What is psychodynamic psychotherapy?
Ever wondered - Why do I become more like my mom or dad even though I am doing everything I can to avoid it?  Why am I attracted to partners with the same problems? According to psychodynamic theory, early life experiences in relationships shape the way that we interact with others for the rest of our lives. The familiar is comforting to us, so we unknowingly repeat the past. Avoidance of the past can paradoxically lead to repeating it. Until we break the cycle, the past may continue repeating itself.  Psychodynamic psychotherapy (also called psychoanalysis) looks for patterns from the past (for example early family relationships) that persist into our present. 


You and your therapist examine present relationships and how they compare to past relationships. The therapist’s job is to understand the relational dynamics happening in session and help change the dynamic which can help break the cycle. Clients learn to stop avoiding distressing thoughts, feelings, and sensations and learn to sit in discomfort, something that psychodynamic therapy has in common with mindfulness based therapies like Acceptance and Commitment Therapy (ACT). The theory is that when we learn to recognize internal conflicts, we can also learn to deal with them in healthy ways, which will lessen symptoms. 


What does psychodynamic theory look for? 
Psychodynamic theory looks for uncomfortable feelings and thoughts that lead to avoidance. According to psychodynamic theory, uncomfortable thoughts and feelings are pushed down and can lead to symptoms in our bodies. Our bodies struggle to bring these conflicts to the surface and thus into our awareness. Examples of possible bodily symptoms are muscle aches, headaches, stomach pain, and loss of feeling in arms and legs or less commonly in other body parts. 


What makes psychodynamic theory different from other theories in treatment?
What makes psychodynamic therapy special is that it focuses on deep-seated issues in order to alleviate symptoms rather than focusing only on the symptoms themselves. This makes psychodynamic therapy more typically long-term. The theory focuses on creating greater, long-term change rather than what are perceived as short-term and surface-level changes via cognitive, behavioral, or solution-focused therapies. 


What can I expect and who benefits from psychodynamic psychotherapy?
Some favorite interventions utilizing psychodynamic therapy involve dream work, art therapy, describing fantasies, and exploring themes and symbols. These types of activities are thought to awaken unconscious content and bring forth important information about inner conflicts and family dynamics. If you enjoy abstract thinking, fantasies, and being creative, you may feel drawn to psychodynamic therapy. 


Psychodynamic therapy has been shown to be helpful in managing depression, anxiety including panic disorder, somatoform disorder, eating disorders, personality disorders including borderline personality disorder, and substance-related disorders

Ketamine has been in use as an anesthetic and sedative in operating and emergency rooms for the last 40+ years. More recently, studies have demonstrated its effectiveness in mental health, most notably in patients with chronic, treatment-resistant conditions like anxiety, depression, PTSD, and chronic pain. Ketamine Assisted Psychotherapy (KAP) is an emerging treatment in psychiatry and psychotherapy.  It combines the medicinal effects of ketamine with therapy in a state that better allows you to access difficult emotions and memories.  

Ketamine is the only current psychedelic substance approved by the Federal Drug Administration (FDA). The effects of Ketamine can lead to relief of everyday distressing emotional, physical, and mental states. Ketamine is thought to be helpful therapeutically as the psychedelic effects lead to non-ordinary state of consciousness where fear of difficult feelings, thoughts, and sensations are lessened.  This can allow for more advanced therapy to occur.

Ketamine shows promise in clinical studies for rapid symptom reduction for individuals with treatment-resistant depression including a reduction in suicidal thoughts.  The rapid reduction of symptoms stands out against common psychiatric medications that require weeks for full effect and traditional talk therapy, which can take months for significant symptom reduction.  Ketamine is considered a NMDA receptor antagonist, but some theorize that ketamine works by encouraging neuroplasticity (neuronal growth). 

Ketamine assisted psychotherapy takes place in the office under the care of dedicated, trained staff. Psychiatrists analyze patient fitness for ketamine: individuals with chronic heart issues, hyperthyroidism, uncontrolled hypertension, among others, should not take ketamine. It is important to disclose all over-the-counter and prescription medications to staff to avoid interactions. Studies that focus on ketamine often utilize a treatment plan that begins with approximately six sessions in the first 2-4 weeks and then tapered maintenance sessions.  Treatment that involves therapy will typically include being in the clinic for 2-3 hours.

