Welcome to my counseling and psychotherapy practice!
I have a Master's degree in Social Work, which I received in
1986, and have been licensed as a Social Worker since 1988. I
have been providing counseling, psychotherapy, assessment and
evaluation services since that time. In addition, I am Department
of Transportation qualified as a Substance Abuse Professional
(SAP) to do evaluations related to substance use or testing
positive for substance use while working in DOT safety sensitive
positions. I have expertise in the treatment of alcohol and
opioid use disorders and also medication assisted therapy for
these disorders, having spend a decade working extensively with a
psychiatrist who is Board Certified in Addiction. I also provide
Eye Movement Desensitization and Reprocessing (EMDR) consultation
and training to psychotherapy professionals.
I provide individual, couples, family and group counseling and
psychotherapy services within my practice. I meet with most
patients on a weekly or bi-weekly basis. Initial sessions,
couples and family sessions are frequently scheduled for 60 or 90
minutes. Phone or internet sessions are sometimes used as an
adjunct to face to face counseling sessions, or in special
circumstances when it is not possible to meet face to face. Group
treatment sessions are generally 90 minutes long, and those
meetings are typically weekly or bi-weekly. In the event that
substance abuse is an issue I may order laboratory studies,
including toxicology screens, to further evaluate this. If it is
therapeutically appropriate I sometimes recommend that a patient
use a breathalyzer device.
The primary types of therapy that I do are Cognitive Behavioral
Therapy (CBT), and Eye Movement Desensitization and Reprocessing
(EMDR). I also use Brainspotting, mindfulness and mindfulness
meditation interventions, Energy Psychology Therapies, and
integrate other types of therapies as seems clinically
appropriate.
Cognitive Behavioral Therapy (CBT)
CBT is a psychotherapeutic approach that aims to solve or reduce
problems concerning dysfunctional emotions, behaviors and
cognitions. It is a solution-focused approach to therapy. CBT is
an umbrella term for a number of psychological techniques that
share a theoretical basis in behavioral learning theory and
cognitive psychology. There is empirical evidence that CBT is
effective for the treatment of a variety of problems, including
mood, anxiety, personality, eating, substance abuse, and
psychotic disorders. Mindfulness and mindfulness meditation focus
on becoming aware of all incoming thoughts and feelings and
accepting them, but not attaching or reacting to them. As a
solution-focused therapist I work with my clients to identify
what they would like to accomplish in therapy and together we
identify strategies to help them to achieve those goals. As goals
are achieved the patient may decide to end treatment, or may
decide instead to continue working with me to address new goals
as identified. Patents may decide to return at a later date to
address new goals. Homework is frequently discussed and assigned
as an adjunct to the work we do in sessions. In this way clients
are able to practice new skills and behaviors which support
identified goals. As an adjunct to the work that I do with
patients I commonly suggest that they access and utilize
resources outside of counseling sessions, such as books,
articles, classes, support groups, and treatment groups. As a
part of my practice I teach patients about strategies and
techniques that, if used, may help them to achieve stated goals.
We may also practice these strategies and techniques in
counseling sessions.
Eye Movement Desensitization and Reprocessing (EMDR
Therapy)
- I am Level I and II trained, EMDRIA certified in Eye Movement
Desensitization and Reprocessing (EMDR), and am an EMDRIA
Approved EMDR Consultant. EMDR was developed by Francine Shapiro
in 1987. EMDR was initially found to be effective to treat
post-traumatic stress. This has been demonstrated empirically.
EMDR may also be helpful in the treatment of panic attacks,
complicated grief, dissociative disorders, disturbing memories,
phobias, pain disorders, eating disorders, performance anxiety,
stress reduction, addictions, sexual and/or physical abuse, body
dysmorphic disorders and personality disorders, and to enhance
performance and creativity and treatment for these issues is
considered to be experimental.
EMDR Therapy "is a psychotherapy that enables people to heal from
the symptoms and emotional distress that are the result of
disturbing life experiences. Repeated studies show that by
using EMDR therapy people can experience the benefits of
psychotherapy that once took years to make a difference. It is
widely assumed that severe emotional pain requires a long time to
heal. EMDR therapy shows that the mind can in fact heal
from psychological trauma much as the body recovers from physical
trauma. When you cut your hand, your body works to close
the wound. If a foreign object or repeated injury irritates
the wound, it festers and causes pain. Once the block is
removed, healing resumes. EMDR therapy demonstrates that a
similar sequence of events occurs with mental processes.
