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trauma

Counseling/Therapy: So Many Types and Approaches…Which One Should I Choose?

By | NESCA Notes 2021

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

Many adults, teens and children struggle with a myriad of challenges from everyday stressors, feelings of worthlessness and insecurities to official diagnoses of anxiety, depression, PTSD, eating disorders, OCD, addiction, and more. Deciding how to grow and change and alleviate the pain and suffering can be daunting. There are so many different ways to address psychological pain. Psychological, medical, behavioral, psychopharmacological, complementary (e.g., acupuncture), and educational treatments, among others, are possible choices and can assist in lessening an individual’s anguish. How do I decide which one(s) to try? Usually, treatment involves more than one of these, so the decisions may not be as difficult as you think. The first step is recognizing that you, your child, your marriage or family needs help and taking a step to get help.

Psychological treatments include many options: psychotherapy (i.e., “talk therapy or insight-based therapy”), psychoeducational counseling, biofeedback, social training, behavior therapy, mindfulness, stress management, anger management and so many more. Therapy can be individual, group, family or couples work, and there is no single approach that works for everyone. It often depends on the referral question and complaint. Counseling is typically provided by a psychologist, social worker, mental health counselor, marriage and family counselor, expressive therapist, psychiatrist and/or psychiatric nurse. Many factors go into making psychological treatment decisions (i.e., referring question/complaint, cost, location, approach, etc.). When it comes to therapy, it is most important to have “goodness of fit” between the clinician and the client. The client needs to have a connection with and feel valued, supported and understood by their practitioner. This allows whatever treatment approach or method to be more readily accepted by the client.

Reviewing the differences between treatment approaches may help with the decision-making process beyond “the goodness of fit.” Psychotherapy involves talking with a clinician to address emotional, psychological and behavioral challenges that can be both conscious and unconscious. The client’s past experiences, perceptions and history may play an important role in psychotherapy. The client “tells a story” that helps the clinician understand their life experiences through their eyes, therefore allowing treatment to be tailored to that client’s personal experience. By working through one’s thoughts, past experiences and stressors with a caring clinician, the client is able to gain insight and perspective, reduce symptoms, change behavior, learn strategies to lighten the load and improve quality of life. Often psychotherapy is long-term and involves good communication/language skills as well as higher level of thinking, often abstractly, and insight capacity.

Psychoeducational treatment is somewhat different than psychotherapy. Education is central to treatment and is a more directive approach. It can have very specific goals and may be short-term. The past is not actively addressed; rather, the purpose is to teach the client to acknowledge, accept and understand their disability and/or mental health condition and provide ways to support growth, change and meet goals. Psychoeducational treatment can be provided to individuals, groups, families, couples, employers and others and may include reading informational text, video analysis, homework, data collection, biofeedback, journal writing and more.

Some of the goals of both treatment approaches may be to:

  • connect how thoughts, feelings and behavior are intertwined;
  • improve coping and problem-solving skills to better deal with life’s stressors;
  • increase positive self-regard; and
  • recognize and better deal with strong emotions.

Many clinicians have training in specific techniques and some use a combination of approaches and philosophies. Psychotherapy typically falls into broad categories: Psychoanalysis and psychodynamic, Behavior Therapy, Cognitive Therapy, Humanistic Therapy and Integrative or Holistic Therapy.  Sometimes a specific approach may be the best method of choice given a specific condition or specific goal of the client. Some techniques have been researched on large samples of people and proven to yield positive results with certain diagnoses; while others are newer, less researched (yet are still effective).

In determining what technique is most appropriate, consider the age, diagnosis, goal of treatment, efficacy of the treatment, as well as the personality, cognitive and language capacity, cultural/family background, location, cost, etc. Many treatment approaches share common techniques, but some techniques are better suited with certain conditions/diagnoses. There are upwards of 100 different types of psychotherapeutic approaches, so knowing which one works with what conditions, resonates with you as the client and can meet the needs/goals.

Another option is online treatment. In recent years, many in-person practices and newer standalone online treatment options have emerged. Often these are for mild depression and anxiety. As you search out any treatment, ask for references and reviews and assess treatment efficacy. Some online sites include Talkspace, TeenCounsleing and more. There are also online apps to help with stress management, anxiety, depression and more, such as Moodfit, HeadSpace for Kids, MindShift, Inner Balance, and so many more. Needless to say, online therapy and apps are not the same as in-person therapy but may augment and be helpful in some situations.

