Psychotherapist Nica Selvaggio on LGBTQIA Mental Health

An Interview with Psychotherapist Nica Selvaggio

Dominica (Nica) Selvaggio, LMHC is psychotherapist at Seattle Anxiety Specialists, PLLC. Nica has experience working with clients on a wide variety of issues, including anxiety disorders, eating disorders, substance abuse, sexual orientation and gender identity, acculturation and systemic oppression related to race and gender, trauma and PTSD, mood disorders, personality disorders, self-harm, relational issues, and attachment struggles.

Jennifer Smith: Hi, thanks for joining us today for this installment of the Seattle Psychiatrists Interview Series. I'm Dr. Jennifer Smith, Research Director at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology and psychotherapy practice specializing in anxiety disorders. I'd like to welcome with us today, Dominica Selvaggio, who is one of the psychotherapists at our practice. Nica has worked as a therapist for roughly a decade in the Seattle area and works with adults and adolescents aged 13 and older. Before we get started today, can you tell our listeners a little bit about yourself?

Nica Selvaggio: Yes, and thank you so much for the introduction, Jen. I'm really excited to be here talking with you today. That's always such a broad question. I never know where to start, but I guess that is the place to start that from a very young age, I was diagnosed with ADHD, and so my inability to pick where to start is a reflection of what I deal with in my brain. I love being a neurodivergent therapist because it brings a sense of understanding and compassion for folks who struggle with this sort of tangential thinking or not knowing where to start, that I find really, really helpful and I just get a lot of joy out of it.

So all that to say, I'm your local ADHD therapist. I'm originally born and raised in Chicago, the Midwest, and I've been in the Pacific Northwest for most of my adult life. I did spend three years living in Hawaii, and that was a really life-changing experience. And ultimately, I came back to the Seattle area because this land really has my heart.

Jennifer Smith: Wow.

Nica Selvaggio: I always describe myself as someone who's incredibly creative and just a lover of nature.

Jennifer Smith: That's great. And so you moved to the Seattle area from Hawaii. So what would be your favorite parts of the Seattle area, or just Washington as a whole?

Nica Selvaggio: It's the land, it's the mountains, it's the water, the plant life, all of it. I always say because of growing up in the Midwest that I was raised in corn and concrete. So when I moved to the Pacific Northwest and saw these huge mountains for the first time, even after a decade of being here, I'm still in awe. Yeah, I just really, really love the landscape.

Jennifer Smith: That's great. What is it that got you interested in being a therapist?

Nica Selvaggio: Big question. There's this storyline of The Wounded Healer that I think a lot of us are familiar with, that archetype of someone who has gone through their own experiences of pain and suffering, have tended to them, and then turned that compassionate attention outwards towards others who are struggling with similar wounds. My story as a therapist is not so different from that. I became interested in working in mental health out of necessity of caring for my own mental health throughout my life.

I'm a former foster care survivor and an adult adoptee, and so I had exposure from a very young age to some of the suffering in the world and in my own world and experience. So walking that path has really led me to wanting to provide a hand to hold for other folks on their own paths.

Jennifer Smith: Wow, that's really fantastic. Thank you for sharing that. What areas or disorders do you specialize in, besides ADHD?

Nica Selvaggio: Well, I got my start working in the clinical world specializing in eating disorders. So the bulk of my career was spent working in high acuity treatment centers, inpatient level residential, partial hospitalization, intensive outpatient, and working with folks who struggle with things like anorexia, binge-eating disorder, bulimia, ARFID, avoidant restrictive food intake disorder, which is often accompanied with neurodivergence. And when you work with eating disorders, you work with everything.

So people often think of eating disorders as being about literally food and body, and while those are absolutely components of a person's experience with an eating disorder, it's a symptom for an underlying issue. And often what underpins eating disorders is trauma, depression, anxiety, huge contributing factor, and other ways that the brain is sensitive. So for example, someone on the autism spectrum might really struggle with their sensory experience with food, be labeled with having an eating disorder, when really, it's something that's going on in a sensory way for them. It's not accompanied by cognitions and things like that.

So that's the bulk of my experience and I could talk about that forever. But because I'm an ADHD person, I have a million interests and my path has diverged many a time from that foundation of working with eating disorders. So through that work, I found my way into the somatic world in treating trauma because trauma is a huge underpin of most folks with eating disorders. And I got my foot into somatic experiencing, which is working with folks more so through the visceral felt-sense experience of trauma held in their bodies and helping them to let go of it rather than talking the story to death, which can be re-traumatizing for folks at times. Absolutely has some value in reclaiming our narrative and making meaning. However, I found working in the body to be a lot gentler.

Through that world, I found my way into psychedelic assisted therapy. I did a fellowship last summer in Jamaica, working with mushroom assisted therapy, and I've done a couple of trainings in San Francisco for ketamine assisted therapy. So that is a world I'm very interested in. And then gender and sexuality. So I'm non-binary. My pronouns are she/they, and working with trans folks, working with gender sexuality came out of working with eating disorders as well because those populations tend to struggle with eating disorders, body dysmorphia, those sorts of things at a much higher rate than the general population.

Jennifer Smith: Wow.

Nica Selvaggio: And then from there, add in interest in couples work, sex therapy. So a little bit all over the place, but a really strong foundation underneath all of it.

Jennifer Smith: Wow, that's fantastic. And basically that means you can help a lot of different people, which is really great. Your online bio notes that you've been trained in several evidence-based approaches. Can you let our audience know what those are?

Nica Selvaggio: Yeah, and I'm noticing in myself through this interview, I'm talking very fast and not breathing very much because I'm oriented to my own body. I'm going to take a moment and just take a deep breath before I answer you.

Jennifer Smith: Yeah, absolutely.

