Psychiatric psychotherapy refers to care in which a psychiatrist not only prescribes medications when necessary but also incorporates psychotherapy directly into treatment. This allows the psychiatrist to treat both your emotional and medical needs in one place, understand you holistically — your life, history, and goals — and provide coordinated care without splitting therapy and medication between different providers.

Nature psychotherapy combines traditional psychotherapy with outdoor nature walks. Sessions take place in natural settings, which research shows can reduce stress, improve mood, and enhance therapeutic outcomes¹. It’s particularly beneficial for patients who find indoor office settings intimidating or who connect more deeply with nature.

Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-cleared treatment that uses magnetic fields to stimulate nerve cells in the brain. It’s typically used when other treatments haven’t worked.

Ketamine is an NMDA receptor antagonist that works differently from traditional antidepressants. It can provide rapid relief for treatment-resistant depression, anxiety, and other conditions.

Patients with treatment-resistant depressive symptoms, particularly those who have not achieved full remission with medications and psychotherapy may find TMS or ketamine treatments to be promising options. TMS and ketamine therapy have different contraindications. We will discuss which is right for you during your consultation.

Both treatments have strong safety profiles. We’ll discuss risks and benefits in detail during your consultation.

TMS: Side effects are typically mild and resolve shortly, including scalp discomfort, headache, and facial twitching. Serious side effects like seizures are extremely rare².

Ketamine: Common side effects include mild dissociation, dizziness, or nausea during infusion³.

TMS: Most patients notice improvement within 2-4 weeks of starting treatment. A full course is typically 36 sessions over 6-8 weeks.

Ketamine: Many patients experience relief within hours to days of the first infusion. A full initial series is typically 6 infusions over 2-3 weeks.

TMS: For conventional approaches, approximately 40% of patients with treatment-resistant depression are responsive to TMS, with over ⅓ achieving full remission⁴. Patients with PTSD also demonstrate significantly improved symptoms⁵. Evidence suggests even higher response rates for accelerated and personalized treatment courses^6,7.

Ketamine: Up to 64% of patients receiving ketamine therapy achieve remission from depressive symptoms, with IV ketamine showing slightly more efficacy than intranasal ketamine^3,8.

TMS: You’ll sit in a comfortable chair with earplugs provided. The coil is placed on your scalp. You’ll hear clicking sounds and feel a tapping sensation. Because TMS is non-invasive, you can resume normal activities right away, including driving.

Ketamine: You’ll relax in a reclining chair. The provider will start an IV or give you a nasal spray to self-administer, and you’ll be monitored throughout. After the session, you’ll need someone to drive you.

At the time of followup, some patients may feel symptoms returning. Maintenance TMS involves booster sessions that sustain the effects of the initial TMS treatment. It is typically shorter than the original course.

In short, TMS may be suitable for individuals with moderate, long-term depression, while ketamine may be better for those with acute, severe depressive symptoms requiring immediate relief. Which treatment is right for you will be discussed during your consultation appointment, where your medical history, symptoms, and goals will be taken into account.

Factor	TMS	Ketamine
Contraindications*	metal or electronic implants in head/neck, epilepsy	pregnancy, history of psychosis, unstable cardiovascular conditions
Onset of Results	gradual	rapid
Duration of Results	long-lasting	more short-lived
Invasiveness	non-invasive	minimally invasive
Insurance Coverage	reimbursement likely	reimbursement unlikely

*Not an exhaustive list

Your first visit is a comprehensive psychiatric assessment that lasts about 75–90 minutes. During this time, your psychiatrist will:

• Explore the concerns that bring you to treatment
• Review your prior treatments, including medications and therapy
• Discuss your medical and family history
• Learn more about you, your life, and your goals for care

Because evaluation is a process, sometimes more than one appointment is needed to fully understand your situation. The first session also helps determine if both you and your psychiatrist feel this is the right fit for your care.

