Before anything, a short conversation
I offer a free consultation of ten or fifteen minutes by video. Nothing clinical happens in it.
It exists so we can both find out whether this is a fit. You get to hear how I talk and ask whatever you want to ask. I get to hear what brought you here. Occasionally the honest outcome is that I am not the right person, and it is far better for both of us to establish that in fifteen minutes than in the sixth week.
The evaluation is long on purpose
I tell people the psychiatric evaluation is ninety minutes. In my calendar I block two hours, because I would rather have the time and not need it than watch the clock during the part that matters.
We start further back than most people anticipate. I ask about your mother's pregnancy, about your birth, about early childhood, about what school was like. Then forward through adolescence and adulthood to where you are now. Family history. Physical symptoms as well as psychiatric ones. What you believe, if belief is part of your life.
I do this because patterns are rarely invented in adulthood. A great deal of what we carry was laid down early, often by parents or a community or whoever was responsible for us, and we go on carrying it unless something prompts a closer look. You cannot see that shape from a symptom checklist.
It also means that by the end I am not making a decision about a stranger. That matters more than any single question in it.
What comes out of it
Not necessarily a prescription. Sometimes yes, and I will explain what I am suggesting and why, what would count as it working, and roughly when we would know.
Sometimes the more useful answer is that something has never been properly assessed. Sleep, thyroid, a substance doing more work than it appears to be doing, or trauma sitting underneath something that has been treated as depression for years. A treatment aimed at the wrong target does not fail because you are treatment-resistant. It fails because it was aimed at the wrong target.
And sometimes what I suggest is not medication at all. Lifestyle changes are unglamorous and they are frequently the thing that moves first.
About the other modalities
I combine conventional psychiatry with breath work, mindfulness, and psychedelic-informed approaches including ketamine-assisted work where it suits the person.
The most common misconception I encounter is that the treatment is the experience itself. It is not. Preparation and integration are often more important than the session, and a session with no preparation and no follow-up tends to produce a vivid memory rather than a change.
Where ketamine-assisted work is part of a plan, the shape is one or two preparation sessions, the session itself, then meeting again within two or three days at the latest, and one or two integration sessions after that. Fuller integration is not a fixed length. It can go on for months.
None of that is a starting point. It is something we would arrive at deliberately, if at all.
Two ground rules
We do not bring judgment into the room. That is one of the first things I agree with a patient, and it applies to me as well as to you.
And I disclose more about myself than some clinicians do. I have found that when I am willing to be vulnerable, it becomes easier for the person I am working with to be vulnerable back. If that is not what you want from a provider, that is useful information for both of us early on.
What progress tends to look like
Subtle, and compounding. People rarely report a single dramatic turn. More often they notice they were kinder to themselves in a moment that would previously have been unkind, or that there was a pause before a reaction that used to be automatic, or that they let go of a standard they had been holding for no reason they could name.
I see adults eighteen and over across Oregon by telehealth.