Nica Selvaggio: Thanks. And if anything-

Jennifer Smith: Oh, I was just just saying-

Nica Selvaggio: Yeah, go ahead Jen.

Jennifer Smith: That's great for our audience to see too. You need a moment, take a moment. There's nothing wrong with that, and I think we could probably all do that at times and we just don't, unfortunately. And then we feel awful.

Nica Selvaggio: Well, we're not really given permission to in our culture and our systems that we operate in.

Jennifer Smith: Yeah, which is unfortunate.

Nica Selvaggio: Yeah. Which ties into that question a little bit about what evidence-based therapies I work with. Most of them I learned when working in treatment settings. So in a lot of eating disorder treatment centers, the foundation of the treatments are evidence-based therapies such as dialectical behavior therapy, DBT, which was developed by Marsha Linehan, and that was a therapy originally developed to treat folks who struggle with extreme emotional dysregulation who are feeling suicidal or are diagnosed with borderline personality disorder. So these extreme swings of mood and inability to regulate.

Off of that came... And that approach is really good for folks who are... The temperament under controlled. So under UC versus OC, under controlled versus over controlled, so more impulsive behaviors, you're going to see things more expressive. You might be able to tell I'm more on the UC side. DBT is great for that. And then on the other side, you've got OC, over control. Those folks are going to have higher levels of generally OCD type thinking, more restricted, flat affect, much more wanting to control their outer experience because their internal world feels so chaotic that it reflects on the outside. In those folks, you're going to see things more like anorexia, restricting behaviors, much more flat affect.

RO-DBT, radically open DBT came out of DBT to help over control folks. So those are two different therapies, even though they have the same name in them, but essentially they're both skills-based therapies that are laid on the foundation of mindfulness and some of our Eastern inspired practices. So as well as another evidence-based therapy that's used a lot in treatment centers, ACT, acceptance and commitment therapy by Stephen Hayes. But these therapies are really trying to bridge the worlds of that grounded mindfulness foundation with concrete skills that people can use to actively change the behaviors that are causing them distress in their lives.

I love a lot of those therapies so much because they work, they can really shift things quickly. I often use those in conjunction with therapies that maybe don't have as much of a robust research base because they haven't had the time or the funding or whatever it is, such as somatic experiencing and more experiential therapies. I went a little bit all over the place.

Jennifer Smith: Thanks. And what about your treatment approach? What's that like?

Nica Selvaggio: Yeah, so I was trained in a clinical mental health counseling master's program and the foundation of my training and program was person-centered humanistic therapy. So for folks who don't know what that means, my foundation of who I am as a clinician, as a counselor is very much through the egalitarian lens of I am not an expert in your life. You are the expert in your life and I'm coming here to join human to human to witness and perhaps equip you with skills that you need in order to change the things that you're wanting to change.

That said, that's the foundation I weave in depending on what a person needs after collaborating with them on what sort of therapy they're interested in working with, all different kinds of approaches. So again, the somatic work is a huge part of my work, bringing in the body. I also do a lot of parts work, internal family systems, and for folks not familiar with that, that involves accessing the different parts of ourselves that are often in conflict. Everyone has different aspects of self that they might connect with at different times. The part of me that's doing this interview with today is my manager part, right? I'm going to present my best self today, but maybe my inner child part is like, "This is scary. I don't like talking in front of people that I can't see." That's an example of parts work.

Who else? Again, super interested in growing more in the psychedelic assisted therapy world. It's really profound powerful work that can really jump start a person's journey, but not to be used without caution and a lot of discernment and support. Yeah, it's just different for everyone.

Jennifer Smith: That's fantastic. I'd like to go back and talk about one of the areas that you can help clients with, and that's regarding their sexual orientation and gender identity. And I was reading on The Trevor Project’s website that they offer 24/7 free, secure access to counselors for young people who are LGBTQ. In a nationwide survey that 41% of LGBTQ people age 13 to 24, so the younger range, seriously considered committing suicide in the past year.

So clearly something's going on here that's severely impacting this population's mental health. So I just have a few questions regarding this, that maybe you can shed some light on.

One is, what types of issues does someone usually struggle with regarding their sexual orientation or gender identity?

Nica Selvaggio: Yeah, I love this question. Thank you for asking this. And first I want to name... I always experience a lot of heaviness in my body when tapping into the sense of powerlessness or hopelessness that comes in for a person to feel like the best option is to end their life, that they've exhausted all of the avenues and this is the best way to escape the pain that they're experiencing when that becomes the option in their brain. This is for so many different reasons and ties to what a lot of folks in the LGBTQIA+ community struggle with, which I want to differentiate that struggling to know what your sexual identity is or your gender identity is, is not in and of itself a pathology or an issue that someone's struggling with.

What people are struggling with is how the systems in the world, how our culture, how our families, how our religions, how all of these things reflect our worthiness of access to resources, safety, the right to use the bathroom in the public. Our daily lived experiences of oppression are the issues that we struggle with, not the fact that we are part of the rainbow community.

So that being said, because of operating or living in a system that... And I can give so many examples of it's February 1st and how many anti-trans legislation bills have been pushed forward this month in January alone? The visceral, physiological, emotional, spiritual, psychological response to being faced with that. Those issues can look like suicidality, that can look like depression, that can look like anxiety, that can look like a nervous system that's chronically stuck in fight, flight or freeze because they're in survival mode because the world is reflecting to them that they're not safe.

Things more classically associated with folks in the LGBTQIA community are things around identity formation. How do I know who I am? How do I put a word or a label to who I am? Do I even want to do that? Is there even a necessity for me to come out and name myself as such? Where do I fit in and belong in this LGBTQ community? How do I move through the world in the straight world? A lot of identity formation issues in that. And again, that's not an issue of pathology in and of itself. Culture's response to that question is the issue.

