At PCH Treatment Center, psychoanalytic psychotherapy is a cornerstone in the treatment of most clients. However, we also incorporate cognitive behavioral therapy, intertwined with our approach to treatment and client care. Our professional staff is well versed in psychoanalytic psychotherapy, both as an independent modality and as a useful and productive part of our comprehensive program of evaluation and treatment. We take to heart the idea that treatment is often a collaborative partnership between therapist and patient. Overall, we never try not to narrow our options to a particular theory or school. Instead, we use the many effective tools at our disposal in the combination that will best help our patients to heal. The PCH clinical team assesses each client and develops a specific treatment plan, assigning specific therapists who may be focused on psychoanalytic therapy or cognitive behavioral therapy, depending on the needs of the clients. (Read more about Psychoanalytic Psychotherapy Treatment here)
Cognitive Behavioral Therapy
Cognitive behavior therapy helps a client to develop a more positive way of thinking about life situations. The client is responsible for discovering and nurturing better mental attitudes and subsequent positive emotional responses. The client is in control of his or her therapy by setting achievable goals. The therapist is there to assist and direct the client’s progress.
Clients unlearn old patterns of thinking and behaving and learn new thought patterns and techniques. They also learn to turn off negative thinking patterns. This is accomplished through purposeful dialogue with the therapist. The learning that takes place during a session is bolstered through the assignment of homework. A client is usually given additional reading as well as some practice drills that reinforce the new thinking and feeling techniques. For example, a client will go through real life scenarios that elicit negative patterns with their therapist and then “practice” managing their thinking on their own in their life.
Somatic Experiencing Therapy
Somatic Experiencing (SE), developed by Dr. Peter Levine, offers a holistic strategy to achieve healing and resolution of trauma or emotional wounds. Somatic Experiencing is based on the premise that a person’s autonomic nervous system (ANS) becomes dysfunctional in relation to sudden arousal during trauma. SE attempts to help a person relearn to automatically regulate the release of energy associated with past trauma. SE Therapy targets the ability of the ANS to regulate and restore itself to balance in order to allow a client to regain a normal level of functioning after experiencing trauma. At PCH Treatment Center, Somatic Experiencing is practiced through individual therapy sessions. This form of therapy is often used for developmental traumas and can be combined with other forms of psychotherapy. Somatic Experiencing attempts to promote awareness and release of physical tension that proponents believe remains in the body in the aftermath of trauma. (Read more about Somatic Experiencing Therapy here)
Sensorimotor Psychotherapy integrates sensorimotor processing with cognitive and emotional processing in the treatment of trauma. Sensorimotor Psychotherapy uses the body (rather than thoughts or emotions) as a primary entry point in processing trauma. Sensorimotor Psychotherapy directly treats the effects of trauma on the body, which in turn facilitates emotional and cognitive processing. This method is especially beneficial for clinicians working with dissociation, emotional reactivity or flat affect, frozen states or hyperarousal and other PTSD symptoms. In this article, we discuss Sensorimotor Psychotherapy, emphasizing sensorimotor processing techniques which can be integrated with traditional approaches that treat these symptoms. Because the therapist’s ability to interactively regulate clients’ dysregulated states and also to cultivate clients’ self-awareness of inner body sensations is crucial to this approach, three sessions are described illustrating the clinical application of this method.
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) is a mode of psychotherapy developed by Marsha M. Linehan. It is used to treat persons with emotional dysregulation and impulse control as typified in “Borderline Personality Disorder” and other psychological conditions. DBT is also appropriate for persons affected by psychological trauma or struggling with chemical dependency or self-injurious behavior. DBT is derived from Buddhist meditative practices and mindfulness concepts, and has become a cornerstone in treatment for Borderline Personality Disorder. With DBT, Linehan attempted to address what she saw as three longstanding failings of cognitive-behavioral therapy. First, clients were threatened by treatment that focused on change when it failed to simultaneously acknowledge and accept the client’s existing identity, with some clients experiencing that focus as fundamentally invalidating. Second, the need to address immediate issues like suicidal and self-injurious behavior often took precedence over work on the development of effective behavioral skills, sometimes supplanting that work completely. Third, Linehan noted that client behavior frequently steered therapy in counterproductive directions: If tackling difficult subjects engendered client hostility, the therapist might avoid those subjects despite their importance to successful treatment.
