Therapy Archives - Page 2 of 3 - Virtual Cognitive Behavioral Therapy

How to Succeed at Therapy

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

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

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

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

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

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

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

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

Brain Training

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

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

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

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

The Mental Skills Report Card

The mental skills report card is a self assessment of mental skills that individuals complete at the end of a game, match or important situation where they “should” have used one or more mental skills to help them perform to their potential.

Mental coaches and cognitive behavioral therapists use self monitoring tools to help individuals stay focused on training and evaluating new mental skills that are taught and then incorporated into the individual’s life.

Typical mental skills to enhance performance of all kinds include: confidence, concentration, calmness, communication, managing mistakes, performing well in pressure situations, recovering from adversity, etc.

Depending on the needs and goals of the individual, the psychologist teaches strategies to develop each of the mental skills. Once learned, the individual starts to incorporate them into their personal circumstances, then self rates their implementation of the mental skills and how effective they felt they were in using them.

Self recording of mental skills helps the individual and the mental coach evaluate the effectiveness of the mental skills training program and fine tune things as needed.

Regularly recording one’s mental skills reinforces the important of using mental skills and provides a more accurate evaluation as to their usefulness.

A mental skills report card can be a simple index card with the skills written on them and a checklist or rating scale that looks at frequency of use and effectiveness of use or it can have individual questions such as:

I remembered to breathe slowly and deeply for up to 5 minutes before giving my presentation (or at the beginning of my game).
When I missed a shot I immediately forgot about it and pictured hitting it successfully the next time.

By regularly reviewing and recording your mental skills progress, the skills eventually become a habit and you find yourself using them without even thinking about it.

Treating Sexual Problems In Females

As a psychologist, I have treated numerous individuals and couples. Clients often come into the office presenting with relationship issues. Many times, there is dissatisfaction in one or both with their sexual lives. Sometimes the sexual problem is caused by problems in the relationship and at other times the sexual difficulty in causing or contributing to the relationship difficulties. There are also times when the individual is troubled or disturbed and sex is not a priority.

I always recommend that clients have a candid discussion with their primary care doctor (not always easy for the client or the doctor) to see if there are medically related and/or medication related factors that could be causing or contributing to the concerns.

I offer a comprehensive evaluation to better understand the often complex factors that cause sexual problems in females. Here are just some of the psychological factors that can be affecting sexual desire and/or satisfaction in women. Many of the same factors could also be impacting men as well:

Poor self image.
Being stressed by personal or work issues.
Distractibility and difficulties with concentration and staying focused.
Feeling overly tired or fatigued due to a lack of a balanced lifestyle.
A negative mindset towards sex.
Poor communication with partner before, during and after sex.
Poor sexual skills leading to a dissatisfied partner.
Sex becoming boring and/or routine.
Performance Anxiety- fearing you will not do a “good enough job”.
Pain associated with the sexual act.
Feeling sexually inadequate and unable to satisfy partner’s needs.
Underlying high levels of depression, anxiety, shame, embarrassment or guilt.
Unresolved issues from past trauma.

As a male psychologist, I am comfortable in working with female clients on understanding and treating many female sexual problems. When a problem calls for specialized treatment or the female is more comfortable in working with a female psychologist, I will help them find another professional who can better serve them.

Treating female sexual problems requires the ability to establish a trusting relationship along with specific knowledge and skills.

Anger Management for Men

In my psychotherapy practice I often see men who are referred to me by their wives or by therapists who are seeing couples and feel the “male” is in need of anger management.

Sometimes, the male is in complete agreement and at other times, they are reluctant participants. Using a cognitive behavioral approach to anger management, I explain that we have most control over our own behaviors and very little control over other’s behavior. We examine how anger is helpful or hurtful to them and their relationships and how they might want things to be different.

Often times my male clients blame their partner for their anger. “She makes me so mad when she…”. In the cognitive behavioral approach to anger management, I explain the ABC’s of Emotion, that is, it is not the ACTIVATING EVENT (A) that causes the anger ( C= emotional consequence) but the Belief (B) view he takes of it that causes his anger. By accepting responsibility for creating his own feelings, the client has begun the process of being able to manage them more effectively.

By working with male clients individually, I can help them to feel calmer, develop more control, tolerance and patience and get them ready to be able to focus on developing and improving communication skills, problem solving, negotiating skills etc. These are ways to modify partner behaviors in a healthy way and get more of what they want and less of what they don’t want.

In individual work with men on anger management, we get them to a place where they don’t lose their temper and can more effectively learn and use other skills to help in improving their relationship with their partner and others. Again, the emphasis is NOT on changing the other person but on changing ourselves. As this occurs, the door to relationship improvement is opened and new changes can be more easily introduced.

