Dr. Chesen strives to provide a non-judgmental, safe, and private place for patients to actively engage in treatment for all psychiatric problems. She is a general psychiatrist, Board Certified by the American Board of Psychiatry and Neurology, who uses trauma-informed, LGBTQ-friendly, and culturally-sensitive evidence-based practices to evaluate and manage her patients’ symptoms. While diagnosis is a critical part of initial and ongoing care, patients find that the focus in Dr. Chesen’s office is about meeting their personal goals, and about achieving true remission of symptoms whenever possible—sustainable optimal functioning in all spheres of life is the goal.
Most patients will require a combination of pharmacologic management and psychotherapy in order to achieve this, and the approach to each patient is individual. Treatment is a team effort, with Dr. Chesen acting as an expert guide or coach. Patient autonomy and choice is key. Dr. Chesen only treats patients in her office who are “voluntary” (not court-ordered or “committed”). Many of her patients see a separate psychotherapist, with whom Dr. Chesen collaborates.
While drug companies and the FDA (Food and Drug Administration) offer some guidance with respect to specific “indications” for medications based on clinical trials, Dr. Chesen believes it is important to critically evaluate all the available scientific literature for options that are applicable to her individual patients, and to understand the sometimes significant limitations of that research. Much of modern psychiatric pharmacologic practice is what doctors call “off-label” meaning that medications are used in an evidence-based manner to target symptoms in patients who have diagnoses that do not necessarily match up with FDA indications. The insurance industry also weighs in heavily for many patients in terms of which medications they are willing to cover. Dr. Chesen does her best to work with insurance companies to achieve good results for her patients, but is also a realist with respect to what an individual patient may expect given one’s specific benefits.
The last important concept that is central to Dr. Chesen’s philosophy of treatment is harm reduction. For many patients, complex comorbidity (more than one medical issue occurring at a given time) may create competing needs. For example, say a woman who is in treatment for bipolar disorder wants to get pregnant—her obstetrician and future pediatrician will understandably recommend steps to minimize fetal/infant exposure to medications while it is critical from a psychiatric perspective for the patient to remain stable—both for herself and for her future baby. Add to this the fact that the peripartum period is a vulnerable time for mood-disordered women from a purely biological standpoint. In situations such as this, Dr. Chesen helps find the safest, least risky option for the patient and her future baby that does not compromise her own well-being and safety. Dr. Chesen believes there are many other situations in which the idea of harm reduction is useful. Overall, Dr. Chesen’s job is to help patients identify the potential risks and benefits of treatment options, including the option of “no treatment.”