"Your visions will become clear only when you can look into your own heart. Who looks outside, dreams; who looks inside, awakes."

-C.G. Jung

TherapyWorks ATL is the clinical practice of Eric Fier, MD. I'm a board certified psychiatrist, treating children, adolescents, and adults. I share my clinical office space with a phenomenal team of creative, dynamic therapists. Individually, each practitioner has his/her own clinical practice, reflecting specific areas of interest, skill, and specialization. Together, we share a space designed to reflect the way we might experience our inner selves; one that is intimate, engaging, childlike, fanciful, and maybe a just a bit magical. My hope is that by abandoning the features that delimit a traditional, sterile office space, we are, together, better able to access the spaces inside ourselves that still hold the innocence and simplicity and joy that remind us of exactly where we need to find our way back to.

I don’t quite understand the way much of Psychiatry is practiced today. Somewhere around the time that managed care began to transform the field of medicine, an artificial schism between the brain and the mind seemed to emerge: the role of psychiatrist seemed to be arbitrarily compressed into one of pharmacologist alone; psychotherapy became the domain of the non-MD clinician. The construct of “split-treatment” was born from this division. Patients would see the Psychiatrist for medication and a psychologist, social worker, or counselor for any necessary therapy. Hopefully, some communication between the two treating parties would yield some semblance of a unified therapeutic approach. In ways I still cannot comprehend, Psychiatrists were supposed to know how to intelligently prescribe medications without necessarily understanding the assorted factors that contributed to how this particular human was developing these particular symptoms. How these symptoms manifest; what they represented to the individual; what factors drove their presentation -- all of these were deemed less relevant to the decisions of what and when to prescribe.

I graduated medical school just as this fissure in the field was emerging. Managed Care Organizations seemed to have decided that Depression and Anxiety were to be treated as illness states that required no more personalization of care than the treatment of Hypertension or Diabetes. The field of Psychiatry shifted to a model in which every psychiatric symptom could be traced to a faulty synapse or imbalanced neurotransmitter. Colleagues would joke about conceptualizing Depression as a “Prozac-Deficiency Syndrome.” Advances in Neuroscience seemed to foster an increasingly reductionistic approach to psychiatric care. When I started medical school, this was not how I envisioned my role as a healer. By the end of my residency training, I was determined not to allow myself to buy into a “damaged-care” model that seemed to be the antithesis of a holistic understanding of illness and wellness.

I began my private practice with a commitment to seeing each of my patients for some level of individual therapy. If I was to prescribe medication, I needed to know the human beneath the Serotonin. If I didn’t take the time to listen to the narrative, how would I possibly understand the significance of the symptoms? I realized that as I came to understand each patient’s journey, I also discovered symbolism, significance, and paths to healing. Over time, I also found that -- probably for a collection of reasons -- medications prescribed seem to work more effectively in the context of relationship. When the patient feels understood, there is an openness to healing that might otherwise have been obstructed.

As I explored different forms of psychotherapy and pharmacotherapy, I continued to sense that the most key ingredient in any given therapeutic approach was one of relationship. It is here that the patient and the clinician meet, join, and eventually trust. It is here that a shared journey towards healing begins. Almost irrespective of the specific tools I bring along, it is a sincere willingness to be present with my patient in their challenges that allows for trust to emerge. Relationship, I decided, was the most effective medium through which medication, psychotherapy, empathy, and understanding could be delivered. It was with this mindset that I sought to design a clinical practice that supported just that.

eric fier, md

Q: What ages do you treat?

A: I see children, adolescents, and adults, usually from around age 5 and up. I work with individuals and with families. I don't do much geriatric psychiatry, though I do really enjoy spending time with older adults.

Q: What kind of individuals do you treat?

A: The individuals with whom I work best seem to have unique and personal challenges that often do not fall neatly or conveniently into diagnostic compartments. These  are kids and teens and adults that are often struggling to bridge the gap between where they find themselves and where they presume they need to be.  Sometimes my job is to help my patients traverse that distance.  Other times, it is to help them discover the goodness and beauty of celebrating their own atypicality. 

Q: Do you see people for therapy or just for medication? 

