This interview is with Brad Lieberman JD (retired), MSN, PMHNP-BC, Founder/Lead Clinician, The Lieberman Center for Psychotherapeutics; The Encrypted Chart.
For readers meeting you on Connectively, how do you introduce your work as Founder/Lead Clinician in the hospital and health care space, and how does your former legal training shape the way you approach counseling and medication management in NYC?
As a Founder and Lead Clinician operating in the fast-paced environment of NYC, my work is dedicated to an often-overlooked demographic in mental healthcare: high-performing individuals in high-stress occupations.
My former legal training is foundational to my approach. Having navigated high-stakes, high-pressure professional environments firsthand, I deeply understand the grueling demands, perfectionism, and relentless pace that my patients face every day. My legal training taught me to be fiercely analytical, to look beyond surface-level presentations, and to advocate tirelessly for my clients—skills that translate perfectly into how I approach counseling and medication management. It allows me to speak their language and truly understand their baseline.
I founded my practice after realizing how drastically disconnected traditional mental health care is from the realities of what high-achievers actually experience. In the traditional psychiatric model, I observed a concerning trend: when high-functioning patients seek help, they are often met with an unhelpful level of deference. Because they possess outward markers of success—a thriving career, financial stability, external achievement—mainstream psychiatry rarely views them as “ill” in the traditional sense.
As a result, their care is often rushed. They are frequently handed a quick prescription with a dismissive ‘What do you want to take?’ mentality rather than receiving thoughtful, integrative care. Even worse, their genuine struggles are frequently minimized. It is not uncommon for the mental health concerns of high-achievers to be brushed off as ‘first-world problems’ or met with a ‘must be nice to have those issues’ attitude.
This is profoundly stigmatizing. The reality is that external achievement does not inoculate someone against internal suffering or burnout. Individuals at every stage of the socioeconomic ladder deserve real, engaging, and empathetic mental healthcare. Simply having financial stability does not make a person less susceptible to severe, debilitating stressors.
Traditional, non-integrative psychiatry often settles for ‘functioning.’ Because these high-performers are still going to work and hitting their metrics, the system deems them ‘fine.’ But in my practice, mere functioning is not the goal.
My approach is entirely centered on optimization. I don’t want my patients to just survive their stressful lives; I want them functioning at the elite level they are accustomed to. Through a highly tailored, integrative approach, I prioritize individualized care that supports both performance and well-being.
What pivotal experiences moved you from emergency/critical care nursing and law into psychiatric practice and ultimately to founding a clinic that serves both NYC and Long Island?
I have a non-traditional path to mental healthcare, deeply informed by my firsthand experience in heavily glorified professions that structurally fail to support their workers’ mental well-being.
My career began in law. While academically engaging, the daily practice was a deeply political, zero-sum environment. I watched petty issues inflate into massive conflicts because the culture prioritized fighting over collaboration. That lack of collaborative problem-solving drove me away from law and back toward my early roots as an EMS volunteer.
I was drawn to emergency and critical care medicine because it demanded what I was looking for: collaboration, fast-paced critical thinking, and the pressure to perform analytically on a moment’s notice. It spoke directly to my legal training.
However, the ER revealed a disturbing reality: the people saving lives were suffering tremendously. I worked alongside brilliant physicians who burned out rapidly. They faced the impossible emotional whiplash of continuous trauma—running from a cardiac arrest directly into a domestic violence case, then immediately consoling a grieving family—without a single moment to cope.
The ultimate wake-up call occurred during the COVID-19 pandemic when an emergency physician in my network died by suicide. It was a devastating realization: in critical care, we were grinding ourselves down to prevent calamity, but fostering a profound calamity within ourselves.
I realized high-performing individuals—physicians, nurses, emergency personnel—were severely lacking access to psychiatric care because of heavy stigma. Culturally labeled “heroes,” they internalized the dangerous myth that they didn’t need help.
These experiences crystallized my mission. I built a psychiatric practice specifically tailored to the unique stressors of high-performers. I established the clinic to serve both NYC and Long Island to create an accessible sanctuary, meeting these top-tier professionals exactly where they live and work to provide the specialized, stigma-free support they deserve.
