Problems We Treat
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Treatments We Use
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Trauma and Complex PTSD
It’s Not Your Fault
Something bad happened to you, and now you’re having a hard time sleeping, you startle easily, you get triggered by the smallest things. This isn’t your fault. It’s a normal reaction to something bad that happened to you. We are experts in trauma therapy and post-traumatic stress disorder (PTSD) and can help you heal safely.
What is trauma anyway?
Traumatic experience isn’t defined by the experience itself, but rather on how you perceive the experience. Trauma happens when you feel that your life or well-being, or that of someone else, is threatened. Two different people can experience the same thing. While one person is unaffected, the other has a deep impact. Getting lost in a large store can be traumatizing for a child if they are scared that they will never see their mother again. Virtually all of us have some kind of trauma in our lives, though at varying degrees.
Is trauma the same thing as PTSD?
Not necessarily. Post-traumatic Stress Disorder (PTSD) has very specific diagnostic criteria in the DSM (Diagnostic and Statistical Manual), which includes experiencing trauma but also includes other criteria such as nightmares, flashbacks and avoidance of “triggers.” Not everyone who has experienced trauma has PTSD. Sometimes PTSD symptoms show up years after the trauma happened, especially if you have blocked out the event.
Read our free e-Book in the Resource Center:
The Hidden Presence of PTSD
Learn about symptoms of PTSD and trauma
Understand the physiology of trauma
Understand how trauma affects the brain
Learn more about methods of treating trauma and PTSD
Learn more about emotional trauma therapy
Answer the question “what is trauma therapy?”
What kinds of things cause trauma or PTSD?
Often people think of trauma as being caused by war or something similar. But trauma can also be caused by physical, sexual or emotional abuse, forced separation from a caregiver at a young age, birth trauma, a car accident, a really bad break-up, or even an invasive medical procedure. The event doesn’t have to cause physical damage. In fact, some research shows that emotional and verbal abuse of a child (yelling at or humiliating them) can sometimes be more damaging than physical abuse. Regardless of its source, an emotional trauma contains three common elements:
It was unexpected;
You were unprepared; and
There was nothing you could do to prevent it from happening.
So how does this manifest in your life?
You might have nightmares, get scared easily, have difficulty sleeping and not be able to trust. You might have trouble maintaining relationships in your personal or professional life. You might feel exceptionally sensitive and be hurt easily.
Even when unrecognized, emotional trauma can create lasting difficulties in your life. One way to determine whether an emotional or psychological trauma might have occurred is to look at the kinds of recurring problems that you are having.
Symptoms of trauma and PTSD
compulsive behavior patterns
overreactions and sudden floods of emotion
self-destructive and impulsive behavior
uncontrollable reactive thoughts
inability to make healthy professional or lifestyle choices
dissociative symptoms (“checking out”)
feelings of shame, despair, hopelessness
feeling permanently damaged or “broken”
a loss of previously sustained beliefs
inability to maintain friendship or other relationships
hostility and arguments with family members, employers or co-workers
feeling constantly threatened and that you always must be on guard
What is Complex PTSD (C-PTSD)?
C-PTSD is more complicated than simple PTSD since it involves chronic assaults on your personal integrity and sense of safety, as opposed to a single acute trauma. Repeated and chronic abuse and trauma result in a confusing array of symptoms that you may not even associate with your childhood experiences.
The symptom clusters for C-PTSD are:
Alterations in regulation of emotions, emotional displays and impulses
Changes in relationship with others
Somatic symptoms – body memories, aches and pains, unexplained physical problems
Changes in meaning of events in your life
Changes in how you see yourself
Changes in attention and consciousness – dissociation, feeling disconnected, “checking out”
When you are repeatedly abused (emotionally, sexually, physically) in early childhood, it becomes almost impossible to develop a cohesive and coherent personality structure. Your personality splits into parts. This is not the same thing as dissociative identity disorder (DID), formerly known as multiple personality disorder. Rather, it is a protection mechanism where some parts keep you functioning in day-to-day life and some parts protect you by resorting to defenses such as fight, flight, freeze and submit.
Trauma therapy requires special training. At Bay Area Mental Health we have that expertise.
Depression and Anxiety
You’re standing in a crowded room, enjoying a party, when suddenly, a darkness begins to envelope you…
It’s heavy and sticky and seems to affect only you. You’re slowly being brought to your knees, panicking at the thought of being consumed by it.
Everyone else is moving on with their lives, and nobody seems to recognize that you’re in pain. Perhaps you’re embarrassed, and don’t want to make too much fuss – convinced you can manage on your own.
Or, perhaps you want to scream, but your voice feels trapped. Either way, the secret weight is crushing, and no one will even notice…
The weight of depression and anxiety are so heavy and can keep you from living your life on your terms.
