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Carmen provides confidential, fee-for-service, psychotherapy services to help both men and women work through their anxiety, performance and procrastination issues. Her practice combines practical advice, support, reality testing and goal-oriented outcomes. Please contact Carmen at 530.601.1003 to learn more.

Oct 25

What is Play Therapy?

By Cisais | Anxiety and Trauma

As psychotherapists, our focus is in child development and play therapy. We use a playful and individualized approach to empower children to cooperate, self-regulate and effectively communicate their needs.

Play therapy is most often used with children ages 3-12 and usually occurs in weekly sessions.  Some children’s behaviors may improve very quickly with play therapy (averaging 15-20 sessions), while others may have more serious or ongoing problems that may take longer to resolve. Play therapy works best when a parent, family member, or caretaker is supportive and actively involved in the treatment process.

Why Play Therapy?

Developmentally, even the brightest children have not developed the capacity to use the insight-based verbal reasoning– which is needed to be successful in one-on-one talk therapy. What works in the world of play therapy is that it play can be used as a language by the child,  overcoming the challenge of more traditional language-based communication while still allowing the therapist to assess and respond to the underlying needs of the child-client. Also, because therapy sessions are child-centered, there is less resistance and often more rapid change than with talk therapy.

Play therapy is different from regular “playdates” because in these specialized sessions, therapeutic space is created to allow the child-client to express, address, and resolve the challenges they have faced. Play provides a psychological distancing from a child’s issues and allows expression of thoughts and feelings– which is the process work of therapy. Through play, therapists can help children learn more adaptive behaviors when there are emotional or social skills deficits. Children learn to communicate with others, express feelings, modify behavior, develop problem-solving skills, and learn a variety of ways of relating to others. Even the most troubling problems can be confronted in play therapy and lasting resilience can be discovered, rehearsed, mastered, and adapted into lifelong strategies.

Play therapy is effective with children experiencing life stressors, such as relocation, hospitalization, chronic illness, abuse, domestic violence, and natural disasters. Therapeutic play and can be used with children dealing with:

  • anger management
  • grief and loss
  • divorce, family dissolution, and abandonment
  • crises and trauma
  • anxiety
  • depression
  • ADHD
  • Autism or pervasive developmental disorder
  • academic and social problems
  • learning disabilities
  • conduct disorders
Nov 18

Are We a Right Fit?

By Cisais | Motivation and Choice , Musings

Carmen-Isais-Coach-and-CounselorOne-on-One Coaching

My clients change.  This is something I say often.  And it is true.

The vast majority of my clients achieve success for themselves. This is because I only work with clients who I believe will succeed.

If I sense up-front that someone isn’t right for my approach, I’d rather not take take their time or money.  Read below to find out if you and I were meant to be…

verified by Psychology Today

My clients –

  • Are looking for a short-term boost rather than a long-term solution.
  • Want to passively have someone “fix them”.
  • Are serious about getting their problem solved.
  • Are ready to take responsibility for their lives and relationships.

I look forward to working with you if –

  • You are ready to do the work it takes to get your goal accomplished.
  • You are ready to learn and change to achieve your outcome.
  • You take responsibility for your decisions and actions.
  • You want a natural, drug-free solution to your issue.

A few other things you should know about me

  • Pricing:  The services I offer enable clients to make profound changes in their lives, usually very quickly.  I charge accordingly.
  • Approach: All work is done with a tailored, one-on-one approach working with me directly.  There are no use of scripts, light/sound goggles or CDs.  In addition to weekly goal oriented solutions, working with me often involves coaching and tasks done outside of the office. Yes, I give “homework”.  :)
  • Medication:  I cannot prescribe, nor am I a proponent of psychotropic drugs. That being said, I understand that they can be a short term buffer between “no longer” and “not yet”.  For most, there are great alternatives to anti-anxiety and antidepressant medications. and I have great referral sources to local medical doctors who can support that. Let’s talk.

If you have read this far, thank you. If you have questions and would like to reach me, please do not hesitate in contacting me via email or by phone at (530) 601-1003 .

 

 

 

 

 

 

 

 

Nov 16

Thinking As a Way of Being

By Cisais | Health , Motivation and Choice

second thoughtsThose of us on the path of personal and spiritual growth have a tendency to analyze our unhappiness in order to find the causes and make improvements. But it is just as important, if not more so, to analyze our happiness. Since we have the ability to rise above and observe our emotions, we can recognize when we are feeling joyful and content. Then we can harness the power of the moment by savoring our feelings and taking time to be grateful for them.

