About Me

I have been a psychologist for over 20 years, and have a private practice in Papillion, NE, largely specializing in conditions affecting adults. Before private practice, I was a University of Nebraska Medical Center staff psychologist working in organ transplant, burn care, cancer, and cystic fibrosis. I see a wide range of people, and am familiar with the needs of clients in sensitive professional and security positions.

Personally Speaking

I grew up in California, but came to graduate school in Nebraska, and liked it so much I stayed. My early career development was with serious and chronic illness. I found this work a tremendous privilege. It shaped me as a person and as a psychologist. Now, I don’t take much for granted, and I put a premium on chasing fulfilling experiences over chasing dust bunnies. Some of my interests include: hand-knitting with wool, (cookies..making and eating), spending time in the mountains, and investing in the stock market from the perspective of a psychologist.

Areas of Specialization

  • Dating, marriage, and family relationships
  • Treatment-resistant depression
  • Core self-concept/personality
  • Bulimia and anorexia
  • Anxiety and post-traumatic stress disorder
  • Acute and chronic illness including autoimmune disorders
  • Caretaker stress
  • Young adults who have lost a parent to crime, addiction, or suicide
  • Adult children of parents with borderline personality functioning

Organizations

American Psychological Association

Nebraska Psychological Association

Education

University of Nebraska-Lincoln, Ph.D. 1998

What to Expect

Listen to what happens in the first session

My Office

Therapeutic Approach

I have doctoral-level training in three different, but complementary, theoretical models of behavior change. I enjoy thinking about the science of effective behavioral interventions, and follow the latest research in terms of best practices. I often combine techniques from these three approaches.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is based on the premise that thoughts create emotions. CBT has good research support for the treatment of depression, anxiety including PTSD, and eating disorders. Therapy focuses on altering thinking and behavior patterns in order to get symptom relief.

Interpersonal Psychotherapy

Interpersonal psychotherapy (IPT) focuses on relationships. IPT has good research support for treatment of depression, eating disorders, relationship conflicts, and grief/loss reactions. The central tenet of IPT is that relationships impact emotions, but emotions also impact relationships. This two-way street provides several points of entry for change.

Psychodynamic Psychotherapy

Psychodynamic psychotherapy has good research support for depression and relationship concerns, and is particularly helpful when people are interested in changing long-standing behaviors and emotional habits. This approach focuses on insight, earlier learning in important relationships, and bringing behavioral patterns into full awareness so that change can occur.

Therapy Science

There is a growing body of research showing that therapy is useful across many different conditions for many different people, but why? How is therapy different from talking with a friend or family member, or privately thinking about a problem without speaking about it?

Through advances in brain neuro-imaging, we know that speaking concerns out loud activates emotional and problem-solving pathways in the brain in a manner that is different than the activation that occurs through private reflection.

We also know that effective therapy is based on a specific style of talking that has few similarities to coffee with a friend or dinner table conversations at home. Therapists are licensed professionals who are paid to ask specific questions in a way designed to reveal emotion, motivation, hopes, and fears. While your mother or spouse might say, “Don’t worry too much, it will get better,” your therapist might say, “What do you think the factors are that keep this pattern going?” Though that might not be a question for polite company at a social function, it may be just the kind of question to trigger an avalanche of change in your life when asked in therapy.

Frequently Asked Questions

Probably. Most people who are interested in this kind of work are usually well-suited for it, though there are some exceptions. Think twice if:

  • You are coming to appease a loved one, but with strong reluctance, and minimal desire to engage with the process.
  • You have frequent problematic use of alcohol, marijuana, recreational drugs, or prescription drugs that you are not willing to address FIRST in the line-up of things that will need to change.
  • You are coming in with a hope that you can learn a set of skills that will allow you to change the people around you while you remain largely unchanged.
  • You are requesting marital therapy, but plan to keep an extra-marital affair going on the side while in therapy.

Most people know by the end of the first session if they feel some kind of fit with the therapist and if the therapist seems to have expert knowledge that will help them. This kind of information should be clear to you by the end of the second or third session. In general, this is an area where you should trust your intuition as the consumer.


An experienced therapist with a strong training background should be able to tell you the frequency of meetings that they think will be optimal for you, and the approximate timeframe for treatment. Different problems take different amounts of time to fix or improve, and this is reflected in the research literature. You should feel empowered to ask your therapist what the latest behavioral science says about your particular problems and the best research-based treatments for them. Your therapist should be able to provide you clear and concise answers about this, and if they don’t know something, they should be willing to research it and get back with you.


