My Practice emphasizes discharge as an important goal.

My practice model prioritizes discharge. That means that my goal is to get you to a point where you do not need to see a psychiatrist anymore with as few (if any) medications as possible. My hope is that patients can finish our work together feeling resilient and strong enough to handle life's challenges. Unlike many other mental health doctors, I do not plan on keeping patients perpetually, but rather wish to help you finish our work feeling "cured".

Q: How will having discharge as a goal help me as a patient?

A: Engaging with psychiatric and psychotherapeutic care takes time, energy, and money. These three valuable resources are better spent in pursuit of a meaningful life, not perpetually seeing a psychiatrist. You will finish our work feeling like you can be your own therapist and no longer needing to depend on a professional to manage your mental health.

Q: How does having discharge as a goal help the community?

A: One of the benefits of proactive discharge is that I have a constantly rotating panel of patients. This means sooner openings for new or established patients as well as a greater exposure to psychopathology that keeps me experienced and builds my skills.

Q: If I get discharged, does that mean I can't see you afterwards or that I have limited access to you? 

A: The decision for length of treatment is collaborative and depends on the individual patient's needs. My plan is not to pursue discharge unless you feel confident in your resilience. This also does not mean you cannot see me again in the future, as I will often end our final appointments without a scheduled follow-up, but instead a "call me if you need it". Since my model proactively discharges patients, I would readily have spots available in a reasonable time frame. 

Q: Are there some patients that would still need to see you perpetually?

A: There are some patients with severe mental illness that may still require perpetual appointments with psychiatry (e.g. schizophrenia, bipolar disorder), but even then my goal would be to minimize your necessary appointments as much as possible. I think it is a big difference to feel good enough to only see a psychiatrist every three months for a quick check-in instead of weekly for an hour-long session.

My goal for treatment is improving overall wellbeing.

My goal for treatment is improving overall wellness and functioning, not mere reduction of symptoms. I hope to help create a balanced life that feels worth living to you. I do this by focusing on not just the biological processes, but also your psychological and social functioning. 

Q: What do you mean by a balanced life?

A: A balanced life is a flexible, value driven life where you are consistently growing and moving in the directions your values take you through concrete goals you can commit to completing. It also means a life where we accept ourselves the way we are, since we, while always trying our best, will always be imperfect. 

Q: What do you mean by flexible?

A: By flexible, I refer to the idea of psychological flexibility, which is when we are open to life's experiences and feel confident in our ability to improvise and adapt to whatever life throws at us.

Q: What does it mean to live a value-driven life?

A: Our values are our underlying core beliefs of what it means to be a good person and have a meaningful life. They are immutable parts of ourselves we cannot change, like our desire to be honest people, to have community, or to fall in love. Living a value driven life means living a life where your values are the primary drivers of your decisions, instead of our emotions. 

Q: Can you give an example of a value-driven decision?

A: Imagine you are considering a career change. You will likely consider important values in this decision, such as which career is more fulfilling, which career has a better work-life balance, and which career allows for better financial security. There will also be many different emotions that come in too, such as maybe excitement over a career change or anxiety over making a mistake. The goal here would be to help you make a decision based on the best balance of your values, rather than one that is driven by emotion like anxiety (not changing careers due to being afraid of making a mistake) or excitement (making an impulsive choice without thinking). You are more likely to regret the outcome of your decisions if you look back and see that they were driven by emotions instead of values, even if the outcome would have been the same.

Q: How will living a value driven life make me feel better?

A: The underlying idea here is that the primary driver for chronic life dissatisfaction is a disconnect between your values and the life you want to live. By working to always grow and live a more meaningful life every day, you will go about life feeling more content with the path you chose.

I see a variety of patients of all types and offer multiple different types of treatments.

What I appreciate the most about my training at University of Washington is that it  empowered me to effectively treat any patient in whatever circumstance.  The Pacific Northwest is a sparsely populated area of the world, and the University of Washington trains their psychiatrists to be the only psychiatrist in town, capable of seeing both mild, moderate, and severe cases regardless of age, background, or specific psychopathology. 

What this means to you as a patient is that I am confident in understanding and managing the vast majority of psychopathology effectively by myself. I am an effective diagnostician who will be able to give you after our initial appointment a clear formulation of what you are experiencing and give you explicit recommendations not just for medication, but also for psychotherapeutic approach and behavioral/lifestyle change. The vast majority of the treatments I will recommend I would be able to provide myself, but also feel comfortable collaborating with other psychotherapists and doctors you are already working with.