Recognition is the first step in creating change, therefore recognizing what it feels like to be happy is the first step toward sustaining happiness in our lives. We can examine how joy feels in our bodies and what thoughts run through our minds in times of bliss. Without diminishing its power, we can retrace our steps to discover what may have put us in this frame of mind, and then we can take note of the choices we’ve made while there. We might realize that we are generally more giving and forgiving when there’s a smile on our face, or that we are more likely to laugh off small annoyances and the actions of others when they don’t resonate with our light mood.

Once we know what it feels like and can identify some of the triggers and are aware of our actions, we can recreate that happiness when we are feeling low. Knowing that like attracts like, we can pull ourselves out of a blue mood by focusing on joy. We might find that forcing ourselves to be giving and forgiving, even when it doesn’t seem to come naturally, helps us to reconnect with the joy that usually precedes it. If we can identify a song, a picture, or a pet as a happiness trigger, we can use them as tools to recapture joy if we are having trouble finding it. By focusing our energy on analyzing happiness and all that it encompasses, we feed, nurture, and attract more of it into our lives, eventually making a habit of happiness.

Nov 12

Diffusing Parent Conflict After Divorce

By Cisais | Divorce

Increasingly in our family law court system we are seeing divorces that can be identified as “High Conflict”.  Entire careers, and hundred of thousands of dollars are being made by this phenomena, and whether you consider this wrong or right, one thing we can probably all agree on is that YOU do not want to be the less that 10% of  divorces that use 80% of the family court resources.

If you are recently divorced and find your co-parenting relationship starting to deteriorate, it is important to stop divorce conflict before it goes too far. Here is my advice to you:

1. Love Your Child More Than You Hate Your Ex.

During divorce, and sometimes long after, parents are so consumed with their hurt and resentments that they retreat into survival mode. For some parents, survival mode equals attack mode. The idea that children are resilient enough to be immune is a myth.

In my work with anxiety and trauma clients, I have adult clients of High Conflict divorce, who at age 20, 30 & 40 are still suffering the emotional damage caused them by having been witness to their parent’s anger towards one another. In adults this effect manifests itself as anxiety, depression, neurosis and chronic health issues. And this damage is not intentional. Minimizing one’s own behavior or blaming a children’s fragility occurs because the High Conflict parent must focus on their own survival. The unintentional damage that loving parents cause their children seems inevitable because these parents do not have the knowledge and practical skills to parent in a crisis. Throughout a difficult divorce, parents’ unbridled emotions almost always put their children in harm’s way.

Refocusing your energy on the childhood experience is paramount to good parenting. Connecting more with your child’s needs and separating them from your own is not so easy when you are flooded with resentment for your ex-spouse. Get really authentic about how you have been inauthentic in your parenting.  Have you made some less than stellar choices under the guise of the children’s “best interest”?  If you cannot bring yourself to make amends with the other parent, find a trusted friend or family member to get clear on this.  This is hard work, I know, but it is necessary work.

Love your child more than you hate your ex, and let that love motivate you.

2. Pay Your Child Support.

It is amazing to me that anyone would need convincing on this issue, but alas… While there are legitimate cases where a parent is unable to pay (job loss, illness, family hardship), in my mediation work I have seen most cases of “failure to pay” are born out of simple spite and vindictiveness. Indeed, if you can afford to see me and pay my mediation fee of $250 an hour, then certainly you can afford to contribute to the care and well-being of your child.

Deliberate non-payment of support, coupled usually with purposeful underemployment, is just gross negligence. And to be clear, this goes for both parents. While the term “Deadbeat Dad” gets passed around a lot, increasingly, Mothers too are falling under the “deadbeat” parent laws across the nation. At the time of this writing, the United States Census shows only 57% of Moms required to pay child support for their children actually do so. Meanwhile, a simple internet search results in a plethora of websites aimed at helping Fathers avoid paying child support. Presumably, there is a demand for this service. Get it together Mom and Dad, equally.

Deliberate non-payment of support adds fuel to the high-conflict fire of divorce. If a healthy co-parenting relationship is not possible between you and your ex-spouse, at the very least separate out your anger with your spouse from your legal and moral obligation to your children. Your children know what is going on and they will grow to understand the motivation.

In his discussion of how children cope with high conflict divorce, San Francisco Psychotherapist and licensed clinical social worker, Paul Livingston, writes that in these circumstances of High Conflict “children are faced with a barrage of words, events and thoughts that they are not prepared to deal with in any healthy way.

