Deer Creek Psychological Associates: Interventions

Adoption and Attachment Counseling

Adoption involves complex relationships and emotions among those involved, including the adoptee, the adoptive parent(s), and birth parents. Adopted children understand adoption in different ways, depending upon their developmental age and stage, and their understanding changes over the life span. It is important that children have as much information about their adoption as possible to help them incorporate their cultural heritage into their identity as they strive to integrate their biological and adoptive roots.

The dynamics involved in adoption are complicated and it is beneficial for all involved to communicate about these issues. It is often easier to share the joy and blessings involved than it is to explore the loss, grief, confusion, sadness, anger, rage, and fear of further abandonment that may accompany adoption. For some, this kind of communication comes easy, for others, it is more difficult. Sometimes children express these emotions through their behavior and it can be difficult for the adoptive parent to help the child process these emotions because they are an integral part of it.

Deer Creek clinicians work with families created by adoption to learn ways to identify and process these complex dynamics; to explore and understand the possible behavioral manifestations and emotional outbursts; to help the family talk openly talk about adoption and the adoptee’s biological family and early beginnings; and to consider options for learning more about the biological family. As the process deepens, the clinician helps the family explore and understand the depth of the fear, anger, grief, and shame that may be involved and means for healing. The clinician works with the family members together; assigns readings; and helps create activities to practice and incorporate into the family’s daily routines.

Attachment is a term that describes the state and quality of an individual’s emotional ties to another person (Becker-Weidman, Arthur; Dyadic Developmental Psychotherapy: The Theory, Creating Capacity for Attachment, 2005). The capacity to become attached or become emotionally tied with another occurs in infancy as the child develops an attuned, reciprocal relationship with at least one primary caregiver. Usually infants become attached to sensitive and responsive adults who remain as consistent caregivers for many months during the first two years. A primary goal of the attachment process is to provide a secure base from which the child can explore the outside world and return for nurturance, reassurance, and refueling. For some adopted children, this normal developmental process has been interrupted by early abuse and trauma or by the adoption process. When this occurs, the adoptive parents must become the responsive, sensitive, and attuned attachment figure, replacing those the infant has lost.

Deer Creek clinicians work with the parent(s) and child during each session to learn and practice interactions, communication, and activities that help facilitate attachment. The clinician creates a safe place and guides the parent(s) and child to learn to tolerate and validate the emotions that arise. During the sessions, the parent learns how to attune with the child, regardless of the emotion, and with the connection established therein, helps the child learn to regulate the emotional expression. The clinician guides the parent and child in establishing and maintaining eye contact, speaking with each other, acknowledging and naming emotions, and thereby processing the early concerns that make this kind of attunement difficult for the child. The therapist also organizes the sessions to include breaks from such intimacy and intensity through the establishment of a playful and fun environment, and other activities that teach self-regulation.


Adult and Geriatric Counseling

Adult counseling addresses the concern of adolescents transitioning into adulthood, adults, and senior citizens. Specialties include the treatment of anxiety and depression; life transitions; relationship difficulties; grief and loss.

Deer Creek clinicians use Cognitive Behavioral Therapy, with elements drawn from Cognitive Therapy, Behavioral Activation, Interpersonal Therapy, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Narrative Therapy.

The clinicians work with clients to help them understand how their difficulties developed, and to devise practical thinking and action strategies that may diminish their suffering; increase their tolerance for people and circumstances that cannot be changed; and help them mourn losses; focus on positives remaining in their lives; and incorporate new positive activities and thoughts into daily living.

Your counselor will help you to set goals and to move towards them. You will be taught strategies you can use to understand and cope with future or continuing difficulties.

