Clinical Services
Clinicians at the Main Line Center for Evidence-Based Psychotherapy work with a broad range of adult and adolescent clients with emotional, behavioral, and/or adjustment problems.
When clients first present for treatment, they first undergo assessment, which is the process by which a clinician gathers information about a client’s symptoms, life problems, background, and strengths. Most of this information is gathered in a face-to-face interview format, but some clients also complete self-report questionnaires and/or invite a close other to provide their impression of the client’s difficulties. The assessment process typically takes between one and three sessions.
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At the end of the assessment period, the clinician arrives upon a diagnosis and formulation of the client’s clinical presentation. In addition, the clinician works collaboratively with the client to identify specific treatment goals, a plan for achieving those goals, and a strategy for monitoring progress toward them.
Most clients who complete the assessment process subsequently participate in psychotherapy, or the process by which a clinician works collaboratively with a client to address their symptoms and life problems. Clinicians at the Center practice evidence-based psychotherapy, which means that she uses treatment packages and strategies that research has shown to be efficacious with certain clinical presentations. You can learn more about evidence-based psychotherapy. Clinicians at the Center most often treat clients using an individual psychotherapy format. However, they also offer couple therapy and, occasionally, group therapy and family therapy.
Common concerns or conditions with which clients present to the Center’s clinicians include, but are not limited to:
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Anxiety Disorders
Anxiety disorders are mental health disorders characterized by worry, nervousness, angst, and fear. Many people who are diagnosed with an anxiety disorder describe “overthinking” about the sources of their anxiety and avoidance of situations that bring on the anxiety. Specific anxiety disorders include the following:
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Generalized anxiety disorder (or GAD): Worry about many life domains that is experienced as uncontrollable and associated with symptoms like restlessness, difficulty sleeping, difficulty concentrating, difficulty tolerating uncertainty, and/or muscle tension
Social anxiety disorder: Concerns about judgment, negative evaluation, or embarrassment in social or evaluative situations
Specific phobia: Fear and avoidance of particular objects or situations, such as insects, heights, closed spaces, or uncomfortable internal bodily sensations
Panic disorder: The experience of sudden and out-of-the blue panic attacks, characterized by symptoms such as a racing heart, difficulty breathing, sweating, and trembling
Anxiety disorders are treated using a broad cognitive behavioral therapy approach, which can involve exposure and the reshaping of unhelpful thinking. Anxiety disorders can also benefit from a mindfulness approach to recenter focus on present-moment experience and calm the mind.
Depression
Depression is characterized by low mood and a loss of interest or pleasure in previously enjoyable activities. In addition, people with depression may experience one or more of the following symptoms:
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Appetite disturbance: Being more or less hungry than usual, with the possibility of weight gain or loss
Sleep disturbance: Sleeping more or less than usual, as well as problems with sleep such as difficulty falling asleep, waking up in the middle of the night, and/or waking up too earlier in the morning
Fatigue
A sense of worthlessness
Excessive guilt
Difficulty concentrating
Difficulty making decisions about every day things
Thoughts that life is not worth living or wishing that you were dead
Depression can be treated using a broad cognitive behavioral therapy approach, which can involve behavioral activation, the reshaping of unhelpful thinking, and mindfulness. An alternative evidence-based approach to the treatment of depression is interpersonal psychotherapy. In interpersonal psychotherapy, your depression is understood within an interpersonal context, and problems in relationships are targeted in treatment.
Insomnia
Insomnia is a common sleep disorder that can take many forms:
Difficulty falling asleep, difficulty staying asleep, difficulty falling back asleep after a nighttime awakening, waking up too early in the morning, not getting good quality sleep.
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Insomnia can be a clinical diagnosis in and of itself, or it can be a symptom of mental health problems like depression or anxiety. When people experience insomnia, they often feel lethargic and sleep the next day. Some people with insomnia develop anxiety about whether they will be able to sleep at night.
Insomnia can be treated using a broad cognitive behavioral therapy approach. From a cognitive standpoint, clients learn to reshape unhelpful beliefs about sleep or unhelpful thinking that prevents them from falling asleep. From a behavioral standpoint, clients learn to acquire healthy sleep habits (called sleep hygiene), and they evaluate and modify their sleep schedule to consolidate the number of hours that are asleep when they are in bed. In addition, clients will often learn mindfulness strategies to facilitate sleep.
Life Satisfaction & Fulfillment
At times, clients present for therapy not necessarily for a diagnosed mental health condition, but because they have a general sense of life dissatisfaction or lack of fulfillment. Sources of dissatisfaction can come from many areas of a person’s life, such as their job or career, their relationships, their (or a loved one’s) health, or the ways in which they spend their time outside of work.
