acceptance and committment therapy

How Riverbank Therapy Got Its Name

by Founder, Toni Aswegan, LMHC, NCC

It is surprisingly difficult to name a therapy practice. When I started Riverbank Therapy, I knew I wanted to expand into a group practice and so I did not want to name it “Toni Aswegan Therapy”. That makes no sense if other therapists would also be working in the practice in the future (which, they are! This team is kickass). I wanted to find a name for the practice that would be encompassing of all sizes of the practice, and that reflected the type of work we do here.

I also didn’t want it to be cheesy AF.

My partner and I sat at dinner for a month throwing words back and forth:

“Rise”…

“Thrive”…

”Evolve”…

all the words you might associate with the therapy process.

Also, all words that felt meaningless and corny to me (no shade at practices with these names, they just don’t feel authentic to me or how I practice therapy).

So, in a last ditch effort to find a good name, I went to my trusty bookshelf. I read voraciously, especially books about therapy, human development, mindfulness, and emotions. I keep all of the books I’ve read related to my work on my office bookshelf, and often reference my notes and highlights in those books.

In the search for a name, I pulled down the books that had the biggest impact on my therapy style and my own personal growth.

Books like the Body Keeps the Score, Trauma Stewardship, and, Wherever You Go, There You Are.

I started flipping through pages, and reading the excerpts I had underlined.

In writing this blog post I went back through several of those books to find the exact quote that inspired me, but alas, I could not find it again! It must have truly been kismet that I found it once and not again.

 In any case, one of the underlined sections described mindfulness practice as sitting on the banks of a river, watching the current go by, carrying sticks and leaves with it, but staying grounded and steady on the riverbank.

It was perfect. Riverbank Therapy.

As a long time meditator, and a therapist who brings mindfulness practices into sessions with clients, this was it. A metaphor for being present, observing, and not being swept up by the currents. Not only is that what I do as a therapist, it’s what I support my clients in learning how to do with their own emotions, and is much of the magic of the therapy process.

Not to mention, “Riverbank” didn’t sound cheesy to me. A win all around.

So, there you have it! Riverbank Therapy. Mindfulness, grounded-ness, presence.

If you want to work with one of our therapists, head to our contact form and we’ll get your free 20 minute consultation scheduled. Like I said, we have a RAD team of therapists here, and our intake coordinator can help you find the best fit.

5 Tools to Deal with Avoidance

By: Abby Lombardo, LMFT

An issue cropping up a lot in my work with folks in this season of the pandemic is avoidance.

Not wanting to do something, procrastinating on this thing, stressing over that thing, completely forgetting the other thing, until we are back at the beginning or something bad happens…like…a consequence for not getting this something done on time or …at all.

I’m not only talking about avoidance that shows up in our work or because of our daunting, never-ending to-do lists, but also the avoidance that results from wanting to push away emotional discomfort. Sometimes the two are deeply linked, more than we often think. This post will give you some tools for when it’s time to look yourself in the mirror and face what you’ve been avoiding, whatever that may be.

Here are some ideas inspired by my work with clients on the topic of avoidance:

1)      Explore what contributes to your desire to avoid.

It might be ironic, that in order to help your avoidance, you must stop avoiding the reason you are avoiding in the first place. Avoidance is often a coping skill, a strategy we use in the face of overwhelm, threat, insecurity, perfectionism, pressure, fear, etc.

It might be helpful to break down your experience to the simplest feeling word you can find. For example, I am afraid of what my boss will think of me if I send this email with an error. Therefore, I am avoiding sending this email until it feels perfect. Once you whittle it down to a basic emotion, it’s a bit easier to deal with than the layers and layers your thoughts and feelings about your feelings have added or even distracted from your original experience.

Discomfort is a common reason I’ve found amongst by own clients for why they avoid certain situations or tasks or conversations. The icky feeling they get deep down that something is not okay can often be a trigger for our nervous system’s stress response: fight, flight, flee, even fawn (neutralizing a threat by befriending it). When we avoid, we are often fleeing to get away from a stressor or threat. Our ancient evolutionary biological systems cannot often distinguish a true threat to our survival from a stressful experience.

