For Therapists

When a client comes to me while working with you, the psychotherapy stays yours. I am glad to handle the prescribing alone and stay out of the therapeutic work entirely, and where a client sees me for both, that happens because you and they asked for it, never because I proposed it.

What I try to avoid is the split that referrals often produce, where a client hears one formulation in your room and a different one in mine. Where we disagree about what is happening, I would rather sort that out with you than have the client arbitrate between two clinicians.

Psychiatric medication can undercut psychotherapy when it flattens the affect the work needs, or when it teaches a client that distress is a thing to be removed. I approach medication management with that in mind, and I try to keep the total regimen as small as the situation allows.

For a client already on a long list, deprescribing is often the more useful intervention. Anxiety that is being managed by avoidance and a benzodiazepine, for instance, is anxiety that exposure therapy cannot properly reach until the avoidance is on the table.

My residency training covered supportive, analytic and cognitive-behavioral work, DBT, ACT, CBT for insomnia, exposure and response prevention, cognitive processing therapy and couples therapy. So a conversation about a client's treatment can happen in the vocabulary you are already using.

In practice that means I can reinforce what you are doing rather than run alongside it. If you are working on distress tolerance, I am not undermining it by treating every difficult week as a dosing problem. If a client is avoiding an exposure hierarchy, I can name that as avoidance in my room too.

Insomnia is the common one. A client who is not sleeping will struggle with almost any psychotherapeutic task, and the reflex answer is a sedative that makes the sleep worse over months. CBT for insomnia is the better-evidenced route and I can deliver it directly, or hand you the protocol if you would rather run it yourself.

The same applies to a medical problem hiding behind a psychiatric presentation. As a physician I can look at that, and say so when the fix belongs somewhere other than psychiatry.

A note through the contact form or a call comes to me, with no intake coordinator in between, and I generally reply within 24 to 48 hours. After a first appointment I will tell you what I am thinking and what I am recommending, with your client's permission, rather than leaving you to file a records request.

A pre-referral conversation is welcome and often saves everyone an appointment. If what a client needs is a one-off consultation and a recommendation handed back to you, that is a perfectly good outcome and I will say so.