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Featured Therapist Interview
Dr. Nehjla Mashal, Ph.D., is a licensed psychologist providing evidenced-based individual psychotherapy for adults and teens in San Francisco at Pacific Anxiety Group. Her areas of expertise include the treatment of anxiety disorders, such as Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder; and depressive disorders, such as Major Depressive Disorder and Persistent Depressive Disorder. She is also interested in assertiveness and effective communication strategies, diversity and intersectionality, and the relationship between anxiety and interpersonal functioning.
Dr. Mashal received her B.A. in Psychology from UCLA and her Ph.D. in Clinical Psychology from Northwestern University. She has served as a study therapist on a randomized controlled trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder and a pilot study of problem-solving therapy (PST) for anxiety disorders. Dr. Mashal had a dual appointment as a postdoctoral fellow at the Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC) at VA Palo Alto Health Care System and at Stanford University School of Medicine in the Department of Psychiatry and Behavioral Sciences.
Dr. Mashal has extensive training in CBT, PST, Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Cognitive Processing Therapy (CPT), Exposure and Response Prevention (ERP), and applied tension and exposure for blood-injection-injury (BII) phobia. Dr. Mashal provides clinical supervision to trainees and engages in diversity and inclusion work. She also writes for her online lifestyle magazine, moxieandcandor.com. Moxie & Candor’s mission is to provide content that empowers us to take better care of ourselves, lead more value-driven lives, and advocate for ourselves more effectively.
What are your personal strengths as a practitioner?
It is an honor to be invited into someone’s life to help them with what pains them or what they cherish most. I have a direct and collaborative style and treat each client with warmth and respect. For me, that makes room for the playfulness and curiosity good psychotherapy requires. You hear a lot of shared laughter in my sessions. With very few exceptions, I work within a short-term model; think months, not years. This brings a sense of urgency to my work. I want to help my clients make meaningful changes in their lives. Everyone who comes to see me wants to feel better. I am always thinking about what interventions would help change this person’s life outside the therapy room.
I think it’s our obligation to stay up on the treatment outcome literature. I do that through some involvement in research, reading journal articles, and attending intensive trainings regularly. In addition, I participate in three consultation groups that meet with varying frequencies. These spaces stretch my clinical skills and provide an opportunity to beta-test new mindfulness techniques or metaphors I develop. I enjoy that our field always has new things to offer, both practically and theoretically. Information rapidly proliferates in our field now, and new therapies have gained empirical support. The changing nature of our field means that there will always be opportunities for professional growth, and that feels like an exciting privilege to have in a profession.
How do you remind your patients of their strengths during the therapy process?
I am inspired and energized by the strength, resiliency, and capacity for change I see in my clients. By the time someone gets to my office, they have usually already weathered a great deal and have adapted to their circumstances in often useful but sometimes unhelpful ways. People are insightful and are the architects of their change. As psychotherapists, it is our job to help galvanize them and provide specific change strategies that empower them to move towards what they care about. I believe that behavioral change is where the “rubber meets the road” in terms of meaningful gains in treatment. Every other intervention I employ is really in the service of helping people move through the world in ways they can feel proud of and contented with. At the same time, people are so much more than a collection of dreams and longings and hurts and disappointments. When people can get in touch with that, possibilities open up.
Are you involved in other types of professional activities in addition to your private practice?
I develop and give workshops on topics related to psychotherapy. I just gave a short continuing education workshop on PST; and am currently developing a 4-hour workshop on Intersectional Case Conceptualization. I have a demonstrated commitment to increasing diversity in my field as well as championing the notion that cultural competency is a sine qua non for clinical competency. I am a biracial (my father is from Jordan and my mother is from Puerto Rico), first generation college student, and have often felt out of place in our field because of it. As a result, I think deeply about intersectionality and perspective-taking in my work. I have a personal interest in and commitment to mentoring future providers, particularly those from underrepresented backgrounds.
Helping others develop professionally and grow clinically is one of the greatest joys of my career. I supervise trainees in the delivery of evidence-based psychotherapy. In vivo, experiential, and teach-back techniques (e.g. role-plays, small group exercises) enhance supervision and deepen learning. I also believe in structured assessments of clinical performance, such as the Cognitive Therapy Rating Scale (CTRS; Young & Beck, 1980), as a way to reduce bias in evaluation and set trainees up for success by having them know a priori exactly what is expected of them. I view evaluation as an on-going transparent bidirectional conversation that occurs throughout the training year to foster self-reflection. I find this conversation personally and professionally enriching for me as well. I also sometimes author articles in the field of treatment outcome research. Lastly, I write posts on my website, Moxie & Candor. Moxie and Candor is for everyone who wants to become more fully realized versions of themselves. We provide evidence-based strategies, opinion pieces based on lived experiences, and interviews that bring us closer to living our lives in ways we are proud of.
Who was your mentor?
I worked with Richard Zinbarg at Northwestern University. My first clinical supervision experience with Rick involved him reviewing video of me delivering his CBT for GAD protocol. Early on, he would write out transcripts of me doing therapy and provide detailed feedback, all in the service of bettering my skills. Needless to say, I got good at the protocol pretty quickly! I never got that same gift again at any point in my training. but that experience shaped how open I am to giving and receiving feedback. His sense of curiosity and commitment to growth have stuck with me and still inform the way I practice and supervise today.
When not practicing CBT, what do you do for fun?
I love polyrhythmic music, talking with people I don’t know yet, cooking, interactive art, and reading sci-fi-fantasy. Some of my favorite authors include N.K. Jemisin, Philip K. Dick, and Neil Gaiman.
What do you think is the single most important thing CBT can do for your clients?
CBT can help people get more vibrantly engaged in their lives. At its most transformative, I get to watch someone go from sleep-walking through life to actually living it.
Where do you see the field of the behavioral therapies going over the next 3-5 years?
I think more and more we will continue to shift toward conceptualizations of treatment acting on processes (e.g. avoidance, repetitive negative thinking, emotion dysregulation) rather than specific presenting problems.
What services do you consider the most valuable from ABCT?
ABCT offers a number of resources that help me keep up with the treatment outcome literature. The conferences are enjoyable and provide valuable information and networking opportunities.
Thank you very much for taking the time to answer our questions!