Sage Anxiety Treatment Program

Intensive Treatment Program Description
Sage Anxiety Treatment Program
1. When did you open your program
The Intensive Treatment Program opened on October 24, 2011
2. Please describe the staff that work at your program in terms of their backgrounds,
credentials and experience
Robin Taylor Kirk, LMFT, Director: 7 years of experience treating OCD, 18 years of
experience treating anxiety disorders and eating disorders; an IOCDF BTTI Graduate;
presenter at three of the past four IOCDF conferences; presenter for the Sacramento Affiliate
Chapter of IOCDF; Instructor at JFK University on the topics of anxiety disorders and mood
disorders; presenter at MFT and LCSW professional organization meetings and frequent
presenter to community groups; provider of information to media sources; former co-owner
of residential and intensive outpatient program for eating disorders.
Melanie Mopsick, LCSW, psychotherapist: 20 years of experience treating anxiety disorders;
attendance at many trainings including a day long training on OCD spectrum disorders
Janet Spaulding, LMFT: Janet has been licensed for ten years and joined Sage 3 months ago;
attended three month three hour per week training on OCD spectrum disorders
Julie Jorgenson, MFTI: 1 year experience treating OCD; attended twelve month three hour
per week training on OCD spectrum disorders
Deborah Miller-Froh, MFTI: 1 year experience treating OCD; attended twelve month three
hour per week training on OCD spectrum disorders
Fiona Arenson, MFTI: 3 months experience treating OCD; attended three month three hour
per week training on OCD
3. Is this program devoted entirely to treating individuals with OCD or will other OCD
spectrum disorders or anxiety disorders also be addressed
OCD, other anxiety disorders, hypochondriasis, body dysmorphic disorder, hoarding,
trichotillomania and dermatillomania are addressed in the Sage Intensive Outpatient
Program.

4. Please describe the core treatment components of your program (e.g., use of
medication, ERP, group therapy, etc.).
The core treatment components used at Sage include ERP, Acceptance and Commitment
Therapy, individual therapy, group therapy and a weekly Family Support group which
includes psycho-education. Sage does not have a psychiatrist on-site; we work with several
psychiatrists in the area and are happy to provide referrals and coordination of care.
5. Please describe the treatment planning process at your program.
While treatment discussions are held spontaneously as needed, treatment planning is formally
scheduled for two hours on Monday, 30 minutes on Wednesday and 30 minutes on Thursday.
These meetings are attended by all clinical staff and during this time information about
clients scheduled to begin the program is presented, the work/progress/challenges of each
client during the previous week or day of service is discussed and further treatment is
planned. Progress and areas of focus are based not only on participation in exposures, but
also on the six core processes of Acceptance and Commitment Therapy (i.e. present moment
awareness, self-as-context, values, committed action, acceptance and defusion). Exposure
records are examined to identify areas of additional focus for each client.
6. If someone has a co-morbid condition, can he or she participate in your program Will
there be treatment for the co-morbid condition If so, can you give an example
Yes, individuals with co-morbid conditions may participate in the program. Sage includes
one fifty minute individual therapy session each week. Clients are assigned an individual
therapist when beginning the program and continue to see that clinician for individual
sessions throughout the program. We also offer the flexibility to include more individual
sessions and/or family/couple sessions if the need arises. Treatment for the co-morbid
condition is included in the intensive program. One example is the treatment of eating
disorders. Robin Kirk, LMFT has 17 years of experience treating eating disorders and is the
former co-owner of Summit Intensive Outpatient Program for eating disorders. If a client
presents to Sage with an eating disorder which is medically stable and appropriate for
treatment at the outpatient level of care, treatment is provided in individual sessions. The comorbidity
of eating disorders and anxiety disorders is high and the ACT concepts are very
useful in the treatment of both disorders. We also have a clinician on staff specializing in the
treatment of Bereavement.
7. Are parents, family members, friends, teachers, etc. included in the treatment If yes,
please describe how.
Yes, parents, family members and friends are included in treatment in that they attend a
weekly Family Support Group during which they receive psycho-education and coaching
with respect to anxiety disorders and how to best help their loved ones. Family therapy is