Many clients at NESCA present with learning differences, anxiety, OCD, depression, trauma, addiction, ASD, and more. The following partial list includes just some of the treatment approaches recommended by many of NESCA’s neuropsychologists. At NESCA, we currently offer a psychoeducational approach to psychological treatment and short-term pandemic related issues of anxiety and depression. If interested in learning more, please visit: https://nesca-newton.com/integrativetherapeutic/.

  • Acceptance and Commitment Therapy (ACT)
  • Attachment-based Therapy
  • Animal-assisted Therapy
  • Bibliotherapy
  • Biofeedback
  • Cognitive Behavior Therapy (CBT)
  • Dialectic Behavior Therapy (DBT)
  • Exposure & Response Prevention (ERP) Therapy
  • Expressive Therapy (art, music, drama, etc.)
  • Family Systems Therapy
  • Hypnotherapy
  • Mindfulness-Based Cognitive Therapy (MBCT)
  • Motivational Interviewing
  • Narrative Therapy
  • Positive Psychology
  • Parent-Child Interaction Therapy (PCIT)
  • Play Therapy
  • Psychoeducational Counseling
  • Trauma-Focused Cognitive Behavioral Therapy

Additional information about treatment approaches can be found at: https://www.psychologytoday.com/us/types-of-therapy.

https://www.nami.org/learn-more/treatment/psychotherapy

https://apa.org/topics/psychotehrpay/approaches

https://talkspace.com/blog/different-types-therapy-psychotherapy-best/

https://verywellmind.com

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

10 Facts about the Rorschach Inkblot Test

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

As an evaluator, I receive a number of questions about the usefulness of the Rorschach Inkblot Test. The following “10 facts” are designed to answer some common questions and also incorporate some new and fresh scientific research findings related to the Rorschach.

The Rorschach Inkblot Test is a diagnostic tool that should always be incorporated within a comprehensive evaluation which includes projective or “performance-based” testing. If you are considering if your child or teen would benefit from projective testing, please refer to one of my earlier NESCA blog posts: More Than An Inkblot: Measuring Problem-Solving and Critical Thinking Skills with Projective Tests.”

  1. The Rorschach Inkblot Test is a test that provides data and information about how a child or teen problem-solves situations “in the moment.”
  2. Research indicates that the Rorschach is a valid assessment tool (with validity akin to other personality measures, as well as measures of IQ).
  3. Recent fMRI studies show high levels of brain activation in brain regions associated with emotion, emotion memories, perception, attention and visual processing.
  4. After the Rorschach Inkblot Test is administered, an experienced evaluator uses an evidence-based scoring system to compare a child’s responses to a normative sample to evaluate their performance. RPAS (Rorschach Performance Assessment System) is the most evidence-based scoring system to date and has strong empirical evidence.
  5. The Rorschach evaluates and detects psychotic symptoms.
  6. The Rorschach is helpful for evaluating trauma, including dissociation and intrusive symptoms.
  7. The Rorschach assesses both trait (stable characteristics or patterns) and state (a temporary way of being) variables. For example, the Rorschach tells us about how a person is coping with everyday stressors (e.g. from bullying to family loss to lack of sleep). The Rorschach also tells us if a person has a more pervasive habit of “bottling up” emotions or behaving rashly or impulsively when overwhelmed.
  8. The Rorschach quantifies a child or teen’s strengths, such as capacity for insight and adaptability, or resiliency to stress.
  9. The Rorschach Inkblot Test is not for everyone. More research is needed about the utility of the Rorschach for individuals with expressive language communication impairments or visual-spatial processing deficits.
  10. Not every evaluator is equipped to administer and interpret the Rorschach Inkblot Test. The Rorschach is a powerful diagnostic tool when interpreted in conjunction with observation and other test results by a skilled, experienced practitioner with extensive training in Rorschach administration and interpretation.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

What’s Up, Postdocs?

By | NESCA Notes 2019

NESCA currently enjoys having three pediatric neuropsychology fellows on its roster: Caroline Kleeman, Psy.M., Miriam Dreyer, Ph.D., and Zachary Cottrell, Psy.D, LMHC. NESCA’s postdoctoral positions are two-year engagements allowing clinicians who have completed or are finalizing their doctoral degrees to advance their training and acquire/hone their skills in preparation for their long-term careers.