Substance use is often higher. Again, this is a way of coping with all the things that I've named and eating disorders and body dysmorphia tend to be much higher incidences in the trans and LGBTQ community.

Jennifer Smith: Wow. And eating disorders too, they're often highly correlated with suicidality, correct?

Nica Selvaggio: Yes, yes. Can be. Not all, but yeah, they tend to be.

Jennifer Smith: Wow. Another question I had is often when you're doing paperwork now for a medical provider or surveys, they ask about someone's preferred pronouns. And can you talk a little bit about that, preferred pronouns and how can that affect someone's mental health? Why do they matter? Why do pronouns matter?

Nica Selvaggio: Yeah. Yeah. And I love how you changed the sentence at the end. Why do pronouns matter? Because even the language of preferred can insinuate that it's someone's choice in terms of... Okay, how can I put this? If you knew that the sky was blue and someone came up to you and was like, "You're nuts. The sky is not blue. I see yellow, and you are bad and wrong for thinking that the sky is blue. How could you?” Take it a step further: “You're going to a bad place because you think this sky is blue."

And then I said to you, “Well, you just prefer it to be blue.” Is that a preference or is that just what you see? So a person's preferred pronouns implies that it's an actual preference, when in reality, it's just their lived experience. And so when someone is vulnerable enough to even name their pronouns, even if we don't understand, even if we think the sky is yellow, the reason it's important is because it indicates a level of belief that that person understands and knows themselves better than we could possibly know, their internal experience.

Jennifer Smith: Right.

Nica Selvaggio: It indicates respect for their beingness, and it creates a level of safety for that person who may have moved through many different systems in their life where it was not accepted or not safe for them to use the pronouns that fit for them.

Jennifer Smith: That's fantastic. Thank you. One anecdote that I wanted to share is that in our practice, we were trying to decide internally, "Should we all put our pronouns in our signature block?" And I'd say one-third were gung ho for, "Yes, we should." One-third didn't care. And there were other people who didn't want to, and one of the members of our team said, "Maybe we shouldn't do this, because if a person isn't comfortable saying what their pronouns are, we're forcing them to either disclose their pronouns or force them to put stereotypical pronouns that you would think that they should be.” And for me, that was really eye-opening.

So for that reason, I went on the bandwagon of I'm not putting pronouns. That way, if someone else didn't want to, they didn't feel like they had to as well.

So I thought that was really interesting, that pronouns can really mean so much to a person and just... Yeah. So thank you for explaining that, that it really does matter.

Nica Selvaggio: Yeah, absolutely. And I love, thank you to that person who brought that point up because that's always what I like to... Oftentimes when we're trying to show up as allies in support of a community that we're not part of, it's easy to misstep and to do things out of good heart and good intention, but ultimately can contribute further to harm. And the pronouns in the bio or in your email signatures requirement is one of those ways where it's like, "Oh, we're trying to help normalize it for everyone." But again, you don't know who you're requiring to out themselves or to live falsely.

Jennifer Smith: Right. That's fantastic. And that's why part of the reason that we do this series is to help educate people and just explain things. Thank you.

Nica Selvaggio: Yeah, thank you.

Jennifer Smith: Yeah. So what can you say to people who simply might not have any understanding or have confusion about what we've just been talking about and just don't understand the distress that some people might have about identity or orientation or pronouns? Why is it a big deal?

Nica Selvaggio: Yeah. I always come back to why do we need to understand? I don't even understand myself. Why do I need to understand another person's experience for their experience to be legitimate and valid for them? I don't. In fact, it's often impossible to try. I can do my best, but I can't ever fully step into another person's experience. And so we don't actually require understanding. We require respect and compassion, just to be believed. Right? And you can compare this across many different experiences of identity. I will never know what it's like to walk through the world, say, as an Arabic man, I don't know what that is.

Jennifer Smith: Right.

Nica Selvaggio: It's not for me to try to understand. It's for me to listen and believe and provide respect. So first throwing away that word understanding, we don't need to understand. What I would say is have you... I would invite folks who really just don't get what the big deal is about to reflect on if there's ever been something in their own life that was really important to them, that they really cared a lot about, but that was dismissed or diminished, or they were told that they were foolish or crazy even for caring about that thing.

And we can do this together too, but just to take a moment and really call to mind that feeling, that memory and see what happens inside. So I notice immediately I start to contract, I start to constrict, and I start to want to feel small and to hide myself. Other folks might have a different experience. Maybe they feel angry, they want to fight back. There's no wrong response here. Just notice how do you feel when you're invalidated, misunderstood, and told that you're wrong to care about the things that you care about? Generally not pleasant.

So when we show up in that way, we're often perpetuating more of the same for people around us. If we've experienced that, then we're going to put that out on others too. Like, "Well, I had to conform. I had to shut down this part of myself, so how dare you not do that?" Right? We face a lot of anger from folks oftentimes as a result of that. Yeah. And what would the world be like if we had more spaciousness for those pauses to actually feel into, what am I reacting to in my not understanding? Am I being reminded of a time that I didn't feel understood? How can I show up in a more compassionate way?

Jennifer Smith: That's great. Thank you. Our final question, which I'm a little bummed to say because I thought this has been great. Do you have any words of advice or anything else that you'd like to say to our listeners today?

Nica Selvaggio: Be gentle with yourself. Working as a clinician, as a counselor, as a therapist, through some of these major world and global events that we've been experiencing collectively over the past decade, something I've noticed in the broader populations is that levels of fear are very high. Anxiety is very high, which makes sense. And levels of burnout, feeling like we just cannot continue on are very high. Levels of trauma and secondary trauma are very high.