According to Livingston and a growing body of research, children who are witness to their parent’s anger towards one another are more likely to suffer as students, experience deteriorated relationships with peers, have a lower level of self-confidence, more anxiety and feelings of depression than they would otherwise. Divorce doesn’t ruin children. Angry, divorcing parents do.

3. Do the Work You Need to do to Heal After a Divorce.

Grieve your Divorce. I don’t care how lousy your ex might have been, a divorce is the death of a dream that did not come true. It is painful, regardless of who initiated the separation. And every divorce deserves to be grieved. Pretending it is a celebration is not only unhealthy, it is inauthentic.

Keep old friends. Make new friends. Divorce can be confronting to others. Be prepared to lose some friends and support. Consider that these occurrences usually have nothing to do with you and are just representative of what happens in the world of transition… things get lost. Be open to new people, new support and new friends.

Get Professional Help. If you want to keep those friends, both new and old, don’t make them responsible for holding the entire magnitude of emotionality you might be dealing with. Moreover, your friends and family are not objective. While you might not always like what you hear from them, they are still unlikely to successfully facilitate the radical self-examination you may need to experience in order to learn and grow. And really, why go through the pain of divorce without at least some growth?

happy_kids_divorceIf you have children, leftover issues from the marriage, such as anger, pain, betrayal and loss of trust can interfere with how you show up as a Mother or Father. Parenting becomes the scene for unresolved marital issues and no one suffers more than the children.

My husband’s psychotherapy website includes the phrase, “Change is inevitable. Growth is optional. Choose wisely.” Heed those words, always, but especially in the face of divorce.

If you recognize yourself in any of this– that level of awareness is HUGE and it is the first step. Without being made wrong or being judged, consider contacting an experienced Divorce Coach or counselor to help move you through the “no longer” and “not yet”.  A lot of little lives depend on it.

Nov 10

EMDR Therapy and Trauma

By Cisais | Anxiety and Trauma

Trauma survivors often complain of recurring nightmares, sudden tearfulness, flashbacks, aversions to places or people and even somatic/physical discomforts. Eye Movement Desensitization and Reprocessing (EMDR), is a technology created about 20 years ago by Francine Shapiro, PhD. EMDR involves systematically bringing highly charged images/experiences to the conscious self without hypnosis where they can be rationally dealt with and resolved into normal memory. This process is rapid and is noted in psychology journals as the most effective treatment available for PTSD.

Oct 12

The One Thing Not to Lose Sight of When Getting Divorced

By Cisais | Divorce

Divorce is a time of great transitions, losses and potentially, growth. Divorce is one of the hardest things you might go through in your lifetime and while you are in the midst of this “hardest time in your life” you might lose sight of one very important thing.

You want to stay out of court. You do.

Yes, you really do.

Yes, I understand that you’re mad/hurt/betrayed/protecting yourself. But you still really, really want to stay put of court.

Court is not a place for families. It is a place for lawyers. It is a place for individuals who have been trained and socially encouraged to make up a paycheck by manipulaing a body of rules and formulas that have nothing to do with you and your family. Court is a place where strangers throw phrases around such as, “in the best interest of the children” to justify bankrupting your children’s parents (yes, that’s you) and all in the name of the law.

If that sounds harsh, it’s because it is. Court is the worst thing that could happen to a healthy family.

Is there a time and place where court and litigation is necessary? Absolutely. I will write more about that in a future post. For now, know that the great majority of divorce cases can and should be settled out of court, mediated, or refer to collaborative divorce.

I get it, you are mad. And yes, your ex is a so and so. And yes, the children would be better off at this school or that school or ??? And no, you can’t agree on a custody plan, and how will you live with no support? Or paying support? And what happens to the house/retirement/family business?

We can figure this out. Mediation works.

Don’t give up on collaborative divorce or mediation. Almost every single divorce mediation client I’ve had starts their first contact with me by telling me that they don’t think their case it is appropriate for mediation. With few exceptions these families have all been able to resolve their divorce, custody, and financial issues through mediation.

When you are in the middle of a divorce there is perhaps a lot of distrust, lack of confidence in your soon-to-be ex, and plenty of hurt and disappointment to go around. These are not times that you should be making huge financial decisions such as dropping thousands of dollars into litigation (and your lawyer’s pocketbook).

What I tell potential clients is that once litigation begins it is very difficult to get out of it. On the other hand, it only takes one person decide to stop mediation for mediation to end. Also if mediation fails you still have the option of litigation. Whereas once you’re in court it’s really hard to turn the hands of time backwards and move into mediation.

