Problems and Issues Addressed in Therapy
Our clients range in age from 5 to 75 and come from all walks of life. All of our clients want to enhance their personal effectiveness at home and at work. They want to create a life they love and they understand that success requires focused effort and self-discipline. We believe everyone needs a PLAN. Acting much like coaches, we help our clients establish and implement plans to achieve their personal goals in the following 4 critical areas: (1) social skills and intimate relationships, (2) work, education & money management, (3) emotional and physical health and (4) recreation. We emphasize the importance of “seeing the bigger picture”, setting priorities, being disciplined and focused, making smart decisions and difficult choices, avoiding destructive temptations that are incompatible with your goals, thinking positively and rationally, and taking action that is consistent with your stated objectives.
When working with patients, we routinely include the following:
- Positive, Rational Thinking is essential for success in life. Positive thinking enables us to maintain hope and optimism, and to perform at peak levels, achieve results beyond the predictable, and maintain loving relationships. Depression (including normal grief) and Anxiety are often precipitated by a variety of stressors, obstacles and losses that may lead individuals to conclude they are unlovable, failures, unattractive, unlikely to find happiness and fulfillment, etc. Our objective is to help our clients replace such pessimistic, self-critical views with more positive, affirming thoughts.
- Self-esteem and Confidence Building. It is of central importance that we each accept ourselves fully, building on our strengths, while recognizing our limitations. Despite significant achievements and outward appearances to the contrary, many individuals secretly harbor the irrational belief that they are not quite good enough. Our objective is to help our clients learn how to think positively and rationally about themselves and others. These are essential skills for those who want to be happy and successful in their career and relationships.
- Responsible Assertion Training: transforms the meek, passive and fearful into confident, strong individuals who have the ability to handle most interpersonal conflicts, while preserving good relations and mutual respect in the process. Assertive communication can be elevated to an “art form” where an individual, with disciplined practice, can become progressively more skillful (in the same way that a martial arts student can progress from a green belt to a 9th degree black belt) at getting good results while maintaining good relationships with others. Assertive action is essential, and goes hand in hand with positive, rational thinking and effective communication.
- Stress Management is something that virtually everyone needs today to maintain emotional and physical well-being. Depression, anxiety, insomnia, irritability, alcohol and drug abuse and psychosomatic problems (irritable bowel, headaches, back pain, etc.) are often symptoms of stress. We work with clients to ensure that they are getting proper exercise, enjoying foods that are healthy as well as tasty, sleeping soundly, minimizing their use of alcohol, cigarettes and other drugs, and enjoying their play time.
Depression & Anxiety Disorders
Depression and Anxiety are the two most prevalent disorders treated at the CBT Center. Both are normal human emotions. However, for many individuals, depression and/or anxiety becomes so excessive that it gets in the way of life. Insomnia, irritability, alcohol and drug abuse and psychosomatic problems (irritable bowel, headaches, back pain, etc.) are often symptoms of depression and anxiety. Fortunately, CBT has been shown to be very effective in treating both anxiety and Depression.
- Smoldering Dissatisfactions and Unmet Needs: While a Mid-life Crisis may seem to erupt suddenly out of nowhere, there are usually longstanding, unresolved conflicts, unrealized expectations and failure to satisfy needs in one or more of the following areas: career, marital relationships, self-esteem, recreation, health and stress-management.
- Reframing the word “Crisis”: A Mid-Life “Crisis,” if addressed constructively, can be viewed as a Mid-Life “transition”, a healthy and desirable period for readjustment and re-evaluation. Counseling can be viewed as an “opportunity” to constructively address and resolve problems that had not been addressed or “successfully resolved” before. Such problems are likely crop up again in the future, possibly with destructive consequences, if they are not addressed earlier! Counseling provides an opportunity to address and resolve such problems, in a “safe, controlled environment.”
- Infidelity: is one of the more painful and obvious threats to marriage and family life. With the advent of the Internet and Facebook, porn addiction and affairs appear to be on the rise; and, with more women working out of the home, infidelity is nolonger a problem initiated solely by men. Affairs can result from any of the following causes: unhappiness resulting from long-term dissatisfaction with oneself or one’s marriage, poor communication and conflict-resolution skills, longstanding stress, unresolved mid-life crises, serious character flaws and the lack of a moral compass, or other psychiatric disorders (e.g., addictions, personality disorders, depression and bipolar disorder, etc.). Once an affair has been discovered, there is an understandable tendency to focus angrily on the affair as the “central” problem. While an affair, and the damages caused by an affair, must be addressed (and complete resolution may take a year or two), it is important to recognize that affairs are usually symptoms of other, underlying problems. An affair can be viewed as a personal disaster that scars one for life or as a “wake up call” to get much-needed professional help for problems that were previously ignored, unrecognized or ineffectively addressed. If destructive behaviors have not persisted too long, if both partners are sufficiently invested in the marriage, and if each partner is willing to address his or her individual issues, then there is every reason to be hopeful that a couple can survive an affair and can save their marriage.
