About Our Approach

“The first step toward change is awareness. The second step is acceptance.” – Nathaniel Branden


Our Approach

MSAM is proud to be on the cutting edge of empirically-based treatment for OCD, trauma and the full range of anxiety disorders. We employ the most effective and best-practice treatment methods available, including CBT, DBT, EMDR, mindfulness, and offers groups for anxiety support, grief recovery, and mindfulness training.

Every person is unique. This unique complexity of each individual guides our assessment and development of the most effective treatment plans. Below are some thoughts on how people become stuck, and how we can learn to escape our difficulties and build a life worth living.


The way in which we view ourselves as unique individuals is influenced both by our temperamental propensities and by our caregivers. It is further molded through our exposures to diverse experiences. Perception, conditioning, and our ability to learn are important factors in forming our unique idea of self.

Give this some thought: from the moment you became self-aware as a child, usually somewhere between the ages of 4-6, you started to view your life day-by-day. Your experiences turned into memories, each building upon the previous. This moment-to-moment learning formed the groundwork for how to live your life. This learning constructed “facts” or “truths” about who you are and the meaning you attach to others, as well as your understanding of the world. These “truths” become instructions for figuring out how to cope, adapt, and survive. Early on, it wasn’t likely that you gave a lot of thought to this idea of survival, because you were concerned about being cared for and being loved. Survival when we are young meant staying attached to a caregiver, fitting in and staying attached.

Being Present

In each present moment, you both experience day-to-day existence and watching this process of experience unfold. You have been watching the trajectory of your life since your earliest memory. You have also arrived at conclusions about your experiences and have become “conditioned” about what living means in each moment. Through each diverse experience that occurred, you were there watching and learning. In fact, at this very moment, you are observing yourself read this paragraph.

It is important to understand that learning is in the eye of the beholder. We are similar, yet also unique. In other words, many people can have the exact same experience, and perceive that experience quite differently. When this experience is perceived differently, what is learned will also be different. Learning, as mentioned earlier, is influenced by our unique developmental paths. 

Integrated Information

Once we have learned something important, it becomes resistant to adjustment or change. The basic way in which we learn often makes what we learn feel permanent and unchangeable. As a result, we can forget that we have choice. We go on autopilot, so to speak. We start being what we believe we are, rather than seeing things as they are. We see the world as we are rather than how the world is.

Without being able to objectively observe our own patterns, we remain stuck repeating them. The first step is to be able to identify your pattern, rather than simply “being” the pattern. This is the path which leads to regaining the ability to understand your decision-making and, ultimately, make different decisions. By observing our patterns, we can make new choices in the areas that we are stuck.


We become “stuck” because of the way in which our minds learn. Our brains love synthesizing and summarizing information, turning what we sense and observe and experience into usable bits of information. In this way, our experiences becomes beliefs or “truths” about living, being and surviving. This information our brains create form habits, conditioning, schema, beliefs, concepts or stories. What ever we call them, they are very useful indeed.

Without previous learning and habits, it would take an incredible amount of time and energy to re-learn all the information we have built up. In order to tie our shoes, we would need to find a shoe-tying video each morning after putting our shoes on; but first we would need to learn how to search for a shoe-tying video on Google; but before that we would need to understand how to use a web browser; and before that how to use a computer; and on and on. Our habits, learning, and conditioning are vital to our daily lives. However, they can also create great difficulties for us. 


So: learning, forming habits, conditioning, and the beliefs that are developed over the course of our lives are very necessary things. The functional problem is finding a method to break away from non-helpful, disruptive, or dangerous patterns. Once our brains have come to a conclusion and decide that a thing (behavior, event, experience) has happened enough times and “works”, we accept it as truth. The longer we identify with this “truth,” the more its maintenance is ensured. Whatever is practiced becomes strengthened, negatively or positively. In fact, this “truth” goes on autopilot—it leaves out of our conscious awareness. It becomes part of our story of self, so to speak.

What if some of the learning that our brain has accepted as “truth” was integrated from the perception of a 6-year old? What if it gets a “free pass” because we don’t see it? If our habits and “truths” are never reexamined for usefulness or accuracy, some of these patterns can become a source of suffering. Certain conditioning, habits, or beliefs may no longer serve you well, instead disrupting and lowering your quality of life.

