Anthony Mazzella, Ph.D.

Products And Services

• Adolescent Counseling

  What is Adolescent Counseling? Adolescent psychotherapy is a type of therapy specifically designed to help teenagers (i.e., adolescents) who are experiencing emotional, behavioral, or mental health issues. Mental health is an important part of a child’s overall well-being and has a profound impact on their physical health and their ability to succeed in school and in society. Adolescent counseling–– which I will call psychotherapy––involves talking about a variety of issues that may be causing emotional distress or difficulties functioning. This psychotherapy may focus on specific mental health issues, such as anxiety, depression, trauma, family conflict, or difficulties in social relationships. The goal is to help adolescents develop coping strategies, emotional regulation, and problem-solving skills. Adolescent psychotherapy may be delivered in an individual or a family setting. In fact, I have found that having a parent actively involved is very important for overall success. The benefits of adolescent psychotherapy include improved emotional regulation, better relationships, and increased self-esteem in addition too overall improved mental health and well-being. What Causes Problems in Adolescence? Adolescence is a period of significant change, growth, and development, all of which can create a range of challenges and problems for young people. Here are some of the psycho-social factors that can contribute to problems in adolescence: Identity formation Adolescence is a time when young people are trying to figure out who they are and where they fit in the world, which can be a challenging and confusing process. Peer pressure Adolescents are often heavily influenced by their peers and may feel pressure to conform to social norms, which can lead to risky behaviors or social isolation. Family conflict Adolescents may experience conflict with parents or caregivers as they assert their independence and push for more autonomy. Trauma or adversity Adolescents may experience traumatic events (e.g., abuse or neglect) that can have lasting effects on their mental health and well-being.< Social media and technology The constant need for social media validation and the fear of missing out (FOMO) can lead to compulsive checking of social media accounts, resulting in addiction-like behaviors. This addiction can cause a range of negative consequences, such as reduced academic performance, decreased physical activity, and decreased face-to-face social interactions, which can lead to social isolation and feelings of loneliness. These factors are complex and interconnected, creating a range of potential problems and challenges for adolescents. Seeking support from a mental health professional can help young people navigate these challenges and develop the skills needed to thrive, both during adolescence and into adulthood. What Are the Signs and Symptoms That My Child Needs Help? Any of the factors mentioned above can lead to problems with stress, anxiety, mood, appetite, sleep, and problems at school or at home. Other factors that may indicate that an adolescent could benefit from professional psychotherapy include developmental delays, behavioral issues, a significant downturn in academic performance, withdrawal from friends or family, mood swings, insomnia, bullying, signs of alcoholism or drug abuse, excessive gaming or screen time, and sudden changes in appetite or eating habits. Changes in an adolescent's relationship with important caregivers can also be a sign that they may benefit from professional psychotherapy. If an adolescent is frequently blaming their caregivers and not taking responsibility for their own mistakes, refusing to communicate with them, or engaging in frequent arguments or fights with them, this could indicate underlying emotional or behavioral issues that require professional help. These types of behaviors may be indicative of underlying issues such as depression or anxiety. It may also indicate an inability to attach and connect to others in ways that allow them to form meaningful and healthy relationships. In my practice, I typically help adolescents and their caregivers identify and address these issues, while also providing support and guidance to improve communication and strengthen the caregiver-adolescent relationship.