Q: Would it be better to see someone who specializes only in my specific population?

A: True specialization means deep expertise. I'd encourage you to look for a clinician who is excellent across their field, not one who has simply narrowed their focus. The harsh reality is that there are many mental health professionals who purport a narrow scope of work not because they are very competent specialists, but because they only feel comfortable with a single type of intervention. In other words, their only tool is a hammer, which means every problem you present to them would be seen as a nail. Having someone whose expertise arises not from a limiting of their scope, but arising naturally from their work with the whole population is the true "specialist" you wish to see. By allowing myself to work with patients with all kinds of backgrounds and all kinds of psychopathology, I keep my diagnostic and clinical skills sharp and effective to give you the best possible care.

Q: Is there any patient population that you would prefer not to work with?

A: I am always happy to be available to provide guidance to anyone who needs help, regardless of their psychopathology. Even if I am unable to provide to you the specific treatment modality I think would be effective, I would still be able to provide you with a recommendation of how to find that treatment and what an effective next step would be. I am also always happy to remain available for appointments to help you navigate our complex medical system until you reach the point you feel you have found what you need. 

Q: Do you do second opinions?

A: One of the benefits of my unique skillset is that I am able to provide you with an effective second opinion and collaborate with your current providers to help improve your care. Unlike many other psychiatrists, I am confident in providing both medication and psychotherapeutic recommendations. Because my practice model is highly collaborative, I create a comfortable environment for all involved and do not make others feel like I am trying to usurp their treatment approach. If you are working with a therapist or psychiatrist and feel stuck, I am more than happy to be available for discussion prior to consultation so I can provide the best possible recommendation.

My style emphasizes empathic understanding and genuineness

My general approach is one where I truly seek to understand what you are experiencing and how you feel about it and express myself genuinely to you. I base my approach on Carl Rodgers’ Person Centered Therapy approach, which has three main values: unconditional positive regard, radical genuineness, and empathic understanding.

Q: What is unconditional positive regard?

A: As your psychiatrist, I seek to accept you unconditionally as a person, without judgement. This will help you feel safe throughout our appointments and hopefully help you come to accept yourself without judgement as well.

Q: What does radical genuineness mean?

A: It means I am my authentic self as much as I can during our work together. I am not “acting” or playing a role. What I express to you is a genuine expression of what I think and what I think will help you. I treat you like an equal who is worthy of respect and not being “talked down” to or treating you as fragile. It also means I will be honest with you even about subjects that may be hard to listen to at times.

Q: What does empathic understanding mean?

A: I seek to understand what you are experiencing from your perspective. I ask questions that bring me as close to your life experience as possible. It is through this understanding that I can offer you the best possible path for healing. It means I will often check in to make sure I am truly understanding what you are trying to communicate and will be honest in moments where I have a hard time understanding you. Although it is impossible for me to understand you every single time, you can know that I am always in search of this empathic understanding.

My practice emphasizes autonomy.

I consider it important for patients to feel in charge of their care. My goal is to provide the best possible recommendation for your unique circumstance while providing you the freedom to guide your own care.

Q: I'm worried I won't be able to make the right call.

A: It is normal to be anxious when making decisions about your health. I would hope that my approach would give you enough information and understanding of your circumstances to feel confident and informed about the decision you are making.

Q: I just want you to tell me what to do so I can get better.

A: I think an important part of your treatment plan is also committing to it. By emphasizing your autonomy, you also feel like you have "bought in" to the treatment and are invested in the outcome. This internal investment can often be a key piece that makes the difference between getting better and being stuck with care.

Q: Does this mean you will give me whatever medication or treatment I ask for, even if it is bad for me?

A: Rest assured, I will never provide you with a treatment that I think is overall harmful for you or not indicated. You will always be informed of any treatment that carries a higher risk than what is usually prescribed.

Q: What if we disagree on the treatment I think will help me?

A: One thing I will always promise you is that my recommendations are what I genuinely think is the best path for you. That does not mean I am always right about it being the best treatment for you. I work with always integrating the path you would like to choose for yourself in the treatment I am offering. I do think it is very important to serve as a consistent "voice of reason" that is always advocating for your wellbeing, so there may be rare moments where we are unable to come to an agreement of what is the best path forward; in this scenario, I am always happy to continue working with you through a different path or to help you transition care to someone who you feel would be a better fit for your treatment goals.

The Concierge Model means more communication for everyone.

