About Renee Hoekstra, Psy.D.

Treatment philosophies and beliefs:

My treatment and training is informed by the behavior and contextual sciences, and I have training in Functional Analytic Psychotherapy, Acceptance and Commitment Therapy, Mindfulness based treatments, and Dialectical Behavioral Therapy. I align my theory and practice with the Association of Contextual and Behavioral Therapies (ACBS) that offers ongoing trainings and an annual conference. 

People tend to get services because they are in some kind of distress and are looking to reduce psychological suffering. A treatment agenda would target specific incidences/ repertories of psychological pain and track its occurrence both inside and outside of session. Specific, nonjudgemental descriptions of behavior are very important to help formulate treatment, elicit shared agendas for working together, provide a context from which to give feedback, reduce shame, and identify effectiveness of services. Effective treatment generally involves approaching something painful (increasing acceptance and tolerance of psychological distress) to reduce suffering and problematic responses in the long term.

Context/ History: Behavior arises in the context of our learning and developmental history; what we have been exposed to, the demands of our current environment/ persons that surround us, the events that have shaped and molded us/ impacted our lives/ made us who we are today. Behavior is continually being shaped and molded by complex contingencies within which we operate. Behavior (including private experience, such as emotions) is caused, evoked, shaped, extinguished, and reinforced. Behavior is not random and occurs for a reason, it is through analysis and assessment that we come to understand its occurrence in working to make our lives better.

Function: Because behavior makes sense in given contexts, it is important to understand what it does for us and what purpose it serves.  In what ways does problematic behavior need our attention? Many people believe that behavior happens “for no reason” and there is no “good reason” to behave the way they do. Understanding the function of behavior helps people with self-understanding, self-awareness, and the development of alternative responses to adapt and move through life more effectively.

What purposes do extreme, problematic, or highly emotional responses serve? What do they do for you, and are your responses to stress, pain, and anxiety effective? Do they help you adapt, cope, grieve, and move on or do they keep you stuck? Emphasis in treatment is about doing what works to reduce psychological distress. Many people tend to avoid addressing the question of how and if their current responses to life are currently working; rather they negate distress by avoidance, shaming, attacking, fixating on the need to be “right”, fixating on “why me”, blaming people for having feelings, or ruminating on “what is wrong with me.”

Behavioral– A behavioral point of view is simply that private experience (such as thoughts, opinions, feelings) is not finite, fixed, reified, or concretized. Sitting with uncertainty, tolerating the unknown, and being okay with oneself in the wake of grief, trauma, loss, and pain is part of a changing and complex, dynamic human experience. Behavioral sciences in general look more closely at context, environment, circumstances, and relationships to understand experience and activate change; and are less likely to attribute behavioral problems to blame, motivation, personality traits, or fault. After all, you can not change your past. Behavior is dependent on, related to, caused by, and maintained by a wide range of factors. Behavior does not happen in a vacuum and is subject to multiple influences. 

Everyone has suffering, and suffering is not unique to you. Because everyone has suffering, it is important to understand that the way people suffer and things that cause suffering are different for different people. Ordinary pain and sadness can often turn into suffering when people are isolated, think that “no one understands,” and people fail to acknowledge the ordinary pain and sadness of oneself or others. Unfortunately, lots of people spend a lot of energy avoiding psychological distress, to the extreme that they can not acknowledge its existence. Isolating oneself and others as “the only one/ ones” who has/have pain and distress is problematic and can create more depression, social isolation, and anxiety. Group therapy naturally pulls for reciprocal disclosure and vulnerability; creating an environment where the experience of “me too” is often reflected among its members. People often feel more connected to others when others share from their hearts, are open to their pain and sadness, and can receive and give without consternation.

Acceptance and Mindfulness. Acceptance and willingness to tolerate, bear with, be present with, and acknowledge ordinary pain and suffering is critical in grieving, growth, and survival. The unwillingness to accept reality inhibits a very normative grief process. 

General goals of treatment: General goals of treatment include helping people cope adaptively and function better in their natural environments. This generally includes increasing 1) Flexibility in thinking and behavior, or cognitive flexibility. This might include seeing things from different points of view, softening repertoires around focusing on the threat, finding self compassion in interpersonal problem solving, and increasing adaptive repertories for responding- being less “stuck”. The second goal, number 2) includes managing and regulating emotion (emotional regulation). As stress increases and emotions get intense, people tend to go into “fight or flight” mode and are less inclined to solve problems, attend to relationships, and access their inner wisdom and thinking mind. Alternatively, people who suppress and inhibit emotions spend a lot of their life not being in touch with what really matters. Cognitive and behaviorally rigid ways of responding often mirror problems with regulating mood and emotions. 

Additional Bits

I managed to get all of your cartoon elephants into one big book. Everything you need to know about your cartoon elephants (emotions!) has been condensed into a graphic how-to self-help book. Clinicians are using this book to teach emotion regulation skills from Dialectical Behavior Therapy, and to start discussions about emotions with individual clients. If you need a playful conversation starter about extreme and intense emotions, you need to buy this book. Here is the link to obtain your Cartoon Elephants. 

How is the last name pronounced? You will do fine if you say it “Hook-stra”, but if you are feeling particularly Dutch you can say it more like “Whook-stra”. It is not Ho-EK-stra, Hoke-stra, nor Hockstra, although I am rather forgiving if you don’t get it right.

I am a white, able bodied female (she, her, hers) who grew up with conservative roots but have worked towards adapting flexibility and inclusion of diverse populations. My continuing education and trainings have included working with transgendered individuals, BIPOC populations, and systemic racism. I do some part time work as a disability examiner working with highly marginalized and at risk populations. I have a pretty good track record for working with teenagers and young adults but I do not have children. 


Doctorate of Clinical Psychology/ Psy.D. (2007)
Pacific University, Forest Grove, OR

Master of Arts, Psychology (2001)
Seattle University, Seattle, WA/ Existential-Phenomenological program.