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I offer evaluation and treatment for a wide range of psychiatric needs. I draw from a
treatment repertoire that includes time-limited or in-depth psychotherapy, biological treatment and medication, and cognitive-behavioral remediation. This treatment is always focused
on the problems for which you came to see me.
The services I offer include:
Psychiatric Evaluation & Treatment Planning
A psychiatric evaluation is recommended for people who find themselves struggling with anxiety, depression, or any other emotionally-related problem. An evaluation usually starts with two to four 1 1/2 hour meetings, during which I take a history and get to know you. At this time I will also review your medical records. School reports and employment records may also be relevant. We may decide to arrange interviews with other members of your family. Consultations from other medical specialties or areas allied to psychiatry and psychology, such as education, may be desirable. The evaluation is carried out collaboratively with you as a full member of the treatment team.
Treatment recommendations following the full evaluation often include psychotherapy. This
psychotherapy is always focused and goal-directed, targeted to the problems you want most to have addressed
in treatment. In this process, you and I will work to
uncover the disruptive events in your life, attempting to understand how they may be implicated in the
development of the behavior patterns or symptoms you would like to change. We will then work together to
undo their influence. Whether we use medication will, of course,
depend on the kinds of problems to be addressed and your preferences.
Whenever possible, the clinical evaluation is accompanied by a neuropsychological or psychological assessment administered by a skilled psychologist. This evaluation is intended to contribute to the accuracy of diagnosis and the formulation of treatment goals. These psychological tests are analogous to the laboratory and radiological tests that an internist routinely uses to guide medical treatment. The psychologist can be re-involved periodically throughout the treatment to provide data about treatment progress, and again at critical points to provide new data for directing the treatment.
The evaluation involves three phases, and the complete evaluation and
treatment consists of five:
Phase 1 - Introduction, orientation, and initial data gathering: This phase is usually
completed in two to four meetings.
Phase 2 - An in-depth clinical evaluation by me, and, when possible, a psychological or neuropsychological evaluation: At the end, the psychologist or neuropsychologist who does the testing provides a report documenting his or her findings and participates in one or more feedback sessions. The result of this phase is a diagnosis and treatment plan, including a range of possible treatment strategies. The objective of the next phase, when it can be included, is to test out these strategies and boil them down to a core treatment approach.
Phase 3 - [optional] Trial implementation of the treatment strategies identified in
Phase 2: The objective of this trial phase is to arrive at a final, goal-directed treatment plan based
on which strategies promise to be most effective. At the end of Phase 3 we will evaluate the
effectiveness of our work to that point. This appraisal may be clinical or both clinical and test-based. During this phase
we will also, together, assess your readiness to participate fully in the anticipated treatment.
Phase 4 - Treatment proper: While focused treatment is being implemented, all through phases
1-3, it can now continue in a more efficient and goal-directed way. "Goal-directed" means that the
problems we have identified as central are targeted. Treatment progress will be monitored regularly.
At each point of monitoring, treatment strategies may be
revised in accordance with your changing requirements. Focused evaluation and treatment is frequently
completed in 9 to 24 months.
Phase 5 - Transfer of care or conclusion of treatment and followup: Before the end
of treatment, a selected battery of psychological or neuropsychological tests may be administered
to verify that the treatment is reasonably complete and to formulate plans for followup.
There are two possible options at this point. The first is the described termination of treatment and
followup. The second, if additional psychotherapy or supportive management is needed, we may decide together to arrange for the transfer of your care. This step is always taken collaboratively, a result of discussions between you and me. I always have a number of excellent psychotherapists who we have trained at the Center for Collaborative
Psychology and Psychiatry available for referral.
During the course of an evaluation, I will write at least two reports for you to use as you see fit. They will not be given to others unless you ask me to do that.
The first report, which is relatively brief
and practical, is completed after the initial clinical evaluation and
assessment. It precedes the report of the testing psychologist or neuropsychologist (end of Phase 2).
This report will provide a diagnostic
impression and a provisional treatment plan. The second report will contain a more definitive
diagnostic statement and treatment plan (end of Phase 3). The treatment referred to here is focused
and goal-directed, aimed at addressing the main problem(s) for which you sought help. It is intended
to be time-limited and its duration dependent on the satisfactory resolution of those difficulties.
A third, optional, report can be requested
at the end of treatment. Other reports will be written whenever they can facilitate the work we are doing.
Collaborative Psychiatry Procedure
Most of my clinical work is performed according to the comprehensive treatment approach developed by my colleagues and me at the Center for Collaborative Psychology and Psychiatry. Each of these treatment procedures is designed to provide a precise and effective diagnostic assessment and focused treatment. Goal-directed treatment is carried on to a point where the major problems for which you came to treatment are satisfactorily resolved. All our work is formally monitored, using appropriate check-lists, self-assessment instruments, and, as possible, selected neuropsychological and psychological tests. To learn more about this approach, please visit the Center for Collaborative Psychology and Psychiatry website,
click here for a detailed description of the Collaborative Psychiatry Procedure or read my books and published articles, several of which can be accessed from this website.
