SERVICES PROVIDED
The staff at CBPsLI  specialize in the diagnosis and cognitive-behavioral treatment of many psychological disorders and life problems. What we do at CBPSLI can therefore be broken down into two related parts, diagnosis (psychological assessment), and treatment. Correct diagnosis at the beginning of treatment (intake) is extremely important in order to focus treatment, so that the patient and therapist in collaboration have an understanding of the problem, and for professionals to communicate accurately about patients. Ongoing assessment of a patient’s difficulties and functioning in response to treatment are also essential for treatment to work effectively. For patients (children and adults) with behavior problems, a detailed functional behavioral assessment (FBA) is essential to effective treatment.   To enhance educational advocacy, we offer comprehensive psychological testing of IQ, achievement and personality.

TREATMENT MODALITIES
•Individual Therapy for Adults and Children
•Couples & Marital Therapy
•Family Therapy
•Educational Advocacy
•Professional Training & Supervision
-ADHD Coaching/Tutoring by Kristin Wolff-Gatoux, Ph.D.
COGMED WORKING MEMORY TRAINING SYSTEM:   www.cogmed.com

DIAGNOSTIC SERVICES
•Psychological Testing (IQ, intellectual and academic achievement) 
•Psychological Diagnosis of Children
•Psychological Diagnosis of Adults
•Functional Behavioral Assessment
•Personality Assessment
•Vocational/Interest Assessment    

PROBLEMS ADDRESSED

Anxiety Disorders
Anxiety is a natural and helpful emotion that helps us to discern and react to real danger. Anxiety disorders happen when the emotional response is excessive and/or not appropriate to the situation. Patients with these disorders often magnify the level of danger in a situation, and worry excessively about these dangers while disqualifying their own ability to manage them.  Cognitive behavioral therapy employs thought restructuring and exposure based techniques to facilitate accurate interpretations of stressful situations and to build one’s skills and beliefs in their ability to face difficult situations. These strategies encourage people to face fear and build a higher tolerance for anxiety and worrying, which then allows them to reach their longer-term goals.

Panic Disorder:  Panic Disorder is characterized by seemingly "out of the blue" surges of fear, a sense of impending death, bodily injury, or doom. The sudden rush of fear occurs with a high degree of anxious arousal and physiological symptoms that may include: racing or pounding heart, sweating, trembling, shortness of breath, a feeling of choking, chest pain or discomfort, nausea or abdominal discomfort, dizziness or lightheadedness, a sense of things being unreal, a fear of losing control or "going crazy", a fear of dying, tingling sensations and/or chills or hot flashes. Additionally, panic sufferers experience persistent concern about future panic attacks and may worry about behavioral or lifestyle changes made in attempts to cope with the attacks. As noted, many people with panic also begin to avoid places or situations where they have experienced panic attacks or situations where they anticipate feeling anxious. This avoidance sometimes leads to what is called Agoraphobia, or being trapped at home. Agoraphobia complicates panic because the person's world gradually becomes smaller and their panic worsens as they avoid more and more.

Social Anxiety Disorder (SAD) :  SAD involves intense fear of being scrutinized (looked at or examined closely) and negatively evaluated by others in social or performance situations. People who suffer from SAD are terrified that they will act in a way that will be embarrassing or humiliating. People with social anxiety often focus their attention on monitoring their own anxiety symptoms and behaviors in social situations instead of concentrating on the actual social interaction. Social anxiety can interfere significantly with daily routines, occupational performance or social life and limit a person's ability to be happy and thrive.

Obsessive Compulsive Disorder (OCD) :  OCD is characterized by obsessions and compulsions. Obsessions are recurrent and persistent thoughts, impulses, or images that people experience as intrusive and disturbing and that cause anxiety or distress. Obsessions are not just excessive worries about real life problems. People who suffer from OCD usually recognize their obsessions as internally generated (as opposed to hallucinations and delusions), irrational, and unwanted, but cannot resist them nonetheless.  The person with OCD attempts to ignore, suppress, or neutralize these obsessive thoughts through the use of compulsions. Compulsions are repetitive behaviors or mental acts that the person feels driven to perform according to rigid personal rules. Compulsions are aimed at neutralizing distress associated with obsessional thoughts, images or impulses or to prevent some dreaded event. For example a person who has an obsessive fear of contamination compulsively or repetitively washes his/her hands excessively. Obsessions or compulsions impair functioning, are time consuming and are recognized as excessive and/or unreasonable.