To help clients not only feel better but get better, I provide practical strategies, ideas and exercises for them to train with. Many of these are described in my brief, pocket-sized educational and self help guidebook, “Anger Management” available on the products side of my website (www.cognitivetherapy.cc).

Anger management for men based on a cognitive behavioral approach can be accomplished in a relatively short period of time if the male client is committed to self improvement and willing to learn and practice simple ideas, exercises and practices between weekly appointments. Many times clients have reported positive changes in their relationship even when their partner is not receiving their own therapy or they are not involved in couples therapy.

Dr. Robert Heller is based in Boca Raton, Florida.

Counseling for Men’s Issues

As more and more men are seeking psychological treatment for a wide range of male related issues, there seems to be less male therapists around to work with them. Over the past 20 years or so many more females than males have entered the psychology and related professions. Just as some females may be more comfortable in working with a female therapist, many men prefer working with a male, particularly when they are dealing with sensitive issues such as those related to sexual functioning.

In providing counseling for men’s issues for almost 40 years now, the range of problems men seek help for fall into several broad ranges:
1. Relationship issues can include sexual problems like pre-mature ejaculation and difficulty getting or maintaining an erection, difficulty meeting women and problems in making commitments to a relationship.

2. Because men tend to equate their job and career performance with their self worth, work-related stressors become more severe as men fear losing their job, struggle to find a job in a difficult market or worry what their significant other will think of them if they don’t keep up or get ahead.

3. Men tend to have problems in understanding, expressing and managing their emotions, especially anger. Counseling for men’s issues around anger is often initiated after the anger has caused a substantial problem in a relationship, job or gotten them in trouble with the legal system.

4. Alcohol and drug problems seen in men are often associated with efforts to control or manage their emotions.

5. In older men, issues arise over health problems, dealing with loss of function and limitations in their ability to engage in lifelong favorite hobbies and activities.

Having experienced some of these issues myself, in addition to relating as a male, I can identify with the pain and suffering other men have experienced.

The good news is that counseling for men’s issues can pay big dividends in learning to adjust and adapt to many of life’s most challenging problems. Increasingly, counseling is seen by many as a commitment to their mental and emotional growth and more and more males are seeking out counseling and psychological skills to enhance their performance and well-being .

A Psychologist’s Approach to Hyperactivity

As a psychologist and former school psychologist, I have followed with interest the growing number of articles and studies that suggest the diagnosis of hyperactivity and attention deficit disorder is being given too readily as is the tendency to put individuals, especially children on medication.Is it really hyperactivity when a 5-year-old boy doesn’t sit still in his seat for hours at a time? Does the elimination and/or reduction of gym or recess make it harder for some of children to concentrate? Is it so surprising that some students may not be paying attention to a boring lecture or reading books they have no interest in? Are some parents blaming their child for not listening when they may not be knowledgeable about natural ways to manage children’s behaviour effectively?

Even when there is an accurate diagnosis of hyperactivity, I have found that psychologists can help children and families manage concentration, attention and behavior issues by learning skills and receiving training in self-regulation.

My psychologist toolbox includes relaxation training, guided visualization, meditation, diaphragmatic breathing, biofeedback and a host of physical and mental exercises designed to help individuals improve their attention, concentration and self control.

In many cases of attention deficit disorder and hyperactivity, psychological skills can be effectively used without reliance on medications.

Parents are taught about normal vs. abnormal developmental behaviors, effective communication skills and behavioral methods to better help their children help themselves.

As a psychologist who also works with athletes, I consult with coaches to help them in similar ways to how I work with teachers and parents.

When I work with children and adolescents I make use of technology they like and can relate to.

A video program I developed on mental conditioning (TENNISMIND) is especially helpful for training self-regulation, concentration and attention. It combines brief relaxation exercises with hypnotic suggestions. The lessons are broken down by topic and taught in 8-10 minute segments.

Increasingly popular, principles and practices from yoga are especially useful in training concentration and attention, stillness and being in the present moment. As one of a growing number of psychologists borrowing from yoga and related ancient practices, I have found them quite useful in treating and preventing numerous physical and psychological conditions.

In short, before putting a child or anyone on medication, consult a psychologist to get a proper diagnosis and to review the wide array of treatment options available to you.

Psychologist Finds Effective Treatment for Alcohol and PTSD

A study published in the Journal of the American Medical Association by well- known psychologist and researcher Dr. Edna Foa, found that those treated with prolonged exposure therapy and medication did the best in lowering percentage of drinking days and cravings when compared to a variety of different treatment groups six months after treatment.