What do we mean when we talk about depression and anxiety?
We use the words depression and anxiety often in our culture. And we can understand them from many points of view.
Biologically, we know that the absence of certain chemicals can result in difficulties feeling joy and regulating emotions.
Relationally, we understand how past experiences may have convinced us that we are unworthy of love and ineffective in navigating relationships.
Emotionally, we see how a feeling can spiral into a belief that is hard to shake and taints how we perceive and interact with the world.
Physically, we feel the sadness, numbness, and tension in our bodies.
Depression and anxiety are both very treatable mood disorders that are influenced by both your biological make-up (genetics or nature) and your experiences (nurture).
But what do depression and anxiety feel like for you?
Feel negatively about yourself and your worth?
Worry constantly about everything from everyday decisions, to the safety of your
friends and family?
Suffer from aches and pains with no identifiable medical reason?
Struggle to enjoy your life – even in activities that used to excite you before?
Have trouble relaxing, concentrating, sleeping, eating, or otherwise doing the things you need to do?
Feel tired, unmotivated, restless, or agitated?
Have emotional outbursts and not knowing why?
Have you felt so overwhelmed by pain that you’ve thought of suicide as an option?
Perhaps you feel trapped by your body and mind – held captive by thoughts that you are unsafe, unlovable, unworthy, incapable, and beyond help. You may feel numb or panicked; perhaps you move between the two or even feel both at the same time.
How do I know if I have depression and/or anxiety?
Depression involves feelings of sadness, emptiness, hopelessness, or a loss of joy and pleasure and may include difficulties with eating, sleeping, and concentrating, low energy, guilt or worthlessness, and/or thoughts of hurting yourself.
Does any of this sound familiar?
You may feel a few of these things for an extended period of time or have shorter, intense periods of overwhelming depression.
If you have anxiety, you’re likely experiencing excessive anxiety or worry you can’t control. You may also feel restless, physically tense, fatigued, and irritable. You may also have difficulty sleeping and concentrating.
Some professionals think of depression as exhausted anxiety – the body and mind have tuckered themselves out from constant worry without solution or relief. This could make you feel hopelessly fated to live without peace or rest. Perhaps you hate yourself for feeling so ineffective in managing your feelings.
Know this: depression and anxiety are not incurable, terminal illnesses. You’re not a failure. You have big emotions and have managed to cope with them all the way up until this point.
We’ve helped many people identify the lies in these dark, persistent thoughts and develop ways to cope and flourish.
The gold standard of treatment for depression and anxiety is therapy, possibly combined with medication. Medication can relieve the most intense symptoms while we help identify and treat the underlying causes. At the start of therapy, we can help you learn coping skills to manage through daily living, helping you build a life worth living WELL.
You’re not alone. There is hope and we can help.
Everybody has good and bad days.
Everybody has highs and lows.
Perhaps you woke up today wondering which monkey was going to be on your back. Would it be a rabid, frenetic monkey pulling you from idea to idea, task to task? Or would the monkey be one of self-destruction, determined to drag you down into the depths of a dark, lonely forest. Part of you may half-hope it’s that frantic monkey, because at least he seems to lead toward life and adventure. At the same time, that monkey is hard to trust. Is it true joy and inspiration? Or is it mania? Will this hope last or will I wake up tomorrow to realize that the excitable monkey was self-destructive too?
Some people feel their moods swing wildly between extremes: from immobilizing depression to energetic elation. Ups and downs are a normal part of life. However, when those swings become dramatic they may indicate that something is wrong.
What is Bipolar Disorder?
Bipolar Disorder is a condition defined by the experience of these extremes. It’s not simple moodiness, hyperactivity, PMS, or ADHD. It’s characterized by the presence of separate periods of depression and mania. People with Bipolar Disorder cycle between manic and depressive episodes.
What do depressive and manic episodes look like?
A depressive episode involves a depressed mood (sadness, hopelessness, worthlessness), difficulty in everyday life (eating, sleeping, concentrating, accomplishing tasks), guilt, and sometimes even thoughts of suicide.
Mania, or a manic episode, looks very much like the opposite. During a manic episode, a person will likely experience extremely high self-esteem, lots of ideas, creativity, and productivity. They will also experience some type of physical symptoms such as little need for sleep, a lot of energy (pacing, talking really fast), and difficulty concentrating. Another aspect of mania includes engaging in risky behavior (gambling, excessive sex, driving really fast).
If you are living with Bipolar Disorder, you may feel crushed by the depressive episodes: feeling completely worthless, sad, and unproductive. On the other hand, you may find yourself extremely productive, creative, and fun during a manic episode.
