River Lake Clinic

Our Services

Psychological Services

Anxiety disorders
Everyone feels anxious from time to time. Stressful situations such as meeting tight deadlines or important social obligations often make us nervous or fearful. Experiencing mild anxiety may help a person become more alert and focused on facing challenging or threatening circumstances.
But individuals who experience extreme fear and worry that does not subside may be suffering from an anxiety disorder. The frequency and intensity of anxiety can be overwhelming and interfere with daily functioning. Fortunately, the majority of people with an anxiety disorder improve considerably by getting effective psychological treatment.
What are the major kinds of anxiety disorders?
There are several major types of anxiety disorders, each with its own characteristics.
  • People with generalized anxiety disorder have recurring fears or worries, such as about health or finances, and they often have a persistent sense that something bad is just about to happen. The reason for the intense feelings of anxiety may be difficult to identify. But the fears and worries are very real and often keep individuals from concentrating on daily tasks.
  • Panic disorder involves sudden, intense and unprovoked feelings of terror and dread. People who suffer from this disorder generally develop strong fears about when and where their next panic attack will occur, and they often restrict their activities as a result.
  • A related disorder involves phobias, or intense fears, about certain objects or situations. Specific phobias may involve things such as encountering certain animals or flying in airplanes, while social phobias involve fear of social settings or public places.
  • Obsessive-compulsive disorder is characterized by persistent, uncontrollable and unwanted feelings or thoughts (obsessions) and routines or rituals (compulsions) in which individuals engage to try to prevent or rid themselves of these thoughts. Examples of common compulsions include washing hands or cleaning house excessively for fear of germs, or checking work repeatedly for errors.
  • Someone who suffers severe physical or emotional trauma such as from a natural disaster or serious accident or crime may experience post-traumatic stress disorder. Thoughts, feelings and behavior patterns become seriously affected by reminders of the event, sometimes months or even years after the traumatic experience.
Symptoms such as extreme fear, shortness of breath, racing heartbeat, insomnia, nausea, trembling and dizziness are common in these anxiety disorders. Although they may begin at any time, anxiety disorders often surface in adolescence or early adulthood. There is some evidence that anxiety disorders run in families; genes as well as early learning experiences within families seem to make some people more likely than others to experience these disorders.
Why is it important to seek treatment for these disorders?
If left untreated, anxiety disorders can have severe consequences. For example, some people who suffer from recurring panic attacks avoid any situation that they fear may trigger an attack. Such avoidance behavior may create problems by conflicting with job requirements, family obligations or other basic activities of daily living.
People who suffer from an untreated anxiety disorder often also suffer from other psychological disorders, such as depression, and they have a greater tendency to abuse alcohol and other drugs. Their relationships with family members, friends and coworkers may become very strained. And their job performance may decline.             
Information taken from APA
How can licensed psychologists help someone suffering from an anxiety disorder?
Dr. Sandra is highly trained and qualified to diagnose and treat people with anxiety disorders using techniques based on many years of experience. Psychologists' extensive training includes understanding and using a variety of psychotherapies, including CBT.
Depression and How Psychotherapy and Other Tratments Can Help People Recover

According to the National Institute of Mental Health, an estimated 17 million adult Americans suffer from depression during any 1-year period. Depression is a real illness and carries with it a high cost in terms of relationship problems, family suffering and lost work productivity. Yet, depression is a highly treatable illness.
How Does Depression Differ From Occasional Sadness?
Everyone feels sad or "blue" on occasion. It is also perfectly normal to grieve over upsetting life experiences, such as a major illness, a death in the family, a loss of a job or a divorce. But, for most people, these feelings of grief and sadness tend to lessen with the passing of time.
However, if a person's feelings of sadness last for two weeks or longer, and if they interfere with daily life activities, something more serious than "feeling blue" may be going on.
Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. People who are depressed may become overwhelmed and exhausted and may stop participating in their routine activities. They may withdraw from family and friends. Some may even have thoughts of death or suicide.
What Causes Depression?
There is no single answer to this question. Some depression is caused by changes in the body's chemistry that influence mood and thought processes. Biological factors can also cause depression. In other cases, depression is a sign that certain mental and emotional aspects of a person's life are out of balance. For example, significant life transitions and life stresses, such as the death of a loved one, can bring about a depressive episode.
Can Depression Be Successfully Treated?
Yes, it can. A person's depression is highly treatable when he or she receives competent care. It is critical for people who suspect that they or a family member may be suffering from depression seek care from a licensed mental health professional who has training and experience in helping people recover from depression. Simply put, people with depression who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen a depression; therefore, the importance of getting appropriate help cannot be overemphasized.
How Does Psychotherapy Help People Recover from Depression?
Several approaches to psychotherapy, including cognitive-behavioral, interpersonal, and psychodynamic, help depressed people recover. Psychotherapy offers people the opportunity to identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal and situational causes. Skilled therapists can work with depressed individuals to:
Pinpoint the life problems that contribute to their depression and help them understand which aspects of those problems they may be able to solve or improve
A trained therapist can help depressed patients identify options for the future and set realistic goals that enable them to enhance their mental and emotional well-being. Therapists also help individuals identify how they have successfully dealt with similar feelings if they have been depressed in the past.
Identify negative or distorted thinking patterns that contribute to feelings of hopelessness and helplessness that accompany depression
For example, depressed individuals may tend to overgeneralize, that is, to think of circumstances in terms of "always" or "never." They may also take events personally. A trained and competent therapist can help nurture a more positive outlook on life.
Explore other learned thoughts and behaviors that create problems and contribute to depression
For example, therapists can help depressed individuals understand and improve patterns of interacting with other people that contribute to their depression.
Help people regain a sense of control and pleasure in life
Psychotherapy helps people see choices as well as gradually incorporate enjoyable, fulfilling activities back into their lives.
Having one episode of depression greatly increases the risk of having another episode. There is some evidence that ongoing psychotherapy may lessen the chance of future episodes or reduce their intensity. Through therapy, people can learn skills to avoid unnecessary suffering from later bouts of depression.

