For one who has never participated in therapy before, the therapeutic process is difficult to describe, and much of what occurs in sessions is hard to put into words. There are nevertheless some key ideas and techniques that govern Dr. Tsukahara’s work. It is a collaborative process in which the client(s) and Dr. Tsukahara work together to determine how best to proceed in order to meet the client’s goals.

1. She utilizes a variety of “cognitive-behavioral” techniques that are designed to assist clients in thinking more clearly and behaving in ways that are consistent with their goals. These techniques include “cognitive restructuring” in which clients learn to identify and change feelings, thoughts and behaviors that are interfering with their ability to achieve their goals. Cognitive restructuring may be an overt exercise with paper and pencil, or it may occur more subtly as Dr. Tsukahara and the client appear to be simply talking. “Homework” assignments are often an important part of the therapy process.
2. Dr. Tsukahara typically works from a short-term, problem-focused perspective, so that clients are able to move quickly to achieve their goals. It should be noted, however, that some clients have long-standing or persistent problems that may require longer or more frequent treatment.
3. Relaxation exercises may be utilized within the session and are strongly encouraged outside the session for most clients.
4. Dr. Tsukahara believes that there is an intricate relationship among the mind, body and spirit and that all three aspects affect psychological well being. Clients may therefore be encouraged to consider making changes in all aspects of life (e.g., sleep habits, dietary changes, exercise).
5. It is Dr. Tsukahara’s ethical responsibility to provide clients with the method of treatment that is currently considered to be the most effective for a given area of concern. If she personally cannot provide the necessary expertise, she will make a referral to someone who is appropriately qualified.
6. Many people find making changes of any sort very hard, especially changes in personality and habits. This can be especially true for those with ADD. There may be times when clients feel reluctant to talk about issues that are on their minds because they feel embarrassed or ashamed that they are not making the changes they were hoping to achieve. These reactions are common, and, when acknowledged, can lead clients to deeper self-awareness and understanding.
7. Many clients find the therapy relationship to be unlike any other relationship they have experienced. It is quite one-sided because the client discloses a great deal of personal information to Dr. Tsukahara, but she tells clients very little about herself beyond what is immediately relevant to the client’s therapy. This one-sidedness can feel strange or upsetting at times.
8. As clients move towards their goals, others will likely begin to notice changes in their thinking, feelings, and actions. These changes can alter existing relationships in unexpected ways (both positively and negatively) because when we change, the ways we relate to others also change.
9. All therapists have a particular worldview or philosophy that influences their work whether or not they disclose it to their clients. Dr. Tsukahara ascribes to a Judeo-Christian worldview, but this does not mean that her clients must share that perspective in order to have a successful therapy outcome. She understands that it is not her job to “convert” clients to her worldview, but rather to assist them in clarifying their own way of understanding themselves and their world.

ALTERNATIVES TO THERAPY

There are many options available as alternatives or additions to individual therapy. The options will vary depending upon one’s particular concerns and goals. Some of the more common alternatives or additions to psychotherapy include:

1. Talking with a trusted friend or family member.
2. Talking with one’s pastor, rabbi, or other religious director.
   
3. medications.
   
4. Couples or family therapy.
   
5. Group therapy.
   
6. Support groups.
   
7. Alcoholics Anonymous and related groups.
   
8. Prayer.
   
9. Journal writing.
   
10. Physical exercise.
11. Spiritual exercises (e.g., meditation, tai chi)

Consequences Of Not Pursuing Therapy

These will vary depending upon the nature of one’s problems or concerns. Certain problems, such as depression, often worsen if not treated. Other problems gradually improve over time or by using some of the above-mentioned alternatives. Still others persist throughout one’s life if not addressed in a fairly direct manner (e.g., ADD-related behaviors, anxiety disorders; relational difficulties).