The brain's information processing system naturally moves
toward mental health. If the system is blocked or
imbalanced by the impact of a disturbing event, the emotional
wound festers and can cause intense suffering. Once the
block is removed, healing resumes. Using the detailed
protocols and procedures learned in EMDR therapy training
sessions, clinicians help clients activate their natural healing
processes. More than 30 positive controlled outcome studies have
been done on EMDR therapy. Some of the studies show that
84%-90% of single-trauma victims no longer have post-traumatic
stress disorder after only three 90-minute sessions.
Another study, funded by the HMO Kaiser Permanente, found
that 100% of the single-trauma victims and 77% of multiple trauma
victims no longer were diagnosed with PTSD after only six
50-minute sessions. In another study, 77% of combat veterans were
free of PTSD in 12 sessions. There has been so much research on
EMDR therapy that it is now recognized as an effective form of
treatment for trauma and other disturbing experiences by
organizations such as the American Psychiatric Association, the
World Health Organization and the Department of Defense. Given
the worldwide recognition as an effective treatment of trauma,
you can easily see how EMDR therapy would be effective in
treating the "everyday" memories that are the reason people have
low self-esteem, feelings of powerlessness, and all the myriad
problems that bring them in for therapy. Over 100,000 clinicians
throughout the world use the therapy. Millions of people
have been treated successfully over the past 25 years. EMDR
therapy is an eight-phase treatment. Eye movements (or
other bilateral stimulation) are used during one part of the
session. After the clinician has determined which memory to
target first, he asks the client to hold different aspects of
that event or thought in mind and to use his eyes to track the
therapist's hand as it moves back and forth across the client's
field of vision. As this happens, for reasons believed by a
Harvard researcher to be connected with the biological mechanisms
involved in Rapid Eye Movement (REM) sleep, internal associations
arise and the clients begin to process the memory and disturbing
feelings. In successful EMDR therapy, the meaning of painful
events is transformed on an emotional level. For instance,
a rape victim shifts from feeling horror and self-disgust to
holding the firm belief that, "I survived it and I am strong."
Unlike talk therapy, the insights clients gain in EMDR
therapy result not so much from clinician interpretation, but
from the client's own accelerated intellectual and emotional
processes. The net effect is that clients conclude EMDR
therapy feeling empowered by the very experiences that once
debased them. Their wounds have not just closed, they have
transformed. As a natural outcome of the EMDR therapeutic
process, the clients' thoughts, feelings and behavior are all
robust indicators of emotional health and resolution-all without
speaking in detail or doing homework used in other therapies.
Treatment Description: EMDR therapy combines different elements
to maximize treatment effects. A full description of the
theory, sequence of treatment, and research on protocols and
active mechanisms can be found in F. Shapiro (2001) Eye movement
desensitization and reprocessing: Basic principles,
protocols and procedures (2nd edition) New York: Guilford Press.
EMDR therapy involves attention to three time periods: the
past, present, and future. Focus is given to past
disturbing memories and related events. Also, it is given
to current situations that cause distress, and to developing the
skills and attitudes needed for positive future actions.
With EMDR therapy, these items are addressed using an
eight-phase treatment approach." (From EMDR Institute, Inc.
description)
Brainpotting
I am Level I and II trained in Brainspotting (BSP), which was
developed in 2003 by David Grand, PhD. It is believed that that
BSP taps into and harnesses the body's natural self-scanning,
self-healing ability. When a Brainspot is stimulated, the deep
brain appears to reflexively signal the therapist that the source
of the problem has been found. BSP can also be used to find and
strengthen our natural resources and resilience. BSP is designed
as a therapeutic tool that can be integrated into a many of
healing modalities. BSP can also be used with performance and
creativity enhancement. Brainspotting is considered to be an
experimental treatment.
Heartmath
Heartmath is a tool that I often use to teach relaxation skills.
