CBT vs Psychoanalysis

The article “Therapy Wars: The Revenge of Freud“, written by Oliver Burkeman and published in The Guardian, is a brief review of “battle” between psychoanalytic therapy, developed by Freud and cognitive behavioral therapy, CBT. While CBT has been dominant for many years the success of CBT is being reconsidered in light of recent studies.

These studies reflect that the short term and apparent gains made using CBT are not sustained over time. To think that one can act without emotion, act without prejudice, be bias free, free of historical beliefs shaped by one’s family and society is simply not possible. To think that therapy cognitive or psychoanalytic is free from bias is also not possible. When a patient and therapist engage one another, there are explicit and implicit agreements within the relationship and about the goals of therapy.

CBT vs PsychoanalysisCBT as does the principals of applied behavior analysis, assume feelings are misguided and/or essentially irrelevant. If we can be logical, rational and reasonable, we can address the folly of our feelings and do what we think we “should” or what we think is “right”. While not widely promulgated, Freudian psychoanalysis and the subsequent psychoanalytic schools of thought also rely on one’s intellect to articulate not only the manifest difficulties but to intellectually understand what feelings and thoughts, conscious and unconscious interfere/conflict with taking what might otherwise be logical actions to attain a desired outcome. In psychoanalysis the work in part is to connect to the feelings which are the genesis of the emotions which sabotage relationships and interfere with the development of love and potentially compromise one’s success in work.

CBT is a mechanistic linear approach based on rational thought. The problem is that the human animal for all its evolution is still predominantly driven by its instincts and/or feelings. We are need gratifying animals with great intellectual powers. Our intellectual abilities have allowed us to dominate all other species and the planet. We have yet to determine the outcome of our dominance.

My belief is that the current psychoanalytic approaches acknowledge with ever increasing humbleness that the therapeutic relationship and treatment is shaped by both the patient and analyst. The analyst having been trained in the tools of analysis and having been in intensive therapy, is able to guide the treatment. The analyst having been in treatment is alert to when their defenses are being activated and able to explore the feelings and thought(s) within themselves, with their supervisor and perhaps with the patient. The analyst can hear the patient’s verbal, symbolic and non-verbal communications and reflect on the patients struggles within the patient, between significant others in their lives and within the therapeutic relationship. The analyst can hear and see how the patient will seek to validate their beliefs in their interactions with others and miss other parts of the communication.

No matter the approach be it CBT or any other I believe ultimately the relationship, the human connection formed to help a patient overcome their pain, suffering, limitations, isolation, anxiety, fears, loneliness, rage and/or hate. The patient must come to accept themselves and be the best they can be, is what ultimately enables a patient to live better and more peacefully. Life, simply put, is not easy. Having someone who understands, who is not critical and who can laugh at oneself and help the patient to do the same, is priceless. Perhaps ultimately being able to laugh at ones’ self is the best medicine. If we can laugh at our own “craziness”, if we can be humble and accept of our own foibles, perhaps we can live with acceptance of others.

Ultimately, we need to focus on what we have in common, as what we have in common, is greater than our differences. Finding areas where we can compromise within our relationships is critical to the success of a relationship be it at work or in our intimate relationships.

Feel free to call for a consultation, 516-297-5705.


My Child Is Receiving Services Through EI, CPSE, CSE, OPWDD – Are They Getting What They Need?

I have been receiving many calls from parents who have been referred by colleagues to help address current concerns about their child’s development and progress. Questions such as:

  1. My child is receiving services through Early Intervention, EI, speech only, but he continues to demonstrate many temper tantrums. What is wrong? Why is this still happening? What else could I be doing to help my child progress?
  2. My child is receiving services through NYC Department of Education, Committee on Pre-School Special Education, CPSE, speech, occupational and physical therapy, but he is demonstrating little progress. What is wrong? What else should I be doing?
  3. My child is receiving services through the NYC Department of Education, Committee on Special Education, CSE. How do I know the school and clinicians providing services are using best practice? What is best practice?
  4. My child is receiving ABA services in his therapeutic pre-school and at home, some clinicians are not having any problem but others are. What is wrong?

speech therapy - autism

The NYS Office of People with Developmental Disabilities, OPWDD, provide services and resources, which compliment the other programs and provide services and resources once the child becomes an adult, over 21 years of age. I often let parents know how to access these services and what they should know.

