Rivkah Kaufman’s Services

EMDR +

Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychotherapy that has successfully helped clients resolve trauma and other disturbing, unresolved life experiences, which has led to PTSD, anxiety, depression, and panic disorders. EMDR focuses on changing the emotions, thoughts, or behaviors resulting from a traumatic event or memory, thereby allowing the brain to resume its natural healing process.

Here’s how it works.

Most of the time, our brains are resilient enough to bounce back from mildly disturbing events. A bad grade on a test, for example, is upsetting, but it’s easier to give ourselves comforting, constructive messages about it, along the lines of, “maybe the professor will drop the lowest grade,” or, “let me find out what I did wrong so I can correct it for next time.”

In other words, we can intellectualize our emotional discomfort and process the information in a healthy way. But when traumatic memories and incidents result in overwhelm, the natural recovery process involving our intellect and our emotions is interrupted by the stress, or fight, flight, freeze response.

The fight, flight, or freeze response describes how the body reacts to stress. When a traumatic event overwhelms the system, this response short-circuits the body’s natural ability to process it. As a result, all the disturbing images, thoughts, sensations, and emotions connected to the trauma become frozen, in exactly the same way they were experienced at the time the trauma occurred.

So while we seemingly move on from the disturbing event, and may even create functional, successful lives, the trauma still lives in our bodies, and can be triggered by any reminder or the disturbance, sometimes years after the incident occurred. And the resulting flashbacks and intrusive thoughts have the ability to plunge us right back into that traumatic moment, along with its accompanying emotions and sensations. EMDR therapy helps restore the natural recovery process, the synergy between our intellect – what we know – and our emotions – what we feel – which in turn reactivates processing of the traumatic event, and allows normal healing to resume. The experience may still be in awareness, but it no longer triggers the stress response.

References

About EMDR Therapy. (1995). Retrieved February 03, 2021, from https://www.emdria.org/about-emdr-therapy/

Psychodynamic Psychotherapy +

The goal of psychodynamic psychotherapy is to help clients to gain more awareness of, and therefore become more intentional about, their choices, relationships with others, lifestyles, and plans for the future. Known as a “talk” therapy, psychodynamic psychotherapy explores the unknown or unconscious motivations behind clients’ thoughts, feelings, and patterns of behavior. The hope is that the resulting insight leads to symptom relief, and enough awareness to short-circuit future dysfunctional choices. In psychodynamic therapy, as in other therapeutic modalities, the therapeutic relationship is very important, as it becomes the lens through which clients gain insight, understanding, and growth.

Psychodynamic therapy is based on the work of Sigmund Freud, who is known as the father of psychoanalysis. While strict psychoanalysis is less frequently practiced today, many modalities that have evolved since Freud, derive from his work.

Psychodynamic psychotherapy is based on several underlying premises:

• Experience shapes personality, and vice versa;
• When clients understand that their past experiences, particularly childhood, affect the present, they can begin the process of freeing themselves from the impact of those experiences;
• Developing insight and emotional understanding helps clients achieve greater awareness, which expands their range of choices, improves their personal relationships, and leads to better quality of life;

Central also to psychodynamic psychotherapy are the concepts of transference and countertransference. Transference occurs when, given the range of experiences and conflicts, past and present, clients bring into therapy, a client may unconsciously transfer some of those conflicts onto the therapist. For example, the client may see the therapist as a key figure in the client’s life, towards whom the client had mixed feelings. Countertransference occurs when the therapist unknowingly begins to engage in the same process.* It is through the therapist’s ability to call out the transference, and explore it with the client, that past conflicts and traumas and brought to light and worked through.

Needless to say, countertransference is a possibility the therapist must guard against, which underlies the need for therapists to receive supervision, and to be in therapy themselves.

References

Dresden, D. (2020, September 29). Psychodynamic therapy: Definition, approach, focus, and more. Retrieved February 18, 2021, from https://www.medicalnewstoday.com/articles/psychodynamic-therapy

DBT +

Dr. Marsha Linehann, the founder of Dialectical Behavior Therapy, or DBT, initially developed this modality to treat borderline personality disorder (BPD). However, DBT has since been adapted to treat other mental health conditions. For example, DBT helps clients who struggle with emotional dysregulation, and self-destructive behaviors, such as self-harm, suicide ideation or gestures, and substance use disorders. DBT can also be used to treat the emotional dysregulation caused by post-traumatic stress disorder (PTSD).

History

Formulated in the late 1980s by Dr. Marsha Linehan, DBT evolved out of a need to meet the needs of some clients who did not respond to cognitive-behavioral therapy (CBT) alone. DBT is based on dialectics, or finding the balance between opposites, a particularly useful skill to develop for clients dealing with BPD and emotion dysregulation, as they see the world in black and white terms. When a balance between opposing forces is achieved, change and growth can occur. For example, between “I’ll never give up!” And “I give up,” the dialectic might be: “maybe I can find a compromise I’d be ok with.”

Another DBT technique is validation. Many clients are uncomfortable with change. However, the data indicates that when clients are validated and accepted, and also encouraged to change, they will cooperate more fully and experience less discomfort at the thought of change.

How It Works

DBT is an evidence-based approach that has been used in settings such as individual and group therapy, and phone coaching. In my practice, I adapt individual DBT therapy to my clients’ life situations, pointing out where and how particular skills can be used to address their challenges.

DBT Strategies

In DBT therapy, clients learn four strategies to achieve behavior change:

• Mindfulness,
• Distress tolerance,
• Interpersonal effectiveness, and
• Emotion regulation.

References

1. May J, Richardi T, Barth K. Dialectical behavior therapy as treatment for borderline personality disorder. Mental Health Clinician. 2016;6(2):62-67. doi:10.9740/mhc.2016.03.62
2. Schimelpfening, Nancy. (2020, March 2). Overview of dialectical behavior therapy (DBT). Retrieved February 21, 2021 from https://www.verywellmind.com/dialectical-behavior-therapy-1067402
3. The Linehan Institute Behavioral Tech. What Is Dialectical Behavior Therapy (DBT)? 2017.
4. Van Dijk S, Jeffrey J, Katz MR. A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. J Affect Disord. 2013;145(3):386-393. doi:10.1016/j.jad.2012.05.054