Treatment Policies
Scheduling Appointments: When you make an appointment with me you are reserving a space in my office and have agreed to pay my fee for that time. While I understand there are times when you may be unable to make a scheduled appointment time, missing the appointment is not necessarily an exemption from payment for that time. Except in the situation where you are medically incapacitated (i.e. hospitalized or bedridden with an infectious disease), missed appointments without notice or on short notice are charged the regular fee.
If an appointment time is changed within fourteen days of the appointment time, I will attempt to fill that time with another patient. If another patient is not found for that time, you will be charged. If you request extended or repeated absences, a specific arrangement will need to be made with me otherwise you will be expected to pay for the missed appointments. If you have specific or unique circumstances in this regard an agreement needs to me made in advance of missed appointments.
Please be aware that I must triage the needs of all my patients to provide an overall balance of care. Therapy patients who use regular appointments as part of their treatment generally have a higher priority for appointment times than patients who work with me solely with medications. However, in times of need, I reserve the right to reschedule appointment times.
Phone Calls: I try to respond to all calls in a timely manner. For normal calls that is within 24 hours. However, I understand that there may be times where there is a sense of urgency to your call. Please include your need to speak with me in your message and clearly state your name and call back numbers even if you think I already have them. If there is emergent concern for yourself or others, call 911 or the Sutter Center for Psychiatry at (916)386–3000. Also be aware that I occasionally receive a very high volume of calls. In those moments I triage calls on a level of clinical need. Also, I occasionally do not get back to calls as quickly as either of us would like – please feel free to call me and leave repeat messages if you feel the need.
Payment: I expect payment upon your initial evaluation and prefer payment for each session. In my office I accept cash, check and credit cards that work with the square payment system. I also accept paypal. However, as a courtesy, for ongoing treatment I will bill you on a monthly basis. I do not hold outstanding balances for patients beyond that time without a prior agreement. If you have any question or concern about your balance please call me as soon as possible.
Scheduling Appointments: When you make an appointment with me you are reserving a space in my office and have agreed to pay my fee for that time. While I understand there are times when you may be unable to make a scheduled appointment time, missing the appointment is not necessarily an exemption from payment for that time. Except in the situation where you are medically incapacitated (i.e. hospitalized or bedridden with an infectious disease), missed appointments without notice or on short notice are charged the regular fee.
If an appointment time is changed within fourteen days of the appointment time, I will attempt to fill that time with another patient. If another patient is not found for that time, you will be charged. If you request extended or repeated absences, a specific arrangement will need to be made with me otherwise you will be expected to pay for the missed appointments. If you have specific or unique circumstances in this regard an agreement needs to me made in advance of missed appointments.
Please be aware that I must triage the needs of all my patients to provide an overall balance of care. Therapy patients who use regular appointments as part of their treatment generally have a higher priority for appointment times than patients who work with me solely with medications. However, in times of need, I reserve the right to reschedule appointment times.
Phone Calls: I try to respond to all calls in a timely manner. For normal calls that is within 24 hours. However, I understand that there may be times where there is a sense of urgency to your call. Please include your need to speak with me in your message and clearly state your name and call back numbers even if you think I already have them. If there is emergent concern for yourself or others, call 911 or the Sutter Center for Psychiatry at (916)386–3000. Also be aware that I occasionally receive a very high volume of calls. In those moments I triage calls on a level of clinical need. Also, I occasionally do not get back to calls as quickly as either of us would like – please feel free to call me and leave repeat messages if you feel the need.
Payment: I expect payment upon your initial evaluation and prefer payment for each session. In my office I accept cash, check and credit cards that work with the square payment system. I also accept paypal. However, as a courtesy, for ongoing treatment I will bill you on a monthly basis. I do not hold outstanding balances for patients beyond that time without a prior agreement. If you have any question or concern about your balance please call me as soon as possible.
Refills: I recognize that medications are important, so should you. To insure that you do not run out of medications, please check your medication supply regularly and prior to appointments so new prescritpions can be supplied at that time. Generally speaking, inform me of your need for refills at least 10 days prior to when they are due. The best way for you to contact me is by voice mail or text at (916)616-5531. Due to the volume of the tasks and other responsibilities I have, advance planning, patience and persistance will be required on your part to get refills outside of appointment times.
