What Clinical Excellence Means to Us

At Libra Virtual Care, clinical excellence is more than a buzzword — it’s a core value that shapes every interaction, session, and decision we make. We believe clients deserve therapy that is compassionate and grounded in the best available research. Our commitment to clinical excellence ensures we’re not just meeting expectations, but working every day to exceed them.

Key Elements of Clinical Excellence

Evidence-Based Practice

Clinical excellence means showing up for clients with skill, intentionality, and heart. It’s not just about being licensed or experienced—it’s about being committed to providing the most effective, respectful, and personalized care possible. That starts with using evidence-based approaches, which are therapies supported by research and proven to help people heal. Whether it’s CBT-E for eating disorders, ACT for anxiety, or DBT-informed skills for managing emotion, we stay rooted in methods that work. But we do not apply these approaches robotically—we tailor them to each person we support.

Thoughtful, Individualized Treatment

There’s no one-size-fits-all treatment here. Clinical excellence means we collaborate with you to create a therapy experience that aligns with your goals, values, and identity. We listen closely, adjust our methods as needed, and co-create a plan that fits your life. Whether you prefer structure or flexibility, short-term goals or deeper exploration, we’ll meet you where you are.

Cultural Humility & Inclusivity

We believe excellent therapy must be inclusive, affirming, and attuned to each client’s cultural context. That means acknowledging how experiences with race, gender, sexuality, body size, disability, and more shape your mental health—and how systems of oppression impact your care. Our team is committed to ongoing self-reflection, anti-oppressive practice, and creating a space where you feel seen, respected, and safe.

Ongoing Education & Training

Our team goes beyond what’s required to stay licensed. We’re continually expanding our knowledge through continuing education, certifications, peer-reviewed research, and supervision. This includes advanced training in eating disorders, neurodivergence, trauma, family systems, and other areas central to our clients’ lives. Clinical excellence means we’re always growing—so you can feel confident your therapist brings both experience and up-to-date expertise into your sessions.

Supervision & Peer Consultation

Behind every therapist is a support system. Our clinicians participate in regular peer consultation and supervision, where we bring cases (confidentially and ethically) to discuss challenges, share insights, and get feedback. This ensures we’re not working in isolation, and that your care benefits from the collective wisdom and experience of a thoughtful, dedicated team.

Outcome-Oriented & Reflective Practice

Therapy should help you feel better, not just go through the motions. That’s why we check in about what’s working, what’s not, and whether our approach still feels aligned with your needs. Clinical excellence means staying responsive: making changes when necessary, referring out when appropriate, and always centering your progress and well-being.

A Deeper Dive into Evidenced-Based Practices

While we’re committed to using evidence-based therapies, we also recognize that they’re not without limitations. Many EBTs were developed and tested in research settings that don’t fully reflect the diversity of real-life clients—including people of color, disabled folks, queer and trans communities, and those in larger bodies. This can lead to important gaps in how certain approaches resonate or how accessible they feel. In some cases, EBTs can also feel overly structured or rigid, especially when a client’s healing process doesn’t follow a neat, linear path. At our practice, we use these therapies as tools—not scripts. We integrate them with cultural responsiveness, lived experience, and clinical judgment to offer care that’s both effective and affirming. Therapy should never feel like it’s being done to you—it should feel like something we build together. Let's take a look at some of the approaches used at Libra Virtual Care.

Cognitive Behavioral Therapy – Enhanced (CBT-E)

CBT-E is a specialized form of Cognitive Behavioral Therapy designed specifically for people with eating disorders. It focuses on understanding and changing unhelpful thoughts and behaviors related to food, body image, and self-worth. CBT-E is flexible and can be tailored to different eating disorder presentations and co-occurring concerns like anxiety or perfectionism.

• Best for: Individuals with eating disorders, including anorexia, bulimia, and binge eating, across a range of body sizes and symptom presentations.

• When contraindicated: When clients are medically unstable, highly ambivalent about treatment, or have co-occurring conditions that need to be addressed first.

• Typical duration/length: 20–40 sessions, usually delivered weekly.

• Structure: CBT-E is structured in four stages: (1) Engagement and psychoeducation, (2) Addressing eating behaviors and thoughts, (3) Targeting maintaining factors like perfectionism or low self-esteem, and (4) Relapse prevention.

• Weight-neutral adaptations: We remove weight-focused interventions and instead center recovery around behaviors, flexibility, and quality of life. Language around “healthy weight” is reframed toward body trust and nourishment without size-based benchmarks.

Dialectical Behavior Therapy for Binge Eating (DBT-BE)

This adaptation of DBT is designed to support individuals who struggle with binge eating, especially when urges are tied to emotional overwhelm. DBT-BE teaches skills in four main areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These skills can help reduce binge episodes and build a more peaceful relationship with food and emotions.

• Best for: Individuals who experience binge eating episodes driven by emotional dysregulation or difficulty coping with distress.

• When contraindicated: When binge eating is primarily driven by dietary restraint rather than emotional regulation issues, or when clients are not yet ready to engage in structured skills practice.

• Typical duration/length: 20–30 sessions; may be adapted for ongoing care.

• Structure: Typically follows the DBT structure of four skill areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, with added focus on eating-related applications.

• Weight-neutral adaptations: We reject any use of weight loss as an outcome. Skills are taught to increase body respect, reduce shame, and support flexible, attuned eating rather than dietary control.

