MY TREATMENT APPROACH AND PHILOSOPHY
Over the past three decades, I have worked in various mental health settings with individuals from many walks of life, and from a wide diversity of cultural backgrounds. You can find my formal credentials elsewhere on this site. Here I will provide an overview of the educational and clinical experiences that have shaped my professional growth and continue to influence my practice.
Following the completion of my residency training at Georgetown University in 1986, I worked as a staff psychiatrist at Chestnut Lodge Hospital in Rockville, Maryland. Known as "The Lodge," this private psychiatric hospital, established in 1910, provided a peaceful environment for healing, and for the professionals who worked there, for learning and growth. Set on a 100-acre property, The Lodge was dedicated to the intensive, humanistic, and psychoanalytically-informed treatment of individuals suffering from severe mental illnesses. Patients sought our help as a "last resort," often after being unresponsive to treatment elsewhere. The time I spent at Chestnut Lodge exposed me to invaluable lessons about therapy and the vicissitudes of the human condition, and I am grateful that I had the opportunity to spend some time there early in my career.
In 1990, I left Chestnut Lodge and established a private practice. My experiences during psychiatric training and subsequent work at The Lodge solidified my conviction that the psychoanalytic perspective offered the most profound and comprehensive understanding of the mind. I decided to pursue further training at the Washington Psychoanalytic Institute, from which I graduated in 1995 as a psychoanalyst. While I make every attempt to keep up on developments in psychiatry and neuroscience, and to use that knowledge in my practice, my approach to treatment—whether conducting psychoanalysis, psychotherapy, or prescribing medications—is fundamentally rooted in the insights provided by the psychoanalytic perspective.
What is a "psychoanalytic perspective?" Psychoanalysis, both a theory of the mind and a therapeutic method, originated from the work of Sigmund Freud in the early twentieth century. It has deeply permeated Western thought and has become ingrained in our cultural, intellectual and academic zeitgeist. Many of its assumptions are now taken for granted. From the time Freud began working out the details of his theory and treatment, and up to the present day, psychoanalysis faced criticism, some of which is warranted. Like any theory, especially one attempting to elucidate the complexities of the human mind, psychoanalytic theory is imperfect.
I am frequently asked whether I am a "Freudian." In one sense, all psychoanalysts can be considered Freudian since he is the progenitor of the theory. However, no one today strictly adheres to Freud's methods; psychoanalytic theory and practice has evolved significantly. In his book "Open Minded: Working Out the Logic of the Soul" (Harvard Univ. Press, 1998), Jonathan Lear stated: "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 endure the test of time, its adherents must continuously question its tenets and, when necessary, discard the parts of the theory that no longer align with ongoing observations and discoveries. Our understanding of the mind and brain has expanded significantly, and numerous scholars and clinicians have refined, expanded, updated and improved upon psychoanalytic theory and treatment. Whichever psychoanalytic school of thought one subscribes to, the essence of the theory can be distilled into a few fundamental statements:
1. Every individual is unique.
2. A significant portion of our mental activity operates outside of conscious awareness. These "unconscious" thoughts, feelings, fantasies, wishes, and conflicts exert a continuous influence on our conscious mental lives and interpersonal relationships.
3. Our personalities, relationships, and life choices are influenced not only by genetic inheritance but also by past experiences and relationships. In simple terms, our past is prologue to our psychological and interpersonal selves.
These seemingly straightforward statements hold profound implications for our understanding of the forces that drive and motivate us. Psychoanalysis and psychodynamic psychotherapy puts an emphasis on the exploration of the unconscious forces and conflicts underlying a person's psychological and emotional distress, as well as his or her day to day struggles in the present. Modern psychoanalytic treatment explores one's past and present relationships, including the relationship between the analyst and the patient as it develops over time. The insights gained through psychoanalytic treatment enable individuals to perceive themselves and the world from fresh perspectives, promoting the kind of mental flexibility necessary for personal growth.
If you are interested in delving deeper into the current state of psychoanalytic therapy, I recommend two papers by Jonathan Shedler: "That Was Then, This is Now: An Introduction to Contemporary Psychodynamic Psychotherapy" and "The Efficacy of Psychodynamic Psychotherapy." (see below).
While psychoanalysis focuses on a psychological approach to understanding people, it does not deny or exclude the fact that we are biological and physical beings. Research on the brain has made remarkable strides over the past several decades. The application of such research to the clinical realm has led to the development of medications that can alleviate the pain and suffering caused by anxiety, depression, panic disorder, bipolar disorder, schizophrenia, and many others. Brain science also offers fresh perspectives to our work as therapists, confirming or challenging our theories.
Dr. Louis Cozolino's books, "The Neuroscience of Psychotherapy" and "The Neuroscience of Human Relationships," provide excellent examples of integrative work that incorporates neuroscience into psychotherapy. The emerging field of Neuropsychoanalysis, spearheaded by Dr. Mark Solms and others, aims to integrate neuroscientific findings with more purely psychological perspectives. Dr. Solms' 2021 book, "The Hidden Spring: A Journey to the Source of Consciousness," is a fascinating read.
My consultation process begins with a discussion of your current difficulties and a review of your life history. After conducting a thorough assessment, I will give you my impressions and recommendations, and collaborate with you to determine the most effective form of treatment. If it becomes evident that you would benefit from a type of treatment outside my area of expertise, I will make a suitable referral.