Psychiatric Treatment
The focused psychiatric treatment I provide has both psychiatric and psychological components. As a psychiatrist, I have training and experience in the use of medication and biological psychiatry. I also have extensive experience in both general and child psychotherapy, and in psychoanalysis (a traditional in-depth psychotherapy technique).Unique to my approach is the ongoing use of psychological or neuropsychological assessment to assure that the treatment plan is well-formulated, on track, and progressing at an acceptable rate.
Neuropsychological or Psychological (Personality) Assessment
While some of the tests and check lists we may use are self administered, much psychological or neuropsychological testing requires the skill of an experienced psychologist or neuropsychologist. Each test battery is uniquely configured for each patient. The tests used range in complexity from the mentioned self-assessment instruments (like the MMPI-II) to those designed to bring out the subtleties of a person's inner life. Neuropsychology is a psychological specialty focusing on brain-based disorders, including those that affect attention, learning, memory, organization, and planning. I work closely with the psychologist or neuropsychologist as he or she integrates findings with our developing treatment plan.
These evaluations are conducted collaboratively between you, me, and a psychologist-assessor, with you involved as an equal partner. The psychologist-assessor provides a clinical and test-based perspective. This additional perspective is similar to getting a second opinion in medicine. Protocols for these assessments are described in detail in my newest book Evidence from Within: A Paradigm for
Clinical Practice.
Medication
I will include medication in your treatment whenever appropriate. Medication for disorders such as depression often does wonders, but not always and not necessarily indefinitely. Numerous studies show that it is often most effective when combined with a well-strategized, collaborative interpersonal psychotherapy. Of note is that I spent a year and a half as a post-graduate fellow at Stanford doing research in pharmacology and continue this focus in my current research and writing.
Collaboration with Other Specialists
Specialized consultations may be required to enrich the diagnostic and treatment process. As part of your treatment I may want to consult with other professionals, such as experts on learning difficulties or occupational counselors.
Add to this list consultation with other medicalspecialists. Medical considerations are an indispensible part of a psychiatric evaluation. Not every psychiatric disorder reflects an emotional problem. For example, commonly encountered medical conditions such as multiple sclerosis or thyroid disease may present with psychiatric symptoms, attention deficit disorder is often misdiagnosed as an anxiety or oppositional defiant disorder, elderly people may bediagnosed as having dementia when in fact they are depressed.
Assessment and Treatment of Children
Children and adolescents are not little adults. They are developmentally unfinished, even through
adolescence. Their thinking and judgment is age specific, evolving through at least their
early twenties.
Throughout my career I have worked extensively with children, adolescents, and their families.
You can find a description of my philosophy and work with children and adolescents in Chapter 6 of
Evidence from Within: A Paradigm for Clinical Practice.
I am heavily committed to the ongoing place of parents and the family in the treatment of children
and adolescents. Each always affects the other, and healthy children require healthy parents, whether
married or divorced. Added, are specialty situations such as those of developmentally
disabled children, single parent families, and adoption, to name only a few. Each group has its own characteristics and requirements.
But the ultimate experts on your children and adolescents are yourselves, the parents. As we work together, my goal will be to restore you, as the parent, to your proper place in your child's life, leaving you with whatever parenting expertise you may require.
My background lends itself to this kind of developmental thinking. I spent two years doing a child psychiatry fellowship after my residency in general psychiatry, then I spent several years on the faculty of the University of Michigan Medical School, where I was based at Children's Psychiatric Hospital, and taught and did research in child and adolescent psychiatry. I have a separate Board Certification in Child Psychiatry. Much of my past research has been in the area of child development.
Work with Family "Systems"
In middle-class American culture today, children and adolescents are typically dependent on their parents until at least the end of adolescence. This dependency is usually financial, but, while most teenagers don’t like to admit it, emotional dependency is most often included as well. It is rarely satisfactory to work in these treatments with only the child or adolescent. Parental guidance and often family therapy are frequently required. I am experienced with - and like to do - both.
It is hard to imagine work with children and adolescents that is not predicated in a careful analysis of the family and a commitment to the resolution of unproductive or destructive family patterns. It is not unusual to find parents divided on how to understand their child's or adolescent's problematic behavior, and most particularly what to do about it. What, for example, about problems parents have communicating with their teenager, or even their child's or teenager's teachers? How about the child that fails to make social connections? And, then there is the never-ending issue of doing homework or falling behind at school. The list is endless.
You can learn more about how I think and work with children and family systems in my newest book Evidence from Within: A Paradigm for Clinical Practice.
Marital Counseling
Maintaining a healthy marriage, or divorce as it impacts on children or adolescents, may not always
be easy. Doing so can get even trickier in a reconstituted family, where the children come from a
spouse's previous marriage. I can provide marital counseling either by itself or as part of a wider
treatment strategy involving other family members. In both cases we will pay attention to the broader
implications of marital strife - its impact on career, extended family, and children, for
example. To work in this area, it is especially important to pay attention to the meaning of marriage
to each partner - does the marriage and its survival have special personal or even religious or
ethical implications? Would either spouse consider him or herself a failure if the marriage did not
survive? How much sacrifice is either willing to make to repair a damaged marriage?
These are the kinds of issues that typically come up in marital counseling or couples therapy, and
which require a delicately balanced "systems" approach to navigate.
To learn more about my services or explore the possibility of working with me, please call
(415) 456-6611 or email me.
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