About

Outpatient psychotherapy can be quite effective (Laska et al., 2014). At Pivot Behavioral Health (PBH), we use various cognitive behavioral therapies (CBT; Hofmann et al., 2012), which focus on a common set of cognitive, behavioral, and emotional processes that keep people stuck and that can foster change. Central to CBT is a personalized case formulation—a structured understanding of how specific thoughts, feelings, actions, and attention interact to maintain a person’s difficulties. For example, procrastinating to avoid obligations may temporarily reduce anxiety, but it can also lead to poorer work performance and increased worry, ultimately reinforcing the anxiety. The focus is on the immediate situations and responses that create and sustain psychological disorders.

CBT emphasizes immediate situations and responses that sustain psychological challenges, offering practical steps to break these patterns. For example, exposure techniques can help reduce the link between feared situations, fear, and avoidant behaviors. These steps can produce measurable changes, allowing the therapist and client to track progress and adjust treatment if needed. This makes CBT an individualized and iterative process. A trained CBT therapist will not only assess which processes are most relevant for you, they will also remain flexible, updating the treatment plan as new data emerges—which is known as a “working case formulation” (Persons, 2012).

“Skills are difficult at first, they get easier over time, but you’re never done practicing.”

The various forms of CBT as well as the integration of known processes of change is highly effective (Hofmann et al., 2012; Hayes & Hofmann, 2018). CBT is considered a "gold-standard" treatment for many psychological disorders, including those treated at PBH (David et al., 2018). Many research studies support it's effectiveness (Hofmann et al., 2012), including when tailored to meet the particular needs of the individual and modified based on ongoing data collection (Schaeuffele et al., 2021). However, CBT isn’t guaranteed and there are a lot of factors that impact how successful someone may be, for example, how many sessions you have, how much effort you put into change, how supportive your environment is, etc.

Guided self-help (GSH) is a structured approach to making change by working through a self-help program of cognitive behavioral therapy (CBT) with some extra support. Unlike traditional self-help, you’re not on your own–a trained therapist provides accountability, helps clarify the material, and assists in overcoming obstacles through check-in appointments. The frequency and duration of these appointments are less than what you will find in traditional face-to-face CBT. Most people find that six appointments with a therapist are enough to get the most out of GSH (Delgadillo et al., 2014; Donker et al., 2013), though some may benefit from a few extra sessions (Zachariae et al., 2016). To get the most out of your check-in appointments, it’s helpful to come prepared with any comments, questions, or concerns you have along the way.

Yes, GSH is well-supported by research. Studies show it’s more effective than traditional self-help for reducing depression, anxiety, insomnia, and binge eating, and it is comparable to CBT delivered in a traditional format. This is especially true when guided support is provided one-on-one by a trained therapist (Cuijpers et al., 2010; Cuijpers et al., 2019; Jensen et al., 2020; Karyotaki et al., 2015; Linardon et al., 2018; Melisse et al., 2023; Richards & Richardson, 2012; Zachariae et al., 2016). This effectiveness likely comes from including CBT’s core elements–cognitive, behavioral, and emotional skills—as well as the benefit of therapeutic support (Watkins et al., 2023; Ebert et al., 2018). However, since it is considered a lower intensity level of care, you may not benefit and may need more attention.

Peer support is when those with shared problems and intentions help one another out by sharing personal experiences and offering up suggestions based on what has worked for them. It can be delivered in a group or one-on-one setting. In groups, those that lead the group may have a particular health system title, e.g., registered nurse, health couch, but this is not always the case. Peer support interactions focus on assisting daily management of health behaviors, social and emotional support, and other forms of ongoing support. It can be a standalone service or service tacked on to traditional forms of psychotherapy.

Peer support can be helpful for some. It can increase feelings of connection and empowerment among those with psychological disorders, but not necessarily improve symptoms (White et al., 2020). The strength of peer support appears to be in improving health related behaviors, especiallly among those who don't have access to support (Sokol & Fisher, 2016). For these reasons, the peer support group offered at Pivot Behavioral Health, isn't intended to be a mental or behavioral health intervention, but a place to find advice, encouragement, and accountability for changing unproductive habits and developing productive habits, which could prevent the development of future problems (Grilo & Jaurascio, 2023; Moss et al., 2014).