The optimal dosage and modality (oral, intramuscular) are determined based on the ketamine experience by the patient and assessment by the psychiatrist. Therapists working with clients will reassure, validate, and deeply listen to each patient while anchoring the KAP session. In this safe environment, the patient is able to engage with the effects of ketamine and begin the journey to long term change.

While some clinics focus on providing ketamine intravenously in a medical setting, we believe long term change better occurs when combining ketamine with counseling in a more relaxed setting.  Accessing and addressing our trauma, frustrations, and emotions that hold us back can better allow for change to occur.

Common side effects are: out of body experience, increased heart rate and blood pressure, dizziness, nausea, and sedation. These side effects typically dissipate within a few hours. Patients in ketamine treatment are not safe to drive for approximately 12 hours, thus must leave the office with a designated driver. 

Ketamine treatment is for patients who have tried psychiatric medications or are looking for another option for treatment-resistant depression and other disorders. Ketamine, however, is not the only alternative. Other options for treatment-resistant depression include transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). Symptom alleviation may not be permanent, and may require further ketamine treatments. 

If you believe you may be a candidate for Houston ketamine assisted psychotherapy, contact our office at 281-849-4080 for a psychiatric consultation. 

Regular and consistent sleep patterns are an important aspect of children’s mental wellness. During sleep, children’s minds process information from daily experiences and stressors. Regular and consistent sleep can lead to greater self regulation and less likelihood for behavioral issues resulting from tiredness and sleepiness.

In short, when children are rested, they feel calmer, less anxious, and more in control of their emotions and responses. Restful activities combined with routines are more likely to lead to good sleep hygiene. The steps to creating a successful nighttime routine include consistency, a calm environment, connection, and preparation for potential hiccups. 


Routine
Create a bedtime routine that includes the routine essentials but also incorporates calming activities. Bedtime routines optimally begin 1-2 hours before sleep, but can take less time once the routine is internalized. This window of time prepares the child for rest both emotionally and physically. Create a bedtime poster with your child, list the activities (written or drawn), and discuss why each step in the routine is important for the child’s health and wellness.

Increase self-efficacy by asking your child how he/she feels after they complete each task. For children who become distracted or are overwhelmed easily, following the steps on the chart will keep them on task and organized. Include options and privileges. For example, when kindergartner Caroline completes her bedtime routine, she may choose one of three calming bedtime activities: story time, coloring, or playing with a fidget toy. Watching electronics at bedtime should be avoided as the graphics, colors, movements, and sounds will activate the brain leading to restlessness rather than rest. 


Environment
Create a calm environment at the start of the bedtime routine. Dim the lights or switch from overhead lighting to lamps. Close the blinds or curtains. Turn on calm music. The child’s sleep area should be as uncluttered as possible in order to decrease distractions and anxiety. Include favorite stuffed animals in their bed.

Select a corner or area of the room in which the child has easy access to calming toys and books. Include comfortable seating, whether a floor pillow, rocker, beanbag chair or tent. Create physical boundaries by naming what rooms/areas of the house are within or off limits during the bedtime routine. 


Connect
Finish the routine with a short mindfulness or loving-kindness exercise to promote a calm mental state for sleep. Ask your child to list three people he/she is grateful for or list one thing that went surprisingly well today.  


Recite a mantra: “ I feel calm in my body. I feel calm in my mind. I feel calm in my heart.” Whatever your activity, take this moment to connect with your child. Caregiver connection, even for short periods, enables co-regulation between parent and child. 


Hiccups
When routines are interrupted, behavior changes due to dysregulation can result. Factors like hunger and tiredness can lead to outbursts or hyperactivity. Introduce a calming activity before beginning the bedtime routine. Explain to your child that calming activities, as moments for self regulation, are neither privilege nor punishment, but essential for healthy emotional regulation development.