Many people struggle with the decision of treating Bipolar Disorder out of fear that treatment will completely dampen the true creativity that comes during times of mania. But you don’t have to suffer for the sake of your creativity; it is possible to treat your Bipolar Disorder and not lose yourself.
How can Bay Area Mental Health help?
Engaging with caregivers you trust is important for all conditions. A mental health therapist is a crucial part of treatment for Bipolar Disorder.
We can help you learn to identify your values, strengths, and goals so you can direct your energy toward flourishing. We can also help you learn skills to cope with the overwhelming sadness that seems to loom in the corner, threatening to squash you.
Managing your own health when dealing with Bipolar Disorder takes skill and support. You are not crazy. You are not bound by the confines of depression or mania. You are more than a diagnosis.
You can live a life of harmony, beauty, balance, and fun; and we would love to help.
Highly Sensitive People (HSP)
A Highly Sensitive Person, or HSP, is a person who has a personality trait known as sensory-processing sensitivity, or SPS. Those with high levels of SPS show high emotional sensitivity, stronger reactivity to both external and internal stimuli—pain, hunger, light, and noise—and a complex inner life About 15 to 20 percent of the population are thought to be highly sensitive.
HSP isn't a mental health disorder; it is more a characteristic of a person's personality. It's a trait that exists in everyone to varying degrees. Being an HSP has some manageable disadvantages and some powerful advantages as well.
HSPs may be more upset than others by violence, conflict, tension, or feelings of being overwhelmed. They may, also make concerted efforts to avoid upsetting situations. Highly sensitive people also tend to be highly creative, have an vivid appreciation of art and beauty, and enjoy deeply beneficial and satisfying relationships with others. HSPs are perceptive, compassionate, empathetic and benefit from their generally high EQ.
The therapeutic goal in helping highly sensitive people is to enable them to survive and thrive in situations without lessening the many clear advantages of their sensitivity. This can be challenging with children but therapy can enable them to have very happy lives. Adults are very capable of learning to manage situations with understanding and a variety of coping skill.
The essence is that HSP is not a disorder at all. It is a trait possessed by perceptive people who can learn to manage stressful situations effectively with therapy, rather than avoidance, enabling them to enjoy vivid and happy lives.
Borderline Personality Disorder
Borderline Personality Disorder (BPD)
The causes of BPD aren’t completely known, though we do know that approximately 75% of people with BPD have a history of childhood abuse. There may also be a genetic component, but that’s not quite clear yet. Once upon a time BPD was considered an intractable diagnosis. Research over the last several decades, mainly by Dr. Marsha Linehan (founder of Dialectical Behavior Therapy or DBT), has shown that BPD is NOT a lifelong sentence but in fact you can get better. DBT has been studied over the last 30 years and has been shown to be incredibly effective at treating BPD. BPD is a learned response, and therefore it can be unlearned and you can “build a life worth living”.
What’s really fantastic about DBT, though, is it can help anyone live better, happier lives. You can “building a life worth LOVING”. I teach DBT to other therapists and use it in my own life, but that’s a topic for another day.
Attachment Disorders are conditions that can develop during early childhood which inhibit a child's development of a beneficial emotional connection with others. These challenges may become apparent within the first year of life and show symptoms like:
severe colic and/or feeding difficulties
failure to gain weight
detached and unresponsive behavior
difficulty being comforted
preoccupied and/or defiant behavior
inhibition or hesitancy in social interactions
being too close with strangers
Children with attachment disorders may (not always) have been neglected, physically, or emotionally abused, or experienced inadequate care. Others have had multiple traumatic losses or changes in their primary caregiver. The physical, emotional, and social problems associated with attachment disorders may persist as the child grows older.
Reactive Attachment Disorder (RAD)
Children with RAD are less likely to interact with other people because of negative experiences with adults in their early years. They have difficulty calming down when stressed and do not look for comfort from their caregivers when they are upset. These children may seem to have little to no emotions when interacting with others. They may appear unhappy, irritable, sad, or scared while having normal activities with their caretaker.
Disinhibited Social Engagement Disorder (DSED)
Children with DSED do not appear fearful when meeting someone for the first time. They may be overly friendly, walk up to strangers to talk or even hug them. Younger children may allow strangers to pick them up, feed them, or give them toys to play with.
RAD and DSED are serious conditions that require treatment for both the child and the family. Without treatment, these conditions can affect a child's social and emotional development. Effective collaboration between the child's family and the treatment team will increase the likelihood of a positive outcome.
Complex Traumatic Grief
The feelings of loss sometimes become debilitating and do not improve after time passes. This is called complicated grief, also called persistent complex bereavement disorder. In complicated grief, painful emotions persist with such severity that people have trouble recovering from the loss and resuming their own life.
