Individual Therapy

Harm Reduction Teletherapy

I will be offering teletherapy sessions for people who are interested in assessing or re-assessing the impact and role that their drug and alcohol use or their gambling is playing in their lives. During the coronavirus pandemic, with many more people isolated, experiencing losses, experiencing unemployment and increased stress, in the U.S. in 2020  and early 2021 alcohol use is up, drug use and drug overdoses are up significantly. Online gambling was up significantly this year as well. If you have concerns about these behaviors, Talking with a trained harm reduction therapist by video (link) can help you regain control over them so that you can do the things you really want to be doing with your life.

If you feel you may be at risk of overdose right now, please call 911.

What is Harm Reduction Therapy?

Harm Reduction therapy starts from the assumption that most people who are using substances or gambling problematically are usually doing so temporarily and have the capacity to change their behavior without stopping completely. In my experience, the earlier that you start dealing with something like this, the easier it is, but I have also worked with clients who have changed substance-related behaviors they have engaged in for decades once they made their minds up to do it. Many people describe harm reduction therapy essentially a “come as you are” approach. It is the opposite of what many people encounter when they seek abstinence-oriented treatment – the “just say no” approach if you will.

If you come to see me wanting to stop your use of all substances or to stop gambling, then I will collaboratively tailor a treatment plan for you with that goal in mind (abstinence is also harm reduction). We will work together on what you need to do before you stop, what the very best way for you to stop is, whether you should go to detox and/or a rehabilitation center and aftercare along with therapy. Then we will do Relapse Prevention Therapy (insert link).

However, if you are like a lot of people, your behavior/use is not to the point that you want to stop. It may be only impacting a small area of your life and that is what is bringing you into therapy. Or perhaps you started drinking more recently due to a loss like a death or divorce. You are trying to cut back on your own but have been having a hard time. What might you do? Here is one example: We might discuss moderation management techniques, the type of alcohol you are drinking, whether you are drinking daily or only on the weekends, etc. But as with all therapy it will be just as important to discuss the underlying reasons for the increase in drinking and how you might build some social support back into your life to ease those feelings of loss that triggered the increased drinking. Many people find that Harm Reduction Teletherapy helps them to get their lives back on track; their substance use is under better control or eliminated, due to whatever the client decides to do after talking through or trying various plans to address it.

What types of drugs have your clients used/do you have experience treating in your clients?

 Since 1991, I have worked with clients who have had mild, moderate and severe problems with: Alcohol, Benzodiazepines, Cannabis (Marijuana), Synthetic Cannabinoids, Inhalants, Amphetamine and Methamphetamine, Cocaine (and Crack Cocaine), Opioids (including Heroin and Opioid medications), and people who have used Hallucinogens, MDMA (Ecstasy), and other drugs that are less commonly major drugs of abuse such as PCP.

 Does Harm Reduction work for drugs other than alcohol?

 It absolutely does! Goals may include: Not driving while intoxicated, using clean syringes, practicing safer sex, carrying Narcan (naloxone) in one’s pocket/handbag, stopping use of a particularly harmful drug (e.g. heroin) while not committing to abstinence to other drugs yet, not using around children, using with others so if overdose or other negative outcomes occur – someone is there to help, using a less expensive drug, etc.

The goals of harm reduction are to reduce any harms whether to the user, their health, their mental health, their relationship with their partner, their family, their economic prospects, and their interactions with their community. The goal of harm reduction is any positive change. Change MUST occur at the client’s pace.

 How does it work for gambling?

 Similarly, harm reduction goals for gambling might include: only spending a certain amount of money per day/week or month, giving control of direct deposit check to partner or parent, making sure to eat proper meals, getting treatment for co-occurring mental health issues, addressing any relationship issues, not gambling at work or school, and if the person is engaging in theft or other criminal behaviors to support their habit, trying to reduce or eliminate those behaviors.

 The most important thing is that you agree with the goals.

 This is generally true in all therapy. It doesn’t really matter what I think you should do or husband or your mom thinks you should do or your probation officer or whomever thinks you should do. In the end, it has to be a goal you want and will want to work toward. Otherwise, your progress will be minimal. 

Teletherapy For Anxiety

I will be offering teletherapy for people struggling with anxiety during this time in our lives when we have been washing our hands what seems like thousands of times a day, wearing masks over our faces, avoiding friends and family (leading to increased isolation), and have had our lives, relationships, employment, and often our health disrupted in such a way that we are left reeling. “What’s next? I hear people ask constantly. Fortunately the vaccinations are here but some folks have anxiety about those also. The level of chronic uncertainty is unprecedented. Whether you are normally a person who has low or high levels of anxiety, living through a pandemic and having so much of your life impacted by it is an inherently anxiety-inducing experience. Doing teletherapy (link to how to set up a consult) can help you maintain control over your anxiety so that you can do the things you want to be doing with your life.