​When your child is dysregulated, attune yourself by bringing your body to their level, using an even and calm tone, and looking them in the eyes. If your child is unable to focus on you, touch them gently, for example by lightly touching their arms. “I see that you have a lot of energy. It is time to sleep. Let’s take a few minutes to calm down with a quiet activity.” Narrating behavioral issues without shame will make the child feel seen by the caregiver and also help the child recognize behaviors and triggers over time. 


When nightmares and specific fears add to bedtime anxiety, try these strategies. Take your child with you as you check around their room for common fears like monsters, spiders, or snakes. Keep it lighthearted. This will validate the child’s fears and show that their safety and wellbeing are important to you. Reframe fears by asking your child if there is anything interesting or likable about the thing they fear. Name exceptions to fears. Ask your child: “What about you could be scary to the monster?” Your local librarian can recommend books about common fears. For example, Seaver the Weaver by Paul Czajak and Verdi by Janell Cannon impart child-like struggles upon a spider (Czajak) and a snake (Cannon). When monsters acquire human-like qualities, children’s fears deflate as children recognize that all things, even monsters, have fears. 

At this time, about 63% of Americans are part of the labor force.  Many employers offer programs designed to promote wellness and connect individuals with treatment options.  In addition, they promote the ability to handle and reduce stress. 
 
The CDC (Centers for Disease Control) reports that 1 in 5 adults (18 and older) reported suffering from mental illness in 2016.  Additionally, 71% reported headaches, feelings of being overwhelmed, or anxiety, all overt symptoms of stress. 
 
Mental health disorders are also closely linked to other physical conditions like heart disease, diabetes, and muscular problems.  Treating the physical and mental disorders separately will cost two to three times more than treating those without combination issues.  By combining the treatment plans, the savings could amount to $37 billion to $67 billion each year.  This means employers can reduce health care costs across the board and have healthier employees.
 
Further, the CDC says that employees with a high risk of depression had the highest health cost during a three year period following the initial assessment.  This includes others at risk from smoking and obesity.  Depression will affect performance at least 20% and affects cognitive abilities about 35%.  However, of those who report moderate depression only 57% receive treatment and for those with severe depression only 40%.
 
Excess stress and other mental health issues translates to negatively affecting:

• Job performance
• Productivity
• Interactions with other employees
• Communication
• Physical issues
• Functionality

 
Especially when mental and physical treatment plans are combined, employer sponsored wellness programs have proven beneficial to both the company and the employees.  Through a combined plan:

• Communications can be combined using the structures already in place
• Social networks become available
• Programs and policies are united
• Offering incentives for healthy behaviors
• Employers can track progress

 
As an employer you have some options.

• Offer self-assessment mental health tools
• Establish clinical screenings by qualified mental health professionals with clinical referrals as appropriate.  These can be free to the employee or offered at a reduced cost.
• Reduce co pays on depression medications
• Programs for lifestyle changes
• Host in-office programs to discuss stress reduction techniques
  • Breathing exercises
  • Meditation
  • Mindfulness
  • Focus improvement
• Treat disrespectful comments or actions as you would any other form of prejudice or discrimination
• Provide managers and supervisors with the tools to identify signs of stress and depression
• Give employees the opportunity to voice opinions

 
There are a number of insurers who provide plans to help implement a mental health program.  This can include videos, emails, education and other initiatives to help management and employees deal with the issues in the workplace.

​The CDC (Centers for Disease Control) estimates that 20% of adults over the age of 55 will experience some form of mental health disorder.  This can include some sort of cognitive issue (forgetfulness all the way to some degree of dementia), mood swings (generally depression), and anxiety. 
 
With depression as the most common form of mental disorder in seniors, it can affect social interactions and impair the ongoing treatment of other chronic conditions.  It is often dismissed as a normal part of aging or under treated. 
 
In reality, depression or other mental illnesses are not a normal part of the aging process.  Left untreated, it will affect the person's ability to function, lead to a poorer quality of life, and can actually slow the healing from physical illnesses and surgeries.
 
Mental health can easily decline after a serious illness like stroke or chronic conditions like Parkinson’s, arthritis, or cancer.  Medication can often play a part with drug interactions between prescriptions that are overlooked.  Older adults have needs that change including loss of friendships, relocating to other parts of the country, and changes in living conditions.  All of this needs to be considered during the treatment of mental health issues.
 
