How I Can Help
I am Dr. Mario Benitez-Lopez, an adult psychiatrist in San Francisco. Below are the symptoms people describe when they first call, and what I would do about each one.
If you are in danger right now
If you are thinking about killing yourself, have made plans, or have recently tried: call or text 988 to reach the Suicide and Crisis Lifeline, or go to your nearest emergency room. If someone is in immediate physical danger, call 911. I am not the right service for that.
The same applies if you are hearing voices, having experiences you cannot explain, or feeling that people are trying to harm you and are frightened by it. That needs same-day assessment, which is a different service from a scheduled appointment.
What I offer is scheduled, ongoing outpatient care. Once things are stable, it is a good place to work out what happened and how to keep it from recurring.
What I can offer
I am a board-certified adult psychiatrist, so I can prescribe, and I provide the psychotherapy myself:
- Dialectical behavior therapy
- Acceptance and commitment therapy
- Psychodynamic psychotherapy
- Cognitive behavioral therapy
- Exposure therapy and exposure and response prevention
- CBT for insomnia
- Hypnotherapy
- Integrative behavioral couples therapy and sensate focus, for couples
- Medication management and deprescribing, for people who want to reduce what they are taking
If what you need is not on this list, I would still rather you call.
If this is how it feels day to day
This covers generalised anxiety, panic, social anxiety, and thoughts you cannot get rid of or rituals you repeat to make the anxiety subside. The strongest evidence here is behavioral: exposure therapy and exposure and response prevention for panic, phobia and obsessive-compulsive patterns, and acceptance and commitment therapy when the problem is a life narrowed by avoidance. Medication can help and is often not the whole answer, so we would decide its role deliberately.
Persistent low mood, loss of interest, a life that feels empty, or grief after a loss that has not lifted. The first job is working out which of those it is, because a depression, a grief and a burnout respond to different things. Treatment usually combines psychotherapy with a decision about medication, and if you have already tried an antidepressant that did not work, that history is useful rather than discouraging. If you are having thoughts of killing yourself, please read the section above first.
Trouble falling asleep, waking in the night and not getting back, anxious thoughts at bedtime, or a schedule that has drifted. CBT for insomnia has the strongest evidence of anything available for this, and it outperforms sleeping pills over any meaningful period, so it is usually where I start. If you are already on a sedative and want off it, that is a taper we plan together.
Emotions that feel bigger than other people's, impulsive decisions you regret, self-harm to bring the intensity down, or saying things in distress you do not mean. Dialectical behavior therapy is built for exactly this and I deliver it directly. If a professional has already suggested DBT to you, you are in the right place.
Sometimes this is ADHD and sometimes it is anxiety, depression or poor sleep wearing down attention, and the difference matters because the treatments diverge. I assess properly before prescribing. If you have read about ADHD and are unsure, or you have a diagnosis and stimulants have not fixed it, both are good reasons to come in. If you would rather not take a stimulant, there are other routes worth discussing.
Living with illness can be stressful, especially when treatment is difficult or different doctors give conflicting advice. I can help you cope with changes in your body and daily life, and work through treatment decisions with what matters most to you in mind. We can also work on communicating your concerns to your doctors. With your permission, I can speak with them to help them better understand what you are experiencing.
We can work on the distress of being ill while you continue care with your medical team. My role can include helping you adjust to your condition and cope with difficult treatments. We can address that distress without assuming anxiety explains your physical symptoms.
If you are unsure about the care you already have
The weeks after a discharge are when the plan either holds or falls apart, and they are also when people are most likely to end up without a psychiatrist. Bring the discharge summary and the medication list, including anything started or stopped during the admission. I will go through what was decided and what it was decided on, and say what should change now that you are at home. If you are still in danger, please read the section at the top of this page first.
A diagnosis that never fit, a medication that has not helped, or therapy that stalled. Because I work across both prescribing and psychotherapy, one consultation can give you an opinion on both, and you do not have to leave your current clinicians to get it.
This is one of the most common reasons people come to me, and deprescribing is planned work here: which medication moves first, how slowly, what withdrawal looks like against a genuine return of symptoms, and what needs to be in place before we start. The goal is the smallest regimen that keeps you well, which is sometimes none.
Plenty of psychiatric care is fifteen minutes and a refill. My residency training was in psychotherapy as well as psychopharmacology, and I do the therapy myself, so the two halves of a plan are decided by the same person in the same room.
The whole appointment can happen in Spanish – I trained in medicine in Spanish, in Mexico, and there is no interpreter in the middle. See the Spanish-speaking psychiatrist page. If it is about culture, values, religious belief or a history of not being believed, tell me at the first appointment and it becomes part of what we work with. The same goes for sex: it comes up in psychiatric treatment constantly and I would rather discuss it plainly than have you work around it, which is also why sensate focus and couples therapy are part of what I offer.
If it is about your life, or someone else's
A transition that feels overwhelming, difficulty making decisions, goals you cannot finish, or trouble accepting yourself. This is squarely acceptance and commitment therapy territory: getting clear on what you actually value and building the flexibility to move toward it, so decisions get made from what matters to you and not from anxiety.
Recurring patterns across friendships, work and family are often better addressed by psychodynamic psychotherapy, which works on where the pattern came from, or by DBT when the difficulty is interpersonal effectiveness in the moment.
I offer integrative behavioral couples therapy, which works on acceptance between partners as well as change, and sensate focus for couples where sex is part of the difficulty. Both are done with both partners in the room.
Call anyway. I will tell you honestly whether I am the right fit, and if I am not, help you work out who is. That includes the case where the person concerned is not ready and the question is really what you should do in the meantime.
In danger right now?
Call or text 988 for the Suicide and Crisis Lifeline, or go to your nearest emergency room. If someone is in immediate physical danger, call 911. Scheduled appointments are not crisis care.
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