  Link: Adolescent Counseling

• Couples Counseling

  What is Couples Counseling? Couples counseling is known by a number of other names, including: Marriage counseling Relationship therapy Couples therapy Family therapy –– if the couple has children and the focus is on family dynamics Premarital counseling –– if the couple is engaged and wants therapy before getting married Regardless of its name, couples counseling is a type of therapy designed to help couples improve their communication, resolve conflicts, and strengthen their relationship. It can be helpful for couples at any stage of their relationship, whether they are newlyweds or have been together for many years. When is Couples Counseling appropriate? I have found that some couples seek counseling in times of crisis, while others want guidance with daily relationship issues. Sometimes couples come for therapy hoping to obtain professional justification for blaming their partner for all relationship problems. These couples benefit from couples therapy by transforming their thoughts toward that of a functioning relationship unit. Couples counseling can help individuals deal with difficult issues such as: Infidelity Divorce –– if married Abuse Financial troubles Generalized interpersonal conflict What causes Relationship Difficulties? Defenses and Coping Mechanisms The issues mentioned above may arise from a variety of factors. From over twenty years working with couples experiencing troubled, conflictual, and emotionally charged relationships, I have found that maladaptive defensives and poor coping mechanisms play significant roles in the development of interpersonal problems. Defenses and coping mechanisms are behaviors used to protect oneself from emotional pain or discomfort. For example, one partner may have a defense of avoiding conflicts by avoiding difficult conversations and walking away when it is time to talk things out. The other partner may have strong feelings around loss and separation but all that is seen, on the surface, is the defense of becoming angry and aggressive when their partner walks away. By understanding these defenses, the couple can work to address them and improve their communication and understanding of each other. Empathy and Trust Empathy and trust are two essential ingredients for a healthy and fulfilling relationship. When couples are able to effectively communicate and understand each other's emotions and perspectives, they are better able to resolve conflicts, navigate challenges, and build a strong foundation of trust. One of the key challenges that couples may face is a lack of trust. This can occur for a variety of reasons, such as past betrayals, ongoing patterns of deception, or a lack of transparency and openness in communication. How do I work with Couples? The following are the means by which I address each of the causes listed above. Defenses and Coping Mechanisms In couples therapy, I guide couples in identifying their defenses and coping mechanisms, helping them understand how these may be contributing to conflicts in their relationship. To do so, I use techniques like exploration, clarification, and confrontation in order to reveal patterns and relational dynamics occurring outside of your awareness. By illuminating these dynamics, you and your partner can work toward improving communication and your understanding of one another. Empathy and Trust In therapy, I work with couples to identify the root causes of their trust issues and to develop strategies for rebuilding and strengthening trust over time. It is my goal to help partners rediscover and strengthen their ability to empathize with one another. This involves helping them to listen actively and without judgment, to try to see things from the other person's perspective, and to express their own feelings and needs in a way that is respectful and open. From this baseline, I work on strategies to effect lasting positive change. Such work involves setting boundaries, practicing honesty and transparency, learning how to navigate challenges and conflicts in a healthy way, and working through past wounds and conflicts.

  Link: Couples Counseling

• Grief Counseling

  In recent decades, various types of grief counseling have been developed to help individuals cope with the intense and complicated pain involved in losing a loved one. It has been accepted that loss involves many emotions which must be dealt with before the bereaved individual can successfully move on and adapt to the changes wrought by the death. For many people, assistance in the form of grief counseling is a necessary part of the process. Grief counselors, trained in the discipline, should have a deep understanding of the complexity of grieving. Stages of Grief In the late 1960s, Kebler-Ross, who worked with the terminally ill, postulated five stages of grief. These stages are: denial, anger, bargaining, depression and acceptance. Individuals suffering a great loss sometimes pass through these stages, but it is more often the case, I have found in my practice, that one may get stuck in a particular way of thinking and feeling. In fact, many individuals respond to loss in a way that is similar to how they responded to other life changing events. Understanding that grieving is a complex process, involving a wide range of emotions, is important for individuals seeking to get their lives back in order. It is important to realize, and slowly begin to accept, that in addition to sadness and longing, it is normal to experience resentment, guilt, anger and relief after a loved one dies. Working through a variety of emotions in therapy, with an experienced therapist, is NOT JUST reassuring and helpful BUT should also help facilitate the grieving process so it does not turn into clinical depression. Behavior of Grief As people heal after the death or loss of a loved one, they may find solace in differing behaviors. While outbursts of tears may be the expected reaction, attacks of laughter also may occur. Grieving individuals may also: Obsessively clean or organize Withdraw socially Become absent-minded or forgetful Engage in ritualized behavior Eat more or less than usual Seek comfort in alcohol or drugs Experience sleep disturbances Become highly emotional or emotionally flat Types of Grief Counseling Several types of grief counseling are available, including one-on-one psychotherapy and bereavement groups. The dynamics of such therapies vary but may include discussion and sharing, meditative or relaxation techniques. If the loss suffered has taken place under particularly traumatic circumstances, a more intensive treatment may be warranted. In my practice, in order to overcome this initial shock, I sometimes need to see and work with individuals more frequently. When the grieving individual is found to be suffering from clinical depression, antidepressant medication is sometimes used as an adjunct to the psychotherapy treatment.

