Alexander Lerman, M.D., P.C.
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Integrative Psychiatry


“Developmental” problems represent an increasingly frequent cause of distress among children today, confronting children and their families with learning, emotion-regulation, social adjustment problems, and often compounded by learning problems as well.

The good news about developmental disorders is that educators, physicians, and other specialists have developed a wide range of assessment tools and interventions with which to diagnose and treat affected children;  returning many kids to the broad track of normal child development,  and helping many others to significant levels of improvement.

The “bad news” about these efforts is that treatment interventions are often fragmented, with communication problems  between teachers, clinicians and parents ; and less-than-perfect assessment of the effectiveness of treatment strategies.  Specialists with different training sometimes have difficulty understanding each other.   The experience and unique needs of the individual child in question are often left out to the equation.

This is an important problem, because the term “developmental” covers a constellation of sometimes very different problems.   Two children diagnosed with the same developmental  problems may share common symptoms, and yet be very different from one another, and respond differently to the same treatment.  There is  no one-size-fits-all intervention, and it’s rare that a single intervention makes all the difference.


Many  factors drive the outcome of a given treatment, but there is one common denominator to therapeutic success: 

  • Teamwork and communication
  • Sophisticated clinical and educational strategies
  • A shared belief in the capacity of a child to grow.

The term “Integrative Psychiatry” refers to a process of inclusion – of parents and family members, teachers, and other clinicians, but above all of the children we are trying to help.  Few  experienced clinicians would disagree with this principle, and indeed the concept of “integrative psychiatry” represents a re-statement of many of the principles of good psychiatric care. These include:

  • Communication: different people caring for a child see and experience different aspects of that child’s life. The quality of psychiatric care is enhanced by feedback from other caregivers who often spend much more time with the child in a psychiatrist does.   The same holds in reverse: teachers and other caregivers are often aided by a collaborative, ongoing dialogue with the psychiatrist caring for a child.
  • Integrative treatment planning:   good communication leads to an ongoing process of diagnostic assessment, treatment planning, and assessment of the success and failure of treatment interventions. The discovery by an individual caregiver of “what works” in a given situation can lead to the generation of successful treatment strategies, and an evolving vision of the potential for growth of a given child.
  • Outcome assessment Ongoing assessment of the success and effectiveness of treatment interventions
  • Inspiration:  children who feel meaningfully engaged communicate more, try harder, and often enjoy better outcomes.  Some children have a meaningful treatment experience in a face-to-face chat, but many don’t. 

How does it work?   The process of integrative psychiatry consists of:

  • a comprehensive psychiatric assessment including a review of the work and assessments of previous clinicians, school records, and psychological and educational assessments.
  • Development of a current assessment of a child’s mental and emotional functioning, strengths, and goals for change.
  • Psychotherapy and case management support by a therapist who will undertake
    • Establishment of ongoing contact and communication with educators, family members, and other involved parties.  Ongoing assessment of a child’s academic progress and social life
    • Initiation of child-centered creative arts therapy or psychotherapy – a process that is undertaken in ongoing collaboration with and supervision by the treating psychiatrist, serving both to engage and support the child, and to provide ongoing information about the child’s mental functioning.
    • Family therapy and parent counseling as indicated.
    • Pharmacotherapy and other psychiatric treatment as indicated, with ongoing monitoring of treatment outcomes.
    • Participation in community creative arts therapy and larger scale projects when feasible and desirable.
    • Outcome assessment to monitor the effectiveness of treatment interventions, and revisions of treatment plans as indicated.
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