Show Notes
Dr. Michael Stein is a cognitive behavioral therapist who specializes in exposure therapy for anxiety disorders. In this interview, he talks about building a busy private practice in Denver, Colorado. Dr. Stein explains the modality of exposure therapy, which he says is not well understood in the wider therapeutic community.
Interview Highlights
[3:00] Michael explains how he came to psychology. He worked for a peer-counseling program while in college, which led him to study clinical psychology. He’s always been interested in human behavior.
[4:17] Michael talks about his introduction to behavior therapy and exposure therapy in particular. He has a lot of confidence in exposure therapy, finding it very effective for treating patients.
[6:25] Here Michael explains the philosophy behind exposure therapy. It’s logically based, which appeals to Michael’s scientific mind.
[7:26] Michael talks about his practice, which focuses on anxiety disorders, especially OCD.
[8:01] Exposure therapy is based on the idea that anxiety is maintained in the long term by what you do to avoid it in the short term. Exposure therapy makes a patient confront the anxiety, in a series of sessions. The first sessions are diagnostic, looking for avoidance behaviors. Michael designs exposures to fit the patient’s avoidance behavior, with specific instructions for practice and implementation. Typically this kind of therapy takes 10-15 sessions to be effective.
[10:25] Michael speaks about the most extreme anxiety cases, which can take 20 sessions to address. More extreme cases have a wider breath and depth of anxiety disorder.
[11:27] Michael sets behavioral goals for his clients. Once they meet the goals with little or no anxiety, exposure therapy ends.
[12:00] Home visits and sessions outside of the office are common with a majority of Michael’s clients. Social anxiety is a common theme. To work with this phobia, he takes clients to the mall or downtown Denver, to involve people (besides him) in the exposure.
[13:42] Michael speaks to the criticism around exposure therapy, which is mainly that it re-traumatizes patients. He doesn’t treat PTSD cases, or many cases around trauma. He says a trauma involves an unconditional stimulus, when something is actually harmful. Remembering the trauma is a conditioned stimulus. You can’t do exposure therapy for unconditioned stimulus, but you can do it for conditional stimulus—the memory of the trauma. That’s what he works with.
[16:58] Michael says his personal experience with clients shows that exposure therapy has been a successful modality.
[18:52] Michael talks about recurring clients, who return after the exposure therapy course has ended. OCD, panic disorder, and general anxiety patients return sometimes, especially when they didn’t complete the first therapy.
[20:26] Here Michael talks more about the criticism around exposure therapy. A misunderstanding of the actual work involved is part of it. Also, exposure therapy feels painful in the short term—this turns off some therapists.
[23:17] Michael says a good therapeutic relationship is a pre-requisite to exposure therapy. In other types of treatment, it’s seen as the treatment.
[24:29] Michael has a private group practice, only seeing individual clients. Two other psychologists besides Michael and two masters students make up the staff.
[26:05] When he started his practice, Michael shared space with another therapist in a windowless office. He built up a website that didn’t take off. Word of mouth was more helpful at first. He credits Juliet’s help in building a new website for increasing his Internet presence and business visibility.
[30:04] The majority of Michael’s clients have already been diagnosed before they come to him. 80-90% of his new patients have gone through other therapy that didn’t work.
[31:18] Michael says 30% of his clients are aware of exposure therapy methods before contacting his practice. The rest of the clients are desperate and unconcerned with methodology.
[33:30] Michael sees 22-23 patients a week. The practice in total sees 70-90 people a week.
[34:11] Michael explains his business model. The other therapists take a percentage of the hourly rate. There’s a receptionist, Michael pays all the business expenses.
[35:00] Dissemination of exposure therapy is poor. Michael would like to open more branches in other areas and offer online classes.
[36:21] Michael says the degree of specialization of his practice is behind much of its success. They are also the first in their area market to have a strong website.
37: 55 Michael’s business advice for new therapists: find your niche.
Bio – Dr. Michael Stein – Denver, Colorado
I am a licensed clinical psychologist specializing in adults and teens with anxiety and OCD.
I love my work. I enjoy treating anxiety and OCD and chose to specialize in this area because therapy for anxiety disorders is very effective, and because I discovered I had a talent for it early on in my doctoral training. I find it to be a very personally rewarding specialty because the vast majority of people that I see for anxiety or OCD get dramatically better.
My core values as a therapist are effectiveness, integrity, and service. I got into clinical psychology because of this core value of service: It is important to me to have a career where I help people reduce their suffering and live fuller, more vital, more meaningful lives. As a therapist, I get to work towards this goal in unique, exciting, and personal ways.
I received my Bachelor’s Degree from Cornell University and my Master’s and Doctorate in Clinical Psychology from the University of Denver. I founded and have served as President of the International OCD Foundation’s Denver affiliate, OCD Greater Denver, and still serve on its Board of Directors.
I was trained as a behavioral therapist and am well-versed in Exposure Therapy and other forms of cognitive-behavioral therapy (CBT). I have experience treating anxiety disorders and OCD in community mental health centers, college counseling programs, outpatient clinics, an employee assistance program, and the University of Colorado Hospital’s Center for Integrative Medicine. I also enjoy teaching and training students and other mental health practitioners in the treatment of anxiety and OCD.
In my spare time, I am an avid skier, rock climber, and chess player. I have been skiing for 25 years and climbing for 20 years. Needless to say, I am in love with Colorado and plan to spend the rest of my life here. I am also (unfortunately for me) a die-hard New York Jets fan. I live with my wife, our son, and our adorable golden retriever named Carabiner. You can find out more about Michael at http://www.effectivetherapysolutions.com
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