Psychotherapy changes slowly, and that’s mostly a good thing. Evidence takes years to accumulate, and the field is generally careful about adopting anything without real research behind it. Most of the approaches that we use today have been extensively researched, which is why the field of psychology is so widely recognized as science.
Still, that doesn’t mean that therapy and mental health are not changing. There are trends – both good and bad – that take place within the mental health world. Some of these are positive – like modalities that can now be used on other conditions. Others are problematic – like mental health issues therapists now need to address, but previously did not have to worry about.
Let’s talk about a few of them.
EMDR Is Being Used for More Than Trauma
EMDR built its reputation treating PTSD, and that’s still its most established use. But research into EMDR for conditions that aren’t trauma-specific has grown substantially in recent years. A 2021 systematic review covering 90 studies found positive effects across a wide range of conditions beyond PTSD, including anxiety disorders, depression, phobias, OCD, and chronic pain, and Harvard Health has reported on more recent research extending into personality disorders as well.
The research for EMDR beyond trauma is still not considered fully established, since there hasn’t been enough time for the series of studies that many therapists prefer to use before integrating it into their practice. It is still described as emerging or preliminary in much of the literature, promising enough that clinicians are increasingly using it for anxiety, phobias, and mood disorders, but not yet at the same level of certainty as its original, trauma-focused use. Flourish Psychology’s EMDR work reflects that, applying it where the evidence and a client’s specific presentation supports it. Still, it is promising that this highly effective, already established approach to mental health may be able to have additional benefits.
Measurement-Based Care Is Becoming Standard Practice
For most of psychotherapy’s history, progress got tracked through clinical judgment and conversation alone. That’s shifting toward something more structured: measurement-based care, where standardized symptom scales get collected regularly throughout treatment and used to guide clinical decisions.
The evidence behind this is substantial. The American Psychological Association points to research showing consistent use of these measures improves patient outcomes, reduces dropout, and lowers the chance a patient’s symptoms worsen during treatment, compared to relying on clinical impression alone. The APA has been developing formal practice guidelines around it, and several state licensing boards now offer continuing education credit specifically for using it. It’s a genuinely evidence-driven shift, backed by real outcome data.
Telehealth Has Become a Permanent Part of Care, Not a Pandemic Workaround
Virtual therapy sessions started as a necessity during COVID-19 and never fully receded once in-person options returned. Mental health now leads every other medical specialty in telehealth use, and recent industry data shows mental health services made up 58% of all telehealth visits as of the most recent published figures, with states extending telehealth reimbursement well into 2026.
Research backs up why it stuck around. What actually drives change in therapy is the relationship between client and therapist and the clinician’s own skill. Flourish Psychology offers online therapy throughout New York State for exactly that reason, alongside in-person sessions at the Brooklyn Heights office.
Clients Are Bringing AI Into the Therapy Relationship
A 2026 APA survey of more than 1,200 psychologists found that 77% now have clients using AI chatbots for mental health support, self-diagnosis, or as a kind of companion, often alongside their actual therapy. The survey also found widespread concern among clinicians about the risks this creates: dependency on a tool with no clinical training that is programmed to sycophantic and isn’t truly capable of in depth thinking. This has led to situations where distorted thinking is reinforced rather than challenged, among many other issues.
This is a trend therapists are increasingly having to navigate directly, asking clients how they’re using these tools, or helping a client understand the difference between a chatbot’s response and a trained clinician’s judgment. Expect this conversation to become a more explicit part of therapy itself, rather than something happening quietly in the background.
Somatic and Body-Based Approaches Are Gaining Research Support
Body-based therapies, approaches that work with physical sensation and nervous system regulation rather than starting with thoughts or conversation, have existed for decades but stayed on the margins of mainstream clinical psychology for much of that time. That’s changing as more controlled research accumulates behind them, particularly for approaches like Somatic Experiencing, where reviews have found meaningful reductions in trauma symptoms that hold up over time.
Flourish Psychology’s somatic therapy work reflects that same shift, often used alongside more traditional talk-based approaches as part of an integrated treatment plan.
