Our Approach to Psychiatry
Unprecedented Person-Centered Care Within a Holistic Evidence-Based Team Approach.
What makes good psychiatry good? For one thing, good psychiatry demands a trusting relationship between the prescriber and their clients. To find the right therapeutic dose, and to avoid the all-too-common event of over-prescribing medications, psychiatric appointments must be collaborative, a space in which the minutiae of a client’s experience, in regard to both their symptoms and medication side effects are freely discussed. And that’s where trust comes in, since such open and attuned connections can’t happen without it. But trust isn’t all of it: hope needs to be in the room, too, both hope from the prescriber, and hope from within the client regarding the client’s future. People are not motivated to change if they don’t have a dream about where they are headed. So the collaboration between client and prescriber also demands some mutual sense of where they want to head.
Trust, hope, a collaborative spirit and a team approach are what we consider the central “medicine” of psychiatry; a “medicine” that exceeds any pill in efficacy. And yet today we live in a world in which psychopharmacology is increasingly becoming isolated and transactional: a mechanical act of writing prescriptions. It’s thus no wonder that the United States outranks any other country in the world in the use of psychotropic medications. At Ellenhorn, however, we take extra-pharmacological ingredients seriously, and work tirelessly to combine them with a multidisciplinary team approach and the high level of contact and accessibility associated with concierge psychiatry.
Our psychiatrists hold very small caseloads, which allows them to devote significant time to the individual care of clients, gives them significant flexibility in regard to crisis situations or changes in their clients’ lives, and ensures their ready ability to stay in constant communication with their teams and attend family meetings etc. Each of our psychiatrists is on call 24 hours a day.
Ellenhorn uses the Program for Assertive Community Treatment (PACT) model of care, an intensive multidisciplinary form of treatment considered the evidence-based best practice for individuals experiencing complex events of mind and mood. PACT programs are often called “hospitals without walls” because they combine the multidisciplinary team approach of a hospital with regularly scheduled communication. In fact, our doctors participate in daily team meetings modeled on hospital “rounds.”
The ability to work flexibly and to communicate regularly due to very low caseloads combined with the time to regularly meet and plan with a multidisciplinary team result in the most effective form of psychiatry for individuals experiencing complex and difficult events of mind and mood. This is the exceptional approach to psychiatry we practice at Ellenhorn.
Cutting-Edge Innovation
A few of our innovative approaches in psychiatry at Ellenhorn:
Metabolic Psychiatry
Open Dialogue
Ketamine-Assisted Psychotherapy
Metabolic psychiatry is an emerging approach that treats acute or chronic mental-health conditions by altering metabolism through the types and timing of food intake, body movement, sleep and other modalities. It is where metabolic health and mental health meet.
Metabolism is the sum of the chemical reactions that take place within each cell of a living organism that provide energy for vital processes and synthesize new organic material. By making specific behavioral changes, we can make alterations at the cellular level that will impact energy and cell function. In fact, emerging science suggests that these changes can have a profound impact on brain function and mental health.
These benefits are available to almost everyone, and the main “side effects” of such biologic intervention, i.e., improved physical health, increased energy and the likelihood of increased longevity, are all positive. The challenge is that these benefits do require significant effort to achieve. That being said, we believe that the intensive, yet empathetic, support of the Ellenhorn team provides a unique opportunity for those who are motivated to make these changes in order to reap the extensive benefits of an improved metabolism.
There is ample scientific and clinical research to support the idea that these interventions are powerful biological treatments for mental-health conditions. Scientists have discovered what these behavioral changes can accomplish on the cellular level and how they can improve brain function at the same, if not higher, level of detail as that of psychiatric medications. For more information on metabolic psychiatry, please visit the Metabolic Mind website. Metabolic Mind, a non-profit advocacy initiative of Baszucki Group, offers resources for those looking to learn more about metabolic and ketogenic therapies for mental health. Metabolic Mind amplifies the science and practice of metabolic psychiatry, as well as personal stories, to offer education, community and hope to people struggling with mental health challenges and those who care for them.
Our doctors often participate in our Open Dialogue meetings. Open Dialogue is both a way to organize care and a therapeutic approach. Open Dialogue teams are highly flexible, typically work on an outreach basis in people’s homes, are multidisciplinary and stay with a person and/or his or her family for the duration of treatment.
Open Dialogue at Ellenhorn is centered on the “network meeting,” which typically takes place with the client, their family and at least two clinicians. The aim of the meeting is to develop a dialogue that gives voice to all concerned. It is a way of working and having conversations with people and families that aims to create a space for many voices as equals, rather than having one authoritative version of the situation. Think of it as polyphony, a combination of all voices, rather than monologue. Dialogic practice is based on the belief that change occurs when all voices in the room are heard and understood.
Research on Open Dialogue shows that the method has a significant impact on decreasing psychiatric distress and enabling clients to return to social roles, such as that of employee or student. When people engage in Open Dialogue, we have seen a decline in the duration of the psychosis, a subsequent decline in people matching the diagnostic criteria for schizophrenia and a 73 percent return to full employment or schooling, all with minimal use of antipsychotic medications. Ellenhorn clinicians are graduates of the first class of Open Dialogue training in the United States, which puts us at the forefront of the movement to use dialogic practice to provide dramatically better outcomes for those experiencing psychotic crises.
Ketamine-assisted psychotherapy (KAP) may be recommended for clients as an adjunct to psychosocial work in the treatment of depression, suicidality and hopelessness once other treatment modalities have been exhausted. Ketamine-assisted psychotherapy distinguishes itself from the widely publicized Ketamine treatment through its emphasis on a comprehensive clinical approach. In contrast to standalone Ketamine treatment, KAP incorporates an experienced clinical team to deliver essential psychotherapy alongside ketamine administration. In addition to ketamine’s antidepressant effects, it promotes neuroplasticity in the brain, expansiveness in the mind and more flexible thinking—effects that, in turn, help facilitate deeper therapeutic work. KAP supports each individual as they integrate the biological, psychological and experiential components of the ketamine journey into what they know of themselves and the world. Before initiating treatment, Ellenhorn completes an extensive evaluation of the client, their needs, and their medical and psychiatric history. Members of the client’s clinical team then make the final determination regarding treatment as they examine how KAP could complement or hinder the core psychosocial work being done. This collaborative and transparent process is completed alongside a psychotherapist and psychiatrist in order to support a safe and healing environment. As with all of our offerings, KAP intervention is integrated into the work that is done daily between the client and their team.