The good news is that older adults can be helped with the same success as those who are younger.  With some psychotherapy and anti-depressant medication, it is reported that 80% will recover.
 
Some symptoms you may want to watch for include:

• Sadness that persists.  If the person remains depressed longer than two weeks, keep tabs to see if it is improving.  If not, consider help with a mental health professional.
• Consistent sleep issues
• Trouble concentrating
• Everyone forgets things.  However if it becomes consistent, occurs more frequently, or in familiar surroundings, start paying closer attention.
• Over use of alcohol
• Confusion with the medication regimen

If these indicators accumulate or become more serious, it is a sign that the individual may need some professional help.
 
Many older adults continue to thrive even on their own.  Some habits that seem to help are:

• Exercising to the best of their physical ability.  This can include gardening in raised beds, walking, dancing, etc.
• Reading.  Joining with others to discuss books is a good way to stimulate mental agility.  Reading as a group event allows for socializing and forces people to read something they would not normally pick up.  There are a number of websites that offer discussion questions.  Check with your local public library for suggestions.

 
The health system in the United States offers Medicare that covers 80% of a physical health issue but only 50% for a mental health condition.  Fear of overspending can often impact an older adult's reluctance to seek mental health assistance.  Studies have shown that over 60% of older adults with a mental health issue will not receive the help necessary to bring them back to a stable head space.

As a concerned family member or as part of the medical team, it is critical to review prescriptions and over-the-counter medications.  This has a two-fold importance:  to be sure the prescribed medication is taken as ordered and to review for any interactions.  

Older adults often visit more than one medical professional.  Most older adults are quite capable of managing their medical care and are conscientious about complying with the medication instructions. However, when multiple prescriptions are involved, medical staff should carefully review all of them. Overprescribing is rampant for older adults who are more vulnerable for adverse effects.

As one ages, the liver becomes less able to break down medications and toxins.  Side effects can become more common if medications are not initiated and titrated slowly.  Lower doses may be utilized compared to younger adults.

At some point, cognitive abilities will fail and it will be necessary for someone else to take responsibility for the medications.
​

The chance of dementia increases with age: 

• 5% of all adults over 65
• 30% in adults in the mid 80s
• over 50% for adults in their 90s. 

While Alzheimer's is the most common form, there are other types of dementia to be screened for.
​
Symptoms like depression, anxiety, and insomnia are often overlooked as changes in cognitive abilities. Wandering will occur in over 90% of patients diagnosed with dementia and is the primary concern for their caregivers.  With supportive guidance to the patients and families, this condition can be dealt with reasonably and safely.  Of primary concern is safe judgment and appropriate living arrangements.

If you know someone who may need some help, don't delay, book an appointment today. 
 ​

A psychiatrist is a medical doctor (M.D.) who becomes specialized to effectively treat mental health issues. If you're wondering how to become a psychiatrist, there are a few vital steps to take.

Psychiatrists diagnose, treat, and help prevent emotional and behavioral disorders. To do this they will use a number of techniques or methods including therapy, interventions, and medication.
​

​To become a psychiatrist, you must first have a bachelor’s degree from an accredited institution. These degrees are often in the pre-med area, psychology, sciences, or a combination.  The degree does not have to be science related though.  Any degree with the appropriate pre-requisites will suffice.  Academic advisors can help develop a program of classes to keep you on track.

Psychiatrists are medical doctors, so it is necessary to start with the MCAT (medical college admissions test), get admitted to a MD or DO Program.  After graduating medical school (4 years), begins years of clinical residency.  For psychiatry, the standard general residency is four years.  Many psychiatrists will work additional years to sub-specialize.  

In order to practice any type of medicine, physicians must be licensed in the state(s) in which they will work.  This includes psychiatrists.  This license must be maintained in good standing which will include continuing medical education credits and renewal.