These are only 5 of the many shifts that we’re seeing in the mental health world. At Flourish Psychology, what we care about most is evidence based care and you. When you need help, no matter what it is, reach out to our therapists and we’ll be here for you.
Intimacy – emotional and physical – is an important part of any relationship. When it’s missing, a relationship often struggles. Many people seek couples counseling because their relationship is struggling with intimacy, and in some of these situations, it can be very helpful.
Yet, for others, intimacy starts from within the individual. Two people can learn better communication skills together, but the capacity underneath those skills — the ability to feel safe being vulnerable, to trust, to stay present instead of shutting down — is something a person may have to understand and build on their own. For a lot of people working on relationship intimacy, that individual work turns out to be the more direct path.
Why the Work Sometimes Can’t Happen With a Partner in the Room
Couples counseling is built around the dynamic between two people, and for a lot of relationship problems, that’s exactly the right focus. But when a partner sits across from someone in session, the conversation naturally centers on what’s happening between them, not on the internal history either person is carrying into the room.
A person who shuts down under emotional pressure, or who has a hard time trusting even a partner who’s given them no reason not to, isn’t going to resolve that by discussing it with the partner present. That pattern usually has a source — something learned early, or carried over from a previous relationship — and understanding that source is easier to do without also managing a partner’s reaction to what’s being said in real time. Individual relationship counseling gives that examination room to happen.
The Role of Attachment with Intimacy
Attachment theory offers one of the clearest windows into why closeness can feel automatic for one person and genuinely difficult for another. The pattern of connection that developed in a person’s earliest relationships becomes a kind of template for what closeness requires and how safe it feels, and it keeps operating largely outside conscious awareness well into adulthood.
Someone with a more secure attachment style tends to experience intimacy as relatively comfortable, without much internal negotiation required. Someone whose early experience trained them to see closeness as unreliable often manages that uncertainty by seeking constant reassurance, in ways that can end up pushing a partner away rather than drawing them closer. Someone who learned that closeness comes with a cost, whether that meant losing independence or getting hurt, tends to create distance almost automatically, sometimes in relationships they genuinely want to stay in.
Most people don’t recognize their own pattern from the inside. A person who consistently pulls away when a partner gets close often experiences it simply as needing space, without registering that the pulling away is a protective habit rather than a neutral preference. Individual therapy is usually where that pattern becomes visible for the first time, which tends to be the necessary step before it can change.
Anxiety, Depression, and Trauma
Many times, a person’s individual psychological struggles can make intimacy much more difficult. Anxiety, depression, and unresolved trauma all have a direct line to how available a person can be in a relationship, and the connection is often more concrete than people expect.
Anxiety can show up as needing frequent reassurance, scanning a partner’s tone for signs of distance, or feeling too keyed up to be present during quiet, connected moments. It can cause people to feel less confident sexually, as well as resistant to taking risks.
Depression can flatten desire and initiative in ways that have nothing to do with how someone feels about their partner, and everything to do with how much energy is available on a given day.
Unresolved trauma can make physical or emotional closeness feel unsafe on a nervous-system level, even when a person’s rational mind knows the current relationship is nothing like whatever came before.
These conditions become part of the relationship’s operating conditions, whether or not anyone names them that way, and treating them individually often does more for a couple’s connection than any amount of relationship-focused work could on its own. Trauma-focused approaches like EMDR can be part of that work when trauma is what’s driving the pattern.
When a Reaction Is Bigger Than the Moment
A reaction that feels disproportionate to what actually happened is often a sign that something older is being triggered. For example, if a a partner arrives fifteen minutes late and it lands as evidence of not being a priority, or a request for space gets received as rejection.
Those reactions are almost always about something other than the moment it’s happening in. Someone who grew up in a household where emotional expression wasn’t safe may find vulnerability difficult well into adulthood, independent of how safe their current partner actually is. Someone who experienced betrayal or abandonment in an earlier relationship can carry a level of hypervigilance into a new one that the new partner didn’t earn and can’t undo through reassurance alone, no matter how much they mean it.
Individual therapy traces reactions like these back to where they started, not to assign blame, but to understand why certain situations trigger a response that’s bigger than the situation itself. Once that connection is visible, the pattern becomes something a person can work with instead of something that just happens to them.
