The experience of Psychoanalysis, Psychoanalytic Psychotherapy,
and Psychodynamic Psychotherapy can be described as exploratory
journeys and insights further into the depths of your own psyche.
Each gate may reveal how you value and perceive yourself, the world,
and other people in your life at subconscious or unconscious levels.
You may find wonder behind each gate... or fret about opening them.
However, a trained Psychotherapist can help you with your journey.
Clinical Psychiatric Services:
Question: What kind of Psychiatric care do you provide... and what kind of patients do you see?
Answer: The most important thing to keep in mind about mental health care is that there are generally three aspects that all clinicians must first examine and continue to keep in mind: medical aspects, neurological aspects, and psychological aspects. Everyone's thoughts and emotions are affected by specific medical conditions, everyone's thoughts and emotions are conducted and controlled by a nervous system, and everyone's thoughts and emotions are regulated by their psyche.
That said, the concentration of my outpatients have been middle-aged women who are suffering from cancer, anxiety disorders, and/or depression, but I otherwise provide general Adult Psychiatry assessments with medical and neurological perspectives that may require other forms of diagnostic testing (e.g. Neuropsychological Testing, blood tests, cat scan, MRI, etc.). After an initial evaluation has been completed, I present to my outpatients an appropriate treatment plan that may involve Psychopharmacological Management (a clinical term for medication therapy) and/or Psychotherapy.
Neuropsychological Testing includes a selection of tests used to assess intelligence, memory, visuospatial functions, executive functions, and language. They are particularly important for diagnosing Attention Deficit disorders. These tests can only be provided completely by trained Neuropsychologists with a PhD, so I do not perform that myself.
Psychopharmacological Management includes the proper use of neurological and psychiatric medications to treat disorders according to research findings. I begin by mentioning categories of medications that might be effective for treating a given disorder before talking specifically about the use, properties, side effects, adverse affects, and drug-drug interactions of individual and combined medications so that my patients can make informed decisions about which medication(s) they think might suit their situation the best. While medications may provide relieving and/or stabilizing effects relatively quickly within weeks, months, or a couple years, their side effects, adverse affects, and drug-drug interactions are rather problematic. Unfortunately, before they have an impact upon the brain, most of the neurological and psychiatric medications interact with and/or influence many of the Cytochrome P450 Enzymes in the liver responsible for metabolizing most foreign substances. Worse, one particular class of Psychiatric medications, the Benzodiazepines, are very dangerous with the potential to kill. Many people become addicted to Benzodiazepines, overdose, and even die from Benzodiazepines, whether or not they are mixed with Alcohol and/or Barbiturates. Thus, it is important to be well-informed and aware of potential problems and hazards.
Psychotherapy includes a formal therapeutic relationship of dialogue between patients and myself. With the main issues and goals in mind, I help patients with their current concerns and lingering issues from the past. Aside from the present, there are a whole host of issues that do bother us from the past because those experiences develop habits within our brains as neural paths are created and reinforced for the various thoughts, emotions, and behaviors that we have. I mainly provide Cognitive Behavioral Therapy (CBT) and Psychodynamic Psychotherapy (which is derived from various Psychoanalytic schools of thought). CBT can provide faster results within weeks, months, or a couple years, but it doesn't delve nearly a deep as Psychodynamic Psychotherapy, Psychoanalytic Psychotherapy, or Psychoanalysis... all of which require longer periods of treatment for significant benefit. For Psychoanalysis or Psychoanalytic Psychotherapy, I would have to refer you to someone else who has trained for a number of years at a Psychoanalytic institute beyond their initial Psychiatric residency training.
Some patients benefit from either Psychotherapy or Psychopharmacological Management, but for many disorders, both forms of treatment are necessary.
Question: Do you provide Psychiatric care for children and adolescents?
Answer: No... because after three to four years of Psychiatric residency training, there is additional fellowship training for the subspecialty of Child & Adolescent Psychiatry to cover the wide range and depth of associated medical and psychiatric issues. I certainly have experience helping college students and can provide psychiatric care for college students, but I must otherwise refer you to Psychiatrists who provide assessments and treatments for children and high school aged students.
Question: Do you provide treatment for addictions?
