What do all those letters mean (ACT/CBT/CRT/DBT)?

Therapy can come in many forms, and certain types or modalities draw from theories that can guide therapists to better understand their patients.

Acceptance Commitment Therapy (ACT) is a present-focused approach that helps individuals understand their thoughts and emotions without judgement and shame to enhance psychological flexibility. This method of therapy is most helpful for those undergoing a major life transition, managing chronic illness and/or disability, or experiencing grief.

Cognitive Behavioral Treatment (CBT) is an active approach to therapy to help individuals understand the connection among their thoughts and behavioral patterns that may be causing current distress. This is accomplished through behavioral/social experiments to challenge unhelpful thinking styles that can inhibit your connection to yourself, others, and the world.

Cognitive Remediation Treatment (CRT) is a time-limited, specific, and evidence-based modality of therapy that focuses on stimulating the development of new neural pathways (neuroplasticity), implementation of restorative and/or compensatory strategies to improve cognition and functioning, learning coping strategies to raise awareness of internal emotional and physical states that can hinder optimal functioning, and adoption of lifestyle changes to enhance cognitive health. A typical course of treatment is 6-12 months.

Dialectical Behavioral Therapy (DBT) is a third-wave behavioral treatment that focuses on building awareness for those struggling with big emotions and unpredictable reactions in your day to day. “Dialectical” is the act of finding balance between two seemingly opposing or contradictory thoughts. This method of therapy has been shown to be very effective for those living with chronic trauma, neurodiversity, queerness and/or gender, relationship, identity non-conformity, addiction, and thoughts of self-harm and suicide.

What does it mean to be “evidence-based” and is that the only way to determine if therapy will work?

Evidence-based practice (EBP) are forms of therapy that have shown through peer-reviewed and up-to-date research to be effective treatments for mental health diagnoses. While research is one way to determine the effectiveness of therapy, due to racism and patriarchy, EBPs may not have been studied in detail with certain populations such as those of the global majority, living with disability, and sexual and gender minorities.

I believe that community-based, spiritual, and cultural practices have a rich and meaningful role and impact on mental health and wellbeing. I utilize an integrative and holistic approach that draws from EBPs and traditional somatic and healing practices, and your own personal cultural practices to better address your concerns and guide you towards integrative living.

What is neuropsychology?

Neuropsychology is the study of how the brain functions and affects your behavior, mood, and thinking skills. Certain life-long conditions such as neurodevelopmental, genetic, and congenital disorders, or acquired brain injuries like stroke, concussion / brain injury, or degenerative illness (Alzheimer’s, Parkinson’s) can produce changes in your functioning that can be disruptive to your daily living.

Most neuropsychologists have a base doctorate in clinical psychology or a related field, and undergo additional post-doctoral training for specialization to learn about brain and behavioral relationships, functional and structural neuroanatomy, diagnostic formulation, and interventions and treatments.

What goes into a neuropsychological evaluation?

A typical neuropsychological evaluation consists of four main parts:

1. Historical review - Collection of relevant records, which can include past developmental, educational, psychiatric, and medical records. It can also include discussion with someone who knows you well such as a guardian, family member, and significant friends and romantic partners.

2. Clinical interview - This is an opportunity to have an in-depth conversation about what your cognitive, behavioral, and/or physical concerns are, and how long you have experienced them. You have this opportunity to also share your goals and reasons for seeking evaluation.

3. Neuropsychological testing - Tests are standardized, meaning that they are administered under the “most-optimal” conditions to reduce the impact of the environment and/or other non-specific variables that can affect performance such as poor sleep and/or pain. Most tasks are done orally, in a paper and pencil format, but there are some that require manipulation of objects such as blocks or the computer/tablet. This process can take between 2-8 hours depending on the complexity of concerns, and can be done over the course of multiple sessions if needed.

4. Interpretation of results and feedback - Neuropsychologists are trained to examine patterns of cognitive strengths and weaknesses, which can provide information on how the brain is functioning, clarity on certain diagnoses, and recommendations for treatment. While individual scores are important, it is quite typical for someone to have an uneven profile or a single low score, and does not always signal that there is an illness and/or disorder present. A evaluation report will then be generated and provided to you.

How should I prepare for a neuropsychological assessment?

Many folks can experience test anxiety, and the idea that you will be tested on memory when you are experiencing memory concerns can seem overwhelming and scary. There is no specific way to prepare for an exam as these tests are not like traditional ones you may have taken in school. There is no “passing” or “failing” as we are only trying to determine how you are functioning.

The best recommendations are to not make any major changes in your routine in the days prior. The night before the appointment, try to get a good night’s rest. Have a meal 1-2 hours before the evaluation (our brain needs sugar to function!). If you take medication that is stimulating or sedating (such as certain pain medicines, seizure medication, antipsychotics, sleep medications), you may be asked to take these medications after the evaluation as they may influence your performance. Avoid alcohol and other substances that may alter your functioning for at least 24 hours prior to the evaluation.

What is sliding-scale?

Affirm Neuropsychology is committed to serving those in need, but may not be financially able to afford the full cost of the fees for specialized care. This as considered a part of my larger mission to strive for racial, gender, sexual, and disability justice. Please contact me to get more information and to see if you qualify for sliding-scale.

What if you don’t accept my insurance?

A superbill/receipt can be provided if you want to use your PPO or EPO for reimbursement. You can confirm with your health insurance company whether they will reimburse out-of-network services. Additionally, you are welcome to pay the out-of-pocket fees for all services. Rates are provided here.

Why is it so expensive?

As the first-generation in my family to complete my academic education in the Unites States, my journey here has been long and fraught with financial insecurity. I do not come from generational wealth, nor do I come from a family with high financial literacy and/or experience working within “white collar” environments.

The sad reality is that there are very few grants and scholarships for graduate school as the decision is seen as a luxury or “extra.” Thus, I had no choice but to take out loans to pay for tuition, books/materials, and the general cost of living in New York City including health insurance, transportation costs, and rent. As a student, I worked 40-60 unpaid hours weekly to complete my coursework, obtain required clinical hours, and conduct research. The average cost of tuition per year is $20-40k, and doctoral programs are 5 years at minimum. I completed my degree in 6 years due to specialization in Clinical Neuropsychology. Additionally, I was required to complete a 2-year postdoctoral fellowship after graduation that paid minimum wage because I was still considered a trainee.

I was well into my 30’s when I started my real first salaried position. Academia is also unfortunately notorious for exploitation and inequitable practices. Thus, I made the decision to go into private practice where I could choose the populations I work with, and to earn my full potential. Because I work for myself, the costs of maintaining my licensure all comes out of my own pocket. This includes state-required registration fees, continued educational courses, and additional trainings and supervision for specializations (all those letters).