Grief recovery includes:
Acceptance of the reality of the loss
Fully experiencing the pain of loss
Adjusting to a new reality where the deceased is no longer present
Ability to resume old relationships and build new ones
If someone is unable to move through these stages more than a year after the death of a loved one, they may have complicated grief. In this case treatment can help process the grief and enable to victim to move through it in a healthy manner.
Normal grief symptoms gradually start to fade over time, but with complicated traumatic grief they continue and often get worse. The possibility of healing seems less possible over time.
Internal signs and symptoms of complicated grief may include:
Intense sorrow, pain and rumination over the loss of a loved one
Focus on little else but the loved one's death
Extreme focus on reminders of the loved one or excessive avoidance of reminders
Intense and persistent longing or pining for the deceased
Problems accepting the death
Numbness or detachment
Bitterness about the loss
Feeling that life holds no meaning or purpose
Lack of trust in others
Inability to enjoy life or think back on positive experiences with the loved one
External signs of complicated grief also may also include:
Having trouble carrying out normal routines
Isolation from others and withdrawal from social activities
Depression, deep sadness, guilt or self-blame
Self-blame, the feeling that the victim did something wrong, or could have prevented the death
Feeling that life isn't worth living without the loved one
Wishing to have died along with the loved one and suicidal thoughts
Complicated traumatic grief may be treated with a type of therapy called complicated grief therapy. It's similar to psychotherapy techniques used for depression and PTSD. This treatment can be effective when done individually or in a group format.
Therapeutic goals include:
Understanding complicated grief and the associated treatment
Processing complicated grief reactions, it's symptoms, adjusting to loss and redefining life goal
Building coping skills
Processing feelings of (self) blame and guilt
In complex traumatic grief the patient may also be treated for anxiety, depression and PTSD.
Trauma Therapy for Sexual Abuse and Rape
Either you or someone you know, has been abused or assaulted. Or both.
There is an average of 293,066 sexual assaults each year; that’s one assault every 107 seconds.
Whether the assault or abuse happened when you were a child or when you were an adult, it impacts every part of your life. Sexual trauma doesn’t just go away – it sticks with you like an unwanted shadow.
Hypersexuality or avoidance of sex
Difficulty setting boundaries
Flashbacks and nightmares
Not trusting or trusting too much
Feeling shame or guilt
Feeling surrounded by unsafe people
Having a hard time coping
Difficulty with self-care
Sexual abuse and assault is a special kind of trauma, and it requires a special understanding. We are specialists in this area, and we can help.
We are trained in treating sexual trauma and can offer different approaches to help you recover. Call us for an initial consultation, and we can make recommendations about the approach that may be best for you.
Emotional and Physical Abuse
Your partner doesn’t have to hit you for it to be abuse.
Domestic violence can take many forms, and it’s not always evident when it begins to happen in your relationship. Abuse usually starts small, making it hard to recognize it for what it truly is, and leaves you with a nagging feeling that something is not quite right with yourself, your partner, and/or your relationship. It’s harder to identify when you are living in the thick of it because the effects of domestic violence, along with your love for your partner, leave you feeling confused, hurting, and hoping for change.
“An abuser isn’t abusive 24/7. They usually demonstrate positive character traits most of the time. That’s what makes the abuse so confusing when it happens and what makes leaving so much more difficult.”
~ Miya Yamanouchi
What is domestic violence?
Most people think of bruises, black eyes, and broken bones when they think of domestic violence. That is physical violence and a reality for many individuals. Physical abuse can also include burning, choking, pulling your hair, pinning you down, or using a weapon on you.
Other, more subtle forms of abuse often appear long before physical abuse begins. These include financial abuse, sexual abuse, and/or emotional abuse. Emotional abuse includes:
Criticism, public shaming, and intentionally embarrassing you
Name-calling and insults disguised as “jokes”
Repeatedly pointing out your mistakes, blame-shifting, and making you feel crazy
Withholding affection and emotional support or giving you the silent treatment
Isolation, checking your phone or computer and making you check-in to your partner
Unreasonable demands or expectations; refusing to be pleased with you
Threats of physical or emotional abandonment
Picking fights, making threats, stalking, or creating chaos
Threatening to harm or harming your children or animals
It’s normal to be unsure if you are experiencing abuse. Some abuse doesn’t leave marks, and it’s hard to believe that someone you love would intentionally hurt you. If you are still unsure, ask yourself some of these questions:
Are you afraid to tell your partner about certain things because you are afraid they will get angry?
Does your partner make you feel bad about yourself or make you feel worthless or stupid?
Do you find yourself avoiding your family and friends out of fear of their reactions about your partner?
