Quarternote Counseling uses a variety of modalities to tailor the therapy session to the individual needs of each client. Please continue reading below to learn more about some of primary modalities and approaches.
Eye Movement Desensitization and Reprocessing (EMDR)
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EMDR involves bilateral stimulation through eye movements or alternating left and right light touch. It is a physiologically based therapy that helps a person perceive disturbing material in a new and less distressing way.
When a person experiences an upsetting event, the brain often cannot process information in the conventional manner. The incident can feel as if it happened yesterday, and thinking about it can feel as bad as going through it the first time. According to the EMDR International Association, “EMDR seems to be similar to what happens naturally during dreaming REM (Rapid Eye Movement) sleep.” Some clients appreciate that the participant does not have to discuss disturbing memories in detail. Bringing up the memory and simply saying, for example, “It was something upsetting that happened when I was 12 years old” is often sufficient to identify the target memory for desensitization. According to leading trauma expert Dr. Bessel van der Kolk of The Trauma Center at the Justice Resource Institute, EMDR is one of the best approaches for individuals who have Post Traumatic Stress Disorder, and it is also useful for those who have trauma symptoms that fall short of the full PTSD diagnosis. (See EMDR International Association’s website for more information on this approach.) |
Internal Family Systems (IFS)
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Internal Family Systems is an evidence-based model of psychotherapy based on the belief that the mind is naturally multiple. Our inner parts contain valuable qualities, but when forced into extreme roles by life circumstances they may create the opposite impact of their original intent. For example, a boundary setting part could be forced by a very threatening life experience into the extreme role of rageful confrontation in order to protect the person. By continuing in that extreme role, it could actually end up causing the person damage, such as rupture of a valued relationship, job loss, or even legal consequences.
IFS is also based on the belief that each person has a core Self, which embodies kindness and compassion, that knows how to heal. When connected to Self we can heal our injured parts so we can live with confidence, all parts of us can team up harmoniously and we have CHOICES about how to behave towards others and ourselves. In IFS all parts of the client are welcome. The client is invited to listen to their parts rather than try to eliminate aspects of themselves. Even clients who have lived through childhoods of abuse and neglect can experience self-acceptance, stability and personal growth when they connect with their “Self”. In IFS there are no “bad” parts, and the goal of therapy is not to eliminate parts but to help them find their non-extreme roles. Extreme parts carry “burdens” that are not inherent in the function of the part, such as extreme beliefs and emotions. Parts can be helped to “unburden” and return to their natural balanced and harmonious role in the system When the goals of therapy are achieved, all parts will exist and lend talents that reflect their non-extreme intentions. IFS is effective with clients experiencing a wide array of symptoms including but not limited to: anxiety; depression; addiction; PTSD; dissociation (including Dissociative Identity Disorder); self-harm; suicidal thoughts; behavioral challenges; attention problems; compulsions; the hearing of internal voices. It is also helpful in family and couples’ therapy. This description of IFS is informed by and paraphrases information that can be found in the following website, which clients are invited to review to obtain more detailed information about the model at IFS-institute.com. Clients might also find it helpful to consult the book Introduction to the Internal Family Systems Model, by Richard C Schwartz, PHD, Trailheads Publications, Oak Part, Illinois, 2001. It can be purchased from the IFS Institute Website. |
Cognitive Behavioral Therapy (CBT)
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Cognitive Behavioral Therapy is an evidence-based approach that aims to improve mental health by helping the client challenge and change thoughts, beliefs, attitudes and behaviors. CBT helps the client improve emotional self-regulation and develop personal coping strategies. The focus is usually the present. CBT is different from many other types of therapy in that it does not focus on the unconscious meanings of behaviors. CBT is problem-focused and action-oriented.