I have installed a program on my laptop computer called Heartmath
which allows my clients and me to monitor achievement with visual
and auditory cues using a simple and non-invasive monitor, which
is placed on a finger or on the earlobe. Research that indicates
that when heart rhythm patterns are smooth and balanced people
are less susceptible to sickness and disease, are more energetic,
and are able to perform daily affairs more effectively and with
greater clarity and ease.
Mindfulness and Meditation
I have received extensive training and a certification in
mindfulness and medication as used in psychotherapy, and practice
meditation myself. I integrate mindfulness and meditation
practices into my work with patients.
Empirically supported benefits of mindfulness
"The term "mindfulness" has been used to refer to a psychological
state of awareness, the practices that promote this awareness, a
mode of processing information and a character trait. To be
consistent with most of the research reviewed in this article, we
define mindfulness as a moment-to-moment awareness of one's
experience without judgment. In this sense, mindfulness is a
state and not a trait. While it might be promoted by certain
practices or activities, such as meditation, it is not equivalent
to or synonymous with them.
Several disciplines and practices can cultivate mindfulness, such
as yoga, tai chi and qigong, but most of the literature has
focused on mindfulness that is developed through mindfulness
meditation - those self-regulation practices that focus on
training attention and awareness in order to bring mental
processes under greater voluntary control and thereby foster
general mental well-being and development and/or specific
capacities such as calmness, clarity and concentration (Walsh
& Shapiro, 2006).
Researchers theorize that mindfulness meditation promotes
metacognitive awareness, decreases rumination via disengagement
from perseverative cognitive activities and enhances attentional
capacities through gains in working memory. These cognitive
gains, in turn, contribute to effective emotion-regulation
strategies.
More specifically, research on mindfulness has identified these
benefits:
Reduced rumination. Several studies have shown that mindfulness
reduces rumination. In one study, for example, Chambers et al.
(2008) asked 20 novice meditators to participate in a 10-day
intensive mindfulness meditation retreat. After the retreat, the
meditation group had significantly higher self-reported
mindfulness and a decreased negative affect compared with a
control group. They also experienced fewer depressive symptoms
and less rumination. In addition, the meditators had
significantly better working memory capacity and were better able
to sustain attention during a performance task compared with the
control group.
Stress reduction. Many studies show that practicing mindfulness
reduces stress. In 2010, Hoffman et al. conducted a meta-analysis
of 39 studies that explored the use of mindfulness-based stress
reduction and mindfulness-based cognitive therapy. The
researchers concluded that mindfulness-based therapy may be
useful in altering affective and cognitive processes that
underlie multiple clinical issues.
Those findings are consistent with evidence that mindfulness
meditation increases positive affect and decreases anxiety and
negative affect. In one study, participants randomly assigned to
an eight-week mindfulness-based stress reduction group were
compared with controls on self-reported measures of depression,
anxiety and psychopathology, and on neural reactivity as measured
by fMRI after watching sad films (Farb et al., 2010). The
researchers found that the participants who experienced
mindfulness-based stress reduction had significantly less
anxiety, depression and somatic distress compared with the
control group. In addition, the fMRI data indicated that the
mindfulness group had less neural reactivity when they were
exposed to the films than the control group, and they displayed
distinctly different neural responses while watching the films
than they did before their mindfulness training. These findings
suggest that mindfulness meditation shifts people's ability to
use emotion regulation strategies in a way that enables them to
experience emotion selectively, and that the emotions they
experience may be processed differently in the brain (Farb et
al., 2010; Williams, 2010).
Boosts to working memory. Improvements to working memory appear
to be another benefit of mindfulness, research finds. A 2010
study by Jha et al., for example, documented the benefits of
mindfulness meditation among a military group who participated in
an eight-week mindfulness training, a nonmeditating military
group and a group of nonmeditating civilians. Both military
groups were in a highly stressful period before deployment. The
researchers found that the nonmeditating military group had
decreased working memory capacity over time, whereas working
memory capacity among nonmeditating civilians was stable across
time. Within the meditating military group, however, working
memory capacity increased with meditation practice. In addition,
meditation practice was directly related to self-reported
positive affect and inversely related to self-reported negative
affect.
