further away. Closer to the kind of person you want to be and the kind of relationship you want or further away from a particular direction.

Examples of Values: (values are active, how you want to be, like being loving, being kind)

  • Kind
  • Assertive
  • Spontaneous
  • Genuine
  • Loving
  • Patient
  • Humorous
  • Honest
  • Self-disciplined
  • Consistent
  • Reliable
  • Flexible
  • Sensual
  • Appreciative
  • Expressive
  • Vulnerable
  • Sensitive
  • Compassionate
  • Fair
  • Forgiving

 

Goals vs. Values

Goals are more specific, they are specific actions or steps that you can take to bring you closer to your value and the kind of person you want to be. Values motivate goals because although we don’t always have control of the outcome of a particular goal we always have control over whether we got closer or further away from our value.

Value: Being appreciative
Goal: Say thank you every time my partner makes dinner, give a compliment.
Value: Being assertive:

 

Goal: Say “no”, say “let me think about it” to any request, ask for help, express  discomfort.
Value: Being vulnerable:
Goal: Share a fear, share an emotion, call a fiend, ask for help.

 

At the Bay Area CBT Center,  we can help you clarify your values and lead a more fulfilling life. We offer individualized therapy that provides the tools you need to reach your goals and improve your well-being. To learn more about how we can help, you can click here to book an appointment online. We have office locations in both San Francisco and Oakland.

 

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Welcome Anxiety

We tend to place judgments and labels on the physiological sensations that we experience. We may label a fast heart rate as “bad” or as “anxiety.” These judgments and labels often make our experiences worse. The more we judge them and the more we try to escape these “bad” experiences, the scarier and more intense they become. For example, if you’ve ever been on a roller coaster ride, then you have experienced the intense physiological arousal that roller coasters produce. Your heart starts racing, you feel dizzy and shaky, and you experience a rush in the pit of your stomach. There’s the intense anticipation as the roller coaster slowly moves upward before a huge drop, which is both thrilling and scary all at once.

anxiety and therapy, counseling in San Francisco and OaklandExperiencing such physiological symptoms on a roller coaster ride is far less threatening than experiencing them when you don’t expect to, such as while lying in bed and trying to fall asleep. In the latter case, you may feel terrified. Your mind starts labeling the experience as “bad” and attempts to figure out reasons, explanations, and hypotheses for why you are feeling the way you are. Your mind asks, “Why am I feeling dizzy?” “Why is my heart racing?” “Is it because I had too much coffee?” “Is it because I didn’t get enough sleep?” “Why am I anxious?” “Am I having a panic attack?” “Did I forget something important?” The more your mind labels the experience as bad, the more anxious and nervous you become. The more you try to eliminate the experience and fall asleep, the harder it is for you to fall asleep.

Our sensations are not in our control. When we are on a roller coaster, we can’t control our heart rates. When we have an important test, we can’t control the thoughts, feelings, and sensations that it brings up. However, we can make an active choice about how we choose to relate to these experiences. We can choose to resist and fight the experience, or we can choose to willingly go for the ride and observe it with kindness and compassion toward ourselves. We can notice that when we get off the roller coaster, it takes three to five minutes for our bodies to come back to homeostasis and for all of those physiological experiences to diminish—and then we may be ready to go on another ride.

So, how can we take the ride with our physical sensations of anxiety, fear, pain, and panic in the same way we ride a roller coaster? The key is to notice what our minds try to sell us about our experiences and still choose to stay present and aware of those experiences. In other words, we can observe the experience in the moment and notice the labels, explanations, and hypotheses that our minds concoct.

We can ask ourselves, “Where in my body do I feel this feeling right now? What color is this feeling? What shape is this feeling? How heavy is it? How intense is it on a scale of 1 to 10? Is this an experience I have had before? How many times have I had this experience in the past month? Does this experience have to be my enemy, or is it something I can handle right now, in this moment? Am I willing to stay in contact with this feeling 100 percent, exactly as it is at this moment? Have I ever managed to get rid of this experience before? Is it possible for human beings to permanently eliminate this experience? How do I usually respond to this experience? Do I try to push it away and get rid of it? How does that work for me? How can I behave differently with this experience? If this experience is not my friend, does it have to be my enemy? Does it have to be something I refuse to tolerate and have? What would it be like if this experience weren’t my enemy?”

