I had the pleasure of interviewing Dr. Elizabeth Cohen. Dr. Cohen received her PhD in clinical psychology from Boston University. As part of her graduate training, she treated clients at the world-renowned Center for Anxiety and Related Disorders in Boston, MA. Dr. Cohen was the recipient of the prestigious American Psychological Foundation Research Award for her doctoral research. Following her time at BU, Dr. Cohen completed her pre-doctoral internship at Bellevue Hospital Center and the New York University Child Study Center. After completing her training, she was asked to become the Director of the CBT program at Bellevue’s Outpatient Psychiatry Clinic. Since launching her private practice in 2004, Dr. Cohen has not only provided direct treatment, but has supervised numerous licensed psychologists, doctoral candidates, and psychiatric residents.
As a teenager, I remember sitting on the phone for hours with my friends trying to analyze the motivations of others. While I was a good student, this was when I felt the most alive. When I arrived as a Tufts University, I signed up for an introduction to psychology class along with 70% of my fellow first year students. I can still remember the room I was in when I heard the professor talk about the connection between the mind and behavior and the wave of feeling of being in the exact right place. Fortunately, Tufts offered a major in Clinical Psychology, so in addition to the typical psychology requirement like statistics and neuropsychology I was able to take courses in family therapy, child therapy and clinical techniques. My experience at Tufts culminated in a senior honors thesis which was a research study on the effect of violent video games on aggression and a clinical internship working at a Partial Hospital Program for Adolescents. After graduation, I began working at the New York State Psychiatric Institute and Columbia University Medical Center. As a research assistant, I was given the opportunity to see first-hand how clinical research is designed and implemented. I can recall sitting in a team meeting and again having that same feeling I had in college that this is where I was meant to be.
I began my PhD studies at Boston University after working for two years. Arriving at Boston University was like winning the lottery. I was able to take only psychology classes, learn how to be a strong therapist, and begin working with clients. The instruction and guidance I received centered around my work at the world-renowned Center for Anxiety and Related Disorders. It was led by Dr. David Barlow, a founding father of Cognitive Behavioral Therapy (CBT). Under his guidance, I learned state of the art CBT techniques and assessment skills.
I still think about some of the work I did there and how powerful it was. In fact, a client of mine from back then recently reached out to me to tell me how transformative our sessions were when she was just 12 years old. They were so transformative that she was writing her thesis on the work we did. After my course work was completed I moved back to New York City to complete my dissertation and my internship year. My dissertation examined the impact of the 9/11 attacks on a group of children who were in the close proximity to the attack. My mentor and guide through this process was the gifted Dr. Anne Marie Albano. From Dr. Albano, I learned how to hone my skills working with anxiety. Her mentorship offered me guidance and encouragement, something I needed as a very new therapist. After my dissertation was complete I enrolled in the Clinical Internship Program at Bellevue/NYU Hospital. My experience of therapy dramatically expanded that year. While most of my clinical work had focused on CBT for anxiety I was now working with a wider range of clients in various settings (psychiatric emergency room, forensic mental health unit, medical unit). My supervision at internship pushed me to think beyond what I was comfortable with and to play around with other therapeutic modalities and approaches. I was happy to see just how flexible I could be. That said, my heart was drawing me towards CBT work and I was offered the position of CBT Director at the Outpatient Clinic at Bellevue Hospital. This role was perfect for me. I was able to see clients, teach psychology interns and psychiatry residents and collaborate with an interdisciplinary team. I learned just how much I enjoyed being mentor myself. While in the position of CBT director, I began seeing a few clients in private practice. I was terrified the first session but as the session continued I could feel that familiar feeling come over me, I knew I was in the right place. One day, after seeing clients I literally starting skipping I was so excited! I felt in that moment just how much joy I receive from working one-on-one with people. Shortly after that I gave notice and went into private practice full-time. I often tell people that I did not get in to psychology to be a business person, but that is what happens quickly when you decide to go in to private practice. So, I learned slowly, with many ups and downs how to run the administration piece of my practice. In the years that followed I have mentored others to help them with these skills. I worked in private practice for 13 years while teaching, supervising and providing clinical care. In 2016 I was struck by how many referrals I was turning away. I wanted to be able to serve more people, but had hit my maximum amount of hours. So, with the encouragement of colleagues I opened Elizabeth Cohen Ph.D. and Associates, a clinic that provides CBT with my guidance and input. I was asked recently what my mission for the clinic is and I said to “nourish and nurture.” I aim to nourish and nurture my employees so they can nourish and nurture our clients in return. I believe this is the road to healthy, vibrant and embodied living.