Paperwork: While I understand getting paperwork filled out is important, I prioritize other aspects of patient care over the immediate filling out of paperwork such as insurance forms, disability paperwork, letter completion, etc. Plan ahead and prepare to wait seven days for medication refill requests to be completed and up to three weeks for more involved paper work to be filled out. If you feel a need for paperwork to be filled out more quickly, you may use some of your appointment with me for the filling out of paperwork.
Records Release: Psychoanalysis is an intensely vulnerable experience where many of the things that are discussed are deeply personal and loaded with strong feelings. It is critical that there be a safe environment to discuss anything that may come up. Also, my therapy records contain information that is of no import for regular medical or even psychiatric evaluations. I have also encountered multiple situations where the release of records had unintended negative consequences due to the type of information contained in the records that is generally misunderstood by those without psychoanalytic training. The records are also in short hand and due to the nature of psychoanalysis, cannot possibly be inclusive of the material discussed in any session. I also take confidentiality extremely seriously, and for that reason I do not release therapy notes except on direct order from a Judge. However, I am happy to discuss my finding with patients and trained colleagues with a signed release of information, after a discussion with the patient involved. Also, if a patient so requests, I will generate a brief, focused treatment summary that will include adequate information for psychiatric evaluations.
Session Length: Sessions times are generally 50 minutes, and begin within the first 10 minutes of the hour.
Disability Evaluations: I do not conduct disability evaluations.
Insurance: There was a time earlier in my career when I worked extensively with insurance companies. I tried to maintain regular contact with them. This worked fine as long as you provided the very limited treatments of frankly questionable scientific validity. I tried to discuss with people at various insurance companies the significant scientific evidence in favor of psychoanalysis and the psychoanalytic support for the kinds of treatment I engage in. In 'doctor to doctor' conversations I would cite large studies and meta analyses justifying, quite clearly, my treatment modality. Unfortunately, I found that these interactions were almost universal failures. The individuals who works for the insurance companies were not trained in psychoanalysis, nor did they have any particular interest to become informed. They often worked off scripts and did not even have the capacity within their jobs to support my claims for treatment, regardless of justification or scientific evidence. I have even been told directly that, prior to my even discussing a patient, that the patient was going to be deemed either too sick to be allowed to see me in treatment, or they were not going to be found to be 'not sick enough' to warrant ongoing care - that it was either one or the other. I had agreements made in doctor to doctor conversations that would mysteriously disappear when it came time to to fulfill the agreements, so with prior warning to the insurance companies, I began recording the conversation to clearly have a record of the agreements. And while this quickly changed the tenor of the conversations, they resulted with the insurance doctors being unwilling to talk to me 'on the record'. Instead the process changed to wanting various documents or records for unclear reasons under the vague term 'utilization review' - which universally resulted in many hours of bureaucracy and in denial of services.
After many hundreds of hours spent in this process, I no longer work with insurance companies. I am not on any insurance panels, have no contracts with insurance companies, and do not participate in any of their bureaucratic processes. I will talk to medical doctors or those trained in psychoanalysis regarding the justifications for the treatments I provide but I will not engage in the lengthy and bureaucratic processes that are not designed to provide actual care for patients but instead devour my time in a process euphemistically referred to as 'bureaucratic fatigue' (that is making things so burdensome and difficult and loaded toward the insurance company that the individuals trying to provide care or fight for care eventually give up). I am willing to provide a bill that should have the necessary information for possible reimbursement, but it is no guarantee. The insurance policy is between you and your insurance company. The responsibility for payment is yours even if you have a policy that contributes toward the cost of this service.
Medicare: Due to the bureaucratic hurdles involved, I do not accept Medicare, nor am I a Medicare provider.
Paperwork: While I understand getting paperwork filled out is important, I prioritize other aspects of patient care over the immediate filling out of paperwork such as insurance forms, disability paperwork, letter completion, etc. Plan ahead and prepare to wait seven days for medication refill requests to be completed and up to three weeks for more involved paper work to be filled out. If you feel a need for paperwork to be filled out more quickly, you may use some of your appointment with me for the filling out of paperwork.
Records Release: Psychoanalysis is an intensely vulnerable experience where many of the things that are discussed are deeply personal and loaded with strong feelings. It is critical that there be a safe environment to discuss anything that may come up. Also, my therapy records contain information that is of no import for regular medical or even psychiatric evaluations. I have also encountered multiple situations where the release of records had unintended negative consequences due to the type of information contained in the records that is generally misunderstood by those without psychoanalytic training. The records are also in short hand and due to the nature of psychoanalysis, cannot possibly be inclusive of the material discussed in any session. I also take confidentiality extremely seriously, and for that reason I do not release therapy notes except on direct order from a Judge. However, I am happy to discuss my finding with patients and trained colleagues with a signed release of information, after a discussion with the patient involved. Also, if a patient so requests, I will generate a brief, focused treatment summary that will include adequate information for psychiatric evaluations.
