As an attachment-informed therapist I believe that consistency is especially important for those of us with histories of trauma, insecurity, and family dysfunction. That being said, I require all clients to make a commitment of weekly therapy sessions for the first 4 months of treatment, after which we can both explore whether bi-weekly sessions would be appropriate. I also offer 2x weekly attachment-informed psychotherapy for clients with histories of complex trauma, disorganized attachment, and/or dissociative disorders. Each appointment is approx. 55-60 minutes in length and can be extended (to 70 minutes) or shortened (to 45-50 minutes) if needed on a case-by-case basis.

Absolutely! All virtual appointments are held via a HIPAA compliant video conferencing platform to ensure secure privacy in on online meeting space. Clients meeting virtually must also meet in a location that provides physical privacy where they feel comfortable with openly expressing their thoughts and feelings. I encourage the use of headphones for further confidentiality. All sessions require a signed consent (HIPAA form) in order for conversation to occur with outside sources with the following exceptions per state law and professional ethics: 1) If the therapist has reason to suspect the client is seriously in danger of harming him/herself or has threatened to harm another person. 2) Suspected past or present abuse or neglect of children. adults, and elders. 3) If a judge were to subpoena a client's records and therapist is mandated to turn them over.

My practice works with individuals who are motivate to actively engage in their trauma treatment. This includes taking time in-between sessions to reflect on the insight gained, incorporate the skills taught, read recommended recovery materials, and engage in independent journaling or self-care work. Because of the nature of our work, prospective clients must not have had a suicide attempt or psychiatric hospitalization in the last year. Prospective clients must not have engaged in non-suicidal self-harming behavior within the last 90 days.

I am currently in-network with Aetna until Jan 1st 2024. Because of this, clients seeking to utilize their Aetna insurance must be willing to continue working together out-of-network once I am no longer affiliated with the plan. If you are not interested in or financially unable to do so, I very much encourage you to find a provider who is not leaving the plan to ensure continuity of your mental health care. I am out-of-network with all other insurance plans. What is an out-of-network provider? This means that I am not formally affiliated with any insurance plans. Instead clients pay me directly for services and your insurance is then informed of payment so that you can be reimbursed for your out-of-pocket expenses through your out-of-network benefits.. Payment Options: Cash, Credit/Debit Card, Check, HSA/FSA Card

Clients Utilizing their Out-of-Network Benefits: - My standard rate is $150.00 for a reserved 60-70 minute appointment slot within my schedule. - I reserve a few 60-70 minute appointment slots in my schedule for clients in need of a reduced rate. Inquire directly with Anthony Dimitrion, LCSW, CST to learn more.

What are Out-of-Network (OON) Insurance Benefits? Many insurance plans include some form of Out-of-Network benefits along with your primary In-Network benefits. Out-of-Network benefits can be used to see medical and mental health providers who are not formally members of your insurance plan's network. How much do OON Insurance Benefits Cover? Most insurance plans reimburse 40%-80% of your monthly mental health expenses. Some insurance plans have an OON deductible that must be met before they agree to reimburse you for OON expenses. How do I find out what my OON Insurance Benefits are? Connecting via telephone with your insurance provider to request your OON benefits information is the easiest way! When contacting them I encourage you to ask them the following questions: 1) Do I have OON benefits? 2) Do I have a deductible that needs to be met? If so, how much is it? 3) What percentage will I get reimbursed once my deductible is met (if you have one)? 4) How do I submit to you the monthly superbill (big receipt) my therapist gives me? Anthony Dimitrion, LCSW can assist you in verifying your benefits when an initial 60-min consultation is schedule. How does payment work if I use my OON Insurance Benefits? As an out-of-network psychotherapist you would pay me our agreed upon per scheduled session rate each week. Unlike other providers who expect you to do all of the legwork around submitting a monthly superbill (big receipt) to your insurance plan, I submit a claim on your behalf directly to your insurance provider after each session. What this ultimately means is that you will meet your deductible faster and get reimbursed quicker than if you had to wait until the end of the month to complete the process. How long does it typically take to get reimbursed by my insurance plan? The average turnaround time for reimbursement varies by insurance plan. Typically once you meet your deductible (if you have one) turnaround time is approx. 2-4 weeks from claim submission. Once your deductible is met you really are only paying out of pocket for 1-2 months of therapy before you begin to receive your insurance reimbursement checks in the mail. * Some insurance plans also offer direct deposit of reimbursement (inquire directly with your insurance plan to learn more).