The thing to know about therapy for anxiety: Anxiety is something all of us have at times: and it can be helpful or harmful

Therapy for anxiety is one of the most common forms of therapy sought by people seeking mental health treatment. Anxiety can be painful, excruciating, and even crippling, making it impossible for us to take care of daily tasks that are important to us, leaving us feeling demoralized and even more anxious because of the feeling that life is getting away from us.

Anxiety, as with all our emotions, has an important function in our lives as do all our emotions. When we experience anxiety when we are starting a new project, job, school, or other challenge, it is adaptive. It is telling us something helpful and useful: “Hey – pay attention! You’re doing something new/important! Be careful so you do it correctly!” It is just considered something that we ourselves have produced naturally as part of putting ourselves in the position seeking of growth and change. A certain amount of anxiety is normal in those circumstances. Sometimes a little bit of extra anxiety evens helps us do better in these new situations.

However, sometimes anxiety starts to increase to the point that it can be difficult to figure out: “Can I handle this amount of anxiety? For how long? What supports do I need to put in place for this to work with my particular level of anxiety? This seems like more anxiety than usual – is there something I should be attending to or doing differently?” Questions like these may lead people to consult with me briefly or do some brief therapy until they feel more stable again, even if they don’t have a formal anxiety diagnosis.

At other times, people feel empowered by the idea that when they are doing things that are a bit difficult for them, it’s likely they’ll feel anxious – but when they stop pushing themselves so hard that the feeling will ease up. So, in these circumstances many times you know that you have the capacity to have your foot on the accelerator or the brake – you are in control of your anxiety. In these cases you know you are in charge and seeking treatment is often not part of your agenda.

However, in the case where a person actually has an anxiety disorder, not just a little uptick in anxiety that goes away on its own, their anxiety system somehow becomes essentially overreactive. It is no longer responsive to the person just easing off on stressful things like new projects (like in the example above) and this is where therapy for anxiety may become essential. While every course of therapy and every treatment plan for my clients with anxiety issues must be individualized because no two people are alike, two things they all have in common are the following: 1) Clients ultimately will need to learn and practice anxiety-reduction skills (there are so many but these may include: meditation, exercise, recognizing anxiety triggers, identifying what I call “micro-anxiety” – anxiety that is just beginning to build so you can stop it in its tracks, and making changes in thoughts and behavior, which can include identifying self-defeating self-talk, creating healthy distractions, and reaching out to supportive people who can help tackle the anxiety in the moment; 2) The second piece is this: we will talk about the role that anxiety may be serving in your life. We may discuss things like: What situations, relationships, conditions, circumstances in your life lead to increased anxiety? What is the relationship between anxiety and your capacity to form relationships? How is it interfering in your work life? Your home/family life? These two types of strategies together (changing your behavior and talking about your inner life and its relationship to your anxiety) will help to reduce your overall experience of anxiety. Will we do this all in one day? Absolutely not. But a day at a time the vast majority of people feel their anxiety improves significantly if they engage in this particular two-pronged approach to treatment for their anxiety problems.

Some terminology clarifications

As with many therapy-related terms, it’s clear that anxiety refers to a variety of different thoughts, feelings and experiences. When thinking about whether you want therapy for anxiety, clarifying these terms can help:

Stress

Many people use the terms ‘stress’ and ‘anxiety’ interchangeably, but therapy for anxiety for stress needs clarifying. In this case, a complaint of anxiety commonly denotes physical symptoms, like exhaustion, difficulty sleeping, headaches or other kinds of tension; or problems in relationships, like difficulty controlling one’s temper or outbursts, or otherwise being irritable with friends and loved ones. Anxiety that is expressed as stress is a killer, can increase blood pressure and increase the likelihood of cardiac events, insert this link https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/anxiety/faq-20058549 can destroy relationships, and is not a necessary or essential part of living a successful life. I offer therapy for anxiety to people who tell me their main problem is that they are “stressed out”, they know it is harming them, but they are having enormous difficulty figuring out how to ‘live differently’ on their own. If you have been feeling stressed and feel therapy for anxiety would help you, click here for a consultation.

Social anxiety

For some of my clients, their anxiety is experienced most frequently around others. This is commonly referred to as Social Anxiety or Social Phobia. Are you extremely afraid of being judged by others? Are you very self-conscious in everyday social situations? Do you avoid meeting new people? If you have been feeling this way for at least six months and these feelings make it hard for you to do everyday tasks—such as talking to people at work or school—you may have a social anxiety disorder. Working through social anxiety involves learning how be more comfortable with other people. It can be critical not just so that you feel comfortable in social situations but also so that you feel and act effectively in social situations. As you begin to feel more comfortable trying new things (Dating? Asking for a raise or promotion? Being more assertive with not-so-nice people at work or online? Wouldn’t it be nice to just be able to DO these things?) As with all treatment, it’s a process, not an event. The more effort and emotional investment you put in, the more you will get out of it. Interested in treatment for social anxiety? Click here.

