Psychotherapy

What psychotherapy looks like with me--the philosophical:

• I believe in the healing power of relationship--in particular, a relationship that is stable, reliable, and deeply caring; in which authenticity is encouraged and celebrated; in which you are listened to with curiosity and non-judgment and received with compassion and understanding; where you feel able to express your most difficult-to-bear truths without risking rupture or alienation; and where you can experience in your mind, body, and spirit what it is to be seen, accepted, and cared about.  This is the relationship I seek to offer you.

• I bring perspectives about the functioning of the mind that are informed by neuroscience, psychoanalysis, internal family systems, neurolinguistic programming, and my internal medicine and palliative care training, yet science hardly captures every mystery of the human experience, and theories and diagnostic labels are only helpful if they lead to greater functioning and understanding for you.  I respect you as the expert on your own experience and seek to apply my knowledge humbly, flexibly, and with a focus on what's therapeutic for you.  

• A core perspective of mine is that the unconscious mind is a powerful force, operating without our conscious awareness and intention, yet determining many aspects of how we think, feel, and behave; and that bringing beliefs, feeling states, and automatic reactions that are currently housed in the unconscious parts of us into conscious awareness increases our freedom to choose how we act and respond.  Although unconscious material is, by definition, outside of awareness, we can follow its clues--feelings, associated thoughts, sensations, images--to gain this greater understanding and freedom.

• Foundational to my understanding of the body is the PNEI (Psycho-Neuro-Endocrine-Immunologic) System, the interrelationships between thoughts/feelings/the unconscious mind, the nervous system (including the "fight or flight" response to stress), our hormonal systems (most notably, the stress hormone, cortisol), and our immune system.  This framework offers a way of conceptualizing the mind-body connection that is firmly rooted in biology and reframes psychosomatic symptoms from "all in one's head" to "squarely in the body and related to one's mental and emotional life."  It also makes sense of the links between chronic illness and chronic stress.

• It is also a core perspective of mine that no one chooses the unconscious processes or PNEI functioning that their mind-bodies hit upon to get by in the world.  We can look at our nature (temperament, genetics, physiology), nurture (culture, family, environment), and the complex interplay between them and recast our thoughts, feelings, behaviors, and physiology as our mind-bodies' strategies for our survival.  We can also recast any shame we might feel about these survival strategies as appreciation for our mind-bodies' ability to get by under challenging circumstances.  Finally, we can update any strategies that aren't working for us anymore and free ourselves from patterns that keep us stuck.  

What psychotherapy looks like with me--the practical:

• I work with adult (>18) individuals whose struggles are related to medical illness--either their own or someone else's--death and dying, and/or the worlds of Medicine and Healthcare

• Sessions can take place in person, by video or by telephone and last for 45 minutes.

• Sessions generally take place weekly, although more or less frequent meetings are also possible as the relationship progresses and your needs become clearer.  Please expect a minimum frequency of once weekly, however, until that assessment takes place.

• During a session, it's customary for the patient (you) to share your thoughts and feelings and the details of your life with me, while I pay careful attention, listening to what is being said and not said and feeling with you; I’ll ask clarifying questions, invite you to notice thoughts/feelings/images/sensations/and bodily responses that arise, and offer reflections, all aimed at helping you better understand the beliefs, feeling-states, and automatic reactions that underlie how you operate in the world.  Sometimes, however, silence and being together is what's needed; sometimes it's a walk.  We decide together how to use our time.  

• Although it will only be the two of us in the room, I will discuss your case with a consulting psychotherapist as part of a training program.

  • My path to psychotherapy is not traditional, given my background in internal medicine and palliative care

  • Even so, I have extensive training and work experience as a medical doctor and am therefore well-practiced in assessing suffering, offering interventions, engaging therapeutically with a fellow human being, and taking responsibility for their life, health and well-being

  • As an internist, I regularly engaged with the psychological life of my patients and observed the inter-relationships between mind, body, and spirit; and as a palliative care doctor, the particular kind of therapeutic listening and “being with” that psychotherapy requires has been fundamental to my work  

  • I’ve also been in my own psychoanalysis for more than five years, unwinding patterns of thought, feeling, and behavior that had me stuck and in distress, and honing the intuition and “felt sense” that underpin psychotherapeutic work

  • I believe there is always more to learn, however, so I’m pursuing additional formal training in the theory and technique of psychoanalytic psychotherapy and look forward to bringing these insights into the therapy relationship