Dr. Nickoloff’s Treatment Approach
At an initial session, I try to get an overview of the “whole person,” beginning with the current problems and symptoms that have brought the patient to see me. This also includes their childhood, family experiences, social background, medical/psychiatric history, significant life events, etc. I find it critical to understand how the patient became the person they are today.
If previous therapy treatments have failed, it is good to try to understand why that was the case. Usually I can offer an initial assessment and some treatment recommendations, and respond to any questions. Sometimes the plan is straightforward and we can begin immediately, while other times its better to meet a few more times before a definite plan is agreed upon. Treatment recommendations are always individualized, and treatment decisions are mutual and collaborative.
I have found that for most of the people who come to my practice, the cornerstone of their treatment is longer term insight-oriented, psychoanalytic psychotherapy. Often prior attempts at brief or symptom focused therapies or counseling, or medication-only treatment, have not been effective, or have had significant limitations. For most, emotional difficulties are complex and longstanding, are interwoven with one’s personality, and involve motivations and feelings that exist outside of conscious awareness (are unconscious). These problems often have their origin in childhood experiences or trauma, but are continually replayed in adulthood patterns and relationship difficulties. Many patients may be very high-functioning and successful in most areas of their lives, but are significantly struggling in very specific areas. Fully understanding all of these factors leads to a treatment experience that results in personal growth and recovery that is both more complete and more long-lasting.
Sometimes, with underlying symptoms such as depression or anxiety, it may be unclear whether these have a biological/medical cause, or a psychological conflict cause. When such symptoms are severe, or interfere with the patients ability to fully engage in their treatment, I may suggest medication. The intention is to reduce these symptoms, to improve day-to-day functioning, and increase the effectiveness of psychotherapy. Medication options are discussed and decisions are always made in a collaborative way.
Having an unusually high level of training allows me to bring a very thoughtful and sophisticated approach to these treatments, with the potential to change people’s lives in often profound ways. Privacy and confidentiality are fully respected. Integrity is at the center of my practice philosophy. People struggling with emotional distress deserve the highest-quality professional care that is sensitive, personalized, confidential and effective.