Exposure therapy is a well-established method used by cognitive behavioral psychologists while naltrexone is a popular medication used in alcohol treatment. In the past, when the alcohol problem was treated without treating PTSD (post traumatic stress disorder), the PTSD would become more severe and the individuals would start drinking again according to Dr. Foa.

This finding is similar to my own experience in working with clients that have alcohol and/ or drug problems and co-conditions of PTSD.

They use the alcohol to self medicate themselves from the painful memories and feelings associated with their trauma. Therefore it is important to target both areas for treatment to reduce the risk of relapse.

For the treatment of PTSD, I have increasingly found that EMDR (eye movement desensitization and reprocessing ) to be a helpful process which works well in combination with cognitive behavior therapy methods to treat the alcohol and / or drug problems. Based on this new study, it may be worthwhile to recommend naltrexone for more resistant cases.

Increasingly, treatment centers are integrating more comprehensive methods in rehabilitating alcohol and drug issues by including sessions using EMDR, cognitive behavior therapy, acupuncture, biofeedback and yoga therapy.

In my own psychology practice located in Boca Raton, Florida I provide one of the few alternatives to traditional AA meetings and 12 step approaches. Clients can continue to attend 12 step programs if they wish or they are invited to join a SMART Recovery Group on line to support their work with me in individual therapy using cognitive behavioral therapy, EMDR, hypnosis and yoga based practices.

Intensive Outpatient Therapy

Intensive outpatient psychotherapy is well suited for a number of individuals. In my practice this means being seen for two, ninety minute sessions per week as opposed to a more standard single forty five minute session per week.

For individuals diagnosed with post traumatic stress disorder (PTSD) one of the treatment approaches I use (EMDR) is designed for extended session use so that the client may process important information and have time to recover and end the session with a sense of calm and /or completion.

For clients recently recovered from serious drug and/ or alcohol addiction, intensive outpatient psychotherapy provides needed structure and skills building to help reduce the risk of relapse, a common problem for individuals in recovery.

For individuals suffering major depression and/ or severe panic disorder, intensive outpatient psychotherapy allows for completing a comprehensive evaluation early on so that appropriate treatment can have an impact on reducing psychological pain and suffering in the shortest amount of time possible.

Intensive outpatient psychotherapy is also sort after by individuals who may only in the area for a short period of time and want to make the most of the limited time available to them.

For couples seeking relationship or marital counseling, intensive psychotherapy is often useful in that both parties often have lots to say and it takes time to teach and practice communication skills, model desired behaviors and convey important ideas in the same session. Emotions are often stirred up and having the time to provide closure on a topic and ending on a positive note is important to maintain progress.

In intensive outpatient psychotherapy, the client is provided with a series of assessment forms and information sheet to help diagnose their problems and concerns, develop short and long term goals and explain various approaches and treatment options available to them.

In the second session the assessments are reviewed with the client, goals are agreed upon and an initial treatment plan is developed. With the client’s permission, past records are reviewed and contact is provided with current relevant health care providers to provided coordinated treatment.

In subsequent sessions, clients are taught a variety of coping skills to help them manage their emotions as they move through the treatment phase.

Hypnosis For Test Taking Anxiety

Millions of high school students spend countless hours preparing for the PSAT, SAT and related national tests that will significantly impact their ability to get into the college of their choice and in some cases, to get into college at all.

Many parents spend hundreds and sometimes thousands of dollars on tutors and specialized college test preparation courses. While these efforts are helpful to many, a significant number of students do not perform to their potential due to anxiety. Anxiety can result in difficulty concentrating, having trouble remembering well studied information, problems in recall and memory, and being easily distracted. In plain English, the student “freezes”. Test taking anxiety is seldom directly addressed in classes, courses or tutors.

Hypnosis provides a useful alternative to those seeking to minimize the impact of test taking anxiety on their performance.

Hypnosis provides direct help in a short series of 6-10 sessions. Following an assessment of the specific worries and concerns that create and maintain anxiety and tension, participants are educated in the important connection between thoughts feelings and performance. Next, participants are guided into a relaxed state where they can concentrate on suggestions designed to help them relax quickly and easily on their own. In future sessions, relaxation is deepened and additional suggestions are imparted to develop the mind set and mental attitude most helpful for increasing confidence and decreasing worry and fear.

Hypnosis sessions are recorded to allow clients to practice on their own and to deepen the effects of the session between each visit.

Dr.Robert Heller, a former school psychologist and approved clinical consultant in hypnosis provides clients with the skills to unleash their best and perform up to their potential. Located in Boca Raton, psychologist, Dr. Robert Heller works with individuals of all ages to reduce worry and nervousness and increase relaxation and confidence.