Session Length: Sessions times are generally 50 minutes, and begin within the first 10 minutes of the hour.
Disability Evaluations: I do not conduct disability evaluations.
Insurance: There was a time earlier in my career when I worked extensively with insurance companies. I tried to maintain regular contact with them. This worked fine as long as you provided the very limited treatments of frankly questionable scientific validity. I tried to discuss with people at various insurance companies the significant scientific evidence in favor of psychoanalysis and the psychoanalytic support for the kinds of treatment I engage in. In 'doctor to doctor' conversations I would cite large studies and meta analyses justifying, quite clearly, my treatment modality. Unfortunately, I found that these interactions were almost universal failures. The individuals who works for the insurance companies were not trained in psychoanalysis, nor did they have any particular interest to become informed. They often worked off scripts and did not even have the capacity within their jobs to support my claims for treatment, regardless of justification or scientific evidence. I have even been told directly that, prior to my even discussing a patient, that the patient was going to be deemed either too sick to be allowed to see me in treatment, or they were not going to be found to be 'not sick enough' to warrant ongoing care - that it was either one or the other. I had agreements made in doctor to doctor conversations that would mysteriously disappear when it came time to to fulfill the agreements, so with prior warning to the insurance companies, I began recording the conversation to clearly have a record of the agreements. And while this quickly changed the tenor of the conversations, they resulted with the insurance doctors being unwilling to talk to me 'on the record'. Instead the process changed to wanting various documents or records for unclear reasons under the vague term 'utilization review' - which universally resulted in many hours of bureaucracy and in denial of services.
After many hundreds of hours spent in this process, I no longer work with insurance companies. I am not on any insurance panels, have no contracts with insurance companies, and do not participate in any of their bureaucratic processes. I will talk to medical doctors or those trained in psychoanalysis regarding the justifications for the treatments I provide but I will not engage in the lengthy and bureaucratic processes that are not designed to provide actual care for patients but instead devour my time in a process euphemistically referred to as 'bureaucratic fatigue' (that is making things so burdensome and difficult and loaded toward the insurance company that the individuals trying to provide care or fight for care eventually give up). I am willing to provide a bill that should have the necessary information for possible reimbursement, but it is no guarantee. The insurance policy is between you and your insurance company. The responsibility for payment is yours even if you have a policy that contributes toward the cost of this service.
Medicare: Due to the bureaucratic hurdles involved, I do not accept Medicare, nor am I a Medicare provider.
Upcoming Times I Will Be Out of the Office:
Times are considered tentative until a month prior to the event.
Times are considered tentative until a month prior to the event.
- Friday, February 14th and Monday the 17th.
- Monday, April 6th through Friday, April 10th
- Monday, May 18th through Monday, May 25th (Returning Tuesday)
What I Do
I am a medical doctor with specialized training in the field of psychiatry and psychoanalysis who has dedicated my life to try and help those who experience chronic psychological suffering and dissatisfaction in their lives. This can be expressed in multiple ways including, but not limited to, problems with severe moods or mood fluctuations, dealing with the repercussions of traumatic events, dissatisfaction in relationships, problematic ways of relating to others, distressing or dysfunction ways of thinking or a long-term process of distressing but seemingly inescapable thoughts. Individuals sometimes have carried diagnoses such as depression, bipolar disorder, post-traumatic stress disorder, anxiety disorders, personality disorders, schizoaffective disorder, schizophrenia, addiction or attention deficit disorder.
Our work begins with a period of consultation. My initial consultation is usually two hours long to provide the time necessary to begin to discover the root causes of your symptoms. After the initial consultation, we discuss different ideas of how we will work together, which may include medications, psychoanalysis or a host of other possible treatments. I will refer to other specialists (cognitive and behavioral therapists, endocrinologists, primary care physicians, family therapists, etc.) as required for your care. You are an active participant in this process and it is only through mutual agreement that treatment occurs.
