About Smith M. Tilka, MS, LMHC, CCTP, NBCC
My clinical perspective and practices are based in the belief that we are all curious, courageous, compassionate, and confident human beings at our core. However, we all may struggle to access those parts of our selves at many different times throughout our developmental lives. And during those struggling times, we may have difficulty trying to find and access our paths towards emotional and physical stability and well-being. Many of the clients I work with struggle with control, self-criticism, negative appraisals, obsessions, compulsions, depression, anxiety, and/or feeling not fully alive and at ease with being themselves in their worlds. I am committed to fostering the therapeutic relationship in order to help reduce or alleviate their symptoms with efficiency and care. That is, because I believe the therapeutic relationship is one of the most powerful resources and tools that we have, and this belief is empirically supported, to create the best therapeutic outcomes for our clients. And I do this by creating a comfortable, non-judgmental environment where my clients can begin to heal and grow. I help my clients feel empowered and get on a positive path towards growth and well-being. Similarly, I work with my clients to address their challenges, uncover their potential, and lead a life that is worth celebrating. Thus, I am excited to be on this path of self-development and self-awareness with all of my clients. It is a true honor to witness a client’s growth and change and it is one of the most rewarding aspects of the therapeutic process for me.
My name is Smith M. Tilka, Licensed Mental Health Counselor and Nationally Certified Counselor. I specialize in psychodynamic psychotherapy and existential psychotherapy. I believe that the conditions of the mind reside in the intra- and inter-personal struggles that rest and reverberate in the consciousness of the mind. Most of us can, and will, have disruptions in our development at some point throughout our developmental lifespan. Unfortunately, none of us make it out of our childhoods unscathed from experiencing wounds and scars. However, that is not to put blame on those times, but it is to help us understand how the mind is developed and how those impressions can have their influence on the presenting symptoms within the here and now. It is through gaining awareness, acceptance, and resolving these disruptions through processing action that we can help clients unburden themselves from their presenting issues and heal their past wounds.
I utilize an individual approach to all diagnostic and treatment planning. I treat individuals, groups, families, couples, adults, adolescents, and children. I offer experiential healing, motivational training, self-regulation training, and psychoeducation. I have been involved in the social and mental health service industry since 2011, and I have extensive training in addictions, traumas, eating disorders, and women’s issues. Some of my additional specialties include phase of life issues, relationship issues, parenting issues, adjustment issues, disorders of the self, post-traumatic stress disorders and their trauma resolution, family of origin and ACOA issues, codependency and addiction recovery, sexual and identity issues, grief and loss, mood disorders, and anxiety disorders. For me, I believe in a holistic treatment integrating the mind, body and spirit into the healing process.
Smith M. Tilka, MS, LMHC, NBCC is a Sarasota Psychotherapist and Counselor with her office centrally located in the heart of Downtown Sarasota. She works with clients via in person, by phone or through Telehealth services.
Over 10 years of experience within the Mental Health Field, which includes treating addictions, relational issues, trauma disorders, eating and body image disorders, suicidal and non-suicidal self-mutilation, sexuality and sexual disfunctions, adjustment disorders, neurodevelopmental disorders, anxiety disorders, bi-polar disorder, and major depressive disorder.
3+ years’ experience in Private Practice
Licensed Mental Health Counselor
Nationally Certified Counselor with the National Board of Certified Counselors (NCC)
Mindfulness Based Stress Reduction (MBSR) Trainer
Master of Science in Counseling and Psychology:
Troy University (2020) Bachelor of Arts in Psychology:
University of South Florida, Sarasota-Manatee (2017)
If you would like to set up an initial consultation please call me at 941.623.6035 or you may email me at [email protected]
Theory of Change
(Smith M Tilka)
My theory of change is based on the following core theoretical perspectives and models that I pull from within my clinical practice and supervision.
Psychodynamic therapy is the psychological interpretation of mental and emotional processes. Rooted in traditional psychoanalysis, it draws from object relations, ego psychology, and self psychology. It was developed as a simpler, less-lengthy alternative to psychoanalysis.