  Link: Grief Counseling

• Psychodynamic vs. Psychoanalytic Psychotherapy

  Psychotherapy comes in all manner of forms. A few of these include, but are not limited to, supportive psychotherapy, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), psychodynamic psychotherapy, and psychoanalysis. In my practice, the primary forms of therapy I use are psychoanalysis and psychodynamic psychotherapy. I have extensive training and experience in both of these forms of psychological treatment, building on decades of validated research in the field of psychology. In the sections below, you can find more information on these psychotherapies including what they focus on and what they are particularly useful in treating. What is Psychoanalysis? Psychoanalysis is one of the oldest forms of therapy, originating from Sigmund Freud. It focuses on historical elements of your life (i.e., family dynamics, past traumas, etc.), their influence on your unconscious mind, and the ways the unconscious affects your current life. Such unconscious influences and effects present in ways that you do not or cannot recognize. The work of naming, unpacking, and addressing these unconscious influences requires an experienced and well-trained psychoanalyst. Due to the deeply ingrained nature of these unconscious influences on your behavior and thinking, psychoanalysis is an intensive––and highly effective––form of treatment, occurring 3-4 times weekly. What is Psychodynamic Psychotherapy? Psychodynamic psychotherapy is a specific type of psychotherapy treatment that examines the connection between thinking and behavior. Most often, these treatments deal with day-to-day experiences, helping the patient process and adapt to life’s challenges in healthy ways. Its focus is usually on the more immediate past and present with direct ways of managing experiences and generating new skills (e.g., improving communication, recovering from grief, generating coping skills). What do Psychoanalysis and Psychodynamic Psychotherapy have in common? Both of these treatment approaches rely upon a strong therapeutic relationship. We will tackle your problems together as a unit, exploring potential causes and solutions. Your past and present play critical roles in this work. Under my trained eye, you will piece together invisible patterns in your life to understand how you might create a path toward a better future. What is the difference between Psychoanalysis and Psychodynamic Psychotherapy? Psychoanalysis and Psychodynamic Psychotherapy both have long histories of clinical practice and many years of research supporting their use and benefits; however, each form has a particular use in treating psychological conditions. After careful assessment and 1-2 consultation sessions, I will determine which treatment approach is appropriate for you. Broadly, the two modalities can be organized according to the following sets of questions: for psychoanalysis, “Why does this happen, and what does this mean for me?”; for psychodynamic psychotherapy, “What happened, and what do I do about it?” What is Psychoanalysis for and when is it recommended? Generally, psychoanalysis targets the root causes of troubling thoughts, feelings and behaviors; uncovering and addressing unspoken origins from your life experiences. The goal is to increase awareness of self, alleviate emotional pain from past traumas and familial conflicts, and modify unconscious responses to create a healthier life. Psychoanalysts play a critical role in the process, allowing you to express past experiences in a profoundly intimate and immediate manner. This treatment approach is often indicated if you experience: long-standing problems that started in childhood or adolescence and affect many areas of your life; intense trouble establishing and maintaining close relationships; frequent problems at work with colleagues or your boss; or difficulties interacting at home or with your family of origin. What is Psychodynamic Psychotherapy for and when is it recommend? Conversely, psychodynamic psychotherapy often seeks to guide day to day processing of life experiences and to address specific aspects of behavior. While this technique may touch upon root causes of problems and discuss unconscious processes, it does not seek to fully uncover the origins of behavior. Rather, psychodynamic psychotherapy helps you understand how events from your past are negatively influencing your thoughts, feelings, and behaviors in the present. The goal is to increase your abilities for self-reflection and self-examination in order to clarify your motivations.

