Mindfulness-Based Cognitive Therapy for Individuals and Couples

MBCT is available in-office and online. In-office counseling offers the opportunity to experience MBCT in a private space in our office where we can guarantee a safe environment free of interruptions. Online therapy involves an online video and audio telehealth platform.

The benefits of telehealth counseling include:

  • accessibility
  • schedule flexibility
  • potential increased comfort and safety.

The potential risks of telehealth counseling include, but are not limited to:

  • confidentiality – we can not ensure you are in a confidential surrounding when you meet with your practitioner. It is your responsibility to find a place that is private so your session can remain confidential.
  • interruptions – we cannot guarantee you will not be interrupted during your session. It is your responsibility to create necessary boundaries with those who are sharing your space to ensure you are not interrupted during your session.
  • Emergencies – if you are not in our office, there are limitations to our ability to support you in the case of an emergency. It is important you inform your clinician of your exact location, so that we can send emergency responders to you in the case of an emergency.

If you choose to meet with a clinician via telehealth, please do your best to find a place that is comfortable, private, and distraction-free.

Groups and Workshops

When experiencing chronic pain, one behavioral health treatment approach that effectively helps change the neural habit and perception of pain is a group experience. Therefore, we offer a variety of support groups and workshops where you will be joined by others who share a similar experience of chronic pain. Together, you will learn a variety of brain exercises and listen to each other’s feedback as a way to feel support and gain perspective. It is highly likely we will recommend both groups during the initial stages of your treatment. When you contact us we will speak with you to find out which options best fits your individual needs.

RETRAIN YOUR PELVIC PAIN WORKSHOP SERIES

This 6-week program provides a comprehensive understanding of chronic pelvic pain (CPP) and how to retrain your brain to unlearn pain. Participants will receive the most up-to-date information on the following topics:

  1. Neurobiology of chronic pain, specifically for pelvic and sexual pain disorders
  2. Mindfulness-Based Cognitive Therapy techniques
  3. Neuro-Linguistic Programming techniques and other brain exercises proven to reduce pain and improve resiliency

When: Tuesdays 6-8pm EST, Wednesdays 10am-12pm EST, & Thursdays 11am-1pm EST

THRIVING WITH ENDO: WORKSHOP FOR PRE/POST ENDO SURGERY

This weekly group will provide practical planning and nervous system regulation skills for patients preparing for and/or recovering from endometriosis surgery. This group is followed by a support group for female CPP patients.

When: Thursdays from 6-7pm EST

REIGNITING INTIMACY WORKSHOP

This 4-part series will provide a structured educational and experiential approach to intimacy while navigating chronic pelvic and sexual pain. This course is for couples and also individuals!

When: Wednesdays from 6pm – 7:30pm EST

Personalized Meditations

Dr. Milspaw provides personalized meditations which can utilize your body’s cellular memory to increase the effectiveness of MBCT and other relaxation and brain healing techniques. When the mind and the body become relaxed, we become more open to suggestion and change. When we become more open to change, our bodies and our lives can more easily heal. Healing is a good thing. Personalized meditations have been demonstrated to increase the efficiency and effectiveness of other healing modalities because it helps the subconscious shift away from fear-based beliefs, and towards beliefs that improve the healing process in a systemic, comprehensive manner. During this session, you will co-create the script of the meditation, which will include a personal memory of your choice of a time when you were safe, peaceful and relaxed. You will also create specific suggestions that state your goals and ambitions for your healing journey.

Frequently Asked Questions

Why is Mindfulness-Based Cognitive Therapy part of my treatment plan?

Pain is mediated by several factors, including the brain and the nervous system. The hardware of the brain and nervous system changes with chronic pain, stress, and trauma. Mindfulness-Based Cognitive Therapy has demonstrated its ability to repair and restore this hardware. Dr. Milspaw teaches that we must “update the hardware in order to update the software.” If our intention is to change the habit of pain within the nervous system, we must first heal the hardware of our brain. As you learn and practice these brain exercises, you train the brain to heal these painful habits. More information about pain and the mind-body connection can be found below.

MBCT can help change the thoughts, emotions, beliefs, reactions, and behaviors related to pain. By improving your coping strategies we help shift your brains perception and reaction to incoming stimuli. Pain causes a stress response which can amplify pain sensations via chemicals in the brain. MBCT can help reduce the stress response and thereby allow the body’s natural pain relief mechanisms to be more powerful.

What is the difference between Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction?

