Process of therapy
Initial Steps:
- After you reach out, Dr Caruso-Maxey will schedule a free 15 minute consultation with you to get a better understanding of what you need, and you will have a chance to learn more about her practice.
- If both you and Dr Caruso-Maxey determine that your needs are aligned with the work she offers and you would like to start therapy, you will receive an email inviting you to a HIPAA compliant client portal. There, you will be guided to complete all intake paperwork prior to the first session. Paperwork is 'paperless' and everything is completed, signed, and submitted electronically. This means no physical documents of your private health information are held or created (just makes it easier to ensure your privacy). Documents include: consent paperwork for both in-office and telehealth visits, acknowledgment of practice policies, acknowledgment of Dr Caruso-Maxey's privacy practices and how she protects your health information, an intake questionnaire, a depression and anxiety inventory, authorizations to communicate with other providers if appropriate, and perhaps a few other screeners or questionnaires that might be pertinent to you.
- The initial visit is one hour, and Dr Caruso-Maxey will be a clinical interview to better understand you and your presenting issues, and your desired outcomes. Dr Caruso-Maxey negotiates this process casually, rather than you feeling assaulted by rapid fire questioning! From there, she will give you an idea of treatment frequency and answer any questions you might have.
Therapeutic Process
Dr Caruso-Maxey's therapeutic approach is integrative, and takes into consideration not only which evidence-based therapies are effective based on your symptoms, but also who you are as a unique individual. Since evidence-based interventions are only effective if you're able to engage in treatment, below are some of the internal and external factors that require consideration:
- Your unique collection of 'cultures:' Think about all of the cultures that you identify with. The term 'culture' refers to all of the identifiers you use to identify and interact with the world around you (including but not limited to your ethnicity, race, age, gender, sexual orientation, political identity, religious or spiritual affiliation, values, beliefs, level of education, access to resources, status of physical/cognitive/mental health, occupation, social and interpersonal relationship status, hobbies, interests). At different times in your life, some of these identifiers might take center stage, while others might feel less important and fade into the background. Some of these cultures might conflict with each other, which can create internal turmoil. These cultures wield power and privilege as well as disadvantages and disempowerment – depending on the context you're in. Dr Caruso-Maxey also considers how her own apparent cultures (things you can surmise about her by her appearance) might impact the work you do with her.
- Your personality and temperament
- How you process, perceive, and retain information
- Your motivations and inclinations
- How you communicate and self-express
- Your attachment style and psychological defenses
- The level and intensity of your central nervous system activation
- Your developmental history and family dynamics
- The community and system you grew up and what you are currently embedded in
- Your current capacity to cope and self-regulate
- The presenting issues you're dealing with
- The signs and symptoms you're experiencing and how long you've had them before treatment
- how much distress you're in, and how well you're functioning in the most important domains of your life
Most of the time, Dr Caruso-Maxey conceptualizes your needs and creates a plan after the first session, though because you are a dynamic individual, different interventions can be added or adjusted depending on what is appropriate at the time. You will be a part of the treatment planning process to ensure both you and Dr Caruso-Maxey are aligned in understanding your needs and desired outcomes.
I meet you where you're at; we walk together. I've never found it to be effective to push clients when they're not ready, or refrain from challenging clients when they're capable of a gentle push. Your body holds wisdom that even you may not be conscious of, creating thoughts, feelings, or behaviors that can seem incompatible with your goals and because of this, must be explored rather than dismissed. My therapeutic style is straightforward, sincere, intuitive, and relational, and I recognize that the work is not effective unless you feel safe enough to be honest with me and with yourself. While I am trained in the art of psychotherapy, you are the expert of you. I'm also quite aware that my role as your psychologist creates a power differential within the therapy relationship, and so I'm here to preemptively empower you to bring up any issues that may arise. I am always open to being wrong, as being 'wrong' is part of the human experience. I welcome and support mutual respect, authenticity, openness, and curiosity in therapy, because without them, there is no trust.
-Dr Caruso-Maxey
Evidence-Based Treatments
Dr Caruso-Maxey has specialized training and/or certifications in the following evidence-based therapies:
- Cognitive Behavioral Therapy
- Mindfulness-Based Cognitive Behavioral Therapy
- Trauma-Focused Cognitive Behavioral Therapy
- Acceptance and Commitment Therapy
- Exposure-Response Prevention
- Principles of Dialectical Behavioral Therapy
- Psychodynamic Therapy
- Emotion-Focused Therapy
- EMDR Therapy
Course of Treatment
"Length of treatment varies depending on the aforementioned factors and how they interact with each other. Treating depression that came on a month ago without any other co-occurring issues is honestly rare these days, but this type of depression would likely be a lot quicker and more straightforward to resolve than say someone coming to see me after they've had untreated depression for two years, carrying of a history of victimization, attachment trauma, and exhibiting poor self-regulation from the habitual use of ineffective coping skills. "
"Everyone's needs are different, even if I'm treating the same diagnosis. If I notice there is no movement in treatment after three sessions, we will explore what might be happening and see if we can't move past any barriers. If I believe you need a different level, style, or type of support to help you that I cannot provide, I will let you know and will help guide you in that direction. All of my clinical training and most of my professional experience has been with brief therapeutic interventions, and I also know that some people need longer-term therapy to get to their desired goals and build a life worth living. If you have any questions, don't hesitate to ask."
-Dr Caruso-Maxey
Do I even need therapy?!
The tendency to question ourselves...
You might be questioning yourself right now. Am I really depressed or just lazy and unmotivated? Am I really anxious or just being dramatic? Was what happened to me really that traumatic? You might start mentally comparing yourself to others and conclude that because there are other people in existence who you believe have it worse, you couldn't possibly be struggling. I mean, it's not like you can peer into anyone else's mind to compare your suffering to theirs, and no one can simply look inside your ears, nose, or throat to see what your suffering looks like from the outside in. But you see, this wound is not like a broken arm or appendicitis. You can't literally see it, nor can anyone else, and no x-ray or invasive medical intervention will simply tell you what you're experiencing is real and pop out a diagnosis. Living with an invisible illness does not mean it doesn't exist, and just because your mental math tells you you're too far down on the hierarchy of suffering to be entitled to be depressed, anxious, or whatever you might be experiencing, doesn't mean it isn't true. The cruel reality is mental illness doesn't care how your life looks on the outside; it happens regardless of your perceived or actual privileges. So, if you aren't sure whether you are struggling but you think you might be because the thought of being in this state for the rest of your life feels intolerable, just reach out. If I don't think you will benefit from therapy at this time, I will let you know.