In the midst of all of that, I want to invite all of us to both stand in the center of honoring and witnessing our sacred human struggles together, and also find those spaces in which things feel a little bit lighter, or we can expand more and access things like rest and pleasure and resilience, and that both of those things need to coexist in order to show up in a more whole way. So gentle, gentle, gentle, gentle. Show up when you can. Rest when you can.

Jennifer Smith: That's fantastic. Thank you so much, Nica, for finding time to speak with us today.

Nica Selvaggio: Thank you for having me.

Jennifer Smith: And for our listeners, if anybody is interested in scheduling an in-person or telehealth appointment with Nica, you can do so and self-schedule at seattleanxiety.com. Thanks again and have a great day.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Psychiatrist Peter Reiss on Psychiatric Medication Management

An Interview with Psychiatrist Peter Reiss

Peter Reiss, M.D. is psychiatrist at Seattle Anxiety Specialists, PLLC. Dr. Reiss specializes in the treatment and medication management of anxiety related disorders.

Jennifer Smith: Hi, thanks for joining us today for this installment of The Seattle Psychiatrist Interview Series. I'm Dr. Jennifer Smith, Research Director at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.

I'd like to welcome with us Dr. Peter Reiss, who is one of the psychiatric providers at our practice. Peter has extensive experience with psychiatric medication management and has worked in multiple levels of care in the Seattle area, including inpatient, outpatient, partial hospitalization, and residential treatment programs, as well as in the psychiatric emergency room.

Before we get started today, can you tell our listeners a little bit about yourself?

Peter Reiss: Yeah. Hi, Jennifer. Thanks for having me, and inviting me for this interview series. As you said, I worked in quite a few places before I started working as an outpatient psychiatrist here. I took a slightly different route than the traditional way of, "What do you do when you start working after residency?"

I initially started working as a locum tenens, which includes more short-term contracts. I was doing six months to a year at different kinds of levels of psychiatric care. It just gave me a way to see what kind of psychiatric jobs I like, and it gave me an opportunity to see what the mental health resources are in the area. And, just gave me a chance to see what I could see myself doing in the long run.

Jennifer Smith: That's great. I think, like you said, to have all that different exposure probably makes you a really well-rounded psychiatrist. I think that's fantastic. Great.

Peter Reiss: I did think that. It just gave me a little bit more opportunities to really see what different acuities look like on different levels of care.

I wouldn't change a thing, so I'm very happy I did it this way.

Jennifer Smith: Fantastic. Just to let our listeners know a little bit more about yourself as well, what are your favorite parts of the Seattle area or Washington as a whole?

Peter Reiss: So, the first time we came to Seattle, I just immediately loved the area. I do think that it has this very special kind of culture. I love how it combines the urban and the nature, and just the fact that there's so much to do. Especially in the summer, with festivals going on. And, even the winter, I mean, people do complain about, or some people say we have particularly bad winters, but, in the middle of winter, it's 55 degrees, and you can go hiking or do whatever if you're okay with a little bit of rain.

Jennifer Smith: The saying is "It's not bad weather, it's bad clothing," or something like that. Right?

Peter Reiss: Well, I think our weather is our best kept secret.

Jennifer Smith: Yes.

Peter Reiss: Not as bad as people say.

Jennifer Smith: Exactly.

Peter Reiss: Or, have the reputation.

Jennifer Smith: Right?

Peter Reiss: Yeah.

Jennifer Smith: Exactly. That's great. And, what is it that got you interested in becoming a psychiatrist?

Peter Reiss: So, I didn't start out in medical school wanting to be a psychiatrist. I did keep my options open. I was leaning more towards primary care, internal medicine, possibly emergency medicine. I always knew that psychiatry and mental health is important, and that it's kind of very ubiquitous anywhere you go in medicine.

I didn't think about psychiatry a whole lot until my third year in medical school when I had my real introduction to psychiatry, where I went to the psych ward and other psych facilities for my medical school rotation. And, I just immediately loved it. I liked how it's just slightly different than other fields of medicine. It kind of forces you to think more outside of the box. It doesn't necessarily follow the standard algorithms that we have in medicine. There's a lot more nuance and room for interpretation, and it's probably the least well-understood specialty in medicine as well. So, I did the fact that there's just so much more that potential will change in the specialty in the near future hopefully.

Jennifer Smith: That's fantastic. One question that we're often asked is, "Should I see a therapist or should I see a psychiatrist, or both?" And, can you explain the difference to our audience why should someone see either of these two professions?

Peter Reiss: Mm-hmm. Yeah. So, we do have quite a good variety of mental health specialists for anyone wanting to see treatment for any mental health problems. The two options, generally, are to see a medical doctor, so a psychiatrist, or see somebody who'll focus more on non-pharmaceutical management, which would be a therapist, which would typically be clinical social workers or psychologists by training. And, it sometimes comes down to personal choice what people prefer.

I would say, if somebody's psychiatric symptoms are fairly mild, they might need to see a psychiatrist. So, not everybody would be necessarily a candidate for psychiatric medications.

Psychiatrists themselves rarely practice psychotherapy anymore. It used to be different. We are trained in psychotherapy. We do go through all these different didactical trainings, how to provide different modalities of psychotherapy, and it used to be much more prevalent back, really, back in the seventies, eighties, up to nineties, where many psychiatrists were still offering psychotherapy. But, mostly due to our insurance landscape, it really has changed that that responsibility has fallen more to clinical social workers and psychologists who are very, very qualified to provide that training. And, they're really specialized in all these different training modalities, since there's just so many of them. So, somebody who has PTSD is getting different psychotherapy than somebody who has an anxiety disorder or depression.