In light of these obstacles, DBT makes therapeutic acceptance central to its approach, addressing one of the most difficult issues encountered in helping individuals with personality difficulties – treatment compliance. Using mindfulness techniques grounded in both eastern and western meditative practice, DBT seeks to forge a therapeutic alliance between client and therapist. In that alliance, treatment becomes dialectical by resolving the tension between two poles: acceptance of the client as he or she is and the necessity of change for the client’s own sake. DBT resolves that dichotomy by synthesizing acceptance and change in a highly structured system of therapeutic interaction. There is much more than acceptance of the client by the therapist. Internal acceptance, in which the client comes to accept both feelings and external situations non-judgmentally, is equally important. From a new perspective, the client can learn to acknowledge difficult situations, develop greater tolerance for distress and regulate emotions that would otherwise be overwhelming. Linehan called DBT a dance. The therapist must constantly balance acceptance and change strategies, often in the face of enormous client resistance, in order to keep treatment moving forward. DBT provides a detailed framework for this very delicate process. (Read more about Dialectical Behavioral Therapy here)
Mindfulness Based Stress Reduction (MBSR)
Mindfulness Based Stress Reduction (MBSR) is a structured program that teaches the practice of mindfulness in an effort to alleviate pain and improve physical and emotional well-being. The program was established by Jon Kabat-Zinn at the University of Massachusetts Medical School. Mindfulness is sustained moment-to-moment awareness of physical sensations, perceptions, affective states, imagery and thoughts. It is the process of focusing attention to direct experience without judgment, comparison, or evaluation. In MBSR, mindfulness is directly practiced in sitting and walking meditation, movement, and eating. Participants are taught techniques for bringing mindfulness and the associated benefits to all parts of their lives. Two decades of published research indicate that people who complete a MBSR program report greater ability to cope more effectively with both short- and long-term stressful situations. By learning to actively participate in the management of health and well being, many participants report they are better able to manage stress, fear, anger, anxiety and depression both at home and in the workplace. Participants have stated that they feel less judgmental and critical of themselves, and subsequently of others. Many also report a decrease of the frequency and length of medical visits to hospitals and other professional health-care providers. There has also been a noticeable decrease in the use of prescription and non-prescription medications among students of MBSR.
Mentalization-Based Therapy (MBT)
Mentalization-Based treatment is highly effective in helping people who are particularly prone to experiencing intense and overwhelming emotional distress which can lead to impulsive and self-destructive behaviors, a fluctuating “sense of self” and difficulties trusting others and understanding their intentions. Mentalizing is our normal, automatic tendency to try to make sense of our actions and feelings and those of others by reflecting on mental states (e.g. thoughts, emotions, beliefs, intentions).
The capacity to mentalize develops throughout childhood and adolescence and is influenced by many factors. If we are able to rely on our ability to mentalize, we feel more secure in our ability to understand our social interactions and relationships, –what is causing our own reactions, emotions, thoughts and actions and those of others. It also allows us to manage our emotions and behavior, maintain a confident, efficacious, stable sense of self, and involve ourselves in satisfying and meaningful relationships.
In some persons, the capacity to mentalize is much more fragile. In these people, mentalization may occur when stress levels are low, but it tends to collapse in the face of stress; especially stress caused by disappointed or rejecting interpersonal experiences. When mentalizing collapses, confusion regarding one’s own thoughts and feelings and those of the other take over. This intensifies distressing emotions and any stable, secure sense of self is undermined. Distortions and distrust of the intentions of others is more likely, and impulsive behaviors occur often as a way to cope with chaotic and painful feelings.