If we agree to work together we will generally meet on a regular basis. Our meetings will include discussing medications, but much of the time will be spent exploring the ways you are with your thoughts and feelings. This means creating and maintaining an environment where we can examine and occasionally challenge the way you are with yourself and others. You need to be willing to meet frequently for this treatment to accomplish its goals.
While I do prescribe medications, be aware I am very sparing in their use. I do this after a reading of the medical literature that generally shows the benefits of these medications are far less than what is promoted by pharmaceutical companies, and come with far more complicated side effects than previously believed. Do not come to see if me if you simply want regular and rapid adjustments to your medication regimens. That is not how I work.
Individuals who come to see me are generally experiencing extreme psychic distress. The distress if often multifactorial and longstanding. Please do not expect longstanding distress to immediately disappear upon meeting with me, it is not how this process works. Instead, expect us to begin a process of deep exploration and discovery. The fact that the process of uncovering psychic material often means uncovering emotionally painful aspects of one’s life is an unfortunate but necessary aspect of our work. The work is intensive, regular, ongoing and evokes a large array of thoughts and feelings. There will be periods of intense feelings or the emergence of troubling forms of thought which may include dreams and nightmares, disturbing bodily experiences or even periods of confusion and disorientation. In addition, people have layers and aspects of themselves that may only be visible at certain times, in certain situations, or after certain milestones in our work have been achieved.
I also believe that the unique relationship that develops between the patient and myself plays an important role in finding a path that leads to lasting change. There are many ways this is important, but a key ingredient to any therapeutic relationship is not simply how you are, or how I am, but how we are together. This dynamic relationship is fundamental to any process of psychic change.
This kind of work is also exploratory. I will not generally ‘tell you what to do’ or have a rigid ‘treatment plan’ that predicts what will happen. We will explore what emerges in our relationship and time together. People may be surprised in that we will pay explicit attention to the nuanced patterns of thinking and imagination, such as spontaneous thoughts and behaviors, bodily phenomenon, dream material or aspects of creativity such as artistic endeavors or writings. We will explore areas where you may be excited, wishful or ashamed. Also, while I am generally more active than most psychoanalysts, many people may experience me as quiet during many sessions and it takes time to realize the deep value of contemplative reflection.
I believe that while there are aspects of a person’s distress that cannot be changed (such as a person’s history, or the fact that they have a genetic disposition towards depression), I also believe that ‘symptoms’ (such as sadness) are usually not ‘random’, ‘organic’ or ‘chemical’ in nature, but instead linked to a variety of stimuli related to a person’s current experience, current way of thinking and ways of relating to others. While we cannot change a person’s genetics or history, by spending focused time with a person’s current thought processes, change can be made in how people experience themselves and have relationships to others. This is true down to fundamental aspects of thinking itself.
I believe that deep and lasting psychic change is similar to other substantial changes a person tries to accomplish in their life. The process is slow and generally develops over long periods of time through sustained attention and work. It is also similar as there will be forces at work that will naturally resist such changes that will both need to be addressed and overcome.
Most of my sessions are 50 minutes in length. We will start within the first ten minutes of the hour or half hour and continue for 50 minutes.
For those who are aware of the different forms of psychoanalytic treatment, I identify myself with the work of Donald Winnicott, Wilfred Bion and the Intersubjectivists.
See 'What is Psychoanalysis' for more.
I am a medical doctor with specialized training in the field of psychiatry and psychoanalysis who has dedicated my life to try and help those who experience chronic psychological suffering and dissatisfaction in their lives. This can be expressed in multiple ways including, but not limited to, problems with severe moods or mood fluctuations, dealing with the repercussions of traumatic events, dissatisfaction in relationships, problematic ways of relating to others, distressing or dysfunction ways of thinking or a long-term process of distressing but seemingly inescapable thoughts. Individuals sometimes have carried diagnoses such as depression, bipolar disorder, post-traumatic stress disorder, anxiety disorders, personality disorders, schizoaffective disorder, schizophrenia, addiction or attention deficit disorder.
Our work begins with a period of consultation. My initial consultation is usually two hours long to provide the time necessary to begin to discover the root causes of your symptoms. After the initial consultation, we discuss different ideas of how we will work together, which may include medications, psychoanalysis or a host of other possible treatments. I will refer to other specialists (cognitive and behavioral therapists, endocrinologists, primary care physicians, family therapists, etc.) as required for your care. You are an active participant in this process and it is only through mutual agreement that treatment occurs.
