Our Services

1. Making an Accurate Psychiatric Diagnosis
   • Depression, anxiety and mood swings are a part of many psychiatric syndromes and can be expressed differently in each individual.
   • These symptoms may also occur in gifted individuals in crisis who have no psychiatric disorder.
   • Distinguishing a Gifted Individual in crisis from a Gifted Individual with a psychiatric disorder is essential for making an accurate diagnosis.
2. The Use of Psychotropic Medication
   • Psychotropic medication is often used during crises to prevent further psychological deterioration and to restore self control.
   • Choosing between the different types of mood stabilizers, antidepressants and major or minor tranquilizers can be a complex process and requires clinical judgement that comes with experience.
   • Once a solid therapeutic alliance is established, psychotherapy can proceed and the use of psychotropic medication often becomes unnecessary.
   • Is medication necessary?
     • When the symptoms prevent the assessment process from proceeding medication can be useful.
     • Identifying the target symptoms so the right medication can be chosen
3. Restoring Self-Regulation
   • Active stress management techniques are suggested.
   • Programs are outlined for Healthy
     • Nutrition
     • Sleep
     • Time Management
     • Work Schedules.
   • Plans are discussed for elimination of
     • Substance Abuse
     • Self-Destructive Behavior

Our model for a comprehensive assessment allows us to identify and evaluate how developmental, familial, educational, social and occupational factors interacted with each other to cause a gifted person’s problems and symptoms.

The psychodynamic component adds a deeper dimension to the assessment process. It is a description of how a gifted individual’s maladaptive attempts to resolve conscious and unconscious conflicts about being gifted have contributed to h/h problems.

Steps in the Assessment Process

1. A description of the problem and associated symptoms: 
   • When did it begin? 
   • What makes it worse/better?
2. Gathering Historical Data 
   • Medical/genetic/trauma/losses
   • Developmental history
     • Were developmental milestones normal or accelerated ?
     • When did reading begin ? 
     • Are there areas of asynchronous development ? 
     • Have interpersonal relationships been appropriate and gratifying ?
     • Did the educational environment succeed or fail in fostering gifted development 
     • Were there occupational opportunities to use giftedness ? 
   • Giftedness: discovered, identified and developed 
     • How would you describe your giftedness?
     • Was it’s development supported or neglected?
     • Were there dramatic successes and unexplained failures? 
     • Were there conflicts about being gifted and conflicts about how to use it? 
3. Formulating the Problem
   • The formulation identifies each of the internal and external forces in a gifted person’s life that contribute to their problems.
   • A “Hierarchy of Causality”
     • The formulation establishes an order of importance for the different stressors and makes a concise statement of how they individually and in interaction with each other cause the symptoms and maladaptive behavior.
   • The Psychodynamic Component of the Formulation
     • Describes and distinguishes unresolved conscious from unresolved unconscious conflicts 
     • It describes and explains how these – individually and together – lead to a gifted person’s psychological symptoms and to h/h repetitive maladaptive behaviors in school, work, and relationships that undermined the expression of this particular gifted person’s potential and well being.
     • It helps in avoiding misdiagnosis: the symptoms of a gifted person in crisis can be mistaken for one with a true psychiatric disorder. The most common of these are: 
       • Bipolar disorder
       • Mood disorder 
       • Anxiety disorders 
       • Personality disorders
       • Depressive disorders 
       • ADHD 
4. Special Applications of the Psychodynamic Formulation
   • The “Inner Experience” of giftedness
     • The psychodynamic formulation helps separate the conflicts and anxieties a gifted individual feels about his/her very personal “inner experience” of giftedness from conflicts and anxieties that he/she has with school, peers and parents.
   • Family Dynamics
     • The psychodynamic formulation helps clarify if a gifted child’s underachievement, self-destructive behavior or psychological symptoms are an acting out of family dynamics. For instance, a family’s ambivalence about having an exceptional child or the child’s way of holding a marriage together.
   • A Learning Disorder or Difference vs. A Learning Inhibition 
     • A gifted individual whose inhibitions about being gifted have caused certain cognitive problems is often misdiagnosed as a twice exceptional individual a gifted individual whose learning problems are caused by a, as yet to be identified, neurological deficit or defect.
   • Existential Depression
     • Gifted individuals may become resigned to living in physical or emotional isolation feeling that no one understands them and that they are unlovable. The cause is often thought to be a set of unlucky circumstances. However, existential depression may result from an inability to find ways to be adaptable and flexible without compromising gifted integrity. A psychodynamic evaluation can help clarify whether conflicts in this arena exist.
   • Distinguishing a gifted polymath from a person with an Attention Deficit Disorder.
     • Under extreme stress, a gifted polymath’s ability to multi-task may unravel. The resultant erratic, behavior and distractibility may mimic a person with Attention Deficit Disorder.
     • Distinguishing a Gifted Polymath – a person gifted in many different domains whose creative process can appear scattered, unfocused, and distracted – from a gifted individual with ADD.

At the conclusion of the assessment process, we can answer  the following questions:

• • What are the primary emotional issues that caused the crisis?
  • What are the secondary factors that accentuated it?
  • Which circumstances need to be changed?
  • Which relationships need to be evaluated?
    • Have there been losses: deaths, friends who moved?
    • Are there conflicts in relationships that need to be resolved?
  • Giftedness itself is an independent factor
    • Are there basic internal conflicts about being gifted that are central factors in the crisis?