Behavioral Activation is used with some clients. This method involves helping clients to identify activities that they have enjoyed, do enjoy, or think they might enjoy, and then to set simple, concrete goals to incorporate one activity at a time into their schedules. It can also focus on beginning an exercise program, using physical activities that the client enjoys, and/or pairing physical activity with other pleasurable things, such as social connection, music, an appealing or supportive setting, etc. Physical activity has been shown to improve mood when done on a regular basis- often, as much as or more than an antidepressant.

Finally, positive attentional focus is always a goal of therapy, balanced with the ability to squarely face the realities of life.


Child, Adolescent and Family Counseling

Child, Adolescent and/or Family therapy are treatment options that your clinician may recommend after an initial appointment. The recommended treatment will depend on the presenting issues or problems, age of the child, concerns about other family members, and the clinician’s assessment of particular strengths or challenges the child displays. With younger children (ages eight and younger) we often find it is productive to have the parent present during the session so than can reinforce strategies at home and in the community. As children mature, often the parent is not present in the session after the initial appointment but will join appointments periodically to provide input and receive updates.

After several appointments, treatment goals emerge and become the focus of sessions. Various strategies may be implemented to reinforce the messages of treatment between sessions and may or may not include sessions with parents and child together, child alone, or consultation with parents and child not present. These decisions are based upon many factors and the final format of treatment may evolve over a number of sessions. The frequency of sessions may also be variable. Whereas with adult psychotherapy, weekly sessions for a period are often elected, treating children and adolescents often is best accomplished with less frequent contact since weekly appointments may be overwhelming to children and not allow enough time for strategies to be implemented and reviewed. Meeting twice per month after an initial period of more frequent sessions is often a productive mode.

Clinicians who treat children and adolescents often find it helpful to coordinate services with the child’s school, especially when the presenting problem(s) involve educational, social, or behavioral concerns during the school day. Management of such communication is critical and most often the clinician is seeking vital information from school rather than sharing information learned in session. When more comprehensive communication with school is indicated, the clinician may join a team meeting at school to coordinate efforts. Any communication with school or other outside agencies would always be discussed in advance with the parents and the child/adolescent, and a release of information would need to be signed before the clinician could talk to an outside party.

Treatment generally ends in a gradual fashion with the frequency of sessions tapering. Some parents or clients will elect to return to treatment at a future date and this often is effective if a strong working relationship was established initially.


Chronic Illness Counseling

Advances in medical care and technology have led to improved care and better longevity for youths and adults with chronic medical conditions. Medical providers are often ill-equipped to help, however, when it comes to supporting individuals with the psychological aspects of living with a chronic medical condition. Physicians and other medical providers often say their training did not adequately prepare them to manage the psychological/social aspects of chronic care and state that patients with chronic medical conditions frequently have mental health needs that are not being met.

Individual treatment by our therapists focusing on helping youth and adults managing chronic medical conditions can help with some of the following:

Addressing the impact of physical and psychological effects of the illness on both the individual and the family, strategies for improved self-management of your/your child’s chronic condition, enhancing communication with your doctors, maintaining emotional balance to cope with negative feelings, strategies for managing anxiety and depression associated with the stress of managing a chronic condition, and building strength and resiliency within the individual and family.


Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) includes many types of psychotherapy that blend behavioral psychology and cognitive psychology principles. Behavioral psychology typically sees behavior change as a function of reinforcement either by expectation of rewards or punishment. The key word is expectation, a mental process. How people form their expectations is the focus of cognitive psychology. Expectations are a complicated mix of feelings, past experience, motivations, social context, hopes, etc. Therefore, CBT explores all of these thoughts (cognitions), feeling memories, etc, and uses cognitive and behavioral psychology techniques to reinforce the adaptive shifts that would increase the chances for making important changes.

Another facet of CBT is the use of homework, that is, clients are often asked to practice a skill, keep records of events, ratings of feelings, use of a strategy, etc., outside of the session. The record gives the therapist a running account that often gives clues to a client’s unique problems to adjust the strategies. In this way the therapist and the client form a partnership for understanding the problem finding solutions in real world situations.

