How I Practice Psychotherapy: A Collaborative, Evidenced-based Approach
As a clinical psychologist practicing via telehealth across Colorado, I draw from multiple evidence-based therapeutic traditions — not because I believe in mixing techniques arbitrarily, but because the science of psychotherapy has made it increasingly clear that different people, even those carrying the same diagnosis, often benefit from different therapeutic processes. My work is grounded in a Process-Based Therapy (PBT) framework, which means that I select and integrate interventions based on what is functionally driving each individual's difficulties, rather than defaulting to a single protocol for a given diagnostic label.
What follows is an overview of the primary evidence-based modalities I draw from in my practice. Each of these traditions contributes specific tools and perspectives, and the particular combination I use with any given client depends on the psychological processes we identify together as most relevant to their presenting concerns.
Acceptance and Commitment Therapy (ACT): Psychological Flexibility and Living with Meaning
ACT is a therapeutic approach grounded in over four decades of basic behavioral science research. It targets psychological flexibility — the ability to stay present, open, and engaged with life, even in the face of difficult internal experiences. Psychological inflexibility, in contrast, occurs when we become locked into rigid thought patterns, avoid difficult emotions, and attempt to control our internal experiences in ways that paradoxically maintain distress rather than resolving it.
One of ACT's core components is cognitive defusion, which helps reduce the behavioral impact of distressing thoughts by altering how we relate to them rather than attempting to eliminate them. Another key component is mindfulness, which cultivates nonjudgmental awareness of the present moment, allowing us to disengage from unhelpful thought loops and ruminative cycles.
What this looks like in my practice: We explore how avoidance of painful thoughts and emotions may be constraining your life. Through experiential exercises, metaphors, and mindfulness strategies, I guide you in learning how to relate differently to your automatic thoughts, how to act rather than avoid, and how to practice accepting what cannot be changed while committing to actions aligned with the life you want to build.
Cognitive Behavioral Therapy (CBT): Restructuring Thoughts for Emotional Well-Being
CBT remains one of the most extensively researched therapeutic approaches in clinical psychology. It focuses on identifying and restructuring the unhelpful cognitive patterns that contribute to emotional distress. Through CBT, clients learn to examine cognitive distortions, develop healthier thinking habits, and create lasting behavioral change.
What this looks like in my practice: Together, we identify thought patterns that may be maintaining your distress. I provide structured exercises to help you examine the evidence for and against specific cognitions, challenge distorted thinking, and develop more balanced and realistic perspectives. Within my PBT framework, I draw on CBT tools specifically when cognitive rigidity or distorted appraisal processes emerge as key drivers of a client's difficulties.
Dialectical Behavior Therapy (DBT): Finding Balance and Emotional Regulation
DBT is particularly effective for individuals struggling with emotional dysregulation, intense interpersonal conflicts, and self-destructive behavioral patterns. It combines acceptance and change strategies, helping clients build skills in four key domains: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
What this looks like in my practice: I work collaboratively with you to develop specific coping skills to manage overwhelming emotions and navigate relational challenges more effectively. We practice mindfulness techniques and explore strategies for building a more balanced emotional life. DBT's skills-based approach is especially valuable when emotional intensity is a central process driving a client's presenting concerns.
Mindfulness-Based Cognitive Therapy (MBCT): Preventing Relapse and Cultivating Awareness
MBCT integrates principles of mindfulness with cognitive therapy techniques to help clients break free from cycles of ruminative thinking, particularly in the context of recurrent depression or persistent anxiety. By increasing awareness of thoughts and feelings without judgment, clients can interrupt automatic cognitive patterns and develop a fundamentally different relationship with their mental experiences.
What this looks like in my practice: We incorporate mindfulness practices such as body scans, meditation, and mindful breathing to develop greater metacognitive awareness. By learning to notice thoughts as they arise and practicing nonjudgmental acceptance, you develop the capacity to respond to difficult emotions with greater clarity and self-compassion rather than being carried away by habitual reactivity.
Mindfulness-Based Interventions: Cultivating Awareness and Presence
Mindfulness is a foundational element woven through many of the approaches I use. By developing mindfulness skills, clients learn to be more fully present, reduce unskillful automatic reactions, and cultivate a more emotionally regulated way of engaging with the world. Mindfulness creates space between thoughts, emotions, and behavioral reactions — allowing for more intentional and skillful responses to life's challenges.
What this looks like in my practice: We integrate mindfulness practices such as breath awareness, body scans, and mindful self-compassion into our sessions. Together, we practice present-moment awareness without judgment, observe the nature of your experiences, and develop skills for relating to difficulty with greater equanimity and acceptance.
How These Modalities Work Together
If you have read this far, you may notice that these approaches share common threads — mindfulness, cognitive flexibility, emotional regulation, behavioral activation, and the capacity to relate differently to internal experiences. This is not coincidental. A Process-Based Therapy framework recognizes that these modalities are not competing schools of thought but rather complementary traditions that each illuminate different facets of the same underlying change processes.
In practice, this means I do not rigidly adhere to a single protocol. Instead, I work with each client to identify the specific psychological processes that are maintaining their difficulties — whether that is experiential avoidance, cognitive fusion, emotional dysregulation, ruminative thinking, or some combination — and I draw from whichever evidence-based tools are best suited to address those processes. The result is a therapy that is both scientifically grounded and genuinely personalized.
Getting Started
If you are an adult in Colorado exploring telehealth therapy and want to learn more about how an integrative, process-based approach might support your goals, I welcome the opportunity to speak with you. Schedule a free 15-minute consultation by emailing rachael.stclaire@hush.com or visit the Appointments page to learn more about getting started.