For the average person in 2022, our day-to-day modern-day stressors do not usually include life or death situations. They mostly include chronic stressors that have to do with our jobs, our relationships, or our sense of self. If we can pinpoint how our avoidance is trying to serve us, as in, get us as far away from our stressor as possible, then we can learn to relabel these threats and recalibrate our response system. We can learn to soothe our nervous systems with mindful movement or self-care, teaching our brains that this task will not hurt me, this person’s opinion of me may sting yet it does not change who I am, this conversation is challenging, yet it is survivable.

 

Try asking yourself:

What am I truly avoiding?

Why am I avoiding that thing?

How is avoidance trying to serve me? Am I fleeing because my nervous system is activated and stressed?

Am I avoiding something because it makes me feel uncomfortable? Or another emotion?

What can I do with that emotion instead of avoiding it?

How can I soothe, self-care, or move my body to remind it I am safe and okay even if I am uncomfortable or stressed?

 

2)      Create a simulation in your mind.

This idea comes from the practice of exposure therapy for anxieties and phobias, as well as trauma. The idea is that you practice simulating in your mind the very thing you have a strong avoidance towards. If you are avoiding household chores that have gone neglected too long, you might imagine yourself taking the first step to get up and collect all the dishes to place them in the kitchen or collecting all the laundry needing to be done. The idea is that step-by-step your brain is getting used to the very thing it has been blocking out via avoidance.

The simulations work two-fold, 1) your brain literally practices the task even in your imagination, which makes it a bit easier to do the task in real life and helps you anticipate some difficulties you might have along the way 2) you are breaking down tasks into accessible steps, which makes the whole thing a little less daunting by the time you actually decide to approach the task in real life.

3)      Break down tasks

When we are overwhelmed, it is usually because we are feeling many things about one or several other things at the same time. My clients who live with ADD/ADHD have to make common use of the skill of breaking down tasks in order to make tasks more accessible to their brains. A helpful question my clients and I have landed on: What is the most accessible thing I can do right now that could help? Then do that. Doesn’t matter how small or ridiculous. For some, it’s standing up, collecting necessary materials, opening the computer, starting the document/email, writing down next steps…

4)      Color code tasks

Along with this idea of breaking down tasks, it can be helpful to have a system to code tasks or steps of tasks into green, yellow, red. Green, accessible now. Yellow, it’s doable but maybe a bit challenging for one reason or another. Red, feels very challenging at the moment. The idea is to start with the green tasks to build momentum and confidence. Then, if you still don’t feel up to the yellow or red tasks at a later time, you can learn to further break those down into green-coded tasks until those tasks feel more accessible.

5)      Organize/prioritize tasks

Great! You’ve learned why you’re avoiding something; you’ve imagined in your mind how to do the thing; you have the accessible steps all listed out. But wait, you have about 10 other tasks you need to repeat this process for, where do you even start in tackling them all? In comes the skill for organizing and prioritizing tasks. For my folks with ADD/ADHD, this is an important skill to learn to externally structure what their pre-frontal cortex (the area of executive functioning) does not. It is important to find a system that works and is intuitive for you, if you don’t like the process or the system you’re using, you won’t use it. Ultimately, find a system that helps you lay out everything you’re expecting of yourself to be done so you can catch early if it is an unrealistic expectation and also so you can prioritize which tasks to do first or in order. Think big picture first, then move into the details of each task once you’ve identified it as a task worth working on at this moment in time. Too often, we get sucked into the minutiae of the tasks that we forget to gain perspective on is this really what I need to be working on right now?

For my visual and tactile clients, I often suggest the use of a dry-erase board or sticky notes. Writing out your items for the day and then placing the one you are currently working on in the center of your workspace/visual field as a practical way to manage focus and keep up with real time prioritization. The other sticky notes can be swapped out at any time to be your “main focus sticky note,” so it is flexible often like our attention and daily demands. Steps can be written on the front of the sticky note or on the back to help with traction towards a bigger item or goal.

Don’t forget a done pile! I encourage clients to have a moment of celebrating the doneness of a task, before skipping right to the next thing. This is an opportunity to “complete the stress cycle” by saying to yourself: you know that thing I was wildly stressed about before? I did what it took to complete this task. Yay me! I did it! It is an opportunity to build confidence and competence for future challenges, as well.

