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Taking a toy gun to school: a consideration of the determinants of adolescent forensic behavior in the aftermath of the Sandy Hook shooting. - International journal of adolescent medicine and health
Adolescent forensic behavior can have a variety of meanings. A consideration of the range of meanings can inform the practice of the psychiatric forensic evaluation. This case report describes the history of an adolescent in individual treatment for disruptive and self-defeating behaviors who brought a concealed toy gun into his high school in the aftermath of the Sandy Hook shooting. The overdetermined nature of this act, as well as a consideration of its multiple meanings in the context of the young man's psychology, his educational and family systems, and his relationship with his treatment provider, will be described and developed. The discussion will broaden to consider the parameters of indicated therapeutic programs to address this subset of adolescent forensic behaviors. The role of deficient implicit emotion regulation capacities in adolescents and the corrective measures to target these neurobehavioral deficits will be described. The report concludes with implications for primary prevention of future adolescent forensic behaviors.
Adolescent mass shootings: developmental considerations in light of the Sandy Hook shooting. - International journal of adolescent medicine and health
Adolescent mass shootings are a special subset of mass killings, which continue despite significant preventative public health efforts. It is often held that these individuals have few salient warning signs that could have been identified. This piece proposes that mass shootings committed by adolescent and post-adolescent young males must be understood from a developmental perspective. The hypothesis proposed in this paper is that such killings occur as the result of the adolescent's frustrated effort to progress along normative development. The goal of normative separation from maternal figures by the boy is presented as a potential risk factor when this goal is thwarted. Childhood case material from the perpetrator of a recent adolescent mass shooting, the Sandy Hook shooting, is discussed as an illustration of this hypothesis. Implications for public health measures and for individualized treatment are presented and developed.
Defense mechanisms and implicit emotion regulation: a comparison of a psychodynamic construct with one from contemporary neuroscience. - Journal of the American Psychoanalytic Association
A growing interest in the neuroscience of emotion regulation, particularly the subfield of implicit emotion regulation, brings new opportunity for the psychodynamic treatment of neuropsychiatric disorders of childhood. At the same time, psychodynamic theorists have become more aware of the centrality of affects in mental life. This paper introduces a manualized psychodynamic approach called Regulation-Focused Dynamic Psychotherapy (RFP-C). Theoretically based on the domain construct of implicit emotion regulation (ER), this approach posits that contemporary affect-oriented conceptualizations of defense mechanisms are theoretically similar to the neuroscience construct of implicit emotion regulation. To illustrate this theoretical similarity, the literature connected with both concepts is reviewed. The implications of this idea, which could promote an interface between psychodynamics and contemporary academic psychiatry and psychology, are discussed.Â© 2014 by the American Psychoanalytic Association.
Berta Bornstein's "Frankie": The Contemporary Relevance of a Classic to the Treatment of Children with Disruptive Symptoms. - The Psychoanalytic study of the child
In this paper the lasting effect of the work of Berta Bornstein is described, particularly the technique of interpreting defenses against unpleasant emotions when beginning an analysis with a young child. This technique is illustrated in the analysis of the patient she called "Frankie" (1949). Although her work is rarely cited (perhaps because she did not publish widely as a result of the dominance of the oral tradition at the New York Psychoanalytic Society and Institute), her work remains centralfor child psychoanalysis and psychodynamic psychotherapy, with the evolution of the experience-near technique of interpreting defenses against unpleasant emotions. The applicability of Bornstein's ideas to contemporary ideas about affect regulation and the treatment of disruptive children is discussed.
Treatment notes: objective measures of language style point to clinical insights. - Journal of the American Psychoanalytic Association
Application of a computerized text analysis procedure is proposed that has the potential for use by psychoanalytic and psychodynamic clinicians: the systematic examination of linguistic style as reflected by clinicians in their ongoing process and case notes, which are ubiquitous in the mental health field. The studies reported here are, as far as is known, the first attempts to study treatment notes systematically using such procedures. Linguistic measures are used to track the trajectory of the clinical process throughout the treatment in two contrasting cases, one rated successful, the other not. The computerized linguistic analysis used here focuses on two analytically relevant linguistic variables: Mean High Referential Activity (MHW), a measure of the degree to which language is connected to emotional processing, and Reflection (REF), the use of words referring to logical functions. Changes in the relative position of these measures indicate nodal points in the treatment that might be analytically or therapeutically problematic, and that might be overlooked in a solely clinical reading. The analyst's activity as reported in notes during such nodal periods is clinically examined to see how it may have affected the course of the analysis. This method has the potential for use in ongoing treatments, and may help clinicians refine their interventions.
