What can I expect at my first appointment?
The first visit is what I refer to as a “consultation”. In some cases the consultation may require more than one, and even sometimes several visits. There are several things that must be accomplished in a consultation. First and foremost, it is important that we both decide if we can feel comfortable with each other, as would be desired in the first meeting of any new relationship. The therapeutic process requires a patient to discuss material that can be very difficult and even painful at times. In order to facilitate this, I want to be able to ask you questions that you will be able to answer as comfortably as possible. I believe that I can only be able to help you if you feel you can trust me. In addition, the consultation allows me to formulate and, if necessary, diagnose the problem that is bringing you to my office in the first place, and then lead to an effective treatment plan which I will discuss with you.
How do I get to your office?
My office is conveniently located at:45 Camino Alto, suite 200 Mill Valley, CA 94941 (Map)
I am located in the Safeway shopping center across from Tamalpais High School at the corner of Camino Alto and Miller. My office is on the second floor over a Starbucks. There is typically plenty of parking. The Golden Gate Transit bus runs from US 101 down Blythdale to downtown Mill Valley, then up Miller to Tam Junction. If you take the bus, it is fastest to get off at Blythdale and Camino Alto and walk the two long blocks south to Miller and my office.
Why is there more than one address listed for your office?
I keep a business address at:145 Corte Madera Town Center PMB 594 Corte Madera, CA 94925
for mail delivery and important documents. It is a UPS delivery store with bonded employees who are very responsible with my mail and packages. This is simply because there is no secure area to leave mail and documents at the Mill Valley address.
What is psychotherapy?
Psychotherapy simply is the process of using talk or other traditional means of communication between a therapist and a patient to assist the patient in alleviating many types of pain or distress. To be able to do psychotherapy, a clinician must have many years of formal training and supervision. In most cases, the clinician has also been involved in a psychotherapy of their own, to assist them in recognizing areas of personal strength and deficiency which can impact their own skills as a therapist. Over the past 100 years, there have been many different “schools” of psychotherapy theory and technique. Among some of the more popular today are: psychoanalysis, psychodynamic psychotherapy, gestalt therapy, cognitive behavioral therapy (or CBT), interpersonal therapy, and dialectical behavioral therapy (or DBT). But there are many others not mentioned as well. Each modality has its own particular strengths and weaknesses. My own brand of psychotherapy borrows from each of these schools of thought, though I do not lay claim to any one particular specialty of psychotherapy. Feel free to ask for more information during your consultation.
What is a psychiatrist?
A psychiatrist is clinician who provides specialized care in mental health treatment. While there are several types of clinicians who offer mental health care, a psychiatrist is unique in also being a physician, having graduated from an undergraduate institution as well as from a medical school. Thus, a psychiatrist has an M.D. and is licensed by the state to practice medicine. But training does not end there. A psychiatrist has also completed a full year of internship in a hospital setting and has also completed a minimum 3 year residency in psychiatry where skills in diagnostic assessment, psychotherapy, medication assessment and management and familiarity with several other psychiatric skills are acquired. In many cases, a psychiatrist may also have completed a fellowship in a psychiatric subspecialty, such as geriatrics, child and adolescent psychiatry, forensics, research, or chemical dependency. Many psychiatrists are also “board certified”, meaning that they have passed a rigorous examination demonstrating proficiency in their specialty or subspecialty. In some cases, a psychiatrist may also have another graduate degree, such as in law, business, or public health. Once formal training is completed, psychiatrists licensed in California will continue to complete at least an additional 25 hours of further skills and training each year.
How do I know if I am responding to treatment?
During the initial consultation, one of the objectives is to assist in determining the severity of your condition. I ask several questions to identify symptoms of your condition. From time to time, I may ask you those same questions again to see if symptoms have improved or worsened. Of course, you may also keep a diary or journal of your own symptoms to measure improvement over time. I will be posting on my website a number of tools to assist you in assessing your symptoms and your progress so that you can more easily see how you respond to treatment.
When should I consider using psychiatric medications?
Medications are a most useful tool in psychiatric care. However, they are not a panacea, nor are they without problems of their own. The decision of when to use a medication can be most simply stated as the point at which the potential benefits of medication use clearly outweigh the potential risks. Traditionally, a medication can not be marketed in this country without a medical indication; a diagnosis, disease, or condition for which the drug shows a clear advantage over placebo. In psychiatry, we often use medications on symptoms for which they were not originally intended – or “off label”. Therefore, placebo controlled studies may not have been done to prove their effectiveness on these symptoms. In addition, almost none of the medications I prescribe are 100% effective. So taking a medication does not necessarily guarantee remission. However, often symptoms can be alleviated or reduced enough to allow you to function better in your daily routine, or to focus more on your difficulties in counseling or therapy.
How can I pay for my treatment?
All fees are due and payable at the time of your visit, unless you and I have made an alternative arrangement. Payment may be made by cash, check, credit or debit card. Matters, such as routine phone calls, refills, doctor letters, etc. are covered by your fee. However, there may be additional fees for services such as longer or more frequent phone consultations, creating a clinical summary or report, completing forms for third parties, or records services. Feel free to ask for more information at the time you request one of these services.
If you have insurance or other third party coverage, once you have paid your bill in full, my office can try to submit a claim to your insurer, as a courtesy to you. However, unless my office has an agreement with your insurance carrier, you are still responsible for the entire amount of your bill. Any amounts paid by your insurance will normally be paid directly to you. If a payment comes to my office, it will be refunded or it can applied as a credit toward future services or visits. If your insurance carrier chooses to deny a claim for reasons other than clerical error, it is your prerogative to dispute it. If you request my assistance in dealing with an insurance carrier with which I am not under contract, additional fees may apply.
If you intend to take medications, unless you have prescription insurance coverage, this can become quite costly. Fortunately, there are several options to help make medication costs more affordable. Many pharmacies and retail stores offer discount pharmacy plans. There are several online pharmacies in the USA with discount plans as well. Be careful not to use a mail order pharmacy outside the USA as they are not regulated by US law. Finally, many drug manufacturers have frequently made available to patients discount coupons or even patient assistance programs that provide free medications for up to 12 months or more to patients who qualify. Go to www.needymeds.org for more information.