 

I hope this practical guide for how to work with your own avoidance feels accessible and applicable to what you find yourself avoiding, if not, stay tuned for Part 2 of this post. Remember that you’re in good company, which is why I felt inclined to write this post in the first place!

Take a moment to also remind yourself that you’re doing the best you can with what you’ve got at this moment in time. If you feel that you might need more personalized help with your avoidance or notice your avoidance significantly impacting your functioning in different areas of your life: work, school, home, relationships, etc., then reach out to us and we will match you with a therapist available to help you address your avoidance more specifically.

10 Things to Stop and Start Doing to Become the Main Character In Your Life

By: Abby Lombardo, LMFT

What is Main Character Energy?

It’s the Gen Z term for being the protagonist of your own life, the hero of your own story.

So many of my clients are learning how to channel their Main Character Energy right now, which inspired me to share what I’ve been working on with them:

 

10 Things to STOP & START doing to become the main character in your own life

 

Stop comparing.

To be the main character in your own life is going to require you to start seeing yourself this way. You aren’t the sidekick, the background character, the cameo appearance. This. Is. Your. Life. Start showing up to it without always trying to find someone who is wealthier, more attractive, more talented (all the things white supremacy, diet culture, patriarchy and capitalism tell us to value). There will always be someone who has more (and less) than you. They get to be the main characters of their stories, and guess what, you still get to be the main character of yours with all of your strengths and your flaws, too. Stop putting other people on a pedestal above you. We are all human, all equals. We all deal with shit, just different kinds of it.

 

Start listening to your own wants, needs, boundaries.

An excellent way to stop comparing is to start being curious about yourself instead: your preferences, likes, dislikes, things that make you smile, things that make you feel cozy and comforted, things that excite you, things that challenge you.

Focus on getting to know what needs you have that are unmet: Do you need more connection? More hobbies & interests? Comfort? A bed-time routine? More manageable goals?

When you spend the time to relate to yourself listening for what makes you happy, it’s much easier to cheer on others going after their joy, too. And here is where boundaries come in—for protecting your joy. When things and people threaten your safety, your emotional energy, your time, anything of yours really—it’s time to consider placing a boundary – saying: here’s where you stop & start and here’s where I stop & start. I’m only responsible for me.

The simplest form of a boundary: saying no. Try it with me. Out loud. I’m serious. No. No. No no no no. Nooo. NOOOOOO. NO. Where do you need to say no in your life? Where do you really want to say it, but aren’t? Why not? What’s stopping you? And is that a good enough reason?

Main characters are interesting because they have something unique to them that they own. They explore who they are through the arcs of their plotlines. They have wants, needs, dreams, goals, motivations. They aren’t everyone’s doormat. They aren’t formless blobs of people, they have spunk or wit or quirks. Get to know yourself as a main character does.

 

Stop people pleasing.

I once heard that people pleasing is a form of control (Dr. Nicole LePera). We want to control other people’s perceptions of us. We want to be what they expect, want, and need us to be so we can be liked and accepted. This is not Main Character Energy.

 

Start doing your inner work.

We need to take a step back and examine this need for control, this need to be liked, this need to be needed.

Where does it come from?

When did I learn this?

How did/does this serve me?

What am I truly afraid of happening if I am not in control, liked, or needed?         

These are usually the youngest parts of ourselves that we try to protect most because we feel the most vulnerable there, in our soft spots: the spot deep in my core that holds on to the fear that I’m unlovable, bad, unworthy, undesirable, etc. Main characters of all kinds have this vulnerable human quality, too. So what do we do with that part once we acknowledge it? See below on how to offer more kindness, compassion, and acceptance. Truthfully, this is hard work. Being honest enough with our selves, the parts we hide the most shame, the most fear, the most pain is not easy. Remember, you do not have to do this work alone. These are typical conversations that come up in therapy and can be supportive if you find value in working through things like this.

 

Stop criticizing and judging.

