2022 Wrap Up & Exciting News for 2023
We've had an eventful year at Respire with some highlights including:
Welcoming 2 new Associates - Srijana and Erica!
Expanding our reach to support clients with Nepali and Hindi language capacity
Offering services to victims of violence through California Victims Compensation program
Website refresh to better reflect the growing practice
As we wrap up the year and look to 2023 we have some exciting new updates!
We are pleased to welcome Krista Gaston, LMFT to provide clinical supervision and join Respire as a licensed clinician serving adults, couples and families. Krista is a trauma informed systems specialist with experience working with children, adults, families and couples in a variety of settings including community based care. Krista also is a certified Eco-Therapist bringing an ecological paradigm to her therapy work. Welcome Krista!!
We look forward to continuing to serve our community supporting mental health and wellness in 2023!
Wishing everyone a healthy, joyous close to the year!
Getting to Know Respire: CBT
We’re back! After a short summer respite, we’re back on the blog with our next as promised topic CBT!
Cognitive Behavioral Therapy is an evidence based talk therapy approach to treatment that focuses on thoughts and behaviors as a means to reduce distress and impairments in functioning.
What: CBT has it’s roots in stoicism philosophy and developed from behavioral therapy (1920’s) and cognitive therapy (1960’s). Aaron Beck is credited as the founder of modern CBT applying it specifically for depression. CBT seeks to help understand and identify the “cognitive distortions” or unhealthy/helpful thought patterns that are present (i.e. catastrophizing, black & white thinking), the behaviors and beliefs that arise due to these distortions and develop skills to change actions related to these patterns. CBT has been widely studied and found highly effective for many presenting concerns including depression and anxiety.
How I use it: CBT can be an effective approach for many concerns. At Respire we often use CBT in conjunction with other approaches to target specific concerns. This may mean in session focused conversations about the type of distortions present and exploring and challenging those distortions. It might mean homework and workbooks to identify and track types of distortions or to test out new approaches or skills.
Application: A good example is work related anxiety. A client experiencing excessive, intrusive ruminative thoughts related to work on a Sunday evening may be experiencing catastrophizing distortions. We can explore the catastrophizing thoughts (i.e. “I am going to be so overwhelmed tomorrow will how much I have to get done, I won’t be able to get anything done”) and check out how true they are or what evidence we have (i.e. counting our tasks and estimating how much time they take, evaluating priority and deadlines). From there a client can identify alternative options or plans for addressing the issues (i.e. spend time at the beginning of the day making a task list and setting priorities for the day). We can practice thought stopping techniques to help client when the thoughts continue to intrude.
Training: CBT is a core theory taught in most degree programs and utilized in many practicums, internships, and post degree work settings. CBT is one of the more researched and validated therapeutics approaches and most clinicians will have some level of exposure to key components and how to utilize in therapy. I was trained in CBT throughout my education and then received years of hands on experience running CBT groups and working in CBT based treatment programs both residential and outpatient.
Getting to Know Respire: CFT
Compassion Focused Therapy or CFT is an integrative approach to therapy that holds a practice of compassion central to the healing process.
What: Developed by Dr. Paul Gilbert, CFT utilizes techniques to help clients challenge critical, negative, and unhelpful thought processes and build internal self-compassion and compassion for others while learning techniques to self-soothe integrated from CBT (check back next month for more on CBT) interventions and mindfulness practice. CFT is rooted in evolutionary psychology and neuroscience, using what we know about how our body and brain works to develop skills and promote healing.
How I use it: At Respire CFT is integrated with our Trauma Informed approach (see last month’s blog) to build safety and support clients from a welcoming, compassionate lens. CFT informed by cross-disciplinary research helps integrate and makes sense of what we know works for clients and the “Why” it works. I support clients in learning skills for self- and external compassion and self-soothing to support their goals.
Application: I find CFT particularly useful for client’s struggling with anxiety and toxic perfectionism that no longer serves their goals and well-being. Supporting clients in challenging -often long standing - beliefs and relational patterns with a compassionate lens can shift how people interact with and show up in their lives for the better. This might mean addressing burn out in the work place, conflict in relationships, chronic depression and anxiety. CFT focuses on exploring causality but just as importantly, building skills for changing the way one thinks and behaves to better align with who they are or who they want to be.
Training: I was introduced to Compassion Focused Therapy while involved with Stanford’s CCARE program (Center for Compassion and Altruism Research and Education) and supporting Dr. Philip Zimbardo while teaching his course for PsyD students at Palo Alto University. Dr. Gilbert was invited to provide a training that I was honored to attend. I subsequently read his book the Compassionate Mind and have sought additional training on integrating this model into my work. As a Supervisor, I support clinicians in learning this modality and integrating compassion into their approach with clients.
Getting to Know Respire: Trauma Informed Care
Trauma informed therapy is an approach to care that incorporates the effects of trauma on our lives including systemic and generational trauma such as racial violence and genocide.
What: Trauma informed clinicians seek to understand “what happened to you” as opposed to “what is wrong with you.” Trauma informed therapy holds several key principles: safety, transparency and trust, peer support, collaboration, empowerment, and cultural/historical and gender awareness.
