Medication Management Approach

From a psychopharmacological (medication) perspective, the most practical and scientific approach, although reductionistic, is to identify symptom domains that hypothetically correspond to dysfunction in specific brain systems and employ medications based upon their purported effects in modulating neurochemistry in those brain system.

Psychotherapy Approach

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” —Viktor Frankl, MD (Psychiatrist and Holocaust survivor)

Medication, while helpful, is just one component of a comprehensive treatment plan. In addition to medication, individual psychotherapy is often highly recommended. It is important to remember that how you feel has to do with both your feelings and your reactions to the things that are happening (or have happened) to you in your life. Psychotherapy can help you experience things differently by changing the way you see and relate to yourself, others, and your future. It can also help you connect with your emotions and provide important insights into how your past experiences (e.g., relationships, family-life, work-life, traumatic events) have influenced current relationships, feelings, thoughts, and behaviors. Medication, on the other hand, can help to “fine-tune” relevant brain systems to reduce specific symptoms impacting your mental functioning. Medication and psychotherapy can work separately or together, depending on your circumstances.  

Below are the most common therapy modalities I usually incorporate in my individual therapy sessions:

Cognitive Behavioral Therapy (CBT) helps you identify and restructure cognitive distortions and core beliefs that negatively impact your feelings about yourself, others, and your future.  

Dialectical Behavioral Therapy helps you better manage extreme beliefs and emotional states. The four key components of DBT are 1) Mindfulness Skills; 2) Interpersonal Effectiveness; 3) Emotional Regulation; and 4) Distress Tolerance. This type of therapy would provide you with coping skills to tolerate distress more effectively, increase your frustration threshold, improve your interpersonal skills, and strengthen your sense of self. It would also help you become more aware of, tolerant of, and compassionate toward, your body’s physical responses to stressful feelings and thoughts.  Lastly, these skills would help you learn to tolerate uncertainty so you can train your brain that avoidance and reassurance-seeking are not helpful or necessary (i.e., it can be very effective in breaking the worry cycle that is paralyzing and exhausting).

Internal Family Systems (IFS) Therapy (Internal Parts Therapy) aims to help you achieve mental and emotional healing by fostering internal harmony and self-leadership. The approach posits that the mind is composed of multiple “parts,” each with distinct roles, goals, and perspectives. These parts can be in conflict with each other, leading to emotional suffering, dysfunctional behavior, and poor decision-making. The primary goals of IFS therapy include understanding the various roles your parts play, how they interact, and why they exist. This facilitates a compassionate dialogue between your “Self” (your true self) and your parts, developing a sense of integrated self-leadership where your Self guides the internal parts, rather than being led by them. Overall, IFS aims to create a more balanced internal system, leading to greater well-being and more effective external relationships.

Overall Integrated Approach

An important goal in recovery from mental suffering is an awareness of, and appreciation for, our bodies. Many mental health and medical problems result from protective defenses we put up to avoid feeling emotional pain in the present moment. Some people ruminate about the past, worry about the future, hyperfocus on performance, or bury themselves in work to avoid uncomfortable feelings like shame, guilt, fear, anger, and sadness. Others use drugs, alcohol, sex, food, food restriction, social media, gambling, self-harm behaviors, or aggression (or a combination) to achieve the same.

When we don’t have a safe place to express our feelings, our body manifests our emotions through physical symptoms like fatigue, physical pain, headaches, and crying spells to name a few. We may also retreat into our thoughts hoping to maintain a sense of control.

If being in the present means feeling uncomfortable, then we tend to avoid it. But avoiding the present allows our thoughts to control our lives. It also means losing the mind-body connection that is so essential to our sense of “self.” 

Emotional wounds, like flesh wounds, require compassionate attention in the moment so we learn to understand the emotional pain instead of fear it. It is through this process that we truly heal.

Therefore, I believe in a multidimensional approach as you learn to accept yourself where you are now so you can make productive changes in your life.

Understanding the Limitations of Diagnoses in Mental Health

Diagnoses in psychiatry were created to provide a common language for mental health professionals. However, there are many problems with our current diagnostic system: (1) There is considerable overlap in symptoms between diagnoses; (2) Almost all diagnoses minimize the contribution of trauma, environmental stress, and adverse life events; (3) Drug intoxication and withdrawal states often mimic symptoms of many psychiatric diagnoses; (4) Our current categorical classification of mental disorders tells us little about you and your specific needs.

While a thorough diagnostic evaluation at the initial consultation visit provides me with enough information to make one or more “provisional” diagnoses, it is important to remember that accurate diagnoses in psychiatric medicine develop over time (i.e., weeks to months) as I get to know a person’s behavioral patterns. When appropriate, diagnoses will be given but should be viewed as provisional and subject to change. That is, diagnoses can evolve and change over time as new symptoms and patterns emerge. I am primarily interested in an individual’s unique experience given that diagnoses do not adequately describe the complexity of a human being.