From your day-to-day in NYC and Long Island, what access challenge in therapy or medication management do people most overlook, and what single fix has proven most effective in your practice?
The most overlooked access challenge in therapy and medication management today is not affordability or wait times — it is the psychological barrier of making time for oneself. In my day-to-day practice across NYC and Long Island, I constantly see high-performing individuals living in a state of perpetual “peri-burnout.” They are barely keeping their heads above water, so the mere thought of carving out one hour a week for treatment feels impossible. They view that hour as a threatening loss of productivity.
However, the stakes of ignoring this are dire. When driven professionals continue burning the candle at both ends, they eventually hit a wall where they can no longer function. This is where crushing depression, substance abuse, and even suicidality begin to rear their ugly heads. At that breaking point, they are forced to step away from their lives and careers entirely — a reality that is completely misaligned with their ambitious goals.
The single fix that has proven most effective in my practice is a fundamental cognitive reframe: shifting the narrative from “sacrificing an hour” to “optimizing the week.”
I work with my patients to understand that therapy is not a trade-off that costs them an hour of productivity. Instead, it is the foundational underpinning that maximizes the quality of every other hour they have. When we catch burnout early and they commit to that weekly hour, the return on investment is massive. They become more efficient, more deeply engaged, and more present — whether as a partner, an executive, or an agent of change within their organization. By addressing their mental healthcare proactively, we ensure they are not just surviving their hectic lives, but truly optimizing their performance and well-being across the board.
When a new patient with anxiety or depression contacts your clinic, how do you structure the first 15 minutes to triage risk and set a plan that keeps them engaged in care?
When a new patient reaches out to my practice, the very first question I ask in our initial consultation is: “What changed that led you to seek care this week?”
For high-performing individuals, there is almost always a specific catalyst. Sometimes it is an acute crisis, like being placed on administrative leave or hitting a wall where they can no longer execute their daily tasks. Other times, the trigger is more subtle and internal: they might be highly effective on paper and functioning externally, but they realize they are zoning out, disengaged, and profoundly disconnected from themselves. Pinpointing that exact catalyst is where our triage begins.
The next step focuses on the tangible impact. I ask, “How is this affecting you right now?” Mental health concerns almost always manifest physically. I look for the hallmark signs of severe stress or peri-burnout:
- Degradation in sleep quality
- Drastic changes in appetite
- A pervasive lack of engagement
Identifying these functional impairments allows us to accurately gauge their immediate risk and the severity of their current state.
From there, I structure our plan into two distinct phases to keep them engaged without overwhelming them.
- Step one: stabilization. Before we can dive into deep psychological work, we have to stop the bleeding and ensure they are sleeping, eating, and functioning safely.
- Step two: the deeper work. Once we achieve that baseline stabilization, we move into a tailored, integrative approach that may involve targeted therapy, medication management, or alternative modalities. By framing the immediate goal as stabilization rather than an instant ‘cure,’ patients feel seen, relieved of immediate pressure, and clearly guided on the path to optimizing their health and getting their edge back.
Across the first 12 weeks of treatment, how do you blend CBT, interpersonal therapy, and motivational interviewing with medication adjustments so each visit advances one measurable target?
As we discussed, the first phase of therapy and medication management is primarily about stabilization. In week one, we focus heavily on collaborative goal setting. It is critical to create a sustainable plan in which the provider and the patient are fully aligned on the desired outcome. We cannot move forward effectively unless we agree on what recovery and optimization look like for them.
Once we establish that baseline, the 12-week progression seamlessly blends therapeutic modalities and medication management to tackle one measurable target per session.
We utilize Motivational Interviewing to examine areas of ambivalence, specifically looking at how patients might be holding themselves back by refusing to carve out personal time. I often remind patients that burning out is rarely a symptom of selfishness. In fact, high performers are usually selflessly pursuing their business, family duties, or industry growth without ever pausing to consider the devastating impact this relentless pace has on their own physical and mental well-being.
