Approach
An active, direct psychotherapy, built from two traditions
For decades psychotherapy has been divided between the focused, measurable change of cognitive behavioral therapy and the lasting self-understanding of psychoanalysis. Cognitive Behavioral Psychoanalysis (CBP), the integrative model I developed, holds the two in one treatment: a formulation of how a pattern formed and what keeps it going, work on the pattern itself, with skills for the moments that matter and attention to what has been avoided, and a review of progress against what you came for.
I am an active participant in the room. I ask close questions, offer my perspective, and help you understand patterns that are hard to see from the inside. Your difficulties and your ambitions receive equal attention, because in my experience the two are rarely separate. The model is organized around four questions. What is the pattern, and what keeps it going? What happens when feeling outruns judgment? What was learned early about feeling, authority and closeness, and how much of it is still running? And what is the work, the marriage or the household for? The questions are weighted differently for each person, and the answers are stated plainly enough to test.
What I draw on
The model draws on the cognitive behavioral and psychoanalytic traditions; my own training is in dialectical behavior therapy, psychodynamic psychotherapy and cognitive behavioral therapy. Which element leads depends on the formulation, and I explain the reasoning.
Dialectical behavior therapy gives us practical skills for regulating intense emotion, tolerating distress, communicating effectively and staying present. I spent five years in a DBT research lab and wrote my dissertation on teaching DBT skills to clinicians. I apply these skills to the moments you actually face.
Psychodynamic work looks at how earlier experiences and relationships shape the way you react now, often in ways that are hard to notice on your own. Understanding where a pattern comes from is frequently what makes it possible to change.
Cognitive behavioral approaches address the thoughts and habits that keep anxiety, low mood and avoidance going, and the concrete steps that turn an intention into something you sustain.
Emotion regulation and the patterns beneath it
A central concern of my clinical work and research is emotion regulation, and the patterns beneath it that shape how a person experiences feeling and relationships. I draw on object relations theory, particularly the writing of Thomas Ogden. In that view, we each carry ways of relating formed early in life, and these shape what we feel, what we can put into words, and what we leave unsaid. I pay attention to how our work together feels to you, because reactions in therapy often show the pattern we are trying to understand.
That attention sits alongside practical work. We build concrete skills for regulating intense emotion and use them on the situations you face.
How the work unfolds
Understanding
We start with a thorough assessment of what brings you in, your history, your strengths, and the changes you want to make. I share a formulation: an account of which difficulties you have and how they developed. A diagnosis names the problem; the formulation explains it, and it is what we agree to work from.
Working on the pattern
We might examine why a disagreement repeatedly ends in distance, what happens when you feel overwhelmed, or what an important next step asks of you emotionally, and at a pace you set we turn toward what has been steered around. I will be direct when I notice something that may be getting in your way, including when it appears between us, and we will think together about how to respond differently.
Reviewing
Progress is reviewed against what you came for, and the formulation is revised as we learn more. The work ends when the pattern has changed, not when a protocol runs out.
With adolescents
With adolescents, I take time to understand their own concerns and goals, including when a parent first suggested therapy. We discuss parent involvement and confidentiality at the outset.
Therapy for adolescents and young adultsUnder pressure
With people whose work or sport asks a great deal of them, the same four questions apply, and the order matters: you have to be able to find yourself under pressure before you can contend with yourself, and only then does the opponent become the real subject.
Therapy for performanceGetting started
The first conversation is a free 15-minute phone call with Dr. Inzinna or Mr. Espinal. Sessions are held in person at our office on East 89th Street.