My Treatment Approach and Philosophy
Over the last twenty-eight years I have worked in various mental health settings and treated people from all walks of life. My formal credentials can be found elsewhere on this site, but here I will try to give a brief sense of the educational and clinical experiences that have influenced my professional development and which guide and inform my work.
After completing my residency training at Georgetown University in 1986, I was a staff psychiatrist at Chestnut Lodge Hospital in Rockville, MD. “The Lodge,” a private psychiatric hospital which opened its doors in 1910, was a wonderful place to work and learn. It was an “asylum” in the best sense of the word. Set on a sprawling 100 acres, it was dedicated to the intensive, humanistic and psychoanalytically-informed treatment of people with severe mental illnesses. Patients came to the hospital from around the country and the world, many of them having been unresponsive to treatment elsewhere and seeking our help as a “last resort.” My colleagues and my patients taught me about therapy and about the vicissitudes of the human condition. I am grateful to have had the opportunity to spend some time there.
In 1990 I left Chestnut Lodge and opened a private practice. My experiences during psychiatric training and my subsequent work at Chestnut Lodge convinced me that of the various approaches to understanding the mind, the psychoanalytic perspective was the deepest and most comprehensive. I therefore pursued additional training at the Washington Psychoanalytic Institute, from which I graduated in 1995. I make every attempt to keep abreast of developments in psychiatry and neuroscience and use that knowledge to guide my work, but fundamentally my approach to treatment, whether I am doing psychoanalysis, psychotherapy or prescribing medications, is informed by the psychoanalytic perspective.
What is a “psychoanalytic perspective?” Psychoanalysis, a theory of the mind and a method of treatment, was developed by Sigmund Freud in the early twentieth century. It has become part of the cultural zeitgeist, indeed it has permeated Western thought to such an extent that we take many of its assumptions for granted. Psychoanalysis has certainly been the object of criticism, some of it deserved, some not. Like any theory, and especially one that attempts to explicate something as complex as the mind, psychoanalytic theory is imperfect. I am often asked whether I am a “Freudian.” In one sense, all psychoanalysts are Freudian, because Freud was the person who developed the theory. In another sense, no one today is a Freudian because no one practices the way he did. In his book Open Minded: Working Out the Logic of the Soul (Harvard Univ. Press, 1998), Jonathan Lear wrote: “Freud is dead. He died in 1939, after an extraordinary productive and creative life...it is important not to get stuck on him... either to idolize him or to denigrate him.”
For any scientific theory to survive the test of time, its adherents must constantly question, and when necessary discard, its constituent parts in light of ongoing observations and discoveries. Since psychoanalysis was first developed we have learned so much more about the mind and the brain, and scores of individuals have refined, expanded and improved psychoanalytic theory and the treatment methods derived from it. It is not possible to summarize the vast literature; any effort to do so would inevitably be a gross oversimplification. But to my mind the essence of a modern psychoanalytic approach can be summed up with a few simple statements:
- Every individual is unique
- A large portion of what goes on in our minds exists outside of our conscious awareness. These “unconscious” thoughts, feelings, fantasies, wishes and conflicts exert a constant influence on our conscious mental lives.
- Our personalities, relationships and life choices are influenced by what we inherit genetically as well as by our past experiences and relationships. Simply put, when it comes to our psychological and interpersonal selves, the past is prologue.
If you are interested in reading more about the current state of psychoanalytic therapy, I'd recommend two papers by Jonathan Shedler: "That Was Then, This is Now: An Introduction to the Contemporary Psychodynamic Psychotherapy" and "The Efficacy of Psychodynamic Psychotherapy."
None of the above denies or excludes the fact that we are not only psychological, but also biological and physical beings. The pace of research on the brain has accelerated over the last several decades, and its findings have contributed immeasurably to our knowledge and understanding of ourselves. The application of this research to the clinical arena has led to the development of medications that can alleviate the pain and suffering caused by anxiety, depression, panic disorders, manic-depression, schizophrenia and many other psychological maladies. Brain science is also bringing new perspectives to our work as therapists and helping us to confirm or disconfirm psychological theories. Dr. Louis Cozolino’s book, “The Neuroscience of Psychotherapy” is a good example of this kind of integrative work.
My consultation process begins with a discussion of your current difficulties and a review of your life history. After completing a thorough assessment, I will review my impressions and recommendations and work with you to determine what type of treatment is likely to be most effective. If it appears that you would benefit most from a form of treatment that I am not qualified to provide, I will make an appropriate referral. Otherwise, we can discuss the details and feasibility of our working together.