To address this, we incorporate Cognitive Behavioral Therapy (CBT) exercises to identify and restructure these maladaptive thought patterns. Alongside CBT, we utilize interpersonal therapy techniques to initiate necessary frame shifts, helping patients evaluate how their pace impacts their relationships and their connectedness to themselves.
To keep things actionable, each week introduces a new, measurable area of lifestyle improvement. Rather than overwhelming the patient, we systematically target one specific pillar per visit:
- Optimizing sleep hygiene
- Adjusting nutrition
- Fine-tuning medication and supplementation
- Introducing grounding practices such as meditation, visualization, and exercise
By breaking the 12-week journey into these digestible targets, we ensure continuous, measurable progress from basic stabilization to peak optimization.
Given your neurophysiology and medication therapy management background, what’s the most common miss you see in busy NYC practices around med reconciliation or side‑effect monitoring, and how do you prevent it?
In fast-paced environments like NYC, I see two major “misses” in medication management: a narrow focus on pharmacology over neurobiology, and a lack of patient-centered dialogue regarding side effects.
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There is often a disconnect regarding the actual neurobiological goals of treatment. One primary mechanism of modern antidepressant therapy, such as the use of SSRIs, is increasing Brain-Derived Neurotrophic Factor (BDNF), a protein crucial for neuroplasticity and mood regulation. The common miss in busy practices is assuming medication is the only way to achieve this. Clinical research consistently shows that behavioral interventions—specifically exercise and meditation—are highly effective at increasing BDNF levels and improving mood outcomes. By failing to integrate these lifestyle modifications aggressively, providers miss a critical opportunity to improve the patient’s baseline neurobiology, often resulting in a heavier medication burden than is actually necessary.
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The second major miss occurs in side-effect monitoring. Providers often operate from a rigid clinical checklist without considering the patient’s personal threshold for what is acceptable. A side effect that is a minor nuisance to one patient—such as mild sedation, emotional blunting, or changes in libido—could be entirely unacceptable and functionally debilitating to a high-performing professional.
I prevent these misses through a highly collaborative approach. I educate patients on the neurobiological “why” behind their treatment, emphasizing how lifestyle changes work synergistically with medication to boost factors like BDNF. Furthermore, before writing any prescription, I have a frank, proactive conversation about potential side effects, explicitly asking the patient to define what trade-offs they are willing to accept. This ensures alignment, maximizes adherence, and keeps the patient fully in the driver’s seat of their own care.
As founder of The Encrypted Chart and a former attorney, what one contract clause or workflow change has most improved PHI protection when adopting AI scribes or telehealth tools in a small practice?
As the founder of The Encrypted Chart and a former attorney, the single most critical workflow change and contract review I advocate when adopting AI scribes or telehealth tools centers entirely on the Business Associate Agreement (BAA).
First and foremost, a mandatory workflow change for any small practice is verifying that a BAA is actually signed and securely filed. It is a common misconception that using a vendor that simply advertises itself as HIPAA compliant is sufficient; it is not. If your vendor experiences a data breach, the Office for Civil Rights (OCR) will immediately ask to see your signed BAA. If you do not have one in place, your practice faces serious regulatory and financial liability, regardless of whose system was actually breached.
However, simply signing a BAA is not enough; you must scrutinize what the contract actually permits. The one contract clause that most improves PHI protection relates to data usage and retention, specifically regarding AI model training.
Many AI scribe vendors include clauses in their BAAs stating they can use your practice data to train and improve their models, provided the data is de-identified. This is a massive vulnerability. True de-identification is incredibly difficult to guarantee with complex medical conversations. Furthermore, once your data is ingested and baked into an AI model, it becomes virtually impossible for the vendor to ever truly extract and delete it.
This creates what I call an evergreen risk. In healthcare cybersecurity, a breach is generally a matter of when, not if. If a vendor cannot definitively delete your data, your patients’ information is inexorably tied to those systems forever, creating a stacked, ongoing risk of disclosure.