Criticizing and judging others often means you turn that on yourself 100-fold. Some of my clients believe that if they aren’t criticizing themselves or judging themselves then they can’t learn or grow. Some think that if they preempt others and point out their own flaws first, then no one can hurt them or embarrass them or shame them first. Sometimes, we learn from our role models what it’s like to pore over your every blemish and flaw, your every mistake and not let up. Main characters do not criticize themselves into a black hole, they learn what they need to learn, trust themselves to make the change, and move forward with their newfound learning and confidence. Cut back on the amount your cutting yourself (and others) down.

 

Start offering kindness and compassion.

You’ve probably heard it a few times by now across various platforms: be kind to yourself. Give yourself some compassion. Hear me now, again: Be kind to yourself. Give yourself some compassion. What we know of main characters: they get into some kind of conflict, they have some sort of trial they work through it internally or otherwise to complete their story arc and learn the lesson, mend the relationship, meet the goal, accomplish the mission, etc. See the bigger story at play here. You’re in a moment of trial, conflict, pain – you do not need to add more. You do not need to motivate yourself with shame and judgment and criticism. So what does kindness and compassion actually look like? Say some of these out loud and see if any of them feel good to you:

Wow, I’m dealing with a lot.

This is really hard.

This sucks.

It makes sense that I feel this way (because…)

I need comfort right now (finds way to give self comfort).

I’m going to take a break from this right now.

I’m struggling. It’s okay to ask for help.

I have it in me to do this.

 

Pro tip: Speak to yourself using a pet name (honey, hun, darling, love, sugar…). My personal favorite is “babe”. It is unusually challenging to be mean to yourself when using a term of endearment while talking to yourself or your body.

 

Stop trying to be perfect.

Listen to me, it’s a trap. It really is. As a recovering perfectionist, I feel especially strongly about addressing the white supremacist and societal expectation of perfection that permeates everything we hear from buy this, wear this, do this in order to be perfect, liked, desirable, successful, loved, accepted, etc…. The truth is that we do not need to be perfect to be all these things (and more). The truth is that we can’t be perfect. It’s not in our DNA. All we can be is human; all we can be is ourselves. The sooner we learn this, the freer we are to actually come to understand and pursue the things that are of value to us and connect us to each other. Besides, a perfect main character is so boring because they have nothing that makes them interesting or human.

 

Start being vulnerable.

Humans find connection through vulnerability. It’s really, really hard to be vulnerable when you’re trying to be perfect. In fact, vulnerability makes for a great antidote to perfectionism. This needs saying: you do not need to be vulnerable all the time, nor should you be vulnerable with everyone. Once you discern that it is the appropriate time and place to take some light risk, then please do share more of yourself, talk about something that’s difficult for you, ask for help, or the like. And then pay attention to the response you get from that person…how do they respond? Do you feel more connected to this person? Do they feel more connected to you? Did they respond by sharing something, too? With support? Or judgment? Then decide from there whether the risk of more vulnerability is called for or not in that moment. Vulnerability is hard, it’s messy. It can also be deeply rewarding and freeing. When we let people see us as the whole person we are, we learn to accept those hard parts of ourselves, too. The best main characters know how to find meaningful connection by being vulnerable and when to hold good boundaries and not be vulnerable.

 

Stop trying to be “normal”.

Normal is a social construct. It’s established by those in power of what this “good standard of human” or “the good life” looks like. In reality, the diversity and differences within our species is too vast to come up with such a model of average/normal. I encourage you to truly examine your assumptions and definitions around a “normal” person or life or experience. Maybe you wish you weren’t neuro-diverse, that you didn’t have to struggle with mental health issues, that your relationships weren’t broken, that you weren’t living paycheck to paycheck… These are not small things to wrestle with. This is what it means to be human. To be alive, to be messy, to experience suffering --to live in a system that does not serve, value, or treat everyone equally. The issue is not you; it’s the idea that there is a “normal” that you do not live up to. With any perceived “deviation” from the “norm” (or what we’re sold as the norm) comes grief, the sadness and anger over the loss of expectation that it should be different. I should be different. When we get stuck here, there’s not much we can do but rail against ourselves and a system not made for us. A true main character journeys through this grief, anger, denial to hopefully find meaning and acceptance.

 

Start accepting who you are.

