E. Alexa Rich, LCPC, LCADC, MAC
Person-centered therapy, developed by Carl Rogers, believes that people are experts on their own experience. My natural tendency to be genuine has resulted in a natural orientation toward person-centered therapy. My practice incorporates Roger's belief that people are experts on their own experience and can fulfill their own potential by relying on their own inner strength to change. As a result of Roger's influence, I hold the belief that the therapis's task is to create safe and therapeutic conditions in which people can make the decision to change. I strive to practice unconditional positive regard with all my clients which is a core component of Person-Centered therapy. Although traditional Rogerian therapy is non-directive and does not give direct solutions or suggestions I believe in balance and will incorporate direct interventions when appropriate.
Motivational interviewing (MI) is a person-centered approach. The spirit of MI is described as a “way of being” with the client. Central to MI is collaboration, autonomy, and evocation. The goals of MI are to reduce ambivalence about change and increase intrinsic motivation. Specific principles include expressing empathy and supporting self-efficacy. MI views ambivalence as normal, and this acceptance and normalization, this state of both wanting to change and remain the same is a complexity that I can relate to. I incorporate all these aspects of MI into my practice.
CBT is broad and many therapies have been born out of it. It has generated more empirical research than any other psychotherapy model. It is a short-term action-oriented approach with a focus on thoughts and behaviors. By evaluating thoughts and beliefs we can gain insight into how we feel about ourselves. I believe aspects of CBT can be particularly helpful in relapse prevention and intervention. It allows for the identification of how thoughts, feelings, beliefs, and behaviors play a role in relapse. This process can provide insight into what changes are needed to achieve ongoing abstinence. Although helpful in relapse prevention it is applicable to any behavior getting in the way of a life worth living. In my practice I utilize CBT principles and interventions for a variety of issues.
People often associate the term “trauma” with an event. However, trauma is not necessarily about a particular event itself, but the individuals experience of the event or event(s). I do not ascribe to one approach or therapy when it comes to addressing trauma. My approach is influenced by training in neuroscience, the work of Bessel Van der Kolk, Jamie Marich, Janina Fisher, and Lisa Ferentz. I take a trauma informed lens when viewing addiction and believe that for some, the experience of addiction is in and of itself traumatic.
DBT is a cognitive behavioral treatment originally developed for chronically suicidal individuals diagnosed with borderline personality disorder. Formal DBT treatment includes individual psychotherapy, group skills training, telephone coaching, and a therapist consultation team. Since its inception clinical trials have shown its effectiveness for a wide range of other disorders and problems. An increasing number of studies have shown that skills training alone is a promising intervention for a variety of populations. DBT's largest influence on my practice is the focus on balancing the dialectic of the need for acceptance and change. I incorporate DBT skills training in my practice when appropriate.
My experience and background in art has resulted in a belief that creative expression can be particularly helpful in the healing process. For those interested I encourage the utilization of music and art materials in the therapeutic process.
Mindfulness is a skill and an attitude. Important elements of mindfulness include present moment awareness and acceptance of the mind body process. It is full awareness of where we are and what we are doing without judgement. Everyone possesses mindfulness. There are a wide range of ways to practice mindfulness. Examples include yoga, coloring, taking short pauses, and meditation. Through its cultivation of acceptance and awareness mindfulness helps one understand and cope with difficult emotions. It helps us accept and observe rather than judge and avoid. I encourage its practice and incorporate activities that foster mindfulness in my practice.
I believe that it's important to not only focus on how to prevent the cycle of relapse from starting but also how to interrupt it at all points. This can be before the initial use or deep into the stages of out of control use. My approach to relapse is to begin by identifying where you are in the process. We must disrupt the cycle that's occurring before we can focus on preventing it from starting. I also emphasize setting people up for success and coming up with a plan that will support long term recovery.
Often with the issue of co-occurring disorders comes a familiar question of which came first, the chicken or the egg. Like addiction in general, the answer can be complex if not impossible to answer. When approaching co-occurring disorders, I believe in an integrated approach and that it's important to pay attention to the relationship between all symptoms involved, no matter their origin. Mental health and addiction go hand in hand regardless of whether there is a diagnosable mental health condition and there for recovery from both is dependent on the other. I believe in taking a collaborative approach and working closely with all providers involved.
I believe addiction is a disease of disconnection and community recovery support has demonstrated to be a vital aspect of recovery. Engagement in the recovery community in combination with treatment increases the chances of being successful in recovery. I do not believe one fellowship is better than the other, they all have their own strengths. I will support you in whatever your choice is, whether you are drawn to one fellowship, a combination, or none. However, because mutual support has consistently demonstrated a vital role in the recovery from addiction and other mental health conditions, I will always encourage it as a powerful tool that is available.
Addiction and substance use disorders are complex. Although the wide consensus is that we may have not found a cure, they are treatable. I hold the belief that the treatment and answers to the problems that arise from these disorders are not a one size fits all and do not believe any one approach is right for everyone. I believe everyone's recovery journey is unique. I do however believe the disease of addiction is chronic and progressive and that people enter recovery at different points of the progression and thus treatment and recovery may look different for everyone. I am an advocate for the combination of medication and counseling and willing to work alongside prescribers in supporting your recovery.
The words we use matter. Addiction and mental health are highly stigmatized, and my approach is to normalize these. I pay particular attention to language and am an advocate of the movement to change the language around addiction and mental health. I strive to use person first language when talking about both mental health conditions and addiction. Currently within the addiction treatment field there is attention and a movement to change the way we talk about addiction. Research has shown that using common terms such as “substance abuser” verses saying “a person with a substance use disorder” negatively impacts perceptions of the individual and result in more punitive approaches by clinicians. Although these terms are often not ill intentioned, they have contributed to the stigma surrounding addiction. It is because of this stigma that only a fraction of the population who suffer from substance use disorders receive the treatment they need. The importance of what language we use and emphasis on person first language is not limited to addiction, but all concerns related to behavioral health.
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