Answer: No... because after four years of Psychiatric residency training, there is additional fellowship training for the subspecialty of Addiction Psychiatry to cover the wide range and depth of associated medical and psychiatric issues. For instance, I have no training and certification with Suboxone, and I cannot provide treatment for either overdose or withdrawal in the outpatient setting; in fact, those situations require either hospitalization or treatment at an Addiction Clinic. If you have an addiction with a substance (alcohol, prescription drugs, illicit drugs, other substances), you are best off with a clinic that can also take care of medical problems that also arise. In fact, in some states, there are designated withdrawal centers. In the meantime, I can provide you with names of Addiction treatment clinics that provide specific assessments and treatments for various Addictions. That said, Yale has a very well-known Addiction Psychiatry program nearby that conducts considerable research and provides a wide range of clinical care for addictions.
Question: What kinds of blood tests do you order?
Answer: Most patients do not need blood tests from a Psychiatrist. However, I may ask for some laboratory specimens (such as a serum "Thyroid Panel" to rule out Depression caused by Hypothyroidism) when medically necessary or medically recommended. Although used with less frequency than most other medications, there are some Neurological and Psychiatric medications also require blood tests to determine serum levels that are correlated with efficacy. In fact, medications that require blood tests may require frequent blood tests. I may also recommend Cytochrome P-450 testing to determine which of your metabolic enzymes may be affected by your current or future medications. Cytochrome P-450 testing is optional and uncommon, but it has grown more common around New York and Boston as patients and clinicians learn about it to help avoid or manage "Drug-Drug Interactions."
Question: Can you tell me more about Cytochrome P-450 Enzymes and "Drug-Drug Interactions?"
Answer: Have you heard of people (e.g. Asians & Native Americans) who have difficulty with the milk (cramps, bloating, and diarrhea), ice cream (cramps, bloating, and diarrhea), or alcohol (rapid intoxication) that the have ingested? The genetic and biochemical reasons are that their genes do not encode to provide them with two Enzymes (Lactase in the Gastrointestinal Tract and Alcohol Dehydrogenase in the liver) as much as people with other people (predominantly Caucasians). Keep these thoughts in mind as I answer the question about Cytochrome P-450 Enzymes and Drug-Drug interactions.
For a short scientific introduction, Carbohydrates and Fats [Note: Carbohydrates, Fats, Cholesterol, Proteins, and Enzymes are capitalized only for emphasis as important subjects in these paragraphs] provide energy for the body, and Cholesterol provides a necessary structural element for the external plasma membrane of human cells. Proteins, on the other hand, are complex molecules (composed of Amino Acids) that have a multitude of important roles. Aside from their role with muscles, Proteins are either crucial building blocks throughout cells or highly active micromachines within or outside of cells. Enzymes are Proteins that metabolize (change) other molecules.
Metabolic conversion of a substrate by an Enzyme...
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Competitive inhibition of an Enzyme by a second drug (dark blue) that blocks the first one (lime green)
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Cytochrome P-450 Enzymes (a large group of Proteins that are found predominantly in the liver), are responsible for metabolizing most of the substances that enters our blood stream, including the drugs and medications that people may take as substances that are foreign to the body. Metabolism either activates or deactivates these foreign substances. In the meantime, these foreign substances, including food and drink, can either increase or decrease the activity of various Cytochrome P-450 Enzymes. This is one major scenario for what is known as "Drug-Drug Interactions." Thus, substances like tobacco, grapefruit juice, cruciferous vegetables, or an Anti-Depressant Medication can alter the metabolism of another prescription medication, either increasing or decreasing its effect by their impact upon Cytochrome P-450 Enzymes. Thus, one can realize that the term itself is a misnomer because the drugs interact with the Enzymes that interact with other drugs.
A separate scenario for "Drug-Drug Interaction" occurs frequently in the brain when different substances interact with the same Proteins in the brain... usually with Neural Protein Channels that impact the activity of nerves... either increasing or decreasing their activity. More than one substance can affect the same Protein Channel... such as the impact of Alcohol, Barbiturates, and Benzodiazepines upon what are known as GABA receptors made of Protein. Combination of any of these substances is additively intoxicating and deadly. In any case, these neuronal Drug-Drug Interactions are separate and less common than the Cytochrome P-450 Enzymes Drug-Drug Interactions.
Physicians and other scientists have known about Cytochrome P-450 Enzymes for a long time. We have known that genetics, age, and gender also play roles in the amount or activity of Cytochrome P-450 Enzymes. For instance, both elderly patients and many Southeast Asian women who more frequently suffer from side effects of various prescription medications even at normal or low doses. However, clinical tests were not available until now. Although modern Cytochrome P-450 tests are not exact, they are still quite helpful... particularly for patients who suffer from considerable side effects, adverse affects, and/or "Drug-Drug interactions."