To properly protect PHI, the most vital contract fix is explicitly rejecting these terms. You must select vendors whose BAAs explicitly prohibit the use of your practice data for their own AI model training and who can guarantee complete, verifiable data deletion.
What is one at‑home behavioral activation exercise—drawn from your interests in cooking or woodworking—that you often prescribe to anxious patients to build momentum between sessions?
When treating anxious patients, I find that behavioral activation isn’t just about assigning a task; it’s about deliberately breaking the cycle of cognitive rumination. Drawing on my interests in cooking and woodworking, the exercise I frequently prescribe is what I call “Active Prep.”
Anxiety thrives in the planning phase. A highly anxious, high-performing patient can sit for hours perfectly drafting a woodworking schematic or endlessly scrolling to plan a meal. While that feels productive, it actually keeps them trapped in their own heads. The true work of behavioral activation requires getting out of the mind and into the body.
The exercise is simple: use physical movement to initiate the task. If a patient wants to cook, the exercise is not just making the meal but physically walking to the store to gather the ingredients. Whenever possible, I encourage them to use their legs as their mode of transportation rather than taking a quick drive. The physical act of walking grounds them in their environment and breaks a daunting task into rhythmic, manageable steps.
I recognize that walking to run errands isn’t feasible for everyone, depending on where they live. In those cases, the rule modifies to standing activation: if you are planning a meal or designing a woodworking project, you are not allowed to do it sitting down. You must stand at the kitchen counter or pace the workshop while you think and prepare.
Engaging the body—specifically walking or standing—while processing thoughts is an effective way to quiet an anxious mind. It forces a transition from passive, paralyzing overthinking to active, physical momentum, providing the bridge patients need to keep moving forward between sessions.
Which community partnership or volunteer‑service model has most improved continuity of care and medication adherence across the boroughs and Long Island in your clinic?
When treating high-performing individuals across NYC and Long Island, the most effective community partnership model for improving medication adherence has not been a traditional volunteer service, but direct collaborations with high-touch, independent concierge pharmacies.
Busy professionals consistently cite a lack of time as the primary reason for medication non-adherence. For someone managing a high-stakes corporate crisis or working a 12-hour clinical shift, taking time out of their day to wait in line at a big-box pharmacy is simply not going to happen. We realized that if we wanted to guarantee continuity of care, we had to remove the logistical friction entirely.
By partnering directly with specialized, local pharmacies that offer secure, direct-to-desk or direct-to-door delivery across the boroughs and Long Island, we have virtually eliminated the time barrier. These pharmacy partners act as an extension of our clinical team. They provide proactive refill monitoring and direct communication with our office if a patient misses a scheduled fill.
This closed-loop system is invaluable. It allows us to reach out to the patient immediately to check in and troubleshoot, rather than discovering a month later that they abruptly stopped their medication simply because they were too busy to pick it up.
Furthermore, this model affords the highest level of privacy and discretion—something that high-profile or heavily stigmatized professionals demand. By treating medication access as a seamless, integrated executive service rather than just another draining errand on their to-do list, we have seen a massive improvement in both medication adherence and long-term continuity of care.
Thanks for sharing your knowledge and expertise. Is there anything else you'd like to add?
If there is one final thought I want to leave readers with, especially the high-achieving professionals reading this, it is that you do not have to wait for a crisis to seek mental healthcare.
High performers are conditioned to push through pain, stress, and exhaustion until the wheels completely fall off. Society teaches us to view psychiatric care or therapy as a last resort—a safety net meant only for when we are actively failing. I want to completely flip that narrative.
Mental healthcare is not just a safety net; it is a performance multiplier. Just as elite athletes utilize specialized coaches and trainers to keep themselves at the absolute top of their game, elite professionals need dedicated, sophisticated mental health support to sustain their edge. You cannot maintain a high-stakes, high-impact career if you are secretly crumbling behind closed doors.
If you are reading this and feeling the friction of peri-burnout, do not wait for the inevitable breaking point. Take that one hour a week for yourself now. It is not a sign of weakness, and it is not a distraction from your goals. It is the single best investment you will ever make in your career, your relationships, and your long-term health.