Areas of care
What I treat, and what happens in each case.
Seven reasons people come. Each one links directly, in case you arrived looking for only one.
Eating disorders
Anorexia, bulimia, binge eating disorder, and the presentations that do not fit cleanly into any of the three, which in practice are most of them.
The work does not begin with food. It begins with what the behavior is solving, because while it is still solving something it does not let go. Food gets ordered afterward, with the family inside the process where the case allows it.
If you suspect something at home, the short route is the families page. For families.
Obesity
Psychological support within obesity treatment, not instead of it. I work inside medical practices and that is the correct position. Weight is a medical matter. The behavior around food is mine.
I do not work with weight targets and I do not design meal plans. I work with what holds the behavior in place, which is usually the restriction that precedes the binge, the hunger that is not hunger, and the guilt that pushes the next cycle.
Emotional eating
Eating to regulate what you feel is a strategy, not a character flaw. It works, which is why it repeats. The problem appears when it is the only strategy available.
The work is learning to tell which signal is which, and widening the repertoire so that eating stops being the only exit within reach.
The introductory article covers this without jargon, emotional hunger included. The types of hunger.
Body image
The image you hold of your body does not update on its own when the body changes. Reaching a weight target and feeling worse is common, and that lag has a clinical explanation.
The work is on the constant evaluation of your own body, the comparison, and the checking behaviors that keep it running.
I wrote about why body image does not update when the body does. The inner voice that judges what you eat.
Bariatric psychology and pre-surgical assessment
A psychological assessment is usually required before bariatric surgery. If your surgeon asked you for one, this is it.
The assessment is not a formality and not an exam you pass or fail. It exists to see which behaviors will arrive intact on the other side of the operation, because surgery changes the stomach and does not change the relationship with food.
I also work with the period afterward, which is when what the assessment anticipated tends to show up.
Support alongside GLP-1 treatment
Semaglutide (Ozempic) and tirzepatide (Mounjaro) are legitimate treatments, and this is not an anti-medication practice. I work alongside the medical treatment, never against it.
What the medication does is lower appetite. What it does not do is change the function food was serving, and that stays waiting. It surfaces on reaching the target, on considering stopping, or before either of those, in people with a pre-existing restrictive pattern that now has pharmacological support and that almost nobody screened for.
Dose, starting and stopping are a conversation with your physician. I do not intervene in that.
The GLP-1 article closes with a section addressed to prescribing physicians. GLP-1 and eating behavior.
Families and caregivers
I work with the family as part of treatment, and also with families who do not yet know whether there is a treatment to be had.
That covers what to observe, how to open a conversation that does not close on the first attempt, and what to do when the person refuses to consult.
There is a whole page on this. For families.
Scope
What I do not do.
- I do not prescribe or adjust medication, GLP-1s included.
- I do not diagnose without an assessment.
- I do not design meal plans. When one is needed I point you toward nutrition and work in parallel with whoever leads it.
- I am licensed in the Dominican Republic and not in the United States, so I cannot provide therapy to anyone located there.
- I do not treat presentations that need a level of care I cannot provide in private practice. If that is the case I tell you at the first session.
Getting started
The first session is an assessment.
I listen to what you are seeing, ask concrete questions, and tell you whether it warrants clinical attention. If it does not, I tell you that too.