This is an example of a something I might say at the end of the first or second session with someone:


“We will probably get your acute symptoms of depression under better control by meeting weekly for 2 to 3 months. Your panic symptoms can probably be substantially improved within 4-6 weeks. This will go fastest if you do out-of-session homework exercises that I will provide you. Because you have been depressed off and on for a long time, we may want to consider medication through your primary care doctor to get things jumpstarted. To dig down into your past learning history and make deeper changes that will make it so you are less likely to become depressed in the future, or have shallower episodes when you do, will take us more of a 6-12 month timeframe.


People want different things out of therapy. Some want immediate symptom remission, and others are looking for a more comprehensive overhaul that may inoculate against future episodes. You will decide at each stage of the process what you would like to do next, and how long you would like to continue in treatment. My job is to pay attention to your emotions, the things you say and how you say them, and nonverbal cues such as your facial expressions. I will float a lot of different ideas and observations by you. Some will hit the mark and others will go wide, but in a relatively short period of time, we will develop a picture of the things you need to work on about yourself and your relationships to improve your mood. This is collaborative process. You are the expert on you, and I am an outside consultant.”

What research shows therapy should be:

  • A professional consulting relationship based on therapist training and expertise that mirrors the relevant scientific literature.
  • A manner of talking about thoughts, emotions, and experiences that is more structured, but at times more emotionally-charged, than the kind of talking that typically occurs between friends or family members.
  • Questions that open up self-understanding, decrease symptoms, and lead to behavior change.
  • Techniques you can use in your daily life to decrease emotional distress and improve interactions in your important relationships.
  • A clear sense within the first 1-2 visits that the therapist has a conceptual model and set of techniques that will get you feeling substantially better over time.

What research shows therapy should not be:

  • A paid friend
  • A “venting” session without larger, mutually-agreed upon goals for change.
  • An amalgamation of techniques and ideas that the therapist finds compelling, but which have little or no scientific basis.
  • A back-and-forth exchange that feels like a friendship.
  • A feeling that the process is adrift, and that, after several weeks, you are still not sure if it is doing anything.

The research would suggest that, when looking at studies of therapy effectiveness across many different therapists, symptoms, patients, and empirically-based treatment modalities, a 50-70% rate of improvement is a reasonable expectation for most of the conditions that prompt a person to seek therapy in a private-practice community setting. However, these numbers can be deceiving, because in treatment research, some people get completely better, whereas others never finish the study they are in, so real life numbers for people who come to therapy and stay with the process, are likely higher. Based on my own practice history, I aim for 70-90% improvement in my patients.

Brooks, J. A., Shablack, H., Gendron, M., Satpute, A. N., Parrish, M. H., Lindquist, L. A., (2017). The Role of Language in the Experience and Perception of Emotion: A Neuroimaging Meta-Analysis. Social, Cognitive, and Affective Neuroscience, 12, 169-183. https://doi.org/10.1093/scan/nsw121


Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A., Hofmann, S. G. (2018). Cognitive Behavioral Therapy for Anxiety and Related Disorders: A Meta-Analysis of Random Placebo-Controlled Trials. Depression and Anxiety, 35, 502-514. https://doi.org/10.1002/da.22728


Champion, L., Power, M. J. (2012). Interpersonal Psychotherapy for Eating Disorders. Clinical Psychology and Psychotherapy, 19, 150-158. https://doi.org/10.1002/cpp.1780


Cuijpers, P., Geraedts, A. S., van Oppen, P., Andersson, G., Markowitz, J. C., van Stratton, A. (2011). Interpersonal Psychotherapy for Depression: A Meta-Analysis. American Journal of Psychiatry, 168, 581-592. https://doi.org/10.1176/appi.ajp.2010.10101411


Hoffman, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., Fang. A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-Analyses. Cognitive Therapy Research, 36, 427-440. https://doi.org/10.1007/s10608-012-9476-1


Murphy, R., Straebler, S.,Cooper, Z., Fairburn, C. G., (2010). Cognitive Behavioral Therapy for Eating Disorders. The Psychiatric Clinics of North America, 33, 611-627. https://doi.org/10.1016/j.psc.2010.04.004


Shedler, J. (2010). The Efficacy of Psychodynamic Psychtherapy. American Psychologist, 65, 98-109. https://doi.org/10.1037/a0018378

Contact Me

How to Book an Appointment

To book an appointment, please call and leave a voicemail with your name and phone number. Calls are typically returned within 24 hours.

402-650-0584

Office Location

535 Fortune Drive, Suite 150
Papillion, NE 68133

Accepted Forms of Payment

  • Blue Cross Blue Shield
  • Midland’s Choice
  • Self-pay: Cash, Check, Credit Card, Health Spending Account

Copyright © 2021 Karen Sigler Naegele. All rights reserved.