Even if you and your soon-to-be ex can find resolve on a few issues, it will have been worth it, both financially and definitely emotionally.

Sep 02

A Soldier’s Unseen Wounds

By Cisais | Anxiety and Trauma

A gun, a tank, a rocket launcher all make sense if you are a member of any of our armed services on a tour in the Middle East. They are necessary for the tasks that these men and women have been trained and, for better or worse, fit into the context of war.

Just as a rifle is a tool with a specific design; the sight to hone in on a target, materials that resist wear and damage, a magazine to hold rounds to defend or attack, a trigger to engage the sole purpose of the tool. So too, can a mind be conditioned to serve a specific purpose to suite an environment and a context that can be imagined, practiced and realized in mission after mission.

The difference is that the rifle is not expected to change purpose at the end of a tour. Whether in ‘that’ environment or another it maintains it’s function and form. We expect our servicemen and women to suddenly, and with little preparation or explanation to change context, change purpose, dial back intensity, leave the thousands of hours of training in the camps.

If you are one of them. It may be one of the most difficult experiences you have ever had or will have. Feelings of detachment and isolation even when around familiar people, not feeling purposeful or needed, having a loss of direction and confusion about the future. These are all common to the returning soldier.

Aside from the personal effects, behavioral issues compound the problem. Poor sleep patterns, rapid mood changes, aggression and irritability, depression and even panic attacks can all be an unfortunate result of a rapid transition into what many soldiers had hoped for upon their return.
These symptoms are all part of a syndrome related to Acute Stress Disorder. This is the diagnosis that precludes Post Traumatic Stress Disorder. In later years the military has done a much better job of acknowledging wars effect on soldiers. However, the treatment modalities used such as Systematic Desensitization and Group therapies often offer little help.

The good news is that the prognosis for Acute Stress Disorder, PTSD and other trauma-related issues is very good in that symptoms can be managed in a relatively short time and a healthier experience of themselves can begin immediately.

Please read more regarding EMDR and Neurobehavioral Medicine or call me to see if you or someone you know may be a good candidate for treatment. And, Thank you for your service.

Aug 16

Anxiety Snapshot

By Cisais | Anxiety and Trauma

One of my many reasons for working with individuals with Anxiety, Panic Attacks and PTSD is that they all carry a very good prognosis. Meaning that, when treated properly, we can expect positive results and we can expect them to last.

When I hear of someone or meet someone who has suffered from long-term generalized anxiety or Panic Attacks I feel a sense of urgency to make changes early on. There is simply no reason why a person should suffer with either of these debilitating clusters of symptoms.

Anxiety and Panic are expressions of a problem at a deeper level. Much like pain in the body, anxiety is a signal that something needs to change. Part of the work is discovering what change needs to occur, part of the work is finding behaviors to manage, reduce or eliminate the attacks/anxiety and part of the work is trusting the change that occurs over the long run.

That being said, treatment approaches can involve emotional, behavioral, environmental, familial and spiritual aspects of a person’s life. While the work to minimize the suffering is primary, the secondary changes that occur in this exploration enrich every aspect a persons’ life.

I work with individuals with problems with anxiety, PTSD, trauma as well as with couples and adolescents.

Nov 16

Lee Ockenden, LMFT – My Approach

By Cisais | Couples and Relationships , Motivation and Choice , Musings

Lee_Ockenden couples counselorWho we are and how we relate to the world and others is dictated by the meaning we give to our past. But if we choose to find the purpose in our experiences instead of the pain, we find new resources, giving us the catalyst to change, grow, heal and pursue the life we desire and deserve.

Traditional therapy was founded in psychoanalysis with the assumption that an individual’s growth and change process was hinged on gaining insight and into their behavioral patterns by processing, free-associating and reflecting on their past. Inside this traditional “treatment culture,” it is not uncommon for a client stay in treatment long periods of time, lasting anywhere from three to seven years or more, including multiple sessions per week.

I believe that traditional therapy can foster dependency and create barriers for lasting change. I often hear from new patients who have been to therapy for many years that they felt their last therapist(s) were too passive. Rather than embracing a “backward looking—coping” approach, I embrace a “forward looking—thriving” approach by focusing on resolving barriers to change, identifying solutions and creating choices. This approach, inside a safe supportive and consistent counseling environment, encourages clients to use their own innate resources to heal.

In addition, I am also clear that my clients will ultimately find their support and accountability through their partner, family or community and I encourage my clients to create a healthy support system outside the office.

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