Below you can find details about the clinical services I offer and my approach to treating anxiety, OCD and related issues.
Services Offered
Diagnostic Evaluation
The diagnostic evaluation is a comprehensive evaluation designed to identify the nature of the anxiety present, as well as any additional areas of difficulty that the child may be experiencing.
Evaluation for individuals under 18 years of age typically consists of parent and child interviews, as well as the completion of standardized questionnaires. For individuals over 18 years of age, parent or family involvement in the diagnostic evaluation is at the discretion of the patient.
Individual/Family Treatment
Based on the results of the diagnostic evaluation, recommendations may be made for individual or family-based treatment/therapy.
While therapy is typically conducted in 40- or 55-minute weekly sessions, treatment length and session frequency are tailored to the individual needs of the child, adolescent and/or family.
In the majority of child and adolescent cases, parent involvement in treatment is very important and strongly linked to progress. Parent-only sessions may occasionally be recommended.
After treatment, follow-up sessions are sometimes recommended in order to maintain the gains made and skills learned during therapy.
Parenting Consultation
At times, parents request 1:1 support around navigation of specific issues or situations. I provide one-time or recurring parenting consultation to parents looking to troubleshoot situations, prevent future issues, and improve family responses during tricky parenting moments. My expertise in both mental health and age-typical child development allows me to work with families on effective parenting strategies that help foster resilience in the face of adversity, tailored for each stage of cognitive, social and emotional development.
Professional Consultation
I provide consultation to psychologists and other health professionals on specific cases as well as in the use of Cognitive Behavioral Therapy and Exposure/Response Prevention for treatment of anxiety, OCD and related issues. Staff or teacher workshops and school consultation are also available. Please contact me for more information.
Training Clinic
I supervise advanced clinical psychology Ph.D. students in a clinical practicum that provides specialized training in evidence-based assessment and treatment of pediatric anxiety, OCD, and related issues. These graduate student clinicians work with me and provide clinical services under my supervision. If you are interested in learning more about the option of working with a student clinician, please contact me to discuss this option.
Approach to Treatment
Cognitive Behavioral Therapy (CBT)
My approach to treatment of anxiety, OCD and related disorders is based in Cognitive Behavioral Therapy, or CBT. This type of therapy is one of the most widely used evidence-based treatment approaches and emphasizes the link between our thoughts, our feelings, and our behavior. By working with a therapist to understand how anxious feelings and physiology can be directly influenced by our thoughts and our actions, children and families are better able to identify the unhelpful behavioral and cognitive patterns that maintain a problem. Once these patterns are identified, therapist and patient work together to develop the necessary skills to break these negative "habits" and replace them with thought and behavior patterns that work to reduce anxiety instead of maintaining it. CBT has been investigated in numerous randomized clinical trials and has demonstrated effectiveness in the treatment of anxiety in children and adolescents. Children and parents are active participants in this kind of therapy, and will be asked to help identify goals and practice techniques and skills learned between sessions.
Exposure-Based CBT and E/RP
One subtype of CBT in particular, called exposure therapy or exposure with response prevention (ERP), has been shown to be particularly effective in the treatment of anxiety and OCD. In exposure-based therapy, the individual overcomes fears by gradually reducing avoidance of a feared entity/event through on-purpose "exposure" to the thoughts and situations which provoke discomfort. These exercises are designed by the patient and therapist together. The patient and/or parents are in the driver's seat during this “brave practice”, with control over how long and/or difficult the exposure is. Improvement in symptoms typically comes after gradually building up the difficulty of exposures over time.
In the case of OCD, systematic exposure exercises to elicit unwanted thoughts or fears are then combined with response or ritual prevention. How this works: Individuals with OCD have developed "rituals" or compulsions that serve to reduce anxiety about a feared outcome (for example, washing hands many times after touching a doorknob to avoid illness). In ERP, by resisting the urge to perform rituals during an exposure, we help to correct inaccurate beliefs about these actions as "protective." For example, by not washing after touching a doorknob, a child is able to learn that touching a doorknob without washing is, in fact, a safe thing to do and does not lead to getting sick... and that the anxiety/discomfort experienced is both tolerable and temporary.
Individualized Treatment
In all cases, I take an individualized approach to treatment and will tailor the best evidence-based treatments to a child or teen's specific needs. As necessary, I often incorporate aspects of other evidence-based approaches into treatment, including Acceptance and Commitment Therapy (ACT), Parent Management Training (PMT), and/or Parent-Child Interaction Therapy (PCIT), and Supportive Parenting for Anxious Childhood Emotions (SPACE).
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