What to Expect as a Patient

A standing psychiatric appointment is a claim on your time, your money and your attention. So the plan carries a target from the first appointment: fewer medications, fewer visits, and a set of skills that stay yours after the appointments stop.

When we reach that point I usually finish without booking a follow-up, and tell you to come back if you get stuck or if symptoms return. That is not a discharge in the sense of a door closing. Because my panel turns over, there is normally room to be seen again within a reasonable window.

Some conditions do need long-term psychiatric care, and I will tell you early if I think yours is one of them. Even then the target moves: a short check-in every few months is a very different life from an hour every week.

I am a physician, so I can prescribe, and I provide the psychotherapy myself. That means the decision about a medication and the decision about what we work on in therapy are made together, by someone who sees both.

After a first appointment you should leave with a formulation – an account of what I think is going on and why – and explicit recommendations that go past a prescription: which psychotherapeutic approach fits, what to change about sleep or daily structure, and what we would expect to see if it is working.

If you already have a therapist, none of that requires leaving them. Working alongside a clinician you already trust is a normal arrangement and often the better one.

Every medication has benefits, risks and side effects, and the balance between them changes as your life does. So the question at each visit is not only whether a drug is working, but whether it is still worth what it costs you.

That makes deprescribing an ordinary part of the work here. If you arrived on a regimen that has grown over years and you would like to be on less of it, say so early and we will build the taper into the plan.

The therapy does real work on this too. Acceptance and commitment therapy and dialectical behavior therapy both give you a way to hold a decision that has a genuine cost on both sides, which is what a medication decision usually is.

If I think a plan you are attached to will not get you where you want to go, I will say so at the time. You should also expect me to check that I have understood you correctly before I recommend anything.

What follows from that is your call. If you want to stay on a medication I would reduce, work on something other than what I put first, or finish sooner than I would have suggested, that is what we do. I will keep telling you what I think, and changing your mind later is part of the process rather than a failure of it.

If you feel stuck – a diagnosis that never quite fit, a medication that has not helped, a course of therapy that stalled – a single consultation is often enough to say something useful.

Because I work across both medication and psychotherapy, an opinion from me can cover both, and I am glad to talk with the clinicians already involved so the recommendation reaches the people who would have to act on it.