“My first job is to listen—intently, empathically and non-judgmentally. At times, just bearing witness to my patients’ suffering is the most therapeutic action I can take.”
What was your path to becoming a therapist? What inspired you to choose this profession?
In the late 1990s, I read an article in the New York Times by Fox Butterfield about the mental needs of Louisiana’s youth in juvenile detention. The burden of illness was tremendous, and the youth were woefully under-served. I was a college student at the time and a volunteer in the local juvenile detention center. In retrospect, this was a pivot point for me. I am not sure I fully realized it at the time, but I went on to become a child forensic psychiatrist. I felt compelled to put forth my best effort to effect change in a deeply flawed, multi-layer system which results in much preventable morbidity. My work over the last decade in New York City's public hospital system, and more recently in the correctional system, has afforded me the privilege of treating individuals with tremendously complex psychiatric cases, and I bring this expertise to my private practice.
What would you want someone to know about working with you?
My first job is to listen—intently, empathically and non-judgmentally. At times, just bearing witness to my patients’ suffering is the most therapeutic action I can take. I collaborate with my patients to arrive at the treatment plan together. These plans are often multifaceted and always individualized. Often times, patients come to see me for medications, which usually works best in combination with ongoing psychotherapy. I've found through experience that those of my patients who have honed their own creative process have had some of the best outcomes. Upon reflection, I recall that my medical training included participation in a group, humorously named ‘Students Against Right Brain Atrophy,’ which fostered student participation (i.e. something beyond spectating) in the arts. Unsurprisingly, what’s good for the doctor is good for patient!
How does collaboration with other providers play into your work?
In working with therapists and referring physicians, I take a team approach. Often times we fulfill different roles in the patient's overall treatment plan, and the parts of the whole work best when acting in harmony. If I am seeing a patient for medication management, I welcome the treating psychotherapist's clinical observations to help inform my recommendations to the patient on his/her treatment decisions. I encourage patients to be the primary conduit of information among providers, and I am happy to speak directly with other providers to coordinate care with a patient's permission. In terms of the type of referrals I make, I most frequently refer patients to primary care medicine, psychotherapy, psychological testing, and education consultation.
What excites you most about the evolving mental health landscape?
Our field is increasingly aware of how traumatic experiences—especially during childhood—impact a wide array of physical and mental health outcomes. Kaiser’s Adverse Childhood Experiences (ACE) study found that youth who experienced traumas had more cancer, heart disease, diabetes, depression, suicide and addiction as adults. This study reminds the entire medical community that preventing illness requires a holistic biopsychosocial approach, on both patient-specific and systems-wide levels. The mind cannot be separated from the body, mental health cannot be carved out from overall well-being, and mental health care must not be neglected in the larger health care profession. In addition to the prevention of adversity, we can foster resilience factors that attenuate the emotional and physical effects of childhood trauma. The most awe-inspiring experiences I've had in my career—those that have replenished me as a clinician—have come from beholding the enormous resilience of my patients.
What is the difference between a clinical psychiatric evaluation and a forensic psychiatric evaluation?
Clinical psychiatric evaluations are confidential, oriented towards a patient’s chief complaint, and include diagnostic assessment and treatment recommendations. Patients (or their parents, in the case of a minor) most often refer themselves for a clinical evaluation; sometimes another clinician, such as a psychotherapist or a primary care doctor, will make a referral. On the other hand, forensic psychiatric evaluations are essentially psychiatric consultations to the legal system. They are requested by one’s lawyer or a judge, rather than the person to be evaluated. These special types of evaluations do not have the same limits of confidentially as clinical evaluations, and they often result in a written report, submitted by the evaluating forensic psychiatrist to the requesting legal party (i.e. the lawyer(s) or the court). These can include diagnostic assessment, treatment recommendations, and/or medical opinions in response to the court’s specific consultation questions.
“The most awe-inspiring experiences I've had in my career—those that have replenished me as a clinician—have come from beholding the enormous resilience of my patients.”