Physiological experiences come and go, just like the weather. No experience is permanent. Sometimes you feel pain, and sometimes the pain can be worse than others—a 6 or even a 9 on a scale of 1 to 10—but your experience is always changing.

Again, when you resist the experience and try to understand it, explain it, and get rid of it, the experience becomes only more intense. The more you resist, the worse it gets.

We don’t try to explain or understand why we need to go to the bathroom. We just accept the sensation as a fact. We don’t ask why or resist it or try to understand it or change it. Other experiences of pain, like having a headache, or feeling dizzy, or having stomach pain, are unavoidable, and they don’t last forever. Are you willing to welcome back all your experiences with open arms, watch how long they last, stay very curious, go along for the ride with compassion and tenderness, and notice the very moment when they change and you feel differently?

 

 

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Schemas and Relationships

According to Jeffrey Young, schemas are core beliefs and stories that we have constructed about ourselves and our relationships in the world. A schema is a deep-rooted cognitive structure or framework that helps us organize information and make sense of the world. A schema is like a lens through which we view the world, organize our experiences, and interpret events.

These are stories that we have constructed about ourselves throughout our life. These stories are like lenses that distort our perceptions and experiences with others and can lead to self-fulfilling prophecies in relationships. Schemas develop in childhood from early experiences we have with our family and peers.

schemas and cognitive therapy, Oakland and San Francisco

Our minds are built to create cause-and-effect relationships and make connections between events, even if there isn’t much of a correlation. Making these correlations is advantageous in many ways, but schemas can become maladaptive when we take random events in the world and make causal connections about what these events mean about our identity and ourselves. These stories were developed in childhood from early experiences where our basic needs were not met. We build stories and theories about ourselves as to why it is that our needs did not get met. We form these schemas as we attempt to interpret events in the world and make sense of why they happened. For example, if you grew up with a mother who was depressed and who was inconsistently available, you might develop an abandonment/instability schema and build a story that you can’t rely or depend on others to be there for you consistently. You may even convince yourself that if you were just different or if you were better, then your needs would have been met, you may build a story that your emotions are too much and that you are the cause of your mother’s depression.

Schemas are like sunglasses that distort how we take in information and how we make meaning of events. For example, an individual with an abandonment schema is predisposed to interpreting others as rejecting or abandoning, and is more likely to reach the conclusion that they are being abandoned even if there is little evidence to suggest it. These lenses distort our perceptions and experiences with others and can lead to self-defeating patterns in relationships. Schemas are hard to give up because they help us organize our experience and create an illusion of safety and predictability in the world. They are hard to challenge because they create the impression that we can make predictions about the outcome of our relationships and protect ourselves.

portrait of amazed man with 3d glasses

Maladaptive schemas may lead to self-defeating themes and patterns that continue to repeat throughout our adult life. These schemas that were formed in childhood continue to get triggered throughout our life in stressful situations and the way you respond when you get triggered can create a self-fulfilling prophecy. Once a schema gets triggered, it brings up specific powerful, automatic, and conditioned thoughts and feelings about ourselves.

Schemas can influence interpersonal behaviors and interfere with our ability to satisfy basic needs in current relationships. When our schemas get triggered in relationships we tend to use certain coping behaviors, which we have learned in childhood, to try to control or block the pain connected to our schemas. These coping behaviors can end up reinforcing and maintaining our schemas by creating a self-fulfilling prophecy.

For example, if someone with an abandonment schema gets triggered, he/she may cope with this experience by seeking excessive reassurance, getting clingy, acting jealous and possessive, or by blaming or accusing. These coping behaviors may actually increase the likelihood that others will withdraw or abandon. Reducing these maladaptive behaviors can help you heal as you learn new more effective ways of getting your emotional needs met, both inside the session with your therapist and in your everyday life. The goal of Schema Therapy is to help you identify the coping behaviors you do that damage your relationships and substitute these behaviors with more effective responses. Schema therapy aids you in healing your early maladaptive schemas, the stories you have constructed about yourself, and breaking self-defeating patterns in relationships.