Different from most other psychiatrists and psychotherapists, I provide faster response times (generally within 24 or 48 hours), greater phone availability, more consistent appointments, and longer appointments (usually an hour). This means you will no longer have to wait a week or more to hear back about prescription issues, have to wait months for your next appointments, or end up feeling rushed with a fifteen minute medication management visit. Since I charge hourly and not through insurance, I am paid the same amount regardless of how many patients I see, so I am not incentivized to increase appointment efficiency at your expense. This also means I provide you the treatment I think is most effective, regardless of the time investment, and not the treatment that will reduce my appointment time the most.

The concierge model also means that I will be proactively collaborating with other members of your care team, both psychotherapists and medical doctors, and will be readily available to discuss your care with them when they need to.

Q: How often would you collaborate with my psychotherapist?

A: I generally reach out to a psychotherapist after our initial appointment. In some cases, I may discuss your case with your psychotherapist ahead of time. After this initial communication, I communicate with your psychotherapist as often as is indicated in your case.

My model translates well with individuals with both complex medical and psychiatric needs

One patient population I often work with is medically complex individuals with psychiatric needs. One of the benefits of seeing a psychiatrist instead of a clinical psychologist for psychotherapy is that, as a medical doctor, I am able to fully understand your medical situation and provide therapy that incorporates that understanding effectively. Unlike a clinical psychologist, I am also able to effectively engage and collaborate with other medical doctors you may be seeing. This would mean I would both be able to help you navigate your medical issues effectively, but also help your medical doctors better understand your and your needs.

I generally offer both medication management and psychotherapy together.

I consider it best practice to provide medication management and psychotherapy together.

Q: How does having a psychiatrist do my psychotherapy help me?

A: Our bodies are the primary way we experience our life. Since a psychiatrist is a physician, they understand the human body in a way that no other mental health professional can. In therapy with people without medical degrees, the physical body is an abstract concept rather than a tangible reality, which can lead to a psychotherapy that feels disconnected with the physical experience of our emotions. It is also helpful to have your medication be in line with the psychotherapeutic work, so we are not inadvertently going in two different directions with these two treatment modalities.

Q: Don't psychologists get better training to do psychotherapy?

A: This is a common misconception. Psychiatrists actually have the longest training of all mental health professionals. The minimum requirement for a psychiatrist is four years of medical school (including two years of classwork and two years of patient facing clinical training) and four years of residency (four full years of patient facing clinical training). It is also a requirement for training that all psychiatrists know how to do at least three types of psychotherapeutic modalities (supportive psychotherapy, psychodynamic psychotherapy, and cognitive behavioral therapy, although many psychiatrists train in much more). In contrast, doctoral level psychologists generally complete four years of school (two of classwork or research, followed by two years of patient facing clinical training) and one year of internship (one year of patient facing clinical training). Doctoral psychologists are often trained in at least one form of psychotherapy (either psychodynamic psychotherapy or cognitive behavioral therapy). Master’s level therapists (including LMFT, LCSW, MSW, LPCC) generally complete two year programs, which includes one year of schoolwork followed by one year of patient facing clinical work. Virtually all masters level therapists train only in cognitive behavioral therapy. Please note that it is common for many mental health professionals, regardless of degree, to pursue additional training beyond the minimum required years.

Q: Why don't more psychiatrists do psychotherapy if it is better for them to do so?

A: The unfortunate reality of our insurance based system heavily influences the way psychiatrists practice. Medication management is paid much more than psychotherapy, meaning that any psychiatrist working in an insurance based practice will either need to take a big pay cut to offer psychotherapy or will be heavily discouraged or penalized by leadership from offering it. It is much more financially efficient for the system to have psychiatrists mostly manage medication and for masters level or doctoral level psychologists to do psychotherapy. While I think this is "good enough" for patients with mild psychopathology, it may not serve the needs of patients with complex or severe symptoms. 

Q: I'm working with a psychologist already. Does this mean I need to stop seeing them to see you instead?

A: While I will always hold that doing psychotherapy with your psychiatrist is the gold standard treatment, that does not mean that a patient cannot choose to work with a psychologist as well as a psychiatrist. Sometimes, patients also have financial constraints and have to pursue the treatment that makes the most sense for them. Psychotherapy can be deeply personal, and patients may often find they have a very good personality fit with a specific therapist that would be important to keep. Some patients may be in search of a very specific psychotherapeutic modality that the psychiatrist they have access to does not offer. There are many very talented psychologists who offer high quality care who I am happy to support by providing medication management that is always in line with their psychotherapeutic work.