What Collaborative Psychiatric Care Actually Looks Like.

I use the word collaborative a lot when I talk about the way I practice psychiatry.

But I also realize that “collaborative care” is one of those phrases that sounds lovely on a website…without necessarily telling you what it actually means.

So, let’s talk about it.

To me, collaborative psychiatric care means that I bring my knowledge and experience as a psychiatric provider to the table.

And you bring something equally important:

You.

Your experiences. Your history. Your symptoms. Your concerns. Your goals. The things that have helped before. The things that absolutely haven’t. And all of those little details about yourself that can’t possibly be captured by checking boxes on a questionnaire.

And then we figure out where to go from there.

I Don’t Expect You to Have It All Figured Out

You don’t need to walk into your appointment already knowing exactly what’s wrong.

You don’t need to know whether what you’re experiencing is anxiety, ADHD, depression, burnout, trauma, OCD, or some complicated combination of several different things.

You don’t even need to know exactly what you want me to do about it.

That’s part of why you’re coming to see me.

You can simply tell me what life has been feeling like lately.

Maybe your brain never seems to turn off.

Maybe you’re exhausted but can’t relax.

Maybe you can’t seem to start anything until the pressure becomes unbearable.

Maybe you’ve been told you’re anxious for years, but you’ve always wondered if there’s something else going on.

Maybe you just know that you don’t quite feel like yourself anymore.

Those are the pieces we start with.

I Think of Mental Health a Little Bit Like a Puzzle

I’ve talked about this before, because it’s probably one of the best ways I can describe how I approach psychiatric care.

You bring me your puzzle pieces.

Some of them will fit together pretty quickly.

Others may not make sense yet.

There may even be a few pieces we’ve been trying to put in the wrong place for years.

My job isn’t to take the puzzle away from you and tell you what the finished picture is supposed to look like.

We’re looking at it together.

I’ll ask questions. I’ll look for patterns. I’ll explain what I’m noticing and why I think it matters.

And little by little, we start to understand the bigger picture.

When We Talk About Medication, We’re Actually Going to Talk About It

If I think medication could be helpful, I’m going to tell you why.

Not just:

“You have anxiety. Here’s an antidepressant.”

I want you to understand what I’m seeing, what symptoms we’re trying to target, why I’m considering a particular medication, and what we realistically hope it might change.

We’ll talk about the potential benefits.

We’ll talk about side effects.

We’ll talk about other options when there are other reasonable options.

And I want to know what you think, too.

Maybe you’ve had a terrible experience with a medication in the past.

Maybe there’s a particular side effect you’re really worried about.

Maybe you’ve researched something and want to ask me about it.

Maybe you’re nervous about medication altogether.

Tell me.

Those things are part of the conversation, not an inconvenience to it.

And No, You Don’t Have to Agree With Everything I Suggest

This one is important.

Collaborative care doesn’t mean that I’ll recommend something and you’re expected to politely say yes.

You’re allowed to ask questions.

You’re allowed to be hesitant.

You’re allowed to tell me that you really don’t like an option.

You’re allowed to say, “Can we try something else first?”

And you’re absolutely allowed to tell me when something we’ve tried isn’t working for you.

At the same time, collaboration doesn’t mean that I will prescribe absolutely anything someone asks for.

There may be times when I don’t think a medication is clinically appropriate or when I think the risks outweigh the potential benefits.

When that happens, I’ll explain why.

We may not always land on the exact same answer initially, but you should always understand the reasoning behind my recommendation and feel like you were part of the conversation.

I Want to Know How You’re Actually Doing

At follow-up appointments, I’m certainly going to ask about symptoms.

But I also want to know what those symptoms look like in your real life.

Because “my anxiety is better” can mean a hundred different things.

Are you sleeping instead of lying awake replaying conversations?

Can you walk into the grocery store without feeling completely overwhelmed?

Are you answering emails instead of staring at them for three days?

Can you sit down and watch a movie without your brain simultaneously running through twelve other things?

Are you getting through your workday without feeling like you’ve used every ounce of energy you have?

Are you enjoying things again?

Do you feel more like yourself?

Those are the changes I’m interested in.

We’re not treating a number on a questionnaire.

We’re treating the things that are making your actual life harder.

Sometimes the Answer Isn’t More Medication

Psychiatry obviously involves medication.

But good psychiatric care should still look at the whole person.

Sometimes we need to talk about sleep.

Sometimes therapy is an incredibly important part of the picture.

Sometimes you’ve been functioning in survival mode for so long that your nervous system is simply exhausted.

Sometimes there are boundaries that desperately need to exist.

Sometimes your schedule is completely unsustainable.

Sometimes medication can make an enormous difference.

And sometimes medication can help tremendously while still only being one piece of a much bigger puzzle.

The goal isn’t to medicate every uncomfortable human emotion.

The goal is to understand what’s happening well enough that we can make thoughtful decisions about what might actually help.

We Can Change Our Minds

This is another part of collaborative care that I think deserves to be talked about more.

Not every treatment decision is going to be perfect on the first try.

Sometimes a medication looks like a wonderful option on paper…and your body disagrees.

Sometimes it helps, but not enough.

Sometimes it works beautifully for one symptom and creates a problem somewhere else.

Sometimes we learn more about you over time and realize that we need to look at things a little differently.

That’s okay.

It doesn’t mean treatment failed.

It means we learned something.

We take that new piece of information, put it on the table with everything else we’ve learned about you, and decide what makes sense next.

The Goal Is for You to Feel More Like You

I never want the goal of psychiatric treatment to be making someone quieter, easier, less emotional, less creative, or simply more convenient for everyone around them.

I want to help with the things that are making it harder for you to live the life you want to live.

Maybe that’s the anxiety consuming hours of your day.

Maybe it’s the depression making everything feel heavy.

Maybe it’s the ADHD that turns things you genuinely want to do into seemingly impossible tasks.

Maybe it’s emotional reactivity that keeps creating problems in relationships you care deeply about.

Whatever we’re working on, the goal isn’t to erase your personality.

It’s to help remove some of the things that have been getting in its way.

That’s What Collaboration Looks Like to Me

You don’t come into my office, hand me your symptoms, and wait for me to tell you what to do.

You bring the pieces.

I bring my clinical knowledge.

And we sit down together and start figuring out the picture.

Sometimes I’ll have recommendations.

Sometimes you’ll have questions.

Sometimes we’ll decide to try something.

Sometimes we’ll decide to wait.

And sometimes we’ll try something, learn from it, and change direction.

That’s okay.

Because ultimately, this is your mental health, your life, and your treatment.

My job is to bring knowledge, curiosity, honesty, and thoughtful guidance to the process.

And then we figure it out together.