Psychiatry andpsychotherapy FAQs.

The Sheppe Group is a psychiatrist-led psychotherapy practice in Midtown Manhattan focused on complex clinical evaluation, personality assessment and development, transference-focused psychotherapy, psychodynamic psychotherapy and psychoanalysis, medication consultation and management, family consultation, and coordinated treatment planning. The practice works with adolescents, emerging adults, adults, families, and collaborating clinicians when the clinical picture is layered or the treatment direction remains unclear.

The practice works with adolescents, emerging adults, adults, parents, families, and care teams. People often seek consultation when symptoms are complex, several diagnoses or treatment approaches have been considered, prior care has only partly helped, relationships or personality functioning are central to the concern, or a family and treatment team need a clearer shared formulation.

No. Many people begin with questions rather than a settled diagnosis. A consultation can help organize symptoms, history, relationships, development, prior treatment, medication questions, strengths, and current goals. The purpose is to understand what may be happening and what kind of evaluation or treatment would be most useful, rather than forcing the concern into a predetermined label.

You may contact the practice directly. Some patients are referred by therapists, psychiatrists, pediatricians, schools, programs, or other professionals, while others reach out on their own. When another clinician is already involved, coordination may be discussed when clinically useful and with appropriate permission.

The first step is a conversation about the reason for seeking care, who is involved, the level of urgency, prior treatment, and the type of help being requested. That initial review helps determine whether the practice appears to be an appropriate fit and whether the next step should be a psychiatric consultation, psychotherapy consultation, assessment, family meeting, medication consultation, or coordination with an existing care team.

No. An initial consultation is used to understand the clinical question and discuss possible next steps. Some people are seeking a focused evaluation or second opinion. Others are considering psychotherapy, medication management, family consultation, or longer-term treatment. Recommendations should follow the evaluation rather than being decided in advance.

A psychiatrist is a medical doctor who can evaluate psychiatric concerns, diagnose conditions, prescribe medication when appropriate, and may also provide psychotherapy. A psychologist is trained in psychological assessment and psychotherapy, with the exact scope depending on licensure and training. A psychotherapist provides talk therapy and may come from several professional backgrounds. At The Sheppe Group, Alexander Sheppe, MD is a psychiatrist who also practices psychotherapy, while Aliza Spruch-Feiner, PhD provides clinical psychological services including psychotherapy.

A psychiatrist may be especially useful when medication questions, medical and psychiatric differential diagnosis, complex treatment planning, or an integrated psychiatric and psychotherapeutic perspective are central. A psychologist may be especially useful for psychotherapy, personality assessment, psychological testing, and detailed psychological formulation. The right starting point depends on the question being asked, not simply the title of the provider.

Yes. Some psychiatrists receive advanced psychotherapy training and provide both medical and psychotherapeutic care. Dr. Sheppe’s work includes psychodynamic psychotherapy, psychoanalysis, transference-focused psychotherapy, psychiatric evaluation, medication consultation, family systems work, and coordination with treatment teams. Whether one clinician provides multiple parts of care or coordinates with other professionals depends on the patient’s needs and treatment structure.

“Therapist” is a broad everyday term. “Psychotherapist” generally refers to a clinician who provides talk therapy focused on psychological, emotional, relational, or behavioral concerns. Training and licensure vary. At The Sheppe Group, psychotherapy is depth-oriented and formulation-driven, with attention to root causes of symptoms, personality functioning, relationships, development, identity, family systems, and the meaning of recurring patterns.

Fit includes the clinical question, age and developmental stage, treatment goals, desired frequency, whether medication or assessment is needed, the complexity of the presentation, and the provider’s training. It also includes the working relationship. A consultation should clarify whether the provider’s approach matches what the patient, family, or referring clinician is seeking.

You do not need to choose perfectly before reaching out. Share the main concern, the patient’s age, whether medication or formal assessment is being considered, and what care is already in place. The practice can help determine whether an initial consultation with Dr. Sheppe, Dr. Spruch-Feiner, or another type of referral is the most sensible starting point. Provider availability and clinical fit are considered together.

A complex clinical evaluation looks beyond a symptom checklist. It may consider current symptoms, developmental history, personality functioning, relationships, family systems, trauma, medical factors, school or work functioning, prior diagnoses, medication history, previous treatment response, risk, strengths, and the perspectives of other involved clinicians. The goal is a coherent formulation and a practical treatment direction.

Personality assessment examines how a person experiences themselves and others, regulates emotion and self-esteem, manages relationships, interprets events, and manages stress and conflict. Depending on the question, assessment may involve clinical interviews, structured measures, psychological testing, review of prior records, and feedback that connects findings to treatment planning.

Not necessarily. Some concerns can be identified relatively quickly, while others require a broader history, collateral information, review of previous treatment, testing, or observation over time. A careful clinician may discuss a working diagnosis or differential diagnosis while remaining open to revision as more information becomes available.