The services provided through EI, CPSE, CSE and OPWDD provide a continuum of services intended to maximize each child’s potential. In most cases, the services provided use state of the art interventions with trained clinical staff and children progress. In some cases, despite the best efforts of these programs, challenges for the child and family persist. Why?

The answer to this question is complex and multifaceted. When asked questions similar to those above, I ask for; the evaluations the IFSP, IEP or plan of care. Who is having the problems, what are the problems, who is not having the problems, and why? What is the perceived reasons for, and motivation(s) for, the behavior? Essentially, a mini-functional behavior analysis, FBA.

Often left out of consideration are the emotional needs of the child and the emotional needs of the family members. In effect only, part of the child’s needs are being addressed, certainly not all the child’s needs or those of the family. This is not to mention that parents must learn to be their child’s advocate and how to work collaboratively with the providers. To be an effective advocate, parents need to know how to assess their child’s progress or lack of it, and how to address their concern(s) at each level of care. In each case, I help parents think outside of the box, to consider needs that might be unmet, and/or different avenues to obtain the necessary services.

Reach out for a consultation which will consist of a comprehensive review and evaluation of your child’s plan of care. We can discuss your concerns and the individual needs of your child. If necessary we can develop a plan to enhance the services and interventions you child receives. I can be reached at my office phone; 516-297-5705 or email,


Finding the Right Mental Care Health Professional

Frank Ridge Memorial FoundationJoin the Frank Ridge Memorial Foundation for their 3rd Annual Symposium

The Duke Ellington Room
400 West 43rd Street, 2nd Floor, New York, NY
Sunday, September 17, 2017
12:30 – 4:00pm

This FREE Half-Day Event Features:

  • Lively panel & participant discussion
  • A silent auction of art created by people with metal health conditions & entertainment industry memorabilia
  • Healthy refreshments catered by Fountain House

RSVP Required:

Download a list of other Frank Ridge Memorial Foundations seminars for 2017.


Register for Frank Ridge Memorial Foundation Seminars

Frank Ridge Memorial FoundationRegistration is Now Open for May & June Frank Ridge Memorial Foundation Seminars

Explore the Unexplored: about Tourette’s, Anorexia and OCD

When: Saturday, May 6, 1:00 – 4:15 pm – 3 CEs
Cost: $60

The Internet & Mental Health

When: Super-Monday-Full-Day seminar, May 15, 10:00 am – 4:30 pm – 6 CEs
Cost: $150

Connecting Dots Too: Focus on Children, Adolescents & Families

A 4-part mental health film series – 12 CEs for the series*.

When: 4 consecutive Saturdays – June 3, 10, 17 & 24; 1:00 – 4:15 pm
Cost: $225 per person for the complete series

*All 4 seminars must be taken for series credit.

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Don’t Pay Attention to: Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactive Disorder (ADHD)

As a Pre-School Consultant, I design school wide systems to ensure systemic behavioral intervention plans (BIP), consistent with behavioral interventions known as applied behavior analysis (ABA)for children. The design of the interventions is consistent with New York State, State Education guidelines. It is important that all Teachers regularly assigned to the classroom are trained in any child’s BIP. This includes all related service providers as well as substitutes and floaters. This is no easy task as it requires a commitment from the whole team including administration. Too often neglected are the parents. Working in the classroom with parents helps but at home it is even better.

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Atlas Camp Days

Atlas is aware that there are no vacations from Autism or learning opportunities! They offer families a reprieve and students a place to come that is both fun and supportive. Learn more about their Camp Day, April 10th to April 18th.

atlas spring camp



Dear Parents and Colleagues:

Why is a discussion about change necessary? When and why do things change? It is often said: “The only constant in life is Change”.