CBT is often cited in evidenced based therapy research studies as equivalent to or more helpful than medications for treatment of depression, anxiety, addictions, trauma, Obsessive Compulsive Disorder and Borderline Personality Disorder. CBT also has shown to have lasting effects beyond the initial treatment period.

Finally, CBT uses many types of therapies such as: Rational-Emotive Behavior Therapy (REBT), Cognitive Therapy (CT), Behavioral Medicine, Dialectical Behavior Therapy (DBT), Mindfulness Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT), Behavioral Activation, and Eye Movement Desensitization Reprocessing (EMDR). Each of these was developed for specific populations or disorders. The variety of approaches is not surprising because CBT is evolving rapidly as new neuroimaging studies reveal the brain processing and structural changes that come with these therapies.

We at DCPA strongly suggest that you talk with any prospective therapist about your concerns and questions about psychotherapy or psychological testing. We believe that therapy or testing should fit the client’s needs and not the other way around.


Educational Testing

Through a battery of individually-administered, nationally normed tests, an evaluator can determine what a student’s cognitive strengths and weaknesses are and how these can impact upon a child’s academic learning. Cognitive, (or intellectual), testing is usually the first step. These tests provide an abundance of information about a child’s cognitive processing skills including, but not limited to, verbal ability, spatial ability, nonverbal reasoning, processing speed and memory skills. An evaluator can further test in these and other areas if it is warranted; for instance, memory skills are an area in which an evaluator often does additional testing. An evaluator can also assess through both tests and rating forms a student’s executive function skills, or the cognitive processes required to plan and direct activities, such as initiating tasks, shifting between tasks, using working memory, sustaining attention, monitoring performance, inhibiting impulses, controlling emotions, and organizing materials.

An evaluator will also do academic testing to look at the student’s reading, writing, math, listening, and expression skills. Again, a variety of tests can be used to look at different aspects of a student’s academic learning. By examining the cognitive processing and academic information together, the evaluator can make recommendations on how to strengthen a child’s academic learning either through modifications or curricular changes. The data gathered through educational testing is typically used by the student’s educational team to determine eligibly for special services and to establish appropriate program goals.


Emotional Freedom Technique (EFT)

Emotional Freedom Technique (EFT) is an energy-psychology technique used for reducing stress and the intensity of negative emotions such as anxiety, fear, anger, prolonged or exacerbated grief and traumatic memory. It reduces the psychological pain associated with stressful experiences, mood disorders and the negative thought and/or behavior patterns that typically prompt people to seek psychotherapy. It can also be beneficial for the relief of physical symptoms and the management of chronic pain.

EFT was developed by Gary Craig in 2003 out of several fields, most notably Thought Field Therapy (TFT), Kinesiology, quantum physics and Chinese meridian therapies. Most simply explained, it relies on neuro-linguistic programming (using language to focus the thoughts) and acupressure (performed by the client and led by the clinician) to relieve the negative emotional intensity associated with painful experiences which may be contributing to unwanted thoughts, feelings, behaviors and in some cases physical ailments. It utilizes some of the same principles as traditional psychotherapy and Cognitive Behavioral Therapy but has the advantage of usually bringing about more rapid change, often immediately or shortly after treatment is initiated. Once learned, clients can apply the technique to a wide range of situations in their everyday lives to reduce stress and improve their overall sense of wellbeing.

Because EFT is relatively new, it is still being researched. In the meantime, client testimonials have been extremely encouraging and there are no known cases where a result has been considered detrimental. However, as with any treatment, individual results are variable. As with traditional talk therapy, you may experience the surfacing of painful emotions that have been buried, but EFT is designed to address and relieve these underlying issues as well and produce greater overall emotional resilience. As with psychotherapy, EFT is a collaborative effort between client and clinician, such that client investment is essential to the final result. If you feel the need to do so, please check with your health care professional about the advisability of this type of meridian based therapy.