Teaching individuals to mentalize consistently as a therapeutic intervention forms the core of Mentalization-Based Treatment. The mind of the client becomes the treatment focus and the goal is to enhance and strengthen the ability to mentalize. MBT continually focuses clients on understanding how they experience themselves and others and how those thoughts and feelings influence their behavior. This frequently includes reflecting on how difficulties and distortions in “reading” people can often lead to emotional overreactions and serious maladaptive actions. Our focus on continually improving mentalization capacity is meant to help people gain a comprehensive understanding of themselves including their emotional responses in certain contexts, mood changes and self-destructive behaviors. By also focusing on an understanding of the feelings and reactions of others, MBT can lead to a new, more objective perspective on the feelings and reactions of others.
PCH Treatment Center offers a mentalization track for clients experiencing emotional dysregulation. MBT components include individual psychotherapy, exploratory group therapy and psycho-educational group therapy.
Exposure and Response Prevention (ERP)
Exposure and Response Prevention is a form of behavioral therapy. Under supervision or on their own, a person is exposed to something that they fear (contamination, crowds) and then they are supported in refraining from their compulsion, avoidance, or escape behaviors (hand washing, fleeing). The exposure may be done indirectly, using verbal cues and imagination or directly.
This class uses a therapeutic style of yoga, which engages muscle, mind, body, and spirit. Therapeutic yoga assists in coping with stress by calming the nervous system, allowing the body to heal and recalibrate. The practice of yoga is not about getting a foot behind your head! Yoga at PCH is specifically designed to support emotional regulation, reduce stress and anxiety, while developing powerful self-soothing practices to quiet and calm both mind and body. Our focus is on finding safety in your body and building skills to ease the nervous system. Clients are introduced to different yoga postures that can be therapeutic in coping with depression, anxiety, trauma, and panic. Each class is meant to provide a safe space to get out of your head, recover from your day, and release tension. All students are fully supported in honoring their needs, and beginners are welcome.
At PCH, neurofeedback is used as a self-regulation program. During neurofeedback, brainwaves that are efficient for you will be reinforced/rewarded with positive sounds and sights (feedback). The brainwaves that are inefficient for you will be punished with harsher sounds and less appealing sights. The program is essentially retraining your brainwaves while you engage in certain activities (relaxing/focusing). It is helpful in practicing skills from yoga, mindfulness meditation, DBT, breathing exercises, visualizations, etc. Neurofeedback offers a place to apply and practice the various skills that are learned in other treatment modalities at PCH. You will gain awareness of your body, while retraining your brain to become more regulated, alert, calm and focused.
Clients are encouraged to share thoughts and emotions regarding their current mood and life situation, while receiving feedback and support from the facilitator and peers. Special attention is paid to group dynamics (what is going on in the room between peers) and how this relates to the clients in their lives, past and present, with friends, family members, romantic partners, and colleagues. Clients are able to work together to process their emotions and experiences both inside and outside the group dynamic.
Therapeutic Writing Group
Clients are given a short writing assignment, typically 10 minutes in length, which is then presented and shared with the group. These assignments may involve writing a short poem, narrative, letter, or diary entry. For example, “If my life were a fairy tale, it would be . . .” or “Write a letter of anger, gratitude or apology to a significant person in your life”. The facilitator and peers make observations about the client’s writing and assist the client in recognizing themes and issues, both past and present.
This group provides support, education and guidance for those who have been through any type of trauma, either as a child, adult or throughout life. We discuss what trauma is and how it affects one’s view of the world, their relationships and sense of safety, while providing techniques for coping through times of crisis. It is through this understanding that healing and hope is possible.
Food and Feelings Group
This group provides clients with a space to explore the thoughts and emotions that underlie obsessions with food, weight and body imagine. Individuals that are concerned or obsess over controlling their food intake, the shape of their body, the amount of calories consumed each day or how much exercise one participates in, tend to find this group beneficial. The unpleasant symptoms that get expressed through the body or the obsession to achieve an “ideal” body are often the manifestation of extreme pain and feelings of being out of control. Together we will address the deeper roots of these obsessive thoughts and the compulsions that accompany them.