We recently sat down with two of our fellows to learn more about their postdoctoral experiences now that they have almost reached the one-year mark in their time at NESCA.

By Jane Hauser
Director of Marketing & Outreach

Tell us about your postdoctoral experience at NESCA so far.

Both: As postdocs, we sit in on every phase of an evaluation – from the intake session to the administering and scoring of the tests, interpretation of the results, feedback session with parents, and writing of the report.

We are always working with a supervising clinician during evaluations, and we participate in a training seminar led by NESCA’s Director of Training Dr. Angela Currie. We get feedback from our supervising clinicians throughout every stage in the testing process.

Caroline: I was fortunate to have worked at NESCA as a practicum student in 2016-2017. It’s been great to be back here in a different role. I’ve had the chance to work closely with Dr. Alissa Talamo during my fellowship.

Miriam: I’ve been on board here at NESCA since September 2018, so almost a year now. I worked closely with Dr. Amity Kulis, and now I am working with Drs. Nancy Roosa and Stephanie Monaghan-Blout.

Based on your experiences at NESCA, have you identified a specialty you would like to focus on?

Caroline: Autism has been and remains my area of interest. I also really enjoy working with children with learning disabilities and collaborating with schools to get the right plans in place for the kids we work with. I’ve really enjoyed and benefited from attending school observations and sitting in on Team meetings.

Miriam: Before I went to graduate school, I was a teacher. My area of interest is the intersection of emotional and learning challenges, including executive functioning difficulties and attentional disorders.  In graduate school, my research and therapy training focused on trauma. So, my goal is to combine my clinical and educational experiences to support families in understanding how emotional experiences impact learning in children and adolescents.

 Why did you choose to do your postdoctoral work at NESCA?

Caroline: As I mentioned, this is my second time being a part of the NESCA team. I came back to NESCA for my postdoc work because I valued the collegial environment. I also felt I could benefit from the different clinical staff and their various areas of expertise. It’s such a great experience to work in a practice where someone always knows the answer to my most challenging questions. I really appreciate the model of teaching at NESCA. Because of the apprenticeship model, there’s so much in-the-moment teaching with our clinical supervisors that I benefit from.

Miriam: I was really Interested in the apprenticeship model of training at NESCA as well. It’s a unique arrangement in that postdocs are with a supervising clinician every step of the of the evaluation process. We receive a lot of mentoring here, which is very important to me. I also value the integrated nature of the reports NESCA produces, which portray the sometimes complex kids we see in a nuanced way. Again, this is very important to me in my continued learning.

Both: We get to work with different people here who do different things. It’s given us exposure to so many new areas of neuropsychology that we may not have seen elsewhere. There are a lot of experts here to learn from.

What makes NESCA different? What did you find most beneficial?

Miriam: The structure of NESCA’s training program and the emphasis on continued learning throughout the organization are both so valuable. We frequently have seminars where third-party speakers come in to educate our staff on new areas of psychology and treatments so we all stay current with the latest evidence-based approaches. We also have a weekly case conference where all of our clinicians gather to discuss complex cases and to share resources, knowledge, and experiences to benefit the case at hand. There is a heavy emphasis on learning within the practice, so I am constantly getting exposed to new ideas. I think that’s a valuable and unique asset of NESCA.

Caroline: I absolutely agree with the fact that we are really benefiting from the heavy emphasis on learning and the years of experience our clinicians have. Their willingness to share the knowledge they’ve gained with each other and us is a great benefit to our clients and to my own education. I have also learned so much from our clinicians who attend and bring back such good information from conferences as well as the conferences I’ve had the opportunity to attend.

What’s been your favorite and your most challenging experience so far at NESCA?

Miriam: Each case is unique, so I’ve had lots of exposure to new areas of neuropsychology. Every person who walks in the door presents new opportunities for learning. While this is one of my favorite aspects of NESCA, it is also challenging. With the unique caseloads we take on, there is a lot to learn about the different profiles. As fellows, we do not yet specialize in one area, so we are getting a broad education across domains of neuropsychology. For every new case, there are unique recommendations tailored to that individual that require research, which is an important part of our training.

