General Approach to Psychiatric Practice

When you see me (or really anyone) as a psychiatrist, I believe the following things should happen:

We should be working together to evaluate patterns in your life that you don't like or want. These could be patterns of emotional reactions, patterns of thoughts, or patterns of behaviors. Usually, all three occur and interact with each other to various degrees.
You should know my opinions about the likelihood that your pattern can change, and what methods can change it. I should give you the pros and cons of different modes of treatment. We should pursue a mutually agreed upon treatment and monitor its effectiveness and side effects.

The first item should occur especially during our initial meeting, but also as treatment progresses, as we should always be reevaluating our goals and understanding. Often, goals can change and what sometimes seems the most important initially is later found to be less important or part of a larger pattern that needs to be focused upon. What feels good in the short run may not be so good in the long run.

It is my philosophy of practice to focus more on the big picture and long term change instead of short term 'feeling better' although that is obviously important, too.

The second item should also occur initially and on an ongoing basis. There are two broad categories of treatment usually offered by psychiatrists: medications and therapy.

Medications are powerful, and as a result create many biological and psychological changes that can be difficult to predict. For this reason, I personally like to avoid medications if possible. However, in some cases, they may be necessary in order to allow a person to change in a desired manner, and in other cases it could be considered unethical for me as a physician to avoid their use.

Psychotherapy aims to help people make specific changes in emotion, thought, and behavior. There are many types of therapy, and my primary experience is with behavior therapy (for changing behaviors and automatic emotional reactions), cognitive therapy (for changing patterns of thought), and dynamic psychotherapy (for understanding patterns of reactions in relationships). I believe each type has its own place depending on where a person is in their life and on predispositions from biology and past history. I also believe that therapy (like medications) can have negative side effects and needs to be monitored on an ongoing basis.

You can find more practical details about how I practice if you are interested.