I help clients overcome and manage anxiety disorders. All humans experience some form of anxiety at some times, but clinical anxiety disorders that require treatment often cause significant distress and impairment in functioning. In many cases, the anxiety disorder is prolonged and worsened by avoidance of the situations that clients anticipate will evoke anxiety. The most effective treatment usually involves a gradual, guided exposure to those anxiety-provoking situations with support for emotional regulation and relaxation techniques to manage acute symptoms that may arise during treatment. Through this repeated exposure and practice, clients begin to experience mastery over the symptoms and trust themselves more to cope with anxiety symptoms as they arise.

Treating major depressive disorder and other mood disorders, such as bipolar disorder, usually involves some degree of symptom management to begin treatment. Often, cognitive-behavioral techniques such as cognitive reframing can improve tolerance of those symptoms and better manage the functional impairment caused by them.

In many cases, after functioning is improved and acute symptoms are reduced through treatment, clients feel they are still vulnerable to recurrence of those disorders, so additional longer-term therapy may be useful in maintaining progress and building confidence in clients’ resilience and ability to master difficult emotional states without spiraling into a more serious episode of illness.

Experiences of trauma can have lasting impacts on a client’s mental health, sense of self, and relationships for a long time after they occur. There are many variables to consider when evaluating these impacts, including whether there was repeated exposure or a single incident, the age at which the trauma occurred, and individual factors that may be related to genetic traits as well as environmental influences.

I recommend that clients new to therapy be mindful of the pace at which they disclose details of traumatic events in therapy, because everyone has a different reaction to sharing these details, and a disclosure very early in treatment (such as in the first session) could trigger symptoms in clients that make it feel difficult to continue treatment. It may be worth developing a trusting relationship with a therapist first so the client feels protected if this happens.

Trauma work in therapy can be a longer-term process for some clients, and I believe the client should set the pace based on their comfort level. Because therapy involves facing parts of the self that are usually avoided by clients with PTSD, trauma work can initially exacerbate symptoms, but it is often worth it to clients to stick with it if they feel connected to their therapist and have established trust. I believe that healing happens in the context of relationships, and the secure relationship with a therapist can be a safe place to experience this before the healing generalizes to other relationships in a client’s life.

Clients who come to therapy in a state of grief sometimes struggle to make sense of the loss, or struggle with the feeling that they can’t move on with their lives. If the person who has died had a complicated relationship with the client while they were alive, the client may still live with those complicated, unresolved feelings after the loss.

Therapy is a place to explore the meaning of death and loss, to understand that everyone grieves differently, and resolve complicated feelings about the relationship that is lost. There can be a lot of ways that grief may persist in a client’s life beyond the period that others in the client’s life may view as “normal” and appropriate. Therapy can help a client gain insight about their loss and communicate their needs more effectively to others.

Many of my clients are students at universities in New Haven and around CT and NY. Students often struggle with a more unstructured schedule than they were used to, feeling as though they are not doing enough if they don’t study or write during every unscheduled period of the day. Additionally, many pre-existing or latent mental health problems arise during college or graduate school because of the stress inherent to being a student, and it can be helpful to speak to a therapist and get support if a student feels they are falling behind or overwhelmed with the stress.

I have experience working with international students, which is always a pleasure because it presents me with opportunities to understand a diverse set of experiences, cultural backgrounds, and life circumstances that I may not otherwise be exposed to.

International students may struggle even more to adapt not only to a different life stage and set of responsibilities, but also to social and cultural differences, language barriers, and distance from support systems that may still be thousands of miles away. The effects of the political context in the U.S. may impact the mental health of international students differently than their peers who are not international students. Therapy is a safe place to discuss these concerns and difficulties in adaptation while students continue pursuing their college or graduate degrees in the U.S.

Workers such as nurses and doctors, social workers, therapists, spiritual/pastoral counselors, and other types of helping professionals who are exposed to some of the most difficult moments in their clients’ lives bear an enormous burden of stress. The stress of this work is chronic in nature, meaning that there is very little opportunity for the body to recover from the effects of elevated stress hormones. Over time, these physiological factors increase vulnerability to the psychological impacts of witnessing and being involved in some of the most extreme and challenging situations that people deal with in their lives.

When the effects of working in a helping profession begin to create a sense of burnout at work, impairment in a client’s personal life, difficulties in relationships, or challenges in self-care, it can help to speak to a therapist. Therapy can promote more balance in a client’s life, improve resilience, restore the joy and meaning that can come from working in a helping profession, and provide a perspective that makes it easier to prioritize self-care.

Attachment styles are formed in early childhood, but in many cases, the effects of being insecurely attached echo through a client’s life well into adulthood. There may be a pattern of unstable or volatile relationships, an avoidance of intimacy, a fear of abandonment that creates tension in an adult relationship, as well as many other problematic relationship patterns.

Therapy is a place to explore those patterns in the broader context of a client’s life history. Ideally, in a trusting therapeutic relationship, the patterns of insecure attachment that a client brings to other relationships in their life will emerge in a much safer context where they can be better understood and worked through.

Through experiential learning, clients begin to disconfirm the beliefs they have historically held about their relationship styles and themselves, sometimes for their whole lives. The insights gained in therapy are then generalized to situations in a client’s current life and relationships, where the positive impacts can be made permanent.

Major life transitions such as graduating college, going through divorce or a relationship breakup, entering retirement, or many other situations can be a source of overwhelming stress when clients find it difficult to adapt to their new circumstances. Therapy provides a safe and supportive context to build resilience and enhance cognitive flexibility so the client can better adapt to their new situation and find a sense of personal growth in the process.