- Spouses and Co-dependency. Spouses usually need considerable support and coaching on how to set limits assertively (read: firmly yet lovingly) in order to bring about necessary change, while preserving their own well-being and addressing their own insecurities. Initially, in most cases, the “offending” spouse is less motivated than the “injured” spouse to thoroughly address his or her individual issues, hoping that the “injured” spouse will simply forgive and forget. This is something that the injured spouse simply cannot do. While the “injured” spouse feels hurt, angry and betrayed, his or her insecurities, co-dependency and lack of assertive training may prevent him/her from finding, and maintaining over the longer term, the necessary between loving support and firm limit-setting. If lasting solutions are to be found, both partners need to be involved and committed to ongoing treatment (of 6-12 months duration, rather than a few crisis sessions) that addresses both individual and marital issues. Initially, both partners are highly motivated to find relief from pain, while they usually disagree as to who’s got the “problem” and how it should be solved. Unfortunately, this motivation to seek help often evaporates, after a few sessions reduce anxiety and inspire hope that all will be well. If couples are not well-prepared for what lies ahead and are not committed to continuing the hard work of therapy, they are likely to revert back to pre-existing habits/patterns.
Our practice focuses on the treatment of individual patients and sometimes this is facilitated by the participation of a spouse or other family member(s). In these cases, we include marital or family therapy as a component in the overall treatment of individual patients.
Insurance plans do not cover any type of therapy, unless there is an identified patient with a clinical diagnosis. For couples who want marital therapy only, and when there is no identified patient with a clinical diagnosis, we provide marital counseling on a self-pay basis. For these couples, we provide pre-marital and marital counseling, which may address the following areas:
- Premarital Counseling provides couples with information and specific skills. Areas reviewed include expectations of oneself and one’s partner, communication and problem solving skills, families of origin and childhood experiences that continue to shape behavior today; differences between women (Venus) and men (Mars), getting off to a good start with your in-laws; setting priorities; providing support and nurturance to your partner; balancing individual, career and family needs.
- Anger Management addresses conflict resolution and assertive communication skills; creative problem-solving and negotiation training; insecurities and inappropriate attempts to control one’s partner; co-dependency and low self-esteem; alcohol and substance abuse.
- Sexual Problems such as loss of desire, infidelity and performance difficulties are usually symptoms of emotional, relational and/or physiological problems. After taking a thorough history and recommending a medical evaluation from a physician, we will certainly want to address the following areas: expectations of oneself and one’s partner, unresolved relationship conflicts, feelings of rejection, poor body image and low self-esteem; inhibitions, depression, anxiety and performance concerns; internet porn and other compulsive behaviors.
- Effective Parenting requires a set of critical skills that are usually not taught in high school or college. All of us are challenged to bring out the best in our children, whether they are talented and gifted or exhibiting behavioral and emotional problems. Our approach emphasizes the consistent use of praise, affection and concrete rewards, while setting clear limits and imposing appropriate consequences. We also examine mixed and conflicting messages given by parents, the challenges of blended families and children with special needs.
- Financial Concerns resulting from unrecognized emotional problems, mismanagement of funds, conflicting priorities, compulsive spending and gambling are but a few threats to a couple’s financial well-being.
- Separation and Divorce is a choice of last resort. We encourage couples to exhaust every opportunity to save their marriages, before considering this drastic step. If divorce is the only solution, then steps can and should be taken to minimize hostilities, while preserving self-esteem and ensuring the children’s needs are met.
- Creating A Life You Love: I like to think of therapy as helping clients “Create A Life They Love”. A central focus of therapy is helping clients find passion and purpose in life, while maintaining BALANCE in work, relationships, recreation and health (emotional and physical). Have you heard the expression: “If you don’t love yourself, you cannot accept love from someone else”? If you do not love yourself and the life you are living, before you go looking for a life partner, you are unlikely to find the lasting satisfaction you seek in the arms of another. I help my clients create a life they love, as a foundation for happiness and success in life, by helping them create and implement a LIFE PLAN, to realize their goals in four critical areas: career, health (emotional and physical), recreation and relationships. I have had many single clients who are desperate to meet “someone special”. Meeting someone special is of great importance in creating a life you love, but placing too much emphasis on this objective, to the exlusion of the other three areas, creates a situation where the more desperate you feel and the harder you try, the more elusive that great relationship becomes. My focus on creating a life you love will give you a greater sense of control over your life, while placing the emphasis where it should be, on you making yourself happy, rather than on someone else, who you expect to satisfy all your needs.