Complex Post-Traumatic Stress Disorder (C-PTSD) develops as a result of prolonged, repetitive trauma, beginning in childhood often at the hand of one's caregiver(s) and/or figures close to them (i.e. relatives, community figures, religious leaders, etc.). This can include, but is not limited to: childhood abuse/neglect, pervasive family dysfunction, domestic violence, sexual abuse, and other forms of exploitation. It is often characterized by pervasive feelings of fear, helplessness, overwhelm, shame, and abandonment/rejection/isolation. The residual effects of the traumatic experiences continue to have an impact on survivors into their present day lives.

Developmental trauma, refers to traumatic experiences that occur within the context of close interpersonal connections such as caregivers, family members, religious/spiritual groups, peers/teachers. Unlike single-event traumas (e.g., a car accident or natural disaster), developmental trauma involves repeated or prolonged exposure to traumatic events within the context of close relationships. Developmental trauma increases the risk of Complex PTSD (C-PTSD), Disorganized Attachment, Dissociative Disorders, and other chronic mental health, medical, and/or substance use concerns.

Narcissistic Abuse refers to a pattern of manipulative and harmful behavior inflicted by someone with narcissistic personality traits. It involves various forms of emotional, psychological, and sometimes physical mistreatment aimed at controlling and dominating the victim for the narcissist's personal gain or to satisfy their own emotional needs.

What is Dissociation Exactly? "Dissociation is a coping skill that disconnects traumatic memories from one’s consciousness, shielding them from the pain or fear associated with the trauma. The traumatic memories still exist but are deeply buried within the mind," (An Infinite Mind) Fragments or entire memories may resurface on their own or after being triggered by something in the person’s[present-day life (i.e. surfacing emotions, physical sensations, relationship dynamics, sights, sounds, smells, tastes, situations/experiences, people, places, things), this can lead to feelings of panic, anxiety, flashbacks, nightmares, conscious or unconscious disconnecting from reality, etc. (adapted from An Infinite Mind) The 5 Types of Dissociation (pulled directly from An Infinite Mind https://www.aninfinitemind.org/dissociation-information) Dissociative Identity Disorder (DID): DID, formerly called multiple personality disorder, develops as a childhood coping mechanism. To escape pain and trauma in childhood, the mind splits off feelings, personality traits, characteristics, and memories, into separate compartments which then develop into unique personality states. Each identity can have its own name and personal history. These personality states recurrently take control of the individual's behavior, accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. DID is a spectrum disorder with varying degrees of severity. In some cases, certain parts of a person's personality are aware of important personal information, whereas other personalities are unaware. Some personalities appear to know and interact with one another in an elaborate inner world. In other cases, a person with DID may be completely aware of all the parts of their internal system. Because the personalities often interact with each other, people with DID report hearing inner dialogue, and the voices will comment on their behavior or talk directly to them. It is important to note the voices are heard on the inside versus the outside as this is one of the main distinguishers from schizophrenia. People with DID will often lose track of time and have amnesia to life events. They may not be able to recall things they have done or account for changes in their behavior. Some may lose track of hours while some lose track of days. They have feelings of detachment from one's self and feelings that one's surroundings are unreal. While most people cannot recall much about the first 3 to 5 years of life, people with dissociative identity disorder may have considerable amnesia for the period between the ages of 6 and 11 as well. Oftentimes, people with DID will refer to themselves in the plural. Dissociative Amnesia: The most common of all dissociative disorders and usually seen in conjunction with other mental illnesses, dissociative amnesia occurs when a person blocks out information, usually associated with a stressful or traumatic event, leaving him or her unable to remember important personal information. The degree of memory loss goes beyond normal forgetfulness and includes gaps in memory for long periods of time or of memories involving the traumatic event. Depersonalization Disorder: Having depersonalization has sometimes been described as being numb or in a dream, or feeling like you are watching yourself from outside your body. There is a sense of being disconnected or detached from one's body. This often occurs after a person experiences life-threatening danger, such as an accident, assault, or serious illness or injury. Symptoms may be temporary or persist or recur for many years. People with the disorder often have a great deal of difficulty describing their symptoms and may fear or believe that they are going crazy. Unspecified Dissociative Disorder: (UDD) Symptoms do not meet the full criteria for any other dissociative disorder and the clinician chooses not to specify the reason that the criteria are not met. Other Specified Dissociative Disorder (OSDD): The other specified dissociative disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific dissociative disorder. Do you believe that integration of the self is the ultimate goal for every DID or OSDD identifying client? In short- No I do not. To elaborate- As an attachment-informed, "relational" psychotherapist, I believe in therapeutic co-collaboration, mutual authenticity, and client autonomy. Each client is the expert on themselves and their lives. That being said, I honor the goals uniquely identified by each individual client and in no way dictate what those goals "should" be. Not every individual with DID sees integration as a goal or ultimately necessary to live a fulfilling life. Do provide psychological testing or give formalized diagnoses to individuals who suspect that may have a dissociative disorder? No I do not. As an LCSW, formal psychological testing is out of my clinical scope of practice. I provide ongoing psychotherapy with clients who already have a DD diagnosis as well as clients who self-identify as experiencing dissociation or having a dissociative disorder. Individuals who are seeking a formal diagnosis are encouraged to reach out to a clinical psychologist or neuropsychologist who is trained in administering standardized psychological testing.

