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Convention 2019

Meet Angela Klein and Nehjla Mashal

Angela Klein

Featured Therapist Interview

Angela Klein Angela Klein, Ph.D., earned her doctorate in clinical psychology from the University of Missouri, Columbia, in 2009. Prior to this she began her study of eating disorders and psychology through the honors program at Kent State University, completing her B.A., with a minor in women's studies, as valedictorian, in 2002. As both a researcher and practitioner, Dr. Klein has extensive experience delivering and conducting treatment trials emphasizing effectiveness in the real world, including her development and investigation of the mindful eating program presented in her book "Mindful Eating from the Dialectical Perspective: Research and Application." She began specializing in dialectical behavior therapy (DBT) in 2004. She also now practices radically open (RO) DBT, becoming one of the first intensively trained RO therapists in the U.S. in 2015. Her evidence-based approach incorporates CBT, including exposure therapy. She has multiple journal publications in the field of eating disorders and has presented both nationally and internationally. She founded and directs her private practice, Centered Ground, providing individual therapy, family therapy, group skills training classes, and coaching support to adolescents and adults, as well as preteens, in the greater San Diego area, with her main office in Carlsbad, offering her expertise in DBT, RO, and mindful eating from the dialectical perspective. With her DBT and mindfulness specialties, she focuses on comorbid presentations, including emotion dysregulation, self-harm, suicidality, mood and anxiety disorders, and personality disorders (borderline; avoidant; obsessive compulsive), as well as disordered eating, eating disorders, and body image. You can find more about her practice at

First, we would like to know a little about your practice.

What are your personal strengths as a practitioner?

Perseverance is definitely one of my main personal strengths as a practitioner, relentlessly persisting through complicated comorbid pathology. Likewise, I am extremely committed to my clients and passionate about my practice, embodying what I teach: dialectical living, finding balance between extremes, and embracing discomfort, not just habituating to it through exposure but also seeking it out for the sake of learning. As a DBT therapist, I have essentially been on call 24/7 for the past 15 years, while also pursuing my own adventures outside of the office, modeling how to live bravely, overcoming.

What "tips" can you offer to colleagues just opening a practice?

Perhaps this goes without saying with this audience, but I would definitely recommend specializing and emphasizing empirically based treatment. In this era of self-help gurus and social media influencers, let alone all the diversity in academic degrees and training, the public gravitates towards what stands out above the crowd. Often this is not necessarily what is effective-and yet, clearly offering expertise in what is supported by evidence will draw clients.

I would also say that you have to absolutely love this work and be able to balance sensitivity with the fortitude to bear the emotional and mental toll of this vocation. Depending on your clientele, hour after hour, day after day, year after year, you will be faced with the darkest accounts of human experience and despair, sometimes truly terrifying, and need to greet each one with full presence and exactitude, even if a session nearly knocks you off your feet, even if there are multiple crises in the background.

I would also recommend starting small, then growing. For example, I first rented a small room without air conditioning in a quirky shared space along the coast here in Southern California, conducting both groups and individual sessions in the room. I will forever hold dear those clients, their good-natured spirit and gratitude, sweating and squeezing together as if in a clown car! And then I added a second larger room for groups. Then I held groups in a larger, separate space. Then I expanded to my current beautiful, modern new location. The clients could see the value through this journey, and it is such a gift to be able to provide them the current setting, designed specifically for my practice.

How do you remind your patients of their strengths during the therapy process?

Before solution analysis, I reinforce skillful behavior and insights. I also balance validation of their experience with reframing to acknowledge their more positive attributes.

Are you involved in other types of professional activities in addition to your private practice?

In addition to my practice I remain active professionally through presenting and writing, with aspirations of further book projects and research.

We would also like to know a little about you personally.

Who was your mentor?

I have been fortunate to have many mentors. I completed my Masters under the mentorship of Anna Bardone-Cone, examining the differential influence of perfectionism, self-efficacy, and stress in various domains on restrictive versus bulimic behaviors. Informing my treatment trials with her expertise in effectiveness, my dissertation mentor was Kristin Hawley, along with integral clinical supervision from Jeremy Skinner. I also completed my latent transition analysis projects in the lab of Kenneth Sher. On internship at the University of South Carolina Counseling and Human Development Center, I received invaluable mentorship from Pete Liggett, as well as Rhea Merck and Russell Haber. My postdoctoral mentor, on her randomized trial of emotion regulation group therapy, was Kim Gratz, with clinical supervision from Matthew Tull, at the University of Mississippi Medical Center. Most recently I can thank Thomas Lynch for my training in radically open DBT.

When not practicing CBT, what do you do for fun?

I love enjoying the beach, travel adventures, cuisine, and the arts. My recent trips include hiking in Ireland and the Camino de Santiago, sailing in Greece, and traversing museums in Paris. At home I especially appreciate the sand and waves with my morning runs before sessions and ocean sunsets as I end my clinical weeks. In my spare moments I also write poetry and play my baby grand piano.

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?

That is a great question. I would say resilience: the ability to realize and choose empowerment over suffering, to face whatever painful experience we encounter without succumbing, to ultimately find our way to balance and joy no matter our circumstances.

How do you use the local or social media to educate your community on the benefits of CBT?

I maintain an Instagram account curated from my life and practice, along with my writing, to demonstrate and share CBT and, in particular, DBT concepts, including mindful eating, mindfulness in general, dialectics, radical openness, and exposure therapy. Perhaps in a way I am thus offering both education and my own journey as a case study, capturing the benefits of CBT in action in a compelling and accessible way. You can follow me: @dr.angela_klein .

Finally, we would like to know your opinions about ABCT.

How long have you been a member of ABCT?

I began attending ABCT as a postdoc in 2009; I remained active and became a member following this.

How has ABCT helped you professionally?

ABCT has allowed me to remain connected to the research community that is my ongoing commitment and background, even as I have moved beyond academia, more primarily into the clinical world.

What services do you consider the most valuable from ABCT?

The annual conference is invigorating and enriching with its energy and gathering of cutting-edge research to enliven practice upon returning to the therapy room.

What service(s) are missing from ABCT in your role as a practitioner?

Tangible research support for the private practice setting seems lacking. This includes adequate time at conferences for practitioners to connect with researchers in meaningful and lasting ways to establish the seminal and necessary groundwork for truly bringing collaborations to fruition. More intentional space for this and even funding resources could exponentially increase the yield of such potentially powerful collaborations. I would absolutely love to maintain an ongoing research program in my practice, and ABCT seems exceptionally poised to contribute to this endeavor for those practices like my own especially, the culmination of rigorous research training in behavioral and cognitive therapy.

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Nehjla Mashal

Featured Therapist Interview

Nehjla Mashal 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, 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.


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