After finishing my Ph.D coursework and my dissertation I enrolled in the Clinical Internship Program at Bellevue/NYU Hospital. I had the great fortune to work at the Survivors of Torture Program providing individuals who were seeking political asylum mental health services. One of my jobs was to conduct interviews with clients to understand how the traumatic experiences they endured impacted them. I remember thinking before my first interview, “This will likely be incredibly painful to hear about the devastation these individuals experienced.” I walked in to the first interview with my shoulders tight, in a state of bracing, preparing to hear about unbearable atrocities. During the interview it became clear that my assumptions were wrong. The clients did recount difficult experiences, but they also spoke about how they pushed back against oppression, advocated for themselves, and believed in their human right. I was amazed and inspired to hear about people’s strength, courage, determination and bravery to survive and to thrive. This was not a recollection of only pain and suffering, but actually of life and the strength of the human spirit. This moment changed my approach to working with people. I was sitting with the experience that we, as humans, have an incredible ability to heal and thrive. I have carried this idea with me through my years of private practice. My main mission is to help clients connect back to this strength, vitality and life. We all have incredible strength and ability within us even if we sometimes need help seeing our true goodness, and ability. I am honored that being a therapist allows me to be on the journey with people.
I am working on a number of new projects at this time. In addition to my growing private practice that includes three therapists, I am also working on creating an online workshop so I can offer my services to those who might not be able to benefit from my work financially or geographically. The workshops will cover important issues: 1) How do I take care of myself as I take care of my newborn? 2) How can I stop worrying all the time? 3) Cognitive Behavioral Therapy training for Psychoanalytic Practitioners. Depending on the reception of these workshops I hope to create online membership sites so I can provide ongoing support.
I have also recently started a podcast called “Off the Couch: Therapists Talk about their Work.” In this podcast, I interview well established therapists about their process, their experiences and the what interventions they find the most useful for different populations. I decided to start the podcast after I realized how much information about therapy is still treated as a mystery. So, we are busting it open. After delivering CBT for years I had some clients who would tell me that even though they knew in their head that what they were thinking was irrational, their bodies still did not believe it. I began to explore how I might be able to help people feel the change in their bodies as well. In 2015 I began a three year training in Somatic Experiencing® therapy. The Somatic Experiencing® method is a body-oriented approach to the healing of stress disorders. SE is a powerful psychobiological method for addressing physical and emotional overwhelm, and stress related conditions. The SE approach releases shock, which is key to moving stress through and out of the body.
When we think about screen time we need to separate out the different behaviors that incorporate looking at a screen. Let’s start with the first one which is simply shifting our attention from one experience to the screen. This is an essential behavior to examine because as anyone who has ever been at a dinner with someone who suddenly pulls out their phone mid conversation knows, you can feel when someone shifts their attention. This shifting of attention for person you are with can be significant. It can impact your connection or your relationship with someone. But it also can affect you. When you are engaged in something and are fully wholeheartedly in it and then must quickly shift then your mind and heart do not have time to adjust. We all need transition time between activities and what’s getting our attention, but when we pick up a screen we dismiss that we’re actually shifting from one experience to another. We will miss moments of transition, emotion and connection. In addition, we often pick up screens because we want to avoid some feelings or experience we are having. If we’re not aware of the fact that we are picking up the phone at all then we can’t be aware of where that behavior is coming. I believe that an essential part of being human is understanding how we’re feeling in the moment and why we are doing different behaviors. If we mindlessly move to the screen and then back to something else and back to the screen then we lose the opportunity to be aware or present in the moment. Related to not being able to be in the moment the more we check our screens and the more we expect to have shifts and our attention throughout the day the more we start desiring that the more we start craving a quick shift or the quick surge of information so a conversation with a friend at a coffeehouse might start feeling unsatisfying because there isn’t enough change or shift in the input.
I believe that a healthy relationship with technology starts with awareness and emotional regulation. Awareness of our relationship to the behavior of reaching for a screen is essential if we are to learn how to live with technology rather than to be ruled by it. In life we have many behaviors that we must be aware of and regulate. For example, we must be aware of how much alcohol we drink, how much food we eat, how much sleep we get and how much work we do. If we do not pay attention to these behaviors and examine our needs then we can develop a serious problem or addiction. The key to living well is being aware of why we are engaging in a behavior and using this information to guide your choice in the moment. For example, if you are out with friends for dinner after a happy hour at work you might ask yourself some questions before you decide to order another drink. You might ask, how am I feeling in this moment? Having a good time? Nervous? Tired? At ease? The answer to this question will lead you to decide to order a seltzer or another drink. The act of turning inward and asking yourself how you are feeling before you engage a behavior is how we develop regulation. This example can also be applied to using technology. When you hear a text, news, email or call notification PAUSE for a moment. Ask yourself how you are feeling in that moment. Be curious about where your body, mind and heart are and if they are in a place ready to receive information from technology. If not, you can wait. Using screens has become such an unconscious behavior that if we bring it to consciousness then we can ask ourselves do I want to engage with this right now? This choice of whether to engage with technology is crucial if we want to live comfortably and with overall wellness in the midst of the demand of technology. I have listed 5 ways that I believe strengthen our ability to be aware and regulate.
a) Meditation- This can be as simple as listening to your breath and noticing when your mind wanders. This exercise builds your capacity to return to the present moment.
