Frequently Asked Questions If you have a question that has not been answered here, please click on the Guestbook tab above and ask your question there. If you prefer to send a confidential message that won't appear on the website, please click on the Contact Me tab above. Alternative Treatments Q. What if I don't want medications and want to try acupuncture, hydrocolonics, kinesiology, nutrition, reiki, and alternatives like these? A. I have a great deal of respect for alternative therapies, and have benefited from these approaches myself. Many of these practitioners are my friends, and are listed on my links page with their addresses. Appointments Q. What can I expect in the first session? A. This is a time to get to know each other and find out how we get along and whether we "click." Also, I will get a sense of the general problem as you see it, as well as taking a family history. Q. How many sessions will I need? A. If you are sent by an insurance company, such as for an independent medical examination, you will just have one visit. Q. How often do I have to see you? A. My rule on that is as much as you feel you want to, need to, and can afford to. Q. What will I get out of seeing you? A. Generally, people get out of anything about as much as they want from and put into it. If patients do their homework, follow the treatment program, set their goals and sights higher than mere survival, they may discover whole new selves and directions. Christianity Q. I'm a Christian. Isn't it a sign of weaknesses or too little faith if I have to take medications for mental problems? A. Not any more than if you had a cast for a broken leg. We understand more and more that behaviors, anxiety, mood disorders, and even addictions have a chemical basis. The medications act like a cast for a broken leg, holding the parts together until natural processes and the proper therapies complete the healing process. Insurance Q. Why don't you do third party billing? A. I need to stay sane. I need to be available for my patients. I need to earn a living. I don't like clerks telling me how to practice medicine. I don't think insurance companies should have access to confidential patient information, which they seem to think they have a right to do. The insurance companies make it so difficult, with so many different forms, rules and regulations for authorization, payments and co-pays, that within the same amount of time that it takes to go through all the rigmarole required for one patient, I can see a half dozen new patients in the same time and get them started on a treatment program. Q. Why won't Blue Choice, GHI, Medicaid, Medicare, Preferred Care, United Behavioral Health, Value Options, and such companies reimburse you? A. Some of these companies will reimburse the patient for me as an "out of network provider." For the first 6 years that I was in private practice, I was a provider for all of these insurance programs. However, I dropped them one by one, and am more effective without them. Medications Q. Do I have to take medications? A. No one HAS to do anything. Sometimes medications are not indicated. I always do my best to inform patients about the pros and cons of various treatment options, and to design a treatment plan with the patient that best suits his or her needs. One of the first things I learned in Medical School in the Pharmacology class is that we never choose between the good and the bad. We always have to choose between the bad and the worse. That also includes other interventions or not making any intervention at all. Q. How long do I have to take medications? A. In psychiatry we usually recommend taking medications for six to twelve months after the patient is in complete remission. However, there are certain conditions such as bipolar illness and schizophrenia, for which medications may be used indefinitely to help persons function for their entire lifetime. We recommend a trial decrease of medication for people with other disorders to see if the symptoms return, or if the person can do well without the drug. For some people, the return of symptoms is worse than taking the medication, and they just don't find it worth being "drug-free" to feel so bad. Q. How do I know if I am taking too much or too little of the medications prescribed? A. We try to prescribe enough medications to get results but not so much as to cause side effects. Of course, if a person has intolerable side effects, we almost always can find another dose, medication or approach for the problem. The first hurdle we have to pass is whether a patient can take the medication at all. The second is whether s/he can take it in therapeutic doses. This varies from person to person. With one medication, one person may take as few as 7.5 mg, and another as much as 60 or 80 mg. Finally, does it help? There is no point in taking a medication if it doesn't help. On the other hand, sometimes people don't realize how much it is helping until they stop the medication or cut down on it. Q. How would I know if I have to stop taking my medication? A. If you have certain symptoms such as a rash, extreme dizziness, hallucinations or delusions, seizures, anaphylactic shock, or tics, you need to stop your medications immediately and call your doctor. Q. Will the medications cure what is wrong with me? A. Generally, the medications only become part of the whole treatment plan. For some people, medications alone can solve the problem, or at least bring the symptoms under control. Psychiatrist vs. Counselors Q. I've been in therapy for 13 years. My counselor doesn't think I need medications. I don't seem to be getting any better. What is wrong? A. Some counselors think that if persons are on medications, they won't deal with their problems. Actually, the opposite is often true. Being on medications can help people feel well enough to actually work on their issues. Otherwise the memories may be painful that escapes such as alcohol, drugs, self injurious behavior or other addictions seem to be better alternatives than working through the distress. Most counselors these days understand this, and are quick to refer persons if they think the situation warrants a psychiatric evaluation for possible medications. Q. I already have a therapist. How will you work with him/her? A. In such cases, the patient signs a release of information so that the therapist and I can share information. This is extremely useful, because if I am just doing medical backup, the counselor is more alert than I am to changes. For example, a counselor I work closely with asked me to put a patient on a 30 day disability, because of the anxiety she could see he was having. Because the counselor and I have worked together for a long time and know and trust one another, I could get this accomplished before the patient was able to get an appointment with me the next week. On the other hand, if I become alert to a therapeutic issue that has not been addressed yet, I can recommend that the therapist work with the patient on these between medication appointments. Psychiatrist vs. Primary Physician Q. Why do I have to see you? Can't my primary physician give me my medication? A. Primary physicians often give medications for depression, anxiety, attention problems. Seeing a psychiatrist for mental problems is like seeing a cardiologist for heart problems. We specialize in and know more about what we do, but know less about other medical problems. When the problem seems particularly difficult, or it seems it needs more attention than an internist or family doctor can give it, s/he will refer to a specialist. When I get a patient stabilized, and s/he only needs medication, I often refer the patient back to his or her own doctor for maintenance. Q. I have a good relationship with my primary physician. How will you work with him/her? A. It works best for everyone to work together. If I discover an underlying medical problem that possibly was missed, I can ask the doctor to follow up on it. If there is another specialty question, I consult the doctor and s/he or I will refer the patient to a specialist. Often primary physicians refer patients to me, because they have run out of ways to help with their more limited time schedules and broader spectrum of problems to address. Psychiatrist vs. Psychologist Q. What is the difference between a psychologist and a psychiatrist? A. A psychologist has spent 4 years in graduate school after college, and has gotten a doctoral degree in psychology. Sometimes s/he does post doctoral or fellowship work in specialty areas of psychology. A psychologist can do extensive psychological testing that a psychiatrist is not trained to do. A psychiatrist has spent 4 years in medical school after college, as well as 4 years in residency training, practicing his/her specialty under supervision. Sometimes s/he does post doctoral or fellowship work in specialty areas of medicine. A psychiatrist can prescribe medications, order laboratory testing and authorize certain other treatments that a psychologist is not able to do.  Both can offer psychotherapy.