Stepped-care is a model for delivering mental and behavioral health treatment (Richards et al., 2012). It emphasizes providing services based on a person’s level of need. For instance, some people don’t need to see a therapist at all. Their problems may naturally go away or they may just need some education about what habits to change and how. Peer support groups that focus on developing health habits, for instance, could be considered a preventative measure. When serious problems develop and don't remit, some may need to see a therapist once or twice, while others may need weekly therapy appointments. Fewer need more intensive care, like an intensive outpatient program or inpatient hospitalization. Guided self-help could be most helpful for those who have some problems, but only seldom need to see a therapist. If more care is needed, people are “stepped-up” to higher, more intensive levels of care, such as outpatient psychotherapy.

Determining who might benefit most different levels of care isn’t straightforward. For example, initial symptom severity doesn’t appear to be a reliable predictor of outcomes, as even those with moderate to severe symptoms can benefit from guided-self-help (Ebert et al., 2018; Loeb et al., 2000; Nordgreen et al., 2012). Similarly, individuals with moderate to severe symptoms can show rapid improvement with traditional psychotherapy as well (Lutz et al., 2009). A person’s preference for guided self-help (GSH) is one predictor of success with some evidence, but more research is needed (Ebert et al., 2018; Wade et al., 2019).

The COM-B model of behavior change (Michie et al., 2011) offers one way to consider who might thrive in a GSH program versus outpatient psychotherapy. This model suggests that behavior change relies on a person’s capacity, opportunity, and motivation for change. Based on this, individuals who (1) have a history of successfully making difficult changes with minimal support from healthcare providers, (2) possess the time and energy to invest in making changes, and (3) are genuinely motivated to change may be well-suited for GSH. However, further research is needed to understand which factors best indicate who could benefit from different care levels.

A lot of co-occurring problems can hinder one's capacity for change and may suggest a higher level of care. For instance, someone with chronic pain, depression, trauma, insomnia, and interpersonal conflicts don’t respond as well to briefer forms of cognitive behavioral therapy (Leichsenring & Rabung, 2011), and hence may have a harder time engaging in GSH. They may need longer forms of therapy, in which a strong therapeutic alliance can be formed and multiple treatment techniques used (Leichsenring & Rabung, 2011; Schaeuffele et al., 2021). We will assess how many co-occurring problems you have at your intake appointment and determine if you need a higher level of care.

It is common to have multiple problems. A standard way of approaching this is to start with one problem and then go from there. You can start with the one that is most central, which means it is at the core of all your other problems or it influences your other problems to a large degree. You can also start with the one that has the greatest impact on your life. For instance, we know from research that treatment for insomnia not only reduces insomnia, but also reduces depression among those with co-occurring depression and insomnia (Cunningham & Shapiro, 2018). Any additional problems can then be treated with additional therapies. Your willingness to work on one problem or the other is also a factor to consider. You and your therapist can work collaboratively to decide what to do first.

In a lot of ways yes, with some added benefits. Cognitive behavioral therapies delivered over a video conferencing platform can be just as effective at reducing depression, anxiety, insomnia, and binge eating than face-to-face therapy in all kinds of treatment contexts (Giovanetti et al., 2022; Lalor et al., 2023; Levinson et al., 2021; Scott et al., 2023; Wangelin et al., 2016). Telehealth can also be more practical for people as it doesn't require driving to a therapist’s office, thereby saving you time and money (Wangelin et al., 2016). A couple downside are that there are fewer non-verbal cues for you and your therapist to detect and some exercises may be difficult to practice over telehealth. We will be offering services via telehealth in the near future.

Cognitive Behavioral Therapy (CBT) was originally designed and tested with “WEIRD” populations—Western, Educated, Industrialized, Rich, and Democratic societies (Terjesen et al., 2022)—and reflects cultural values such as individualism and self-determination. As a result, in its traditional form, it may not fully resonate with individuals from different cultural backgrounds (Naeem et al., 2019). CBT is now embracing a broader range of evidence-based change processes, drawing inspiration from Eastern traditions, becoming more flexible in accommodating diverse values, such as respecting interdependence, and focusing on the contextual and functional roots of psychological distress (Hayes et al., 1999; Hayes & Hofmann, 2017). Still, cultural adaptations have proven especially effective (Naeem et al., 2023; Terjesen & Doyle, 2023). These adaptations preserve the core principles of CBT while adjusting its delivery to include culturally relevant metaphors, relatable examples, or even the involvement of family members in treatment (Naeem et al., 2023). Although research on culturally adapted guided self-help CBT is still in its early stages, preliminary findings are promising (Cashelin et al., 2014; Lee & Williams, 2017; Shehadeh et al., 2016; Tol et al., 2018).