And, it's really hard for a therapist to be very good at all of these therapy modalities. So, I think sort of the specialization among the different therapies works very well, and it's great to just share that professional space with all these very qualified therapists that we work with.

Jennifer Smith: Wow. Have there been times when a patient will come to you and you realize this person probably doesn't need medication - do you refer them to therapy? Does that ever happen?

Peter Reiss: Oh yeah. That is quite common.

I mean, I would say, in the majority of cases, probably at least a trial of medication might be helpful, just for the patient to engage better in psychotherapy if symptoms are just a little bit too severe at that time. But, for a lot of mild cases of the anxiety and depressive disorders, often starting with therapy alone might be a good option.

Jennifer Smith: Okay, fantastic. In what ways can someone's mental health impact their physical health?

Peter Reiss: So, that's actually a really good question. I think most people do understand the connection between chronic medical conditions causing psychiatric symptoms to worsen, but it's really also the other way around. So, I mean, for example, most psychiatric disorders, whether it's anxiety disorders, whether it's depressive disorders, trauma, excessive trauma responses, they typically cause physiological changes as well. Things like, for example, chronically increased stress hormones, like cortisol. And, that can have an impact on immune function, it can increase somebody's risk for cardiovascular issues.

And then also, indirectly, somebody who has low executive functioning, low motivation due do psychiatric issues, is less likely to take care of themselves and engage in these kind of activating behaviors that tend to improve one's mental and physical health.

If somebody, for example, is less likely to engage in things that are good for social connections, that leads to loneliness. And that, in itself, leads to worsening mental health and physical health as well just due to increasing chronic stress and things like that.

Jennifer Smith: Oh, wow. So, when they say, "Mental health IS health," it really is true.

Peter Reiss: Oh, it is absolutely true. I mean the two... It's not only that it's just in your head, right? It does cause real physiological changes, whether those are directly caused by mental health issues or indirectly.

Jennifer Smith: Right. Can you talk a little bit about your treatment approach?

Peter Reiss: So, I emphasize a lot of psychoeducation, making sure that I meet my patients where they're at, and also give them as clear information about what's going on for them to make the best informed decision.

Sometimes, maybe, they have a particular treatment modality in mind, particular medications or whatnot. Just, trying to understand what their idea is, where they're coming from. So, our treatment goals might be different; we might not always agree, and that's not necessarily wrong. But, giving them as much information as I can for them to make the most informed decisions, that's very important to me.

Then also, I tend to put a big emphasis on always reassessing... Just, speaking specifically about medication management, to reevaluate the need for a particular medication. Sometimes, patients come to me having been on one medication for 10 years. We don't know if they still need to be on that. We don't need... Maybe they need to be on something different. We need to reevaluate what, really, each component of their treatment is really doing, if it still has any effect on their mental health. Sometimes, less is more with psychopharmacology.

I do always want to do check-ins, even with patients who have been on a long-term medication, "Is that really necessary, and what can we do about it?"

Jennifer Smith: That's really great that you work with a patient. And, it sounds like you strive to just get the optimal dose and really not put things that are not... Meaning that you don't do unnecessary things.

Peter Reiss: Right, because each medication could not have side effects; it could have unwanted side effects; or, something else that the patient might not know about. So, they're still... Psychiatric medication's still among the safest medication in medications in general, but we shouldn't take it lightly to have somebody on long-term medications generally.

Usually, it's not a problem. We just have to do it the right way.

Jennifer Smith: Right. And, what type of disorders do you specialize in?

Peter Reiss: So, the disorders that I see here in the clinic are fairly standard, the average psychiatric disorders, including the depressive disorders, wide variety of anxiety disorders, including OCD and different kinds of phobia. We do see ADHD patients here in our clinic as well, patients with PTSD and more trauma-related issues, and also different levels of functioning. So, there's many of my patients who are really doing well, especially on the surface. They're able to do their day-to-day activities. And then, there's patients who are not doing well at this time, who might not be able to have a job right now. So, it's a big variety of different psychiatric issues that we're dealing with, but also, different, wide variety of patient needs.

Jennifer Smith: And, let's say that I was going to sign up for an appointment with you. You are a medical doctor, so of course, I would have to complete the intake paperwork so you have an idea of where I'm coming from, what medications I'm on, my past history. So that's, I think, pretty standard. But, after that, I have no idea what to expect. So, what can I expect in the first session with you? What would we do? What would we talk about?

Peter Reiss: Mm-hmm. Yeah.

So, after a patient signs up for an appointment, there's the initial intake. That can be done either here in my office, in person, or it could be done remotely. There's always those two options. On most days during the week, I have those two options available.

The first session is just gathering a lot of information, getting to know the patient. And, that typically takes at least 45 minutes to an hour so we are clear on establishing a diagnosis, getting enough information about the patient's medical background, mental health background, social background. And, the last part of the initial meeting... Well, there's initially the psychiatric interview, and then, we kind of talk about what we're going to do.

And, if there's any disagreements, or the patient might need a little more time to think about these different options, we might talk about... Besides different medication options, we might talk about potential referrals for therapy as well to see if there's somebody who might have that particular therapy skillset that the patient needs, whether that's in our office or outside of our office.

And then. If the patient decides to be a patient with us, there would be a follow-up appointment to check in, within usually two to four weeks or so. Depending on the acuity, really, and if there's any problems.

Jennifer Smith: Okay. And, that actually leads to my next question regarding follow-ups. So, at our practice, we have a form of concierge care. Can you explain what that is to the audience? And, how does it differ from a traditional practice, and what are the benefits that our patients may have?

Peter Reiss: Mm-hmm. So, the main difference with concierge care is really that it's a subscription-based access to our services.

