“If I had a medical problem, such as trouble breathing, I would go to my doctor and ask for the treatment that research has shown to be the most effective. The same should hold true for emotional problems.” – Judith Beck

Cognitive Behavior Therapy (CBT) is a form of psychotherapy that has been rigorously tested and found to be effective in clinical trials for a variety of mental health conditions.  It’s very structured, focused on the present, and usually time-limited.  In CBT, clients and therapists work together to solve problems and practice life skills.  These might include identifying unhelpful thoughts running through your head or recognizing when you’re about to do something that will make you feel worse (and choosing to do something more helpful instead.)

Many therapists utilize CBT techniques while working with clients.  As a certified CBT therapist through the Academy of Cognitive Therapy, it’s important for me to discuss the pros-and-cons of adherent CBT with my clients.  A formal session of CBT looks like this:

• • Mood Check – Your therapist will always ask you to determine how you’ve felt this week versus other weeks.
  • Agenda Development – Throw everything the client and therapist want to discuss onto an agenda so we can make the best use of our time and make sure we cover everything we want to in the session.
  • Bridge– Follow up on loose ends from the previous session, as well as how the Action Plan from last time worked out.
  • Session Content – Tackling the issues and topics on the agenda, including assessing the accuracy of your thoughts and beliefs during stressful situations, looking at how your thoughts and feelings drive your behaviors, and developing new coping skills.
  • Action Plan – Develop an action plan to help you cope with the coming week.  This might include tracking data on a log, writing things out, or being proactive in other ways.  If there are barriers in implementing the plan, we can address them the following session.
  • Wrap Up– Review the whole of the session, in which client can give therapist feedback on what is working and what isn’t and both can check in on overall goals.

As a certified cognitive therapist, I’ve seen the structure of CBT really benefit many clients with a diverse range of concerns– including perfectionism, uncontrollable worry, flashbacks of past traumas, self-destructive habits, self-criticism, and unnecessary guilt.   It’s a proactive and pragmatic modality.  The focus on problem solving, developing an agenda, and addressing present needs can be very empowering for clients and carry through to in-depth therapy work.  It’s also a really collaborative model that prioritizes what the client wants to get out of treatment.

Additional Reading on Cognitive Behavioral Therapy

The Academy of Cognitive Therapy trains and certifies cognitive therapists and was the entity that certified me in 2017.  Their site has extensive information on the practice of Cognitive Behavioral Therapy, as well as a database of clinicians.

Feeling Good by Dr. Dan Burns is a classic self-help book on CBT.  He identifies Cognitive Distortions in a clear and succinct way.  He also has a well-regarded TED Talk on CBT.

CBT Radio is a podcast for profesionals and consumers about all things CBT.

UCLA Bright Manual is a free CBT group therapy manual for providers to implement.  This program is a part of the Community Partners of Care Initiative at the UCLA Semel Center for Health Services and Society.

“We do not have any data indicating that people who are dead lead better lives.” -Marsha Linehan

Dialectical Behavioral Therapy (DBT) is an evidence based psychotherapy intervention designed to help folks improve their problem solving and achieve a “life worth living.”

This therapy places an emphasis on the concept of dialectics–the idea that two opposite or contradictory ideas can exist at the same time and both be true.  It’s about embracing uncertainty and the grey areas of life, rather than clinging to black-and-white thinking.  It’s about accepting who you are while changing misery-generating behaviors in your life.

DBT is a behavioral therapy that focuses on decreasing unhelpful coping behaviors and increasing the use of healthy coping skills.  Emphasis is placed on picking up coping skills from these dimensions:

• Mindfulness – Being aware of the present moment without judgement.
• Emotional Regulation – Understanding and reducing vulnerability to unwanted emotions; changing unwanted emotions.
• Distress Tolerance – Getting through tough times without making things worse; accepting reality as it is (even if you don’t approve of it or like it.)
• Interpersonal Effectiveness – Meeting your relationship objectives and goals, sustaining healthy relationships, and increasing your self respect when interacting with others.

“DBT-informed” Therapy

I was trained by Dr. Lynn McFarr at Harbor UCLA to deliver adherent, comprehensive Dialectical Behavioral Therapy for low-income clients at the Los Angeles County Department of Mental Health.  I also trained and supervised Master’s level interns from UCLA and USC in the delivery of DBT.