Caroline: Seeing each child who comes to NESCA as a unique individual is probably my most rewarding and challenging part of being in this practice. Getting to work with some of the more complex profiles out there is exciting to me, but is obviously a challenge, too. There’s always a lot to be learned about each child, and that can take some time to do.

What advice can you share with others looking into this field or who are looking for the right place for their postdoc experience?

Miriam: It’s a great opportunity to be here. My advice is to visit NESCA for an interview, see what it’s like here and learn about the different specializations of the practice’s clinicians. In your search, look for a postdoc position where you get varied training and exposure to a lot of different cases, even if they aren’t in your specific area of interest.

Caroline: Neuropsychology is a very fulfilling career. Every day and every child are different, so it never gets boring. Of course, it can also be frustrating in that there are sometimes barriers to kids getting what they need, whether in school or with community resources not being available. In those moments, you have to be creative and problem-solve. That said, the rewards far outweigh the challenges.

 

About Pediatric Neuropsychologist Fellow Miriam Dreyer, Ph.D.:

Dr. Dreyer enjoys working with children, adolescents and families who come to her office with a wide range of questions about learning, social and emotional functioning. She is passionate about helping children and parents understand the different, often complex, factors that may be contributing to a presenting problem and providing recommendations that will help break impasses – whether they be academic, therapeutic, social or familial.

Dr. Dreyer joins NESCA after completing her Doctorate in Clinical Psychology at the City University of New York.  She most recently provided psychological assessments and comprehensive evaluations at the Cambridge Health Alliance/Harvard Medical School for children and families with a wide range of presenting problems including trauma, anxiety, psychosis, and depression.  During her training in New York, she conducted neuropsychological and psychological testing for children and adolescents presenting with a variety of learning disabilities, as well as attentional and executive functioning challenges.  Her research focused on developmental/complex trauma, as well as the etiology of ADHD.

Dr. Dreyer’s experience providing therapy to children, adolescents and adults in a variety of modalities (individual, group, psychodynamic, CBT) and for a wide range of presenting problems including complex trauma/PTSD, anxiety, depression, ADHD, and eating disorders informs her ability to provide a safe space for individuals to share their concerns, as well as to provide tailored recommendations regarding therapeutic needs.

Before becoming a psychologist, Dr. Dreyer taught elementary and middle school students for nine years in Brooklyn, NY.  She also had an individual tutoring practice and specialized in working with children with executive functioning challenges, as well as providing support in writing, reading and math.  Her experience in education informs both her understanding of learning challenges, as well as her capacity to make specific and well-informed recommendations.

She received her Masters in Early Childhood Education from Bank Street College, and her B.A. in International Studies from the University of Chicago.

About Pediatric Neuropsychologist Fellow Caroline Kleeman, Psy.M.:

Caroline Kleeman comes to NESCA with experience providing evaluations for children with a range of neurodevelopmental profiles.  She has focused on assessing children with autism spectrum disorder, including those presentations accompanied by cognitive delays, language impairments, or genetic disorders.  She also enjoys evaluating children with academic difficulties stemming from learning disorders or attention/executive function disorders.

Ms. Kleeman’s approach to testing recognizes that children are so much more than a list of scores.  Combining her own careful observations with input provided by parents and teachers, Ms. Kleeman strives to differentiate between skill deficits or performance deficits, while also identifying unique strengths.  Additionally, drawing on her applied behavior analysis (ABA) background, Ms. Kleeman looks beyond the individual to identify helping and hindering features of the surrounding environment.  The result is meaningful, highly individualized educational and therapeutic recommendations.

Ms. Kleeman received her Sc.B. with honors from Brown University, where she studied cognitive science.  Focusing on early childhood, she conducted research on the role of sleep (especially naps!) in cognitive development.  After college, Ms. Kleeman worked as a therapist at Nashoba Learning Group, using the tenets of ABA to provide instruction across educational, vocational, behavioral, and adaptive domains.

Bridging between psychology and education, Ms. Kleeman is finalizing her doctorate in school psychology at Rutgers University Graduate School of Applied and Professional Psychology.  Her dissertation is investigating the role that Sesame Street’s autistic muppet, Julia, could play in early childhood social and emotional learning (SEL) programs.  She completed her pre-doctoral internship at the Center for Children with Special Needs in Connecticut, where, in addition to psychoeducational evaluations, she provided ABA therapy and ABA-based reading intervention for children across the autism spectrum.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with one of our expert neuropsychologists, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.