Learning to Recognize and Share What You Actually Feel
A lot of what makes intimacy difficult comes down to two connected skills: knowing what you’re actually feeling, and being able to let a partner see it. Neither one is automatic. Most people were never taught to identify their own emotional experience with much precision, and plenty of people learned early on that the safest thing to do with difficult feelings was to manage them privately rather than share them.
That shows up in relationships as a gap between what a person feels and what they’re able to express, or between what they need and what they actually ask for. A partner can be willing and attentive and still miss what’s needed if the person who needs it can’t name it clearly. Emotional unavailability works the same way — it’s rarely a lack of care, and much more often a defensive habit that developed to manage pain earlier in life, one that stayed in place long after the original threat was gone.
Individual therapy builds both halves of this directly. Naming internal experience with more precision, and then risking being seen with it, are skills that develop through consistent practice with a therapist before they show up naturally in a relationship. As that capacity grows on one side of a relationship, the whole dynamic tends to shift, sometimes prompting change in a partner who never set foot in a therapy office.
Signs the Pattern Belongs to You, Not the Relationship
Recurring conflict can point to something between two people, or to something one person is carrying individually, and a few patterns tend to signal the second case specifically:
The Same Conflict Across Different Partners — A dynamic that’s shown up in more than one relationship, with different partners, usually says more about the common denominator than about any particular relationship.
A Reaction That Feels Bigger Than the Moment — Intense fear, anger, or shutdown in response to something relatively minor often signals an older wound getting triggered.
Wanting Closeness and Pulling Away From It at the Same Time — Genuinely wanting a relationship to work while also resisting the closeness that would make it work is a common sign of an attachment pattern at play.
Difficulty Naming What You Feel or Need — Struggling to identify or express an internal experience, even in a relationship that feels safe, points to a skill gap that predates this particular partner.
That list points toward where some of the work is most effective, not toward which person is failing the relationship. Individual work like this often happens best alongside couples counseling, rather than as a replacement for it.
Recognizing a pattern is the beginning of the work, not the end of it. Individual therapy gives that process a consistent, supported place to happen, with a therapist who can help connect what’s showing up now to where it actually started.
Remote work, cell phones, and – in many cases – the pandemic has caused people in New York to feel lonelier than ever, despite living in a city of eight million people. While there are many factors that contribute to this loneliness, one is that many people are feeling like they’re not a part of something.
There is a phenomenon that may help explain this. It’s called “ambient belonging.” It is especially relevant to those that work from home, or spend most of their time on their phones when they’re out, less present to the people around them.
Ambient belonging is the term researchers use to describe the low-level psychological sense of inclusion that comes not from specific relationships but from simply sharing a context with other people. It is different from other forms of connection because:
You don’t need to know anyone.
You don’t need to be known.
The idea is that presence of other, familiar people going about their lives in a shared space produces a background sense of connection that matters to the brain in ways that aren’t always obvious until it disappears.
Where Ambient Belonging Shows Up
Ambient belonging doesn’t require a conversation or a friendship to exist. It shows up in environments where people share a space and a purpose, even without interacting:
A coffee shop where everyone is working on something of their own, present alongside each other without speaking.
A gym where the same faces appear at the same time every morning, familiar without being known.
A neighborhood where people recognize each other from the street, the bodega, the laundromat, without ever learning names.
An office where co-workers are doing separate work in the same room, each absorbed in their own tasks.
A library, a park, a waiting room, a commute — any environment where people share proximity and a common context without sharing a relationship.
None of these situations require closeness. What they share is the background social signal that other people provide simply by being present. It’s a signal that affects how the nervous system operates, how mood holds up through the day, and how depleted or sustained a person feels by the end of it.
What Ambient Belonging Does for Mental Health
The nervous system doesn’t regulate itself in isolation. Research on co-regulation — the process by which proximity to other people helps calibrate our own nervous system states — shows that the presence of others, even strangers, reduces the brain’s baseline threat response.
So many of us, however, live lives that do not contain these opportunities. We are:
Working entirely from home.
Homebodies
Paying attention to our phones instead of our surroundings.
Living without schedule or structure.