In a traditional setting, patients would have their appointment and then schedule follow-ups, and then, essentially, the difference in payment would just be that they would pay for each follow-up appointment. But, a subscription-based model of concierge care, it's really that patients pay a monthly subscription for, essentially, unlimited access. So, they can have one appointment, they can have two appointments; they have access to their psychiatrist via messaging system or email. It just makes it easier for us to respond in real-time to any issues that might come up.

It also helps us to see who is continuing care at a regular interval. So, sometimes in outpatient psychiatry, it becomes a little tricky, because patients might be partially lost to follow up. They might not show up for an appointment, so we're not sure is that patient still patient with us, right? But, with a subscription model, we at least know, "Oh, that patient actually wants to continue, and that patient will continue with their follow-up appointments."

So, I think it helps with patient retention in the outpatient setting.

Jennifer Smith: Great. And, I think one thing that I've noticed from the administrative end is that, because we essentially cap the number of patients that our psychiatrists will see, and you've kind of alluded to this, that our patients really can have unlimited access, to a degree, because you're seeing X amount of patients and not thousands of patients. So, there's just more time that you can give each of your patients, which I really think makes more specialized care as well.

Peter Reiss: Mm-hmm. Yeah. So, our overall patient numbers are lower than you would see in a typical outpatient clinics, which helps with just the time that we give each patient. We're not necessarily back-to-back.

I mean, there's some days where we see more patients than other days, but it just feels a little bit more... It feels a little more less time pressure, to give that extra time as well, whether it's directly during the appointment or to communicate with the patient through our messaging system and hone in their treatment that way.

Jennifer Smith: Wonderful. So, our final question, do you have any words of advice, or anything else that you would like to say to our listeners today?

Peter Reiss: So, the main thing that I probably would say is that, to somebody who's starting out with their mental health recovery, really seeing that they want to get treatment, it initially seems very daunting, but I do want to say that it does get easier when somebody is actually establishing care and is getting the help that they need.

And, oftentimes, we often forget to check in with ourselves, especially when we're in treatment, making sure that we're really doing well, that we're not just doing okay, that we're really thriving and flourishing. And, that can mean different things to many people, obviously. But, often, what suffering from a lot of mental disorders and mental illness does to us, we're losing the sense of self-worth and almost like forgetting what our normal... We're getting used to this normal baseline of functioning and being. And, sometimes, it becomes difficult to keep track of what our purpose is in life and what we can do to thrive.

So, don't settle for any less when it comes to your mental health. That would be my main advice.

Jennifer Smith: That's great. Thank you so much for your time today.

If anyone is interested in scheduling an in-person or a telehealth appointment with Dr. Reiss to discuss psychiatric care and medication management, you can self-schedule at seattleanxiety.com

Thank you again, Dr. Reiss, we appreciate your time.

Peter Reiss: Thank you, Jennifer. Good seeing you.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Psychologist Monica Reis-Bergan on Personality Psychology

An Interview with Psychologist Monica Reis-Bergan

Monica Reis-Bergan, Ph.D. is Professor and Assistant Department Head of Psychology at James Madison University. She specializes in the personality psychology.

Kendall Hewitt:  Hi everyone. Thank you for joining today for this installment of The Seattle Psychiatrist Interview Series. I'm Kendall Hewitt, an interdisciplinary research intern at the Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology, and psychotherapy practice, specializing in anxiety disorders.

I'd like to welcome Dr. Monica Reis-Bergan today. Dr. Monica Reis-Bergan is a professor and assistant department head of psychology at James Madison University. She's an expert in the field of personality psychology, health psychology, and addictive behaviors, and has written several articles on the topic, including The Impact of Reminiscence on Socially Active Elderly Women's Reactions to Social Comparisons, and Self-esteem, Self-Serving Cognitions, and Health Risk Behavior. Before we get started, can you please tell us a little bit more about yourself and what made you interested in studying health and personality?

Monica Reis-Bergan:  Hi. Well, first of all thank you for talking with me today. My interest in personality really comes from the opportunity to teach personality at James Madison University. In my research field in health and social psychology, personality is often a variable that's measured and sometimes just controlled for to see how different interventions might impact individuals. Over my time at JMU, I have really learned to love it as a teaching domain and also use it in my research, especially more recent research looking at health and social media.

Kendall Hewitt:  Perfect. So, would you give us a little description of what personality psychology actually is and why it's interesting to researchers?

Monica Reis-Bergan:  So, personality psychology is a relatively large and yet small area of psychology. So, it's large in that it impacts so many different disciplines in psychology, but it's small in that the researchers and theorists that focus on it and would focus only on it are very tiny. So, within personality, we talk about what is personality, and even looking at the definition of personality as something that different theoretical viewpoints don't always agree on as far as what it is. But in general, when we talk about personality, we're talking about some kind of enduring characteristic behavior pattern. As I like to tell my students, it's something that you know the person has and is often very difficult to change.

In terms of why is it interesting to researchers and really anyone, it's that for whatever situation you might have or even research paradigm, we recognize that people are coming with their own individual differences, and one of those individual differences is these elements of personality. So, trying to assess what that is, and then also, can you change it, and then the impact it has is what makes this such a great field.

Kendall Hewitt:  Awesome, thank you so much. And I know we've talked a little bit about what personality psychology is, but in the way of categorizing personality, that's changed over time in my understanding. So, can you expand a little bit on that topic a little bit more and explain what system we use to categorize personality psychology today?

Monica Reis-Bergan:  Well, I think that I would say that if you look at how do we categorize, and I think you're using that kind of making types or quality approach, it is changing and it will continue to change. As I tell my students, what they're studying today could be very different than what they're going to find in 2050. As we develop our assessment tools, we develop the ability to look at things in more and more detail and look at those differentiations. Each domain of personality also has a different way of thinking about it. So, if you look at a psychoanalytic perspective, you're often talking about types.