Distorted “Facts”

Problems occur as our early conditioning becomes inadequate to address our current needs. In particular, problems can arise when conditioning was shaped by emotional invalidation, neglect, abuse or even simple misinformation. This may leads problems interpreting life as we are rather than how life is. These patterns, reliant on distorted “facts” from the past, will not not serve us well in navigating life in the present.

Having negative patterns to address is natural for all humans. If you think about it, it is very difficult—if not impossible—to make it to adulthood without learning something wrong, getting hurt, or worse. Everyone benefits from attending to the misperceptions that negatively affect our ability to achieve a life worth living.


Often, we continue to act in ways that are not in our best interest. We become stuck in old “facts” or “truths” that have outlived their usefulness and are less sophisticated than life in the present demands. Being “stuck” makes us suffer, creating more negative information about living.

Imagine a person who was often bullied and developed an idea that they were “less than others.” Most of us would believe that being bullied does not reflect their worth as a person. But they may believe that, regardless of what we think. A distorted conclusion without the benefit of reality adjustment can continue to present itself as “fact” or “truth.”

From Misunderstanding to the Moment

We can, and often do, continue to depend on old learning that has lost its usefulness as our guide for living now. Most of this learning is out of our immediate awareness, and leads to persistent suffering.

“There is that moment in time where you have to realize you have to let go of the rope…” – K. Farrell St. Germain

It is healthy to learn to build the skill to become aware of your internal world of thoughts, feelings, and emotions. By doing this you gain the skill to become less reactive to non-useful or harmful patterns of thinking and behaving learned earlier in life. You also learn to be with the moment in a way that allows you to observe with clear eyes and begin gaining the skills needed to build a life that is worth living now. You can learn to be mindful and present in such a way as to see your internal world, rather than reactively be the pattern.


We all repeat mistakes even in the face of our best rational judgment and in the face of real and painful negative consequences. Often we become stuck by choosing to continue to avoid hurt that occurred early in life. What was seen as too big for you to handle as a child may not be too big for you to handle as an adult. But with years of practice it may have become your habit to avoid. You are not looking through the lens of the present moment when stuck in a pattern, but instead you are on autopilot looking through the lens of early learning and conditioning.

The first step to any change is recognizing the problem and its nature and finding effective means to change what needs to be changed. We won’t be changing your old experience, that is not possible. You can work on changing your relationship to the old experience and begin to live from what you want now.


“The most fundamental aggression to ourselves, the most fundamental harm we can do to ourselves, is to remain ignorant by not having the courage and the respect to look at ourselves honestly and gently.” – Pema Chödrön

Comprehensive, individualized, and collaborative therapy can help you learn how to become your own therapist. Recall that you have been observing yourself your whole life, even though you may never noticed. You are much more than just what you have learned and have become conditioned to believe and act upon.

MSAM is committed to providing you with the tools that lead to learning to live a life you value. Rather than being dragged through life on autopilot trying to avoid a life that you don’t want, begin thinking about building a life that you do want

Getting Started

I have provided a Treatments section in this website detailing the disorders I specialize in treating. Before you look it over, please understand that you are infinitely greater than any description of your problem. The criteria in each of the categories helps us (you and your therapist) to identify the specific here-and-now issue that is affecting your quality of life.

These categories are also used for research purposes, to look at problems that are presented with similar symptom profiles in order to continue to find better ways to help. You may feel relieved knowing that what is hurting you has a name, but remember: the symptoms may be what you have, but they never describe who you are. I look forward to working with you. 

Kind Regards,

Harold Kirby, LCSW/BCD
Founder and Director, MSAM

Contact Harold at 610-517-3127 to schedule a consultation or appointment. Harold provides telehealth treatment for clients in Philadelphia and the surrounding areas of Pennsylvania and New Jersey (Main Line, Montgomery County, Camden, Cherry Hill), as well as in the South Carolina Lowcountry (Hilton Head, Bluffton, Beaufort, Colleston County, Dorchester County, Berkeley County, Charleston).