In What Other Ways Do Therapists Help Depressed Individuals and Their Loved Ones?
The support and involvement of family and friends can play a crucial role in helping someone who is depressed. Individuals in the "support system" can help by encouraging a depressed loved one to stick with treatment and practice the coping techniques and problem-solving skills he or she is learning through psychotherapy.
Living with a depressed person can be very difficult and stressful on family members and friends. The pain of watching a loved one suffer from depression can bring about feelings of helplessness and loss. Family or marital therapy may be beneficial in bringing together all the individuals affected by depression and helping them learn effective ways to cope together. This type of psychotherapy can also provide a good opportunity for individuals who have never experienced depression themselves to learn more about it and identify constructive ways of supporting a loved one who is suffering from depression.
Information taken from APA

Testing, Psychotherapy for individuals and marriages
Coming soon

Routine Eye Care
Comprehensive eye examinations are important for many reasons.  It is best for patients to at least have an annual comprehensive eye examination and more frequently as ordered by your eye doctor or as needed given any problems with or changes in vision.  During a comprehensive eye examination, your eye doctor may discover sight threatening vision problems, such as glaucoma or a retinal detachment, which be present in a patient without the patient even knowing there was a problem.  Early detection of visual problems helps prevent blindness.  When an eye problem is discovered early enough and through annual eye examinations, your eye doctor may be able to take steps to save your vision.  For many patients, the annual eye examination is geared at enhancing their vision and maximizing comfort.  A person's eyes are not supposed to burn, itch, or be red.  A person should not have blurred vision just because they are getting older.  Your eye doctor can help address these problems.  Please call 612-722-1003 to schedule your appointment today. 

Contact Lenses
Let our eye doctors help you navigate the complex and ever changing world of contact lenses. Properly fit contact lenses should provide exceptional vision and all-day comfort.  Come in and get fit properly so your contact lens are the most comfortable they can be.  Many patient's prefer the health benefits and convenience of daily wear lenses, which are worn for only one day and then discarded.  Certain patients benefit from full-scleral, corneoscleral, multifocal, or monofocal fitting, and we will discuss what lenses are best for you and how we will insure you are happy with the vision and comfort of your contact lenses.  We can evaluate your current contact lenses at your annual examination or begin the process of refitting you into an even better lens today.  Please mention you are currently or are considering being a contact lens wear when making your appointment by calling 612-722-1003.

Although proper contact lens cleaning, storage, insertion, wear, and removal should insure complication free wear, if vision changes, redness, or discomfort with your lenses occurs, we stand ready to address any contact lens related complications.  If you experience any redness, pain, or change in vision with your contact lenses, discontinue wear and schedule an appointment.

Diabetes has been one of the leading causes of new blindness in the USA. The pathophysiology of diabetic retinopathy centers on the leakage of blood fluids into parts of the retina, which then causes structural damage. Other conditions that are related to diabetes include diplopia or double vision. An annual examination of the eye is absolutely essential in every diabetic or pre-diabetic patient. Your primary care physician will receive a written report from River Lake Clinic every year. 
The best monitoring of retinal health in the diabetic patient is achieved by using the best technology available. In addition to a dilated fundus exam, we utilize spectral-domain optic coherence tomography to analyze retina edema (fluid leakage into the retina). If there is overt leakage, we have Autofluorescence to detail the amount, position, and size of leaking capillary beds. With decades of experience in monitoring of diabetic patients and the best technology available, River Lake Clinic optometrists are positioned to provide you with the best monitoring of retinal health and the appropriate treatment if that is required.

Corneal Conditions
There are many conditions that affect the cornea (clear front ‘window’ of the eye). A short list would include: herpetic keratitis, keratoconus, corneal dystrophies, corneal guttae, Fuch’s dystrophy, and infectious and inflammatory conditions. This tissue is the most important optical component of your eye. Damage to this tissue causes severe loss of clarity of vision.
River Lake Clinic optometrist have decades of experience in the treatment of corneal disease. Our experience includes the use of therapeutic contact lenses for optically compromised corneas and the medical treatment of keratitis, herpetic keratitis, marginal keratitis, limbic keratoconjunctivis and other infectious or inflammatory conditions.
We are currently using Endothelial Specular Microscopy as an evaluative method of assuring corneal health in any patients requiring such specialized imaging, such as in the evaluation of corneal guttae and for Fuch’s dystrophy patients. This technology allows us to evaluate our treatment choices to assure the best possible outcomes for our patients. 