Take stock of yourself. Honestly. Truly. What are your growth areas, your strengths, your interests, talents, hopes, dreams, flaws, issues, the things that make you you or make you human. Then, own your shit. Own it all. All the socially acceptable, good parts along with the bad and the ugly.

You’re not perfect.

You may not be “normal.”

But finally, finally, you can arrive at just being. If you try to fight reality, you will always lose.

You’re human.

You’re you.

Find your way to this acceptance as often as you can, for it is not a destination, something we arrive at once and done; it’s a journey, mixed in with all the aforementioned grief, loss, denial, anger, anxiety, and pain. Own that this is your journey and do with it what you can with what you’ve got. And remember, you’re unique, but you’re not alone. This is what it means to be alive. To be the main character of your own story, a story you own.

If you want to learn more about how to apply these concepts specifically in your life, reach out to schedule with one of our therapists!

4 Steps to Better Sleep

by Sara Laurino, LICSWA

A consistent bedtime routine is an act of self appreciation and gratitude.

“Healthy sleep habits” as a buzzword has been floating around for years now. Today we’ll break down what this phrase actually means for you, in your life and your bed.

Good sleep isn’t just about what happens when you close your eyes-- healthy, good, sleep is a way of treating ourselves kindly, and genuinely spending time with ourselves before our eyes close. The suggestions here take about 30 minutes after you’re done with your evening, before you close your eyes.

Just like we receive signals from our environment and our body that it is time to eat a meal, or have sex, we receive signals that it is time to go to bed.

Have you ever been walking down the street as a strong, delicious scent from a nearby restaurant wafts your way? When this happens, you may notice that you feel hungry when you weren’t a few minutes ago. This scent of cooking food is an environmental cue that allows you to notice your hunger. The rumbling in your stomach that follows is a bodily cue that it is time to eat.

Same goes for sexual interactions! Touching, verbal cues like flirting and consistent eye contact are all cues to your body that it can begin to get aroused. Once your body has received the environmental cue, you will probably notice your heart beating faster, perhaps you are breathing a little faster too-- those are cues that your body is ready to be sexually stimulated.

We need the same environmental and body cues to know it is time to go to bed.

OK, so how do actually I do that?

Step 1: Spend some time with yourself directly before going to bed. (15 minutes)

This one can be a little tricky… because if I was on the couch watching Great British Baking show alone (ahem, yes, that is me) and then I feel ready to go to bed…. wasn’t I just spending time “with myself”?

No. Spending time alone and spending time with ourselves are different acts. Spending time with yourself is active time that you are engaged and noticing what is happening around you, QT (quality time) with you!

This is a time before bed that your phone/ iPad/ computer/ TV isn’t invited to. Plug it in, lay it facedown on a surface, put it in a drawer…. This is time for you + you.

After you put your screens away and before you get into bed, I recommend fifteen minutes of spending time with yourself.

Some ways that this might look:

A warm shower/ bath with your favorite scented soap

Cup of hot tea on the couch, or at the kitchen table with the lights turned low

A walk around the block where you notice that interesting tree, or how your neighbor’s beautiful purple house looks different at this time of night.

Teeth brushing/ face washing

Petting/ cuddling with a dog/ cat/ pet

Doing a low key/ low stakes task around the house, like watering the plants, putting away clean dishes

Any combination of the above!

Step two: Getting ready to directly enter your bed (5 minutes)

Now that you have spent a little screen-free time with yourself, its time to actually get into bed! Rituals are very helpful here as our bodies love and thrive on routines, and knowing what to expect.

These are Rituals that invite all your sense doors to the bed time experience. Feel free to mix and match them based on your home/ your preferences/ what feels right!

Tactile

A shirt/ pajamas specifically for sleeping.

Something soft and cozy, that you put on while you’re getting ready for bed. (different from your couch/ lounge wear)

Touch & Smell

Lotion/ moisturizer you put on after face washing/ teeth brushing.

