My Approach

Step One: The Diagnostic Evaluation

Forming an accurate understanding about the nature of the problem you face is one of the most critical steps in providing high-quality mental health treatment. Many conditions have overlapping signs and symptoms. For example, an individual experiencing low mood, a lack of enjoyment of life, sleep disruption, and appetite changes might identify how they are feeling as "depressed." While that description is a helpful starting point, we need to know more! Further exploration might reveal that those symptoms stem from a unipolar Major Depressive Disorder, from Bipolar Disorder, from hypothyroidism, from a substance-induced mood disorder, from a personality disorder, from Post-Traumatic Stress Disorder, or from a range of other issues. Failing to properly identify the issue can mean starting the wrong treatment, which (as you might expect) can lead to a poor response.

In our first meeting we will spend around 75 minutes reviewing your history. This includes discussing topics such as your developmental history, your current life circumstances, a detailed description of the symptoms you are experiencing and how they have developed over time, and a review of your general medical history. When possible, it is ideal to bring past lab work, imaging, information about past medication trials, and medical documents from other providers who have evaluated you to your initial session. From there, I will provide initial impressions about the nature of the problem. I may ask you to obtain labwork or imaging, or to try to gather historical records for review. If needed, we may continue to discuss your history over several sessions. 

Once we have completed the initial evaluation, we move on to...

Step Two: Treatment Planning

Once we have completed the initial evaluation, I will make recommendations about best next steps for treatment. We will discuss the risks and benefits of each approach, and you will make the decision about how you are comfortable proceeding. Several approaches are commonly recommended:

• Medications: For some conditions, medications can be a crucial part of treatment. For others, psychotherapy or other options may be first-line. We will discuss what medication options have been shown to be helpful for your condition. We will also discuss the risks associated with these options so that you can make an informed decision.

• Psychotherapy: Psychotherapy, or "talk therapy," is often helpful for managing a range of mental health conditions. Therapy approaches vary, but common strategies across approaches include coming to a better understanding of yourself and the causes of your mental distress, working collaboratively to make changes that alleviate suffering, and developing techniques and strategies to deal with symptoms. People often have an image of therapy as a years-long process, and while that can sometimes be the case many modern approaches to therapy can produce significant results on much shorter timelines (for example, 12-session protocols of Cognitive Behavioral Therapy or Cognitive Processing Therapy). We will discuss what psychotherapeutic approaches might be helpful to you. Depending on the particulars of your case, I might provide the psychotherapy or you might work with both me and a separate psychotherapist (commonly referred to as "split treatment").

• Improving management of other medical problems when applicable: at times other conditions, such as chronic pain, sleep apnea, hypothyroidism, or a range of issues might worsen or cause mental health symptoms. When those issues are identified, I will discuss the condition and the ways it affects your mental health. Typically referral to another provider (such as a pain management specialist or a sleep medicine physician) will be a part of the plan for treating such issues.

• Lifestyle changes: much of the work of recovery takes place outside of the psychiatrist's office! We will discuss strategies that may help, such as implementing plans to increase activity levels, reviewing behavioral strategies to normalize your sleep schedule, reviewing ways to address stressors in your life, considering the role that diet or other lifestyle choices may play in your condition, and considering other real-world changes that can aid in recovery.

Step Three: Implementing Treatment and Assessing Results

Once we agree on a treatment plan, the treatment begins. We will discuss what to expect at the outset. As you progress in treatment we will regularly assess whether the treatment is effective. This can be tracked by standardized rating scales, by your observations about your symptoms, and by observations about how you are doing in-session. If we find that a particular approach is not helpful, we will discuss modifications and alternatives.

It is not possible to to outline the approach that might be used for every presenting problem, but I have written more about what treatment might look like for some example conditions below: