Psychotherapy

People often come to therapy because something in the mind has become overwhelming. There may be too much of something painful, too little of something good, something unwanted that will not go away, or something important that cannot be found. Sometimes the mind repeatedly tries to solve a problem but misses its mark.

This is often experienced as an inner pressure that needs relief. The word “psychodynamic” refers to the interacting forces within the mind that create and sustain such pressure. In psychodynamic therapy, doctor and patient work together to understand where the problem comes from, what keeps it in place, and what may allow it to change. The aim is not only relief, but relief that can last. Therapy can help us find—and even create—room for change. It can also help us make peace with what remains beyond our power, without deciding too quickly what can and cannot change.

Many substances can affect the mind, often in powerful ways. Psychiatric medications, hormones, vitamins, supplements, and other treatments act on the mind through the body. Deciding whether—and how—they might be helpful requires more than matching a symptom to a pill. It requires considering the particular person: physical health, psychological life, other treatments, previous responses, and goals.

When a substance is started or adjusted, we assess together whether the expected benefit actually occurs, what unwanted effects may emerge, and whether continuing it remains worthwhile. Psychological treatment and other alternatives remain part of the discussion, whether used instead of—or together with—a substance.

Prescribing and deprescribing are complementary parts of the same work. Treatment may call for starting, continuing, changing, reducing, or discontinuing something. Decisions are made carefully and collaboratively, they revisited over time, with attention to the patient’s experience, goals, stability, and overall health.