Elizabeth Nelson, Ph.D.
The mainstays of my clinical approach are consistent with cognitive-behavioral therapy (CBT), although I certainly did not start there. My early training was very traditional: as a therapist-in-training, I was expected to speak very judiciously, and present myself as "neutral" as possible. This psychodynamic method did not fit my personal style well in the end, but training in that approach did give me a great appreciation for the layers of meaning within a client's words and gestures, and ways in which people can block their own way even when they are just trying to protect themselves emotionally.
I longed to help people change more quickly if possible, and wanted to be able to use more parts of myself as a therapist. When I finally had a chance to try doing CBT, and couples/family therapy, it was a breath of fresh air for me. In these modalities, I can educate people directly (sometimes this is mostly what a client needs), use my sense of humor and let myself "show" (while maintaining good boundaries), and see people take great strides (sometimes in quite a short time). I recently have taken an interest in adding mindfulness and visualization practices to the work with certain clients and issues. I suspect the core of my practice will always remain CBT, but look forward to continuing to expand my knowledge and use of other approaches that help unlock change for the individuals with whom I work.
acceptance of things-as-they-are
career change (see life transitions)
grief & loss
hair-pulling (see trichotillomania)
life transitions (marriage/divorce, job search/retirement, becoming a parent)
perfectionism & OCD
preparation for medical/dental procedures (MRI, surgery/anesthesia, colonoscopy)
public speaking/performance anxiety
trichotillomania (hair-pulling); also: skin-picking, nail-biting
At first blush, this may sound like I would be trying to get you to be a yogi on a mountain top, but that's not it! Think of past times and situations in your life that may have been complicated, but with which you now are largely at peace. Or when you went through something very difficult or painful for you, but you actually went through it pretty evenly. Notice that a large part of that sense of peace or evenness came with ultimately accepting things just as they were - no more, no less, no pushing, no tugging, just dealing with things as they really were. And notice that this is a skill you already know and have used at times in your life. In working together, we consciously develop your "inner observer" to help with feelings and situations that you are dealing with right now. This doesn't mean that you mute your feelings, or don't take action on things you want to change. It does mean that things get simpler - that you have space to take a mental and emotional step back from what's happening so that you have flexibility and choice in how you move through life. Not just reacting in order to survive, but observing in order to thrive.
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Depression is a terrible advisor. Depression whispers in your ear that you should "wait to feel better" before you do many of the things you'd normally do in your day or week. So you put off or cancel plans, don't listen to or return messages, neglect relationships, drop hobbies, use sleep or substances to numb out, and maybe don't even get out of bed some days. The pain and loneliness might be so bad that you think of suicide as a solution, although it never really is. Here's the problem: depressed thinking is extreme, and slanted toward exactly the behaviors and thoughts that will keep you depressed. If you shrink your activities and relationships until you feel better, you actually are depriving yourself (and your brain) of the chance to experience some enjoyment or sense of accomplishment and hope. At first, it's true that you won't experience these good things as much as you would if you weren't depressed--but you may hardly experience any if you don't keep creating opportunities for a non-depressed response. This is why an important component of helping you with your depression is structuring your time to consistently include enjoyable and productive activities every day, no matter how small.
When you're depressed, you have a whole bunch of tangled and distorted thoughts that help trigger the depression, but also thoughts that maintain the depression. Cascades of thoughts such as "I'm not doing well at my job -> I'm not good at anything anymore -> I'm going to be fired. -> I might as well just quit now -> If I can't work, I have no worth -> The world would be better off without me." And all of that can happen in less than a second! There are very easy-to-learn tools for stepping back from your thinking just enough to get a handle on what's realistic vs. distorted thinking. This allows you to have a more realistic and proportional emotional response to what's happening.
We can work together from either side: untangling your thoughts and beliefs to free you to take different action, or going ahead and doing things differently in a way that can help shift your thinking. Either way, you begin to get out of the depressed mode of just marking time, and back to living your life more fully.
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When you are facing a big transition in your life, you can feel a messy mix of emotions. You may be excited to be getting married, and unsure about your ability to be content in your new life. You may be surprised to find yourself going through a divorce, and confused about starting over at this age. You may be looking forward to retirement, and sad to give up a role and sense of agency that may have been part of your life for years and years.
Major life transitions can become times of deep re-evaluation: Who am I now? What is important to me in this new phase? What parts of me remain the same no matter who I share my life with or what job I am in? What parts need to grow? How can I accept the past and move forward? How can I point my life in the direction of my deepest dreams and values from here forward? It is immeasurably helpful to have a space in which to slow down and explore your feelings and ideas about the changes occurring in your life, get support without judgment, and (re)connect with whatever gives you a sense of aliveness within yourself, and meaning in your daily life. I look forward to having those conversations with you.
