I believe that caring and respectful relationships are the basis for any kind of healing. In my work with patients I view what we do together as a collaboration. You are the expert in yourself and your feelings, I bring to that collaboration the expertise from my academic experience and training as well as from the care of thousands of patients with similar problems, together we create a treatment plan that will lead to a sustained recovery from a mood or anxiety disorder.
The essence of good psychiatric care, to me, is trying to see through your eyes and to understand your expectations, perceptions, and experiences, rather than just seeing through my professional eyes.
In my work I try to always address these aspects of care: 1) respect for your values, preferences, and needs; 2) communication and education; 3) coordination and integration of care; 4) physical comfort; 5) emotional support and addressing your fears and anxieties; 6) involvement of family and friends if that is appropriate; and 7) continuity of care.
Twenty years of work with people who have mood disorders has taught me the value of a very thorough initial assessment. To many people depression seems easy to understand. They have answers ready, but their answers often seem to have more to do with who they are than with the person they are talking to. My approach is to look at depression from many different perspectives: biological, psychological, social and even spiritual. Often I work with other clinicians in the Mood Disorders clinic who can help me to understand a particular aspect of a problem. All of this makes an initial assessment expensive. It also means that we are much more confident when we make treatment recommendations. Although many of the people who come to see us have seen mental health professionals before, often many times, and many have had unsatisfactory experiences, we help almost everybody who comes to see us. I think it is because we take the time to really understand what is going on before we begin treatment.
After we have finished an initial assessment I will have some thoughts about what is going on, and I will have some suggestions for treatment. I try, however, to involve you as much as possible in decision-making. Often there are several reasonable approaches to a problem. Making a decision about how to begin should be collaborative. I will want to give you information, books and articles to read, so that you can understand the nature of the choices clearly. I will highlight those approaches which have the best support. This is what we mean by evidence-based care. We try to do what we know works first. We also want to be sure to let you know about reasonable options that might be available from practitioners outside our clinic.
I always remember my own experience of being a frustrated patient. I had an acute back injury that took many months to get better. In the process I went to see many practitioners: doctors, physical therapists, chiropractors, massage therapists, acupuncturists, etcetera. After a while I realized that, without fail, the recommendations for treatment always reflected the services that the practitioner provided. I felt discouraged about the quality of the recommendations. Were these people really making suggestions that were based on my particular need, or were they more based on their skills and knowledge.
As a psychiatric physician, I provide biologically based treatments: medications and referrals to other medical practitioners, if needed. Sometimes I provide psychotherapy as well. I am particularly expert in:
Often we feel most comfortable talking about things that are not really important, and those things that are at the heart of who we are we feel awkward talking about. We think that the fears we have are fears that no one else can have. Our sadness sets us apart. And of course, we are all unique. However, 30 years ago I decided to go into the mental health field based, in large measure, on the work of one man, Carl Rogers. Carl had many important things to say, but he preferred to say them simply, and so the depth of his thinking was sometimes ignored. He said this about our deepest thoughts, feelings and fears:
"I have almost invariably found that the very feeling which has seemed to me most private, most personal, and hence most incomprehensible by others has turned out to be an expression for which there is a resonance in many other people."