If we agree to work together we will generally meet on a regular basis. Our meetings will include discussing medications, but much of the time will be spent exploring the ways you are with your thoughts and feelings. This means creating and maintaining an environment where we can examine and occasionally challenge the way you are with yourself and others. You need to be willing to meet frequently for this treatment to accomplish its goals.
While I do prescribe medications, be aware I am very sparing in their use. I do this after a reading of the medical literature that generally shows the benefits of these medications are far less than what is promoted by pharmaceutical companies, and come with far more complicated side effects than previously believed. Do not come to see if me if you simply want regular and rapid adjustments to your medication regimens. That is not how I work.
Individuals who come to see me are generally experiencing extreme psychic distress. The distress if often multifactorial and longstanding. Please do not expect longstanding distress to immediately disappear upon meeting with me, it is not how this process works. Instead, expect us to begin a process of deep exploration and discovery. The fact that the process of uncovering psychic material often means uncovering emotionally painful aspects of one’s life is an unfortunate but necessary aspect of our work. The work is intensive, regular, ongoing and evokes a large array of thoughts and feelings. There will be periods of intense feelings or the emergence of troubling forms of thought which may include dreams and nightmares, disturbing bodily experiences or even periods of confusion and disorientation. In addition, people have layers and aspects of themselves that may only be visible at certain times, in certain situations, or after certain milestones in our work have been achieved.
I also believe that the unique relationship that develops between the patient and myself plays an important role in finding a path that leads to lasting change. There are many ways this is important, but a key ingredient to any therapeutic relationship is not simply how you are, or how I am, but how we are together. This dynamic relationship is fundamental to any process of psychic change.
This kind of work is also exploratory. I will not generally ‘tell you what to do’ or have a rigid ‘treatment plan’ that predicts what will happen. We will explore what emerges in our relationship and time together. People may be surprised in that we will pay explicit attention to the nuanced patterns of thinking and imagination, such as spontaneous thoughts and behaviors, bodily phenomenon, dream material or aspects of creativity such as artistic endeavors or writings. We will explore areas where you may be excited, wishful or ashamed. Also, while I am generally more active than most psychoanalysts, many people may experience me as quiet during many sessions and it takes time to realize the deep value of contemplative reflection.
I believe that while there are aspects of a person’s distress that cannot be changed (such as a person’s history, or the fact that they have a genetic disposition towards depression), I also believe that ‘symptoms’ (such as sadness) are usually not ‘random’, ‘organic’ or ‘chemical’ in nature, but instead linked to a variety of stimuli related to a person’s current experience, current way of thinking and ways of relating to others. While we cannot change a person’s genetics or history, by spending focused time with a person’s current thought processes, change can be made in how people experience themselves and have relationships to others. This is true down to fundamental aspects of thinking itself.
I believe that deep and lasting psychic change is similar to other substantial changes a person tries to accomplish in their life. The process is slow and generally develops over long periods of time through sustained attention and work. It is also similar as there will be forces at work that will naturally resist such changes that will both need to be addressed and overcome.
Most of my sessions are 50 minutes in length. We will start within the first ten minutes of the hour or half hour and continue for 50 minutes.
For those who are aware of the different forms of psychoanalytic treatment, I identify myself with the work of Donald Winnicott, Wilfred Bion and the Intersubjectivists.
See 'What is Psychoanalysis' for more.
What I Do Not Do
I no longer begin treatment with patients solely for the aim of managing their medications. I recommend those patients seek care from other providers who specialize in medication management.
I do not prescribe marijuana or pain medications to any of my patients for any reason.
I do not prescribe medications for medical or psychic conditions that are outside my scope as your psychoanalyst for any reason.
If addictions are part of what you struggle with, you must be willing to address this in treatment and consider engagment in 30 day treatments or other substance abuse programs such as Alcoholics Anonymous. If you are unwilling to engage in these treatments and do the hard work of facing your addictions, our work together will likely be unsuccessful.
I no longer begin treatment with patients solely for the aim of managing their medications. I recommend those patients seek care from other providers who specialize in medication management.
I do not prescribe marijuana or pain medications to any of my patients for any reason.
I do not prescribe medications for medical or psychic conditions that are outside my scope as your psychoanalyst for any reason.
If addictions are part of what you struggle with, you must be willing to address this in treatment and consider engagment in 30 day treatments or other substance abuse programs such as Alcoholics Anonymous. If you are unwilling to engage in these treatments and do the hard work of facing your addictions, our work together will likely be unsuccessful.