  Link: Psychodynamic vs. Psychoanalytic Psychotherapy

• Stress Management

  Now that the deep connection between physical health and emotional well-being has been established, stress management is recognized as an important component of daily life. Reducing stress has been found to improve relationships and personal satisfaction, and make students and employees more efficient. In order for successful stress management to take place, a stress assessment must be completed, designed to evaluate a patient‘s stress level and to highlight any areas of concern. These results are used to devise a customized treatment plan that provides patients with a variety of techniques to alleviate stress and increase comfort, energy level and productivity. Negative Effects of Stress We know that stress can produce physical, cognitive and psychological symptoms as well as exacerbate existing ones. Research has demonstrated that there are physiological reasons for this since the human body reacts to stress by producing cortisol, which alters metabolic, cardiovascular, neurological and immunological responses. While, almost any symptom can be precipitated, people who are stressed most typically experience: Anxiety Depression Headaches Forgetfulness Inability to concentrate Fatigue Appetite and sleep disturbances Gastrointestinal symptoms In addition, research has shown that stress worsens many medical conditions including: Asthma Chronic pain Fibromyalgia Multiple sclerosis High blood pressure Cardiovascular disease Stress also decreases the immune response, slowing healing and making individuals more susceptible to infection. Because of all the scientific data demonstrating the negative effects of stress, stress management is now available through health care providers, educational institutions and places of employment. Stress Management Techniques There are many ways to combat stress. A method that helps one person cope may not be as effective for another. It is often necessary for individuals to experiment in order to find which combination of techniques works best for them. Stress management can provide relief from stress-related symptoms and a pathway to a healthier lifestyle. For many people, eating a healthy diet and engaging in physical exercise are a good beginning for reducing stress levels. Various types of psychotherapy, in which the patient expresses and explores the causes of personal stress and is trained in new coping strategies, are often helpful. In extreme cases, medication may also be prescribed to get the individual through a particularly trying situation. For ongoing stress, a variety of other techniques from the world of alternative, or complementary, medicine are also available. These include: Meditation Deep breathing exercises Progressive muscle relaxation Visualization Acupuncture Aromatherapy Biofeedback Chiropractic care Herbalism Homeopathy Hypnotherapy Massage therapy Osteopathy Yoga Qi gong Reflexology Reiki Tai Chi While stress is an unavoidable part of modern living, stress management can make life more manageable, providing the ability to relax in the midst of turmoil and a sense of personal control. Typically, a combination of stress-reducing strategies works best.

  Link: Stress Management

• Generalized Anxiety Disorder

  Generalized anxiety disorder, or GAD, is a psychiatric problem in which anxiety is not a temporary state but a chronic condition. While it is normal for all individuals to worry about an upcoming event such as an examination or job interview, patients with GAD are in a perpetual state of anxiety and therefore are unable to relax or feel at peace. The disorder may become so severe that it interferes with school, work or relationships. GAD is a very common disorder, affecting millions of individuals in the United States alone. More than twice as many women as men suffer from the disorder. Causes of GAD While precise causes for GAD have not been determined, from my twenty plus years of experience in working with these individuals it seems that often times this kind of anxiety is related to a loss or separation, either real or imagined. It is important to assess and determine the extent of the anxiety because it can range from over-whelming - to having a dramatic life or death quality. When one plunges into these deepest levels of anxiety, I have discovered, it is sometimes triggered by thoughts and feelings of abandonment, insignificance, and annihilation of one's sense of self. GAD is thought to be exacerbated by environmental factors like trauma or abrupt and unanticipated life changes. Symptoms of GAD Symptoms of GAD, which most commonly begin during childhood or adolescence, may begin in adulthood as well. These symptoms may be both psychological and physiological. Often diffuse, these symptoms may be accompanied by a fear of dying. Psychological Symptoms Excessive worry about small things Perpetual worry Anxiety without a perceived cause Fear or dread Inability to relax Restlessness, irritability, tension Difficulty concentrating Extreme or frequent startle response Physiological Symptoms Insomnia or other sleep disturbances Headaches, fatigue, nausea, lightheadedness Muscle aches, muscle twitching Palpitations, chest pain Gastrointestinal distress Other aches and pains Frequent urge to urinate Breathlessness Hot flashes or sweating Trembling Difficulty swallowing Lump in the throat Dry mouth Diagnosing GAD Generalized anxiety disorder is typically diagnosed through a full medical history and a psychological evaluation. In order to be diagnosed with GAD, a patient has to meet the following criteria: Experience extreme anxiety for at least 6 months Be unable to overcome or control anxiety Have difficulty with everyday activities because of anxiety Have anxiety unrelated to another medical or psychiatric disorder In addition, in order to be diagnosed with GAD, adults must experience three of the following and children must experience at least one: Fatigue Sleep disturbances Irritability Restlessness Muscle tension Difficulty concentrating Treatment for Generalized Anxiety Disorder In my practice Generalized anxiety disorder is typically treated with insight oriented psychodynamic psychotherapy. At times it is important, and helpful, to lend support to the individual in the form of problem solving, judgement, and self-regulation of the emotions. Advice on specific issues is not helpful but looking closely, together, at what makes one anxious or doubt one's capacities is far more valuable. Helping the individual think out loud about the anxiety is a technique, that when done correctly, in an empathic environment, leads to a better understanding of one's thoughts, feelings, and experience with the intense anxiety.

