Examples of Strategies I May Use in the Office

DISCLAIMER:   The examples provided below are meant only to illustrate Dr. Ostoja’s therapeutic style. They are not meant to diagnose, treat or provide any therapeutic advice.  When Dr. Ostoja uses these metaphors with patients, she first peforms an in-depth assessment of each client’s needs and symptoms.  The strategies are copyrighted and should not be attempted or reproduced without explicit permission from Dr. Ostoja. By reviewing this page I acknowledge that I have reviewed and agree to the Terms and Conditions of Using Dr. Ostoja’s website.


Over the years, I have amassed a “Cookbook of Strategies.” Some are standard strategies used by many therapists and others are silly metaphors or humorous stories that have been helpful to clients in the past. After getting to know each client and listening carefully to the issues that bring the client to therapy, I suggest different “recipes” that may be helpful. We practice each strategy in session. Then clients practice it at home. Their success or difficulties are processed in the next session.  Over time, clients end up with a collection of their favorite strategies. Sometimes we come up with new strategies as we problem solve during sessions. I then ask clients to grant me permission to include the new strategy in the “Cookbook” for the benefit of all.

1. EXAMPLE OF A STRATEGY: THIS AND THAT (Copyright Ewa Ostoja Ph.D.)

For people with intense emotions that overwhelm them, I might use the “THIS AND THAT” strategy, which allows clients to hold two seemingly incompatible possibilities in mind simultaneously. Many people become overwhelmed when they allow their brains to zero in on either possibility, in what we call black and white thinking (EITHER this OR that strategy). THIS AND THAT strategy introduces a new mindset that competes with catastrophizing.


When I am working with a teenager with severe OCD, I will often ask: “IS YOUR QUEEN IN THE DUNGEON?” I have a little book that tells a story of how the brain behaves “when OCD runs the show.”

I use an elaborate story to illustrate the various principles of OCD treatment. For younger children I use a bit more drama, and for all I use a lot of humor. Later on in treatment I can just refer to “the Queen” and the children or teens can invoke the entire strategy and walk themselves through it. Since it is my goal to empower clients to solve their own dilemmas and problems, such metaphors become very useful in self-guided response to an “OCD attack.”



Many people believe that success comes from having an amazing “will power.” But for multitudes of healthy and productive individuals, success comes from outsmarting their brains! Many healthy and fit people do not particularly enjoy getting up in the morning and exercising. But many have made the connection between exercise and feeling better! (Another strategy: See what leads to what…). That realization is wonderful but the truth is that the realization alone will rarely get you to exercise on any kind of a regular basis. Most regular exercisers understand that you do not want to leave the decision to exercise to the morning when you are groggy and tired. Your “Nightshift Homonculus” is going to tell you to go back to bed… The strategy of outsmarting your brain involves knowing this, and setting up the conditions ahead of time, to eject you from bed and onto your stationary bike or straight into your running shoes without giving your brain much of a chance to sabotage you. Outsmarting Your Brain is a strategy of forming habits that do not leave the decision making power to Your Nightshift or Tired Homonculus!