also available. The cessation of reassurance-giving and performing behaviors for loved ones
(e.g. opening the door for someone with contamination OCD) is challenging and we have
found that ongoing education, support and problem-solving contributes significantly to
clients’ progress. Family members and friends are also invited to continue in the Family
Support Group after their loved one steps down from the Intensive Outpatient Program to
individual therapy. The individual clinician working with a particular client is the liaison
with the client’s teachers, other/former individual outpatient therapists, primary care
physicians and psychiatrists. Each relevant collateral person is contacted at the beginning of
and throughout treatment.
8. How often do patients in the program meet with staff individually How long are these
individual sessions
Each client has an individual therapist with whom he or she meets weekly for a fifty minute
psychotherapy session. This schedule may be adjusted to include more frequent individual
sessions if the need arises. The client also works with this therapist to plan exposures.
9. Is there a set time period for a patient’s treatment in the program What is the overall
time commitment to the program (for example, attend daily for three weeks) How
much flexibility is there in extending someone’s stay if needed
Clients usually attend the program between three and five days per week, depending on need,
for three hours per day. The program consists of both individual and group therapy. The
minimum length of stay at Sage is four weeks. The first two weeks of the program are
largely devoted to the concepts of Exposure and Response Prevention and Acceptance and
Commitment Therapy. This provides each client with a solid foundation from which to
begin exposure in earnest in week three of the program. Exposure homework is assigned for
those days on which the client does not attend the program. If needed, clients may attend
five days of service per week. There is significant flexibility in extending clients’ stay. Sage
is in-network with several insurance carriers and obtains single-case-agreements if not innetwork.
Our philosophy is that clients are welcome and encouraged to stay as long as
necessary before stepping down to individual therapy. We work diligently with insurance
companies to obtain the necessary authorizations and to demonstrate medical necessity for
extended stays. For individuals who private pay, we provide long-term financing and also
accept credit cards. Sage generally provides two pro bono courses of treatment per year. It
is our commitment to provide care as long as this level of care is therapeutically indicated.
10. Is there a homework or “self directed” component to the treatment
There is a homework component to the program. Clients receive instruction in mindfulness
meditation which they practice not only in the program, but also at home. In addition, once
exposures are begun in the program, clients are expected to do at least one hour per day of
exposure on the days they do not attend the intensive program. While this formal homework

is decided upon collaboratively between clinical staff and the client, it is usually reported by
clients that they also encounter many in vivo exposure opportunities during the course of
their day and having a solid foundation in the concepts of Acceptance and Commitment
Therapy makes these “life happens” exposure opportunities much easier to approach. Not
only does this provide additional ERP work, it also provides clients with a sense of agency
that they are able to do the things that are important to them even if they are experiencing
anxiety.
11. Please describe the relapse prevention strategies you use in your program.
As mentioned above, clients receive training in both ERP and Acceptance and Commitment
Therapy. Once they have mastered the process, clients report confidence in being able to
work with any trigger that comes along. In a more formal sense, upcoming possible stressors
including decreasing the amount of treatment as well as life events that might result in
relapse are identified and problem-solved. Clients are discharged to individual therapy with
either the therapist they were seeing during the Sage program, or to the referring individual
therapist. We coordinate with other clinicians to ensure they understand the ERP/ACT
process and are available to answer questions even after a client has left the Sage program.
Additionally, clients may attend a weekly support group with others who have completed the
intensive program and their family members/friends may continue to attend the weekly
Family Support Group.
12. What kind of follow-up do you do for those who complete your program Will the
members or your treatment team be in contact with or willing to consult with the
individual’s regular treatment provider(s)
With respect to clients who have completed the program, Sage does follow-ups on a three
month, six month, one year and two year basis. The therapist with whom the client saw for
individual therapy during the intensive program consults with the individual’s regular
treatment provider prior to the commencement of the intensive program, during the program
and is available for consultation once the client has completed Sage’s program.
13. Do you offer a sliding fee scale or scholarships for those who cannot afford your
program
Sage offers a sliding scale for those who do not have insurance and also accepts major credit
cards. We also offer payment plans that may extend beyond attendance in the program if that
makes treatment more accessible. In addition, Sage generally offers two pro bono courses of
treatment per year.
14. Does your program only work with individuals who are local or are there arrangements
for those who come from farther away (for example, lodging arrangements)

Sage is very conveniently located for those who come from out of the area. There is a long
term stay hotel, grocery store, drug store, restaurants and other conveniences within a half
mile of Sage. Our Intake Coordinator is happy to assist people who need to make
arrangements for lodging while attending the program. We are also located on the American
River which has a more than 25 mile bike/walking trail and many opportunities for
recreation.
15. Please add any information you think would be helpful in describing the unique aspects
of your program if this has not been covered in the questions above.
Our facility is uniquely designed for exposures and has a fully functional kitchen, two large
group rooms, a “getting ready room” with a mirror and sink, multiple listening devices,
TV’s/computers with internet and access to an onsite gym and locker room. There is ample
space for nine clients to do exposures in private. Other features of the Intensive Outpatient
Program at Sage include the assignment of each client to an individual therapist with whom
the client has a weekly individual therapy session, the Family Support Group, the
combination of Acceptance and Commitment Therapy with Exposure and Response
Prevention which gives clients a different way to experience and relate to their anxiety and
makes exposures easier to approach and a weekly process group for clients to help process
the feelings associated with OCD Spectrum Disorders as well providing additional
exposure/support for those with social anxiety.