How I use it: At Respire, trauma informed therapy is a mindset - how we approach everything. We integrate trauma informed principles into every step including the website, scheduling and fee process. We want to be transparent, safe, and collaborative from the moment we make contact throughout your therapy experience.
Application: In sessions this means allowing clients to make decisions about their own care, support them in creating relationships and accessing their community support, addressing relationship issues in therapy with compassion and non-judgement, and genuinely holding space for clients to process and explore the areas most important to their life. We work collaboratively to create a plan of care that helps you meet your goals including discussing appropriate frequency of meetings and offering flexible scheduling when available. We understand at the core that safety and relationship are the path to healing.
Training: I was introduced to trauma informed therapy while in graduate school and applied those principles while working with youth in a pediatric clinic. I received supervised training and experience while working at San Francisco's YMCA Urban Services providing support to youth with severe chronic truancy issues and then further experience while working with detained youth at San Francisco Juvenile Hall. I currently also work within the SFDPH system of care and receive regular training and experience working with folks impacted by trauma including community based and domestic violence. In 2019/2020 I pursued certification as a clinical trauma professional and maintain the certification through continuing education and experience annually. As a clinical supervisor I support my Associates in learning and applying these principles as clinicians and also seek to provide trauma informed clinical supervision, knowing many of our clinicians have experienced trauma themselves.
Getting to Know Respire: EFT
We’re back after a much needed respite in March and many exciting happenings at Respire! We’ve welcomed clinician Srijana Giri, AMFT to the team, expanding our capacity to serve folks including those seeking services in Nepali and Hindi. We’re gearing up to welcome more in the coming month!
In this month’s segment we’re looking at Emotional Freedom Technique or EFT.
Emotional Freedom Technique, EFT or “Tapping” is based on Eastern and alternative medicine practices including Chinese Acupuncture. The practice was taken by Western practitioners and developed in the 1990’s to fit a model of Empirically Supported Treatment (EST) used by western practitioners. The following represents EFT from a western perspective. Traditional medicine practitioners continue to practice today and provide valuable support to clients. Please reach out if you’d like support identifying a TCM practitioner.
What: Tapping “pressure” or “endpoints” on the body coupled with breathing techniques, affirmation repetition and scaling emotional distress rating
How I use it: I have found this to be a useful coping skill for my clients that are dealing with anxiety, symptoms of ADHD, and feelings of shame or guilt. I teach clients how to use EFT and discuss strategies for incorporating into practice. Client’s who find mindfulness or meditation to be challenging might find this practice a little more manageable.
Application: Client’s who struggle with symptoms of ADHD often report feeling difficulty in spaces where they need to sit and focus, reporting increased feelings of anxiety and physiological discomfort. Client’s have reported success when utilizing tapping in those situations, reducing feelings of anxiety and redirecting thoughts. In this case, I teach client’s how to use EFT points on just their hands and can practice just about anywhere, anytime.
Training: I was first introduced to EFT through a training in my graduate program. I have since participated in trainings and experiential exercises with several EFT practitioners in both personal and professional settings.
Getting to Know Respire: IFS
In this month’s segment we will explore IFS, which stands for Internal Family Systems. IFS is an evidenced based systemic, integrative therapeutic model developed by Dr. Richard Schwartz.
What: The model explores different “parts” of self that interact and have relationships with one another. The model encourages working toward the individual compassionately understanding these parts and how they impact their actions, emotions, and well-being. There are different types of parts that emerge with different goals, i.e. ‘protector’ parts that wish to protect the person from pain or negative outcomes.
How I use it: I find this model effective with several presenting concerns and utilize this model through conversation and experiential exercises. Often this looks like exploring what emotions are coming up and the thoughts attached to those emotions and learning how to name these patterns of emotion and thoughts as ‘parts’ of self. An example is a ‘perfectionist’ part that might hold fear based or pride emotions and is attached to thoughts such as “if I don’t do this perfectly I fail.” For clients that utilize journaling or art for healing, IFS exercises outside of the therapy room can be a beneficial enhancement to this work.
Application: For eating disorders, the ED self (and it’s subparts) can be a particularly dominating part interacting with other parts including critical self and often a part that identifies feeling like “too much”. In clients managing trauma, parts of self can include younger selves, angry, scared, and empowered parts. Exploring, naming, and giving space to each part of self to understand it’s motives and how it presents in our thoughts, feelings, and behaviors. The idea isn’t to “banish” but to heal with compassion.
Training: I was introduced to IFS in graduate school and then received training and supervision in this model while serving as a community based clinician working with youth and families in San Francisco. I have also completed further training applying IFS to trauma and Eating Disorder treatment.
Getting to Know Respire and Evidenced Based Care
When searching for a therapist, you might notice an abundance of acronyms - CBT, LPCC, LMFT, DBT, EFT, IFS, RO-DBT, MBCT, etc.*
Some acronyms refer to a clinician’s training and license and then others refer to a treatment modality - or how a clinician works and applies theory to practice.
You might find yourself googling or asking someone in the field what does it mean and how do I find someone that can help me?