With thoughtful adaptation, these services can be helpful. With respect to outpatient psychotherapy, our therapists are trained in culturally-competent care and will work collaboratively with you to develop an individualized treatment plan that fits your needs within your specific context. Some prefer to utilize different forms of support. You’re welcome to involve your own support system to help you make change—even inviting them to join your appointments.

For guided self-help, the workbooks we use here were authored by individuals from majority groups and may not fully address the unique challenges faced by ethnic, gender, and sexual minorities, such as discrimination, inequality, and marginalization. While this is a limitation, the workbooks are designed to flexibly target psychological processes that maintain depression, anxiety, insomnia, and binge eating, allowing you to adapt the activities to reflect your lived experiences and personal goals and values.

Finally, peer support group theoretically can include people from various backgrounds, but this may not always be the case. We do encourage people to be patient and respectful of others and speak from their own personal experience versus trying to preach a particular way of living. If this is suitable for you, give it a try.

For peer support group, no. For guided self-help and outpatient psychotherapy, yes. Services will initially be provided in Illinois only. In the near future, services will be provided within PSYPACT states and territories—42 in total. When that happens, if you live in any of the following states or territories, you will not be able to receive services at Pivot Behavioral Health:

• Alaska
• American Samoa
• California
• Guam
• Iowa
• Hawaii
• Louisiana
• Massachusetts
• Montana
• New Mexico
• New York
• Oregon
• Puerto Rico
• U.S. Virgin Islands

If you live in any other state or territory, you can be treated at Pivot Behavioral Health.

We don't currently take insurance, but we will in Illinois in the future. Good news, however, peer support group meetings are free and we offer reduced rates for guided self-help and outpatient psychotherapy appointments. You don't have to commit to a set number of appointments so you can utilize our services when you need and can. Appointments are either 25 or 50 minutes long, with 25 minute appointments being half the price. We hope you will find this to be equitable and flexible.

Cost of services are based on market rates from similar practices. The cost of an initial intake evaluation is $250, while the cost of a 50-minute appointment is $140 and a 25-minute appointment is $70. However, we may be able to reduce these rates depending on your income. We offer a sliding scale fee structure, which is based on your household income divided by the number of people, including you, in your household. This will generate your “sliding scale income.” We may ask for proof of household income and dependents and this information may impact your final estimate.

Income Range	Intake Appt	50-Minute Appt	25-Minute Appt
$200,000 or greater	$250	$140	$70
$199,999 - $150,000	$200	$120	$60
$149,999 - $100.000	$150	$100	$50
$99,999 - $75,000	$100	$80	$40
$74,999 - $50,000	$75	$60	$30
$49,999 - $25,000	$50	$40	$20
Less than $25,000	$25	$20	$10

We unfortunately cannot sustain a practice if too many clients are paying lower amount. So, Dr. Emerson Epstein may negotiate a price with you that works for both parties.

We are not quite enrolling new clients. We plan to roll out a pilot program in the near future. This pilot program will help us work out any bugs and start to evaluate our services. Our pilot program will be at a reduce rate for a limited time. Add your contact information here to get notified of our start date.

Appointments are currently only face-to-face in my office. You can get there a few different ways. If you are arriving from a car, there is on-street parking available. Make note of the street signs. Some areas you will need to pay for and others you can park for free. Directions from public transit are below:

• From the Red, Brown, or Purple Lines – Exit the Belmont station and walk east on Belmont Ave toward the lake. Turn right on Halsted St, then turn left on Briar Pl. Walk for a couple minutes. The office will be on your right. Look for “Briar Office Suites” and use the intercom to get buzzed in.
• From the #22 Bus – Exit at the Clark & Barry/Halsted stop. Walk north on Halsted St, then turn right on Briar Pl. Walk for a couple minutes. The office will be on your right. Look for “Briar Office Suites” and use the intercom to get buzzed in.
• From the #8 Bus – Exit at Halsted & Clark/Barry stop. Walk north on Halsted St, then turn right on Briar Pl. Walk for a couple minutes. The office will be on your right. Look for “Briar Office Suites” and use the intercom to get buzzed in.
• From the #36 Bus – Exit at Broadway & Barry stop. Walk north on Belmont Ave, then turn left on Briar Pl. The office will be on your left. Look for “Briar Office Suites” and use the intercom to get buzzed in.