To read more information about specific schemas click here

 

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Personal Treatment That Works

At the Bay Area CBT Center, we dedicate ourselves to integrating an interpersonal approach to a wide variety of evidence-based treatments. We base our therapy on the notion that psychological symptoms occur within an interpersonal context. The way we interact with others around us maintains and reinforces anxiety, depression, trauma, OCD, chronic pain, and other conditions. And just as our relationships impact our moods, our moods also impact our relationships.

We can help you find a path through the often bewildering maze of interpersonal relationships and life’s challenges by developing healthier and more effective ways of relating—not only to others but to yourself as well.

Relational Approach:

We base our therapy on the notion that the relationships in your life including your relationship with your therapist are of central importance and are a primary motivator for behavioral change. Psychological symptoms occur within an interpersonal context. That could be your relationship with your partner, your boss, your family, your coworkers, or your therapist. Therefore we focus on creating an authentic and healing relationship with you. To understand your relationships and how they work (or don’t work) and how they impact your life, we explore not only how you feel but also what you think and how you behave.

Active Approach:

We need more than insight to create behavioral change. Understanding the root of your struggles is not enough to create long-lasting change. Knowing where you are stuck is just the beginning. Creating behavioral flexibility and taking deliberate and meaningful actions, even in the face of fear is our ultimate goal. We need to learn specific tools and practice new skills in order to develop more effective coping strategies in our daily life.

Integrative Approach:

There isn’t one type of treatment or therapeutic approach that is equally effective for everyone. An integrative approach is necessary for effective treatment outcomes. We consistently integrate tools and techniques from various treatment approaches to co-create a method that specifically works for you.

We can help you overcome your difficulties and start living a more fulfilling and vital life. Our goal is to provide you with effective, collaborative, and integrative therapy that is specifically tailored to you and your situation—in short, to help you learn the skills you need to live the kind of life your desire.

 

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Take Steps Towards Improving Your Relationships

For those who want to know a bit more about our theoretical foundations, we provide an interpersonal approach to the practice of empirically- supported treatments and offer a variety of evidenced-based therapies including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), and schema therapy. We apply the principles of evidence-based treatments while considering all aspects of our clients’ lives by utilizing a relational frame.

A Relational Approach to Cognitive Behavioral Therapy (CBT)

A common myth is that CBT does not prioritize the importance of the therapeutic relationship. The psychotherapy field has become split into two major schools of thought—psychodynamic therapy and cognitive behavioral therapy. The common misconception is that the former prioritizes the therapeutic relationship and takes a more relational approach. While the latter, CBT, prioritizes the client’s thoughts, feelings, and behaviors. Although some CBT therapists do not explicitly focus on the therapeutic relationship or on making interpretations about the dynamic between the client and the therapist, the Bay Area CBT Center aims to integrate these two schools of thought in a consistent way by emphasizing a relational approach to cognitive behavioral therapy.

What does this mean?

Simply put, we combine notions from both interpersonal and cognitive behavioral therapies. We believe that relationships in your every day life, as well as your relationship with your therapist, are of central importance and are primary motivators for behavioral change.

People require genuine, supportive connections and relationships. It is an essential human need. Yet, these relationships can maintain and even exacerbate psychological conditions. The way we interact with others around us preserves and reinforces anxiety, depression, trauma, OCD, chronic pain, among other disorders and conditions. And just as our relationships impact our moods, our moods also impact our relationships.

This is why it is fundamental that we aspire to establish authentic, healthy interactions and maintain them. Studies show that individuals who identify having a stable, supportive relationship in their lives are physically, mentally, and psychologically healthier, and actually live longer.

In relational CBT, your therapist uses himself/herself as a tool to motivate, reinforce, and experiment with new behaviors and explore their outcome with you. The therapeutic relationship is used as a safe space to practice new behaviors as a model for other healthy relationships. The therapist and client discuss the behaviors that the client wants to work on in his/her relationships. Through cognitive behavioral approaches, those behaviors are identified and explored openly and honestly when they arise with the therapist. Additionally, the therapist encourages the client, to practice newly learned skills in an emotionally activated state. With the trust and collaboration of the therapist, the client can practice new behaviors, for example, being assertive, saying no, making a request, setting a boundary, etc. in an authentic environment.

At the Bay Area CBT Center, our goal is to help you become the healthiest you strive to be. We trust in your ability to make changes for the better.