My Diagnostic Approaches

I begin with the premise that patients are the experts of their experiences and emotions. They often come to me because they feel that something in their lives is amiss. What this is may feel unclear and vague, or precise and concrete. My approach is psychodynamically-driven, in that I assess not just what the patient feels they consciously need in the moment, but also the unconscious drivers that may be at play. I do this by asking many questions. The patient's approaches to these questions are often just as instructive as the answers they may provide. Patients are often not yet ready to uncover traumas buried deep within them, and may not even be aware that they exist. Nevertheless, I recognize the need to meet patients exactly where they are ready to be met.

Diagnostics are ongoing with each successive visit and are intended to provide more than what can be achieved by psychological case formulation. I also want to help the patient uncover, to the best of my ability, any biological or psychosocial underpinnings of their experiences. Biological causes of emotional distress can include chronic high levels of inflammation, thyroid disorder, low vitamin B12 levels, ongoing drug or alcohol use, obstructive sleep apnea, mutations of certain key genes, and family histories. These may be identified through interviews, lab tests, collaboration with other providers, or specialist clinical tests.

Environment plays an outsized role in a patient’s mental health, but is often overlooked or minimized. It is imperative that we examine the impact of life situations, such as a toxic work environment, an unsupportive domestic situation, a recent breakup, or a death in the family. In addition, the effects of past environments, such as childhood bullying, can linger into adulthood. And pervasive societal situations, such as microaggressions endured by BIPOC in their daily lives, can have cumulative effects.

Given the vast complexity and uniqueness of each individual, the work of a diagnostician may never be fully complete, but with time and commitment, many patients can realize positive and lasting improvements to their daily lives.

My goals for the diagnostic process are twofold: first, to continuously clarify the patient's mental health goals in time-limited and measurable ways, if possible; and second, to help the patient come up with a "curriculum" to work on in their pursuit of these mental health goals, using all available resources at the patient's disposal. The "curriculum" in the population I treat often involves medication, but that is not necessarily a given.

Coming up … My Approaches to Treatment