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Therapy

Individual Psychotherapy

I view individual psychotherapy as a partnership where the therapist and client work together to identify and address longstanding and current problems that cause distress, psychological pain, and suffering and impact everyday functioning in multiple settings including interpersonal, academic, and professional. People may seek psychotherapy because they struggle with relationships, or in academic or professional settings, or because they find it hard to adapt to a change in life circumstances, feel they don't fulfill their potential, or because they struggle with life stressors.

Is psychotherapy helpful?

Psychotherapy, and particularly research- (or evidence-) based treatments, are effective in alleviating distress, and improving quality of life, as well as overall functioning. Psychotherapy may help people reduce the psychological burden and emotional distress and ultimately result in living a fuller life, where clients are then free to pursue their goals. Psychotherapy also provides 'tools' that aid in managing psychological distress, and facilitate adaptive coping. These 'tools' can be a lifelong aid in coping with new and challenging situations. I draw from multiple approaches and techniques with the goal of helping clients undergo meaningful and lasting changes. My approach relies on goals we set together and frequent assessments of our progress towards those goals. To me, honest and direct communication (without long uncomfortable silence and mmm mmm's) with my clients is the best way to achieve meaningful change.

How does it work?

After the initial 'intake' session, where the goal is to get to know and understand you and the challenges you face, I will share with you what are the core issues I identified, what are the mechanisms that I believe we should work on, and suggest a path forward. As partners, I will offer options for a path forward, and we will decide together what is the best course to take that will bring relief, improve functioning, and grow. Therapy sessions run 50 minutes and intake sessions run a bit longer. 

Misophonia 

 

Sep 2023 NEW STUDY! - Dr. Abramovitch published the first study examining the neuropsychology of misophonia.

Misophonia (Selective Sound Sensitivity) is a condition characterized by an intense emotional and physiological response to specific sounds produced by humans. These sounds, often referred to as "trigger sounds," can cause feelings of anger, anxiety, and disgust in individuals with Misophonia, leading to avoidance behaviors and social isolation.

The trigger sounds that cause Misophonia can vary from person to person, but some common examples include chewing, breathing, tapping, and clicking. When exposed to these sounds, individuals with Misophonia may experience a range of physical and emotional symptoms, such as increased heart rate, sweating, and feelings of rage or disgust.

Misophonia is often misunderstood and misdiagnosed, as it is not yet recognized as a formal disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, research has shown that Misophonia is a real and debilitating condition that can significantly impact an individual's quality of life.

However, Misophonia is treatable! Through a comprehensive evaluation, psychologists with expertise in the assessment and treatment of misophonia can help individuals better understand their symptoms and develop coping strategies to manage their emotional and physiological responses to trigger sounds.

One common evidence-based treatment approach for Misophonia is cognitive-behavioral therapy (CBT). CBT can help individuals with Misophonia identify and challenge negative thoughts and beliefs about trigger sounds, as well as develop techniques to manage their emotional and physiological responses. CBT for Misophonia also involves exposure therapy. This involves gradually exposing individuals to trigger sounds in a controlled environment while utilizing emotional regulation skills to manage their emotional and physiological responses. 

In sum, Misophonia is a real condition that can be functionally debilitating, cause significant emotional burden, and ultimately can significantly impact an individual's quality of life. However, the condition is treatable! Please feel free to email me if you would like to learn more about my approach.

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Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder affecting both children and adults. ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily functioning and development.

Symptoms of ADHD

Symptoms of ADHD can be classified into three main categories: inattention, hyperactivity, and impulsivity.

In addition to these symptoms, ADHD also impacts executive functioning. Executive functioning refers to a set of higher-order cognitive processes that are responsible for planning, organizing, initiating, and completing tasks. Individuals with ADHD may struggle with these processes, often resulting in procrastination, and difficulties with time management, organization, and task completion. Executive functioning difficulties can manifest in a variety of ways. For example, individuals with ADHD may have difficulty planning and starting tasks and completing tasks on time. They may also struggle with prioritizing tasks, managing time effectively, procrastination, and organization. These difficulties can have a significant impact on academic, social, and occupational functioning.

Causes of ADHD

​The exact cause of ADHD is unknown, but research suggests that genetics, as well as some environmental factors, may all play a role. ADHD may be one of the most misdiagnosed disorders because many other conditions may present with similar symptoms, such as anxiety or depression. In fact, multiple emotional, and even medical conditions can lead to inattention, impulsivity, and executive dysfunction. Therefore, ADHD should be assessed by a mental health professional through a comprehensive evaluation that includes a clinical interview, rating scales, and behavioral observations. In many cases, neuropsychological assessment (frequently referred to as ‘ADHD testing’, may be warranted).

Treatment of ADHD

Treatment for ADHD typically involves medications, which tend to be effective in cases where ADHD has been professionally diagnosed. However, medications do not eliminate ADHD-related problems. This is why Cognitive Behavioral Therapy (CBT) is the first line empirically supported treatment for ADHD. CBT for ADHD is a modular treatment that targets functional problems (such as work, school, leisure time, and interpersonal relationships), coping strategies, as well as ADHD-related emotional problems such as self-defeating thoughts, intrusive thoughts, anxiety, depression, etc. 

Why is it important to carefully assess ADHD?

