for New Patients
Disclaimer: This site is for information only and is not
intended as a substitution for psychiatric treatment.
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.
are many kinds of therapy available; among those I offer are:
therapy: an open-ended, explorative therapy.
behavioral therapy (CBT): an active, problem-solving approach.
collaborate with other therapists to provide medication for patients
who are in therapy elsewhere.
Brain, and Body:
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.
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.
better or worse, this inborn temperament is radically modified by
one's early childhood environment and later life experiences. The
most obvious examples are the deleterious effects of neglect, abuse,
or the loss of a loved one on the developing child. Traumatic events
can effect not only brain chemistry but also result in hormonal dysregulation.
Cortisol - a hormone which plays a major in modulating the immune
system and also affects neuroanatomical structures involved in memory
processing - can be dramatically altered in trauma. These changes
result in the debilitating symptoms of PTSD (post-traumatic stress
disorder). On the other side, a loving, empathic parent can help a
child overcome an anxious disposition that otherwise might severely
impair that child's healthy adaptation to the world.
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.
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.
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.
treatment addresses five fundamental areas of dysfunction:
Disturbances in affect or emotion.
Disturbances in cognition or thinking.
Disturbances in self-esteem or identity.
Disturbance in relations with others.
Inhibitions in sex, intimacy and work.
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 patientŐs thinking, he or she is actually better able to make
use of therapy and receive the insights treatment has to offer.
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.