Generalized Anxiety Disorder (GAD) : People with GAD experience recurrent and persistent worry. The worry is excessive and difficult to control and centers on multiple real life circumstances or concerns. Physical symptoms associated with GAD may include: muscle tension, fatigue, restlessness or feeling "keyed up" or feeling on edge, with difficulty concentrating, irritability, and sleep disturbances.

Posttraumatic Stress Disorder (PTSD):  PTSD can only occur upon exposure to a traumatic event where a person experienced, witnessed or otherwise confronted event involving threatened death or serious injury. The individual must have reacted with intense emotional arousal that is characterized by intense fear, helplessness or horror. Symptoms of PTSD fall under the three main categories of,
1) re-experiencing the traumatic event (e.g., intrusive thoughts or memories, flashbacks, nightmares etc...),
2) avoidance of stimuli which remind or signal aspects of trauma, and
3) hyperarousal (e.g., exaggerated startle response, sleep disturbance, irritability, etc...).

Phobias:  A phobia is a fear that is unreasonable. Common phobias/fears include animals, environmental events (storms, thunder), blood or injections, heights, enclosed places, bridges, and vomiting. The person knows that the fear is excessive, but it still causes great distress and anxiety when the person sees or even thinks about the feared thing. Sometimes this fear can lead to avoidance of important events and places, and can have a negative impact on a person's quality of life.

MOOD DISORDERS

Depression (Major Depressive Disorder) :  Depression impacts all aspects of life. When we become depressed, our work and relationships suffer and we are at greater risk for physical health problems and self destructive behaviors. At any one time, up to 1% of the population may suffer from depression. All of us experience a sad mood when we feel down about ourselves or aspects of our lives. Fluctuations in our mood are normal. However, when depression is excessive, lasts more than a few days, and interferes with regular functioning it becomes a problem.

Symptoms of depression include:
•Depressed or sad mood
•Diminished interest or pleasure in activities previously enjoyed
•Significant weight loss (not due to diet) or gain or appetite change
•Insomnia or sleeping too much
•Restlessness or slowness
•Fatigue or loss of energy
•Worthlessness or guilt
•Diminished ability to concentrate
•Suicidal ideation

Depressive disorders in childhood may look different than depression in adults. However, despite the differences, it is just as insidious. Untreated childhood depression can lead to other problems such as poor relationships, chronic low mood and pessimism, self harming behavior, drug and alcohol abuse and even suicide. A child who is depressed may be sad or angry and irritable. She may be socially withdrawn or exhibit behavioral problems where the number of social interactions is generally more telling than number of friends. Decreased social interactions often lead to a decrease in pleasurable activities which in turn contributes to further depressed mood. "Acting out" behavior is also common in depressed youth since these children may not be adept in conveying their feelings through verbal means.

Other symptoms of childhood depression include:

•difficulty getting along with others
•restlessness or difficulty sitting still
•lack of energy
•recurrent somatic complaints
•problems with eating or appetite increased or decreased weight or appetite
•problems with sleeping trouble sleeping or sleeping too much

Bipolar Disorders:  Bipolar disorders are characterized by alternating periods of depressive symptoms as noted above and symptoms of mania (noted below). Usually, mood changes fluctuate between severe highs (mania) and lows (depression). These mood changes generally occur in a cycling fashion; sometimes fluctuating in a rapid manner with mood shifts repeating often, and at other times there can be weeks, months or years between episodes. When experiencing a depressive episode, a person with bipolar disorder can have any or all of the symptoms of Major Depression including hopelessness and suicidal thoughts or behaviors. In the manic phase, the person may be very talkative, have an abundance of energy, and be full of big ideas and plans.