Psychodynamic therapy aims to address the foundation and formation of psychological processes. In this way, it seeks to reduce symptoms and improve people’s lives.
In psychodynamic therapy, therapists help people gain insight into their lives and present-day problems. They also evaluate patterns people develop over time. To do this, therapists review certain life factors with a person in therapy:
- Early-life experiences
Recognizing recurring patterns can help people see how they avoid distress or develop defense mechanisms to cope. This insight may allow them to begin changing those patterns.
Following Freud’s influence, psychodynamic therapy tends to utilize both the topographic and structural models to explore the mind. These assumptions help to organize the mind through two distinct but interconnected perspectives: unconscious, subconscious (or preconscious), and conscious / ego, super ego, and id.
The therapeutic relationship is central to psychodynamic therapy. It can demonstrate how a person interacts with their friends and loved ones. In addition, transference in therapy can show how early-life relationships affect a person today. Transference is the transferring of one’s feelings for a parent, for example, onto the therapist. This intimate look at interpersonal relationships can help people understand their part in relationship patterns. It may empower them to transform that dynamic.
Self psychology, an offshoot of Freud’s psychoanalytic theory, forms much of the foundation of contemporary psychoanalysis as the first large psychoanalytic movement recognizing empathy as an essential aspect of the therapeutic process of addressing human development and growth.
In self psychology, the self is understood to be the center of an individual’s psychological universe. If a child’s developmental environment is appropriate, a healthy sense of self will typically develop, and generally the individual will be able to maintain consistent patterns/experiences and self-regulate and self-soothe throughout life. When individuals are not able to develop a healthy sense of self, they may tend to rely on others in order to get needs met. These others are called self-objects (because they are outside the self). Self-objects are a normal part of the developmental process, according to Kohut. Children need self-objects because they are incapable of meeting all of their own needs, but over the course of healthy development, self-objects become internalized as individuals develop the ability to meet their own needs without relying on external others.
The role of transference is also important to self psychology. In psychoanalysis, transference is understood as the process in which a person in treatment redirects feelings and desires from childhood to a new object (usually the analyst). Kohut formulated three specific types of transferences that reflect unmet self-object needs:
- Mirroring: In this type of transference, others serve as a mirror that reflects back a sense of self-worth and value. Just as people use a mirror to check appearance, mirroring transference involves use of the affirming and positive responses of others to see positive traits within the self.
- Idealizing: Kohut believed individuals need people who will make them feel calm and comfortable. An example of this can be seen in children who run to a parent for comfort after falling and being injured. The external other is idealized as somebody who is calm and soothing when one cannot provide that on their own.
- Twinship/Alter Ego: Kohut suggested that people need to feel a sense of likeness with others. For example, children want to be similar to their parents and mimic the behaviors they observe. Over the course of healthy development, a child becomes more able to tolerate differences.
Ego State Therapy is based on the idea that a person's psyche is the amalgamation of several distinct people or egos, such as the wounded child or controlling personality. It developed from psychodynamic psychotherapy, and uses techniques similar to those used in family and group settings.
Ego state therapists frequently refer to a “family of selves” or “parts.” They don't literally mean that a person has multiple personalities. Instead, each of us must navigate several discrete identities and roles. For example, a woman might adopt the role of protector toward her children but feel like a fearful or neglected child around her mother. Ego state therapy aims to identify these different roles and then integrate them into a coherent self.
Ego states are an adaptation to various life circumstances, rather than innate states of being. Sometimes a person becomes stuck in an ego state, or finds that an ego state is no longer beneficial. A child abuse victim, for example, might get stuck in the role of frightened child. This could lead to anxiety, unhealthy relationships, and other behavioral patterns based on an ego state that's no longer functional.
Ego state therapists identify four distinct ego states:
- A Vaded ego state is an ego that has experienced a traumatic event it has not yet processed. Vaded ego states cause emotional reactivity and require resolution of trauma.