Focus. Another study examined how mindfulness meditation affected
participants' ability to focus attention and suppress distracting
information. The researchers compared a group of experienced
mindfulness meditators with a control group that had no
meditation experience. They found that the meditation group had
significantly better performance on all measures of attention and
had higher self-reported mindfulness. Mindfulness meditation
practice and self-reported mindfulness were correlated directly
with cognitive flexibility and attentional functioning (Moore and
Malinowski, 2009).
Less emotional reactivity. Research also supports the notion that
mindfulness meditation decreases emotional reactivity. In a study
of people who had anywhere from one month to 29 years of
mindfulness meditation practice, researchers found that
mindfulness meditation practice helped people disengage from
emotionally upsetting pictures and enabled them to focus better
on a cognitive task as compared with people who saw the pictures
but did not meditate (Ortner et al., 2007).
More cognitive flexibility. Another line of research suggests
that in addition to helping people become less reactive,
mindfulness meditation may also give them greater cognitive
flexibility. One study found that people who practice mindfulness
meditation appear to develop the skill of self-observation, which
neurologically disengages the automatic pathways that were
created by prior learning and enables present-moment input to be
integrated in a new way (Siegel, 2007a). Meditation also
activates the brain region associated with more adaptive
responses to stressful or negative situations (Cahn & Polich,
2006; Davidson et al., 2003). Activation of this region
corresponds with faster recovery to baseline after being
negatively provoked (Davidson, 2000; Davidson, Jackson, &
Kalin, 2000).
Relationship satisfaction. Several studies find that a person's
ability to be mindful can help predict relationship satisfaction
- the ability to respond well to relationship stress and the
skill in communicating one's emotions to a partner. Empirical
evidence suggests that mindfulness protects against the
emotionally stressful effects of relationship conflict (Barnes et
al., 2007), is positively associated with the ability to express
oneself in various social situations (Dekeyser el al., 2008) and
predicts relationship satisfaction (Barnes et al., 2007; Wachs
& Cordova, 2007).
Other benefits. Mindfulness has been shown to enhance
self-insight, morality, intuition and fear modulation, all
functions associated with the brain's middle prefrontal lobe
area. Evidence also suggests that mindfulness meditation has
numerous health benefits, including increased immune functioning
(Davidson et al., 2003; see Grossman, Niemann, Schmidt, &
Walach, 2004 for a review of physical health benefits),
improvement to well-being (Carmody & Baer, 2008) and
reduction in psychological distress (Coffey & Hartman, 2008;
Ostafin et al., 2006). In addition, mindfulness meditation
practice appears to increase information processing speed (Moore
& Malinowski, 2009), as well as decrease task effort and
having thoughts that are unrelated to the task at hand (Lutz et
al., 2009)." (American Psychological Association (APA) Monitor on
Psychology, July/August 2012,"What are the Benefits of
Mindfulness").
Energy Psychology
"Energy psychology (EP) is a collection of mind-body approaches
for understanding and improving human functioning. EP focuses on
the relationship between thoughts, emotions, sensations, and
behaviors, and known bioenergy systems (such as meridians and the
biofield). These systems and processes exist, and interact,
within individuals and between people. They are also influenced
by cultural and environmental factors.
Within an EP framework, emotional and physical issues are seen,
and treated, as bio-energetic patterns within a mind-body-energy
system. The mind and body are thought to be interwoven and
interactive within this mind-body-energy system, which involves
complex communication involving neurobiological processes, innate
electrophysiology, psychoneuroimmunology (PNI), consciousness,
and cognitive-behavioral-emotional patterns.
The use of EP has resulted in the development of associated
methods and models to treat psychological and emotional problems,
facilitate health and wellbeing, and improve human performance.