If we look at it from a trait perspective, the Big 5, HEXACO model, what are the models of the future in that sense? And then also, as culture changes, we start to develop different personality variables that we think are important. So, 30 years ago, we wouldn't have had a measure of FOMO or something of that nature. So, I think it's really important, especially when we look at personality, to have a contextual understanding of what do we have today, how do we think about it today, and that will be different tomorrow.

Kendall Hewitt:  And then how are you able to use your knowledge of personality psychology in the real world? Do you often find yourself analyzing others around you and using your knowledge to understand them better?

Monica Reis-Bergan:  That's a good one. In a sense that I think I'm always thinking about people, but I'm not sure that's because I'm a personality researcher that I would do that. I think we all naturally think about people and notice differences in people. I think that's why it's very interesting for people to try to create a type or a characterization of a particular type of person. My orientation is much more a social psychology with a personality perspective. So, I'm always looking at the social environment to see what factors I think might be related to why a person is displaying a certain behavior that they have. So, I'm not as true personality as some people might be in that sense.

Kendall Hewitt:  And then what is one piece of your research that you've found the most interesting in your time when looking at personality? And is there any research questions or topics within research for personality that you want to explore more?

Monica Reis-Bergan:  So last year, and we're in the process of working on this manuscript now, I worked with an honor's student that was very interested in TikTok, and to be honest, she thought TikTok was terrible for people, and that's a different conversation topic. But what it led to was really good conversations about what are some of the factors that might make... what are some people who might be impacted by TikTok more positively or negatively? And the personality variable that we chose to study was social comparison orientation, and this is the individual difference variable in terms of how much a person compares themselves with others in their environment, just more generally.

Specifically, the study that we did looked at TikTok engagement and young college women, and so how much they clicked on, they liked, those kinds of things to different kinds of TikTok material. And what we found was that individuals who engaged in TikTok, so liked, all of those things, in addition to having high social comparison orientation, meaning they were more likely to compare with others, had more of the negative body eating disorder types of symptoms associated with TikTok. So, while we couldn't say that TikTok was bad for everyone, we could say there does seem to be a relation between TikTok engagement and this personality variable on this outcome variable, so.

Kendall Hewitt:  That's super interesting. Is there anything that you hope to research in the future within the personality field?

Monica Reis-Bergan:  So, some current studies right now are students that are looking at super fan behavior. So, the idea that 20 years ago we would've maybe read a book about someone, but now, influencers, celebrities, we have almost daily information about them, especially if you're someone that's scouring multiple social media sites and other kinds of information. So, what types of people are more likely to develop these parasocial relationships with celebrities or influencers? And specifically, are there certain personality indicators that might make some people more likely to be super fans?

Kendall Hewitt:  That's very interesting. I'd be very interested to read that research in the future.

Monica Reis-Bergan:  We just finished data collection and we did find among our college students that about 50% identify as super fans or “stans”, I guess, is the word.

Kendall Hewitt:  Got it.

Monica Reis-Bergan:  So, we found that super interesting,

Kendall Hewitt:  Very interesting. And then going into that, many children and adolescents these days are using BuzzFeed quizzes or magazine quizzes to find what their personality type is. How do you feel about that and how accurate would you say that those are?

Monica Reis-Bergan:  So, as you know from my class, I really believe that if we're going to have a measure, we really need to look at the reliability and validity of that measure. And that's often a pretty painstaking process in psychology to make sure we have enough types of validity evidence to really have faith in our measures. So, a lot of the measures you're going to find on TikTok or BuzzFeed or wherever are not going to be particularly valid. However, I think that there's a lot of value in talking about personality and talking to your boss or your friends or your family, just about the enduring characteristics, the behaviors that you perceive for yourself to be stable, that is valuable self-knowledge.

We do know that our own perceptions of our own personality have what we might call causal force. Like, if I think I'm really friendly, I'm more likely to go and do things that I think friendly people do. And then if other people think I'm friendly, they're more likely to select me to be in clubs and organizations. So that self-knowledge piece, even if it's not the exact correct number, maybe you're really a 35.7 instead of a 23.2, but just the knowledge that you have about yourself I think is very valuable.

Kendall Hewitt:  So, do you think it would be beneficial for people to actually take valid and reliable quizzes to know what their personality type is?

Monica Reis-Bergan:  I mean, I do think that especially that's part of that metacognitive self-discovery if someone's so inclined. However, I honestly think people can live happily ever after without ever knowing their score and extraversion as well. So, I think it really comes down to a lot of psychology is when you have a problem, let's explore what the problem might be. In that case, I think personality is a great thing to look at what kind of enduring beliefs, cognitions, behaviors do people have, especially that don't seem to change based on situations, as a great way to see how can this be an issue, likewise people who are striving to be better, to also have that self-reflection. But I don't think it's necessary.

Kendall Hewitt:  And then how popular and accessible do you think the study and research of personality psychology is compared to other psychology disciplines such as social psychology? I know you mentioned that earlier. How accessible do you think that personality psychology is to the general public?

Monica Reis-Bergan:  I'm going to start or stage back from that question. I think personality research is almost everywhere because a lot of your clinical research, your I/O research, your health research, they're including personality measures in them, because as they try to look, they're going, and we're going to account for this individual difference. We're going to measure this difference. We think this difference might be important. So, it really transcends far beyond personality journals per se. So that's number one. But as far as the general population, I do think that the language we use in personality is so universal, and so it comes from language in part.

