cognitive behavioral 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.

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.

How to Get the Most Out of Therapy

Common questions I hear about therapy:

Where to start and how to know what you talk about?

In short, start anywhere! Talk about anything!

Most therapists will somewhat guide the first few sessions. They’ll likely ask what motivated you to start therapy, what your present concerns are, and go from there. I love to get a life timeline from new clients so I can get a sense of you in context of your whole life, while other therapists focus more on what’s happening in the present/near past.

One of my mottos in therapy is that “everything is everything” so anywhere you start will get you somewhere useful. Usually the most important thing will bubble up if you just start talking.

How do I open up if I’m not used to being vulnerable with people?

Therapy does require some vulnerability and openness. You’re going to have to talk about yourself. If this isn’t something you’re used to doing, that’s okay! There are some clients who come to therapy ready to talk and spend the whole session filled with words. Others are more reserved or more quiet in session. If this is you, your therapist will sense this and likely ask you more questions. You might also tell your therapist that you have a hard time opening up, and ask them to direct the process a little bit more until you become more comfortable. It can take time to build up the trust needed to be vulnerable and open with your therapist, and this is totally okay. Take your time, we have to earn your trust.

What if I have a challenge between sessions but feel fine on the day of my session?

This is so common! A few thoughts:

-bring up the challenge anyway. Often, it can be useful to explore an issue when it’s “cold” rather than “hot” because you have a different or clearer perspective.

-bring up something that you don’t usually get to talk about. Therapy isn’t always about day to day struggles, it can also be about processing the past, exploring an aspect of your identity, etc. So if you come into therapy on a good day, you and your therapist can brainstorm about things you’ve pinned in the past that might be useful to dig around. Sometimes these end up being the BEST sessions.


Other tips that will help you get the most out of the therapy process:

Do your homework! I almost always give something to my clients to do between sessions--whether it's reflect on something, journal about something, or try something new. The clients who get the most out of the process are the ones who actively do their homework. Remember--the therapy hour is only 1 of 168 hours in a week. If you want change to happen, you have to apply the therapy work in the other 167 hours!

Be honest and specific with your therapist. It can be difficult to work on an issue if we are constantly talking about it only a conceptual level. Bring in specific examples where this issue showed up, how you were feeling, what you were thinking about, what triggered that emotion, etc. As you build awareness in therapy, this will get easier. It can be helpful to make notes between sessions and come into your session with a few things you'd like to talk about.

Tell your therapist what is and isn't working. Give feedback! This process is FOR YOU, so if something isn't working, if you want to do more of something else, if you're upset at your therapist, say something! This feedback is hugely helpful for you and your therapist to make sure the process is tailored to you.

Take an experimental, curious attitude. Try something before you say "this won't work for me". See how it fits! If something doesn't work well for you, examine with your therapist what didn't work about it. Even when tools don't work, that's great information for the therapy process. Being specific about what you tried, when, and how it felt can help you and your therapist hone in on the tools that WILL work for you!

Be patient and kind with yourself. Shame gets in the way of each of the recommendations above. Give yourself credit for showing up for yourself, for taking care of yourself, and for doing what you can to make changes. Ask your therapist what changes they're seeing in you--often they might see things that you don't. Make time to give yourself kudos for doing the damn thing!

Want more? I answer these questions in more detail, and other questions on the podcast! Access the Toni Talks Therapy podcast anywhere you get your podcasts!

5 Ways to Cultivate Self-Love

Self-love is a game-changer.⁠ Your life radically changes when you start to care for yourself the way you care for those around you. And love is a verb, it comes through actions. You cultivate self-love when you show up for yourself, consistently and with compassion. It takes practice.

What I’ve noticed over time, is that the belief “I am unloveable” begins to shift to a belief that “I am loveable” when people consistently treat themselves as if the latter is true, even when it doesn’t feel that way.

I don't buy the bullshit that says "no one will love you until you love yourself"...because it's just not true. You will still be loved even if you don't love yourself, but that love will be harder to accept and savor. You might find yourself pushing love away, fearing that people will leave you or “find you out”. When you practice loving yourself, you’re more able to be present with the love other people are showing you.

Self-love can come in a lot of forms, but these are five tried and true ways that I know help develop self-love:⁠

1) 🖤Stop judging others.

What you're judging in them is something you reject about yourself, or it's just plain mean and feeding into focusing on the negative about yourself. Stop judging others and notice how much easier it is to be kind to yourself and feel connected in any situation.⁠ This is a practice I adopted several years ago, and it made massive shifts in how I looked at other people and myself.

2) 🕵️‍♀️Observe your inner critic.

Notice the mean shit she's saying to you daily! Would you say that to your best friend? Are those shame-y thoughts helping you get anywhere? NO.⁠

3) 💥Challenge those statements with something that is true, kind AND useful.

Yes, all three. True (because maybe you did fuck that thing up), but how can you say it in a way that is KIND and USEFUL at the same time? Not "you're such a failure, you really messed that up", but instead "that didn't go well, you made a few mistakes, here's how you can do better next time/learn from this". Way kinder.⁠

4) ❓Ask, "what do I feel right now?"

Isn't this how we so often show people we care? We want to know how they're feeling and what's going on in their lives. Get curious about your own experience, without so much judgement. It's amazing what can change just through asking yourself "what do I feel right now?⁠

5) 🌮Ask "what do I really need?"...and give that to yourself!

This is another way we show that we care. We support our loved ones, we try to meet their (reasonable) needs, we do what we can to SHOW UP for them.⁠

How can you show up and show love for yourself today??

Want to show yourself love by giving yourself the gift of therapy? Click here to schedule your complimentary consultation.