Services Provided by Dr. Ducat
Sometimes my work with patients consists largely or exclusively of psychoanalysis with individuals, or psychotherapy with families, couples or individuals. Psychotherapeutic treatment has been referred to as the “talking cure” because it heals, in part, through conversation. Putting troubling thoughts, emotions, and memories into words enables them to be felt and understood more deeply, to be borne with greater resilience, and to facilitate wiser choices
The privacy, boundaries, empathy, and safety of the therapeutic relationship can enable even the most shameful and frightening feelings to be faced and worked through. There is also the opportunity to give new meanings to old stories, so that the traumas of the past needn't be the script for the future, and real change becomes possible.
I view therapy as a zone of curiosity, discovery and the unexpected. One paradox of the deep trust that develops between patients and myself is that it allows for the unconscious conflicts and patterns that impair an individual's everyday life and relationships to emerge in the psychotherapy relationship itself. While this can be momentarily uncomfortable, when old difficulties emerge in the here-and-now context of treatment, it can lead to unprecedented insight and an ability to imagine and experiment with new, healthier ways of being with oneself and others.
From an integrative perspective, psychotherapy is an intervention in the body as well as the mind. Just as imbalances in various parts of the body can show up in our brains, our brains can think and emote the other parts of our bodies into health or illness. This has long ceased to be a controversial assertion, even in mainstream medicine. Since the mind is a manifestation of the brain, anything that affects how we think and feel transforms our neurochemistry.
By changing how we direct our attention, we create corresponding changes in our neural circuitry. When psychotherapy helps to produce integrating links in the mind -- when we experience the connection between things that have always felt unrelated -- it simultaneously facilitates new anatomical links in our brains. And flowing from these brain changes, we can experience a cascade of effects that impact our entire physiology, from the functioning of our hearts to the responsiveness of our immune systems. In this way of thinking, talk therapy is a form of bodywork.
Psychotherapy for Couples
Couples therapy can facilitate greater understanding of both oneself and one’s partner and what is co-created. I help partners explore and understand their patterns of interacting, the causes of dissatisfaction, and help them notice and make use of their strengths. We all enter relationships with the models of past experience potentially playing a role in our choice of a partner, expectations about what a relationship should look and feel like, and often fears of possible dangers. These influences usually function largely outside of our awareness. For some people it is helpful to notice and talk about this.
While each relationship is unique, the kinds of issues that people struggle with include conflicts over, sex, money, infidelity, fair allocation of responsibilities, and communication styles, as well as feelings of anger, jealousy, boredom, abandonment, insecurity and betrayal. Sometimes couples find themselves in a continual state of tension without knowing why
There are certain conditions like phobias, post-traumatic stress disorder, extreme grief, unbearable loss, and self-destructive behaviors that are frequently resistant to ordinary talk therapy. To more effectively treat these problems, I use EMDR (Eye Movement Desensitization and Reprocessing), a technique that begins by evoking the mental imagery, emotions, thoughts, and body sensations that are associated with painful memories or experiences. This is followed by the application of bilateral stimulation, achieved by the non-invasive use of sound, vibratory sensations, tapping or guided eye movement in a pattern that alternates from one side of the body to the other.
This stimulation seems to play a vital role in the neural integration of the insights and experiences that emerge in an EMDR session. While the precise neurological mechanism by which EMDR helps to resolve various intractable problems is still being debated by scientists, its validity and effectiveness, as well as the sometimes remarkable speed of its results, have been well established in the research literature.
Tolle causam means find and remove the cause. It is a foundational principle of naturopathic medicine. Unfortunately, many conventional physicians are content to name an illness and then prescribe drugs for that name. While naturopathic doctors certainly recognize the importance of diagnosis, they are committed to looking beyond the label of a disease, and identifying its causal mechanisms. So, when it comes to mental health, my goal is to treat the patient – not the just the DSM code.
This means engaging in a thorough and individualized assessment of the psychological, biochemical, and environmental factors that interact to produce mental and emotional suffering. As the set of causes for each person's symptoms is unique, so must be the treatment.
The upstream causes of downstream symptoms can sometimes include: abuse or neglect in childhood, traumatic loss, ongoing unmanageable stress, or current relationship conflict. But at other times, the primary issues may be systemic inflammation, heavy metal poisoning, dietary deficiencies, genetic abnormalities, or gastrointestinal dysfunctions. And not infrequently, psychological and physiological factors, to varying degrees, can combine to produce illness.
My first task with a patient is to review his or her history and medical records. The next step, when appropriate, is to order laboratory tests that can identify the upstream biochemical imbalances often missed in conventional medical work-ups.
Then, based on the data, I formulate a personalized treatment plan that utilizes modalities that the scientific literature has shown to be safe and effective. These modalities may include dietary modifications, nutritional supplements, medical foods, botanical medicines, hormones, stress reduction techniques, exercise prescriptions, and psychotherapy. When, in my judgment, evaluations and/or treatments are indicated that are outside the scope of my expertise, I will refer to the appropriate practitioner.
For some patients, hormone imbalances are at the root of their physiological and psychological suffering. In those cases, bio-identical hormone supplementation can be a vital part of the treatment plan. But for this approach to be safe and effective, it must be based on what a particular person's body needs. This is determined by testing a patient's hormone levels before and after prescribing anything. To provide the best preparations, I work closely with a renowned local compounding pharmacy that specializes in formulating bio-identical hormones, and can ship directly to patients. (See the Virtual Dispensary page.)
While some people may require conventional psychiatric drugs to function optimally, many patients can make effective use of more natural, biocompatible, and science-based alternatives. Some patients, in collaboration with their prescribing psychiatrist, may be able to wean themselves off of traditional pharmacological agents. In other cases, integrative approaches can diminish the side effects, and even augment the therapeutic benefits of these drugs. Often patients may be able to avoid going on prescription medications in the first place.
As a specialist in integrative mental health, I have chosen not to take on the broader responsibilities of primary medical care. Patients who work with me must have an ongoing relationship with an internist, family practice physician, or general practice naturopathic doctor on whom they can rely for basic health care, such as treatment for injuries and acute illnesses. Once a patient gives written permission, I will make every effort to communicate and collaborate with any health care provider with whom that patient is working.