Symptoms of mania include:
•excessively elevated mood
•irritability and agitation
•decreased need for sleep
•increased talking
•poor judgment
•increased sexual desire
 •increased risk taking
•significantly increased energy
•racing thoughts
•grandiose ideas
•inappropriate social behaviors 

Individuals with Bipolar disorder in a manic episode may behave impulsively and not think or care about the consequences of their actions. Explosiveness is common.  During a manic episode a person may find themselves spending a lot of money, driving recklessly, making risky business investments and staying up all night working or partying. Problematic thoughts may include, "I can do anything I want," "I'm going to strike it rich," "Everybody love me." Often individuals with bipolar disorder experience multiple episodes of depression and only one or an occasional manic episode. Many individuals have difficulty accepting their bipolar disorder since episodes of mania can be
enjoyable and productive, but exhausting.  Bipolar disorders are distinguished by the types and durations of moods that a person experiences. In Bipolar I Disorder, the person experiences long episodes of mania and depression. In Bipolar II Disorder, the mania lasts less longer and can be of less intensity. In Cyclothymic Disorder, the person experiences episodes of sadness and extreme happiness that cannot be classified as either depressed or manic but have a negative effect on the persons quality of life. Rapid cycling an interesting clinical phenomenon, involves alternations between good and bad moods over hour long intervals. 

Dysthymic Disorder:  Also called Dysthymia, this is a disorder where an adult is significantly unhappy for at least two years or a child for at least one year, but the person never had enough symptoms to be considered clinically depressed or suffering from Major Depressive Disorder. People with Dysthymic Disorder suffer from symptoms that may include poor appetite or overeating, insomnia or too much sleeping, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. Being chronically unhappy, people suffering from Dysthymic Disorder have difficulty keeping jobs, keeping friends, and keeping busy.

BEHAVIORAL PROBLEMS

Behavior problems are seen in children and adults. The first step for adults and children is the completion of a thorough functional behavioral assessment (FBA). Cognitive, behavioral, contextual, social, medical, perceptual, and other relevant variables are taken into account. With an adult, most often a functional assessment of the behavior problem can be done together with the therapist, but with children it is very helpful to have parents and other important people such as the teacher provide information for the FBA. A treatment directly based on the FBA is then developed and implemented in collaboration with the patient, family, and school as needed. Assessment and treatment of the problems listed below usually involve a collaboration with medical professionals as well.

Trichotillomania:  Trichotillomania or chronic and debilitating hair pulling and chronic skin picking are impulse control disorders where the person finds it very difficult to resist the temptation to pull their hair, pick their skin or bite their nails. The urges to engage in the behavior are often accompanied by a sense of mounting tension that is believed by the person to be only relieved by picking or pulling. Indeed, individuals, with this problem report a release of tension or even pleasure afterwards. People who exhibit this self injurious behavior often develop other difficulties related to the pulling or picking behavior such as hair loss, bleeding, scarring and a feeling of shame about their inability to control their impulses. They may also develop anxiety about others seeing the results of their behavior.

Tic Disorders:  Tics are involuntary movements of the body (motor) or involuntarily produced sounds (vocal). These movements are considered sudden, rapid, recurrent, and nonrhythmic. If they happen often or most of the time, they are considered chronic and can be diagnosed if they are specifically motor or vocal as: Chronic Motor or Vocal Tic Disorder. If they happen once in a while or in episodes, they are considered transient (Transient Tic Disorder). People with multiple motor and at least one vocal tic most of the time, with a beginning before age 18 that negatively impacts quality of life can be diagnosed with Tourette’s Disorder which can sometimes include the bizarre behavior of coprolalia (tics involving cursing or making other sounds that could be considered socially inappropriate).

Aggressive and Disruptive Behaviors:  Most often seen in children, sometimes at school, and sometimes at home with targets including parents, peers, siblings, pets, and others, aggressive behavior involves physical or even attempted or threatened physical attack. Common aggressive behaviors include hitting, kicking, scratching, slapping, and spitting. While often due to frustration in children, the source of the frustration or must be very carefully assessed and treated in the setting where and with the people with whom the behavior occurs. The same exact thing can be said about children with disruptive behaviors including tantrums, non-compliance, annoying others, leaving the seat, interrupting, and for a special class of behavior, Self Injurious Behavior, which is seen more frequently but not exclusively in individuals on the Autistic Spectrum. Such behaviors can be life threatening and/or debilitating.    