The act of touching your own face/ body gently and lovingly signals to your nervous system that its ok to settle. Your olfactory sense (smell) will also notice the scent of the lotion and give your body the permission to begin to relax

Essential oils you gently rub between your palms, on your neck, and across your brow to massage your skin and soothe yourself

Auditory (hearing)

White noise machine

This goes allllll the way back to our time in utero, where our mothers digestive tracts, blood flow and internal organs made all sorts of sounds that soothed us. White noise machines are a really wonderful way to auditorily signal to your body to settle down for sleep

Visual

Low light/ night light/ salt lamp/ lava lamp

Turning this special light on while you get ready for bed is a way for your eyes/ visual sense to understand that bed time is approaching

Step three: Spending time in bed before you close your eyes. (10-15 minutes)

This is an opportunity for our bodies to settle into the reality that we will be going to sleep soon. Just like smelling that delicious scent as we walk down the street and noticing we’re hungry, this is our bodies time to notice that we are calmer, we are settled, we are here. In our bed.

Ideas of how to spend this time:

Journaling: Freewriting (writing whatever comes to mind) is great! A simple prompt to use day after day is: three things I feel gratitude for right now

Reading: Choose something you want to read, and enjoy reading! Usually this means a fictional book, as stories are easier to read at bedtime that facts in a nonfiction book

Give yourself permission to re-read a paragraph or a page! It’s ok if your thoughts wander.

Choose a small number of pages to read, like 5.

Doing nothing (with the light on)

Yep, you read that right. I’m talking about staring at the ceiling nothing. Why? Because your mind might have more thoughts it wants to think through before you settle down for bed. Doing this with the light on allows it to be a self-reflective practice. If your thoughts get the time they are asking from you before you turn out the light, they are less likely to pop up when it’s actual sleep time.

Step four: Lights out, eyes closed

You did it! You put yourself to bed! Congratulations, because this is not an easy task. It is a real choice to give yourself and your body the time and attention before bed that leads to deeper and more restful sleep during the night.

It can be very helpful to have a calming practice (yep, bedtime is allll about calm) once your eyes are closed but you’re still awake.

Breathing 4 seconds in and 4 seconds out

This might include a hand on your heart, or belly, and actively counting to 4 as you inhale and counting to 4 as you exhale. If a thought creeps in and distracts you, no problem, come back to counting when you notice you’ve left

Toe to head body scan

Begin in your toes and really allow yourself to notice feeling/ sensation in your toes. Is there a tingling? Pulsing? Spend a moment here, then move your awareness into your foot. Slowly move up your body, inch by inch, noticing sensations. Again, if your mind wanders, thats normal and OK! Bring your awareness back to wherever you were when you got distracted

Counting backwards from 100 … slowly

Focus on each number and slowly count backwards from 100. Make it to zero? Start again, and again, and again, as needed

Sleep FAQ’s:

What do I do if I wake up in the middle of the night?!

Acknowledge it! It is normal and natural to wake up sometimes. This might mean putting your hand on your heart and quietly saying “it’s ok” to yourself. I also like to imagine a big funnel beneath my body, allowing all the extra energy I have to spill into the funnel and down into the earth. Any imagery you like can be used here. If/when you wake up, being kind to yourself about it will allow sleep to return more easily.

Is it OK to have my phone next to my bed?

I find it really really helpful to have an alarm clock that isn’t my phone. This means I am able to touch/ look at/ interact with my alarm clock both before bed and when I wake up without the pull of looking at my phone. Even if you need your phone next to your bed for on-call/ emergency purposes, I recommend having it face down, and not using it as your alarm clock.

Read more about sleep tips HERE

This practice is just that, a practice. It takes time to figure out what feels right for you, and how your body best responds to calming down after a long day. Over time, this can develop into a lovely self care ritual you look forward to at the end of every day! Happy sleeping!

Your Guide to Starting Therapy

by Abby Lombardo, LMFT

It’s daunting.

I get it.

Yes, I, too, have had to search for a therapist (therapists seeing therapists who see therapists, it’s a thing) and have just stared blankly at my screen hoping the right someone would fall into my inbox.

In this way, searching for a therapist is like dating: you’re basically courting someone to see if they are trustworthy and make you feel comfortable enough to tell all of your vulnerabilities and still feel accepted by them.

 Actually, it’s a lot like dating.

 It’s also like searching for an apartment or a place to live, you might not know it’s a good fit until you try it out, step into the space, spend some time there…to know if it is a good fit or not for what you’re needing.

