Recovery cannot be achieved with just one approach. Multiple perspectives are required to help you overcome your symptoms. To that end, I utilize the following powerful models in treatment. I hand pick which ones I believe will be most helpful for you based off your treatment goals and the experience I’ve had. Some models (like the Goal Setting Model) are necessary in all situations regardless of individual factors. Ultimately, the decision to utilize these models will be your choice, and none of them will ever be forced on you without your informed consent. I will always discuss the model with you ahead of time before implementing it with you.

Goal Setting Model

Forcing yourself to work on something without a clear outcome or direction in mind is usually ineffective. Treatment involves work! It takes a commitment of time and energy. If those items are spent on an unrealistic outcome or an undesirable direction, you will usually end up feeling frustrated. To increase your odds of success, you’ll have to come in with a list of Goals. Broadly, Goals can be defined as desired outcomes. Once those are decided on, we’ll have to get into the details of what treatment will look like and what can realistically be expected. Goal Setting is the very first thing that is always done in treatment.

Commitment Model

Recovery is not just a simple improvement in symptoms - it’s a completely new way of life and living. That is what it means to change. Therefore, recovery will require certain decisions and commitments ahead of time. Those who make these decisions and commit to be “all-in” usually recover quickly. Those who do not make these commitments or remain ambivalent usually remain stuck. This is perhaps the most important model and makes up the majority of treatment planning. It can easily take 2-4 appointments to formalize. You can refer here to common the Decisions and Commitments page to see what common items you’ll have to commit on if you wish to recover.

The Right Time and the Right Place

Many people go to treatment because they want to change something in their lives. What they may discover upon evaluation is that change requires two additional things: the right time and the right place (context). The treatment techniques are powerful that much we can all agree on, but techniques applied at the wrong time will almost always fall flat. Applied at the wrong place, techniques may end up causing harm. Therefore, if I determine that your current condition cannot be properly managed on a typical outpatient basis, you’re likely in the wrong Place. Referral can be very helpful and oftentimes life saving if that’s the case. If you’re feeling undecided on one or more commitments I ask of you, you’re likely in the wrong Time. Taking a Break from treatment can be helpful. A Break is a very underutilized tool in recovery, but its power should not be overlooked. While away from treatment, you’ll have the opportunity to live your life, try some things out yourself, see other providers who do things differently, and think about what decisions you want to focus on in your life. Eventually, you’ll come to a time and place where it makes sense to reach out again. You can return to treatment because now, both of us will be at the right time and right place.

Hidden Emotion Model

Many people have the impression that depression and anxiety are “bad” things. This is supported by the use of the DSM-V’s diagnostic system which labels peoples’ symptoms as “disorders”. The Hidden Emotion model purports that it’s unwise to look at your symptoms in this way. Your symptoms are always there for good reasons - one of the most common reasons is unconscious or willful avoidance. You’re not owning up to certain feelings that are bothering you out of fear towards the repercussions. You may also be pushing away a desire to change something in your life out of kindness or consideration for someone/something else. The result is usually symptoms of anxiety, depression (less commonly), or somatic symptoms (unexplained neurological symptoms or aches/pains). After we bring the “hidden” issues out into the open and solve them, the symptoms usually take care of themselves.

Cognitive Therapy Model

This is a very old idea with parallels to Buddhist and Stoic philosophies. They purport that the negative events of life are inevitable and that the real problem is your perception of those events. In practical terms, suffering and pain is a part of being alive, but humans are capable of inflicting a special level of suffering other creatures may not experience: self-deception and ignorance. Self-deception leads to distorted perceptions that cause us pain and are clearly illogical. Ignorance pushes those distorted perceptions into distorted actions as we desperately run away from our self-deception. Sadly, despite how distorted our perceptions can be, they can also feel absolutely real and inevitable to us. Navigating out of these distorted perceptions through self-compassion can result in freedom from our suffering. Cognitive Therapy requires persistence and a strong intent to understand and accept our painful thoughts/feelings. Much easier said than done though! This model is a jack-of-all trades. It has great utility during the beginning, middle, and end of treatment.

Behavioral Model

Avoidance and inaction tend to worsen or reinforce depression/anxiety. This is why the act of doing written homework (even if you don’t want to) and exposing yourself to your fears head on are required to help you achieve recovery. Other behaviors that tend to reinforce depression/anxiety include problematic substance use, non-suicidal self-injury (NSSI), suicidality of any severity, problematic use of as needed anxiety medications, problematic gambling, eating disorder behaviors, and many other behaviors that are not listed here. A full assessment of these behaviors will be done in the evaluation which includes education about the behavior, discussion of the risks/benefits of said behavior, and negotiation regarding what you’d want to do with the behavior. Oftentimes, stopping/abstaining from even one of these types of behaviors tends to improve people’s symptoms dramatically without very much additional input.