In short, I have completed post-graduate advanced training and clinical consultation in structural dissociation and dissociative disorders. I take a non-pathologizing stance on dissociation, recognizing that dissociation is an every day occurrence for all humans (i.e. reflexively driving from one destination to the other without full awareness and 100% presence; "zoning out" while watching television or playing a video game; etc.). When an individual experiences trauma, dissociation is utilized as a coping mechanism to avoid further harm. The experience of trauma leads to more pronounced dissociation that can be more pervasively triggered as the survivor attempts to cope with and navigate through life.

Trauma can have profound effects on the brain, particularly on areas involved in emotion regulation and memory. The amygdala, responsible for processing emotions, can become hyperactive, leading to heightened anxiety and fear responses. The hippocampus, crucial for memory, may shrink, impacting the ability to form new memories and manage stress. The prefrontal cortex, involved in decision-making and impulse control, can also be affected, leading to difficulties in regulating emotions and behavior. These changes can contribute to conditions like PTSD, C-PTSD, and other mental health conditions. Trauma can trigger a cascade of responses in the nervous system, particularly the autonomic nervous system (ANS). The sympathetic branch, responsible for the "fight or flight" response, can become overactive, leading to increased heart rate, elevated blood pressure, and heightened alertness. Conversely, the parasympathetic branch, responsible for calming the body, may be underactive, resulting in difficulties relaxing or sleeping. Chronic trauma can lead to dysregulation of the ANS, causing symptoms like hypervigilance, emotional flashbacks, dissociation, and panic attacks. This dysregulation can persist even after the traumatic event has passed, contributing to ongoing stress and health issues.

Overt Incest is explicit sexual act(s) enacted by a non-spousal family member, relative, or close friend. Emotional Incest also known as covert incest or spousification, is described as a relationship between a parent (or a close relative or friend of the family) and child, in which the parent relies on the child to meet their emotional and relational needs often times while neglecting certain needs of the growing child. Emotional incest does not include overt sexual touching, however a child's emotional and physical boundaries are inevitably crossed. Because of this, the child may feel like their relationship with their parent is too close for comfort. Their privacy and sense of autonomy can feel compromised. The child may feel used, trapped, angry, confused, emotionally neglected/ignored, and emotionally entangled with their parent. Some parents may invade their child's personal space or engage with their child in an affectionate way that borders sexual or inappropriate (i.e. longer than comfortable hugs, holding their teenage child's hand, non-consensual kissing, etc.). They may also be sexually suggestive or body-focused in their comments toward their child (i.e. buying their daughter tight "sexy clothing", frequent comments on their child's appearance, etc.). Overt and Emotional Incest can occur individually as well as together.

Many individuals, both straight and queer, have worried about this very question. Sexual abuse DOES NOT ORIENT our sexuality it DISORIENTS our sexuality. Sexual abuse is not about sexuality it is about abuse.

Yes AND no. Sexuality and erotic interests are unique for each and every person. Because of this, sexual fantasies, kinks, and turn ons tend to have many contributing experiential, relational, biological, and sensorial origins. Sexual abuse does not determine our sexual or erotic orientations, it disorients us. Sexual abuse can leave a trauma imprint on our sexual-erotic template. This imprint can have an influence on how we relate to and engage with our sexual and erotic selves (solo and partnered). That being said, there are many individuals both with and without SA histories that claim to trace their fantasies/kinks/turn ons to experiences from their childhood. At the end of the day, if it is pleasurable, consensual, honest, non-exploitative, safe, and aligns with the values for all parties involved, YOU get to decide how YOU want to engage with your sexual and erotic self regardless of your past.