If you wish to learn more about EFT, visit: www.emofree.com


Eye Movement Desensitization Reprocessing (EMDR)

EMDR stands for “eye movement desensitization and reprocessing” and is a fairly new treatment for traumatic memories. To explain EMDR, it helps to explain what would bring a person to therapy after a trauma or loss. Although some people are able to work through a trauma or loss and come out stronger, others seem to get stuck. Along with getting stuck, comes a variety of distressing symptoms, which could include nightmares, depression, anxiety and other problems. A therapist can help you to get unstuck, and work through the memory piece by piece, until you are finally “over” it. Unfortunately, this process can take many months, and while most people get at least somewhat better, some of the problems can stubbornly hang on.

With EMDR the process seems to go much more quickly. The EMDR session itself is different for each person, but can be very emotionally intense. The patient is asked to concentrate on the worst part of the upsetting memory, while moving the eyes back and forth by following the therapist’s finger. It is actually a lot more complicated than that, which is why specialized EMDR training is very important. Often an upsetting memory can be worked through in one to three sessions. And the results seem to be more consistent, with symptoms usually completely disappearing.

Even though the treatment is fairly new, the research results are positive. The controlled studies have been showing that EMDR is really as good as it sounds, for working through a single traumatic memory. There is not enough research on other uses yet. Ricky Greenwald just co-authored a first controlled study using EMDR with children, which also had very good results in just one session.

Just remember that EMDR is just one tool to be used by a trained therapist. It is important to work with a therapist that you trust, who will know when to suggest EMDR and when to use other approaches.


Neurological Evaluation

A neuro-developmental evaluation comprises a complete neurological assessment, including tests of mental abilities, verbal and communication skills, and tests of sensory and motor function, placed within the context of a child/adolescent’s developmental age. This assessment seeks to determine if there are underlying biological and/or structural causes for often complex events and behaviors. A neurological assessment can be useful in determining the nature of a child’s learning challenges, when testing for specific learning disability has not been conclusive.

An autism-specific evaluation focuses on the child’s developmental history within the first 5 years of life, as well as his/her current social, language, communicative, and motor planning abilities, in order to determine the presence of a spectrum disorder. In these cases, it is important to “rule in/out” other distinct conditions which can give rise to autistic behaviors or symptoms. The neurologist also seeks to determine whether there are co-morbid conditions that could further impact on the student’s function or well-being.


Neuropsychological Evaluation

A neuropsychological evaluation tests a client’s functioning in many areas of cognitive functioning, including intelligence, academic achievement, language processing, memory, visual perception and organizational skills, processing speed, attention, executive skills, fine motor skills, and emotional functioning. The clinician is often asked to assess a student for an autism spectrum disorder such as autism, Asperger’s disorder, and Pervasive Developmental Disorder, not otherwise specified (PDD-NOS). This involves an assessment of reciprocal social interactions and communication skills. This test typically incorporates the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) which are both specifically tailored for assessment of autism spectrum disorders. Adaptive functioning is also assessed by means of a questionnaire that is completed by parents and teachers, often the Vineland Adaptive Scales or the Adaptive Behavior Assessment Systems (ABAS).

Information needed to be provided before this testing can take place includes: relevant historical records such as academic and/or medical records. Any records that are given to the clinician will either be returned to the sender (if requested), or will remain in the client’s chart for ten years, after which time the chart is destroyed

Before beginning an assessment, the clinician will discuss the nature of the referral questions with educators and parents. Many schools and parents have specific questions for the clinician to address in the evaluation, and specific types of assessments for the clinician to administer. All neurological evaluations performed by the Deer Creek Psychological clinicians meet the guidelines set forth by Vermont and New Hampshire school districts for assessment of learning disabilities, autism, and/or ADHD.

A written report of the evaluation findings, strategies, recommendations and diagnosis is completed by the clinician usually within a three-six week period after the testing is completed. This report is released to the person, school or agency financially responsible.


