A Different Kind of Approach

I have a great deal of respect for the patterns that people have developed in order to stay safe, present themselves to the world, survive, and thrive in relationships. But these patterns, that might have been adaptive as children, are sometimes irrelevant or frankly destructive outside their families and thus, fail them as adults. Often these patterns drive people into relationships that don’t work for them, and into careers that are unsatisfying or frustrating. The painful feelings that emanate from these situations can lead to anxiety and depression, if not a sense of hopelessness and despair. What is most ironic is that people sometimes repeat over and over the patterns and decisions that inevitably lead to this result and ensure that they will continue to suffer.

People deserve kindness and compassion for their struggles, but it is vital that a therapist resist the temptation to enable and, thereby, perpetuate the patterns that are making their lives miserable in the first place. The reason that most of my patients have seen multiple therapists with no real change in their lives, is often because therapists have been uncomfortable tackling their underlying self-defeating patterns. No one is comfortable having these pointed out and challenged, however gently, but without this, people can’t be expected to make the kind of fundamental changes they need to make to extricate themselves from their unhappiness. They will continue to choose the wrong partners, the wrong friends, and the wrong career paths. I view it as my obligation to help people recognize what is getting in their way, and what drives them to make decisions that are not good for them, especially when their choices are largely out of their awareness. Without helping people face the discomfort inherent in this, they can’t change their approach to their lives and relationships. Yes, this process can be unsettling, and yet most of my patients experience enormous relief in finally understanding and being able to change the patterns of thinking, feeling, and behaving that have defeated them and extracted a lot of the joy from their lives.

I am a psychiatrist, and can and do prescribe medication, but I have found that most medications have side effects and need to be used selectively. I have also found that some medications subtly anesthetize and dull peoples’ access to their feelings, making it more difficult for them to do this kind of work. I want to help people with their symptoms of anxiety and depression, but I also want to help them make more fundamental changes in patterns that create their symptoms in the first place.

I am active in the sessions and defy the stereotype of the passive psychiatrist who expects people to talk for 50 minutes while they confine themselves to making some observation at the end of the session. This may be helpful for some patients, but is useless for others, leading to years of frustrating therapy in which people may gain an intellectual understanding of why they are suffering, but in which they continue to suffer nevertheless. I do my best to listen deeply and help people untangle the problems that they come with. I offer empathy, curiosity, humor, and active engagement to foster collaboration and hope. I believe in peoples’ resilience and have deep respect for their autonomy and innate strengths.

I believe that helping people gain an intellectual understanding of their emotional lives is important, but as a very astute psychiatrist once said, “People need an intense experience in therapy, not just a brilliant interpretation.”  Beyond understanding, they also need to feel differently.  

People who come to see me have largely been referred by my other patients. They come expecting to work, wanting to face their deepest fears, willing to tolerate the pain of this kind of deep dive into their emotional lives, and willing to be held accountable for this.  If you are this kind of person, then I may be your guy.