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Featured Therapist Interview
Joel Guarna, PhD is a psychologist licensed in the state of Maine. He earned his PhD from Bowling Green State University in 2000 and completed pre- and postdoctoral training at the Boston Consortium in Clinical Psychology. Dr. Guarna later served as a staff psychologist in the Department of Veterans Affairs Healthcare System in Boston, where he provided individual, couples, and group treatment to veterans with mood and anxiety disorders, trauma and PTSD, and substance abuse and dependence. He ran an intensive outpatient program for veterans with addictions.
He provided training and supervision to psychologists-in-training and psychiatry residents as a Clinical Instructor of Psychology in the Department of Psychiatry at Harvard Medical School. Dr. Guarna has been in private practice since 2005 and currently operates his independent practice in Portland, Maine.
First, we would like to know a little about your practice.
When did you begin your practice?
I initially joined a group practice in Dover, New Hampshire, and worked there for a year and a half. I started my own practice, White Pine Behavioral Health, in Portland, Maine, in 2006.
Do you have a specialty?
Historically, my specialty has been addictive behaviors, and that remains an important component of my practice. Since moving into private practice, I have become more of a generalist, treating trauma, anxiety and mood disorders, doing a lot of health psychology and behavioral medicine work. The other major draw to my practice is the forms of therapy I do: CBT, generally, and Acceptance and Commitment Therapy (ACT), in particular.
How important are board certifications and/or credentialing programs to your practice?
Overall, I would say that they are not very important. However, I do maintain an APA College Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders and recently completed the Certificate Program in Primary Care Behavioral Health through UMass Medical School.
What are your personal strengths as a practitioner?
I am curious, an incurable skeptic, and never satisfied with the status quo of what I (or we as mental health professionals) have to offer my clients. I enjoy humor in the therapy room and do not take myself too seriously. There are many absurd moments in therapy and I am not shy about laughing about them with my clients. I like to think I am quite empathetic and compassionate and able to work with difficult client issues without being judgmental. I think this lattermost quality is particularly important for addictions work. I do not work from a medical or pathologizing model, and I believe, and have been told, that clients appreciate this.
What is one method you use to promote your practice?
My website, www.whitepinehealth.com, and online advertising are major sources of new clients. I include a lot of information about my practice on my website so clients generally have a good idea of what to expect from me before they schedule with me. As a consequence of this, most of the new clients who actually show up at my door have already self-selected and tend to fit well with my practice. Many of my clients are self-referred in this way, though, increasingly, new clients have come to me recommended by other therapists and by previous clients.
What “tips” can you offer to colleagues just opening a practice?
Be visible where today’s clients will see you: online. While you need to be mindful of the types of content you put out there, I think most therapists err on the side of providing too little information for fear of turning away clients. In my experience, this self-selection works in both your favor and your clients’ favor as it prevents wasting both your time and your clients’ time.
What self-help books do you suggest to your clients?
Russ Harris’ The Happiness Trap, other disorder-specific self-help books on Acceptance and Commitment Therapy (ACT), and The Mindful Way Through Depression by Williams, Kabat-Zinn, Segal, and Teasdale. The book I lend out most often is not self-help, per se, but Viktor Frankl’s Man’s Search for Meaning.
Are you involved in other types of professional activities in addition to your private practice?
I developed a training component to my practice called the White Pine Institute (www.whitepineinstitute.com) to create opportunities for me to provide professional trainings around New England. I am also active in the Maine Psychological Association and in various peer consultation groups in Maine.
Next, we are interested in your continuing education activities.
How do you stay current with new research or advances in the field as applied to your practice?
I subscribe to ABCT journals, the Behavior Therapist and Cognitive and Behavioral Practice, and to a few APA journals on addictions and health psychology. I am active in the professional community of ACT researchers and clinicians, the Association for Contextual Behavioral Science (ACBS) and attend ACBS conferences about every two years.
Where do you earn your continuing education credits?
Primarily through conference workshops at the Maine Psychological Association and the Association for Contextual Behavioral Science (ACBS). I am a bit overdue to attend the annual ABCT conference.
We would also like to know a little about you personally.
Who was your mentor?
Harold Rosenberg at Bowling Green State University was an amazing mentor to me. We have recently been co-reviewing a journal article submission and this interaction with him has reminded me how fortunate I was to have Harold to guide and support my professional development.
What is the last book you read?
I cannot answer with one book: I am either reading half a dozen or none at all. I recently finished Dan Carlat’s Unhinged: The Trouble with Psychiatry, and am reading Anatomy of an Epidemic by Robert Whitaker and Mindfulness for Two by Kelly Wilson. Outside of mental health, I am in the middle of The Greatest Show on Earth by Richard Dawkins, Thirteen Things That Don’t Make Sense by Michael Brooks, and Hitch-22, the memoir by Christopher Hitchens.
How do you avoid burnout?
For me, preventing burnout has three fronts: Ensuring that I have sufficient personal and professional support, practicing in a manner that works against burnout, and being plugged in to many interests outside work. I am active in several peer consultation groups: a large, multidisciplinary group called the ACT Peer Consultation Group in Portland, a telephone-based consultation group on evidence-based practice, and a more casual peer support group that meets monthly for breakfast. While I strongly advocate that my clients meditate, my “dirty secret” (no longer) is that my own meditation practice is very inconsistent. In truth, I believe that using mindfulness-based strategies in-session with my clients is a key part of my own practice. Done well, therapy can be a great model for mindful activity. Lastly, I do have many interests outside work (see next item).
When not practicing CBT, what do you do for fun?
I have a lot of interests outside work including running, hiking, fishing, reading, time with friends and family (especially my wife and young daughter), local music, arts and food, following the Red Sox, and exploring Maine.
We are also interested in some of your views of CBT.
What do you think is the single most important thing CBT can do for your clients?
It shifts the focus from clients’ histories and unworkable “stories” about their life problems to patterns in their thinking and behavior that “show up” in the present. Here-now is the only place they can do meaningful work and, as a system, CBT is explicit about working here-now. CBT helps clients make this shift in a bolder and more workable way.
Where do you see the field of cognitive and behavioral therapies going over the next 3-5 years?
I have been very excited to see the spread of behavioral therapies like ACT, Dialectical Behavior Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT), and Functional Analytic Psychotherapy (FAP) and a renewed emphasis on applying basic behavioral principles in innovative ways. I think metacognitive strategies have much to offer many patient groups. I imagine these trends continuing and even broadening as the general public and other healthcare professionals gain an increased appreciation for the potential role for psychologists, especially cognitive-behavioral psychologists, in primary care and other healthcare settings.
Finally, we would like to know your opinions about ABCT.
How long have you been a member of ABCT?
I have been an ABCT member since graduate school, coming up on 12 years.
How has ABCT helped you professionally?
I attended ABCT conferences and trainings early in my professional development and my experiences there solidified my identity as a CBT therapist, influencing my career trajectory ever since.
What services do you consider the most valuable from ABCT?
I most appreciate the journals, the find-a-therapist online tool, information and fact sheets for clients, and knowing that I can attend the annual conference for a quick infusion of evidence-based information and training.
How do you see the future of ABCT?
I hope that ABCT can increasingly become active in advocacy for CBT therapists and education about CBT to healthcare systems and to the general public. Professional journals and lists of evidence-based practice will never be viewed as widely as any one pharmaceutical advertisement. There is much work to be done to counter the unfortunate economics of this.