Psychodynamic Psychotherapy

Modern psychodynamic psychotherapy is a unique form of intensive psychotherapy that alleviates emotional and mental suffering through an in-depth exploration of the client’s life. In psychodynamic therapy, client and therapist collaborate to understand the meaning of the client’s emotional reactions, thoughts, memories, fantasies, dreams, images, and sensations. As a team, the therapist and client seek to discover repetitive, unsatisfying patterns of living. In this form of therapy the client leads the way and is invited to say whatever is on his or her mind. The therapist primarily listens and offers hypotheses in an effort to enrich the client’s understanding of themselves and move them forward in their lives. Typically this form of therapy fosters a restorative relationship between the therapist and the client. Psychodynamic psychotherapy is process-based, open-ended, and may be lengthy, because understanding the nuanced complexities of a client’s life takes time. Often this therapy is helpful when clients have not responded well to more directive treatments. Psychodynamic psychotherapy has a well established tradition and is practiced worldwide.


Psychological Evaluation

A Psychological Evaluation is performed by a licensed psychologist to assess a problem or clarify the cause of the cognitive, emotional, attentional or behavioral difficulty. The purpose is to understand a child, adolescent or adult’s personality characteristics to assist in diagnosis or treatment interventions. This type of evaluation consists of several components: Clarifying the presenting problem or reason for the referral, gathering information via clinical interview with client (child, parent, teacher, etc), and tests that measure moods, personality, intelligence or ability. The evaluator integrates information gained from interview and testing to create a clinical picture that can assist in diagnosis, treatment considerations and/or educational recommendations.


Sensorimotor Psychotherapy

Traditional psychotherapy addresses the cognitive and emotional elements of trauma, but lacks techniques that work directly with the physiological elements, despite research findings that trauma profoundly affects the body and that many symptoms of traumatized individuals are somatically driven. Unassimilated somatic (bodily) responses evoked in trauma involving both arousal and defensive responses are shown to contribute to many PTSD symptoms and to be critical elements in the use of Sensorimotor Psychotherapy.

Sensorimotor Psychotherapy Training presents simple body-oriented interventions for tracking, naming and safely exploring trauma-related somatic activation, creating new competencies and restoring a somatic sense of self. Clients will learn effective, accessible interventions for identifying and working with disruptive somatic patterns, disturbed cognitive and emotional processing, and the fragmented sense of self that they experienced because of their trauma. Techniques are taught within a phase-oriented treatment approach, focusing first on stabilization and symptom reduction.

Sensorimotor Psychotherapy identifies two general kinds of interrelated psychological issues: developmental and traumatic. Developmental issues result from disturbed early attachment relationships that lead to limiting beliefs about oneself and the world, while post-traumatic stress disorder results from overwhelming experience that remains unintegrated. When combined with unresolved trauma, early attachment disturbances can lead to a wide variety of adult relational problems. Treatment focuses on how traumatic, attachment, and developmental issues influence one another, and how to provide effective treatment given their inevitable intertwining.

Sensorimotor Psychotherapy techniques are uniquely suited for clients with complex symptoms and disorders. Complex trauma and Borderline Personality Disorder clients benefit from the emphasis on mindfulness and present day focus, while dissociative disorder clients benefit from working with the body that is a shared whole for all parts. Despite the fact that more complex clients can be body-phobic or have difficulty with movement and action, Sensorimotor techniques can be adapted to suit their special requirements. Slowing down the pace, working with ‘slivers’ of information, combining body and parts work, increasing the amount of repetition and practice all contribute to expanding the Window of Tolerance.

Before starting this therapy it is important to discuss with your therapist all the questions you have and see if this will be a good therapy for you and answer any treatment questions you may have. This is a new therapy, but there is a useful book written by Pat Ogden, Kekuni Minton and Clare Pane: Trauma and the Body.


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