The therapist will help the client identify “cognitive distortions” such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing, and replace them with more realistic and rational thoughts, thereby decreasing emotional pain and maladaptive behaviors. Quarternote Counseling therapists often weave CBT approaches into other treatment modalities, as appropriate for the client’s presenting issues. |
Ketamine Assisted Psychotherapy (KAP)
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If after reading this information you are interested in receiving KAP please call Clinical Director Gillian Clissold, LPC at 703-675-5361. THERE IS LIMITED AVAILABILITY FOR THIS SERVICE. Ketamine is a synthetic pharmaceutical compound. It was developed in 1963 and approved by the FDA in 1970. It is a Schedule III medication that has long been used safely as an anesthetic. The administration of Ketamine in lower, sub-anesthetic doses, to treat depression, anxiety and other psychiatric diagnoses has expanded in recent years. It has been studied and promoted by researchers at the National Institute of Mental Health. It is typically used only after other treatment approaches have been unsuccessful. Research supports its “off label” use for mental health disorders. Ketamine is a dissociative anesthetic, which means it disconnects a person from their ordinary reality. The current understanding of Ketamine’s mode of action is that it is an NMDA antagonist which works through the glutamate neurotransmitter system in a way that is different from other psychiatric medications. It is believed to enhance neuroplasticity, which is the ability of brain cells to form new connections with one another. At the dosage level administered to you, you will likely experience mild anesthetic, anti-anxiety, anti-depressant and potentially psychedelic effects. You may experience relaxation from ordinary concerns and usual thought patterns, while maintaining conscious awareness of the flow of the mind, with a consequent disruption of negative feelings and obsessional worries. The therapist’s role is to offer psychological preparation, emotional support during the experience, and guidance around effective and sustained integration. Though research has demonstrated a therapeutic response to low doses that are minimally psychoactive, or sub psychedelic, the effect is more sustained when the client experiences repeated administrations over short periods of time. In general, lower doses provide empathy enhancing responses towards self and others, while higher doses create dissociative, psychedelic, out-of-body, ego-dissolving experiences. Depending on the individual and the dose, the time out of normal experience will vary between 30 minutes and 2 hours. Your therapist will be continually present to assure your physical safety, leaving your mind free to have experiences that you will integrate with the help of your therapist after the effects on your mind have passed. The experience can sometimes be disorienting and/or confusing, and every experience is different. Your therapist will help you navigate potential challenges that come up to help contextualize them in the therapeutic process. Ketamine can be administered in a variety of ways: by IV, by injection, and orally. Quarternote offers sublingual oral ketamine. While ketamine can be used without therapy, the research suggests it is most effective when combined with therapy. It seems that therapy conducted when the client is in an altered state of mind with lowered psychological defenses allows for more efficient healing than traditional therapy. Clients develop greater self-compassion, insight into their struggles, and some find a spiritual dimension to their healing. Many clients report KAP facilitates a sense of meaning and interconnectedness. It is important you are aware that the Food and Drug Administration (FDA) has not yet established the safety and efficacy of KAP with generic “racemic” ketamine, which is what you will be using. Its use is considered off label and the only official “indication” of generic ketamine is as an anesthesia. Ketamine is a new treatment. While studies have shown it to be a safe and effective treatment for depression, bipolar disorder, anxiety, OCD, PTSD and alcoholism, it is not yet a mainstream treatment. KAP may not permanently relieve depression or other symptoms. You may decide to withdraw from KAP at any time, and we will then discuss other treatment options. You will be monitored closely during and after your treatment. The literature indicates a 70% response rate to ketamine, and a remission rate for clients with treatment-resistant depression of 40 to 50%. Relapses do occur and clients may require additional maintenance ketamine sessions once every one to three months. The frequency of your maintenance schedule will be determined in collaboration with you, your therapist, and the prescriber. Eligibility for KAP Pregnant women and nursing mothers are generally not considered eligible for KAP because of potential effects on the fetus/child. Untreated hypertension is a contraindication for ketamine use because it raises blood pressure. A history of heart disease may also make you ineligible. Finally, ketamine should not be taken if you have untreated hyperthyroidism. Potential for Addiction Ketamine’s abuse potential is equivalent to that of other hallucinogenic substances. Hallucinogenic compounds generally do not cause tolerance or withdrawal. However, ketamine’s impact on feelings, thinking and imagery may make some people want to use it frequently. Therefore, ketamine should never be used except under the direct supervision of a licensed therapist and a prescribing physician. Our colleagues doing clinical ketamine work have not had patients become dependent on ketamine. However, there have been reports of clients obtaining ketamine without medical oversight and turning to compulsive overuse. Preparation Sessions Clients new to Quarternote will be required to receive at least six (6) preparation sessions before dosing with ketamine. Current clients of Quarternote may need fewer preparation sessions before dosing with ketamine. Preparation sessions are usually covered by insurance and, if the individual carries an insurance policy with which Quarternote participates, these sessions will be billed to insurance for payment consideration. Integration Sessions Clients will have at least one 1-hour integration session between each ketamine session. At these sessions, the client will process, with the support of the therapist, the material that came to conscious awareness during the sessions when they were under the influence of ketamine. Cost Fees due to Quarternote: The cost for each 2-hour session under the influence of ketamine is $300. ($600 for two sessions, up to $2,400 for eight sessions). The cost for each 1-hour integration session can usually be covered by insurance. If the client is not using insurance, the cost is $150 per 1-hour integration session. Most clients will require the same number of integration sessions as ketamine sessions. However, additional integration sessions may be necessary. Fees due to prescribing enterprise: Each client will pay fees to the prescribing enterprise that start at $250 for the initial medical consultation, $88 for the initial two (2) doses of ketamine, follow-up medical consultation fee of $150, and additional medication cost of $148 for up to an additional six (6) doses. Unfortunately, KAP is not covered by any insurance companies with which we are credentialed. Individual vs. Group KAP Quarternote currently only offers individual KAP, but expects in the near future to offer group KAP, which will be considerably less expensive. If you are interested in only group KAP please call Ms. Clissold at 703-675-5361. |