Do you find yourself frequently defending your partner?
Do you think that you are the one with the problem and that you need to change yourself to make your partner happy?
Does your partner make fun of your achievements rather than celebrate them with you?
Do you ever feel trapped in your relationship or worthless if you were ever without your relationship?
Does your partner control what you do, whom you see, or how you spend money?
Does your partner ever tell you, “If you didn’t do that, I wouldn’t have to act this way?”
Do you put them above everything else, including yourself?
Do you ever experience anger or rage toward your partner, yourself, or others?
Do you think that you deserve to be treated badly?
Do you ever believe that if you work hard enough, your partner will become the same caring person you fell in love with?
Do you ever wonder if you could ever be loved by anyone again?
You are not alone.
Anyone can be a victim of domestic violence – women or men; those in heterosexual or same-sex relationships. Just like you, most remain silent out of fear of judgment and shame. Many have successfully broken from these toxic relationship patterns. Taking steps toward healthy change is possible.
It’s not your fault. We understand, and we can help.
Bay Area Mental Health continuously strives to provide a framework for safe, supportive, and caring relationships with LGBQIQA individuals, groups, and communities. While LGBTQ+ individuals suffer from the same mental conditions and circumstances as all others, stigma and anachronistic social viewpoints may require a provider relationship that is actively embracing of all orientations. We focus aggressively on enabling LGBTQ+ clients to benefit from a therapeutic experience self-acceptance and personal, social, emotional, and relational development.
Our practice reinforces:
Affirming all shades of the rainbow
The use of evidence-based practices with oppressed populations
Promoting LGBTQ students’ well-being in schools
In search of an affirming faith
Management and skills to deal with bullying and oppression
Skills for straight children of same-sex parents who experience oppression or rejection
Embracing the ongoing push for progress
Partners in transition
Addiction and Substance Abuse
Substance Abuse Disorder is the term we use to describe conditions where a person using drugs and/or alcohol suffers a sustained and adverse impact on their lives. The condition is progressive when untreated. Fortunately, it is manageable and people can recover fully with appropriate treatment
"Substance abuse" is the repeated use that causes significant impairment, such as disabilities, failure to meet responsibilities, health issues, impaired control, risky behavior, and social issues. Examples of this could be drinking enough to get frequent hangovers; using enough drugs that you miss work or school; smoking enough marijuana that you have lost friends, or often drink or use more than you intended to use.
"Addiction" simply means a physical dependency on a drug. Addiction (and "alcoholism" - physiological addiction to alcohol) is a medical term and falls in the high end of the spectrum of substance abuse disorders. For example, perhaps 95% of people being treated for alcohol abuse are not addicted or "alcoholics". The remaining people suffering from alcoholism face serious risks during withdrawal and treatment for them often requires hospitalization.
It is important to emphasize that the word "abuse" means only that use of a substance differs from what is intended. The term abuse should not ever be seen as a judgment of a person's behavior or character. The term "abuse" applies equally to the abuse of legal or illegal drugs. Substance abuse disorders are serious medical and mental health conditions - not character flaws.
When to seek help.
For many legal substances, the line between use and abuse is not clear. Is having a couple of drinks every day after work to unwind use or abuse? Is drinking two pots of coffee in the morning, to get your day started, use or abuse? Is smoking a pack of cigarettes a day substance abuse?
Generally, the question to ask is, "Is substance use causing harm?" If someone is worried about increasing use and has never discussed it with family, friends, or coworkers, chances are that people have noticed behavioral changes but decline to confront or intervene. The personal secrets of substance abuse are rarely a surprise to others. They see their choice not to mention their own concerns as being polite.
If you have concerns it is best to speak to a mental health practitioner. Abuse is often intertwined with other issues and the best way to address the abuse is to address all of the other concerns at the same time. The earlier this begins the easier and quicker all of these issues can be addressed.
Dialectical Behavioral Therapy (DBT)
What is DBT and can it help me?
Do you know those emotions that get out of control and get you in trouble? DBT teaches you how to keep them in check. Sounds cool, right?
DBT is a combination of Group Therapy and Individual Therapy that helps people learn to manage their emotions. This allows them to have better relationships, handle crises when they come up, make better decisions, and keep emotions in check.
Developed 50 years ago, it’s been shown to effectively treat problems including depression, bipolar, anxiety, PTSD, caregiver burnout, relationship problems, substance use, and of course borderline personality disorder.
DBT is considered the gold standard approach for treating Emotion Dysregulation:
Emotions that spike out of control from nowhere
Emotions that are super intense, more so than most people seem to understand
Emotions that seem to last forever
I’m still confused – what is Emotion Dysregulation?