These models and methods are usually used within an integrative
or holistic approach to practices such as psychotherapy,
counseling, coaching, integrative medicine, and other healing
modalities.EP models have been beneficially applied to assessment
and treatment of trauma, anxiety, depression, pain, stress,
psychophysiological issues, and self-sabotaging behaviors by a
broad range of healthcare providers, to regulate affect and
promote emotional and physical health. Treatment results have
been shown to be enduring and relatively rapid. There are
currently over 100 research studies, including 50 randomized
controlled trials (RCT) published in professional and refereed
journals, confirming the treatment value of EP. Taken as a body
of knowledge, these findings suggest that EP meets the criteria
for evidenced-based treatment. In fact, in 2016, TFT (Thought
Field Therapy) was validated by NREPP (the National Repertory of
Evidence Based Practices and Procedures, a division of SAMHSA in
the U.S.) as an evidence-based treatment." (From Association for
Comprehensive Energy Psychology (ACEP))
RISKS AND BENEFITS OF THERAPY
Psychotherapy can have both benefits and risks. Psychotherapy has
been shown to have benefits for people who go through it. Therapy
can lead to better relationships, solutions to specific problems,
and significant reductions in feelings of distress. There is
evidence that some types of psychotherapy offer equal or better
treatment results at a lower cost than medication.
However, since therapy often involves discussing unpleasant
aspects of your life, patients may experience uncomfortable
feelings like sadness, guilt, anger, frustration, loneliness, and
helplessness. Approaching feelings or thoughts that you have
tried not to think about for a long time may be painful.
Processing emotionally traumatic events may initially increase
discomfort. Making changes in your beliefs or behavior can be
scary, and sometimes disruptive to the relationships. It is
important that you consider carefully whether these risks are
worth the benefits to you of changing.
CONFIDENTIALITY AND THE LIMITS OF CONFIDENTIALITY
The information you discuss during a psychotherapy session is
protected as confidential under law (C.R.S. 12-43-214)(1)(d))
with certain limitations.
- It is my policy and responsibility to report suspected child
abuse and elder abuse, without an investigation, to the proper
authorities, who may then investigate.
- I may also take some action, such as seek an order for your
emergency or involuntary commitment under C.R.S. 27-10-101,
without your consent if I feel that you are either gravely
disabled or I deem you to be a serious harm to yourself or to
another. Any action I take without your consent will be discussed
with you if possible.
- If I am unable to collect the agreed upon fee, I may send your
name to a collection agency.
- According to Colorado Law, your right to confidentiality is
waived in the event that you file an official complaint or a
lawsuit against me.
- If you chose to use your health benefit plan, you will have
given your insurance or managed care company consent to obtain
required confidential information for the purpose of determining
eligibility for reimbursement. (See Health Care Benefits.)
- I sometimes consult with other therapists or other
professionals about my patients. This helps me to provide quality
treatment. However, these persons are required to keep your
information private. And, in order to protect your personal
information and identity, your name will never be given to them,
some information will be changed or omitted, and they will be
told only as much as I believe that they need to know in order to
understand your situation.
- Clerical, billing, and other persons hired by me may have
access to limited confidential information. This information is
protected from further disclosure and is used solely for
administrative purposes.
- When I am away from my office for a few days, I may ask another
licensed therapist to cover emergences for me. Generally, I will
tell this therapist only what he or she needs to know for an
emergency.
CONFIDENTIALITY AND TECHNOLOGY EMAILS, TEXT MESSAGING, VOICE
MESSAGES, FAXES, PHONE, INTERNET:
When working with patients I prefer using email or text messaging
only in cases when a client wishes to arrange or modify
appointments. Please do not email me content related to your
therapy sessions, as email is not completely secure or
confidential. If you choose to communicate with me by email, be
aware that all emails are retained in the logs of your and my
Internet service providers. These transmissions may be accessible
to others, such as system administrators or the Internet service
providers, employers, or government agencies. In addition, I may
not have access to emails or text messages, or I may not receive
an email, voicemail or fax due to a technology failure. In
addition, I do not accept friend or contact requests from current
or former clients on any social networking site (Facebook,
LinkedIn, etc.). Adding clients as friends or contacts on these
sites can compromise confidentiality and privacy and may also
blur the boundaries of our therapeutic relationship. Many clients
choose to use cell phones, cordless phones, faxes, email,
video-conferencing and computers to augment their counseling with
me. These methods of communication may not be completely secure
despite best efforts.