Comprehensive, adherent DBT programs are a huge commitment and also very rewarding.  Comprehensive DBT looks like this:

• You see the same therapist 1-on-1, an hour a week, for at least whole year.
• In addition to working face-to-face, your therapist will provide coaching on how to use coping skills over the phone.
• You are enrolled in a weekly 90 minutes Skills Group class to help increase your coping capabilities.
• It’s built in to the treatment that all of the clinicians involved in your care will consult with one another.  This is so they can make sure they’re motivated and able to collaborate with you on your treatment.

No matter who you see for psychotherapy, please be aware that individual therapy without concurrent DBT skills group, phone coaching, and consultation is not actual DBT.  It’s important that mental health consumers and providers know the difference.  

I also want to be clear that comprehensive, adherent Dialectical Behavioral Therapy is the gold standard of treatment–especially for folks at serious risk of suicide, self injury, or psychiatric hospitalization.  If I feel you would benefit from comprehensive DBT, I owe it to you to inform you of my assessment–even if it means losing you as a client.  You deserve the best, evidence-based care that you can get.

That being said, I’m excited to discuss how DBT-informed treatment may be helpful for you!  Although I am not currently equipped to provide comprehensive DBT, what I can provide is “DBT-informed” treatment.  I frequently use the methods or structure of DBT to help clients develop new coping skills or to modify unhelpful coping behaviors.  These skills are helpful for a number of concerns–especially to reduce the frequency of behaviors that create additional suffering in your life.

DBT Resources

Resources for Comprehensive DBT Treatment in the Los Angeles Area

PROGRAMS THAT ACCEPT INSURANCE

• • Clearview Treatment Center has inpatient and outpatient DBT programs, including programs for individuals with co-occurring substance abuse disorders.  They are in-network for Anthem Blue Cross.
  • Kaiser Mental Health offers in-house DBT programs for members with Kaiser insurance; some of these programs are comprehensive and others are DBT-informed (such as a DBT skills group.)  

PROGRAMS THAT MAY BE REIMBURSABLE BY INSURANCE

• • DBT California is an outpatient program in Beverly Hills and Torrance.  They are out-of-network but can provide invoices for PPO reimbursement.
  • Westside DBT is an outpatient program located in Sawtelle.  They are out-of-network but can provide invoices for PPO reimbursement.
  • San Fernando Valley DBT is an outpatient program located in Sherman Oaks.
  • DBT Associates of Southern California is an outpatient program located in Westwood.
  • DBT Center of the South Bay is an outpatient program located in Torrance.

PROGRAMS FOR LOW INCOME INDIVIDUALS

• • Los Angeles County Department of Mental Health offers DBT to Medi-Cal and Medicare patients at it’s directly operated clinics, including Harbor UCLA Medical Center, West Valley Mental Health Center, Rio Hondo Mental Health Center, and Edelman Westside Mental Health Center.  Please contact the main referral line at 1-800-854-7771 or go to the website to determine which clinic will be closest to you.
  • UCLA Psychology Clinic offers a DBT group for adults with difficulties in their emotions or relationships.  It’s sliding scale and costs as little as $5-$10 a session. Current UCLA students, faculty, and staff receive a 10% discount on therapy services. (This program is not offered through UCLA Health but through the academic side of things at the University, via the Department of Psychology.)

Many of these programs have wait lists, but they are well worth the wait.

Many of these programs are expensive; some may have sliding scale or hardship scholarships for financially needy clients who demonstrate determination and commitment to therapy.  It’s worth it to inquire.

Additional Recommended Reading on DBT

The Dialectical Behavior Therapy Skills Workbook by Matthew McKay is a great resource for DBT self-study.  The publisher, New Harbinger Publications, also has workbooks for DBT applied to specific issues such as Anger, Anxiety, and Bipolar disorder.  [Amazon]  [LA Public Library]

Borderline by Mishell Baker is an urban fantasy novel starring a protagonist with borderline personality disorder.  Filmmaker Millie Roper is recruited by a shadowy organization to solve a Faerie murder mystery in Hollywood.  Throughout the book trilogy, Millie uses her sarcasm, quick thinking (and some coping skills learned from DBT) to solve mysteries and prevent an arcane civil war.  If self-help books make you yawn, this trilogy of books should keep you reading–and you’ll learn a lot about how DBT helps folks cope with things like social rejection and arguments with your friend’s pet dragon.  [Amazon] [LA Public Library]

BehavioralTech.com is the official website for Dialectical Behavioral Therapy and it’s creator Marsha Linehan.

