Below you can find details about the clinical services I offer, my approach to therapy, as well as a few recommended resources for parents.
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 and Family-Based 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 45- or 60-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.
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.
Approach to Therapy
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-based" therapy, 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 exposure exercises are designed by the patient and therapist together. The patient and/or parents are in the "driver's seat" during exposures, 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" (referred to as Exposure with Response Prevention, or E/RP). How this works: Individuals with OCD have developed "rituals" or strong habits that serve to reduce anxiety about a feared outcome (for example, washing hands many times after touching a doorknob to avoid illness). In E/RP, by resisting the urge to perform rituals during an exposure, we help to correct inaccurate beliefs about rituals 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.
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 may incorporate aspects of a number of evidence-based approaches into treatment, including Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and/or Parent-Child Interaction Therapy (PCIT).
Resources for Parents
If you would like to learn more about child anxiety and available treatments on your own, below are a few recommended books and websites:
Freeing Your Child from Anxiety, by Tamar Chansky, PhD. Harmony Books, 2014.
You and Your Anxious Child: Free Your Child From Fears and Worries and Create a Joyful Family Life, by Anne Marie Albano, PhD, with Leslie Pepper. Avery Trade, 2013.
Helping Your Anxious Child: A Step By Step Guide for Parents, by Ronald M. Rapee, PhD et al. New Harbinger Publications, 2008.
Talking Back to OCD: The Program that Helps Kids and Teens Say "No Way"- and Parents Say "Way to Go", by John March, MD. Guilford Press, 2007.
Freeing Your Child from Obsessive-Compulsive Disorder, by Tamar E. Chansky, PhD. Three Rivers Press, 2000.