Family-Based Treatment (FBT)

Also known as the “Maudsley approach,” FBT empowers parents and caregivers to take an active role in their child’s eating disorder recovery. It’s an evidence-based model with strong research support for treating young people at home while keeping them connected to their daily lives and relationships. Our therapists provide structured guidance and support throughout all phases of treatment.

• Best for: Adolescents with anorexia, bulimia, or ARFID who have a supportive caregiving structure at home.

• When contraindicated: When caregivers are unable or unwilling to take an active role, or when home dynamics are unsafe or severely impaired.

• Typical duration/length: Roughly 6–12 months (about 20–25 sessions), depending on severity and pace of progress.

• Structure: Three phases: (1) Parents/caregivers take control of eating, (2) Gradual return of control to the adolescent (as developmentally appropriate), (3) Focus on identity development and relapse prevention.

• Weight-neutral adaptations: We avoid using “ideal weight” targets and instead focus on functional improvements and physical/emotional well-being. Caregivers are educated about weight stigma and encouraged to support recovery with compassion, not control.

  
  

Emotion-Focused Family Therapy (EFFT)

EFFT is a family-focused approach that equips caregivers with tools to help their loved one’s healing, even if the client is not actively in therapy themselves. It focuses on emotional coaching, repairing relational ruptures, and reducing family distress. We often integrate EFFT principles into sessions with parents or caregivers to create a more supportive environment at home, and often it is used in combination with FBT when supporting an adolescent client with an eating disorder.

• Best for: Families and caregivers who want to support a loved one’s healing from eating disorders, mood disorders, or other mental health challenges.

• When contraindicated: When family relationships are actively harmful or unsafe, or when caregivers are unable to engage in emotion coaching or self-reflection.

• Typical duration/length: Flexible; can be brief (4–8 sessions) or integrated into longer-term therapy.

• Structure: Focuses on four caregiver domains: emotional coaching, behavioral support, repairing relationship ruptures, and reducing self-blame.

• Weight-neutral adaptations: We coach caregivers to avoid moralizing food or bodies and instead model curiosity, compassion, and body respect. Emotional support is prioritized over “fixing” food or weight.

  
  

Acceptance and Commitment Therapy (ACT)

ACT helps clients build a life aligned with their values—even in the presence of difficult thoughts or emotions. Instead of trying to eliminate distress, ACT focuses on accepting internal experiences while committing to meaningful actions. This therapy can be especially helpful for those who feel stuck, disconnected, or at war with their thoughts.

• Best for:Individuals with anxiety, depression, eating disorders, or anyone feeling stuck in rigid thinking or avoidance.

• Contra:Less effective when individuals have difficulty tolerating experiential work or are in acute crisis and need immediate symptom relief first.

• Typical length: Often 12–24 sessions, but can be open-ended.

• Structure: Six core processes: present-moment awareness, cognitive defusion, acceptance, self-as-context, values clarification, and committed action.

• Weight-neutral adaptations: ACT helps clients move away from body-control goals and toward living in alignment with their values. We use defusion techniques to unhook from weight-focused thoughts and build body neutrality and respect.

  
  

Exposure and Response Prevention (ERP)

ERP is the gold-standard treatment for OCD and is also effective for Avoidant/Restrictive Food Intake Disorder (ARFID). It involves gradually and safely exposing individuals to anxiety-provoking situations while helping them resist the urge to engage in rituals or avoidance. Over time, ERP helps reduce fear and increase confidence in navigating triggering situations.

• Best for: Individuals with OCD, BDD, ARFID, and anxiety-related avoidance behaviors.

• Contraindications: When exposure work is done without consent or trust, or when co-occurring issues (like trauma) must be addressed first to prevent retraumatization.

• Typical duration/length: 12–20 sessions for moderate cases; longer for complex or severe presentations.

• Structure: Starts with building a fear hierarchy, then engages in gradual exposure to feared stimuli while resisting compulsions or avoidance behaviors.

• Weight-neutral adaptations: For food or body-related exposures (e.g., ARFID or body checking), we avoid reinforcing fatphobic narratives and instead focus on increasing flexibility, nourishment, and self-trust.

Radically Open DBT (RO-DBT)

RO-DBT is an evidence-based therapy for people whose coping style is marked by excessive self-control. This can look like perfectionism, rigidity, social withdrawal, or emotional inhibition. RO-DBT focuses on increasing openness, flexibility, and social connection—especially helpful for clients who don’t respond to more traditional therapies.

• Best for: Individuals with overcontrolled coping styles, including chronic perfectionism, anorexia nervosa (especially restrictive subtype), social isolation, or treatment-resistant depression.

• Contraindications: Not recommended for individuals in crisis or with severe emotional undercontrol (e.g., high impulsivity or suicidality).

• Typical duration/length: Usually 30+ weeks (individual and skills classes).

• Structure: RO-DBT focuses on three core themes: openness, flexibility, and social connection. Structured skills include self-enquiry, social signaling, and emotional expression.

• Weight-neutral adaptations: We shift focus away from rigidity around food, movement, or appearance, and explore how overcontrol may be reinforced by internalized weight stigma. Clients are supported in cultivating flexibility and body acceptance without moral judgment.

Why This Matters

Using evidence-based therapies means your care is informed by what works—not just what’s popular. It also means our team is trained, supervised, and committed to ongoing learning so we can match the right tools to your unique needs.

Whether you're navigating an eating disorder, anxiety, depression, or just feeling overwhelmed by life, we’re here to offer support that’s both affirming and clinically sound.

Ready to learn more?

If you have questions about these therapies or want to know which approach might be right for you, feel free to reach out. We're happy to match you with a therapist who’s trained in the best fit for your goals and experiences.