|Private Practice of Psychiatry and Psychoanalysis
|Letter from Dr. Aslami:
It can be very difficult for a person with a possible psychological problem to discover the best
possible treatments and venues for them. There are a bewildering array of methods, theories,
and types of degrees professionals hold. It is often best to obtain guidance from a source who
has experience screening psychological problems and referring patients to practitioners with a
known track record of effective work and ethical conduct. This source could be a trusted
internist or OB/GYN. It could also be a respected friend or family member who works in the
Any good treatment must begin with a good consultation with a practitioner. I find that
spending two or three visits of 45 minutes each usually provides time to have a comprehensive
assessment and to agree on a treatment plan. The assessment involves learning about the
presenting problem, but also about the individual person coming for help. This is where
training in both psychiatry and psychoanalysis is very helpful. Psychiatry is a medical specialty
concerned with the diagnosis and treatment of acute problems in mood, anxiety, sense of
reality, reaction to trauma, alcohol and substance abuse, as well as ongoing problems such as
attentional, learning or behavioral disorders. Psychoanalysis is a specialty which works with
these problems, but usually in the context of the person's broader personality make-up and
personal history. Bringing both of these disciplines together can mean a more nuanced
assessment covering biology, social and interpersonal factors, and psychological meaning.
This can lead to better and more flexible treatment planning. Sometimes patients report that if
they go to a "psychopharmacologist" they know they will be given a medicine for their
complaints. Or with someone else they feel they will automatically be put into a certain type of
psychotherapy. Of course, sometimes medicines will help symptoms, but may not have really
been necessary if a particular area of emotional conflict was addressed in psychotherapy.
Conversely, there will be situations in which not starting a medicine may have meant
needlessly prolonging suffering when no other treatments would have provided good relief in
and of themselves. Another dimension of treatment is whether its focus is narrow and short
term or broad and long term. I often ask patients about their preferences in this regard and
also lay out recommendations based on each individual's circumstances.
After the consultation, the recommended treatment plan should be started. I frequently
handle the administration of treatment myself, whether it involves medication or a specific type
or mix of psychotherapies. If a very specialized treatment that I do not routinely practice is
required or if it is more feasible to have part or the whole of the treatment done by someone
else, I can often recommend a skilled practitioner whose work I know well. Of course, every
treatment plan is subject to reassessment and mutually agreed upon revision initiated either by
myself or the patient. My hope is for the most productive relationship possible and for patients
to feel that whatever may come their way in the future, they will feel assured they can bring it in
to me and know that they can work with it.
Brian A. Aslami, M.D.