My Background
I chose to train at University Hospitals in Cleveland for multiple reasons. I was very much impressed with the range, variety, and expertise of their clinical faculty and training experience. In my training, I worked with general psychiatrists who had a focus on therapy and understanding a person who also knew much about medication and applying DSM (at the time) IV diagnoses. My program also focused on a consideration for ruling out medical causes or confounders of psychiatric illness. I am very grateful to the wonderful thinkers that I was exposed to in my training. The infusion of that experience has, over time, continued to shape me and has greatly contributed to my clinical skill and global perspective which still serve me well today. What I came away with in my residency was how to fine-tune a diagnosis and look for little details but only after getting a global perspective of what is going on so that one does not miss major categories. An ability for observation is critical in accurate diagnosis. Psychotherapy training was an important aspect of my residency. I felt then and still do now that psychotherapy is integral in the functioning of a psychiatrist. My program had a strong connection to the Cleveland Psychoanalytic Center, and I am very thankful to have been exposed to this type of thinking.
As I made my way in general psychiatry practice, I found that using perspectives from my training, thinking for myself, continuing to learn and to study, and listening to my patients have all been very important in my development as a psychiatrist and as a caring human being. I would be aware that at times I would be expected to utilize an hour with the patient with which to do a “full” evaluation and make a diagnosis and plan. It was often possible to make at least a preliminary diagnosis and plan, however, I often found that observing over time and getting to know a person within their context was often more valuable in really knowing them. That to have a visceral sense of who they are, who their family is, and what trials they deal with in their lives gave me a clearer picture of what their situation entailed. There have been times I have met a patient for the first time, spoken to them for an hour, and still had very little idea of what the real diagnosis was. This has to be allowed as well. In my opinion, each person presents as they do for a reason. Every interaction can be thought of as a communication. Rushing to an answer when I don’t know truly what’s going on is not in the best interest of my patient, and I find that if I allow myself to be curious, patient, and caring, the patient and I will usually find what is really going on.
I have found patients who are satisfied with medication. Some patients get great benefit from medication but find that there is more to be had from treatment. Some people do not like the side effects that medication gives them or, despite multiple medication trials, they find that their symptoms are still not completely resolved. Some patients simply don’t wish to be on medication at all. In any and all of these cases a talking therapy can be very helpful in either adding to or taking the place of medication.
In the patients that I have treated with medication, I have found that people still have a wish to be understood, to be known, and to have their story known. We sometimes find that their stories contain plots and meanings that neither of us suspected or imagined - but which add to the meaning in their lives. I have found that the quest for insight, kind understanding, compassion, and empathy to be nearly universal among us all. Sometimes, in seeing a patient over time, we (the patient and I) get curious about something in them. It is then that another level of working together begins.
It was with this summation of experience that I determined to go back for extra training in psychotherapy. In the fall of 2014, I entered training at the Cleveland Psychoanalytic Center in psychodynamic psychotherapy and contemporary psychoanalysis. This perspective and the psychoanalytic method of working are both fascinating and helpful for treating patients. There are many ideas about what this practice actually is, and I choose the perspective that it helps me and the patient look together to understand what their story and their truth are up to this point. The search and the understanding gleaned from the search seem to allow people greater freedom, greater empathy, and greater happiness and well-being. This training adds to my general psychiatry perspective and simply becomes another tool in my toolbox that I can apply to help patients when both the patient and I feel there would be benefit.
I have found that my psychoanalytic training informs my psychiatry training and vice versa. There is a slightly different outlook that a psychoanalyst has, and I have found that blending these perspectives is helpful in my approach to patients. In a psychodynamic model, the therapist looks along with the patient and thinks of hypotheses or possibilities of what may be going on. These ideas are merely ideas and can be confirmed, changed, or thrown out by the patient. In this way, this perspective seeks to help a person understand themselves but not to tell them who they are or what is going on in their mind. There is a partnership and a respect for the patient that I find refreshing. Something that I find is not in a psychodynamic perspective is the striving to categorize, label, or simplify a patient and their experience. Patients who would meet criteria for the same DSM-IV or DSM 5 diagnoses can be radically different. Having the ability to understand a person’s difficulties as a category can be useful in some ways, however, I find that it is too narrow to be truly meaningful. It is only a label and is not a person.