- RECOVERY BOOKS - Narcissistic Abuse: Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers (Karyl McBride) Will the Drama Ever End? Untangling and Healing from the Harmful Effects of Parental Narcissism (Karyl McBride) It's Not You: Identifying and Healing From Narcissistic People (Ramani Durvasula) Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility (Ramani Durvasula) Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents (Lindsay Gibson) Growing Up as the Scapegoat to Narcissistic Parents (Jay Reid) Traumatic Narcissism (Danial Shaw) Narcissistic Parents: The Complete Guide for Adult Children (Caroline Foster) Silently Seduced: When Parents Make Their Children Partners (by Kenneth M. Adams) The Emotional Incest Syndrome (Patricia Love) C-PTSD, Sexual Trauma, Traumatology, & Dissociation (books): Complex PTSD: From Surviving to Thriving (Pete Walker) The Body Keeps Score (Bessel van der Kolk) Transcending Trauma: Healing Complex PTSD with Internal Family Systems Therapy (Frank G. Anderson) Victims No Longer: The Classic Guide for Men Recovering from Sexual Child Abuse (Mike Lew) The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse (Ellen Bass & Laura Davis) Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation (Janina Fisher) Dissociation Made Simple: A Stigma-Free Guide to Embracing Your Dissociative Mind and Navigating Daily Life (Jamie Marich) Coping with Trauma-Related Dissociation (Suzette Boon, Kathy Steele, Onno Van Der Hart) Finding Solid Ground Program Workbook: Overcoming Obstacles in Trauma Recovery (H. Schielke, Bethany Brand, et. al) Reclaiming Pleasure: A Sex Positive Guide for Moving Past Sexual Trauma & Living a Passionate Life (Holly Richmond) Beyond Betrayal: Taking Charge of Your Life after Boyhood Sexual Abuse (Richard B. Gartner) Sibling Sexual Abuse: A Guide for Confronting America's Silent Epidemic (Brad Watts) When Religion Hurts You: Healing from Religious Trauma and the Impact of High-Control Religion (Laura E. Anderson) No Bad Parts: Healing Trauma and Restoring Wholeness with Internal Family Systems (Richard C. Schwartz) - ONLINE RESOURCES - https://narcissistabusesupport.com/ https://www.thetrevorproject.org/ https://rainn.org

AEDP is an attachment-based relational approach to therapy. "Many psychotherapies focus on the content of the stories that people tell about themselves, looking for insights that can be used to fix what’s wrong. By contrast, AEDP focuses on fostering awareness of the emotional life of the client as it unfolds in real time in front of the therapist. The therapist is actively affirming, emotionally engaged and supportive. She encourages the client to attend not only to their thoughts and emotions but also to the physical experience of those thoughts and emotions,” Hillary Jacobs Hendel, LCSW, AEDP Therapist.

Internal Family Systems (IFS) is an evidence-based approach created by psychotherapist Dr. Richard Schwartz. IFS presents a framework of the mind that understands the individual as being composed of a network, or system, of parts. These parts hold feelings (worry, anger, sadness guilt, fear, etc.) and thoughts (judgements or criticism of self or others) that impact behavior in our daily life (i.e. overworking, avoiding worrisome/triggering situations, acting out impulsively, over controlling, etc.). In IFS we refer to these parts as being an "Internal Family". At the center of this system of parts (or inner-personalities) is the Core Self (the internal "I" or "Me"). The Core Self can best be seen as our "Authentic Self" and can be described as compassionate, dedicated, respectful, clear, and playful. The goal in IFS Therapy is to help clients become aware of, and differentiate their authentic Core Self from the various inner parts (the anxious part, angy part, wounded inner child part, etc.). When one is able to make this distinction, they no longer feel directed by their parts, and can more fully make sense of their inner and external life, as well as past and current experiences. IFS is a great approach for anxiety, depression, self-esteem, and trauma. Below is a great video clip about what is IFS:

EFIT is a relational-experiential therapeutic approach that privileges emotion and emotional regulation in the therapeutic session. EFIT pulls from attachment theory, modern emotion theory, and affective neuroscience. The EFIT therapist serves as a secure and compassionate base for the client to process suppressed emotion and heal from childhood, attachment, and emotional wounds.

Mindfulness is being in the present moment without judgement or criticism. Throughout sessions we will weave in mindfulness techniques that will help you become more attuned to your inner thoughts/feelings and somatic sensations. Mindfulness also helps couples become more aware of the overall presence of one another. This mindful connection can increase attunement and intimacy with couples. Mindfulness has been found to help help with anxiety, depression, concerns with sex and intimacy, trauma, and much more.

TIST Therapy is a trauma and dissociation informed model of treatment that has its roots in interpersonal neurobiology, attachment research, structural dissociation theory, and somatic mindfulness. TIST integrates concepts from several modalities including Internal Family Systems and Sensorimotor Psychotherapy. TIST was specifically developed to treat survivors of complex childhood trauma, disorganized attachment, and dissociation.

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