The approach taken at Stalzer Counseling & Consulting emphasizes competence, equity, collaboration, and dignity. In keeping with those values, it is important to use evidence-based approaches for the conditions treated. I am trained and highly experienced in Enhanced Cognitive Behavioral Therapy, Dialectical Behavior, and similar techniques.
Cognitive Behavioral Therapy (CBT) is an approach that targets a person's thoughts to influence how they respond to situations. There are many versions including the Enhanced version for Eating Disorders and Behavioral Activation.
The key belief underlying CBT-E is that a person's overevaluation of their shape and weight leads to a focus on extreme dieting behaviors. This engagement in extreme dieting behaviors and thoughts inevitably leads to other eating and compensatory behaviors such as binge eating, purging and restriction.
Typically treatment involves approximately 20 sessions over 20 weeks.
Stage One: Achieving Early Change
The first stage involves beginning interventions aimed at self-monitoring and building regular patterns. Typically sessions are twice weekly during this beginning phase.
Stage Two: Taking Stock
The shortest of the four stages, Taking Stock involves building a case conceptualization to identify which modules will be addressed in the third phase. This is a collaborative process between the clinician and client and often takes approximately two sessions.
Stage Three: Targeting Underlying Causes
In the third stage, clients target the underlying causes of their problems with eating. Modules may focus on mood, body image, and mentalities that need to be targeted.
Stage Four: Ending Well
In the final stage of treatment, the goal is to begin phasing out the self-monitoring techniques introduced in the first phase and maintaining certain interventions. The client and clinician will develop maintenance plans. At this point in treatment, the frequency of sessions decreases to allow for more independence in readying a person for discharge.
Several studies have explored the efficacy of CBT-E and found that it can be very helpful. Currently it is the treatment of choice for adults with eating disorders.
CBT-E may be less effective with those who are underweight, those with a primary disorder needing greater attention, and those with moderate to high risk suicidal ideations and self-harming behaviors. In these instances, treatment may need to be supplemented with additional treatment or more intensive treatment may need to be considered.
Dialectical Behavior Therapy (DBT) was created to address emotional dysregulation that some people experience making standard CBT approaches difficult. It is a skills-based treatment that is ideal for individuals whose underlying issues relate back to mood.
Underlying DBT is the biopsychosocial theory which posits that some individuals are prone to issues with emotional dysregulation because of invalidating environments and biological predispositions. This notion provides the framework for the dialectic of accepting oneself and needing to make changes.
In DBT, there are four modes of treatment: skills training, individual therapy, phone consultations, and supervision.
Most often, skills training is facilitated through a group approach, but can also be done in an individual session. In those circumstances, one session would focus on skills training while the other focuses on individual work. The skills taught include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. In DBT for Binge Eating and Bulimia, Interpersonal Effectiveness skills are often not taught, and in the Adolescent version of DBT, an additional set of skills called Walking the Middle Path is discussed.
Skills training emphasizes learning new skills, and individual therapy is where the focus is on the application of the skills. Individual sessions are highly structured and focus on analyzing behaviors to better build skills.
In addition to individual therapy, phone consultations are a part of treatment to allow for learning in between skills training. Phone consultations are planned, often around homework assignments.
In addition to the parts of treatment directly with a client, clinician supervision is a regular part of the therapeutic process.
DBT has been researched in many populations including the Major Depressive Disorder, Borderline Personality Disorder, Bulimia Nervosa, Binge Eating Disorder, and Bipolar Disorder. It has been found to be helpful when delivered in the standard manualized approach, and also has been effective when adapated for various treatment setting such as higher levels of care.
Exposure and Response Prevention (ERP) is a widely used approach to treating anxiety and obsessional disorders. It is most often used in the treatment of Obsessive Compulsive Disorder, and has also be helpful in treating similar condition such as Panic Disorder and Phobias.
Individuals with anxiety-related disorders utilize anxiety-reducing behaviors to manager their symptoms. The habituation model posits that anxiety symptoms slowly reduce as anxiety-reducing behaviors are eliminated.
Most often, clients are able to complete treatment in 12 to 20 sessions.
In the initial sessions of ERP, the client and clinician collaboratively work together to explore the situations that bring about anxiety and complete a functional analysis of the sutiations to identify a specific plan for exposures.
In the middle part of treatment, the client and clinician work together to implement the exposures identified in the first part of treatment. They are planned out and processed, and clients will either repeat exposures or move to the next exposure.
As a client nears the end of treatment, they are prepared for discharge by identifying maintenance plans and reviewing skills learned.
ERP is the standard treatment approach for many anxiety-related conditions, and has shown a great deal of efficacy in treating Obsessive Compulsive Disorder, Phobias and Panic Disorder.