I provide a unique service for people with anger problems. Why unique? I am the only Psychotherapist who recognizes the need for face to face Group Services.

 

I meet with everyone on an individual basis to assess their needs. I look at whether their needs are best suited for Individual treatment or Group. When anger presents itself after a significant trauma I usually recommend individual treatment so that the trauma is given time to heal. But when someone comes in for road rage they are perfect for group.

 

I provide an on-going 11 week group with a new way to look at anger.

This group will allow 5 people to be seated only.  First come first serve.

 

NEXT GROUP:

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03/30/2023, Time to be determine 

 

03/30/2023  Women (Held separately)

 

 

 

 

ARTICLE:

PTSD — Seeking the Ghost in the Machine

List of authors.

Rebecca D. Folkerth, M.D.

Article

Metrics

13 References

 

Acentury after “the war to end all wars,” we continue to find our human community divided by conflict and our military service members at the leading edge. The ghostly scars of shell shock, later termed post-traumatic stress disorder (PTSD), have haunted generations of soldiers, as well as civilian survivors of many types of trauma, since long before the Great War. Despite current societal acceptance of PTSD as a disorder worthy of compassion, diagnostic recognition, and multidisciplinary research, these scars have remained, like ghosts, largely and frustratingly invisible in the sense that little is understood of their cellular basis in the human brain.

How do we find the substrate of PTSD, this ghost in the machine? Is it the result of chronic traumatic encephalopathy (CTE), which is proposed to underlie what has been termed traumatic encephalopathy syndrome?1

The answer, of course, is not so simple. Our grasp of CTE and traumatic encephalopathy syndrome is far from firm, despite what the lay press and even scientific articles would have us believe. The dearth — and sometimes conflicting nature — of prevalence data in large populations, and perhaps our inherent human desire to seize on attractive explanations, have left us in this predicament.2,3 Witness the reflexive leap to invoke CTE as the reason for highly publicized incidents of behavioral anomalies, interpersonal violence, and suicide among competitors in contact sports, which, although supported in some cases by autopsy examination, may needlessly frighten persons for whom there may remain other explanations.4 In fact, the understanding of what constitutes CTE-related neuropathologic change is rapidly evolving.5 Nevertheless, a very reasonable starting point in caring for our military personnel who have suffered from neurologic injury, including PTSD, is to seek the currently accepted pathognomonic lesion of CTE — namely, the presence of neuronal phosphorylated tau protein deposition in characteristic locations and patterns.6

Priemer and colleagues7 have done just this, having aggregated by far the largest group of military service members ever systematically studied in this respect, with relatively well-defined exposures and clinical annotations; the findings are published in this issue of the Journal. Specimens of the 225 brains that were examined in this study showed remarkably limited CTE-related neuropathologic features; the investigators found few microscopic foci — or as measured according to consensus criteria, a low neuropathologic burden — in only 10 of the 225 brains, all from men who had in common an exposure to contact sports. Remarkably, this low level of CTE-related neuropathologic change stands in contrast to the large proportion of high levels of CTE-related neuropathologic features (i.e., multifocal microscopic foci) in a curated group of elite American football players.8 This discordance begs the question of what fundamental differences exist between these study populations.

Factors to consider in comparing these groups include the means of accrual for analysis (keeping in mind that both are convenience samples and not population-based), the characteristics of the persons whose brains were studied (predominantly male in both groups, but otherwise largely uncontrolled for ancestry and genetic makeup, including a predisposition to other neurodegenerative disorders), the physical exposures (differential impact forces or numbers of subconcussive impacts), and many potential confounders (e.g., drug and alcohol use and the availability of support systems). Differences in neuropathological techniques, including sampling strategies, among brain repositories are unlikely to account for the differences, given the consensus framework for an analysis of neurodegenerative brain changes.6

Although according to historical metrics the current military study group is sizable and reasonably well characterized, the many variables that must be considered (as listed above) render the final body of data short of statistical power to establish the neurohistologic basis for the functional difficulties of PTSD or other psychological disorders. We are forced to face the possibility that the pathognomonic neuropathologic features of CTE either are unrelated to the neurocognitive entity of PTSD (or for that matter, traumatic encephalopathy syndrome) or are neither necessary nor sufficient to produce it.9 Larger cohorts, novel biomarkers, or both will need to be analyzed to confirm the causal association between pathologic change and behavior.

Lest we become discouraged as we seek the neuropathologic basis for PTSD, let us recall the decades-long diligence of untold numbers of physicians and scientists working around the world to understand one of the most challenging disorders, Alzheimer’s disease. We have only to recount the leads followed and abandoned and the markers embraced and discarded before we arrived at our imperfect and evolving concept of how plaques and tangles result, or perhaps do not, in cognitive impairment.10 We have many new and powerful tools in neuroscience, including single-cell molecular and transcriptomic technologies, neurocircuitry analysis, and neuroimaging techniques,11-13 but the path to understanding PTSD, CTE, and traumatic encephalopathy syndrome will still be difficult. The magnitude of the problems associated with combat compels us to move forward with patience, resolve, cooperation, and humility. We owe it to our warriors — past, present, and future — to find and address this devastating ghost in the machine.

Disclosure forms provided by the author are available with the full text of this editorial at NEJM.org.

Author Affiliations

From the New York City Office of Chief Medical Examiner, and the Department of Forensic Medicine, New York University Grossman School of Medicine, New York.