For example, many people exercise at home now using tools like Peloton or Tonal, and when they do exercise away from their home they do not look up from their technology or take out their earphones. There is no opportunity to notice people or familiarity in the world around them.
This leads to a situation where people do not feel they belong anywhere, and are lacking even the ambient belonging that is meant to be beneficial for mental health. This can contribute to issues such as:
Depression and the absence of ambient belonging create a particularly difficult cycle. Depression drives withdrawal from shared environments, which removes the ambient social presence that might otherwise provide some buffer against the depression’s deepening. The more isolated a depressed person becomes, the fewer environmental resources they have available — which makes everything else about recovery harder.
Anxiety responds to ambient belonging in a different but equally direct way. The brain running in an elevated threat state costs more — more cognitive effort, more emotional energy, more of everything. Shared environments reduce that baseline cost by providing the background co-regulation that a nervous system running alone doesn’t have access to. People with chronic anxiety often find that their symptoms are worse during periods of more social isolation, even when they can’t identify what changed.
Productivity – There is evidence that we are more productive at home. But there is even more evidence that we are even *more productive* when we work at a coffee shop. Why? Because of ambient belonging.
Ambient belonging can also affect self-esteem and self confidence. It is often much more important than many of us realize.
Social Anxiety and Ambient Belonging
The relationship between social anxiety and ambient belonging is also important. Social anxiety drives avoidance of shared environments. The fear of judgment, embarrassment, or negative evaluation makes cafés, gyms, offices, and public spaces feel threatening rather than supportive. The avoidance that social anxiety generates as a protective response removes access to exactly the environments that would provide the nervous system the ambient belonging it needs.
The person ends up more anxious and more isolated, without recognizing that the isolation is part of what’s sustaining the anxiety.
Exposure-based treatment for social anxiety produces benefits that extend well beyond the specific fear being targeted — partly because returning to shared environments restores access to the ambient belonging those environments provide. The goal in early exposure work isn’t meaningful social interaction. It’s the gradual return to being present among other people, which the nervous system responds to independently of whether any relationship develops.
Ambient Belonging and Remote Work
The widespread shift to remote work that began in 2020 and became permanent for many professionals created a real-world demonstration of what happens when ambient belonging disappears from the workday. The results have been consistent enough that mental health researchers and clinicians across the country now discuss it as a significant contributing factor to the mental health declines documented in remote workers over the past several years.
The office environment has its own problems, and few will argue that it is necessarily better. But it also provides ambient belonging continuously — in the background awareness of other people working nearby, in the incidental contact of shared physical space, in the collective rhythm that a populated workplace creates. Most people didn’t recognize any of this while it was happening because ambient belonging operates below conscious awareness. They recognized it when it was gone.
Remote workers who replace office contact with scheduled video calls often still report feeling more isolated than they did when proximity made contact happen naturally. Structured social interaction and ambient belonging are neurologically different experiences. One requires effort and attention. The other happens in the background, without effort, simply by virtue of being somewhere with other people in it.
For New Yorkers who work remotely — and there are many — this has particular relevance. NYC’s density means that simply leaving the apartment to work in a coffee shop, library, or co-working space restores ambient belonging in a way that isn’t available in the same form to people in more suburban or rural environments. The city that can feel isolating in some respects is, when engaged with physically, one of the richest sources of ambient belonging available anywhere.
Ambient Belonging in Therapy
When the absence of ambient belonging is contributing to anxiety, depression, or a more general sense of depletion, therapy addresses it in several ways.
For people whose isolation is circumstantial — the result of remote work, a move, a life transition, or the gradual narrowing of daily routines — identifying what environments could restore ambient belonging and what’s making it difficult to access them is often a practical early focus.
For people with social anxiety whose avoidance has removed shared environments from their daily lives, the restoration of ambient belonging happens through the exposure work that treats the avoidance itself. As the feared environments become more approachable, their psychological benefits become available again.
For people in depression, behavioral activation — the evidence-based strategy of reintroducing engagement with the world even when motivation is absent — often targets ambient belonging directly, by getting people back into shared environments before they feel ready, because the environment itself supports the mood shift that makes readiness more possible.