The formulation is the final step in the assessment process

• • It identifies the primary emotional cause of the crisis and points to where the psychotherapy should begin.

The Initial Consultation

Consultation With Other Professionals

• Educating other professionals about the psychological aspects of giftedness.
• Using each individual’s formulation to explain difficult or strange behavior.
• Building alliances with other professionals so that effective collaboration actually occurs.
• Acting as a liaison between parents and other professionals so that parents can be effective advocates and misunderstandings can be prevented.
• Helping translate psychological needs of gifted children into sensible recommendations for curriculum changes.

The Therapeutic Alliance

• Developing a therapeutic alliance with a gifted individual may be difficult. Feeling relieved once their crisis has been resolved may stimulate them to end therapy prematurely. This almost always ensures a return of symptoms. Gifted individuals may also abbreviate psychotherapy because they believe that therapists do not “get” giftedness. As part of crisis intervention, addressing their inner experience of giftedness can convey that psychotherapy has more to offer than symptom relief.

Early Stage

• In this stage of psychotherapy we frequently act as psychologically informed mentors, coaches and advisors. The first task is to help establish more effective strategies for managing the real world. Once this is accomplished we help gifted individuals establish or reconnect with a vision for their giftedness. Addressing embarrassment and guilt about being exceptional helps a unified and coherent vision to emerge. We help validate, clarify and explore this vision. Suggestions are made for finding the appropriate venues for full expression of their gifted potential.

Middle Stage

• In this stage our patients come to understand
  • That efforts to avoid conflict about being gifted by disavowing it through underachievement and self-destructive behavior are the leading causes of depression, anxiety and other psychological symptoms.
  • The basic concepts of psychodynamic psychology
  • The universal nature of psychological conflict
  • That psychological conflict is not a sign of mental weakness or mental illness
  • The differences between conscious and unconscious conflict
  • The origins and long-term effects of unresolved early normal and gifted developmental conflicts and how they intersect with each other.
  • The value of tolerating, examining and exploring conflict and anxiety instead of acting impulsively to avoid or deny them.
  • Healthier ways of resolving psychological conflicts

Late Stage

• In this stage, more complex aspects of psychodynamic psychology are introduced and explained.
  • The ubiquitous nature of transference in all relationships
  • The nature of psychological resistance to change.
  • The nature of adaptive and maladaptive psychological defense mechanisms
  • The working through process
• Conflicts within the “inner experience” of giftedness are explained and examined.
• The extra cognitive aspects of gifted endowment are explained and examined.
  • Facilitating the synergy of intuition, imagination, clairvoyance, curiosity, aesthetic, and physical sensitivities, helps creative work become more productive.
• Obsessionalism, procrastination, oppositionalism, and impatience are explored in more depth.
• Warning how to handle phases of creativity that are explosive is just as important as learning how to handle phases of creativity that seem stagnant.
• Psychotherapy becomes a model for collaboration in all relationships.

The Family in Crisis

• When a gifted child, adolescent or young adult develops a psychological crisis, the entire family unit may also go into crisis.
• How do we manage this?

The Elements of Parent Guidance

• Education
  • Explaining the differences between normal and gifted development.
  • Using the formulation to differentiate circumstantial conflicts from developmental conflicts.
  • Using the psychodynamic parts of the formulation to distinguish between conscious and unconscious conflicts.
  • Exploring conflicts about the “inner experience” of giftedness.
• Information about these issues can be reassuring to parents as they begin to understand different aspects of their child’s problems.
• This knowledge provides a foundation for a parenting approach that goes beyond simple behavior management.

Improving Communication

• Establishing ground rules for respectful communication and interaction between both parents as well as between parents and child.
• All opinions and feelings – negative and positive – are legitimized.
• Discussions about difficult topics are limited until trust is restored.

Developing a Plan for Encouraging and Supporting Gifted Development and Limiting Destructive Regressions.

• We help parents become familiar with each of their reactions to their child’s giftedness.
• Individual sessions help each parent learn more about their own values, strengths, weaknesses and unresolved conflicts about their own family of origin.
• In individual sessions, each parent discusses their view of their marriage. Confidentiality promotes a discussion of more sensitive issues.
• We learn whether or not each parent is gifted, how they feel about it and what they have or have not done with it.

Discussion about Differences

• We encourage an open and honest discussion about differences parents have with each other.
  • • How and in what way do each of them feel about supporting gifted development?
  How much do they feel gifted development should be limited? How much sacrifice should be made as well as other possible differences unique to their situation?
• Becoming a Team
  • The process of parent guidance then becomes a combination of education, support, exploration as well as coaching and advising. Invariably, parents discover they cannot completely resolve their differences yet have to become a team in order to successfully help their child.

• Coaching: We can help you develop and refine the skills to maximize the use of particular aspects of your gifted endowment to achieve a specific personal goal. The process is focused on taking action and is oriented toward the present and the future, it is generally short-term.
•  Counseling: This addresses the specific aspects of your psychological dysfunction and dysregulation. It may involve an exploration of the past psychological roadblocks that have prevented you from using your gifted endowment.
• Psychotherapy: This is a more in-depth process that explores the long-standing self-defeating ideas and behaviors that may have prevented you from the full use of your gifted endowment. The deepest part of this process – is a psychodynamic one – an exploration of unconscious unresolved psychological conflicts that may have prevented you from achieving your full potential.