Emotion Dysregulation is a part of the following problems:
Inability to stay in healthy relationships
Unsure what you are feeling
Feeling like no one can understand your emotions
Feeling overwhelmed all the time
Borderline Personality Disorder
PTSD and trauma
Does DBT really work?
We believe that DBT can help EVERY SINGLE PERSON and have found it incredibly helpful in our own lives. No one can teach DBT unless they use it in their own lives, and we do. Here’s what past clients have had to say:
“Your DBT classes have changed my life! It has helped me more than 10 years of traditional talk therapy could. Thank you so much!”
“I’ve taken DBT before at other places, but I didn’t really understand the skills until now. You are amazing therapists, and I can’t thank you enough. You have changed my life.”
“These skills really should be taught in school. I could have used them when times were the toughest. Thank you for doing this.”
“Linnea and Ann are wonderful teachers. They are compassionate and warm, and teach the skills in a way that helps me use them in my life every day. My only regret is that I didn’t find out about this sooner.”
We’ve all experienced times when emotions take over. This is called getting “hijacked.” You can get hijacked when you are stuck in traffic and are late for a meeting, when you get into a fight with a loved one, when you feel attacked or threatened, when you’re overwhelmed at work, and so on.
When you’re hijacked, you literally can’t think – and you might make bad decisions that cause you more problems.
Maybe your therapist or psychiatrist recommended that you do DBT, or maybe you read a few of the many articles on the effectiveness of DBT. We believe that DBT changes lives. It changed ours, and it will change yours, if you do the work.
Components of the DBT Program
DBT Skills Group: Groups meet once a week for two hours and are like a class. We teach you skills to help you manage emotions, assign skills to practice (“homework”), and review homework from the previous week. Groups are a maximum of eight people and are run by two DBT therapists.
DBT Graduates Group
Once clients have completed a DBT program with either Bay Area Mental Health or another program, they can join one of our Graduates Groups. The DBT Graduate Groups are intended to provide a safe space to deepen your use of DBT skills. These groups are a mix of skills training and processing.
Tuesday 6:00 pm – 7:30 pm
Wednesday 6:00 pm – 8:00 pm
Monday 6:00 pm – 8:00 pm
Tuesdays 5:00 pm – 7:00 pm
Thursday 6:00 pm – 8:00 pm
Our program typically reduces symptoms of depression and anxiety by half over a 6-month course of treatment!
You can start the program during the mindfulness section in any of the modules. We strongly recommend that you complete all three modules two times. This takes a total of 13 months. We know it feels like a long time, which is why we break it down into modules. You only have to sign up for one module at a time.
How do I sign up?
We open up groups to new clients at the beginning of a new module. Because we have multiple groups running, there is usually only a three- to six-week wait to get into a group. Groups tend to fill up quickly so we maintain waitlists for each group. We can reserve a spot for you – call now to hold your place in line. If you are ready to start now, we can make an appointment to start to see you individually.
It’s most effective if you work with a Bay Area Mental Health therapist during the time you are in DBT because we know what you are working on in group and can support that process. However, if you already have a therapist, we want to honor that relationship and are happy to collaborate with them. In other words, you can stay with your current therapist if you prefer.
Coaching calls are short phone calls (less than 10 minutes) in-between sessions designed to help you use the coping skills that you learn in a group. This is not the same thing as phone therapy. There is no charge for this support.
Our therapists consult regularly to provide you the best experience possible. We function as a team to give you excellent care.
Skills Group Modules
The full DBT Program consists of three group modules with Mindfulness incorporated into each one:
Distress Tolerance (8 weeks) – Learn skills to manage emotional crisis situations, short-term and long-term.
Interpersonal Effectiveness (8 weeks) – Learn to communicate more effectively, to ask for what you want, and to say no. Learn to set and maintain boundaries.
Emotion Regulation (10 weeks) – Learn to identify and understand what you are feeling. Learn to reduce the frequency and intensity of emotions, and even to change them once they start.
“Long-lasting responses to trauma result not simply from the experience of fear and helplessness but from how our bodies interpret those experiences.”
Talking about trauma doesn’t make it go away.
If you have been told that, you were sold a bill of goods.
Focusing solely on the story of how the trauma happened can actually be dangerous. You can re-trigger the trauma, flooding yourself with intense, overwhelming emotions. Even your biology can change – if you keep re-living the story, you will strengthen the neural circuits for the trauma, cementing the trauma experience in yourself. That is the opposite of what you want.
Research shows that strong emotions, old patterns, and trauma are held in the body. That means that to heal these old wounds you need to access body memories. Somatic therapy (soma means “of the body”) uses talk therapy, body awareness, and mindfulness to access deep emotional pain to provide lasting relief from the pain.
