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I specialize in working with difficult clinical problems requiring expertise in one or more of the following areas:
- Psychiatric assessment and treatment of adults, adolescents, and children
- Medical-psychiatric treatment coordination
- Psychopharmacology (medication) and focused psychotherapy
- Family systems, including family and marital therapy, as well as parental guidance
- Cognitive-behavioral techniques designed to modify problematic thought patterns or behavior
- Neurology and neurobiology
Psychiatric issues are almost always complex! A person’s welfare — his or her occupation, as well as children and family — may be on the line. At times the problem is straightforward, such as a depression or anxiety disorder, but more often there are important contributions from other sources. I work with my patients and their families to make sense of these problems, including the causes and the reasons they are not resolving. Together, we address all the important psychiatric, medical, psychological, and social issues. I evaluate the patient, confer with any needed specialists, create and implement treatment plans, and write successive reports, formally tracking 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 more likely to be accurate and treatment distinctly more on target.
For example, take Sally, a nine-year-old who adults describe as bright and personable but has 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. In this situation, to what extent are we dealing with Sally’s problems and to what extent with the product of the parents' marital discord? Further complicating her condition, Sally has a congenital heart defect. An added requirement in working with her, then, is that the treating person routinely communicate with the involved medical professionals.
Think also about Mark, a highly trained chemist, who 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. Such a good family, loving and smart. What could be happening?” 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 the marriage, not just Mark, needs professional attention.
Or consider thirty-four-year-old Susan, who is adopted and has Tourette’s Syndrome. Her facial tics make her hard to look at when conversing with her. Her adoptive father didn’t bargain for this grotesque problem. His attacks on Susan, expressing his disappointment, contrast starkly to the manner in which he treats his other three, biological children. Susan claims that if it weren’t for these attacks, she would be perfectly okay. The father maintains that he has treated all of his children equally, without prejudice. Who is the patient here: Susan, the father, or both? Also, what can be done to mitigate Susan’s tics?
My point is that the person delivering treatment needs to be well trained, not only thoughtful and intuitive. Good sense and judgment obviously count, and usually count a lot, but think about the other parts. Essential elements include the range and depth of the clinician’s experience, biases, and willingness to look for verification that progress is occurring.
Clearly, finding the right treating person 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 or psychological treatment. Imagine the implications of beginning to treat someone with a medical problem or a brain-based learning disorder after looking only at their psychological needs. Even more, consider the potential impact of unmonitored talk therapy, continuing for months or years - with no attempt made to see if the treatment is producing results.
These issues can be reliably addressed through a rigorous initial evaluation, clinician-patient collaboration, and ongoing monitoring of progress within the treatment. My method uses such an approach. The treatment recommendations that result from this kind of evaluation can be manifold. They typically include, but are generally broader than, problem-focused psychotherapy. Medication and other medical measures are used as needed. In addition, consultations with other, appropriate specialists are included as required.
This is an outline of the principles by which I work. I have written extensively about them in my four books and professional articles. For more about the services I provide, please visit my Services page or view my Collaborative Psychiatry Method fact sheet. I have thirty-five years of experience. In addition, I have available a close-knit group of experienced clinicians at the Center for Collaborative Psychiatry, Psychology, and Medicine with whom I meet regularly to discuss clinical and theoretical matters.
This group includes a psychologist skilled in psychological assessment, a neuropsychologist, a neurologist, and another psychiatrist. Backing me up are also a number of seasoned psychotherapists who have participated in my consultation groups.
To learn more about my services or explore the possibility of working with me, please call (415) 456-6611 or email me by clicking on this link.
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