Self-Defeating Beliefs Model

This model strives to answer the following question: why are people the way that they are? This question gets at the heart of many peoples’ issues. Techniques such as psychoanalytic methods or uncovering approaches can help us find out what “drives” us. Oftentimes, we already know what drives us: our hopes and dreams. These can be taught to us or we may even be born with them. They shape our Beliefs of ourselves and the world around us pushing us towards what we want. When reality doesn’t match up with our expectations however, we may paradoxically double down on our Beliefs rather than give them up. This makes sense - giving up our Beliefs feels like giving up who we are and what we want. However, doubling down on our Beliefs can distort our actions, and we may end up becoming/doing the exact opposite of what we wanted. Hence, our Beliefs become “Self-Defeating”. Once we find out what our Self-Defeating Beliefs are, we do a Cost Benefit Analysis (CBA). The CBA is necessary because changing a Belief means changing a fundamental part of who you are. You’ll have to decide if it’s worth it for you to even attempt this change. This model can lead to profound changes particularly for those who’ve felt compelled or controlled by their thoughts and behaviors.

(Everything but) The Kitchen Sink Model

This model is indicated for people struggling with hopelessness/doubt. It’s to help deflate the following expectations: that what your provider is offering is “special”, that the techniques “will work”, or that the provider is “the one” who can help you. The basic idea is to have an informed discussion that the provider doesn’t know what they’re doing, but will confidently make stuff up as they go along, try a bunch of random things based on the information provided, and go with the flow of whatever is happening. For someone who feels hopeless/doubtful of the treatment working, doing things this way will appear completely foolish. Joining together on a foolhardy journey like this can be fun and rewarding, but it’s understandably not what people are looking for. Many people are looking for confidence and a clear path forward. I’d be offering only confidence. It can take a lot to put your trust into that kind of setup let alone feel confident yourself that this would help. You may not want to which is understandable. However, if you’re willing to lower your expectations, you can increase the odds of recovery for yourself.

Motivational Model

You may be interested in changing your thoughts, feelings, beliefs, or behaviors. However, your heart will not always feel fully set on making that change. Maybe you could consider doing things differently, or maybe you’ll end up doing what you’ve always done before. Unfortunately, going to see a provider to ask for help won’t magically transform that “maybe” into a “yes” or “no”. The only person who can make that decision is you. You will always have GOOD reasons to change and GOOD reasons to keep the status quo. The only thing your provider can do is help you be more honest with yourself about what it is that you want. This in turn will assist your ability to decide on the following: is it worth it for me to change? Once you navigate this, you’ll oftentimes find that change can come a lot easier to you!

Exposure and Response Prevention Model

This is a subset of the behavioral model, but deserves its own section because clients and therapists generally avoid doing this. In this model, you purposefully put yourself in situations that increase your anxiety. You then deliberately do things to provoke that anxiety and ignore any urges to run away, calm yourself down, or dissociate from the intense fear. You do NOT try to distract yourself, calm yourself down, or engage in any behavior to relieve yourself. You instead keep pushing yourself until your anxieties are no longer frightening. This model is necessary for recovering from intrusive thoughts, obsessive behaviors, excessive worrying, all forms of anxiety, and panic attacks.

Interpersonal Model

In this model, you focus your efforts on giving up blame, taking full ownership of improving how you deal with people, and acknowledging that you are the one who are ultimately responsible for how people will react and behave around you. This is a model that people are usually resistant to because it can feel unfair and “icky”. Many people are also conflict avoidant, and they do not like how this model pushes them to be vulnerable with how they feel with others especially if they don’t like the other person or believe that sharing their genuine thoughts would be ruinous. However, if your intention is to improve a difficult relationship and to get people to do what you want, this model is absolutely required.

Biological Model

This model is indicated for conditions like Bipolar Disorder, Schizophrenia, and disorders related to them. The idea is that there are lesions/dysfunctions in the brain that leads someone to become manic or psychotic. Those who are diagnosed with these disorders are particularly vulnerable to recreational drugs - they exacerbate manic and psychotic episodes. While we still don’t know the exact causes, medications are required for mania and psychosis. For depression and anxiety, this model (which includes the serotonin dysfunction theory) has spotty evidence for their effectiveness. We also do not know the exact lesion/dysfunction causing depression or anxiety. Furthermore, the medications are just barely better than placebo. Therefore, if you want to take medications for conditions like depression/anxiety, it’s largely a personal decision decided on by some important factors you can read on here.

Conflict of Interest Model

These are usually legal-financial cases that subtly discourage recovery. Disability Income, Paid Medical Leave for Depression/Anxiety, Emotional Support Animals, School-Based Services, and Legal Cases are common examples that complicate the treatment relationship and your process of recovery. To be most effective to you, I’ll be completely uninvolved from those items. Money arrangements for personal matters can also complicate the process of recovery. This can be the case in prenuptial agreements that favor one party over the other, in cases where one party provides undue financial support to another, or in cases where one party has a clear power advantage. Finally, there can be instances of a physical power dynamic that is abusive or controlling. Staying in such relationships will typically worsen outcomes and is very dangerous. This is the case for relationships where one partner threatens violence against the other or in cases where neglect is apparent. Depending on the circumstances, I may require you to relinquish/change a financial/legal agreement you have to assist with your recovery. I may also ask you to distance yourself from or leave a problematic relationship. This model is unpopular, and many do not want to follow it even though it is oftentimes highly recommended.