The core symptoms of ADHD are cognitive deficiencies related to attention, executive functions, and memory. Other symptoms may include procrastination and disorganization. However, numerous psychological, and even medical problems can lead to those symptoms. For example, depression, and Clinical Perfectionism may lead to significant procrastination and problems with meeting deadlines and managing time. This is why it is important to conduct a comprehensive Neuropsychological Assessment to assess the person's cognitive abilities, symptoms, and developmental background and to integrate this information in order to identify, or rule out other psychological problems or disorders that may result in the presented symptoms and functional difficulties. Importantly, ADHD is the most misdiagnosed disorder, and the consequence of taking medications for ADHD where in fact the underlying cause is related to anxiety disorders (such as OCD and Clinical Perfectionism), may be worsening of the true underlying cause. 

Assessment and treatment of ADHD in adults and older teens are my primary area of expertise. Additionally, for nearly two decades I have been engaged in research examining differential diagnoses of ADHD – which allows me to clearly identify conditions that may result in ADHD-like symptoms or conditions that co-occur with ADHD. In turn, this facilitates tailoring the best treatment solutions.

In conclusion, ADHD is a complex disorder that impacts executive functioning and has a significant impact on an individual's life. Careful assessment and empirically-supported treatment can help individuals with ADHD manage their symptoms and improve their daily functioning.

 

Clinical perfectionism is a maladaptive psychological construct characterized by excessive and persistent pursuit of perfection, often accompanied by a chronic fear of failure and harsh self-criticism. While striving for excellence can be a healthy and motivating factor, clinical perfectionism can lead to significant distress, impaired functioning, and increased risk for various mental health disorders, such as anxiety, depression, obsessive-compulsive disorder (OCD), and eating disorders.

Roots of Clinical Perfectionism

Clinical perfectionism can be traced back to various factors, including genetics, upbringing, and environmental influences. Often, individuals with clinical perfectionism have internalized unrealistic expectations and standards from their parents, teachers, or peers, leading to a belief that their self-worth is dependent on their performance, and the ability to achieve perfection.

Manifestations of Clinical Perfectionism

Individuals experiencing clinical perfectionism may exhibit an array of behaviors, including excessive attention to detail, procrastination, avoidance of tasks, and a constant need for reassurance. They may also engage in all-or-nothing thinking, where anything less than perfection is deemed as failure, and overgeneralization, where a single negative experience is generalized to other situations.

Impact on Mental Health and Well-being

Clinical perfectionism can have a significant impact on mental health and well-being. Individuals with clinical perfectionism are more likely to experience anxiety, depression, and eating disorders. They are also more likely to have difficulty in relationships and at work.

If you are struggling with clinical perfectionism.

Treatment of Clinical Perfectionism

If you are struggling with clinical perfectionism, there are effective treatments available. Cognitive-behavioral therapy (CBT) is a type of empirically supported therapy that can help you identify and challenge perfectionistic thinking and behaviors. CBT can also help you develop more realistic expectations of yourself and others. The goal of CBT for perfectionism is not to lower one's high standards but to allow flexibility so that not every aspect of one's life would be subject to unrealistic rules requiring perfection. Other elements of CBT for perfectionism include exercising self-compassion, mindfulness, and belief testing. 

If you are struggling with clinical perfectionism, it is important to seek professional help. There are a number of effective treatments available, and with treatment, you can learn to manage your perfectionism and live a more fulfilling life.

Clinical Perfectionism

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Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a common mental health condition characterized by recurring thoughts, impulses, or mental images (obsessions) that cause significant anxiety and distress, as well as repetitive behaviors or mental acts (compulsions) performed to alleviate that distress. OCD affects approximately 2% of the population, with symptoms often emerging during childhood or early adulthood.

Obsessions are intrusive, unwanted thoughts or mental images that cause distress or anxiety. Common obsessions include concerns about contamination or disgust, accidental harm to oneself or others, forbidden (taboo) or unacceptable thoughts, and an excessive focus on order and symmetry. Compulsions, on the other hand, are repetitive behaviors or mental acts that a person feels compelled to perform in response to an obsession or according to specific rules. Common compulsions include excessive cleaning, checking, counting, ordering, and repeating words or phrases. Additionally, avoidance behavior may be a form of compulsion (for example, avoiding certain places that may feel contaminated). Clinical perfectionism is another central symptom of OCD. In addition, many individuals with OCD also experience other disorders, such as anxiety disorders (including panic disorder, social anxiety disorder, and generalized anxiety disorder), depression, and other OCD-related disorders (such as hair-pulling disorder).

If left untreated, OCD can cause significant distress and mental burden. Furthermore, OCD symptoms can be time-consuming (sometimes taking several hours per day) and can lead to functional impairments at work, school, and/or in interpersonal contexts. Fortunately, there are effective, empirically supported psychological treatment options for OCD. The first-line treatment is Cognitive-Behavioral Therapy (CBT). CBT is a highly effective, evidence-based treatment for OCD that focuses on changing maladaptive thoughts and behaviors. The primary CBT technique for OCD is Exposure and Response Prevention (ExRP), which involves exposing the individual to anxiety-provoking situations or thoughts (exposure) and preventing them from engaging in compulsive behaviors (response prevention). ExRP for OCD is gradual, carefully, and deliberately planned together with the client. This technique helps individuals learn that anxiety will naturally decrease over time even without performing compulsions or engaging in avoidance and that they can tolerate the distress caused by their obsessions.

In sum, OCD is a complex condition that can become debilitating if left untreated. However, with appropriate treatment and support, individuals struggling with OCD may experience sustainable emotional relief, regain the ability to function at their full potential and pursue their life goals.

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