b) Self compassion — Self compassion involves being on your own side and loving yourself no matter what. This can help when the feeling of guilt starts creeping up that you have not texted someone back, or you are taking time off from looking at your screen.
c) Sharing with others about your experience- Being vulnerable can be scary. Most people do not want to be vulnerable, but report feeling connected when others are vulnerable with them. Share with others honestly about your struggles with technology. See how others cope with this challenging issue. Share with friends when you feel like you are overloaded by demands and you need a break. Be real. The more real you are with others the more real you can be with yourself.
d) Gratitude list — Our brains are velcro for bad experiences and teflon for good. We evolved to remember where the danger was not where the joy was hiding. So, we need to actively focus on what is working in our life. Gratitude lists are a great way to do this because they prime you to look around during the day for positive experiences. I typically recommend to clients that they should use small moments rather than the large ones. Often when we think “ I am grateful to be healthy” it is too vague and hard to feel in the moment. Whereas if we say “I am grateful to have been able to carry a heavy box up 3 flights” you can feel the accomplishment in your bones. Focusing on the positive helps when we are bombarded with negative images and stories from 24 access to technology.
e) Moving our bodies- If we are moving our bodies than we are most likely not looking at a screen. Our bodies need to be moved in order for stress to move through them. Also the more we move our bodies the more open and ready we will be to ground ourselves when interacting with technology.
My answer to this question goes back to my suggestion about grounding yourself and being present in relationship to your phone. If you are aware of what you are feeling and thinking in the moment you can ask yourself do I want to answer this call now? Or even better can I put my phone on do not disturb right now?
In addition to working on greater awareness of your emotions when reaching for the phone people need to start putting in clear parameters for themselves around smartphone use. Parameters or rules allow people to feel a sense of predictability and safety. For example, when someone interviews for a job one of the first questions asked is what the vacation/sick day policy is. This is because we want to know what the limits are on our behavior. We need the same limits around our phone use. The struggle is that we don’t have an employer to make the rules, we need to make them for ourselves. Some helpful rules are:
a) No picking up phone until after breakfast
b) No phones in bedroom
c) No phones when talking to someone face to face
d) Have at least 1 hour a day with no phone use
e) Turn phone on do not disturb at night
f) Do not use phone for an alarm clock
g) Set a reminder to breathe and put your phone down twice a day
h) Leave your phone at home once a week
“FOMO” or fear of missing out can make it difficult to follow some of the above suggestions. When clients mention this concern to me I often ask them to write down what they are most afraid of feeling. Often they are feeling inadequate or not enough. This feeling can often cause us to pick up our phones (or a piece of chocolate) to push that feeling away. The more someone can become aware of their underlying fear the less likely they will have the same deep need for the phone.
Starting your day with looking at screens is a choice many people make that is out of our awareness. The more we increase our awareness of how relating to technology and information affect us the sooner we can examine behaviors like checking our phone before brushing our teeth. When we wake up for the day we are beginning a new day and setting the foundation for what we want to think and do that day. Waking up and looking at a phone that is filled with scary stories and negative images quickly puts the body in a hypervigilant fear state. We live in a culture obsessed with selling and showcasing fear. Think of the last time you read an article or social media post about someone dying from a disease; now think about when you read about someone who recovered from a disease. We are oversaturated with images and stories about bad things happening to people. When we see videos of others suffering, our body often reacts. We feel tight, scared and on guard. The body cannot differentiate that this incident is happening to someone else — and not us — and that we are just watching it. The amygdala, or emotional brain, signals us to be on guard for further danger. So let’s think about what we are exposing our amygdalas first thing in the morning. Negative images seep into our bodies from everywhere, and we carry them with us even if they are not in our awareness. So, if you want to have a day filled with positivity and hope the longer you wait to pick up your phone the better.
If we think about the morning as setting the emotional temperature for the day then what are the techniques that help you feel more hopeful, positive and grounded. Often strategies mentioned in question 5 help a lot. Affirmations are a great way to set the tone for the day. For example, “I am open to the abundance and opportunities that will come my way today” is a great beginner. We need to think about how we want to set the tone for the day.
“Just when the caterpillar thought the world was over, it became a butterfly. You never know what is around the corner. From suffering can come great lessons.”
If I could start a movement to increase wellness I would suggest a way to have movement and gratitude as a daily practice. For example, if you want to to open your phone, you need to breathe for 3 minutes and move your hips. In order to have wide ranging effects we would have to link the healthy behavior to something everyone is already motivated to do. I do commend schools that have been bringing in movement and mindfulness to the classrooms. By starting early, we can encourage young people to continue to turn inward to lead them rather than outward. This turning inward can lead to more present individuals who can examine why they do what they do developing insight. With insight we can soar.
On my website (www.drelizabethcohen.com) you can sign up for my online offerings (blogs, podcasts, workshops). You can also follow me on Instagram at https://www.instagram.com/elizabethcohenphd/ and Facebook at https://www.facebook.com/ElizabethCohenPhD/
Originally published at medium.com