A diagnosis names a recognized pattern of symptoms. A formulation explains how symptoms, personality, relationships, development, stress, biology, family systems, strengths, and prior experiences may fit together for a particular person. Two people with the same diagnosis may need different treatment plans because the meaning, function, and context of their symptoms differ.

It may help clarify why prior care produced limited or temporary improvement. The issue may involve an incomplete diagnosis, an overlooked developmental or personality pattern, medication questions, treatment intensity, family or environmental factors, a mismatch between approach and need, or several interacting concerns. Evaluation cannot guarantee a different outcome, but it can provide a more organized basis for deciding what to try next.

Yes. A second opinion may focus on diagnosis, medication strategy, level of care, psychotherapy approach, personality assessment, or how several treatments should be coordinated. Records from prior clinicians can be useful when available. The purpose is not automatically to replace existing care, but to offer an independent clinical perspective and clearer options.

A medication consultation is often a focused review of symptoms, diagnoses, previous medication trials, benefits, side effects, risks, preferences, and alternatives. Medication management involves ongoing prescribing and follow-up when medication is part of the treatment plan. Either may be integrated with psychotherapy or coordinated with another therapist, depending on clinical need.

Psychodynamic psychotherapy explores how automatic experiences of self and others, related emotional experiences, and coping strategies affect present difficulties. It pays attention to recurring patterns, including patterns that may appear within treatment itself. These patterns and mental models are often automatic and operate outside the person’s awareness. The work can be supportive, exploratory, or more intensive depending on the person’s needs, goals, stability, and capacity for reflection.

Transference-Focused Psychotherapy, or TFP, is a structured psychodynamic treatment that pays close attention to patterns in identity, emotion, relationships, and the way a person experiences themselves and others. The therapeutic relationship becomes an important place to observe and understand these patterns. Treatment fit is determined through assessment rather than diagnosis alone.

No. TFP was developed in the treatment of severe personality pathology and is an evidence-based treatment for borderline personality disorder, but its concepts inform work with other difficulties involving identity, relationships, affect regulation, self-esteem, and personality functioning. Whether formal TFP is appropriate depends on the clinical formulation, treatment goals, safety, structure, and the clinician’s assessment.

Both can explore unconscious patterns, relationships, emotion, and identity. Psychoanalysis is generally more intensive and frequent, with a treatment structure designed for sustained exploration of internal experience and recurring patterns. Psychodynamic psychotherapy can vary more widely in frequency, focus, and level of support. The appropriate format depends on goals, clinical needs, practical considerations, and readiness for the work.

Yes. Some people benefit from psychotherapy alone, some from medication, and others from a combination. Medication may reduce certain symptoms or improve stability, while psychotherapy addresses emotional, relational, developmental, and personality-related patterns. The balance should be individualized and reviewed over time.

Family consultation helps parents, partners, relatives, and care teams understand the clinical picture, clarify roles, improve communication, set realistic expectations, and support treatment without taking over the patient’s work. It may be a focused consultation or part of a broader treatment plan, depending on age, consent, family dynamics, and clinical need.

Integrated psychiatry and psychotherapy means that symptoms, diagnosis, medication, personality functioning, relationships, development, and the treatment relationship are considered as parts of one clinical picture. Integration may occur within one clinician’s work or through thoughtful coordination between a psychiatrist, therapist, psychologist, family, school, program, or other members of a care team.

An adolescent psychiatrist may be helpful when there are diagnostic or medication questions, complex mood or anxiety symptoms, significant emotional dysregulation, attention or behavioral concerns, safety concerns, school impairment, family conflict, multiple prior treatments, or uncertainty about the appropriate level of care. The first step is evaluation, not a predetermined recommendation for medication.

Parent involvement depends on age, development, safety, treatment goals, and the structure of care. Adolescents need meaningful privacy, while parents often hold essential information and play a critical role in safety, logistics, and support. A clear framework should explain what is confidential, what must be shared, how parent meetings are used, and how everyone can participate without undermining the adolescent’s treatment.

Failure to launch is an informal phrase used when an emerging adult is struggling to move toward education, work, independence, relationships, or adult responsibilities. It is not a diagnosis. The underlying picture may involve anxiety, depression, attention concerns, trauma, personality functioning, family accommodation, substance use, learning differences, developmental issues, or a mismatch between expectations and current capacity.

Treatment begins by clarifying what is driving the difficulty and what is maintaining it. The plan may involve individual psychotherapy, psychiatric evaluation, medication consultation, family work, changes in expectations or support, coordination with school or programs, and realistic steps toward autonomy. Progress is usually more sustainable when support and accountability are balanced rather than treated as opposites.