Mindfulness-Based Cognitive Therapy (MBCT) combines the practices of Mindfulness-Based Stress Reduction (MBSR) techniques with Cognitive Behavioral Therapy techniques. Mindfulness is the practice of being in the present moment without judgment and without trying to change anything. It is the practice of experiencing what some call “the beginner’s mind” as if we were experiencing something with wonder and awe for the first time. It is the practice of being the observer of our experience. Mindfulness is a “being” state of mind rather than a “doing” state of mind. Often, we focus on the past (what we should/could/would have done differently) or we focus on the future (what might happen). MBSR techniques help guide us to focus on the present moment. Through the practice of being in the moment one can both quiet the mind and calm the body. MBSR works to relax the body through a variety of different exercises, including breathe work. As we breathe, we relax the mind through redirecting conscious awareness. MBSR is ideal for cultivating greater awareness of the unity of mind and body, understanding how our conscious and unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health, and increase levels of acceptance and compassion in our lives. The benefits of MBSR address a variety of health problems. The mind is an important factor in chronic pain and other stress and stress-related disorders. Scientific research establishes that MBSR positively affects a range of autonomic physiological processes involved in reducing chronic pain, such as lowering blood pressure and reducing overall physical and emotional arousal and reactivity. Mindfulness is a lifetime engagement – helping all of us counter the inevitable dissociation that we all tend to develop as a protective mechanism against pain and other types of trauma.

MBCT utilizes the effect of MBSR to bring the client into the present moment and gain awareness over their thoughts and beliefs they are experiencing in reaction to their mental, emotional and physical state. As we become capable of observing our emotions, thoughts, and sensations, we increase our ability to change our focus and thereby change our brain and nervous system’s response to our experience. As we change our focus, we change our experience of pain. As we change our experience of pain, the brain and nervous system relax and have an opportunity to heal more effectively and efficiently.

 

How long do you work with clients?

MBCT tends to be a short-term therapy modality. The goal is provide you with the skills and experiences you need to manage and heal your pain within 12-16 weeks. Your treatment duration depends on many variables, including your individual needs for more in-depth trauma work and support. We use a 3-month mark as a reassessment point when we will review your goals and commitment to the therapeutic process.

 

If I need MBCT, does that mean the pain is all in my head?

No. When someone is referred to see a psychologist or counselor for behavioral health treatment, a common misperception is that the clinician is claiming the pain is “only in their head”. This is not our belief. It is important to understand that the pain you experience is 100% real. It is also important to understand that your brain mediates the perception of pain, and therefore, your thoughts, beliefs, past experiences, and brain health are all involved in your experience of pain.

 

How do I prepare for a telehealth session?

There are several steps you can take to prepare for a successful telehealth counseling session. The more you prepare for your session, the higher the probability of success.

  1. Find a place that is comfortable, private, and distraction-free.
  2. If possible, try to be the only one on your Wi-Fi and close out other internet tabs on your computer.
  3. Inform those at your location that you will be having a confidential meeting to help decrease the likelihood of being interrupted.
  4. Turn notifications off on your phone, tablet, and/or computer.
  5. Set intentions for your session. When we set intentions, we increase the probability of feeling fulfilled and successful. Ideas can include:
    • Topics you wish to address in session
    • Questions you may have for the counselor
    • Specific behavioral goals you wish to work towards

 

For your first therapy session, we recommend you bring a journal or something to take notes. You may wish to write down topics that are covered in session, such as the pain education we will review in session 1. You may also wish to write down your personal goals, intentions, and experiences you have during session. Note-taking can be a great way to keep track of how you’re feeling and what exercises or interventions work for you. This can also be a great reminder for you to have between sessions in case you forget what was covered during the session.

 

Are there any other therapies you may suggest that are complementary to the MBCT process?

There are several other therapies which may help our patients outside of MBCT. Some of the therapies train the body to relax, while others seek to create movement and body awareness. These other therapies may include:

  • Mindfulness-Based Stress Reduction
  • Hypnotherapy
  • Exercise and Movement, including Qi Gong, Tai Chi, Restorative Yoga and Pilates
  • Myofascial Massage
  • Acupuncture and acupressure
  • Pelvic floor physical therapy

 

What are my responsibilities as the client?

We believe that counseling is most effective when the client and counselor collaborate on resolving the client’s concerns. This process includes a willingness to challenge yourself to think about issues in new ways, be honest with yourself and your counselor and follow through, to the best of your ability, on tasks and goals discussed in session.

 

Are there any risks?

It is possible that during the session you might experience uncomfortable or painful feelings. However, counseling has been demonstrated to have many benefits and clients often report significant improvements in the problems for which they sought help.

 

Do you take insurance for therapy sessions?

We urge people before our first session to talk with their insurance company about reimbursement. There are many different plans and they vary greatly when it comes to behavioral health services. Often, people are able to get a percentageIf your insurance covers behavioral health services, we will bill your insurance directly and you will be responsible for a copay after you have met your deductible. If you have a deductible, or if your plan does not cover behavioral health services, then we can issue a Superbill for our clients to submit for reimbursement. All sessions with Dr. Milspaw are cash-fee only.

 

What is your cancellation / no-show policy?

We have a 24-hour cancellation policy. If the session appointment is rescheduled before 24 hours of the appointment time/date, there is no charge. If changes are made within 24 hours of the session you will be charged the full session fee. The same rules apply for appointment no-shows. We do realize there may be something going on and emergencies arise. Please call the office as soon as possible if you realize you are unable to keep your appointment.

 

Is telehealth counseling available in my state?