Macular Degeneration
Macular degeneration affects nearly one in three Minnesotans over the age of sixty-five. It causes significant vision loss is many patients. The loss can be as severe as making it impossible to identify the face of your children or grandchildren. The best time to initiate treatment of this condition is at the earliest possible detection of macular disruptions. The most advanced imaging technology for the eye is OCT (optical coherent tomographty) and at River Lake Clinic we use the Spectralis OCT, considered to be one of the very best OCT devices in the world.
Our aim is to offer care based upon prevention of progression of a devastating disease at the earliest possible stage of the disease. A family history of macular degeneration in your parents or grandparents places you at risk for this disease. If you have a family history that is positive for macular degeneration, please advise us at your annual evaluation.
In 2009, River Lake Clinic optometrist, Dr. Mike Hanen-Smith, gave a lecture on “Vitreo-retinal Adhesions as an Etiology for Maculopathies”. This lecture detailed the importance of the vitreous and vitreous floaters in the development of macular problems. If you experience a change in your floaters, or the presence of an unusual or obnoxious floater, or distortions in your perception of the world, you should schedule an evaluation at our clinic.

Glaucoma is a multi-faceted disease process, which causes vision loss unless treated. The management of these diseases has to be approached from the multiple factors that cause the disease.
Family history, high blood pressure, exposure to Agent Orange, vascular disease including occlusions, or diabetes places you at risk for these diseases. Please set up an appointment for evaluation if you have any of these issues in your personal history. One sector of the glaucomas is narrow angle glaucoma, which can cause an ‘attack’. Symptoms of a narrow angle attack include: sudden onset of marked eye pain, red eye, poor vision, a semi-dilated pupil that is poorly responsive to light and often nausea.. This is usually in one eye. Immediate care should be sought.
Highly technical evaluations for the glaucoma family of diseases include confocal scanning laser, spectral-domain optic coherence tomography, visual evoked potentials, threshold visual fields, anterior segment imaging, and extensive family and medical history. River Lake Clinic utilizes all of these technologies. 
River Lake Clinic optometrist, Dr. Mike Hanen-Smith, has given lectures on glaucoma at educational meetings for optometrists throughout the Midwest, and has publications on this topic. 
We take an aggressive approach to comprehensive treatment of the glaucomas. Please consider our clinic for the management of any of the glaucomas, or if you are in a high risk group for glaucoma.

Beginning with INFANT SEE ®, River Lake Clinic optometrists provide you with peace of mind when it comes to your children. The first recommended eye examination is actually during the first year of life, and we do it for free under the INFANT SEE ® program. This program is like a wellness examination for your baby’s eyes and vision.
Pediatric eyecare entails the careful monitoring of vision, beginning as a baby and continuing on an annual basis through your child’s formative years. During these years, we will be evaluating the normal development of visual abilities or visual skills that fall into functional vision. Convergence, accommodation, and alignment are basic skills required for the visual system to perform in school. These develop during the formative years. As parents, we ask that you look for signs of visual distress: rubbing eyes especially after doing near point visual tasks, redness of eyes in the afternoon when each morning the eyes are clear, clumsiness after a time when coordination should be better than it is, double vision, skipping words or letters, and re-reading lines in a book. These are all signs and symptoms of inadequate visual abilities. Please notice that blurred vision was not listed since that is a symptom of ametropias. These include: myopia, hyperopia, and anisometropia which all contribute to inadequate development of visual skills. Strabismus (crossed eyes) may be present at birth, but usually begins between ages 2 through 5 years old. An immediate evaluation should be done. Please call us for that appointment if you think your child has a deviated eye(s).
Your children will acquire up to 80% of their knowledge from the visual system. Good vision, good visual skills, and proper care of vision all contribute to a productive school experience. The school screening system is not an acceptable alternative to a comprehensive eye examination and in many states the student is required to have an actual eye examination by doctors. That is not required in Minnesota at this time, but River Lake Clinic optometrists strongly recommend that you provide your child with a comprehensive evaluation by having us do annual examinations. The signs and symptoms listed above are the same ones that school age children will experience if they have visual issues affecting their learning
Vision training (or VT), or binocular training, or sports vision therapy, or behavioral optometry, or orthoptics is the use on specific techniques to train or re-train the visual skills required for clear, single, and comfortable vision. River Lake Clinic optometrists have provided vision training in excess of forty years to our patients. This is a complex area and long standing expertise is helpful in establishing techniques and therapy that works.  
River Lake Clinic optometrists take the care of your children as a cornerstone of our commitment to provide comprehensive, most technologically advanced, and highest quality of eye care available. What the visual system learns in childhood will affect your life forever.

Optical Center
River Lake Clinic is a premier eye care facility in the Twin Cities. We are dedicated to providing excellent patient care and optical services. We look forward to meeting you and taking care of your vision needs. Please see our Optical Service at River Lake Clinic for more information.