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Maybe people in your life have been telling you for years that you are "narcissistic." Bravo for finally getting curious about what that means and if you can change! Narcissism is popularly thought of as meaning self-involved - that's true, but not in the way most people think. The seemingly high opinion you hold about yourself actually can be a persona or façade you've developed to compensate for an inner sense of shame and unworthiness. So, your self-involvement is really an ongoing reaction to the hidden negative feelings you have about yourself, that you may have never admitted to anyone (even yourself). I know how to help you transform those negative feelings and accept yourself, warts and all, so that you can truly feel good about yourself and have successful relationships with important people in your life.
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Panic attacks are the right response at the wrong time. When there is a true life-or-death situation, it's good for you to take short, fast breaths, to tense your muscles, to think really fast, and for your heart rate to rise. You would need all of that to increase your chances of surviving…if it were really a life-or-death situation. However, you are not living in the jungle about to be attacked by a tiger, and most of us will go our whole lives without being in such a situation. So why can you be triggered into panic just having a casual conversation with your spouse or co-worker, or driving on the highway?
How you are perceiving things makes all the difference. If your mind takes you from what is happening to imagining catastrophic or dangerous events, your whole system will dutifully respond to help you survive. If you are anxiously monitoring your body for the slightest change in your heart rate or a hint of lightheadedness, then alarm bells will ring and panic will start when you think you've detected it,. When you and I work together on panic, we identify and challenge the thoughts that trigger panic (like, "Uh-oh, something's wrong with my heart"), those that occur during an attack ("I'm out of control and no one will help me"), and those that occur between attacks ("I must avoid having any anxiety at all costs").
When you send more accurate messages to your brain, your system can ratchet down and respond more adaptively. I also teach you how to take control of your breathing and the rising tension in your body, so that you can keep your system out of the "panic zone." Panic is one of the things I like to help clients with the most because I can usually help you make a big difference very quickly - don't suffer needlessly!
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Interacting with our kids can push every button! The ups and downs of love, immense pride vs. worry, disappointment and anger can be exhausting. Take heart--you are not alone in your feelings and reactions, and you can change. I will work with you to identify the true source of your reactions, and have specific skills for calming down, setting clear boundaries (or lightening up if that's what's needed), and self-care. Working on your communication style with your spouse/partner (if present) also makes a huge difference in the two of you acting as a team to help your child. Please note: I do not do family or child therapy--this is help for you as a parent.
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If you have OCD or are perfectionistic, you build a box around your anxiety and worry. You try to contain and suppress those feelings so you won't feel out of control and overwhelmed. The box has rigid sides in the form of impossibly high standards, specific rules that must be followed, and even specific actions or rituals you feel compelled to perform in order to feel better for a little while. Adding insult to injury, if you "break a rule" or fall short of your unattainable standard, you feel guilty or ashamed--and try to contain those feelings by further reinforcing the sides of the box (greater perfectionism, more rigid rules). Socially, you might feel also feel ashamed of the effect that your worry, rules, and routines have on others. On the other hand, you might spend lots of energy keeping it all a secret. So, you may end up feeling very isolated even when you are around people. If this is a cycle you are caught up in, you don't have to deal with it all alone. I can help you to identify your worries more precisely and resolve them, rather than just contain or suppress them. That process involves learning how to get a fuller perspective on what's worrying you, and also involves some experimentation on your part in the form of "risking" giving up a little bit of control in order to feel substantially higher self-esteem, improved productivity, and more flow in your daily life.
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We seem to be hard-wired to be afraid of certain situations, animals, and insects. This is very likely due to there being a strong survival value to avoiding a venomous snake, for instance, that was passed on to us by our ancestors who did so. Some of our ancient relatives survived because they ran away from an actual snake (or tiger or wolf), but others survived who had just run away from what they believed to be a snake (or tiger or wolf) lurking in the bushes. Some of our ancestors surely died falling off of cliffs, leading those who survived to be extremely cautious about heights or even situations that they simply believed to be "too high." The same with spaces that seemed to those ancestors to be suffocatingly small, or any situation in which they perceived themselves to be physically vulnerable. In these ways, humans became programmed to over-estimate our vulnerability to certain dangers - not always basing our reaction on the facts, but on beliefs instead.
