Combined Treatment Requirement
I find I am better able to help people when I combine medications with psychotherapy. For this reason, in my private practice I only prescribe medications for clients who are also seeing me or one of my colleagues at Psych Garden for psychotherapy. If you already have a therapist, you may continue seeing them in addition to your psychotherapy with me or a therapist at Psych Garden, however I do not see clients for medication management only.
Internal Family Systems (IFS)- trained therapists may refer their clients to me for medication management, as we can work together more easily to combine treatment. If are doing IFS therapy with an IFS-trained therapist who would like to collaborate with me in your treatment, please have them contact me directly by email.
My ultimate goal is to safely get you to the point where you no longer need me. This means safely out of therapy and off of medications. Please understand that in some cases it may not be safe or advisable to discontinue medications or therapy, in which case I will let you know, and continue prescribing accordingly. Since medications are limited and non-specific in their ability to help patients (in comparison to the right kind of therapy), I tend to be quite conservative as a prescriber.
Since pharmacotherapy requires both the participation of the physician and the patient to be effective, we will make medication decisions together as a team. No medication is prescribed until we are both completely on-board. I will not press you into medication decisions while you are still ambivalent, as I myself do not prescribe medication without careful consideration of risks and potential benefits. I am quite comfortable working with patients to help resolve their ambivalence and arrive at a decision that feels safe and comfortable to them. I believe in the patient's right and responsibility to educate themselves with regard to any substance they are ingesting, in addition to the physician's responsibility to provide education to the best of his/her ability.
Realistic Expectations from Medication
The psychopharm industry has framed psychiatric disorders as biochemically based conditions that can only be treated by medications. This has caused many people to have unrealistically high expectations from medications. In most mental health clinical situations, however, a patient’s conditions are psychologically and environmentally based and can only be remedied by dedicated work on the part of the patient, under the guidance of a skilled and dedicated practitioner, to change limiting beliefs, emotional burdens, lifestyle habits and relationship patterns.
Medications are a way of shutting down or stimulating various natural biochemical pathways that often have an effect on the brain and body. Sometimes altering these pathways can have a temporary positive effect while a client is using other methods to help address underlying psychology and external situations. The brain will often adjust to offset such biochemical changes caused by medication, which means in most cases medication will only be successful partially and temporarily. Because medications don’t just effect the desired brain pathway, but have effects all over the brain and body, side effects can be expected.
Policy on Addictive Substances for Anxiety and Concentration
Clients who are only seeking prescriptions for addictive substances or medical marijuana will be promptly dismissed from my practice at either location and should seek treatment elsewhere.
In my private practice I generally do not prescribe addictive substances that work by numbing one to their experience (ie benzodiazepines like Xanax and Klonopin, or sedative hypnotics like Ambien). This is due to repeated long term negative outcomes with these substances (including temporary relief at the cost of long term dependency). I am more interested in helping people to process and manage their experience in a healthy way that will last them a lifetime.
Likewise, for clients reporting trouble with concentration, I tend to encourage exercising the brain’s natural capacity for concentration (anterior cingulate cortex- via meditation exercises and guided visualization) rather than starting stimulant medication (Adderall, Ritalin, Vyvanse, etc). Proof of diagnosis or prior prescription is necessary but NOT sufficient for receiving stimulants in my practice. I will prescribe only what I believe is the best solution for you in the long term. Often it takes time and additional testing to determine if this is the case and frequently it is not.