- Intelligent Mate Selection: Selecting a life partner is one of the most important decisions anyone makes in his or her lifetime. Most human beings do not approach this decision slowly and systematically, building a foundation of friendship, with a rational focus on getting to know each other well enough to determine whether or not your partner is an ideal match for you. I believe you deserve the best and need to be realistic in your expectations. Therefore, I recommend that you approach mate selection with the same mind set you would approach any other important decision (e.g., purchasing a house, car, looking for a job, hiring an employee). You cannot make an intelligent decision without asking lots of questions. Of course, every question cannot be bluntly asked on the first date and you almost certainly will not get honest answers to all of your questions, but the more information you can gather, before being blinded by sex, the better you can answer the central question: “Is this person an ideal match for me?” If and when you come to the conclusion that the other person is not a good match, then you must communicate this in a kind and constructive manner. Too many people continue relationships long after they know these relationships are not what they really want. The other person may or may not continue to be a friend, but you are doing no-one a service to continue acting as if this is the “special person’ you are looking for if you know that he or she is not. There are many exceptions, complications and variations to these generalizations, of course we all know that we are not perfect and that there is not perfect partner waiting out there for us. We must be willing to address our own issues as well, which could may interfere with our ability to establish and/or maintain a healthy relationship. Unfortunately, too many individuals fail to go about mate selection in the way I’m recommending. Generally, (and this seems more true of men) physical attraction and animal chemistry leads too quickly to sex and the experience of “falling in love”…. way before either party knows much about the other person. Once a couple has had sex and “love is in the air”, it is much more difficult to think rationally about compatibility and it is much more difficult to see and address those waving red flags of incompatibility. It takes time, asking many questions, while you interact in many different situations, to really get to know your potential partner. Only after a prolonged period of time, sometimes after years of marriage, do most individuals clearly see things that could have been detected much earlier if they had asked the right questions.
- Self-esteem and Confidence Building: I believe that you deserve the best in life and in your relationships. It is of central importance that we each accept ourselves fully: building on our strengths, while fully recognizing our limitations. Despite many achievements and outward appearances, many people secretly harbor the irrational belief that they are not good enough. My objective is to help clients learn how to think positively and rationally about themselves and others.
- Social Anxiety and Formative Relationships: It may come as a surprise to you that most people have some degree of social anxiety, because we all tend to compensate for, hide, or manifest this anxiety in a variety of different ways. Some individuals are generally anxious, others have been shy all their lives and still others have fears and insecurities born out of past experiences. We all need to understand the powerful influence of formative relationships we have had with our parents and what we have learned about marriage and family life (good and bad) during those early years when we were living with MOM and DAD.
- Assertive Communication Skills Training helps clients express themselves fully and effectively, while respecting the rights of others; handle criticism and hostility from others, without becoming hostile or bitter in the process; ask for the things they want and say “no” if they do not wish to do something. Responsible assertive action and communication resides in that middle ground between hostility on the one hand and passivity on the other.
- Where and how to meet desirable members of the opposite sex: Are you attracted to the wrong kinds of men or women? Are you searching in all the wrong places, doing everything you can to meet someone, but turning up empty-handed and wondering why? You need Dr. Mulligan’s list of “Things to Look For In A Mate.” There are many new opportunites (and hazards) provided by some of the online dating services. However, in keeping with my overall emphasis on creating and maintaining a life you love, I urge my single clients to identify things they love doing, where they can also meet others. By engaging in these activities, my clients are having a good time, whether or not they meet that special person. I also recommend my clients be “friendly” toward others (using good judgement and being safe). This approach reduces the “pressure” on you and others, provides fun no matter what, and enables you to gradually widen your social network, as you make friends and get to know others with similar interests, in a more natural and relaxed setting. If there are sports or athletic activities that you really enjoy, this meets the above objectives, while also providing good physical exercise.
- Setting priorities: Being single today can be stressful, as you (1) cope with a bewildering array of temptations (internet porn, drugs and alcohol); (2) balance work, health, relationships and recreation; and(3) maintain your own standards and well-being while searching for a compatible partner.
Problems in Childhood and Adolescence
When treating children, parents are often involved in therapy sessions, particularly when the child is young or when behavior problems are the target of treatment. Children and teens face multiple challenges, and teaching children how to effectively cope with these challenges can reduce current symptoms and prevent a variety of symptoms and problems in the future. Child and adolescent behavior problems at home and school are a common source of referrals to mental health practitioners. Parenting practices that work well with typical children are often not effective for strong-willed and/or difficult children, who require a specialized set of parenting techniques. Therefore, treatment of children with behavior problems includes a large parenting component designed to equip parents with the skills necessary to reduce oppositional, defiant, disruptive, and/or aggressive behaviors.
Adulthood Problems Treated with CBT
Assertive Training; Grief counseling; Communication Skills; conflict resolution and problem-solving skills; Issues specific to women and men; Stress Management; Depression, ADD/ADHD, Bipolar Disorder; Retirement, Mid-Life Crises and other Life Transitions; Addictive, Compulsive and Self-destructive Behaviors; Low self-esteem, Dating, Relationship and Mate-Selection concerns; Career concerns and job-related stress; Anger Management.