A separate scenario for "Drug-Drug Interaction" occurs frequently in the brain when different substances interact with the same Proteins in the brain... usually with Neural Protein Channels that impact the activity of nerves... either increasing or decreasing their activity. More than one substance can affect the same Protein Channel... such as the impact of Alcohol, Barbiturates, and Benzodiazepines upon what are known as GABA receptors made of Protein. Combination of any of these substances is additively intoxicating and deadly. In any case, these neuronal Drug-Drug Interactions are separate and less common than the Cytochrome P-450 Enzymes Drug-Drug Interactions.
Physicians and other scientists have known about Cytochrome P-450 Enzymes for a long time. We have known that genetics, age, and gender also play roles in the amount or activity of Cytochrome P-450 Enzymes. For instance, both elderly patients and many Southeast Asian women who more frequently suffer from side effects of various prescription medications even at normal or low doses. However, clinical tests were not available until now. Although modern Cytochrome P-450 tests are not exact, they are still quite helpful... particularly for patients who suffer from considerable side effects, adverse affects, and/or "Drug-Drug interactions."
Question: Do you provide any Coaching?
Answer: Life Coaching is similar yet different from clinical Psychiatric Care. I do work with others who provide Academic Coaching, Career Coaching, Life Coaching, Performance Coaching, and Executive Coaching as well in my private office.
Different forms of Coaching can be very effective for certain goals and problems in life. In fact, Coaching can help clients attain certain goals/results much faster in fewer sessions than Psychotherapy, including CBT, because they are quite focused on successful achievement of personal goals. However, there are other considerations you need to be aware of:
(a) Despite their superficial similarities, no form of Coaching is considered a part of clinical mental health treatment even though they can help in parallel to Psychotherapy. Therefore, no form of Coaching is a substitute for Psychiatric Care. Along this topic, ADD Coaching has certainly emerged, and certain aspects of Health Coaching is getting studied predominantly by researchers at Duke University, but they are still considered non-clinical supplementary help.
(b) Coaching doesn't and isn't meant to reach or help resolve deep and painful issues as certain types of Psychotherapy can. Thus, there may be certain personal issues you have may interfere with attaining the goals you wish to reach with Coaching just as they might interfere with the goals you wish to reach in college, your career, or your social life... which means that you would still need Psychotherapy to help you. Good coaches try to help clients with their internal and external resistances... but they realize that they do not have the dynamic or scenario to delve deeper.
(c) A Psychotherapy Patient can obtain Coaching from their former therapist as a Client... but a Coaching Client cannot effectively get Psychotherapy from his/her previous Coach for the more casual Coaching relationship ruins the future possibility of a formal doctor-patient relationship.
For much more info about similarities and differences between Coaching and Psychotherapy, see www.ECRIT-Coaching.com.
Answer: Life Coaching is similar yet different from clinical Psychiatric Care. I do work with others who provide Academic Coaching, Career Coaching, Life Coaching, Performance Coaching, and Executive Coaching as well in my private office.
Different forms of Coaching can be very effective for certain goals and problems in life. In fact, Coaching can help clients attain certain goals/results much faster in fewer sessions than Psychotherapy, including CBT, because they are quite focused on successful achievement of personal goals. However, there are other considerations you need to be aware of:
(a) Despite their superficial similarities, no form of Coaching is considered a part of clinical mental health treatment even though they can help in parallel to Psychotherapy. Therefore, no form of Coaching is a substitute for Psychiatric Care. Along this topic, ADD Coaching has certainly emerged, and certain aspects of Health Coaching is getting studied predominantly by researchers at Duke University, but they are still considered non-clinical supplementary help.
(b) Coaching doesn't and isn't meant to reach or help resolve deep and painful issues as certain types of Psychotherapy can. Thus, there may be certain personal issues you have may interfere with attaining the goals you wish to reach with Coaching just as they might interfere with the goals you wish to reach in college, your career, or your social life... which means that you would still need Psychotherapy to help you. Good coaches try to help clients with their internal and external resistances... but they realize that they do not have the dynamic or scenario to delve deeper.
(c) A Psychotherapy Patient can obtain Coaching from their former therapist as a Client... but a Coaching Client cannot effectively get Psychotherapy from his/her previous Coach for the more casual Coaching relationship ruins the future possibility of a formal doctor-patient relationship.
For much more info about similarities and differences between Coaching and Psychotherapy, see www.ECRIT-Coaching.com.