Yes, coordination can be considered when it adds clinical value and the appropriate permissions are in place. Shared treatment works best when roles are clear, communication is purposeful, and each clinician understands the formulation and goals. Coordination may involve an existing therapist, psychiatrist, school, college, residential or outpatient program, pediatrician, or other care professional.

Confidentiality is discussed at the beginning of care so the adolescent and parents understand how information will be handled. Adolescents need meaningful privacy for treatment to be useful, while parents may need updates related to safety, treatment participation, major recommendations, or other agreed-upon areas. The exact framework depends on age, development, clinical circumstances, and applicable professional requirements.

Yes. A parent consultation can help organize concerns, review prior care, clarify safety or family questions, and consider what kind of next step may be realistic. It does not automatically establish treatment for the adolescent, and recommendations depend on the clinical situation, the young person’s participation, and whether the practice is an appropriate fit.

Yes. Family consultation may be a focused service used to clarify patterns, roles, communication, boundaries, accommodation, expectations, or coordination with an existing clinician or program. In other situations, family meetings may become one part of a broader treatment plan. The purpose and limits of the consultation should be defined at the outset.

Evaluation considers the timing and pattern of mood changes, sleep, energy, activity, impulsivity, irritability, psychosis, family history, medication response, substance use, medical factors, and whether symptoms occur in episodes. The distinction can be difficult when anxiety, trauma, attention concerns, personality patterns, or antidepressant effects are also present. A fuller discussion is available on the depressive and bipolar disorders page.

Psychiatric evaluation may be useful when anxiety or panic is persistent, severe, physically overwhelming, interfering with school, work, sleep, relationships, or leaving home, or when the diagnosis and treatment plan remain unclear. Evaluation can also consider trauma, obsessive-compulsive symptoms, mood disorders, medical causes, substance effects, attention concerns, and personality functioning. Learn more about anxiety and panic disorders.

Personality refers to enduring patterns in thoughts, feelings, and behaviors; specifically, the typical ways people experience themselves in relation to others (thoughts), associated emotional experiences (feelings), and characteristic ways of managing stress and conflict (behaviors). A personality disorder is considered when patterns are maladaptive, inflexible, and cause significant distress or impairment. Personality-functioning concerns can also be clinically important without a fixed diagnosis. Assessment should be careful, developmental, and designed to guide treatment rather than reduce a person to a label.

Yes. Difficulties with self-esteem, identity, relationships, attachment, emotional intensity, anger, shame, emptiness, or recurring interpersonal patterns may deserve treatment whether or not a personality disorder diagnosis applies. The self-esteem, relationships and emotion regulation page describes how these concerns may be understood within a broader formulation.

Trauma-informed evaluation considers the nature and timing of events, current symptoms, avoidance, arousal, dissociation, mood, identity, relationships, safety, and developmental context. Not every painful experience results in PTSD, and trauma symptoms can overlap with anxiety, depression, attention problems, personality functioning, and other conditions. Treatment planning should follow a careful assessment. Learn more about post-traumatic stress disorder.

OCD involves obsessions, compulsions, or mental rituals that can be difficult to control and are often performed to reduce distress or prevent a feared outcome. General anxiety may involve broader worry without the same obsession-compulsion cycle. The two can coexist, and other conditions can resemble either one. More information is available on the obsessive-compulsive disorder page.

A careful ADHD evaluation considers childhood onset, functioning across settings, attention, impulsivity, organization, sleep, learning, mood, anxiety, trauma, substance use, medical factors, and the effects of stress. Symptoms such as distractibility, restlessness, low motivation, or poor follow-through are not specific to ADHD, so developmental history and differential diagnosis matter.

Irritability or oppositional behavior can reflect many different processes, including mood symptoms, anxiety, trauma, attention difficulties, learning problems, developmental struggles, family dynamics, personality development, environmental stress, or a pattern consistent with oppositional defiant disorder or disruptive mood dysregulation disorder. Evaluation should clarify function and context before deciding on treatment.

The practice is located at 122 East 42nd Street, 32nd Floor, New York, NY 10168, in Midtown Manhattan near Grand Central. The location is accessible from across New York City and surrounding areas.

Telehealth may be available when it is clinically appropriate and permitted for the patient’s location and treatment needs. Some evaluations, testing, or clinical situations may be better suited to in-person care. The appropriate format is discussed as part of the consultation and may change over the course of treatment.

Family members, therapists, psychiatrists, schools, programs, and other clinicians may be included when their participation is clinically useful, the patient’s age and circumstances support it, and appropriate permission has been obtained. The purpose is to improve understanding, clarify roles, and coordinate treatment rather than create unnecessary communication.

No. The practice provides scheduled outpatient evaluation and treatment and is not a substitute for emergency or crisis services. Urgent or emergency concerns should be directed to appropriate local emergency resources. Suitability for outpatient care and the need for a different level of support are considered during consultation and ongoing treatment.