Lois Zsarnay
LMFT, BCPC, RD

Cognitive Behavioral Therapy

Cognitive behavioral therapy is one of the things that I do a lot of. Cognitive Behavioral Therapy involves looking at what people think, and how they then behave because of their thoughts. For example, a key concept to this therapy is "If the thought is correct, and if our behavior follows from the thought, then it is usually appropriate behavior. However, if we have a distorted thought, and if our behavior follows from the thought, then perhaps the behavior is not appropriate".

Frequently clients will come in and say "Well, its not what they said, its how they said it." That type of sentiment is all about the meaning that is assigned to the words, the body language that is used, the tone of the voice, the intonation, and the emphasis that is placed on certain things. It is these things that really can send the wrong message or a mixed message and get us into trouble.

So, part of the cognitive behavioral therapy process is determining what is working in the relationship and what isn't. One of the initial concepts to understand in this process is that there are 7 steps in communication, therefore before we rush to conclusions when we're angry, upset, or offended, it is important to ask ourselves, or each other, questions such as "Was that what they really meant?", "Did you mean this? Because that is what it meant to me." Then it is important to give the other person a chance to clarify what they've said. If we keep focusing on what our first impression of what they said was and choose to ignore their explanation then we're not willing to compromise and we're staying stuck with the first impression. It is key to clarify what they've said and then let the initial impression go.

So whether it is families, couples, or older parents with their adult children, cognitive behavioral therapy can work really well for people who, at times, don't quite understand the way that they think and then what they do as a result. There are actual cog-logs (or cognitive logs) for writing these things down. This can help a person keep track or make sense of any sort of lingering thoughts which they may not be aware of that continuously exist in their mind. Sometimes those thought patterns have been with them since childhood so they can be very automatic, almost subconcious. Often people are not even aware of the automatic thoughts since they happen so quickly and, well, automatically. We can not change what we don't even know is happening so the first part of this type of work is to become aware of what we are thinking.Then we have to take a look at those thoughts in the cold, hard light of day and decide if that's how we would like to think (i.e. does that thought fit with the kind of person I want to be). If not, then we explore how we would really like to think about that.  Then we start the journey to re-write the automatic thoughts.

Behavioral Therapy and Behavioral Health Services

Behavioral therapy by itself is just working on people's behaviors. An example of this would be a child behaving a certain way and as a result their parent needs to have or do something which decreases the frequency of that behavior. The parent in this case would also need to be conscious of not inadvertently reinforcing this behavior or rewarding the child for it. In this case, the child would naturally need to be allowed to go through a transitional process in which they are given time to try to stop engaging in the behavior that is trying to be eradicated.  Often times the target behavior will get worse before it gets better so we need to be ready for that initial response.

Dialectical Behavior Therapy (DBT)

I've had training in dialectical therapy and I use these skills often in my practice. Some of the basic premises which I think that many people can benefit from include radical acceptance, emotion regulation, distress tolerance, and being mindful and present. These are the primary components of DBT therapy and it is known to be very helpful to people for many reasons.

Dialectical Behavior Therapy began with the research which was originally being conducted for borderline personality disorder. Currently, its most common uses are with people who have eating disorders, addictions, or people who have significant emotion dysregulation. Emotion dysregulation is when a person becomes very upset about things.

I have worked with numerous young people from middle school thru high school who have a lot of emotion dysregulation where their feelings overwhelm them. We focus our work on developing the skills to be able to manage those feelings, contain the feelings, and be able to respond appropriately. Anger is not a bad thing, it is a feeling. It is what is done with those feelings that can sometimes make it a problem. For these situations I work with the person to develop the skills needed to deal with these feelings appropriately.

One of my specialty areas is substance abuse and addictions. In some cases the addiction is a process addiction like gambling, shopping, pornography, or an eating disorder. I often work with these types of issues as well as drug and alcohol problems in private practice. I also teach part time at the Addictive Disorder Studies program at Oxnard College.

Eating Disorders

I'm a Licensed Marriage, Family Therapist as well as a Registered Dietitian, so I do a lot of work with disordered eating or eating disorder clients. Disordered eating clients are people who are having an unhealthy relationship with food and want to change that but they don't really know how to go about it or they haven't been able to put the changes into practice. It's the person who comes in saying, "I know, I know, I should eat more of this and less of that, and do more of this and less of that!" They often already know what they "should" be doing but haven't been able to put the changes into practice. That is where my training in Motivational Interviewing works really well. It helps us to identify the ambivalence, clarify the thinking and help the client to verbalize their own reasons for change.

Another type of disordered eating that I have worked with is texture aversions. This is often identified in children but sometimes it's not identified until adulthood. It is where a person won't eat certain foods because the texture of that food in their mouth feels bad, or is aversive to them. This situation can be very challenging for parents to be able to get enough nutritional foods that the child is able to eat so they can grow and be healthy.

The eating disorders that I work with are Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. With my dual licenses in psychotherapy and nutrition, my 25 years experience working with people with eating disorders as well as my extensive experience working and teaching in the addictions field, I am uniquely qualified to work with both the psychological as well as the nutritional components of eating disorders. I come along beside the person on their journey to normalize their relationship with food and eating to a healthier place.