THEORETICAL FOUNDATIONS

Psychotherapy

The theoretical foundations of my psychological practice draw from three evidenced-based frameworks: mindfulness (holistic, ecological, systemic), cognitive-behavioral psychology, and the narrative paradigm. Specifically, my approach to psychotherapy does not separate mind and body. For example, I use the Buddhist technique of Mindfulness to assist individuals in learning how thoughts affect their physical experience and how focusing on one’s breath may alter thoughts and emotions. Clients are taught how to meditate to "center" and "ground" themselves, achieve harmony, relieve anxiety, and perceive their experiences in healthy and creative ways. Similarly, my use of Cognitive-Behavioral therapy is informed by an integration between cognitive and behavioral approaches as an extremely powerful way to change maladaptive beliefs based on the existence of two cognitive systems with different functions and properties, one that is automatic and outside of awareness and involves large-scale parallel information processing, and one that is more effortful and involves conscious experience. Data from numerous areas of psychology support the idea that most cognitive processing has the potential to include a large amount of information and takes place extremely rapidly and completely outside of awareness. Although we are unaware of this kind of processing, we can become aware of its products, for example, in the forms of thoughts and images. This kind of processing is heavily influenced by previous learning, and new stimuli tend to elicit routinized responses in a relatively inflexible way. In contrast, conscious processing is slow and deliberate and operates on a tiny fraction of the information available. At the same time, it is extremely adaptable and responsive to new information, which allows for great flexibility in behavior. It is reasonable to suppose that the output of both types of processing is represented in memory.

Finally, my use of Narrative therapy recognizes that the primary focus of a narrative approach is exploring people's expressions of their experiences of life. These are expressions of people's experiences of a world that is lived through, and all expressions of lived experience engage people in interpretive acts. It is through these interpretive acts that people give meaning to their experiences of the world. These interpretive acts render people's experiences of life sensible to themselves and to others. Meaning does not pre-exist the interpretation of experience. Expressions of experience are units of meaning and experience. In all considerations of people's expressions of life, meaning and experience are inseparable. Acts in the interpretation of experience are achievements that are dependent upon people's engagement with interpretive resources that provide frames of intelligibility. Expressions are constitutive of life - expressions have real-effects in terms of the shaping of life - in that:

As expressions constitute the world that is lived through, they structure experience and subsequent expressions.

Expressions are in a constant state of production, and these productions are transformative of life.

Action in the world is prefigured on meaning, the specifics of action being determined by the particularities of the meanings that are derived in the processes of interpretation.

Expressions have a cultural context and are informed by the knowledge and practices of life that are culturally determined.

Making sense, giving meaning to experience, is a relational achievement in that:

All acts of interpretation require a frame of intelligibility, one that locates specific experiences in contexts of experiences of a similar class, one that brings particular events of people's lives into some relationship with each other.

Linearity is invariably evoked as people's experiences of events are situated in progressions of events that unfold through time.

People traffic in meanings that are relevant to and shared by communities of people.

The meanings of experiences that are, in the first place, ambiguous and/or uncertain are negotiated in communities of people according to established procedures.

In that it is through expressions that people shape and re-shape their lives, expressions are not an 'academic' matter. Expressions cannot be considered a static reproduction of some experiences that they refer to: they are not 'maps of the territory of life', not 'reflections of life as it is lived', not 'mirrors of the world', and not 'perspectives on life' that stand outside of what is going on. The structure of narrative provides the principle frame of intelligibility for people in their day-to-day lives. It is through this frame that people link together the events of life in sequences that unfold through time according to specific themes. Linear causality is a dominant feature of narrative structure - events are taken into linear progressions, in which each event contributes to the foundations of possibility for subsequent events.

Behavioral Medicine

Health, happiness, success, personal growth, and inner peace require constant work. Work at it every day, and learn to do it better the next day.

Health and Behavior

Stress and emotion appear to have important implications for the initiation or progression of cancer, HIV, cardiovascular disease, and other illnesses. Health-enhancing and health-impairing behaviors, including diet, exercise, tobacco use, and protection from the sun can compromise or benefit health and are directed by the role and interplay of biological, psychological, and social (biopsychosocial) factors in the way people feel, think, act, and how these affect their health and illness.

Changes in behavior and lifestyle can improve health, prevent illness, and reduce symptoms of illness. Behavioral changes can help people feel better physically and emotionally, improve their health status, increase their self-care skills, and improve their ability to live with chronic illness. Behavioral changes can also improve the effectiveness of medical interventions and reduce the overall costs of health care.

About My Practice and Behavioral Medicine

Behavioral medicine is a multidisciplinary field that takes a life-span approach to health and health care, working with children, teens, adults, and seniors individually and in groups, and working with racially and ethnically diverse communities in the United States and abroad. The primary purpose of behavioral medicine is to enable clinicians to understand the relationship between health and behavior and to deliver interventions that promote health, prevent disease, and manage chronic illness.

As a behavioral medicine specialist, I am:

• competent in the assessment of biopsychosocial factors affecting an individual’s overall health and well being including psychological, cognitive, behavioral, social, environmental, and biological/physical factors.
• skilled in developing and delivering psychological interventions to promote prevention and wellness and treat psychological conditions that affect health and illness.
• skilled in a broad range of psychological interventions and techniques, ranging from psychotherapy to targeted interventions such as stress-management, relaxation training, health promotion, and problem solving therapy.
• skilled in collaboration, consultation, and teamwork, which are essential to working within a multidisciplinary team of health professionals such as medical doctors (e.g. family medicine, psychiatry, neurology, cardiology), nurses, physician assistants, occupational therapists, physical therapists, exercise physiologists, nutritionists, social workers, counselors, speech-language pathologists, and public health professionals.
• an expert in contemporary research so as to rigorously conduct and apply scientific methods to understanding health and illness and be able to select and evaluate clinical treatment strategies based on established scientific knowledge and empirical support.

Treatment Specialties

My practice emphasizes an interdisciplinary understanding of biopsychosocial factors relevant to health and illness and the applications of this knowledge to prevention, diagnosis, treatment, and rehabilitation. I embrace evidence-based approaches to the assessment and treatment of:

Adolescent Health, Aging, Anxiety, HIV/AIDS, Incontinence, Insomnia, Low Back Pain, Minority Health, Myofascial Pain, Obesity, Pulmonary Disease, Quality of Life, Rehabilitation, Sexual Abuse and Trauma, PTSD, Relationship Issues, Social Support, and Psychological Assessment and Evaluations.

Treatment strategies are explicitly aimed at reducing the overt physical and behavioral manifestations that constitute the patient's complaint. Common behavioral change interventions involve the use of psychotherapy, meditation, relaxation training, dietary control, stress management, and/or the application of environmental contingencies across the following three areas.

• Lifestyle Changes to improve nutrition, increase physical activity, stop smoking, use medications appropriately, practice safer sex, prevent and reduce alcohol and drug abuse;
• Skills Training related to relaxation, self-monitoring, stress management, time management, pain management, problem-solving, communication skills, time management, and/or priority-setting;
• Social Support and Therapy Groups focused on education, skill building, caretaker support and training, health counseling, and group therapy interventions.

Evaluation Services

I also provide specialized evaluations for requesting psychiatrists, medical consultants, employers, and various social service agencies. These services include:

* Comprehensive psychological evaluation of adolescents and adults;

* Bariatric surgery evaluation;

* Evaluation and referral of persons with chemical dependency;

* Aptitude and interests evaluation and career counseling;

* Cognitive assessments.