For children life is constantly changing. They are constantly changing due to their developmental maturing. Their physical and cognitive skills are constantly in flux and as such their perception of the world changes and evolves. As they develop, our perceptions and expectations of our children change as well. Change can be a good thing, fixing something, making it better, it can be a bad or sad thing, such as loosing someone you love. In most cases, change can be perceived as having both positives and negatives, some known and some unknown. Change can cause anxiety if we have fears, worries or concerns as we don’t always know what is going to happen when things change.

In our school, all year we work setting up routines and schedules, to provide consistency for each of our children so that they come to feel comfortable by knowing what to expect. We provide as best we can, consistent expectations. Each teacher and related service provider are part of the schedules but they provide more than consistency, they should be providing emotional constancy. This means that as teachers we provide care in terms of love and support and each of us in our own way become attached to the child as the child becomes attached to us.

Beginning in December of each year we start preparing the paper work for our aging out children; our children turning five years of age, “T5s”. By the end of January, the paper work is done. But the real challenging tasks in preparing our children for kindergarten is just beginning. Our T5s need to be prepared for change as do our children within our school, who are changing teachers and/or classrooms, aging up from 3 to 4-year-old classrooms.

During the period, February through September we must be aware that all of us are going to be dealing with changes in our jobs, who we work with respect to colleagues and losing the children we have come to care for and love. Many of us don’t like change and prefer not to talk about it. But talking about moving on, change, in life is part of life. Weather we talk about it or not, change and loss happens. As teachers, it is our responsibility to talk about it and be aware of the children’s feelings. As parents, teachers and clinicians it is important to let the children know as best we can what is going to happen to them. It is important to find out what they are thinking and feeling about moving on to the “big school”. What are their fears and thoughts? Are they excited about meeting new people, making new friends, being with an older sibling at the “same school”, meeting new challenges and mastering them? Are they feeling scared and/or sad about losing teachers they have come to know and love?

As we know sometimes our children cannot speak well due to developmental delays. But even typical children will have difficulty talking about change and loss depending on the parenting and/or social environment. If children cannot talk about things, they may well act out. This leads us to our children who have behavioral challenges and trying to understand the “communicative function of the behavior”. (That is, what is the child trying to tell us by acting the way they do?)

It is a good idea to start talking about change in general and perhaps making changes in routine and schedule so it can be experienced and talked about.

What do you do if the child says he does not want to go to a new school or change something? We can ask why and try and get to the feelings and thoughts. We can then validate them. If they don’t want to leave you, we can understand, by being empathetic. Emphasize new teachers and others will care for him or her. Make new friends and learn about new people. Perhaps take pictures of you and the child so they can take that with them. Don’t make false promises about seeing them after they leave, they must learn to deal with the change and loss. If you speak honestly about the future and the loss, that will take them a long way in preparing them for whatever reality they are going to face. Thinking about the positive things in the relationship they have had with you, thinking about and feeling the good feelings inside in their heart and mind will be a way of coping with change in the future.

As always, I am available for consultation.

Adam J. Holstein, P.D., L.P.

Psychoanalyst/Behavior Therapist

Cell: 516.297.5705



The Motivator is the Reinforcer

Adam J. Holstein, M.S., P.D., L.P.
Certified School Psychologist
Behavior Therapist
Licensed Psychoanalyst
Office: 516-297-5705

Intervention is a matter of Perspective, Understanding and Training.

I was sitting in an Intermediate Care Facility many years ago. The Individuals were moving to a new home and an Aquarium with a ¼ of the water was sitting there with fish waiting to be moved as well. The water was dirty as the filter was unplugged. Present with me was an Occupational Therapist and Nurse. The Nurse commented that the dirty water was unhealthy, the Occupational Therapist O.T., indicated she was thinking there was not a lot of room to move about and I as the psychologist commented that they might be getting claustrophobic! (We each bring our own bias and perspective.) It is important to have a common language across disciplines such that interventions for any child be as consistent as possible. In my work in pre-schools, schools and programs under the auspices of the Office of People With Developmental Disabilities, OPWDD, I train teachers, clinicians and staff to understand these basic principles.