But just because a fear is natural, doesn't mean it needs to be a phobia that interferes with your life. The key is to develop the ability to stay in the feared situation just long enough to assess it accurately: Is the elevator really hermetically sealed, or is there enough air to breathe normally? Does that noise really mean the plane is falling apart in midair, or is it the normal sound of the landing gear retracting? I help you learn to calm your breath and body, so you can think clearly and respond appropriately to the situation you're in. We also take time to assess the accuracy of your typical thoughts about the focus of your fear. We put it all together by first imagining the feared situation step-by-step in session until you feel sufficiently calm and confident enough to be able to take on some version of that situation in reality--again, step-by-step. This approach is called exposure therapy. I've worked with many people on their fear of flying, helping them work up to going to the airport, taking a short flight, and then even flying overseas. I've worked with one client to overcome a fear of rats - we went from imagining rats and then dealing with a plastic rat in session, to literally playing with rats in a pet store for an hour. This work is extremely satisfying to me as a therapist, because I see people change in ways they might never have thought possible. I have yet to come across a fear that is too strange, too silly, or too big to tackle using this approach.
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I have a beautiful new baby, why am I crying all the time? I love my baby, but I find myself thinking that I can't be a good mother to him or her. I notice that my friends who are also new moms don't seem to be nearly as exhausted, or irritable, or unhappy as I am. What's going on?
For a new mother, it can be devastating to think and feel these things. And they are signs that you need immediate support and therapy to deal with post-partum depression. The hormonal changes that happen in the days and weeks following the birth of your child are dramatic, and can dramatically affect your mood, energy, and perspective. Don't suffer alone--I can help you understand what's happening, develop ways of coping with the feelings of extreme sadness, anger, and isolation, and guide you in taking steps that will relieve the depression and help you be present for yourself, your baby, and your family again.
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Many people avoid medical/dental procedures or surgery/anesthesia, or feel very anxious beforehand. I can work with you in a very focused way over just a few sessions to help you prepare and reduce the stress around an upcoming procedure or surgery. Guided visualization is very powerful: to address specific aspects of the surgery or procedure, and to improve the mind-body connection--especially when you also use your breathing to calm your nervous system. I also help you identify your specific worries about the procedure or surgery/anesthesia, and can coach you to approach it in a realistic, calming way.
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Procrastination is a uniquely human behavior. Spiders are never behind in weaving their webs, bees are never behind in collecting pollen, caterpillars are never behind in spinning their cocoons, and ants are never behind in all the tasks that sustain the colony! When I work with you on procrastination, we work toward procrastination becoming less of a mindless habit, so that you are truly making conscious choices about where you put your focus, time, and energy. First, you need to be thoughtful and reasonable about what you are planning to do at certain times (scheduling), and I help you evaluate that. Then, if you find you are not doing what you planned at that time, it's useful to consider: What are the pros/cons of what you planned to do? What are the pros/cons of what you are doing instead? Are there specific expectations or attitudes that are getting in your way? Are they realistic or helpful? It may be fine to change your plan: our goal in therapy is for you to be clear with yourself that you are changing it, and that you know why. And then make sure to reschedule the thing that isn't getting done right now. This is all easier said than done, at least at first, but it is a set of skills I can help you learn and practice until it really is second nature--a mindful and healthy habit.
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Fear of public speaking is one of the most common fears humans have, and when it's a problem for you, it can really put a damper on your career, or even make it seem impossible to pursue certain positions. There's a lot more you can do than imagine the audience in their underwear! I can help you overcome this fear by identifying your "hot spots" in a public speaking situation, and helping you practice dealing with them step-by-step--beginning by imagining a relatively low-stress situation, and working up to your personal "nightmare" scenario. While you are imagining a specific situation, you are also learning to use tools such as breathing and challenging your catastrophic thoughts, to move through the situation with less fear and more confidence. Once you are successfully navigating more stressful scenarios in imagination, you will begin step-by-step to actually practice in the real world between sessions. By the time you've successfully faced your most dreaded scenes in imagination, taking on a "5%-stressful" public-speaking situation in your real life (like speaking up at a meeting), is a snap!
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It's become a mindless habit: twirl your hair, find a hair that feels "just so," pull it out, maybe even test it with your teeth. Later, you feel self-conscious, wondering if anyone can see the bald spot under the hairstyle you've created to disguise it. You may feel too ashamed to even get your hair cut. Hair-pulling rises and falls with stress and anxiety (as do skin-picking, nail-biting, or cuticle-biting). However it began, your hair-pulling probably has come to function as a "self-soothing" activity, something that calms you (even as it also distresses you). I can help you appreciate the importance of this self-soothing, and develop other strategies for balancing yourself and dealing with stress. You can become mindful rather than mindless in how you handle the ebbs and flows of your own emotional life. There are also very practical steps to take to interrupt the hair-pulling habit, and literally retrain your attention (and fingers) away from pulling. Let me help you break the habit.
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