HEALTH CARE BENEFITS
If you choose to use your health care benefits, and my services
are reimbursable under your insurance plan, you must give me
written authorization to release required information. Released
confidential information may range from identifying information,
diagnosis, dates and types of sessions and charges to a complete
assessment with treatment goals and progress reports when your
benefits fall under managed care. My policy is to provide only
the least amount of information necessary for the purpose of
authorizing benefits. However, it is necessary that I provide
insurers and often employee assistance programs with a diagnosis
and other personal information. I cannot be in control of the
storage of confidential information nor access to your
confidential information when it is given to a third party. The
insurance company will determine benefit coverage and the kind of
service for which they will reimburse. I will discuss with you my
recommendation for treatment and you will decide how you want to
proceed. You are responsible for seeing that my services are paid
for regardless of whether the insurance company will reimburse
for treatment you receive. Many people choose to self-pay for
psychotherapy services in order to better safeguard their
privacy.
AVAILABILITY
You may leave a voicemail message 24 hours a day and I will
attempt to return your call within 24 hours during the weekdays
or on the first working day following a weekend or holiday. I
will get back to you as soon as is possible. It is my policy to
charge for calls such as these at my regular rate in 15-minute
increments. Please call 911 or go to the nearest emergency room
if there is a life-threatening emergency. If I am away for an
extended time and unable to respond to calls I ask another
licensed therapist to manage urgent calls for me.
GRIEVANCE PROCEDURE
If you are unhappy with the services you receive from me you it
is important that you indicate that to me either in writing, by
phone, or in person. In addition, the practice of both licensed
and unlicensed psychotherapists is regulated by the Department of
Regulatory Agencies under CRS 12.43.214 (1)(c) . Under this
statute, 12.43.214(1)(d)CRS, you are entitled to receive
information about the methods of therapy, the techniques used,
the duration of therapy (if known), and the fee structure. You
may seek a second opinion from another therapist or may terminate
therapy at any time. In a professional relationship, sexual
intimacy is inappropriate and intolerable and should be reported
to the Grievance Board.
ACCESS TO RECORDS
Patient records are kept and stored securely and in a manner that
both assures that only authorized persons have access to records
and protects the confidentiality of the records and of the
information contained in the records. Records are kept for 7
years as required by Colorado Statute. Patients are granted
reasonable access to their records, but not my psychotherapy
notes. You may request, in writing, an amendment to your record.
If you choose to read your record, it is my policy to be present
in order to respond to any questions or confusion you have about
the recordings.
LENGTH OF TREATMENT
I generally meet with patients once weekly or, after the first
several sessions, biweekly, for four to six months. There are
times I meet with clients for an agreed upon finite number of
sessions (as in the case of a consultation, an evaluation, or
employee assistance services). Sessions are generally 45-minutes
in duration, and intake appointments are typically 60
minutes to 90 minutes in duration. Sessions may be extended when
there is a clinical need. During the course of treatment we
generally review progress and goals often. As treatment
progresses and goals are met we generally decrease the frequency
of sessions. As we approach termination we will review our goals
and what has been accomplished, discuss strategies for future
success, and identify additional goals for the future. Sometimes
patients choose to take a break from counseling and then resume
sessions at a later time to continue to work on achieving goals,
or we end treatment and they choose to return for a brief number
of sessions during periods of stress for support, to review
strategies, or to address other issues that have arisen in the
interim.
TERMINATION
Termination will usually be agreed upon mutually, but you are
free to terminate treatment at any time. Unless we have made
other arrangements, I will assume that you have terminated
treatment if you have not scheduled with me for a period of one
month or more.
I reserve the right to terminate our relationship for any reason,
including but not limited to whenever, in my opinion, an
effective therapeutic relationship cannot be established or
maintained. I may also terminate our relationship is you have
failed to meet the terms of our fee agreement, or if I determine
that there is a need for special services outside of my area of
competency, or if there is prolonged failure to make progress in
our work together. Should this occur, you will be notified
of the reason for termination and, if you would like, I will help
you to make different plans for yourself such as a referral to a
more appropriate treatment resource.
ACKNOWLEDGEMENT OF INFORMED CONSENT
I have read the preceding information, it has also been
provided verbally, and I have asked any questions I have. I fully
understand the treatment considerations and risks presented in
this form.