Applied Behavior Analysis is a tool/process that all of us are subjected to from birth and all of us are utilizing in our interventions with the children we teach and care for.

I believe human behavior and child development are inextricably intertwined. As such any intervention with a child is a highly complex task and one that is further complicated by the fact development is fluid (changing from moment to moment) as are the dynamics between teacher/clinician/parent and child.

I do not believe anyone intervention is the correct intervention for all children. There is simply too much we do not know. When it comes to a child having a disability or life challenge understanding a child becomes ever more complicated. Each child’s development is like a fingerprint. Understanding what part of a child’s development is biological and what part is learned is one of the major challenges in addressing a child’s needs and/or challenging behavior(s). Adjusting the interventions to be consistent with overall cognitive abilities, speech, receptive and expressive, gross and fine motor, sensory and social emotional development is critical to successfully helping the child realize his or her potential.

As a behavior therapist and psychoanalyst my bias and interventions focus on the social/emotional and behavioral needs of the child as a whole. In my limited understanding of the other disciplines I do my best to integrate the interventions being utilized in my behavioral treatment plan to support the child’s needs in each domain and to facilitate generalization of skills learned and those being taught.

My position here is to help address the social/emotional and behavioral needs of the child. To do that I integrate the teams understanding of each child’s behavioral/social emotional needs and development. To simplify this complex process, I begin by breaking down my understanding of a child’s behavior into 5 basic categories which then fantail into each discipline of a child’s development.

By performing a Functional Analysis of Behavior (FBA) the motivation of a challenging behavior, or any behavior for that matter, is understood. Behaviorally speaking most behavior is broken down into 4 basic categories and a 5th complex category. (Depending on your perspective any of the motivators are complex.) As they say; “Nothing in life is simple!”

As I delineate the following motivators, be mindful of the title, namely the Motivator is the Reinforcer!

1. Sensory in-put: Here I defer to our OT’s and PT’s and always seek to integrate a sensory diet into the behavioral program. It is critical to meet the sensory needs as an elemental level of development. If the child is not able to organize his or her world neurologically through the various sensory modalities, the child’s ability to understand his world and attend to the world will be compromised. The inability to organize the world and perceive the world and/or attend to objects in the world impacts on all areas of development. This includes the child’s ability to organize caregivers as meaningful people and establish a warm trusting relationship, which impacts on a child’s ability to separate from parents and/or transition from one place to another and feel safe. When designing any behavior program, I want to make sure the sensory needs are being addressed as best as possible, in treatment, in the classroom and home. My goal as much as it is feasible is to rule out sensory needs / rule out the communicative function of acting out, as motivation for the behavior. Conversely consistent with the O.T. and Physical Therapist, P.T., recommendations Sensory in-put is provided either at fixed intervals during the day and/or provided as a Reinforcer for appropriate/desired behavior(s).

2. Attention: is the second most basic need children have behaviorally speaking. We are all aware of the condition called Marasmus which is defined as:

Psycho-social deprivation is very common. Such neglect is not the same as abuse, although they are often said together. Unresponsive and apathetic children can inadvertently have their needs neglected. Neglect is usually failure of the two-way communication between the mother and child – not a willful act on the part of the mother. Mothers may not know how to care properly for their children. This is particularly common when the mothers were themselves neglected as children (so it is thought of as normal behavior) and where experienced elders are not present to teach the new or young mother. Fathers, through ignorance, often make such demands upon the mother that the child is neglected. All who are dependent on others for food and care are likely to suffer from neglect. Children in schools, hospitals and orphanages, the mentally ill or disabled, prisoners, and the elderly are particularly at risk.” From: http://www.abdn.ac.uk/medical/unicefprotect/marasmus

The contingent use of attention, in particular eye contact, holding, vocalizing, verbalizing and care through the consistent and constant emotional environment as well as ensuring health (bodily safety) and routines are all a critical structures which are part of caring, loving and attention. All of these components are interacting in microscopic and macroscopic ways shaping and forming feelings, behavior and personalities.