  Link: Generalized Anxiety Disorder

• Depression

  What is Depression? Depression––or Major Depressive Disorder (MDD)––is a medical condition that causes extreme feelings of sadness and emptiness. People who suffer from depression may lose interest in activities they once enjoyed and experience a near-constant feeling of hopelessness. Depression may be triggered by events or occur alongside other illnesses. Depression can interfere with your ability to work, sleep, eat, interact with others, and generally enjoy life; however, depression can become a manageable condition with proper treatment. For a deeper dive into the causes of depression, different types of depression, and my approach to treating depression, be sure to check out my commentaries on depression. What causes Depression? While the exact cause of depression is unknown, experts theorize that it has multiple origins, which vary from person to person. Based on decades of research, experts suspect that chemical imbalances (i.e., affecting serotonin, norepinephrine, and dopamine) and changes in the brain (i.e., affecting its structure and function) play a significant role in depression. From an emotional and behavioral perspective, underlying personality traits as well as unaddressed, self-directed anger may be centralizing causes of depressive symptoms. In a commentary on depression, I have also written about how a masochistic personality disorder and/or a narcissistic crisis may lead to the development of depression. What are the symptoms of Depression? The criteria for depression are determined by mental health experts across the globe and validated in clinical research. They are published in two clinical manuals, which are made in conjunction with one another: the Diagnostic and Statistical Manual (DSM) and the International Classification of Disease (ICD) of the World Health Organization (WHO). According to these manuals, depression is characterized by 1) sadness and/or 2) loss of interest or pleasure that occur alongside a number of the following most of the day over a period of weeks: weight loss or gain; difficulties sleeping (e.g., too much or too little); physical agitation or slowing; fatigue or loss of energy; feelings of worthlessness or guilt; difficulties concentrating; and thoughts of death or suicide. Depression is a serious condition that can severely affect individuals and their families. Notably, it is often an episodic illness that can worsen with each episode. Left untreated, depression can steadily worsen, leading to anxiety, social isolation, difficulties at work or school, substance abuse, and suicide. How is Depression different from sadness? Depression differs from sadness in a few meaningful ways. Foundationally, depression impacts most, if not all, of a person’s life (i.e., work, school, family). When experiencing a traumatic event or a difficult time period, those without depression may exhibit some––or all––of the symptoms listed above. The key differentiator is that those with depression experience them nearly all the time and cannot bounce back to their previous level of functioning. Those suffering from depression may be more profoundly impacted by relatively small life stressors compared to those without the disorder. Over time, depression can worsen and evolve into an absence of feeling and emotion. Patients use words like “hollow” and “empty” to describe this experience. How is Depression generally treated? Depression can be treated using psychotherapy and medications. Studies have repeatedly shown that both can be effective, especially when undertaken together. When both are used, treatment consists of a team-based approach with both a physician and a therapist. How do I treat Depression? In my practice, I treat depression through either psychodynamic psychotherapy or psychoanalysis. These sessions can occur one or more times per week over a period of months to years. I have utilized these techniques over the last twenty plus years with great, lasting results. An important piece of the work I do with patients is addressing how they think. I guide patients to distinguish between thoughts and the act of thinking, developing a capacity to think with intention rather than be subjugated by painful thoughts. The premise is that this new thinking can lead to new ways of behaving. Ultimately, the positive impacts of these changes to thinking and behavior enhance self-esteem and reduce symptoms of depression. I find that long-term relief requires a longitudinal psychotherapeutic relationship with particular focus on targeting the root mental causes of depression.

