Why we're here
Lead with GRIT.
Otherwise the care drifts back toward the thing we left.
Our mission
The goal is actually getting somewhere, not just keeping the lights on.
Most clinics are literally set up to keep you functional and call it a win, which is a low bar and we don't use it.
We go with what actually works and stay honest about what that turns out to be, which might be meds, might be a hard look at how you're framing the whole thing, or both at once. We'll push you when pushing is what the situation calls for, we'll back you up, and we'll tell you the truth.
Why we built this.
If you've spent any real time inside the corporate version of psychiatric care, you already know what the problem is. The visit is fifteen minutes because the billing template says fifteen minutes. The provider you saw last time is gone because the system shuffles people. The chart is full of canned phrases that someone clicked through to make the note codable, and almost none of it has anything to do with what you actually said. You leave with a prescription and a vague sense that nobody really heard you, which is correct, because nobody really did. The system wasn't set up for them to.
That isn't because the clinicians inside those systems are bad people, most of them aren't, it's because the economic model of corporate medicine treats psychiatry the same way it treats anything else, which means it optimizes for throughput. More visits, shorter visits, more codes per hour, more refills per click. The math works for the parent company, and the math sort of works for the insurance company, and the patient is the one absorbing the cost. Not in dollars, in attention. Real attention is the resource that gets squeezed out first.
So we picked the other one
- Smaller panelsYou can keep working inside a model you don't believe in, or you can build something smaller, slower, and more honest. We picked the second one.
- Longer visitsReal continuity, the same provider visit after visit, no front-desk maze to get through to ask a question.
- We say the quiet partA longer visit with the same person every time costs more to run than a fifteen-minute mill does, and we're not going to pretend otherwise.
The other piece of why we built this is the content of the work itself.
Psychiatry has gotten very good at writing prescriptions and very bad at the conversation that figures out if you even need one.
We think both halves of the job matter, and we think a lot of the people who walk in needing a prescription actually need a conversation first. Sometimes the conversation is actually the answer. Not drugs. The Naming Method is mostly just calling the thing what it actually is, out loud, with someone who isn't going to let you bullshit yourself about it, and a clinician who isn't allowed to spend more than fifteen minutes with you can't help you do that. We can, so we do.
The shortest version of all of this is that the work we wanted to do didn't exist in the form we wanted to do it, so we built it. The four letters are what keep us from sliding back into the thing we left.
Our four letters
G
Grounded
Grounded just means we follow what actually holds up when you look at it, and if it doesn't pass the bullshit test we scrap it, doesn't matter how established it's supposed to be.
R
Responsibility
We bring the full hour and we expect you to bring yours, because nothing moves until you actually decide to move it.
I
Integrity
We're not putting on a show, we're not perfect, and we don't pretend to be, we just do the inconvenient thing when it comes up and stand by it.
T
Truth
We say the thing nobody else will say, because if we don't name it, it just sits there getting bigger.
G · Grounded
Whatever works.
This isn't some professional standard we hang on the wall, it's just about seeing the world the way it actually is instead of the way somebody told you it's supposed to be. We go with what holds up when you actually look at it, and we trust what we can see and what our own bodies are telling us over whatever the conventional (but dusty) or trendy (but thoughtless) story happens to be at the moment.
Most people do what they're told because it's easier than asking whether it actually works, and we just don't care about easy if it doesn't move anything. If something doesn't pass the bullshit test, we scrap it, and we don't care how "established" it's considered to be.
R · Responsibility
You're holding the pen.
Nothing moves until you actually decide to move it, and owning that's the whole game, we run our own lives the same way. We own our work and our limits, and we don't make excuses about either one.
Victimhood framing is a dead end, and we're not going to pretend otherwise. You're steering, so grab the wheel or don't, but the car goes where you point it. We'll show up, but you're still the one driving. You're the one holding the pen, so use it.
I · Integrity
Doing what's right, even when it costs.
We don't make a big deal about integrity, we just do the inconvenient thing when it comes up and don't bend the truth to make people comfortable.
A lot of medicine is obsessed with optics and looking the part, and we aren't, full stop. We care about credibility because this isn't a performance, it's personal. We do the hard thing because the easy thing doesn't actually work.
T · Truth
We say the thing no one else will.
We don't tiptoe, not with each other and not with you. We'll say the part you've been hoping nobody notices, because not naming it doesn't make it go away.
We call each other out when something is off, because softening it just means the problem sits there longer. A lot of people think being nice means lying a little to protect somebody's feelings, and that's just screwing them over on a delay.
What this looks like when the door closes.
Here's what it actually looks like when the door closes and it's just you and the clinician. If a follow-up doesn't need to happen, we cancel it. If the medication is working and your life is good and there's nothing to adjust, we're not going to invent a reason to bring you back in monthly so we can bill another visit. Stable patients stretch out to whatever interval makes sense for the medication and for the situation, which sometimes is every three months and sometimes is every six. We'll level with you on the right frequency, and the answer isn't always "come in more."
If we don't think meds are the answer, we say so. That's awkward sometimes, especially when someone has walked in already convinced that a prescription is the fix, but pretending to agree and writing the script anyway isn't respect, it's laziness. Sometimes the right move is sleep and a hard look at the drinking. Sometimes it's therapy and not medication. Sometimes it's grief, not depression, and the only thing that helps grief is time and people. Telling the truth about that's the job, even when telling the truth costs us the visit.
Honesty in both chairs
- We won't cover for the dodgeDaily benzos nobody has tapered, daily cannabis as the only thing keeping anxiety down, daily drinking that's now the requirement. None of those get a free pass just because they're common.
- No shock, no lectureWe're not going to perform shock about it, and we're not going to lecture, but we're not going to pretend it's fine when it isn't fine.
- We change course out loudIf a medication change isn't going well, we say it and we change course. We would rather hear "this isn't working" at week three than have you ghost the next appointment.
Not the right room if
- You want a pill millWe'll prescribe a controlled substance when it's the right call, and we're not going to make you feel like a criminal for asking. What we won't do is hand them out just because you asked, that's a pill mill, not us. Benzos are the one we genuinely push back on, we think they're overprescribed and we rarely start one, so we're not adding another without a real reason and a plan to taper off what you're already taking.
- You want a rubber stampThis isn't the place to come if what you want is a clinician who will sign whatever you ask and not say anything inconvenient. There are practices that do that. We're not one of them.
- You want it done for youWe'll give you the framework, the medication, the reading list, and the next concrete step, and then we expect you to actually do it before we see you again.
Who we attract, and who we don't.
Most of the people who end up in our chairs aren't looking for a five-minute med check, they're looking for a real conversation with a clinician who's going to remember them next time and is going to push them when pushing them is what the situation calls for. Most of the people who end up in our chairs are mid-career, maybe managing a team or a family or both, the kind of person who has read enough to be skeptical of the cleaner stories and who would rather have it explained in plain language than dressed up in clinical vocabulary they don't need. If that's you, we'll probably get along.
Nobody can do that part for you, no matter how much they want to. If you want someone to push you, we're it, and if you want someone who's going to leave you alone and just refill the script forever, that isn't what we built this for.
If that sounds annoying, we're probably not your people, and that's fine, but if it sounds like what you've been looking for, drop us a line.
