What should I bring to the initial evaluation?

The initial evaluation will focus on your history—both on the actual events of your life and on your feelings and behaviors throughout your life. More specifically it is often very helpful to think through the events of your life that you feel are significant and have contributed to the problem that brings you to us.

If you have taken psychiatric medication in the past please take some time to write down your medication history. This should include the medication, the dosage, the effects, the side effects and the time course of the medication trial. Please also include the reason for trying this medication and the reason for stopping.

What is the difference between a psychologist and a psychiatrist?

One essential difference is that a psychiatrist can prescribe medication and a psychologist cannot. However, the real difference is in their training and preparation.

Clinical psychologists are psychologists who have specialized training in the practical application of psychological knowledge. In general this training focuses on training in psychotherapy. A psychologist spends between 4 and 8 years completing a PhD (doctor of philosophy in Psychology) or a Psy.D. (Doctor of psychology). This is then followed by a year-long hospital-based internship. Many psychologists have gone on for further training in even more specialized areas of psychotherapy or research.

Psychiatrists have attended medical school and have MD degrees. After medical school psychiatrists have all completed a 4 year residency in psychiatry and some have done fellowships after residency to further specialize. Psychiatrists are trained both in hospital and clinical settings in the use of psychiatric medication and in psychotherapy.

We see psychiatry and clinical psychology as fields with many areas of overlapping expertise but also with differences that allow for different perspectives and treatment options.

Many of our clinicians, including our nurse practitioners and social workers, have additional training after they obtained their particular license. All will be happy to discuss their training and approach with you in as much detail as you would like.

Is a diagnosis important?

Sometimes! Our job is to work with you to understand past patterns and experiences. Sometimes these patterns and experiences are most important in their uniqueness to you and your experience. Sometimes, however, these patterns are familiar to clinicians from our training and from previous patients we have treated and then fall under the heading of a diagnosis. Some diagnoses are harder to treat and some easier but it is often the case that a diagnosis can be very helpful in explaining current difficulties and guiding efficient and effective treatment. Sometimes a diagnosis is clear and obvious but often we think of a diagnosis as provisional in that we use it as a model to guide treatment but only continue to feel that the diagnosis is accurate if this proves to be a helpful model for understanding a patients experience and helpful in guiding treatment. We do our best not to over diagnose and reduce a complex situation to a simple one but we also do our best not to under diagnose and thus leave a situation more complicated than it need be.

How you know if someone needs medication?

Medication is often just one of the treatment options available.

Sometimes we judge it to be the one most likely to help, the most likely to help quickly, or the treatment that is likely to be most practical and cost-effective. Some medication works well in tandem with psychotherapy while some psychotherapeutic treatments have been shown to be more effective if the patient is not taking medication.

Our overarching way of thinking about our clinical practice is a practical one—we pride ourselves in guiding people through the process of figuring out what works for them. Medication can be one part of the treatment options and we recommend only asking the question about “needing” medication until after it has been tried to see if the effects are particularly effective and the side-effects are not particularly onerous.

How do you know which is the correct type of therapy?

In general, the correct type of therapy is less important than the connection with the therapist. We focus on recruiting therapists who are genuine, caring, flexible and empathetic in addition to being extremely well trained.

That said, at Union Square Practice we employ the most up-to-date and empirically-based treatments. We strive to monitor our work with our clients regularly and review their progress with them frequently to ensure that we helping them to achieve their desired outcome.

Our expertise lies in knowing what type of therapy is likely to work. We use this expertise to decide upon our first approach to treatment and work with you closely to ensure that the plan meets your needs.