- Conflicted ego states are those that are in conflict with one another. They lead to a sense of internal conflict, and ego state therapy aims to resolve the conflict.
- Retro ego states are ego states that once worked but that are not harmful. Ego state therapy endeavors to help these states learn to come out only when they are useful.
- Normal ego states are healthy states that are openly acknowledged, not in conflict, and not maladaptive. The goal of ego state therapy is to achieve normal ego states.
Object Relations is a variation of psychoanalytic theory that diverges from Sigmund Freud’s belief that humans are motivated by sexual and aggressive drives, suggesting instead that humans are primarily motivated by the need for contact with others—the need to form relationships.
The aim of an object relations therapist is to help an individual in therapy uncover early mental images that may contribute to any present difficulties in one’s relationships with others and adjust them in ways that may improve interpersonal functioning.
In the context of object relations theory, the term "objects" refers not to inanimate entities but to significant others with whom an individual relates, usually one's mother, father, or primary caregiver. In some cases, the term object may also be used to refer to a part of a person, such as a mother's breast, or to the mental representations of significant others.
Object relations theorists stress the importance of early family interactions, primarily the mother-infant relationship, in personality development. It is believed that infants form mental representations of themselves in relation to others and that these internal images significantly influence interpersonal relationships later in life. Since relationships are at the center of object relations theory, the client-therapist alliance is important to the success of therapy.
The term “object relations” refers to the dynamic internalized relationships between the self and significant others (objects). An object relation involves mental representations of:
(1) The object as perceived by the self, (2) The self in relation to the object, and (3) The relationship between self and object.
Internal objects are formed during infancy through repeated experiences with one's caregiver. The images do not necessarily reflect reality but are subjectively constructed by an infant’s limited cognitive abilities. In healthy development, these mental representations evolve over time; in unhealthy development, they remain at an immature level. The internal images have enduring qualities and serve as templates for future relationships.
Awareness, Acceptance, Action Model of Change
As a result, I believe change thus happens for all of us by a three-stage process. This three-stage process consists of: Awareness, Acceptance, and Action. Moreover, this process is considered fluid and is frequently repeated. Therefore, we continually move in and out of these stages throughout our life processes and each stage is met with many emotions and feelings that can be both negative and positive for the individual.
In the first stage, Awareness, it is without a doubt the most important and vital first stage for us. That is, because for all of us, there can be no need or agency for change to begin without increasing one’s awareness of a presenting issue. It is essential to additionally note that awareness in this stage is meant as understanding and reflecting on self, situations, others, perspectives, and/or feelings with an open and curious mindset. By engaging in this stage of the process we get to raise our awareness and insight about our issues and decide if we want to make changes to our thoughts, feelings, engagements, beliefs, and/or memories about it.
Once one’s awareness has been raised then we can get into the frame of mind of Accepting that parts about oneself (past and/or present) or their life’s situations. When we do not accept where we are right now, it is typically because we are intrenched in a defense mechanism, such as denial, rationalization, or suppression. It is important to remember that just because one may come to accept something it does not have to also mean that one approves of it. We are just accepting where we are with this issue at this very moment in time.
But we cannot move into the last stage, Action, until we have gone through the process of truly connecting to these Awareness’ and Accepting the parts of our self and/or our situations. Thus, we must self-actualize and “own it” to start the process of repairing and healing; thus, this is required in order for the change to start to take root.
Once that happens, we can start the Action stage by gathering information that leads one down another path and ultimately through the situation, feeling, and/or event. If we start from a state of resistance or anxiety, it will certainly feel like a struggle. However, if we have been thorough in our process of understanding, reflecting, exploring, and accepting what is or was, then moving into action stage will be the result of having worked through what needed to be processed in the decision.
Finally, this three-stage process creates the framework that brings the mind, body, and emotions together to move one along the path of personal growth, self-compassion, and a deeper understanding of self.