Positive Relationship

Oftentimes arriving at a correct diagnosis and effective treatment is more of an ongoing process than a single event. Our ability to work as a team is critical for success. My goal as your provider is to offer you choices, make recommendations, and explain the risks and benefits; and the pros and cons of various choices. In addition to discussing this with you, I may also refer you to written materials, books and the internet and encourage you to explore these more at length. Even if we disagree on which choice is best, usually we can continue to work together provided there is a plan to monitor outcomes in an ongoing way. If I feel we are not able to build a positive relationship, I will refer you to another provider in hopes of helping you find a good fit for treatment. A movie that illustrates this point is Good Will Hunting.

History

In general, we will seek collateral sources of information, with your permission. People live and learn in systems (i.e. family, work, school) and getting collateral feedback from alternative sources can be very helpful in making a correct diagnosis. Generally this needs to be done with your consent, with only a few emergency exceptions, and generally we do this during the session (i.e. while you are in the office or the waiting room). In some cases, if I feel collateral history is vital, but you do not allow me to obtain this, I may decide it is best to refer you to another provider. In addition to collateral history, at times we will order medical and psychological tests to better identify or exclude possible diagnosis or to more safely monitor medications. These tests cost money and time, and these would be ordered and performed with your permission. In some cases, you may want to forgo testing and we will continue treatment. In other cases, when I think testing is essential and you do not agree, again I may decide to refer you to another provider.

Commitment to Treatment

Successful treatment often demands attention, energy, and effort on the part of the patient to change habits and improve behavior. This often can be a “two steps forward, one step back” process, requiring patience and determination. If you cannot commit to treatment and complete my recommendations, then, like practicing the piano for lessons, we may not be able to continue working together.

Medication Treatments

Woody Hayes, the great former football coach from Ohio State University used to hear complaints from alumni about his boring style of football (i.e. running the ball up the middle or off tackle most plays). To their complaints, he would reply “when you pass the football three things can happen—and two of them are bad”. Similarly, when we try a medication three things can happen – two of them are bad (side effect, no benefit, vs. improvement in symptoms). Be aware that generally when there is symptomatic improvement it is usually not 100%. Substance abuse, i.e. alcohol or illegal drugs, can interact negatively with prescribed medications or overuse of prescribed medications can negatively impact treatment. If substance abuse is a key issue of concern in treatment, then I may refer you to specialized treatment. Medication treatment may involve drug screening.

Minors and Parents

Patients under 18 years of age who are not emancipated, and their parents, should be aware that at times I may be required under law to allow the parents access to their child’s information. Also, I like to work with the consent of both parents, and need the support of all legal guardians to treat a child.

Non-Pharmaceutical

Treatments

In general, non pharmacological treatments and lifestyle changes should be considered and attempted as a first line of defense (i.e. exercise, journaling, therapy). In other cases, medications can be considered. Medications should be thought of as complimentary interventions (i.e. facilitating non pharmacologic treatments and lifestyle changes).

Generally treatment will involve homework, monitoring symptoms, establishing goals and working towards achieving those goals. I often ask patients to carefully monitor for symptoms, (i.e. sleep, mood, anxiety level, energy level), clinical benefits and side effects. In the past some patients have also found it helpful to work from a workbook—i.e. manual based therapy or bibliotherapy.