Yes. At your initial appointment, your psychiatrist will review potential treatment options and discuss the pros and cons of each approach. Depending on your needs, your doctor may also request past medical records or order lab tests to help guide recommendations.

Not at all. Many patients use second opinion consultations to guide ongoing treatment with their current provider. Others may choose to continue care with us if it feels like the right fit. The goal is to give you clarity, confidence, and direction in your treatment.

A second opinion consultation is an in-depth review of your current treatment plan by a psychiatrist with expertise in complex cases. It’s an opportunity to gain a fresh perspective, new options, and reassurance about your care.

You may benefit from a second opinion if:

• You feel stuck or unsure about your progress in treatment
• Your condition involves medical and psychiatric complexity
• First-line treatments haven’t worked as well as you hoped
• You’re interested in exploring second- or third-line options
• You want to learn more about new or emerging treatments in psychiatry

A second opinion consultation is an in-depth review of your current treatment plan by a psychiatrist with expertise in complex cases. It’s an opportunity to gain a fresh perspective, new options, and reassurance about your care.

Follow-ups are focused on your progress and response to treatment. Together, you and your psychiatrist will evaluate what’s working, adjust medications if needed, and incorporate therapy when appropriate.

Standard follow-ups: 25 minutes

Extended follow-ups: 45 minutes (for psychotherapy + medication management, complex concerns, family involvement, or if it’s been 6+ months since your last visit)

At the beginning of treatment or during medication adjustments, visits may be more frequent. As your symptoms improve and stabilize, appointments may become less frequent. Patients must be seen every 3 months at minimum to ensure safe and effective care.

You’ll have direct access to your psychiatrist for both clinical and non-clinical questions. We pride ourselves on being highly responsive—typically replying to messages within hours. This allows us to provide ongoing support and continuity of care, even between appointments.

For stable patients, we may approve admin refills between visits:

• Controlled substances: Up to 2 refills (30-day supply each = 3 months max)
• Non-controlled medications: Up to 1 refill (90-day supply = 6 months max)

Most patients require monthly to every-other-month visits. All patients must be seen at least every 6 months.

Please notify us at least 24 hours in advance. You may refer to our Payment and Policies page for late cancellation and no-show policies.

If you are seeing us as an out-of-network provider, you may request a superbill (itemized health care receipt) to submit. Many plans will reimburse a percentage of the visit fee. However, we cannot guarantee insurance reimbursement, and some insurance companies may require additional documentation, contracting, or business information that we are unable to provide. Administrative fees for doing insurance paperwork and responding to insurance inquiries sometimes exceed the reimbursement patients receive from their insurance. If insurance reimbursement is a priority, we would recommend pursuing an in-network practice instead.

No, we are not in network with any insurance plans. This means our services are considered out of network. Insurance does not pay us directly, but many plans do reimburse for a portion of out-of-network mental health services.

Being out of network means you pay us directly at the time of your appointment. You can then request reimbursement from your insurance company, depending on your plan’s out-of-network benefits.

Many patients do get partial reimbursement, but the exact amount depends on your specific plan. We recommend calling your insurance company and asking:

• What are my out-of-network benefits for outpatient mental health services?
• What percentage of the fee will be reimbursed?
• Do I have an out-of-network deductible I need to meet first?

After each appointment, we provide you with a superbill (a specialized invoice) that includes all the information and billing codes your insurance company requires. You typically upload this to your insurance portal or mail it in to request reimbursement.

Not working directly with insurance companies allows us to:

• Offer longer appointments when needed
• Combine psychotherapy and medication management in the same visit
• See you more often at the start of treatment and less frequently as you improve
• Provide direct access to your psychiatrist—all clinical and non-clinical questions are answered personally by us, and we typically respond within hours
• Focus on what’s best for your care, not what’s dictated by insurance restrictions

This model helps us provide care that is more comprehensive, flexible, and tailored to your needs.