The common thread is that ambient belonging isn’t a luxury or a nice-to-have. The nervous system is built to use the social environment as a resource, and when that resource is absent, everything else costs more.
Flourish Psychology works with individuals navigating anxiety, depression, social anxiety, and the range of challenges that affect daily life and wellbeing. Our Brooklyn Heights office serves clients throughout New York City, with online therapy available throughout New York State. To get started, call 917-737-9475 or schedule an appointment online.
Editor’s Note: This is a guest post from Dr. David Tzall
As a psychologist who has spent years in the trenches working with high-achieving individuals, I’ve noticed a glaring blind spot in the pursuit of peak performance: unprocessed emotional baggage.
We like to think we leave our personal lives at the door when we start our workday. But the brain doesn’t work that way. The neural pathways that fire when we deal with a difficult client are the same ones that fired when we dealt with a difficult parent, a bullying classmate, or a past professional failure.
Unresolved trauma and deep-seated anxiety don’t just make us unhappy; they make us inefficient.
The Cost of “Keeping It Together”
High achievers are often masters of compartmentalization. Compartmentalization means me keep our inner world hidden while we look good from the outside. No one would ever know what is swirling inside of us. This is simply a facade that eats away at us. We lose out on achieving peak performance. We make decisions out of emotional reaction and not out of ones that are in our best interest. The brain and body go into survival mode. In survival mode, the brain prioritizes safety over innovation. You become reactive rather than responsive.
We make fear-based decisions and these types of decisions are limiting as they have a cap. These decisions do not move us forward, and they hold us back, if anything. We take fewer risks, too. We are so afraid of losing something rather than what we could gain, that we almost become paralyzed into doing anything new and significant. Growth comes from conflict, and we start to avoid any level of conflict.
Redefining Resilience
There is a common misconception that resilience is about “toughing it out” or “grinding through the pain.” That isn’t resilience; that is endurance. The problem with endurance is it has a limit. If not careful, it will burn us out as we cannot keep going at the same pace over and over again. True resilience is the ability to process. It is the capacity to sit with discomfort, understand where it comes from, and move through it without letting it control your narrative.
A Challenge to the High Performer
If you are feeling stuck, exhausted, or like you are working harder for less return, I challenge you to stop looking at your spreadsheet and start looking inward.
Consider these questions:
What is the narrative you tell yourself about your capabilities?
What is your relationship with failure and what makes you label it as failure?
Have I really opened up to people when they ask how I am doing and check-in on me?
Therapy is not just for “fixing” what is broken. For the high achiever, therapy is an optimization tool. It is the most significant investment you can make in your ability to lead, inspire, and create.
Plastic surgery is more accessible and more openly discussed than it was even a decade ago. People get rhinoplasties, breast augmentations, facelifts, and a range of minimally invasive procedures without much social stigma attached. For most people who pursue cosmetic procedures, the decision comes from a genuine desire to change something about their appearance, and the result produces measurable satisfaction.
For a smaller group, the picture is more complicated. Body dysmorphic disorder — BDD — is a condition in which a person becomes preoccupied with a perceived flaw in their appearance that others typically can’t see, or see only minimally. The preoccupation drives significant behavioral patterns, including repeatedly seeking cosmetic procedures that never produce lasting relief.
Therapists are frequently asked to help draw the line between a healthy cosmetic decision and one driven by BDD, and that can be hard, because most perceived flaws are subjective to the individual.
What is Body Dysmorphic Disorder?
Body dysmorphic disorder is an obsessive-compulsive related disorder that follows the OCD pattern: intrusive, unwanted thoughts paired with compulsive behaviors designed to relieve the anxiety those thoughts produce. In BDD, the intrusive thoughts center on appearance — a nose that seems too large, skin that seems blemished, a feature that seems asymmetrical — and the compulsive behaviors include mirror-checking, seeking reassurance, camouflaging the perceived flaw, and repeatedly seeking procedures to fix it.
BDD produces a mismatch between the person’s perception of the flaw and what others actually observe. A person with BDD may spend hours examining a feature that their friends, family, and physicians can barely discern. The disorder carries high rates of depression, social withdrawal, and impaired functioning — but cosmetic correction doesn’t resolve it. A procedure that addresses the specific feature of concern typically doesn’t produce relief. The preoccupation either stays on the same feature or shifts to a new one.
