Treatment Philosophy

Each person is unique, so the approach I take in therapy is flexible and responsive. Some people need only a few sessions to make the changes they want in their lives. Other problems are long-standing and benefit from more exploration.

There are many kinds of therapy available; among those I offer are:

• Psychodynamic therapy: an open-ended, explorative therapy.
• Cognitive behavioral therapy (CBT): an active, problem-solving approach.

I also collaborate with other therapists to provide medication for patients who are in therapy elsewhere.

Mind, Brain, and Body:

Central to my treatment philosophy is the concept of mutualism as opposed to that of dualism (or nature versus nurture / mind versus brain). By mutualism, I suggest that the mind affects the brain and the body just as much as the body and brain affect the body. This theory has been validated in a numerous clinical studies which demonstrate through neuroimaging that therapy can affect the levels and distribution of neurotransmitters in ways similar to that of antidepressants.

Temperament refers to an individual's genetic heritage. It determines on a neurochemical and anatomical level one's primary modes of thinking, feeling and acting. Moreover, it affects a person's vulnerability to developing psychiatric illnesses such as depression, bipolar disorder, panic attacks and even substance abuse. For example, recent studies show that alterations in the gene for the serotonin transporter increases the likelihood that a person will develop a major depressive episode in response to external stressors. Someone with other vulnerabilities might respond to the same stressors with anxiety, symptoms of obsessive-compulsive disorder, or even psychosomatic illness.

Biochemisty and personality cannot be separated. The person who suffers from the inhibitions of chronic depression or the instability of a bipolar temperament has no choice but to build his or her personality around it. The resulting personality inevitably reinforces the original temperament. For example, the depressed person will develop a negative self-image that makes it difficult to establish friendships or pursue long held ambitious. This persistent failure to obtain satisfaction from one's life validates the person's low self-esteem and further perpetuates the depression. Similarly, when a person develops depression in adulthood, these chemical changes will significantly distort that person's personality during the episode - the extrovert becomes the introvert, the optimist becomes the pessimist.

In summary, chemistry affects the way a person thinks which affects the way a person behaves which affects the way a person feels which affects a person's chemistry.

Treatment Implications:

The reasons that people seek treatment are as diverse as the people themselves. Not everyone needs or benefits from medications, not everyone needs therapy, and some people benefit most from a combined treatment. In order to determine the best treatment modality, it is essential to do a full diagnostic assessment. This includes not only a detailed history of current symptoms and areas of difficulty, but also medical co-morbidities, and perhaps more importantly, a thorough exploration of the person's life story. Understanding how current problems fit into the broader context of a person's life is essential for true healing and lasting change. The present can only be understood as it relates to the past.

Psychiatric treatment addresses five fundamental areas of dysfunction:

(1) Disturbances in affect or emotion.

(2) Disturbances in cognition or thinking.

(3) Disturbances in self-esteem or identity.

(4) Disturbance in relations with others.

(5) Inhibitions in sex, intimacy and work.

Disturbances in affect include the predominant biochemical disorders such as panic attacks, depression, and bipolar disorder. Disturbances in thinking include problems with concentration, organization, obsessional thoughts and compulsions, paranoia and impairment in reality testing. These first two areas are usually but not always an indication for medication treatment. The later three areas are best addressed through psychotherapy. In the past, the use of medication in psychotherapy was considered counterproductive. Anxiety or depression was considered essential for providing the motivation for treatment and change while medication was seen as simply masking the deeper problems. By contrast, current practice recognizes that treating underlying neurochemical imbalances actually enhances the therapy. By freeing the patient from the distortions that these imbalances impose on the patientÕs thinking, he or she is actually better able to make use of therapy and receive the insights treatment has to offer.

The goals of treatment are the relief of distressing symptoms, restoration of emotional balance and clarity of thought, deeper self-awareness and improved self-esteem regulation, more stable and intimate relationships, and a healthier, more satisfying life experience. A successful treatment is one that helps a person not only feel like him or herself again (or for the first time), but one that gives that person a greater sense of control over his or her life, a richer emotional experience, and greater sense of personal freedom.