While in college and during residency, the individual usually settles on a specialty in which he or she wishes to practice.  The classes and clinical work should focus on those areas.  The choices include:

• Behavioral Science – This focuses on human behavior involving emotions, personality, and social actions.  It involves biochemical, pharmacological, and physiological personality actions and traits.
• Cognitive, Affective, and Behavioral Neuroscience – This deals with neurological components that explain how people think, remember, make decisions, and deal with emotions.
• Psychopathology – This deals with serious disorders and how they can be treated.  It also explores the legal and ethical elements of the treatments.  Frequently it delves into multicultural influences

Psychiatrists work with patients either in private practice, in a hospital, or other institutional setting.  Away from the patient, they review and record notes and assure that treatment protocols are being followed.  They may meet with patients' families, support groups, or other interested parties.

Specialization can involve illnesses like anxiety or sociopathy, or with a demographic element like children, older adults, or veterans.  In some cases the working hours are very regular, but it is not unusual for psychiatrists to work extended hours in some settings.
  
There are a number of historical issues that influence the treatment and those who are seeking help.  Psychiatrists help dispel myths and stigmas and promote healthy mental and physical outlooks for their patients.

The psychiatrist will also need to understand the brain and how it works.  People perceive and process information in different ways and the interrelationship of the nervous system and behavior becomes critical in many cases.

Communication skills are particularly important in psychiatry.  How someone explains their symptoms and digging out the details can make a big difference when it comes to making the correct diagnosis.  Better care is often provided after a thorough evaluation.

Tele-medicine is the provision of health care remotely through the use of technology. Telehealth psychiatry is a method to provide a range of services including:

• Evaluation
• Therapies
• Individual
• Group
• Family
• Education
• Medication management

​Although it uses video-based electronics, telehealth psychiatry involves direct care between the psychiatrist and patient. Telehealth is a live interactive method for a doctor to provide needed mental health service to remote patients. It can also be used to transmit medical information to other consultants.

• Brings accessibility to rural areas
• The care is brought directly to the patient
• Incorporates mental health care along with primary medical services
• Allows for continual follow-up services
• Reduces barriers like transportation, child care, etc.
• Provides a confidential and convenient service

Telehealth psychiatry provides a needed service in what might otherwise be an underserved area due to access  or safety concerns. It is a cost effective method to offer aid to patients in privacy. The psychiatrist must be licensed in the states they are working, and can only provide care for patients in those states.
It is used in a number of different settings:

• Military
• Nursing homes
• Correctional facilities
• Schools
• Nursing Homes
• Clinics and hospitals

Experts estimate that 1/8 emergency room visits require a psychiatric intervention. Electronic Psychiatry visits can help evaluate the patient and offer treatment options. Nursing homes and long-term care facilities use telehealth psychiatry appointments to provide mental health treatment without compromising accessibility. Those in jail and prison can now also receive valuable psychiatric treatments for ongoing mental issues.

For the ordinary individual, they will schedule an appointment for a video appointment. However, it is suggested that, if at all possible, the patient should be prepared for an in-person appointment. The individual should have all relevant information, medical records, medications, and other materials readily accessible.  
Research is showing that telehealth psychiatry visits are equivalent to in-person appointments. Diagnoses are just as accurate, treatments are as effective, and patients show a high degree of satisfaction. Privacy and confidentiality are still maintained to standards or greater.

For people with severe anxiety disorders or those with mobility issues, remote treatments have proven highly beneficial. 
 
When considering a telehealth psychiatry appointment, it is important to find a secure place for your appointment. The psychiatric team will be responsible for their location. Be sure to verify the software works and you have a working internet connection. While many devices and operating systems offer secure software, not all do.

How often has mom told us “eat a little something and you will feel better”?  Think about it...your brain never stops working.  All day and all night, your brain keeps your bodily functions operating.  Using all that energy requires constant fuel.  What you eat directly affects your bodily functions, including the brain.  So the better you eat, the better your brain will work.  Conversely, when you overeat, or consume junk food, or otherwise skimp on nutrition, you are prone to sadness and anxiety.


This is the basic principle of nutritional psychiatry.


Today's research is showing a correlation between good nutrition and the reduction of free radicals, inflammatory cells, the kinds of bacteria that live in the intestinal tract, as well as how you feel, and behave.  Eating highly refined sugars is now linked to impaired brain function and the aggravation of mood disorders like depression.  Nutritious foods with vitamins, minerals, and antioxidants protects the brain from oxidative stress or free radicals produced as the body oxygenates.