Elimination Disorders:  Usually diagnosed in children, Enuresis is uncontrolled urination. If it occurs during the day, it is called "Diurnal" and is usually associated with either social anxiety, reluctance to use an unfamiliar toilet, or over-focusing on an activity. If wetting occurs at night when the person is asleep it is referred to as "Nocturnal". Encopresis is the repeated passage of feces in inappropriate places. This can occur with or without a medical complication called "Constipation and Overflow Incontinence". When it involves this complication the treatment must be in collaboration with the child’s Pediatrician.

Eating Disorders:  Because of their life threatening nature, an eating disorder at LICCT is always treated in very close collaboration with the patients’ Primary Care Physician and relevant family members. Eating problems include overeating, obesity, anorexia nervosa, and bulimia nervosa. 

Cutting (Self Mutilation) :  Seen in children and adults, self mutilation is apparently a maladaptive coping strategy involving deliberately inflicting harm upon oneself by cutting, burning, depriving oneself of air, or otherwise hurting oneself. Since such behaviors are physically dangerous, it is essential to employ the cooperation of the patient and other individuals that the patient trusts in order to assist with the management and treatment of this potentially debilitating behavior problem. 

Addictions:   Addictions, such as gambling, can be treated and the beginning is the development of a strong collaboration between the patient and the therapist with a focus on truth. Careful gauging of the patient’s readiness for and commitment to treatment occurs at the beginning and throughout treatment. Since addictions to medications, drugs, and alcohol involve damage to the body and internal systems, treatment of these types of addictive problems always involve frequent communication with a patient’s Primary Care Physician.

Psychological Problems
in Children
and Adolescents
All children have problems at some point during childhood or adolescence. They might experience periods of anxiety or fearfulness, problems getting along with peers, parents or other adults, problems succeeding in school or problems with their daily functioning. For many children these problems are solved without significant intervention. Other children and families can greatly benefit from cognitive-behavioral therapy to correctly assess the problem and work to resolve it. For these children, difficulties are severe enough to impact their academic, social, or emotional development. At LICCT, the parents are always very involved in the treatment of their child.  Children can suffer from the Mood Disorders. With children, however, irritability is often a key indicator of bad mood and diagnosing Bipolar Disorder is very difficult. Children can also suffer from any of the Anxiety Disorders discussed in the Anxiety Disorders Section. The following is a list of psychological problems in addition to Mood and Anxiety Disorders that are usually first seen in childhood or during adolescence that are often treated at LICCT. 

Separation Anxiety Disorder:   It is common for children ages eighteen months to 5 years to display crying, tantrums and fear upon separating from parents and other close family. This naturally occurring developmental stage usually does not persist past preschool age. Some children do experience excessive anxiety when having to separate from primary caretakers. These children often fear that something terrible will happen to them or their caretaker or that their caretaker will abandon them. Symptoms include: crying, pleading or clinging to caretakers, refusing to attend school, parties or other social events without parents, complaints of physical illness such as stomach aches or headaches when no illness is present, demand for caretaker to stay with child while falling asleep, and frequent visits to parents bedroom during night, and nightmares about bad things happening to parents and loved ones.

Selective Mutism:  Children who are anxious about social interactions may fear speaking in social contexts where they are not fully relaxed and comfortable. These children are fully capable of speaking but are inhibited by anxiety. They are able to speak in certain circumstances such as at home, away from home in the presence of a safety person, or only in a whisper. Many children with selective mutism also have social anxiety disorder.

Attention Deficit Hyperactivity Disorder (ADHD):  Children with ADHD have difficulty following directions, organization, completing tasks, and functioning effectively at school or at home. These children often have difficulty making friends, completing their homework, and present constant behavioral and emotional challenges to parents and teachers. It is very hard for children with ADHD to delay gratification and they often say things or engage in behavior before thinking through their options (behave impulsively). Excessive activity level and frequent movement and fidgeting can interfere with the completion of activities.