Radically Open.net, a website about Radically Open DBT (aka RO-DBT), DBT-inspired interventions for people with excessive self control.  

“The curious paradox is that when I accept myself just as I am, then I can change.” – Carl Rogers

I practice Anti-Oppressive Social Work, primarily informed by humanistic, feminist, and anti-racist social justice oriented approaches.

A Humanistic approach to psychotherapy operates under the assumption that you are innately capable of developing your potential and taking charge of your own life.

In a Humanistic therapy relationship, the client and therapist have a relationship that has:

• • Respect for the client’s cultural values and freedom of choices.
  • Therapists work to understand the client’s life and experiences.
  • Collaborative and authentic therapy sessions where we approach each other as equals.
  • Negotiation of a contract by formally or informally asking, “Where do we go from here?”

Feminist & Critical Race Theory in Therapy

“More generally, identity‐conscious perspectives help to illuminate how racial power infuses other phenomena – for example, merit, choice, emotion, and methods – that mainstream psychological perspectives portray as race‐neutral.” – Phia Salter

Personally and professionally, it’s been important for me to be conscious of how “mental health” is constructed in society and how expectations around wellness impact people who hold subordinated (“minority”) identities, as well as people who hold identities that allow them access to cultural and societal privileges.

In order to be effective as a social worker, I need to have a grasp on feminist and critical race theory praxis, especially since the mental health profession has historically enacted violence* on people with targeted identities in our society.  For example, both feminist social work and critical race theory would posit that you, the client, are the expert in your own life and that your story and perspectives matter.    Additionally, these paradigms encourage providers to be open to other ways of knowing and understanding.

*(Not an exaggeration–from insane asylums for punishing rebellious wives, pathologization of sexual orientation and gender identity, disproportionate overdiagnosis of people of color, inhumane treatment of immigrants with mental illnesses, dismissal of traumatized veterans, jails as mental health treatment for lower income individuals–the list goes on.)

Since existing USAmerican mental health systems were designed–whether deliberately or not–to center around the experiences of educated, upper-middle class, white American individuals–a lot of folks have fallen through the cracks.  Insurance might hold out if someone doesn’t meet diagnostic criteria, but what if the screening tools are not normed to your cultural or racial group?  And, frankly,  as a cognitive therapist, I can see how CBT’s emphasis and cognitive distortions and “thinking errors” could easily lead to inadvertent pathologization of survival strategies or invalidation of lived realities.  Also, as much as I have seen DBT improve clients’ lives, the modality can overlook how the ability to deploy those skills–or how clients are received by others when they are trying to be skillful–is impacted by the intersecting identities they hold.

I know stating this on my website is a form of self-disclosure and it may turn some folks off; I also believe that not explicitly stating a commitment to social justice is still a form of disclosure.  I debated about putting this up here, and ultimately decided that since my clients are brave with me in the therapy room, I can be brave enough to put this out there on my website.

These values empower and enrich psychotherapy–which is great because they also dovetail nicely with social work professional ethics around social justice and viewing individuals in a cultural, historical, and contemporary socio-political context.  Our stories are important–especially those that are unheard and unacknowledged in dominant narratives.

Additional Recommended Reading

Enhancing the Cultural Sensitivity of Cognitive Behavioral Interventions for Anxiety in Diverse Populations is a paper that discuses how multicultural perspectives can be applied to the delivery of Cognitive Behavioral Therapy.

Towards a Critical Race Psychology by Phia Salter and Glenn Adams on how identity-conscious knowledge can transform the field of psychology to draw on different perspectives and illuminate gaps in conventional of mainstream psychological science.

Cal State University Dominguez Hills on CRT is a good resource about integrating critical race theory with social work.  Although I went to UCLA, several of my professors moved to CSUDH to teach after the program opened.  Clients searching for therapists with a strong foundation on racial justice may wish to seek out a provider from this program.

An Overview of Anti-Oppressive Practice by Donna Baines provides a historic overview and contrasts Anti-Oppressive social work with more mainstream social work practices.