Life Skills and Planning Group
Life Skills and Planning Group, or “Life Transitions” is an alternative for clients who have gone through a course of DBT, and aimed toward clients who are transitioning out of PCH and into the next phase of their lives. This group is more experiential than didactic, involving discussion, role play, and exercises, and the occasional handout. The focus is on “real life” solutions to current or upcoming problems and situations, e.g., a job interview, choice of career path to take, education, relationship, conflict resolution, and more, and incorporates elements of CBT, solution-focused therapy, stress management, and a touch of psychodrama and humor coupled with shared experiences and facilitator coaching.
This group allows an opportunity for clients to explore issues relating to their addiction in a safe non-judgmental environment. Clients that are in recovery from compulsive substance abuse and/or alcoholism are able to work through their issues of addiction, while the facilitator and other clients provide guidance and support. The format of these session will reflect some of these principles of the 12 Step program, however, clients are not required to attend meetings outside of PCH.
In Family Systems Group we explore the client’s family of origin and the components of that family system from the point of view and remembered experience of the client. The group helps to identify and articulate roles that were played by all the family members and patterns that developed over time. By bringing these into awareness, the client begins to see how those roles and patterns may continue to play out in the issues they are working on while in treatment.
The timeline group is an opportunity for community members to gather together and bear witness to the life history of another community member. In a wholly supportive atmosphere clients can, if they choose, relay to the rest of the group a chronological account of their lives, describing significant events and relationships in their life journey up until joining us at PCH. Clients are welcome to bring along pictures, symbols or play music that was significant to them at particular times. Each week a new member shares their history and then can move on to alternative groups in the program. Participation is encouraged but not required. However experience suggests that this can be a very healing part of the program, now running for a fifth year at PCH.
Coping with Shame and Anger Group
The objective of this group is to increase emotional intelligence surrounding two distressing emotions; shame and anger. Through group process, participants will learn to identify these emotions and create a language for how they experience shame and anger. In addition, participants learn to recognize their defensive reactions when triggered and develop new strategies for coping.
This group provides members with the most recent research on the cause, diagnosis, and treatment of bipolar disorder. Group members will also learn how to effectively cope with their diagnosis, how to accurately identify the symptoms of bipolar disorder, ways to manage and stabilize their mood, and methods to prevent the escalation into mania and the spiral into depression. This group provides mood management strategies that fit the unique psychological and biological needs of each member, allowing them to successfully pursue their life goals and ambitions.
Based on his book “Pop Your Patterns” by facilitator Seth Kadish, Psy.D. Group members begin to identify negative patterns of thought, emotion, and behavior through the use of written and experiential exercises. Through this identification, clients’ work together to establish ways in which they are able to diminish these habitual patterns by means of support and guidance from the facilitator. This is an important step on the road to personal transformation. Common patterns addressed include shame, low self-esteem, displaced anger, aggression, people-pleasing, caretaking, complaining, blaming, anxiety, depression, and many more.
Identity and Self Group
The Identity and Self Group is a semi-structured group in which clients are welcomed to explore topics that are involved in the exploration and development of one’s sense of self and identity. Topics include, but are not limited to: definition and development of self identity, as well as in their relation to others; distinguish their self boundaries, image, love, and the impact of their trauma on the sense of self. Clients are encouraged to share personally relevant examples of their experience with defining and discovering a true sense of self and identity. Group facilitation is conducted in an open-ended and process-oriented manner.
Clients learn about and practice “mindfulness”, which is loosely defined as “paying attention on purpose, moment-by-moment and non-judgmentally”. Using various mindfulness meditation techniques, guided visualization exercises and psycho-education, clients learn to identify a “triangle of awareness” which includes their thoughts, emotions and body sensations. This can enhance the ability to self-regulate feelings, increase frustration tolerance, and manage anxiety by learning how to be with one’s actual lived experience. Clients learn to identify repetitive and habitual thought patterns (such as comparing, judging, negative self-criticism, anxious anticipation of the future or regretful rumination on the past) in order to gain greater agency over where their minds go. In addition, many find “relief” from overactive and often cruel thoughts with calming techniques and specific meditations that foster compassion and acceptance.