Currently, we are offering virtual groups and workshops, as well as personalized meditations sessions with Dr. Milspaw. Stay tuned for when we have hired a licensed therapist in your state.

 

How do I begin?

Depending on your individual needs, your physician may recommend beginning with our 8-week Retrain Your Brain program and our support groups. If you are needing, or if you desire, a more individualized approach, you may schedule a one-on-one session with one of our clinicians.

 

Request an appointment through this website by following these prompts:

  • Click on “Make an appointment”
  • Choose your reason for an appointment (individual or couples counseling, support group, or one of our workshops)
  • Choose your desired consultation time and date
  • Choose the closest office near you
  • Fill out the rest of the requested information
  • Wait for a PRM Representative to call contact you to schedule

You may also call us at (646) 481-4998 with any questions you may have about our services.

 

Pain and Mind-Body Connection

 

What is pain?

Pain is a warning system in the body. There are two types of pain: acute pain and chronic pain. We need acute pain to survive. If we step on a nail or burn our skin, we need to know that something is wrong so we can react and seek proper medical attention. When this happens, a signal is sent up the spine through the nervous system and into the brain where it is then evaluated by different parts of the brain. These different parts of the brain include the motor cortex (what you are doing in that moment) and the sensory cortex (what part of the body the signal is coming from). The signal also travels to the parts of the brain where thoughts, memories, and knowledge of our bodies are stored. Therefore, the brain is looking at our “neuro-matrix”, which is the accumulation of our past experiences (those we remember and those we do not remember, from birth to death), beliefs, thoughts we focus on throughout the day, our emotional state, and our overall understanding and perception of the situation. The brain decides what is painful or not, depending on our brain’s perception and understanding of the situation. This process happens in micro-seconds, without our conscious control. This process can decrease or increase our experience of pain, depending on the perceived “danger” level of those signals. The more we understand what is going on in the body, how chronic pain or “danger signals” are processed in the body and mind, and the more “tools” we have to temper these signals and how the brain responds, the less pain we are likely to experience.

“Chronic pain” is the result of our brain interpreting signals through our nervous system commonly long after the actual tissue damage has healed. Triggers of these signals can include one or all of the following: functional systems (bladder, bowel, or uterus/prostate), structural systems (muscles and ligaments in spasm, nerves firing, tingling, burning, itching of surface tissues), all of which add up in our memories, emotions, and thoughts. When the trigger is a memory, emotion, or thought (conscious or unconscious), it lights up the neuro-matrix connected to our sensory cortex. This phenomenon is similar to “phantom limb syndrome” where the individual experiences pain in a part of the body that is no longer there. Focused training redirecting the mind can help our brains avoid these particular triggers and signals as much as possible. Mindfulness-based stress reduction and diaphragmatic breathing techniques are proven tools to help guide us through this process to reduce or even eliminate chronic pain.

 

Our Body’s “Fight or Flight” Response

Fear triggers our brain to produce chemicals that make it more difficult for us to relax. In fact, mere emotions and thoughts (both conscious and unconscious) can trigger this chemical reaction placing us in the “fight or flight” response. When the body goes into this mode, it is an evolutionary protective response, as if there was a dangerous lion nearby. This “fight or flight” response causes muscle spasm (to give you strength to fight or run away), increased heart rate, dilated pupils, shallow breathing and other autonomic nervous system responses, such as dry mouth, slower immune response and inhibited digestion. The brain then seeks more feedback from the body to know more about what’s happening, increasing the sensitivity in the nervous system. Our brain “turns the volume up” on our nervous system. Regretfully, this means that our physical sensations increase and consequently we feel more pain. In other words, when it comes to pain, the more we fear it, the more we feel it.

 

Emotions & Pain

Our emotions affect how we feel and interpret physical sensations. Our beliefs, emotions, and thoughts all affect how we feel pain. Research demonstrates that depression, anxiety, and guilt can all make it more difficult for us to cope with pain. Fear and worry can especially increase the amount of pain we feel. When we are afraid, stress or anxious, our muscles tense, the heart begins to race, and we may begin to tell ourselves things like, “I can’t relax, this really hurts, I can’t handle this.” Then, the next thing you know, we can’t relax and every sensation actually does become more painful. A positive, less fearful emotional state, such as being confident and relaxed, can help coping with pain easier. We will teach you techniques to help your brain and nervous system respond to your beliefs, emotions, and thoughts in a way that can help decrease anxiety, stress, and pain.

Meet Pelvic Rehabilitation Medicine

At Pelvic Rehabilitation Medicine, we treat whole human beings, not symptoms. In the body, everything is connected; and the pelvic region is the vital center of the body’s connected functioning. Our physicians take an innovative approach, combining traditional medicine with holistic modalities and rehabilitative medicine.... Learn More »

Practice Safety Protocol

The health and safety of our patients and employees is Pelvic Rehabilitation Medicine’s top priority. While remaining open, our Team is strictly adhering to the recommendations offered by the CDC, and our disinfecting policies are meticulously executed in each of our offices. We assure you a healthy, safe environment while bringing you the exceptional healthcare you deserve. 

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