Panic attacks

It’s no accident that often people having their first panic attack mistake their symptoms for those of a cardiac event. Rapid, pounding heartbeat? Check. Sweating? Check. Feeling faint, Chest pain, chills, shortness of breath…all of these and these rest of these symptoms https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021

can be very frightening.

Often, people with anxiety disorders have panic attacks as well. They come on without warning in most cases. Anxiety therapy I offer for panic attacks will include a thorough look at other co-occurring anxiety disorders and other mental health and substance use disorders that may contribute to this condition. Treatment will include strategies to use if/when panic attacks recur and how to address underlying conditions and situations that may be impacting the frequency/intensity of your panic attacks. You deserve to live a life that is not anxiety-ridden, waiting for your next panic attack. Click HERE to schedule a consultation.

Therapy for anxiety and its relationship to trauma therapy

It is not difficult to explain the origin of most anxiety. Sadly, when human beings experience serious traumas, we often experience anxiety related to that trauma – sometimes for months or years. Commonly, this sort of anxiety is called Post-Traumatic Stress Disorder (PTSD) though this phrase can be overwhelming and difficult to take in itself for some people.

Sometimes these difficult experiences happened in childhood (such as abuse or neglect). For my other clients, they have experienced serious assaults, rapes, accidents, or fires, that have left painful emotional scars. In my experience, some people minimize or feel ashamed of their trauma (“It was such a long time ago. I should be over it”) and others have had their trauma delegitimized by family or others (“Worse things have happened to people. What’s your problem?) and still others have been in treatment previously, thought they were ‘all done’ but have new PTSD-related issues popping up now (this is common when you have children for example – your child turns 7 and if 7 is the age when you were first abused, your symptoms can either emerge or re-emerge). However your trauma is impacting you – you can be better in charge of it, instead of it being in charge of you, with your symptoms interfering with your life. We will do this work at your pace, as you feel comfortable. I, like many practitioners now, see the most value, NOT in re-hashing what happened to you in the past over and over again which can actually be re-traumatizing in many cases, but in focusing on how the trauma impacts you today, in the here and now, and how we can work together to improve that situation. CLICK for free consult

I am also have experience working with people who have been using drugs or alcohol to numb themselves from their PTSD symptoms but who also end up simultaneously numbing themselves out to pleasurable things in their lives due to excessive use of this coping skill. I will teach you new coping skills that lead you back to a more fulfilling life where you have peace and connection to the people and activities you love.

Therapy for anxiety and alcohol, marijuana, and other drugs

I am what’s known as a “harm reduction therapist”. That means 1) I don’t insist that my clients who use substances stop using them immediately (or ever) if they are in treatment with me. This is true whether they are using them to excess or in other ways that are suboptimal (from my clinical or safety perspective); I will however provide education, counseling, and guidance. 2) my clients should feel open to discuss with me what substances they may be using, to the extent of their use, how they find the drugs they are using helpful, if there are ways they find them less helpful at times, and whether I can provide counseling and education about that that they would be interested in/find useful. I am a Licensed Advanced Alcohol and Drug Counselor (LAADC) as well as an LCSW and specialize in treating clients with co-occurring mental health and substance-related disorders so I have a lot of experience in this area. So, in the context of therapy for anxiety, it may come up that you have been self-medicating your anxiety symptoms with alcohol, marijuana, or other drugs because you have not had the skills to manage your anxiety and/or perhaps you haven’t had a psychiatrist who has been treating your symptoms well. We will work on all of this as you feel ready to. If you want to cut back or use differently, we will talk about safe ways to do that, if you want to stop, we can talk about that as well. It’s your life after all, you set the treatment goals. Treatment for COD

Psychiatric medications and therapy for anxiety

Do I have to take medications for my anxiety to get better? Anxiety is second only to depression as the most common reason for the use of psychiatric medications. (Several of the medications used to treat depression are the very same ones used to treat chronic anxiety.) Many people do find immense short and long-term relief from some of the extreme symptoms of anxiety through these medications and clients I’ve worked with over the years swear by them. However, there are some people who come to therapy for anxiety with the express intention of treating their symptoms without medications. Will I work with you? Absolutely! There are alternatives to medications and although the dedication and commitment from you the client will be necessarily a bit more that a client who has medications on board to assist them, relief from your symptoms is still possible. Please call me at 415-873-9828 for a consultation.