Somatic psychotherapy is grounded in neuroscience, how the body stores memories, and how to release the pain of those memories.
Experiencing emotions in the body is a universal experience. A study done in 2013 shows that no matter where you come from geographically, the felt sense of emotions is the same. “More than 700 participants in Finland, Sweden and Taiwan participated in experiments aimed at mapping their bodily sensations in connection with specific emotions.”
Emotions can trigger body sensations, and body sensations can also trigger emotions, creating a feedback loop. With somatic psychotherapy, we can access painful emotions through body sensation and interrupt that feedback loop, creating lasting change.
Sensorimotor psychotherapy has been developed and refined over the last 40 years by Pat Ogden, founder of the Sensorimotor Psychotherapy Institute and co-founder of the Hakomi Institute. Sensorimotor Psychotherapy blends traditional talk therapy with a mind-body approach to effectively treat childhood trauma, neglect and abandonment that often lead to PTSD and complex PTSD.
“Sensorimotor Psychotherapy blends theory and technique from cognitive and dynamic therapy with straightforward somatic awareness and movement interventions… that promote empowerment and competency.”
~Dr. Dan Siegel, award-winning educator, researcher, and author
Great Books on Mind-Body Approaches
Touching Enlightenment: Finding Realization in the Body, Reginald Ray
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der Kolk, MD
Waking the Tiger: Healing Trauma, Peter Levine
The Body Remembers, Babette Rothschild
Articles on Somatic Psychotherapy in Trauma Treatment
You can find in the Resource Center for this site
“Putting the Pieces Together: 25 Years of Learning Trauma Treatment” Published in Psychotherapy Networker, May/June 2014.
“The Treatment of Structural Dissociation in Chronically Traumatized Patients Published in In Anstorp & Benum (2014). Trauma treatment in practice: complex trauma and dissociation. Oslo: Universitetsforlaget.
“Clinical EFT as an Evidence-Based Practice for the Treatment of Psychological and physiological Conditions”
“Sensorimotor Approaches to Trauma Treatment” Published in Advances in Psychiatric Treatment, July 2011.
“Attachment as a Sensorimotor Experience” Published in Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, July 2011.
“Retraining the Brain: Harnessing Our Neuroplasticity” Published in the Psychotherapy Networker, March, 2011.
“Brain to Brain: The Therapist as Neurobiological Regulator” Published in the Psychotherapy Networker, January, 2010.
“Working with the Neurobiological Legacy of Trauma”
“Addictions and Trauma Recovery”
“Stabilization in the Treatment of Trauma”
“Self-harm and Suicidality”
“Dissociative Phenomena in the Everyday Lives of Trauma Survivors”
Internal Family Systems
Internal Family Systems (IFS) is an approach to psychotherapy that identifies and addresses multiple sub-personalities or families within each person’s mental system. Sub-personalities consist of wounded parts and painful emotions such as anger and shame, as well as parts that try to control and protect the person from the pain of the wounded parts.
The sub-personalities may be in conflict with each other and with one’s core Self, a concept that describes the confident, compassionate, whole person that is at the core of every individual. IFS focuses on healing the wounded parts and restoring mental balance and harmony by changing the dynamics that create discord among the sub-personalities and the Self.
IFS was developed by Richard Schwartz, Ph.D., who developed the concept of an undamaged core Self that is the essence of who you are, and identified three different types of sub-personalities or families that reside within each person, in addition to the Self. These include wounded and suppressed parts called exiles, protective parts called managers, that keep the exiled parts suppressed, and other protective parts called firefighters, that distract the Self from the pain of exiled parts when they are released.
For example, an exiled part may be the trauma and anger of earlier abuse, emotions that are suppressed by the manager, while the firefighter may be an alcohol addiction or behavior such as overeating that distracts the client from facing and re-experiencing those uncomfortable emotions. These parts can be healed, transformed, and better managed by the Self by achieving the three goals of IFS:
1) Free the parts from their extreme roles
2) Restore trust in the Self
3) Coordinate and harmonize the Self and the parts, so they can work together as a team with the Self in charge.
Psychodynamic therapy is a form of talk therapy based on psychoanalysis. Psychodynamic therapy is often shorter than psychoanalytic therapy with respect to the frequency and number of sessions, as well as beneficial results.
We use psychodynamic therapy to treat drug resistant depression and other serious psychological disorders, especially in those who have lost meaning in their lives and have difficulty forming or maintaining personal relationships. It may also be effective in treating addiction, social anxiety disorders, and eating disorders.
