How I PracticeProblems/DisordersTypes of TreatmentSocial IssuesFirst Appointments
Clinical Psychiatry
Forensic Psychiatry

How I Practice
I believe psychiatry is one of the most collaborative of the medical specialties. Since there are no X-rays or lab tests for anxiety or depression,  I try to listen very carefully to what patients tell me about their experiences.  And when decisions have to be made about treatment options or medication choices, I tend to think aloud and share the pro's and con's for each choice.

A trusting relationship has to develop for patients to feel safe talking about personal issues. Sometimes it is only later in treatment that people will discuss their more difficult problems. Each person's treatment is different. I ask people to let me know, when possible, what will make treatment feel safe and relevant.

During the evaluation, I find it helpful to consider four kinds of issues:

Biological issues—Are any general medical disorders like hypothyroidism or anemia causing the problems? And are psychiatric medications likely to be of any help?

Individual issues - Are there individual ways of thinking and feeling that contribute to the presenting problems? Are any of the individual psychotherapies likely to be of help?

Family issues – Do issues with a person's current family or their family growing up contribute to the problem? Is it enough to discuss these issues in individual psychotherapy or do family members need to be involved?

Societal issues - Do social issues contribute to someone’s struggles? (homophobia, racism, sexism, prejudice against older people, etc.). Can discussion of these issues or connection to community resources or activism help?

Not all these issues are relevant for every problem, but it's usually worth considering them at the initial evaluation.

A person's strengths are also important to understand. When psychiatry focuses only on problems, it can be discouraging.  Discussion of strengths is often empowering, and also can help clarify what kind of treatment would work best.

A patient's own goals and priorities must be clarified.  I may want eventually to determine whether someone has Attention Deficit Disorder, but their first priority may well be a good night's sleep.

Psychiatric treatment can be helpful both for serious, potentially disabling problems and also for making a good life better.  I work with people who are acutely and suicidally depressed. And I also work with people who have good families and jobs but want to be more creative or more hopeful.