Oppositional Defiant Disorder:  Put simply, a child who is over 3.5 years old and shows a consistent pattern of behavior typical of a child in his/her "terrible two’s" with most people, most of the time. This pattern of behaviors includes: often loses temper, argues with adults, refuses to comply with adult’s requests and rules, deliberately annoys others, blames others, is easily annoyed, seems angry and resentful and is spiteful or vindictive. Working closely with the child, parent, and other relevant authority figures (such as the teacher), the staff at LICCT are experts at developing cognitive and behavioral treatment plans based on a thorough individualized functional assessment of such problems. These plans involve positive supports, rewards, contracts, as well as techniques designed to increase the child’s ability to self monitor.

DEVELOPMENTAL DISORDERS
Developmental Disorders, by definition are always diagnosed during a child's development (ages 0 to about 11 years). These disorders are pervasive. That is they have a negative impact on many of a child's areas of functioning such as language, coordination, learning, behavioral flexibility, adaptableness, sensory systems, and social skills. These problems can be very mild or subtle, or severe and debilitating. The early and accurate diagnosis of a developmental disorder in childhood is essential because these disorders are most successfully treated if the treatment starts when the child is as young as possible.

Autism Spectrum Disorders (ASD's)
Includes:
•Autistic Disorder
•High Functioning Autism (HFA)
•Asperger’s Disorder
•Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)
•Childhood Disintegrative Disorder
•Rett’s Disorder
Children with ASD’s show patterns of uneven development and pervasive delays starting as early as 12 months or younger but usually noticed by age three, and as late as by age 10. Delays in and difficulty with social relationships, communication, and inflexible patterns of behavior are the three major areas that must be closely assessed. The diagnosis of Autism is based on the child consistently demonstrating at least six of the following symptoms, with at least two of the first four: difficulty with eye contact, inadequate social relationships, a lack of sharing a focus with others, a lack of reciprocity with others, delay or absence of language, difficulty initiating or maintaining a conversation, repetitive or unusual use of language, a lack of spontaneity in play, obsessive preoccupations, inflexibility, repetitive or stereotyped movements, and overly selective attention. Sadly, about 70% of children diagnosed with Autistic Disorder also have measured intellectual functioning within the range of Mental Retardation. The approximate 30%, who have an IQ’s in at least the average range, are diagnosed with High Functioning Autism (HFA). Asperger’s Disorder is very similar to Autistic Disorder, but individuals with Asperger’s never have a delay in language, and usually have intellectual functioning within at least the average range. PDDNOS is diagnosed when a child shows a pattern of uneven social, language, and behavioral development, but does not meet enough of the criteria for Autistic Disorder for that diagnosis. Childhood Disintegrative Disorder is diagnosed when a child develops normally for at least two years and then shows a sudden loss of language, social, adaptive, play, and motor skills as well as a loss of bowel or bladder control and a pattern of social, communication and behavioral inflexibility similar to that seen in children with Autism. Rett’s Disorder is only seen in females and is diagnosed when the child’s development during pregnancy and through the first five months of life is entirely normal, but is followed by severe losses of purposeful hand use, social engagement, coordination, and expressive and receptive language and declines in head growth by between 5 and 30 months of age.
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Reactive Attachment Disorder:  This is a problem seen in children under 5 years of age who have been exposed to persistent neglect. Care-giver neglect can include disregard of the child’s need for emotional comfort, stimulation, and affection, or neglect of the child’s basic needs (food, water, sleep, etc.), or repeated changes of the care-giver such that the child never gets to emotionally bond. The child then develops a either a pattern of behaviors that show fear of social interaction or attachment (Inhibited Type), or a pattern of indiscriminate sociability including excessive familiarity with strangers (Disinhibited Type).   

Learning Disabilities:  A learning disability is diagnosed when a child has difficulty in one specific area of learning in spite of not having such difficulty in other areas of learning. Technically, the child’s poor skill in the one specific area is inconsistent with their overall good intellectual functioning. The child’s difficulty can be in reading, writing, coordination, math, receptive or expressive speech. Many children with learning disabilities have secondary emotional problems because of the difficulties presented by school, homework, competition with peers and siblings, and the pressures of well intentioned parents.