A: My practice is a blend of Psychotherapy and, when indicated, Pharmacotherapy (which may also include herbal and complementary therapies, not simply traditional medications!) I see no one for medication only -- that's not something that ever made much sense to me. How can I make wise decisions regarding medication choices and adjustments when I have no more than a superficial understanding of the real-life context within which the symptoms I'm treating are presenting? I am not treating neurotransmitters; I am treating a whole human being. That requires my understanding who this individual is, what underlies their symptoms, and why they continue to struggle with certain patterns of challenge.  I find all of that powerfully relevant to designing a thoughtful and effective treatment plan. To truly understand the significance and impact of any given symptom -- this is something that emerges through dialogue and thoughtful discourse. These are more than binary metrics captured on generic checklists and rating scales. 

Q: Can I still see my own individual therapist?

A: Absolutely. Quite often, a patient of mine sees me only after they have already begun working with a psychotherapist they very much like. While I will still see my patient for some level of talk therapy, I am always enthusiastic about the opportunity to collaborate with other clinicians. 

Q: How long will our sessions be?

A: Our initial session will likely be 2 to 3 hours, depending on the complexity of the clinical history (I'm pretty detail oriented). Follow up sessions typically range from 60-90 minutes in length, depending on the frequency we meet and the goals we set to accomplish in a given session.

Q: Do you accept any private insurance, Medicaid, or other third-party payers? 

A. I do not. In the mid 1990's, when managed care was beginning to redefine health care, psychiatrists began being pressed into the role of prescriber-only. This was largely the result of HMO financial officers, who decided that it would be less expensive to have non-psychiatrists do talk-therapy while the psychiatrists would simply prescribe the meds.  Non-reimbursement for MD's doing talk-therapy gave rise to a system in which psychiatrists slowly began talking less and less with their patients. Before long, it was hard to find a psychiatrist that would see a patient for meds AND therapy. Suddenly, if you were struggling with a serious mental health issue, you needed to see two different clinicians for your care -- one for meds and one that would speak with you. 

I completed my training in Psychiatry in 1997, just as these polarizing forces were emerging. I promised myself that I would not succumb to a model that -- quite literally -- incentivized me to NOT talk or listen to my patients. The model that was being sold was the furthest thing from why I chose to become a psychiatrist. I opted out of any and all managed care panels and slowly began to build a practice based on the principles I believed would allow me to serve my patients with sincerity, compassion, understanding, and deep personal investment.

Q: Do you have areas of clinical interest or specialty?

A: I see many "quirky" kids and adults in my practice. (I speak that language reasonably fluently.)  Many of these kids are on the Autistic spectrum; some have Tourettes; many have OCD; most have some "asymmetric" attentional challenges, and some notable social "eccentricities." 

Many of the teens and adults I treat struggle with anxiety and mood instability. This may sometimes reflect a unipolar or bipolar process. 

I have a small subspecialty practice working with kids with infection-triggered neuropsychiatric illness. This often takes the form of Strep-induced OCD (PANDAS), but may include other inflammation-promoting pathogens (PANS). These kids are extremely complex and our understanding of the exact pathophysiology behind these sudden-onset, inflammation-driven encephalopathies is quite limited. I keep this portion of my practice relatively small for these reasons.

Among the adults that I treat, I particularly enjoy working with individuals seeking to find underlying meaning through their journeys. These unique journeys may involve navigating illness, relational challenges, or unanticipated loss. It's my belief that these trials are all rich with meaning. How we choose to signify these difficulties ultimately impacts how we allow them to affect and change us.

Q: Are you accepting new patients?

A: I aim to keep my practice intentionally small. This allows me to spend more time with each of my patients/families and to know them with a depth and familiarity that hopefully allows for a measurably enhanced level of care. While I do not accept many, several times a year I will see a small number of new patients. My office manager, LaTisha Barnes, is the gatekeeper with whom to speak about becoming a new patient of mine.

Q: What do you enjoy most about your work?

A: What I love most about psychiatry is that -- no matter what the illness or personal challenge -- we have each arrived here through a path that is uniquely ours. While the end-point symptoms may be similar, we each have a different narrative that reflects our personal journey to this point. To me, this invites -- even requires -- the astute clinician to design a treatment approach that reflects an understanding and appreciation of the uniqueness of that journey. That opportunity, I believe, is both a challenge and a privilege.
This is where healing begins.