How I Work
I work differently from most psychiatrists. I can and do provide traditional medication management and psychotherapy for adults, families, and children. However, I generally take a more comprehensive approach, making sure to include full consideration of all relevant issues, people, and influences impacting a person’s life. My objective is to eradicate the problem, not just the symptoms. I specialize in the assessment and treatment of complex or otherwise difficult psychiatric and medical-psychiatric problems.
The complexity of psychiatric and psychological problems:
Psychiatric issues are almost always complex! A person’s welfare — his or her occupation, children, or family — may be on the line. At times the problem is straightforward, such as in the case of an uncomplicated depression or anxiety disorder, but often there are important contributions from other sources. I work with my patients and their families to make sense of these problems. Together, we address the important psychiatric, medical, psychological, and social issues. I evaluate the patient, confer with needed specialists, create and implement a treatment plan, and formally track the treatment.
When a person’s psychiatric or medical-psychiatric condition is complicated, the opinion of a single professional, working alone, may be insufficient to determine the best approach to treatment. In situations like these, I work together with other specialists who can perform needed testing and provide appropriate services. As required, I assemble and coordinate a treatment team, with the patient and his or her family as integral members. By working in this comprehensive way, diagnosis is likely to be more accurate and treatment distinctly on target.
Examples of the kinds of problems I work with (names and other identifying information disguised). While not included in the text two of the three patients have been treated with medication:
A forty-five-year-old man and his family:
Mark, a highly trained forty-five-year-old chemist, becomes depressed and begins to drink at night. His teenage son, the captain of his high school basketball team, was just arrested for vagrancy. His son’s teachers “just don’t understand why this is happening. Such a good family, loving and smart. What could be going on?” In the first meeting, Mark reveals that he has received a warning that his job may be on the line, marking the beginning of a convoluted process of self-reflection and remediation for him. Mark’s wife also insists that, while she and Mark have a “strong and loving relationship,” communication within the marriage and not just Mark needs attention.
An eleven-year-old girl with rages:
Sally is an eleven-year-old who adults describe as “bright and personable” but as having rages at home that are getting worse. She also has a number of compulsive rituals that keep her from getting her schoolwork done on time. Her parents’ relationship is stormy. They disagree about most things, including how to understand and handle Sally. One says she needs more discipline, the other that she requires more love and tolerance. To what extent are we dealing with Sally’s problems and to what extent is her behavior the product of the parents’ marital discord? Further complicating her situation, Sally has a congenital heart defect. An added requirement in working with her, therefore, is routine communication with the involved cardiologist and internist.
A socially isolated twenty-seven-year-old:
Twenty-seven-year-old Susan was adopted at 3 months of age. She has Tourette’s syndrome and isolates herself socially. Her facial tics give her an odd appearance. Her adoptive father didn’t bargain for this “grotesque” problem. His verbal attacks, expressing his disappointment with Susan, contrast starkly with the manner in which he treats his other three biological children. Susan claims that if it weren’t for this “abusive treatment,” she would be perfectly okay. The father maintains that he has treated all of his children equally, without bias. It is difficult to tell who is most in need of treatment here: Susan, the father, or both? Also, what can be done to mitigate Susan’s tics?
What effective psychiatric treatment requires:
The professional administering psychiatric treatment needs to be well trained, not just thoughtful and intuitive. Good sense and sound judgment obviously count, but consider the other parts. Essential elements include the range and depth of training and experience, willingness to obtain other opinions, and verify that progress is occurring
Clearly, finding the right psychiatrist is not just a matter of luck. A good personal match between that person and the patient means a great deal. But beware — that is not all there is to effective psychiatric treatment. Imagine the implications of beginning to treat someone with a problem that is primarily medical or a brain-based learning disorder after considering only their psychiatric needs.
These issues can be reliably addressed through a rigorous initial evaluation, collaboration with the patient’s family and other needed professionals, and ongoing monitoring of progress within treatment. I use such an approach. The resulting treatment can take a variety of forms, but generally include medication and/or psychotherapy.
These are the principles by which I work. I have written extensively about them in my books and professional articles. For more about the services I provide, please visit my Services page. I have over thirty-five years of experience. In addition, I have available a close-knit group of experienced clinicians including psychiatrists, primary care and specialist physicians, and psychologists. We meet regularly as the Center for Collaborative Medicine, psychiatry, and Psychology to discuss clinical matters .