How Therapists Assess the Difference
When someone comes to a therapist asking about cosmetic surgery — or a surgeon refers a patient for psychological clearance — the evaluation involves a clinical conversation that explores several dimensions at once.
* The first area therapists explore is the nature of the concern itself. A person who wants a rhinoplasty because they’ve always disliked the profile of their nose and feels the change would make them more comfortable in social situations is describing something different from a person who thinks about their nose for several hours a day, examines it repeatedly in mirrors, and has already had two previous procedures on the same feature without feeling better. The difference isn’t in the feature or the procedure — it’s in the relationship the person has with their appearance and how much of their daily life it consumes.
Therapists also look at motivation and expected outcome. Healthy cosmetic decisions tend to involve realistic expectations — the person wants a specific change and understands that surgery addresses the physical feature without guaranteeing broader life changes. BDD-driven motivation tends to involve the belief that fixing the feature will resolve much larger problems, repair relationships, or produce a sense of self that the preoccupation has been blocking.
Several specific clinical signs point more clearly toward BDD:
Preoccupation That Consumes Significant Time — Thinking about the perceived flaw for an hour or more each day, or finding that thoughts about it intrude regularly into daily functioning.
History of Multiple Procedures Without Relief — Having had previous cosmetic work on the same or similar concerns and finding that the result didn’t produce the expected satisfaction, or quickly shifted focus to a new concern.
Social Avoidance Driven by Appearance — Avoiding social situations, photographs, or public settings specifically because of the perceived flaw.
Mirror Checking or Avoidance — Compulsively checking the feature in mirrors, windows, or phone cameras, or completely avoiding reflective surfaces to prevent distress.
Seeking Reassurance — Repeatedly asking others whether the feature looks the way the person fears, while finding that reassurance provides only brief relief.
Camouflaging Behaviors — Spending significant time covering the perceived flaw with clothing, makeup, or positioning.
The presence of several of these together, particularly alongside high distress and functional impairment, moves the clinical picture toward BDD rather than a straightforward cosmetic preference.
Why the Evaluation Requires Care
The reason this assessment requires clinical skill rather than a simple screening instrument is that the categories genuinely overlap. A person can have realistic concerns about a feature and also have some BDD tendencies. Someone whose appearance concern is rooted in trauma — a scar, a feature that became associated with a painful experience — presents differently from someone whose concern developed without a traceable origin.
Therapists working in this area also recognize that social media has complicated the landscape significantly. Constant exposure to filtered images, face-altering apps, and the ability to see one’s own face from every angle creates appearance concerns in people who wouldn’t have developed them otherwise. Whether a specific concern reflects BDD, a reasonable response to a real cultural environment, or something in between requires context, time, and genuine clinical engagement.
What Happens When BDD Is Present
When a therapist identifies BDD as the driver behind a pursuit of cosmetic surgery, the recommendation is typically to address the BDD before any procedure. Plastic surgery in the context of active BDD almost always fails to produce the relief the person is seeking. In some cases, it worsens the disorder, by confirming the belief that the appearance concern was legitimate and fixable while leaving the underlying pattern untouched.
CBT with a specific focus on exposure and response prevention — the same approach used for OCD — is the most evidence-supported treatment for BDD, alongside work on the core beliefs about self-worth and appearance that sustain the preoccupation. When BDD treatment works, many people find the cosmetic concern either resolves or becomes something they can relate to differently, and the drive toward repeated procedures diminishes significantly.
For people whose body image concerns don’t meet BDD criteria but still create real distress — a category that includes many more people — therapy addresses the relationship with appearance more broadly, building self-concept on a foundation that doesn’t depend on specific features looking a specific way.
Flourish Psychology works with individuals navigating body image concerns, BDD, and the intersection of appearance and self-worth at their Brooklyn Heights office, with online therapy available throughout New York State. To get started, call 917-737-9475 or schedule an appointment online.
Location: 300 Cadman Plaza West Floor 12 - Brooklyn, NY 11201
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