That’s the important part: try to focus on what YOUR needs are at THIS time in your life and the kind of person/professional you’re looking to help support your journey.

 

To aid in this purpose, I’ve devised a “Searching for a Therapist Cheat Sheet” that outlines common words, phrases, acronyms, and questions to help guide your search. It can help to feel informed and oriented to the search process, so that you can focus more on what the professional has to offer YOU.

Ideally, this information is best used in a consult with a provider. A consult is usually a free 15-30 minute meeting (over the phone or virtual) to assess whether you’d like to work together and schedule your first appointment. If the provider’s website or profile page doesn’t advertise that they do consults, don’t be afraid to ask!

 

Let’s get started with common therapy words used in the search for a therapist, that might not be so intuitive or self-explanatory.

 

7 Common Therapy Search Words:

1.      Specialty: this is something a professional has added training, experience, and interest in. Usually this includes some kind of certificate, training, and additional letters after their name. It is also probably the clients they have seen and want to see. Pay attention to these, they can be a helpful way to filter through who you might want to work with on a certain issue or topic.

2.      Modality: this is a bit different than specialty in that it refers to the way a therapist conducts treatment, or, how they do therapy. Modalities are therapeutic frameworks, lenses, theories that often guide the professional’s way of doing things in session. See more in the Acronyms section for the names of several common modalities to know about.

*The cool thing? Research shows that it’s not necessarily the modality that brings success in therapy, but the relationship you have with your therapist! So, modality does not make or break unless it leads to you not vibing with your therapist!

3.      Intake: the term for the 1st session. Intake sessions are usually billed at a higher rate than normal sessions as they are used traditionally for assessment, onboarding, orientation, and paperwork. Intake sessions vary from therapist to therapist. Some have you, the client, talk about why you’re coming to therapy and what the issues are you’re experiencing. Some will ask for your family information to get more context. Some will go through a timeline with you of different experiences you had while growing up. Mostly though, they’ll all discuss confidentiality and privacy with you, as well as the exceptions and you will probably be asked about why you’re coming to therapy, what your goals are, and how the therapist can support you.

4.      Scope of practice: this is a lot like specialty and modality in that it is WHAT a professional provider can OFFER you in terms of services. For example, a marriage and family therapist (LMFT) cannot prescribe medications, it is legally and ethically outside of their scope of practice. Make sure you are looking for a provider who can offer you the services you are actually looking for.

5.      Somatic-focused: this term refers to anything body-related. Somatic techniques and modalities often help you learn to work with and regulate the systems of the body: the “flight, fight, freeze” system and the calm/rest/soothe system (for example). A somatic-focused therapist might ask you: “Where do you feel that in your body; can you describe it?” If this feels daunting, they are there to help you every step of the way. They see the body as a source of wisdom and connection. They also see the body as the #1 place that we store all of our emotion, trauma, energy, and pain. There’s a lot you can work with somatically that you might not be able to through talking.

6.      Attachment-based: this refers to a general modality/theory of therapy that examines and explores the way you relate to people and things. Attachment begins when we are infants, depending on caregivers to provide us with what we need to sustain life and be nourished. How we attach/ed to our caregivers can have a lot of sway over how we relate to significant others and even friends. This modality is incredibly informational and slightly Freudian, and most therapists have training in this, though some zoom in and use only an attachment-based lens as their main modality or get extra training in it.

7.      Mindfulness-based: this refers to a therapist who uses present-focused, attention-centering techniques in the therapy session or for the client’s homework to engage the client more mindfully with the here and now, whether that be with your breath or with the uncomfortable, restless feeling you are having. Mindfulness has many, many amazing benefits and can really help with anxiety, mood, and attention issues.

 

9 Common Therapy Acronyms (in alphabetical order!):

1.      ACT: Acceptance and Commitment Therapy – teaches mindfulness-based coping tools for unwanted/negative thoughts and emotions, while focusing on identifying client’s values and moving towards goals based in the client’s values.