Objective measures of subjective experience: the use of therapist notes in process-outcome research. - Psychodynamic psychiatry
Computerized linguistic measures of emotional engagement, and reflective and affective language, previously applied to session transcripts, were applied to notes of 14 treatments by candidates under supervision at the New York Psychoanalytic Society and Institute, covering the five decades from the 1950s to the 1990s. The findings indicate a strong relationship between candidates' subjective experience as represented unintentionally in the linguistic style of their case notes and the effectiveness of their clinical work. The treatments were evaluated for effectiveness by experienced clinicians using the Global Assessment of Functioning (GAF) and the Psychodynamic Functioning Scales of HÃ¸glend and colleagues; a Composite Clinical Effectiveness (CCE) measure was constructed based on level and change in these measures. The Mean High Weighted Referential Activity Dictionary (MHW), a computerized measure of emotional engagement developed in the framework of Bucci's theory of multiple coding and the referential process, showed a positive correlation of .73 with CCE. The Hostility subcategory of the Negative Affect Dictionary (ANH) showed a negative correlation, -.48, with CCE. In a multiple regression analysis, these two variables accounted for over three-quarters of the variance in the CCE. Implications of the findings for process/outcome research and supervision and evaluation of trainees are discussed.
One hundred years after Sigmund Freud's lectures in America: towards an integration of psychoanalytic theories and techniques within psychiatry. - History of psychiatry
The impact of Sigmund Freud's lectures in America in 1909 is discussed. Some of the roots of psychoanalysis and their contemporary relevance are addressed: neurological ideas, the discussions of the sexologists, and the degeneration theories at the turn of the twentieth century. Factors which led to the dominance of psychoanalysis in psychiatry included, in particular, its arguments against the hopelessness of degeneracy theories;yet,by isolating itself from mainstream academic psychiatry and psychology,organized psychoanalysis itself contributed to its own subsequent marginalization. In order to re-integrate itself with mainstream psychiatry, psychoanalysis needs to appreciate the importance of systematic demonstrations of the therapeutic power of psychodynamic/psychoanalytic concepts and techniques when caring for individuals.
A cross-sectional survey of child and adolescent analysts in New York City. - Journal of the American Psychoanalytic Association
The field of child and adolescent psychoanalysis has been considered an endangered specialty for many decades. This study surveyed the nature of the practice of child and adolescent analysts (graduates and candidates) affiliated with three institutes accredited by the American Psychoanalytic Association in the New York City area. Sixty-one percent of those surveyed (63 of 103) responded. The child and adolescent analysts in this cohort treat a total of 201 adult, child, and adolescent analytic cases (M = 3.2, SD = 2.6). Of these cases, 17% are at a three-times-weekly frequency. Child and adolescent analytic practice is small, with a total of 56 analytic cases (M = .9, SD = 1.2). While 64% of these analysts have no child or adolescent analytic cases currently in treatment, 24% have very active child and adolescent analytic practices, conducting 73% of all the child and adolescent analyses reported. Implications of these findings and recommendations for future work are discussed.
Do children get better when we interpret their defenses against painful feelings? - The Psychoanalytic study of the child
This paper represents a step toward trying to integrate clinical and research perspectives. To achieve this integration, analysts need to be clear about the clinical constructs and specific interventions they utilize as they try to unpack the concept of "therapeutic action. "In trying to understand "how" interventions work, technical interventions need to be clinically formulated in a narrow fashion within the more global therapeutic approach in which the particular analyst practices. In this paper, I address one specific technical approach. I discuss the therapeutic importance of an intervention, especially during the beginning phases of an analytic or dynamic therapeutic process: interpretation of defenses against unwelcome affects, a technique in whose development Berta Bornstein was instrumental. This paper puts forward the hypothesis (which remains to be systematically empirically verified or refuted) that this approach is not only a core element of defense analyses but may very well be common to all good psychodynamic treatments, regardless of the manifest theoretical orientation of the therapist or analyst, and regardless of the analyst's or therapist's explicit consideration that he or she is utilizing this approach. Clinical material from the literature is discussed in order to illustrate the technique and to show how, when analysts are attempting to demonstrate the value of other or new interventions, analysts may ignore how they are, in fact, utilizing the technique of interpreting defenses against affects.
Mothers' ambivalence with their babies and toddlers: manifestations of conflicts with aggression. - Journal of the American Psychoanalytic Association
In this paper the author continues his study of conflicts over aggression in women, discussing the implications for contemporary theories of feminine psychology of observations of mothers in parent/child groups with their infants and toddlers. Many mothers experience conflicts over aggression (both in themselves and in their children) and become intolerant of their ambivalence toward their children. The author suggests that this observation provides an avenue that allows an integration of psychoanalytic ideas about maternity and childrearing with psychoanalytic understandings of women's conflicts about achievement in the social realm outside the home. In both roles, difficulties mastering conflicts with aggression may cause women to struggle profoundly, and to experience problems, in successfully negotiating their important life goals, whether the goals refer to their roles as effective mothers or their roles as effective individuals in the social sphere outside the home. Some women may demonstrate these difficulties in one sphere or the other, some in both, and others in neither. The author suggests on the one hand that we need to eliminate the concept of normality when considering the activities of women, and on the other hand that we need to normalize the omnipresence of ambivalence in the psychology of women.
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