Seeking Safety Group
This group is an evidenced-based treatment for PTSD, substance abuse, and other problem behaviors that stem from emotional dysregulation. With a primary emphasis on establishing safety, each week the group covers one of several topics that address coping skills relevant to these disorders. Some topics include Grounding, Asking For Help, Compassion, Honesty, and Healing From Anger. Through this skill training, clients are able to better regulate and control their emotions and subsequent actions.
Sleep Hygiene Group
This group provides members with the most recent and important research on sleep and reviews in a step-by-step manner the findings of major sleep centers across the United States. This group offers practical advice about sleep fitness and designs sleep hygiene protocols that meet the unique needs of each member, thereby providing the support to the elimination of insomnia and sleep related anxiety.
Coping with Grief and Loss
The Grief and Loss Group gives clients the opportunity to explore and process feelings related to the loss of a significant person in their lives, through death, break up, abandonment or traumatic circumstances. For some, the loss of a job, educational opportunity or even a beloved pet can be very difficult to process. The focus of the group is to help identify key losses and to put words to these experiences.
Suicide Resilience Group
This group is designed to reduce suicidal thinking and behavior through the development of emotional resilience. Group members actively collaborate with the group facilitator to create an atmosphere of safety and acceptance which allows for the full disclosure of the thoughts and feelings that drive suicidality: hopelessness, helplessness, worthlessness, and unrelenting emotional despair. This group builds long-term resilience by supporting group members in the development of cognitive flexibility/curiosity, grit/perseverance, mindfulness, self-compassion, happiness, and gratitude. This group serves to normalize and de-stigmatize suicidality by viewing suicidality as a coping mechanism and then provides effective and lasting strategies to reduce the risk factors associated with suicidality. This group meets for 60 minutes twice a week.
Anxiety Management Group
This group provides treatment for anxiety. The goal of the group is to offer support, education and guidance to those who struggle with anxiety by helping them gain more insight into their automatic thoughts, cognitive distortions, underlying assumptions and core beliefs and to reframe them as needed. Secondly, various stress management, emotional regulation and distress tolerance strategies are identified and discussed. Through in-group discussions, exercises and psychoeducation of different topics, clients gain a better understanding of their internal and external triggers. Topics discussed include, but are not limited to: differences between worry, anxiety and fear; need for perfection; need for certainty; acceptance and tolerance of uncomfortable feelings; mindfulness and relaxation exercises; primary and secondary feelings.
Smoking Cessation Group
Smoking is a behavior that is maintained by four different processes, making it a difficult behavior to change. The four processes are physical, social, behavioral and psychological. Each individual person’s addiction to smoking uses the various processes in more or less degrees. The clients who attend this group will identify which processes support their unique smoking behavior, impacting their ability to quit. After each person identifies what drives their smoking behavior, interventions will be designed by the group with the help of the facilitator to alter the particular process. Continued participation in the group will result in increased understanding, intervention and support to cease smoking.
PCH Alumni Group
The PCH alumni group is an opportunity for clients to continue therapeutic group services during transitional periods out of full-time care. The group is an opportunity for past and present clients to be able to stay in touch with familiar people and therapists whilst participating in a group setting. For a monthly commitment, the Alumni Group provides an opportunity for clients to share difficulties and success in a nonjudgemental atmosphere, building relationships of trust and support as clients adjust to new settings and situations in their lives.
Mentalization Based Family Support Group
Mentalization is a mental and emotional processing capacity by which we interpret behavior (both our own and others) as being driven or motivated by underlying mental states. It is the ability to see the inside story (the thoughts, feelings, intentions, etc.) that motivates people’s actions. This group will provide family members with an opportunity to develop greater mentalizing skills while also offering a supportive experience connecting families within the PCH community. The group is facilitated by Dr. Penelope Facher who is part of the Mentalization Based Treatment Program at PCH, where she leads mentalization groups with clients as well as providing individual therapy, family therapy, and consultation.