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Therapists at the Main Line Center use principles of evidence-based psychotherapy to help these clients clarify their values, commit to action that is consistent with these values, and think creatively about changes that they can make to optimize their life.
Life Transitions
Many clients benefit from therapy when they are facing a life transition, such as a new job, changing roles at work, a relocation, separation or divorce, or the loss of a loved one. These transitions often serve as stressors that increase the likelihood of depression, anxiety, or other mental health symptoms. Therapists at the Main Line Center use principles of evidence-based psychotherapy to help these clients navigate life changes, prevent an exacerbation of mental health symptoms, and thrive in their new life circumstances.
OCD
Obsessive compulsive disorder (OCD) is a mental health disorder characterized by the presence of unwanted, intrusive thoughts. Most people with OCD also engage in some sort of ritual that serves to neutralize the anxiety associated with the intrusive thought. In some instances, these rituals take the form of overt behaviors like handwashing or checking, and in other instances, these rituals take the form of mental maneuvers like counting or praying.
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OCD can take many forms, including (but not limited to):
Contamination OCD – concern about germs, disease, illness, contamination, poisoning, polluting, or being impure. Some people with this type of OCD focus on become contaminated themselves, whereas other people with this type of OCD worry about contaminating others.
Checking OCD – the urge to check something over and over to be sure that it is the way it should be (e.g., checking the locks on the door multiple times)
Harm OCD – concern about causing serious harm to oneself or others (e.g., stabbing someone, jumping in front of a train)
Sexual orientation OCD – doubts about one’s sexuality
Relationship OCD – doubts about whether one’s romantic partner is “right” for them or their partner’s true feelings toward them
“Just right” OCD – concern about something feeling not right when things are not a certain way (e.g., cans in the cupboard facing a certain direction)
Religious OCD (also called scrupulosity) – concern about whether one has committed a sin, behaving in a manner that is consistent with religious doctrine, or behavior in a moral way
OCD is treated through the use of exposure coupled with response prevention. This means that clients work with their therapist to systematically face the fears that characterized their intrusive thoughts, coupled with an intention to resist engaging in compulsive or ritualistic behavior. Exposure with response prevention can be supplemented with other strategies that are typically incorporated into cognitive behavioral therapy, including the reshaping of unhelpful thinking and those that promote acceptance and tolerance of risk and uncertainty.
Personality Disorders
A personality disorder is a long-standing and inflexible pattern of thoughts, emotional experiencing, and behavior that causes problems for people and interferes with relationships. The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-5) recognizes ten personality disorders. The personality disorder that has received the most attention in the research literature and in clinical practice is borderline personality disorder, which is characterized by the following symptoms:
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Efforts to avoid abandonment
Unstable and intense relationships
Identity disturbance
Impulsivity that is self-damaging
Suicidal or self-injury threats or behaviors
Intense mood reactivity
A sense of emptiness
Inappropriate anger
Transient paranoia or dissociation
Personality disorders can be treated using a broad cognitive behavioral therapy approach. Moreover, one particular type of CBT was developed specifically for borderline personality disorder—dialectical behavior therapy (DBT). In DBT, clients learn acceptance-based and behavior change strategies in order to achieve emotion regulation, learn to tolerate emotional distress, and improve their interpersonal relationships.
PTSD
Posttraumatic stress disorder (PTSD) is a mental health disorder that can emerge when a person has been exposed to a trauma, defined as exposure to actual or threatened death, serious injury, or sexual violence. Such exposure can take many forms, including directly experiencing the event, witnessing someone else experiencing the event, learning that a close family member or friend experienced the event, or repeatedly hearing gruesome details of the event. People with PTSD experience symptoms that generally fall into four domains:
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Reexperiencing the trauma in the form of intrusive memories, nightmares, flashbacks, or heightened psychological physiological arousal in response to reminders of the trauma
Avoidance of memories, thoughts, or reminders of the trauma
Negative effects on mood and thinking, including negative beliefs about the self or safety, self-blame for the trauma, the inability to experience positive emotions, or a sense of detachment from others
Heightened arousal and emotional and physiological reactivity, such as angry outbursts, hypervigilance, exaggerated startle response, or difficulty concentrating or sleeping.
PTSD is treated using a broad cognitive behavioral therapy approach, which can involve exposure and the reshaping of unhelpful thinking. Exposure is often done imaginally, such as by developing a narrative account of the trauma and reading it or listening to it in a safe environment. Unhelpful thinking that is often reshaped in PTSD includes that pertaining to excessive self-blame or the likelihood of future danger.
Stress
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Suicide Risk
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Relationship Problems
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“If we climb high enough, we will reach a height from which tragedy ceases to look tragic.”
– Irvin Yalom
