Psychotherapy
What is therapeutic about psychotherapy? Mental life's complexity led to the development of many theories of the mind and many forms of psychotherapy. More than a century of experience, thought, and effort by dedicated people has gone into answering this question. Researchers of the mind differ in observations, interpretations of data, theories of mental functioning, methods for addressing difficulties, and views of ideal outcomes. Sometimes they contradict, sometimes they complement one another.​
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Certain foundations are shared across all approaches: the therapist provides an environment for safe expression, and acts in the patient’s best interest. Education about health and the teaching of coping mechanisms tend to be helpful.
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Beyond these basics, psychotherapy is called “individual”, for a very good reason. Training in psychoanalysis and psychodynamic psychotherapy provides tools that prepare therapists to understand and help unique people in their unique circumstances. One tool may prove more useful than another for different challenges and different individuals, but in the end, healing depends most on the doctor and patient forming a thoughtful team in using them.
Medications: Psychopharmacology, Deprescribing
In light of two precepts of medicine—first, do no harm, and do not attempt to treat what you do not understand—I see the use of synthetic substances to address mental health issues as, at best, a fair and hopefully temporary compromise. Medication should rarely be a first-line treatment, and almost never a standalone, long-term strategy for mental health.
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Many factors contribute to the widespread underestimation of the risks that accompany psychiatric medications—dangers, side effects, and long-term consequences. This casual attitude toward prescribing is often paired with less attention to physical health, diet, lifestyle changes, and psychotherapy. Yet these approaches carry far fewer risks. Rather than numbing distress or dulling responses to life’s challenges, they can foster growth and resilience, bringing new coherence to suffering and transforming it into a springboard toward fuller participation in life.
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From the start of my career, I have relied on optimizing physical health and psychotherapy as central to healing. Over the years, experience has only intensified this emphasis, adding new depth and urgency while progressively reducing the role of psychotropics. I discovered the term deprescribing long after I was already practicing it. Deprescribing is not an end in itself, but a means to a greater end: better overall health.
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Interest in deprescribing has been growing. Still, tapering or discontinuing medications is not always possible, desirable, or timely. When it is pursued, the process is demanding. It requires commitment from both doctor and patient, along with support from family or community. Done well, it is always individualized, informed, and patient-led. While challenging, it can be deeply rewarding.​
Mind and body: Psychosomatic Medicine
When mental distress manifests through bodily symptoms, or when physical illness disrupts the mind’s healthy functioning, the picture can be confusing for patients, their loved ones, and their healthcare providers. At times, nothing seems to fit within the usual categories. The more complex the situation, the more likely everyone involved is to feel lost or overwhelmed.
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In Consultation-Liaison (Psychosomatic) Medicine, my role often involves fostering understanding among patients and medical teams, clarifying priorities, addressing expectations, and formulating coherent plans for complex problems—then evaluating how well those plans work once put into practice.