Just as your concerns and reasons for seeking therapy are personal and individualized, so can be the therapist and the way they apply theory. How a clinician approaches the therapeutic relationship can have a big impact on whether therapy with that clinician will be successful for you.
With Respire clinicians, we hope to demystify and support clients in engaging with the therapist that is right for them. In this monthly series we will explore some of the modalities and techniques we use in therapy and how they might be applied from a clinician’s perspective. We will start off this year exploring a broader concept EBT’s or Evidence Based Treatment.
EBT’s - Evidenced Based Treatment
What are EBT’s?
EBT’s refers to utilizing treatment approaches that have been validated and studied in research. EBT’s generally are developed over the course of many years and based in well-established psychological principles. EBT might also refer to an individual clinician utilizing assessment and outcomes measures to help guide treatment and determine efficacy.
There are many EBT’s and what is considered an EBT changes with the research. CBT and DBT are two of the more well-known EBT’s utilized in mental health care - stay tuned for more on these in a later blog - but there are many. EBT’s can be a manualized approach, aka step by step, or psychodynamic meaning focused more on therapeutic relationship and experience approaches, among others. There are theories related to EBT’s including Common Factors model that looks more at how to determine efficacy and what are the key pieces in effective therapy.
How We Use It
We use EBTs throughout the course treatment starting from the first appointment utilizing bio-psycho-social assessment and standardized assessment measures to guide treatment planning. Our clinicians are trained in a variety of EBT modalities most commonly CBT, DBT, IFS, Mindfulness and Somatic Experiencing which we employ during session to support clients in their treatment goals.
Application
EBT’s really are applied across the therapeutic experience. One example of utilizing an EBT is working with a client experiencing anxiety with CBT thought stopping techniques to help manage the distressing experience of ruminative or intrusive thoughts.
Training
EBT’s are generally the primary focus of a clinician’s graduate education with different programs focusing on different EBT’s. Clinicians are also required to engage in continuing education which often involves training and learning about EBT’s and keeping updated on the research. During supervision, we discuss application of EBT’s and explore further educational experiences to enhance a clinician’s depth and breadth of knowledge about the EFT’s they utilize.
(* CBT- Cognitive Behavioral Therapy, LPCC - Licensed Professional Clinical Counselor, LMFT - Licensed Marriage and Family Therapist, DBT - Dialectical Behavior Therapy, IFS - Internal Family Systems, RO-DBT - Radically Open Dialectical Behavior Therapy, MBCT - Mindfulness Based Cognitive Therapy)
Written by Cora Keene, LMFT CCTP
Founder of Respire Therapy
Tips for managing stress in Quarantine.
Living in San Francisco, California (and all over the world) is a getting a bit stressful. Everything is shutting down, we’re being told to work from home, and the crux of what draws many to live here -our social events- are being cancelled. Covid-19 or Corona virus is significantly impacting the way we live our lives and for many in this uber expensive city, our livelihoods.
I think it goes without saying that mental health concerns don’t just suddenly go away and previously managed mental health distress may be increasing with these new stressors. For those already dealing with feelings of social disconnectedness, depression, anxiety… this transition to a new “normal” may be overwhelming.
So how do you cope in a time of ‘novel’ experience? I’ve compiled some “tips” that I offer clients for managing new and old distress that may arise. All of these suggestions are just that - suggestions- please take what helps and leave the rest. Share, build, and expand for what works for you:
Stay connected. Call that friend on the other side of the country you’ve been meaning to check in with. Call your grandma, your dad, you great uncle. Join an online support group. Create a group chat with your friends. Send funny memes to your co-worker. Whatever it is, stay connected socially. The small and sometimes mundane things are important to maintaining our feelings of social connectedness. And with that, it’s ok to put down the news or stop checking Facebook! Self-care!
Remember the basics. Food, shelter, sleep. Keep a regular schedule of feeding yourself - even if you are moving less, you still need to eat. Pay attention to your hunger cues and plan meals accordingly. Your body can tell you what it needs. Keep your space in a way that helps you feel centered. Take the time to tidy or rearrange. You may have “just a closet” but it’s your closet. Talk with your roommates about navigating changes in schedules and space. Sleep. This one is huge and easy to get pushed aside. Continue to rest and allow yourself regular sleep. It can help you cope with stress, anxiety, and transitions. You may need more right now and that is ok.
Continue to move. Dance in your living room (or where ever you have space!). Stretch out. Pull up a youtube yoga video. Let yourself have the silly wiggles for a minute. Breath deep slow breaths. Set reminders to move in ways that work for your body, acknowledging how that movement might look different for a while.
Positive Coping Skills. This is a perfect time to try that new coping skill. Meditation. Tapping or Emotional Freedom Technique. Qi Gong. Make music. Video gaming. Even though you might be working from home, you still get time off! This is self-care and you deserve it.
Remember that this is likely temporary. Remember that you cannot control it. Remember that you are not alone. Remember you are enough.
And finally… ASK FOR SUPPORT. There is community in this. You are not alone. You are not a burden. Many people are struggling and not just emotionally. This virus is impacting how many earn their livelihoods. We can work together to support our community. We will be better together (but 6ft apart!)