  Link: Depression

• Personality Disorders

  A personality disorder is a psychiatric illness in which the patient‘s thoughts, emotions and behaviors are distorted in unhealthy ways. Patients with personality disorders tend to be inflexible and may appear irrational, at least at times, to those around them. Over a long time period, their behavior leads to serious difficulties in school, in the workplace and in relationships. For those with personality disorders, life is troubling and often stormy. For them, everyday stresses often represent overwhelming, or even, insurmountable problems. Believed to begin in childhood, personality disorders may have genetic, as well as environmental underpinnings and are often difficult to treat. Personality disorders are a group of mental health conditions characterized by persistent patterns of thoughts, feelings, and behaviors that differ from expectations of society. They have been generally divided into three categories based on the predominant patterns exhibited by individuals. For a more in-depth understanding of the various types of personality disorders and their symptoms, individuals are encouraged to visit my service pages, which provide a comprehensive overview. Please find below a general overview of the three clusters of personality disorders, which are characterized by distinct patterns of thoughts, feelings, and behaviors: Cluster A Personality Disorders Cluster A personality disorders are characterized by odd or eccentric thinking or behavior. They differ according to the types of thoughts patients experience and the types of behavior they engage in. Paranoid Personality Disorder Patients with paranoid personality disorder are distrustful, suspicious, secretive and often hostile. They attribute malicious motives to those around them, interpret oversights as insults, and hold grudges over imagined slights. It is common for patients with this disorder to suspect disloyalty in friends, co-workers and sexual partners. Schizoid Personality Disorder Patients with schizoid personality disorder present as flat emotionally, appearing indifferent or cold. They show little excitement about activities normally considered pleasurable, such as sex, and usually prefer to be alone. Schizotypal Personality Disorder Patients with schizotypal personality disorder are considered odd by those who come into contact with them. Their peculiarities of speech, dress and behavior set them apart. Such patients frequently believe that their thoughts have magical powers or that they are being contacted through hidden messages. They may experience auditory hallucinations and have difficulty with social situations or close relationships. Cluster B Personality Disorders Patients with cluster B personality disorders are overly emotional and melodramatic. Their thinking and behavior are unpredictable and often disconcerting to those around them. Antisocial Personality Disorder Patients with antisocial personality disorder, previously known as sociopaths, are impulsive and irresponsible. They repeatedly lie, steal or misrepresent themselves, frequently veering into criminal behavior. They are unconcerned with the feelings of others and may become aggressive or violent. They may seem to have no conscience, expressing no remorse for their bad behavior. Borderline Personality Disorder Patients with borderline personality disorder engage in impulsive, risk-taking behavior, including gambling or unsafe sexual activity. Their relationships are intense and unstable and their lives are filled with drama. These patients are extremely moody, often fluctuating between euphoria and feelings of emptiness or abandonment. Those with borderline personality disorder may have violent outbursts of anger and may threaten or attempt suicide. Histrionic Personality Disorder Patients with histrionic personality disorder constantly need to be the center of attention. In order to achieve this, they behave in a theatrical manner, dressing flamboyantly and often being sexually provocative. They tend to exaggerate the details of their life to make them more interesting or dramatic and to believe their relationships are more involved or intimate than they actually are. These patients express themselves with hyperbole and express strong, controversial opinions in order to draw attention to themselves. Narcissistic Personality Disorder Patients with narcissistic personality disorder have never passed through the childhood phase of narcissism and continue to believe that they are more important, special and deserving than others. They are not tuned in to the needs or emotions of those around them and tend to be arrogant. Such patients exaggerate their talents and achievements, expecting constant adulation. They may believe that others envy them, but may also experience intense jealousy of those who garner more attention than they do.

  Link: Personality Disorders