We talk about, where did our traits come from? They come from the differences in people that we notice and then we create a word for that difference. And then we have that word in our language. Allport used the dictionary to help determine what kind of traits people might have. And I think that happens in every culture, not just the English language. We want to notice and identify those people that we want to seek or we want to stay away from. So, I think it's there whether it's always in the language that researchers or theorists use, maybe not. But I also think FOMO is a great example. Fear of missing out came in part from culture as a variable that people notice this person has this fear of missing out. Okay, let's develop a scale to measure it.

Kendall Hewitt:  Yes, that's really interesting. I feel like there's always new scales coming out. You mentioned that personality psychology is always going to consistently change. And I want to take a step back, could you explain your education and career path that brought you to where you are today? And if someone were to take a similar career path, what advice would you give them?

Monica Reis-Bergan:  So, as I mentioned at the very beginning, I don't necessarily consider personality psychology as part of my professional identity. I'm really more of a health social psychologist. In the part of my college degree, obviously, I took a personality class. We obviously measured personality in almost all of our studies, but I didn't think of myself as a personality psychologist because I wasn't... At that time, I felt like because I wasn't trying to understand what personality was, instead I was using personality to ask other questions and being like, this might impact these people in a different way than it would impact people with a different personality per se. And that's really how I think about myself today as well. I appreciate personality, I love teaching it but to try to actually understand it from just the sole study of personality, I'm really more interested in how it's related to other kinds of behaviors like social media, health, substance use, those kinds of things.

As far as advice to other students, I think I tell all of my students to look and see what you're curious about and realize that those curiosities can change. And personality finds itself in a lot of different domains, whether it's cognitive, it can be I/O, it can be all of these different areas that students might be curious about, and then think, oh, what personality individual difference might be important to study? So, personality is really nice to teach because I feel like students have a lot of different opportunities of which to interact with it and may pursue it more depending on the opportunities they have.

Kendall Hewitt:  And once you finished your bachelor's degree, did you go straight into a master's and then straight into a PhD, or how did that fit into your life?

Monica Reis-Bergan:  So yes. So, I went directly from my undergraduate degree into a PhD program of which I got my master's degree as part of that, and all of them at the same school.

Kendall Hewitt:  Oh, wow. What was that like for you? Did you enjoy doing the master's along the way programs and finishing your PhD that way?

Monica Reis-Bergan:  Yeah. So, I was a little bit strange in that I was an elementary education major, who then had a double major in psychology that started as a minor, and I actually was planning to teach and I also happened to be doing research, a paid research assistant, and it just came about that I was so curious. It was in the early '90s and some of the questions about HIV/AIDS datasets that we were working with and just questions about people's health cognitions was very curious for me. And so, I just started doing the lab work and then I happen to have an extra class, so I took an advanced statistics class and then they were like, oh, have you considered graduate school? I'm a first-generation college student, I really hadn't. And then it was like, well, apply to graduate school. And so, I didn't really have the knowledge, skills, or experience to really scope out schools and think about it in that way. I was very fortunate that I had people that saw in me that this might be a good career path.

Kendall Hewitt:  Very nice. And then once you graduated from your PhD program, did you go right into teaching psychology at a university and just begin research through that?

Monica Reis-Bergan:  So obviously, you do a lot of research in graduate school. And in my case, I also did quite a bit of teaching. So, my first personality class, I actually taught at community college while I was working on my PhD and teaching at the university. So that was a lot to do, but I loved teaching personality. It's such a fun topic to teach and students are so excited to learn about it. So, a little different experience than my teaching statistics that they're not always so thrilled about. So definitely, I was looking for an academic home where I would have the opportunity to teach, as well as the opportunity to do research and work with students in that way. So actually, when I got here, I really hoped I would teach social psychology because I love social psychology. But I've been here for 23 years, and that class has always been filled by another faculty member, and so I just keep teaching personality very happily and health psych and research methods and statistics. I guess my position at James Madison is what cemented and really made me appreciate even more personality.

Kendall Hewitt:  That's very interesting. And you've mentioned, so as a health and personality expert, are there any tips that you would give college students or research excerpts that you believe would be beneficial for everyone to know?

Monica Reis-Bergan:  I don't know that I have a really great answer to that, but I think one of the things from teaching personality, and I'm just going to talk a little bit about my final project in my personality class, is that I have students who are already so interested in people, do a psychobiography project, and in that psychobiography project, they study someone in depth and then they think about how the different personality theories, which are pretty different from one another- you have a psychoanalytic theory, you have a phenomenological theory, you have trait theory, you have social cognitive theory- really fundamental different ways of thinking about what personality is and how it impacts people, to take those different lenses and look at one person. And when we look at the reflections from that assignment, what I find is that a lot of students start to realize that you have this person and this behavior, and it can really be interpreted in a multitude of different ways.

And I think that, that appreciation I think is what's important. So, when you see someone and they're behaving in a certain way, one of the questions might be why, and that why really depends on the view or the lens or the perspective that you're looking at. And the next steps really depend on the perspective you're looking at. So, I think it's important for students and people to be open-minded in that process of, there's not just one answer, they don't have a personality type, they're not an X person, for example, but let's look at it from all these different perspectives.

Kendall Hewitt:  Very interesting. And then lastly, is there anything else you'd like to share with our listeners today?

Monica Reis-Bergan:  Personality just is this great phenomenon. I always tell students, it's within the person. You can't go to the store and buy a new one. It's not like a backpack on the first day of school. And so, I think we will continue to be perplexed by what it is, to see how it changes. The more we learn about biopsychology, the more we learn and study how... biological functioning, the connection between mind and body, we might even learn more about personality from that. And then at the same time, our cultural world is changing, looking at how COVID could change locus of control and those kinds of things. So, I think it's just a really great and exciting place to study and to think about.

Kendall Hewitt:  Well, thank you so much for joining us today and giving all your insight. I hope our listeners enjoy!

Monica Reis-Bergan: All righty. Thank you.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.