Mental Retardation:  A child is diagnosed with Mental Retardation when they consistently score well below average on standardized measures of both intellectual functioning (learning ability), and adaptive behavior (the ability to do things independently). The level of Mental Retardation is defined statistically as Mild, Moderate or Severe based on a person’s scores on these tests of IQ and adaptive behavior. Adults and children with Mental Retardation also suffer from anxiety, depression, and other psychological problems and benefit from the techniques of cognitive behavioral therapy as demonstrated in various research studies

Cerebral Palsy:  The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a "scissored" gait; and muscle tone that is either too stiff or too floppy. A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.
(From: www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm)

LIFE ADJUSTMENT PROBLEMS
Throughout life, people encounter obstacles to their happiness, quality of life, and ability to function. These difficulties can be found in relationships, at important life crossroads such as marriage, changing jobs, divorce, having a child, loss, graduation, confronting a mid life crisis or getting old. Certain individuals also experience prejudice and exclusion by society because of their sexual, political, or behavioral preferences and this can lead to alienation and self deprecation. The process and techniques of cognitive behavioral therapy are especially helpful for these problems since the therapist and patient actively collaborate to examine how a person's thoughts and behaviors can minimize such negative feelings.

Weight Management :  In this age of diet mania in overweight America, many people struggle with weight and body image concerns, including anorexia, bulimia, obesity, and everything in-between. Learn how to find your ideal weight and make peace with food and body image issues, without overeating, under-eating or yo-yo dieting. Improve self-esteem and gain control through innovative coping strategies and a greater understanding of contributing factors. Become so comfortable in your own skin that you actually can say you love the way you look and feel.

Health Problems: Since cognitive behavioral therapy is based on human learning and universal emotional and behavioral processes, it has been successfully applied to a whole host of health problems. Scientific studies have documented that cognitive behavioral therapy (often in combination with medication or other techniques) can be used to effectively treat conditions such as hypertension, obesity, smoking, substance abuse, sexual dysfunction, chronic pain, irritable bowel syndrome, vertigo, tinnitus, and many others.

Relationship Problems:  Relationship problems occur in marriages and other long term commitments, between parents and children (of any age), in same-gender couples, and amongst relatives and friends. These problems become most noticeable during periods of stress and crisis and are often amplified during arguments and disagreements. Using cognitive-behavioral strategies, the couple is taught how to communicate efficiently in order to effectively resolve conflicts especially under stressful conditions. Individually tailored cognitive-behavioral rehearsal, practice, and generalization techniques assist the couple in learning the new skills they need to negotiate with respect and sensitivity and then to use these skills in the real world. 

Individuals who are Trans-gendered, Trans-sexual, and/or Lesbian/Gay:  Seeking surgery in order to change one’s gender is a serious commitment that one undertakes with careful consideration and planning and that requires tremendous social and emotional support. Indeed, almost all surgeons who perform these surgeries require their patients to have at least one year of weekly psychotherapy before this surgery. Of course, after undergoing such surgery, it is also important to receive psychological support in order to facilitate adjustment. Research shows that supportive cognitive behavioral therapy can create a positive, responsive, safe relationship which helps people through difficult periods of life and life transitions. In this form of therapy, patients are supportively taught how thinking and feeling are very closely related and how to more adaptively think and respond. This relieves distress, and frees one to initiate and maintain corrective action in life. The cognitive therapist advocates and encourages the clear formation of the patient’s corrective thought and assertive behavior patterns, often using guided imagery to assist the patient with applying these new skills in current life.

Individuals who are lesbian or gay also face unique stressors, especially secondary to societal prejudices. From deciding to "come out", to the complications of gay relationships, to aging as a homosexual, a gay person can benefit from Cognitive-behavioral counseling. Specifically, using a supportive, warm relationship and cognitive principles, the therapist can guide the patient to discover personal empowerment, and develop adaptive assertive responses to social prejudice. Thoughts and feelings of shame are skillfully challenged and changed so that assisted by CBT, many homosexual patients are enabled to lead more enriched lives, and experience themselves as more confident and esteemed in the world.

Geriatric Psychology:  Growing older can be a delightful and rewarding time in our lives. Many older adults have jobs, satisfactory relationships and good health. Sometimes, however, normal developmental challenges and declines in certain abilities lead to emotional and/ psychological difficulties even in well functioning adults. Guilt or resentment about becoming more dependent on others is not uncommon. Late life challenges addressed by cognitive-behavioral therapy include depression, anxiety, relationship problems, care-giver stress, dementia, and functional decline.