I’ve described my approach to psychiatric care throughout my web pages. In case you’ve missed those comments, I’ll briefly summarize them below. I’m writing this post primarily so that I will have a web address to give people who ask about my practice.
Some background for the goals I’ve set for my practice:
- There are times when medication is a Godsend for psychiatric illness and symptoms, for example in treating moderate to severe depression, REAL bipolar disorder (i.e. not the bipolar label that is tossed on to every teen who is acting out), psychotic disorders, and moderate to severe anxiety disorders. Children and adults with significant ADD also do much better with medication than with treatments that do not include medication.
- On the other hand, there are many cases of over-reliance on medications. Studies have established that the best treatments are those that combine medication with attempts to improve insight into problem behaviors. Recent studies suggest that antidepressant medications do little for mild depression, and that at least some of the benefit comes from the patient feeling understood, cared for, and reassured that things will ultimately be OK.
- I find the practice employed in some psychiatric offices to be utterly deplorable, where people are seen for very limited periods of time, diagnoses are assigned, and potent medications are prescribed– without taking the time to understand ALL of the factors involved in the patient’s symptoms, and to explain all options for treatment– including the risks of each option.
- People do well when they are treated well. People want to be ‘understood’ by their psychiatrist, and that cannot happen if an appointment begins with a 30-minute wait! How, in such cases, can the psychiatrist claim empathy for the patient’s feelings– right after demonstrating the opposite? And how can someone accurately assess the personality traits of a person who has just been forced to go through a dismissive, frustrating experience?
- It takes time to understand a person– for many reasons. When I begin treatment of a person seeking help, I want to know that person’s strengths; not just the strengths that the patient knows about and describes, but the strengths that I witness and hear about as the patient settles into a long discussion. I also need to know the things that threaten the patient; those that the patient is aware of, but more importantly, the things that the patient does not yet recognize. And again, that takes time. People have a way of acting when meeting a person for only 15 minutes, that disguises how that person truly feels inside. It takes time for a person to let go of that presentation, and settle into being him/herself.
My practice
- With these principles as background, my practice is designed create an environment where people feel relaxed, respected, and understood. I set aside at least 30 minutes for every appointment, allowing time for us to truly understand each other. My appointments start on time. My patients wait a couple minutes for a 30-minute appointment– rather than waiting 30 minutes for a 5-minute appointment!
- I provide formal psychotherapy, usually with hour-long appointments that are scheduled for a predefined period of time, in order to tackle a predefined problem. My approach is ‘psychodynamic,’ meaning that I assume that we all have an unconscious part of our minds, where we repress painful and frightening feelings. I sometimes use tools from cognitive behavioral therapy as well, depending on the particular symptoms and on the patient’s style of interaction and comfort level. Beyond formal psychotherapy, I use every visit as a chance to understand the person seeking help, and to help that person understand their symptoms and options. Having a full 30 minutes for a ‘medication visit’ allows us to get things right the first time, instead of random trials of medication after medication.
- I do not belong to insurance panels. I realize that by not contracting with insurers, some patients may pay more for care than they would from a participating doctor. Unfortunately, insurance is set up to pay for ten-minute med checks– a form of psychiatry that I find to be worthless, in cases where it is not actually harmful. I wish that I could be flexible, and accept insurance in some cases, but the insurance industry does not allow that situation. I encourage people to consider the ‘big picture.’ Recent articles in the Wall Street Journal and the New York Times have decried the loss of traditional psychiatry as a result of the pressure by insurance companies. The articles describe the problems with the ’15 minute med check’ in a field as complex as psychiatry.
- I do submit to all insurers, and many do cover non-participating doctors, at least in part. If you have a high deductible, my relationship with panels may have no relevance to your costs. I do accept charge cards for payment.
- I ask that people consider a couple of factors when choosing a psychiatrist. You will not wait more than a few minutes in the office when see me, meaning that your time away from work or from home is more predictable. I answer e-mails, so that I can answer the short questions that invariably come up when starting any new treatment. But most of all, I believe that my approach is more likely to reduce your symptoms, and more likely to prevent recurrence of your symptoms. Working together we will improve your insight into the causes of your symptoms, helping you become more proactive in maintaining good health.
- The kind comments that I hear most often from my patients is that they feel that they can ‘be themselves’ with me; that I do not judge them, and that I act as if I have been where they are. Those comments are accurate; I have been there. Life is sometimes very difficult, and I have had times of great struggles, as well as times of success. I make no secret of my own experiences, hoping that my own openness will help to reduce the stigma that people continue to feel and experience when dealing with psychiatric symptoms.
That is my practice, in a large nutshell! If you have any questions about my practice, feel free to write to me drj@fdlpsych.com .
JJ
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Sign in nowI’m impressed, Dr. J. Personally, I have a psychiatrist that does the dreaded 15 minute med-check which I combine with a separate individual psychotherapist. I don’t think they have ever consulted with each other.
One of the problems, I believe, with regard to treating mental/psychiatric illness is how the healthy insurance industry splits coverage between medical and mental health. To me, this is uncalled for and unacceptable. It’s still all part of the same person and the brain is part of the same body! There needs to be a movement to combine these two into one coverage plan (unless there is one that I’m unaware of.)
Thanks for sharing your way of practicing with us and for the opportunity to comment on it.
M.
Indeed, I have a psychiatrist that does the “15 minute med check” if you’re lucky – it’s usually closer to 5 – and he’s considered one of the upper-echelon psychiatrists where I live (was psychology correspondent for cable news channels) according to all of the other psychiatrists – who send a patient to him when they feel “in over their heads” – and all of the therapists as well.
I’m lucky to know more about medications than almost all doctors (pharmacists tend to be more knowledgeable about the actual “drug” of the drug, and not just the intended effects, so make use of them!) and am used to a hurried environment (even with terrible anxiety, which might have played a part in my addiction): there is a sort of shorthand that “the professionals” can – do – use in such situations (almost like the Latin on a script!), so it’s possible for someone who is likewise trained to communicate the necessary information within two minutes, make suggestions, have those suggestions revised, and then to, in one’s own time – after the “final orders” have been given – draw the necessary conclusions about what the medications are being prescribed for, and if they’re likely to be of any use (and then call the doctor up and ask for clarification or a reality check if they’re not).
Surprisingly, my current psychiatrist, as much as Dr Junig describes him spot-on above, usually gets medications right, unlike the psychiatrist I went to, and got chlorpromazine and venlafaxine – for a condition that the drugs both together are notorious for exacerbating.
Although, if I didn’t know what the doctor aimed to do, and wasn’t able to speak in the language of pharmaceuticals, I would be completely lost as to what the doctor was trying to do, what his goals were, how he was trying to do it, and what the possible benefits and negatives, and adverse reactions, that could arise from the treatment are.
In that case, I think it would be scary even for a “normal” individual – let alone someone with PTSD, an anxiety disorder, or severe clinical depression.
Added to the above:
The closest there was or is to a movement to combine mental and physical health insurance and/or care that I am aware of was the “mental health parity” initiatives of the early 2000s, which was, by-and-large, successful: before the “mental health parity” statutes were passed, you were lucky to be able to see a therapist and psychiatrist twice a year each at half cost with the Cadillac plan of insurance without having to pay out-of-pocket, or paying $1000 a month for a $100 deductible.