Getting started and treatment approach           

When should you think about coming in for a consultation?

Here is a shortened list of reasons for which people have sought a professional evaluation in my practice:

1. ✓an increasing difficulty feeling motivated to pursue goals or a decreasing sense of meaning about life commitments or direction;
   

2. ✓a concern about being in an impasse in a relationship or feeling stuck in patterns of dating;
   

3. ✓a sense that happiness is seldom experienced, compared with others;
   

4. ✓worries about the potential for self-sabotage;
   

5. ✓a tendency to brood about past events or decisions;
   

6. ✓worrying about things when others see no need for worry;
   

7. ✓a sense of loneliness despite having others in your life;
   

8. ✓questioning how and why life is turning out differently than expected;
   

9. ✓concerns about winding up regretful about current decisions (or lack of decisions);
   

10. ✓curiosity about whether a medication for anxiety or depression might help in ways that previous counseling or therapy hasn’t.
    

 

What happens in a consultation?

A consultation, which typically takes place over one or two visits, consists of an in-depth history, assessment of your current concerns and psychological health, and discussion of treatment options such as psychotherapy or medication treatment.  These options may include referrals to colleagues, therapies, or local resources with specific expertise that match your needs.  My evaluations, recommendations, and treatment are based on over 40 years of teaching, research, and adapting evidence-based medical findings to the unique circumstances of each individual’s life.

What type of psychotherapy do I practice?

In general, I practice a type of psychotherapy called “dynamic” or “insight-oriented” therapy that helps individuals examine their conflicts and inhibitions that often underlie feelings of worry, regret, guilt, anger, or sadness and thereby prevent a greater sense of well-being.  My underlying philosophy is that people make the best choices they can given the limitations of their assumptions and that psychotherapy provides an opportunity to realize what those assumptions are, examine them, and make better choices for their lives (as stated by my colleague Tom Kranjac, M.D.).

Psychotherapy is also a professional relationship that leads patients to experience an enhanced sense of control, meaning, and coherence in their lives and life stories.  And in this day and age, it’s also one of the last refuges of “low tech” human engagement -- i.e., the experience of a live conversation with another person sitting in the same room as you.  This can serve as an antidote to the new “e-intimacy” that is becoming ubiquitous in our lives. Real Talk Isn’t Cinematic (R Kertzner, NY Times)

What is my philosophy about prescribing medications?

Not everyone needs to be on a medication, which, when prescribed, I typically suggest for anxiety or depression.   Sometimes, however, medication treatment speeds up the process of feeling better.  Recent research suggests that a combination of psychotherapy and medication treatment may offer the best results for the treatment of depression.

These days, there is a wide choice of medications, many of which have minimal side effects.  The conversation about if a medication would be helpful, how to think about medication benefits versus side effects, and what is an optimal combination of medication monitoring and  psychotherapy is often an important part of the consultation process.  These conversations are guided, in large part, by findings published in medical journals, but are also guided by clinical experience and your preferences.