Services
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Consultation / Evaluation
The purpose of a consultation is to provide a comprehensive assessment
of the patient’s difficulties, a diagnosis and a recommended
treatment plan. Consultations generally require my meeting with
the patient two or three times, after which I share my understanding
of their difficulties and recommendations for treatment. In some
cases, the patient may wish to start treatment with me after the
consultation. If I have time available for new patients I will
make this clear prior to our first consultation meeting; otherwise,
I will provide an appropriate referral at the conclusion of the
consultation. If the patient is seeking a second opinion I will,
with the patient’s consent, share my findings with the referring
doctor or the patient’s therapist.
Psychoanalysis
Psychoanalysis is a form of intensive psychotherapy based on
the belief that factors beyond our conscious awareness have a
profound influence on our behavior. Unbeknownst to us as we go
about our daily lives, these factors (implicit beliefs about self
and others, unconscious wishes and fantasies) are often related
to the difficulties for which patients seek treatment.
Psychoanalysis is often indicated for people whose lives are
essentially stable, who have achieved some success in work and
relationships but for whom an enduring sense of life satisfaction
or relief from troubling symptoms has proved elusive. Psychoanalysis
can be helpful for people who experience:
- Chronically poor self-esteem
- Feelings of ineffectiveness and failures of performance in
work
- Inflexibility, rigidity, and a strong need for control
- Chronic anxieties
- Recurrent depression
- Problems feeling happy and satisfied, even when things are
“going well”
- Problems with anger and irritability
- Recurring disappointments in love relationships and friendships
- Problems with intimate and sexual relationships
Patients in psychoanalysis attend four times per week and are
encouraged to lie on an analytic couch during sessions. Both the
session frequency and the use of the couch are designed to help
patients explore the full range and content of their mental and
emotional life, without censor, and without attention to what
is socially appropriate. The patient’s dream life, fantasies,
memories, experiences in relationships and work, and reactions
to the analyst are frequent subjects of investigation in psychoanalytic
treatment. By examining the themes raised by the patient and through
learning about repeated patterns of behavior, thought, and feeling
in the patient’s life outside of treatment, the psychoanalyst
is able to generate and share hypotheses about the patient’s
underlying, unconscious motivations, and how these relate to the
patient’s present-day difficulties.
Psychoanalysis is frequently caricatured as a treatment that focuses
on the patient’s past. Although many psychoanalysts would
agree that one’s experience of early family relationships
forms important templates for later experiences, many modes of
contemporary psychoanalysis involve an intensive examination of
the patient’s current life through the lenses of work, love,
and other interpersonal relationships. This characterizes my approach
to psychoanalysis.
Psychoanalysis is a collaborative venture in which learning and
growth occur not simply through the intellectual understanding
of the patient’s difficulties, but through the emergence
of problematic behaviors, thoughts, and feelings in and related
to the relationship with the psychoanalyst. The emergence of the
patient’s difficulties in the treatment relationship and
their discussion in ‘real-time’ with the psychoanalyst
promotes an emotion-based learning that is particularly powerful.
Over the course of an analysis, through the enactment time and
again of troubling behavioral patterns and their discussion in
the treatment, the jointly constructed understanding of the patient’s
difficulties sharpens. Patients start to feel that they have greater
sense of self awareness and control in their lives, resulting
in an expanded range of choice in work and relationships. Ultimately,
an enduring, more positive experience of oneself, one’s
relationships and one’s activities prevails.
Psychotherapy
Psychotherapy is based on the same principles as psychoanalysis
but differs in two key respects: patients are seen less frequently
(once or twice, rather than three or four times weekly), and patients
are seated rather than supine. A determination of suitability
for psychoanalysis versus psychotherapy is made according to several
factors, assessed during an initial consultation, including: the
nature and extent of the patient’s presenting difficulties;
the patient’s life situation; and logistical considerations
such as sessions times and fees.
Couple Therapy
My approach to working with couples draws from contemporary psychoanalytic,
systems, and cognitive perspectives to address the problems related
to communication, intimacy, sexuality, and partnership with which
couples frequently present. With couples, the work is problem-
and solution-focused. In the evaluation period I work to clarify
the nature of the difficulty and the contributing behaviors of
each partner that maintain the presenting problems and mutual
sense of impasse. Over the course of treatment couples develop
an understanding of why they are drawn in, repeatedly, to conflicts
with similar content (money, child-rearing, sharing responsibilities,
sex) or form (one approaches, the other withdraws; one asserts,
the other submits, but resents). By the conclusion of treatment,
each member of the couple develops an improved understanding of
their respective fears and anxieties about change and the skills
to break the maladaptive cycle of communication or impasse on
their own.
In addition to helping couples resolve areas of conflict, I also
help couples identify and cultivate areas of interest, passion,
and strength. Research has shown that these positive factors provide
resilience against the inevitable stresses associated with couplehood,
and that couples that understand, appreciate, and actively support
and enjoy one another stay together longer and with greater satisfaction.
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