Psychotherapy Modalities

People do not fit neatly into diagnostic or therapeutic boxes. Neither should good psychotherapy.

My approach is integrative, evidence-informed, and responsive to the person in front of me. I draw from several established forms of psychotherapy, but I don’t expect you to arrive knowing which modality you need or to contort yourself to fit into one style.

Different people need different kinds of work. Sometimes we need structure, practice, and direct behavioral change. Sometimes we need to slow down and understand what is happening between us. Sometimes we need acceptance, exposure, emotional regulation, philosophical reflection, practical problem-solving, or room to grieve.

Sometimes we need to be challenged. Sometimes we need to be validated. Sometimes we need both, neither or the in-between.

The modalities are tools. The relationship is where we learn which tools help.

Now for the list: therapists love acroynyms, but lets break it down without the jargon.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy, or CBT, helps us understand the loops connecting thoughts, emotions, bodily responses, behavior, and environment.

This does not mean replacing every painful thought with a positive one, I've heard from clients how CBT can sometime be practiced in a way that reinforces a shaming, tone-deaf, toxic positivity. But CBT remains at the heart of much of psychotherapy. It may mean examining whether a belief is accurate or useful, noticing how avoidance keeps fear alive, changing routines that reinforce depression, or testing a prediction through real-world experience and experimentation.

Sometimes insight changes behavior. Sometimes we have to behave differently before the rest of us catches up.

Dialectical Behavior Therapy

Dialectical Behavior Therapy, or DBT, recognizes that the world is not Black or White, its Black, White, Gray, everything in between and all at the same time. To think dialectically is to practice holding truths or feelings that appear to oppose each other: I can accept myself as I am, and I can want to change. I can be doing the best I can, and I can need to do something differently.

DBT offers practical skills for mindfulness, emotional regulation, surviving crises, navigating relationships, setting boundaries, and getting through intense moments without making them worse.

These skills can be particularly helpful when emotions arrive quickly and powerfully, when relationships become destabilizing, or when staying alive requires something concrete to do next.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy, or ACT, is useful for when changing our thoughts, feelings or life circumstances is difficult, or even impossible.

It asks: How can I make room for what is here without allowing it to dictate my life? What matters to me? What kind of person do I want to be in this moment? What small action would move me toward that life?

Acceptance does not mean approval, resignation, or passivity. It means ending an unwinnable fight with the fact that this experience is already happening so that more of your energy becomes available for living a more meaningful life regardless.

Exposure and Response Prevention

Exposure and Response Prevention, or ERP is a leading treatment for OCD and related patterns of anxiety. If you have OCD or OCD-like tendencies and haven’t had the opportunity to work with ERP, I will likely recommend that we consider it.

OCD demands certainty. It promises relief if you check one more time, analyze the thought from one more angle, seek one more reassurance, avoid one more trigger, or complete the ritual exactly right. The relief is usually temporary, and the demand returns.

ERP helps you gradually approach feared thoughts, situations, sensations, and uncertainties without performing the compulsions that have been keeping the cycle alive.

Over time, your nervous system can learn that distress rises and falls without the compulsion and that you can tolerate more uncertainty than OCD predicts. The goal is not necessarily to make every unwanted thought disappear. It is to reclaim the time, attention, and freedom that OCD has been taking from you.

Prolonged Exposure

Prolonged Exposure, or PE, is a leading evidence-based treatment for PTSD.

Trauma can teach the body and mind that the danger is still happening, or just around the corner. People can't be trusted. The world isn't safe.

Avoiding memories, places, sensations, conversations, and other reminders can bring short-term relief while preventing your nervous system from learning that the present is different from the past.

When appropriate, and with preparation and collaboration, PE helps you deliberately revisit traumatic memories and gradually face what trauma has taught you to avoid. We can't erase what happened or force the memory away. But PE shows you how to hold it and move forward rather than let the past hold you back from your life.

Humanistic, Existential, and Relational Psychotherapy

Your symptoms matter, but they are not the whole of you.

Humanistic therapy begins with your dignity, agency, complexity, and capacity for growth. Existential therapy makes room for questions of mortality, freedom, responsibility, isolation, uncertainty, purpose, and meaning. Relational therapy recognizes that psychotherapy does not happen through techniques alone, it happens between people.

These approaches shape how I use every other modality. They help us pay attention not only to what is wrong, but to who you are, what matters to you, what is happening between us, and what kind of life you want to build.

They are not alternatives to evidence-based treatment. They are part of the ground on which that treatment stands.

Positive Psychology

Healing is not only the reduction of symptoms.

It can also involve cultivating connection, agency, meaning, play, curiosity, purpose, community, spirituality, creativity, and a relationship with the living world. 

Positive psychology helps us ask not only what makes life painful, but what helps make life worth inhabiting.

I integrate these ideas without prescribing what a meaningful or fulfilling life should look like for you. But I want to hear what makes you smile, and if you don't know anymore, we can find out together.

Ketamine and Psychotherapy

For some people, ketamine can provide rapid and substantial relief from symptoms, deep insights, or surface emotions that you have missed for years. It can also be incredibly challenging, surfacing difficult memories, emotions or truths that are hard to integrate into your life, let alone tolerate in the moment. Some people experience little benefit, and not every ketamine experience is profound or transformative. 

Research suggests that ketamine may temporarily support neuroplasticity: the brain’s capacity to change. But a more changeable brain is not automatically a healed one, and neuroplasticity does not determine which changes will occur or whether they will last.

What follows depends on many things: the medicine, your therapeutic work, your relationships and environment, timing, circumstance, and sometimes chance. It is not a matter of willpower alone.

Depending on your needs, our work may include preparation before treatment, therapeutic support during ketamine sessions, and integration afterward. We may draw from acceptance, exposure, mindfulness, emotional processing, values, meaning-making, behavioral change, or simply the difficult work of putting an unusual experience into words.

Medical evaluation, prescribing, and administration remain the responsibility of your medical provider. My role is psychotherapy.

How We Decide What to Do

You do not need to choose a modality before reaching out.

We will begin with what is happening, what you have already tried, what matters to you, and what seems to keep the difficulty going. I will offer my understanding and recommendations openly. Some problems benefit from a clear treatment structure, particularly OCD and PTSD. Others call for a more exploratory, relational, or flexible approach. Often, we will use both.

If an approach is not helping, that is information, not a failure on your part. We can talk about it, change course, or acknowledge when someone else may be better equipped to help.

People think therapy is hard work, and they're right. What they don't expect is that play and rest are hard too. Some of my clients would rather face their trauma than take a break. Too "unproductive".  

How human.

We practice all of it.

And with time, life gets better.