Treatment begins with an evaluation that lasts one hour. Treatment is based upon the evaluation, because the response to each available treatment can be predicted based upon the patient's symptom profile and response to prior treatments. The evaluation consists of hundreds of questions which reveal the individual symptoms and pattern of symptoms which are the hallmarks of illness and predict treatment response.

The questions cover the current episode as well as prior episodes in order to understand how the illness manifests itself in the individual patient. The questions also cover related illnesses that the patient may suffer and may pose complications for treating the primary illness.

We will also review current medical problems, any family history of mental illness and current social, family or economic problems which all offer clues to an effective treatment.

At the end of the evaluation I review with the patient the diagnoses I am using to direct treatment. I discuss alternative treatments including their side effects and likelihood of responding to each alternative. I predict the length of time necessary for an initial improvement and complete resolution of the illness symptoms.

At the end of the first session I send a summary of the patient's treatment to their therapist or primary physician.

Subsequent sessions are 20-30 minutes. Their content is based upon the patient's treatment goals and includes monitoring the treatment effects of the medication and the patient's progress as well as any additional problems that may have arisen. The treatment approach I use is pragmatic and based upon helping patients achieve their goals. I often work along with the patient's therapist or I may recommend a therapist in the patient's insurance plan if the patient does not have one. For patients with anxiety or depression I may recommend a self-help manual (cognitive-behavioral therapy) and utilize the manual in sessions.

The frequency of sessions is based on the patient's needs. Usually, patients begin to respond by three weeks and sessions are then scheduled each 1-2 months.

My patients tend to be achievement oriented people. They are people who accept responsibility for themselves and others and are concerned about restoring or surpassing their prior level of function. They are about setting goals and achieving them. My treatment contract with my patients is to help them achieve their goals.

All patients must be heard and appreciated as individuals. Their goals may differ. Their priorities may differ. The manner in which they experience their illness and the words they use to describe their experiences all differ. The clinician must be prepared to listen carefully and to know his patients as individuals. They must share the same goals, the same understanding of the individual so that the patient may trust the doctor and accept his help.

People who are likely to benefit are patients who have full-time responsibilities for work, school or family or who wish to resume these responsibilities. They are generally cooperative in their treatment plan: able to follow directions for medication, keep scheduled appointments and follow through on mutually agreed assignments.

People who are not likely to benefit are those who have problems which are unlikely to be helped by medication, or with current drug or alcohol dependence, or have factors that might prevent them from resuming their responsibilities such as disability payments or court settlements.

I generally recommend that patients remain at work in order to achieve more rapid improvement and that they not make life-changing decisions during an episode of illness.

When you call my office number you will be asked to leave your name and call-back number.

Reva, my office manager will contact you and will conduct a brief initial interview which will determine whether we may be of benefit to you. In most cases the designated patient must answer these questions. If we decide we cannot help your problem you will be given the name and contact information of an alternative provider.

Please be ready to provide a medication history: all medications, doses, lengths of time of use and history of response. It is also useful to provide the medication history of all blood-related relatives.

Our treatment philosophy is to be available to people of moderate means.

We are in-network providers for most insurance plans, and out-of-network providers for others. You will be asked to pay your copayment by cash or check at time of service.

Patients without insurance are likely to find my rates are affordable.

I charge $350 for the initial one-hour evaluation and $165 for subsequent 20-30 minute sessions.

Patients must cancel a scheduled appointment by 6 PM the preceding day to avoid being charged for a missed session.

For comments from my patients please refer to Healthgrades.com and Vitals.com