Richard Gottlieb, M.D., Psy.D.

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Psychiatry & Psychoanalysis

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Services

Psychiatry

 

 

 

 

 

 

 

 

"psychiatrist" is a medical doctor who has successfully completed a one year long medical internship and a three year long psychiatric residency program. A "board-certified psychiatrist" is a graduate psychiatrist who has passed comprehensive written and oral examinations that prove competence in the field. A "fellow" of the American Psychiatric Association is a member psychiatrist who has been recognized by the professional community as providing excellent professional service to the community in which he or she practices. A "distinguished fellow" of the American Psychiatric Association is among the select few that are recognized as both providing exceptional professional care and as serving his or her community in a variety of capacities. These include services such as serving on professsional committees, working as a clinical teacher of physicians that are still in training, or volunteering his or her time to champion the needs of patients with mental or emotional illnesses. 

 

I am both a board-certified psychiatrist and a distinguished fellow of the American Psychiatric Association. I have also been named a "Top Doc" by Phoenix Magazine three times, an honor bestowed by vote of my peers, who also recognize my clinical skills. What this means, is that if you choose to see me, you are choosing someone who is among the most qualified psychiatrists practicing in the Phoenix area.

 

When I do a psychiatric evaluation, I endeavor not only to understand the psychiatric symptoms that are troubling my patients (especially those that respond well to psychiatric medications), but I also try to understand the people in whom the symptoms are occurring. Such evaluations consist of a comprehensive history of the present illnesss, a review of past psychiatric and medical history, family history of psychiatric and substance abuse problems, social and developmental history, mental status examination, diagnostic formulation, and treatment recommendations. The evaluation takes about one hour and is designed to serve as a snapshot of what (if anything) requires treatment with medication, therapy, or both. I recognize that, at best, it is a first impression subject to change as I might get to know my patients better. However, treatment has to start somewhere, and this is a time-tested approach and a reliable way to get started.

 

For more information about psychiatry, please visit the American Psychiatric Association's website at:   

 

 

 

      

 

 

Psychopharmacology

 

 

 

 

 

 

 

 

Today most psychiatric disorders are believed to have both genetic and environmental causes. Most of the modern research in psychiatry has focused on the biological basis of psychiatric disorders. This has led to the development of numerous medications that manage psychiatric symptoms. Since the late 1950s when Thorazine was discovered, psychopharmacology has become an increasingly powerful tool used by psychiatrists to manage symptoms found in a wide variety of psychiatric disorders such as Major Depression, Generalized Anxiety Disorder, and Bipolar Disorder. Antidepressants, anti-anxiety agents, mood stabilizers, anti-psychotics, sedative-hypnotics, and stimulants have all found important roles in psychiatry.

 

In some psychiatric disorders, biology is the dominant factor in syndrome development. In those cases, the use of psychiatric medication may be essential to a rapid and sustained remission of the target symptoms. In other cases, psychological factors predominate and psychotherapy is the treatment of choice. In those cases, psychopharmacology can still be a useful adjunctive treatment because when symptoms are intolerable or impair functioning, progress in psychotherapy can stall. In still other cases, social or other environmental factors must be addressed before symptoms will remit. Yet even in those cases, medication can still help patients cope with adverse circumstances. Each case results from a unique mix of biological, psychological, and social factors. It will be up to you and I to determine which factors are primary and whether or not psychiatric medication is indicated.

 

To learn more about psychopharmacology, click on the link to the American Society of Clinical Psychopharmacology below. To check your medications for possible drug interactions, click on the link to the Medscape drug interaction checker below. 

 

 

 

 

 

 

 

Psychoanalysis and Psychoanalytic Psychotherapy

 

 

 

 

 

 

 

 

Psychoanalysis is a theory of unconscious mentation, a method of uncovering unconscious emotionally charged memories from past experiences that affect current thinking and behavior, and a body of professional literature read by clinicians in psychiatry, psychology, and counseling that have extra training in psychoanalytic theory and practice. 

 

Clinicians who practice psychoanalytic therapy and psychoanalysis understand that the majority of emotional and mental processing in the brain occurs below the level of conscious awareness. This is similar to the idea that most applications running in the computer or cell phone you are using to read this paragraph are running in the background rather than on the computer screen. Psychoanalysts understand that not only are we usually unaware of most mental processes, but also that we may defensively resist allowing them to be consciously recognized. While in some ways, this is analogous to your computer's firewall denying access to a file or process that is running in the background, the brain processes involved in repression are not yet well understood. However, we do know that they are learned as a way of avoiding recall of ideas and experiences that generate unacceptable and painful feeling states such as guilt, rage, shame, and anxiety.

 

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Psychoanalysts recognize that genetic predispositions contribute to the development of the brain anatomy and physiology that underlie psychological defenses. They also accept that neural networks mediate the formation of symptoms that are targets for psychopharmacological interventions. The main difference in the focus of cognitive neuroscience and psychoanalysis is that psychoanalysis is primarily interested in how life experience shapes the individual's (mainly unconscious) mind, while cognitive neuroscience focuses more on how neurobiological processes affect the development of measurable brain structures and functions present in us all. Both accept that development hinges on the interaction of nature and nurture across the early years of development and beyond. Genes turn on and off in response to life experiences. Cognitive neuroscience uses the scientific method to study how in general those processes affect development, but it has a very limited ability to explore individual minds - especially unconscious mental processes.

 

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It is only when two people regularly meet and use the tools first developed by psychoanalysts (free association, dream interpretation, and transference interpretation) that it becomes clear how an individual's unique life experiences shaped his or her mind. More importantly, it allows patients to recognize how past experiences generated psychological defenses that affect present day behavior, and gives patients the power to make conscious choices different from the automatic responses they first developed earlier in life. This is quite different from the methods of cognitive therapists, who generally focus on the present-day problematic emotions and behaviors and the thoughts believed to underlie them. Psychoanalytic therapists work to put the present-day problems in context of the entire story of a patient's life, which deepens and enriches their self-understanding and enables them to change stubborn behavior patterns that have followed them across all the chapters of their lives.

 

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These unconscious mental and emotional processes can be inferred by analyzing dreams, slips of the tongue, how the patient repeats past experiences in present behavior, and by noticing subtle behaviors that manifest in the therapy itself. Analyst and patient work collaboratively to construct a personal narrative that helps to explain how early life experiences generated a style of relating to others and the world in general, both in adaptive and maladaptive ways. This new understanding and the working through of associated emotions enables the patient to make changes that are difficult to make using any other treatment method.

 

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For more information about psychoanalysis and how psychoanalysts work, please visit the website of the American Psychoanalytic Association at:

 

 

 

 

 

 

 

 

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