2.      CBT: Cognitive-Behavioral Therapy - probably the most common therapy acronym used these days; explores the connections of the 3 parts of the CBT Triangle: thoughts, emotions, behaviors and how they all interact with each other to build negative cycles and habits. Offers ways to interrupt negative/unwanted thought, emotion, or behavior sequences through practical changes and reframing. Most mental health professionals are trained in this type of therapy.

3.      CPT: Cognitive Processing Therapy – a common therapy for treating PTSD

4.      DBT: Dialectical Behavioral Therapy – a skills-based therapy that offers tools for many things including: self efficacy/assertion, emotion regulation, distress tolerance, receiving feedback, making a decision, etc. Great for someone who benefits from structured therapies.

5.      EFT: Emotionally-Focused Therapy – often for couples, this process-oriented therapy strives to find the vulnerable, intimate spots that we often try to protect out of fear or hurt and uses it to reconnect partners who are struggling.

6.      EMDR: Eye-Movement Desensitization and Reprocessing – this therapy is very cool. It is a somatic-based, trauma therapy that uses your body’s way of processing information to help you work through issues, sometimes without talking about them with the therapist. They teach a lot of coping strategies so that you feel ready for what comes up, too. Essentially, they use what you naturally do in REM sleep in session and utilize bilateral stimulation (sensation happening on 2 different sides of your body at different intervals). This is a therapy that I recommend for people who want to have tools and process their trauma without having to re-hash a timeline or go detail by detail with a therapist – or for someone who talk therapy just hasn’t helped much.

7.      IFS: Internal Family Systems – a family systems therapy that is also used with individuals in therapy to look at the different “parts” we all have within us that make us who we are and influence our behavior. For example, most clients have a “part of them” that wants change and a “part of them” that resists or is scared of change. IFS therapists work with these different parts in different ways to work towards client’s goals and self-integration.

8.      RO-DBT: Radically-Open Dialectical Behavior Therapy - this is a specialized therapy, that is derived from traditional DBT but geared more towards those that are over-controlled, think: perfectionist, Type-A people. This has been used successfully with those with eating disorders as well. RO-DBT is also a skills-based, structured therapy that teaches skills about emotional expression, social signaling, self-inquiry, personal effectiveness, boundaries, how to receive feedback, how to challenge rigidity in order to be more flexible, etc.

9.      SFBT: Solution-focused Brief Therapy – a strengths-based, post-modern approach that believes the client is the expert in the therapy room and the therapist is the guide to the client’s own wisdom about what has worked for them and what they want instead of the issues/problems they are experiencing now. Together, they build moments of “exceptions” to the problem and identify what success and solutions looks like for the client, sometimes without diving too deeply into the problem. “Brief” refers to length of treatment common for this type of therapy (~ less than 10 sessions, but not all SFBT providers limit their sessions to be this brief).

10.  TF-CBT: Trauma-focused Cognitive-Behavioral Therapy - this framework is therapy that guides the clinician and the client through trauma processing. Usually the therapy involves desensitizing oneself to one’s trauma story by sharing it with the clinician and reframing and reprocessing where necessary to work through an “old trauma story” and hopefully find a new story that helps the client integrate the events into their life while decreasing triggers and PTSD symptoms.

 

Questions to Ask Them (at first contact/consult):

1.      Do you take insurance/how much will this cost?

2.      What would a session with you look like?

3.      What experience do you have working with these issues/topics?

4.      How frequently will we meet/What determines the frequency of sessions?

5.      What are your specialties?

6.      What modalities do you use?

7.      What client do you work with best?

 

Questions to Ask Yourself (after first contact/consult):

1.      Did I feel comfortable talking to this person?

2.      Do I feel hopeful about working together?

3.      Did I feel heard and understood?

4.      Does it feel like a good fit for what I’m needing/wanting right now?

5.      Am I looking forward to my next session?

 

I hope you can use this cheat sheet to feel empowered in your search to find the a provider who is a good fit for what you are needing.

 

Trust yourself.

And if it turns out to not be such a good fit, you have the right to terminate treatment at any time! Remember, research shows it is the quality of the therapeutic relationship that determines overall therapeutic success.

 

Good luck out there! I’m cheering for you!

If you’re interested in scheduling a free consultation with one of Riverbank’s therapists, fill out the contact form here.