So when we are saying; “Oh he is acting out for attention.” We are stating that we are failing the child by not giving him enough attention AND/OR not giving him enough attention in whatever from, when he is behaving appropriately. So it is up to us to change our behavior. We have to ask ourselves, dynamically speaking; “Why would we give the child what he wants by his inappropriate behavior?” Again, we have to change our interaction(s) such that we are giving the child attention, when he or she is demonstrating the desired behaviors, thereby reinforcing these behaviors. (The Motivator is the Reinforcer!)

3. Tangible Gain: is where the child has learned that by acting out, yelling and screaming or demonstrating other challenging behaviors, he or she will get what he wants in terms of tangible objects. Examples of this can be seen in the supermarkets where a child will be yelling, screaming, falling to the floor (or worse) in order to get the food, candy or toy they desire. The parent in order to escape the embarrassment or not upset the child gives the child what he wants. This is true too of teachers and clinicians in schools and private practice. Here we want to provide the desired objects when appropriate behaviors are demonstrated. (The Motivator is the Reinforcer!)

4. Escape: is where the child gets out of doing something, a task or activity by demonstrating his challenging behavior. This can be an extremely challenging motivation, because once the child escapes he is reinforced. So here we have to be mindful to keep the demands limited with respect to level of difficulty and/or duration. Set goals within the child’s current ability and reinforce with escape or time to do as he or she pleases.

If life were so simple there would be no challenging behaviors. However, where Applied Behavior Analysis falls short too often, not all the time, is understanding the feelings behind the behavior(s) being demonstrated. This falls into the communicative function of the behavior, which in part includes the above motivators but something else. What is the child or person trying to tell us they are feeling?

5. The Communicative Function of Behavior: What is the child trying to communicate to us. What is his or her needs and/or feelings? Here the child’s level of speech development both receptive and expressive is critical. How do we communicate with the child our expectations, and how do we enable the child to communicate to us his or her needs and feelings?

In my Behavior Intervention Plans there is a direct line between our understanding of a child’s motivation and reinforcement for appropriate behaviors and a means to appropriately communication of his or her feelings and/or needs. There are proactive interventions and reactive interventions. It often boils down to; “Catching the child when he is Good!” Increasing the physical, social, verbal, tangible reinforcement when they are being good.

How much of any behavior we see is part of any given diagnostic category and how much is learned in the environment? This is also a critical line to understand and address. We also have to be mindful that any given behavioral challenge or behavior, has multiple motivations and teasing these out and addressing the need(s) is the science and art of a skilled clinician.

I am available to meet with school directors, clinicians in private practice and parents to discuss their needs and how to better serve the children they care for. I have offices in Manhattan and Great Neck. I provide staff training and consultation to schools and programs under the auspices of OPWDD.


NAA Golf Outing to Support the NY Metro Autism Community

I am on the board of the National Autism Association New York Metro. NAANYM is an all-volunteer organization providing an incredible array of services and advocacy – most at no cost – to individuals with autism, their parents and caregivers, and the professionals who support them in the NY metro area.  Visit the NAANYM website to learn more.


1 in every 68 children is diagnosed with autism. Many of us have family members who are affected and the odds are, if you don’t have an affected family member, you probably know someone affected by autism.

To continue to serve the NY Metro autism community we need your support!

On July 21, 2016, we are having a golf outing at Fenway Golf Club in Scarsdale. If you are a golfer, come out – it should be a fun day for a really good cause. And there are other non-golfer options – yoga, tennis, swimming, or even just dinner. Of course, we are also happy to receive donations in any amount and there are specific sponsorship opportunities as well. All donors will be acknowledged at the event. Information about the event, registration and donation is here: http://nationalautismny.org/take-swing-at-autism/

Thank you so much for your support!


Parenting Maladaptive Behavior & How to Get School District Funding for Behavioral Intervention

Thursday, April 7, 2016

379 West Broadway, NYC 10012, 5th floor

Small steps lead to big behavioral changes.
Let’s take some small steps together.


Presented by:

beigel walsh

Light refreshments will be served.