Ketamine Assisted Therapy
Ketamine Assisted Psychotherapy (KAP) is a unique approach to traditional psychotherapy. KAP applies the medicine ketamine within an extended psychotherapy session. This combination can accelerate the process of growth and change. Sessions are conducted with medical support to ensure patients are well cared for throughout your experience.
Ketamine has the ability to produce a disconnection from our usual way of feeling and experiencing. At low doses given during a therapy session, this influence produces shifts in consciousness such as expanded states of awareness, novel ways of viewing life concerns, and freedom from the worries and anxieties of our ordinary mind-states. KAT offers real-time reflection on this experience to enhance growth and change.
Ketamine may, at times, facilitate psychedelic experiences such as expanded consciousness, and spiritual connection. These characteristics are similar to other psychedelic drugs that have been used successfully in psychotherapy sessions to reduce pain and distress. However, ketamine is currently the only available medication that may produce a psychedelic effect that can be used in psychotherapy.
KAT is used to augment treatment for PTSD, trauma, depression, anxiety, unresolved issues from childhood, rejoining life after a major illness, grief and loss, and end of life distress.
Mindfulness, from a therapeutic, secular perspective is a conscious awareness of our present moment. This includes openness and non-judgment about the experience. It is often coupled with other types of therapy, such as Cognitive-based Therapy (CBT), Dialectical Behavior Therapy (DBT), or Acceptance and Commitment Therapy (ACT).
Mindfulness therapy is not focus solely on relaxation but that may result from the practices. The focus is on increasing our awareness of the thoughts, feelings, and actions that hinder our progress. When we are able to do that, we can engage with those aspects of ourselves, learn to tweak our language, and choose how to respond.
Existential therapy is more of a way of thinking than a neatly defined model with specific techniques. It is a philosophical approach to therapy that assumes we are free to choose and are responsible for our choices. Existential therapy asks questions like, 'Why am I here?', 'What is my purpose?', and 'Who am I?'
Existential therapy typically deals with people in what is called a restricted existence. They have a limited awareness of themselves and the nature of their problems. They see few options available to them and feel helpless or trapped.
The goal of existential therapy is to help the client understand their subjective world view and to help them come to new understandings with new options. We help the client become fully aware of their feelings and actions in the present, confront their anxiety, and develop a more genuine relationship with themselves and with the world around them.
Existential therapy does not use a defined, systematic approach. Therefore, it must be applied by a therapist who is mature, experienced, and well trained
Emotion Focused Therapy (EFT)
Emotion Focused Therapy, or EFT, is based on the idea that emotions represent the key to who we are. EFT presumes that we construct our very selves based on emotion.
This theory makes intuitive sense. Clearly, emotions play a wide variety of important roles in our lives, including:
Informing people that an important goal or need can be pursued or stopped by choice
Forming the understanding of one's self and the environment
Communicating intentions to others and regulating interactions
Informed decision making
Alerting people to threats
Emotions are not only an important part of our daily lives, they also contribute to our identities, helping us to understand who we are and how we share ourselves with others.
When we use EFT we are recognizing the importance of emotions and focus on them in therapy.
EFT is based on three core principles. They form a model for working effectively with emotions:
Increasing awareness of emotion
Enhancing emotion regulation
The goal is to learn to notice and recognize emotions as we experience them. That is the first step toward learning to manage them rather than being managed by them. Once we have a basic ability to recognize and regulate emotions we can then learn to effectively change them to more positive and productive experiences. This enables us to cope more effectively with difficult and complex situations and feelings.
Expressive Art Therapy
Expressive arts therapy uses various arts to help with growth and healing. It is a process of discovering ourselves through any art form that comes from an emotional depth.
Expressive art refers to using the emotional, intuitive aspects of ourselves to create external art. This means going into our inside ourselves to discover feelings and to express them through visual art, movement, sound, writing, or drama. Talking about our feelings is also an important way to express and discover ourselves.
Most of us already use some aspect of expressive art as being helpful in our daily lives. Perhaps you doodle as you speak and find it soothing, or write a personal journal and find that your feelings and ideas change, or you write down your dreams to look for patterns or symbols. Maybe you paint or sculpt as a hobby and realize the experience transports you from your everyday problems. Maybe you sing while you drive or walk. Expressing yourself in this way car alter your state of being. They help you release your feelings, clear your mind, raise your spirits, and bring yourself into higher states of consciousness. The process is therapeutic and provides powerful insight to both the client and therapist.
In experiential therapy, clients use expressive activities to recreate situations from past and present relationships. The process enables them to identify and understand emotions and feelings associated with their experiences. Understanding leads to the ability identify, acknowledge and release harmful feelings and transform harmful emotions.
We use experiential therapy as a powerful tool to augment treatment for emotional dysregulation, complex traumatic grief, behavioral problems, PTSD and substance abuse.