Serotonin is a substance, a neurotransmitter, that regulates sleep, appetite, evens out moods, and reduces pain.  The vast majority of serotonin is produced in the gastrointestinal organs.  So there is a direct connection between the transmitters in the gut and the serotonin that keeps our lives on track.  As proper nutrition is processed by the body, it helps regulate our moods as well.


Studies have found that the risk of depression is lowered by 25% to 35% in persons who follow a Mediterranean or Japanese diet.  These eating plans are high in vegetables, fruits, unprocessed grains, and fish and low in meats and dairy.  They also shun processed and refined sugars and other foods.


A food diary is an easy way to see if it works.  Try one of these diet plans and after about a week start keeping a record of what you ate through the day and then how you felt the next day.  Continue this for another week and see if there is a change in your mental attitude.  This is also a way that you can find trigger foods by reintroducing them into your eating plan and then tracking how your emotions are affected.  Also note if you have increased or decreased energy and sleep patterns.


Nutritional psychiatry is applying these studies to patients who suffer from various forms of mental illness especially anxiety and depression.  It appears to be an effective method to reduce or eliminate medications that can have other side effects that adversely affect some people. 


Combining healthy eating with approved psychiatric counseling sessions is one of the non-invasive techniques that can greatly improve lives. 


A 2020 study has revealed that anti-inflammatory fats like Omega-3 are connected to a lower risk of depression.  This study found that women who consumed fish twice per week had a 25% lower risk of depression as compared to those women who ate fish less than twice per week.


Higher risk of depression was found in people who failed to get enough magnesium (beans, lentils, peas, avocado, nuts, whole grains, and dark chocolate).  The same was found in those who were deficient in zinc (oysters, pumpkin seeds, cashews).

Stress is an emotional strain that comes as a result of difficult or adverse circumstances.  It is an emotional response to external factors but can have physical symptoms as well.  Some of the physical issues are:

• Digestive problems
• Reproductive issues
• Muscle tension
• Headaches
• Fatigue
• High blood pressure
• Chest Pain

 
Mental health issues include:

• Anxiety
• Irritability
• Depression
• Anger
• Feeling overwhelmed
• Racing thoughts
• Worry
• Making bad decisions

 
Situations that cause us concern are called stressors.  Stressors can be negative like relationship issues or financial problems.  Stressors are also internal like pessimism about life, worrying about something that may or may not happen or self perception.
 
Stress is basically our perception of something difficult to deal with.  Stressors are somewhat individualized in that what may bother one person has no affect on another.  Strict deadlines may have you in a tizzy but  your coworker thrives in that atmosphere.  Common external stressors are:

• Major life changes (good or bad)
• Work or school
• Relationships
• Finances
• Overworked
• Commitments including family

 
Internal issues include:

• Lack of flexibility
• Pessimism
• Negative self image
• Unrealistic expectations

 
There are some indicators to show that you are having difficulty dealing with stress:

• Work or school performance drop
• “Self medicating” with alcohol, drugs, or tobacco or an increased use of any of them
• Difficulty dealing with daily situations
• Withdrawal from friends, family, or social situations
• Sudden irrational outbursts
• Taking dangerous chances
• Thinking of hurting yourself or others

 
There are definitely some ways you can learn to adapt or handle the stress in your life:

• Activity – Regular exercise can make you feel better.  Rhythmic pursuits like walking, dancing, and swimming are some of the best choices, especially if you try to focus on the sensations around you.  Park further from the entrance and enjoy a brisk walk into the building.  Turn on your favorite tunes and dance around the home.  Greet people you see along the way.  When you go out for a smoke break, just once per day, walk around the building instead.
• Interactions – Instead of texting, look up and speak to someone.  If your friends make you more anxious or worried, spend less time with them.  If you are trying to build some friendships, there are many free activities.  Try your local library movie night and join in the discussions afterward.
• Healthy eating – A diet of processed and convenience food, sugary snacks, and refined carbohydrates will only worsen the situation.  Eating good, lean protein, fruits, vegetables, reducing caffeine and sugar and drinking enough water every day will help you feel physically better and then more capable of handling the challenges that come your way.