Psychiatry, Medication & Trust — Integrative Psychiatry in Calabasas

[00:00:00] Hi everyone. My name's Jess, and this is Adelina. Welcome to the Engage Podcast. Look for the helpers. Today we met with Dr. Rob Fey. He's our medical director at Engage. He also has his own practice in Calabasas, California. Today's episode talks about misconceptions with medication and medication management, medication with trauma, and a little bit about Rob's background and how he became educated in Buddhism and how he integrates that into his practice.

Yeah, he has a really integrative approach to psychiatric medication and supporting his clients. So listen in and we hope you enjoy the episode, and I think we as mental health professionals, um, align with how we think we can help people. But oftentimes we don't take into consideration how patients think they, we can help with.

We can help them. I realized in college that there were, was sort of a parallel approach where if I looked at Buddhism. It was almost like this ancient form of neuroscience, so I kind of became interested in that. And then [00:01:00] that was a launching pad for, um, just getting involved in other, uh, things like meditation and yoga, and breathing.

Welcome to look for the Helpers, a podcast by Engage Therapy in Agora Hills, California, hosted by Adelina Brisboy Licensed Marriage and Family Therapist and her husband, Dr. Blake Brisboy. Licensed psychologist. Thanks for being here. Hi, Ralph. Welcome. Hi. Thank you. I'm so glad you're here with us. So Jess and I, um, are excited to chat with you and.

Share with our audience all the awesome knowledge that we get to, um, borrow from you all the time. And just to kind of set the tone about this podcast, um, you know, we wanted to invite people on that we all normally talk to and, and learn so much from, and just wanted to share it with the rest of the world because, um, we feel like we're surrounded by really amazing [00:02:00] professionals and clinicians and actually not just clinicians.

In fact, just people who we've identified as helpers and the name of our podcast look for the helpers. It comes from our inspiration, which is Fred Rogers who talks about, um, in the face of a crisis. His mom used to tell him to look for the helpers. And we think that's really a great way to think about things that happen.

Unfortunately, there's a lot of challenge that happens in our world and it gives not just kids some hope, but actually adults as well. To remember that there's always people that are there to help get kid, get the community out of crisis anyway, so, um, the work that you do has helped us a lot in the work that we've done with our clients to get people out of crisis, but also just to maintain.

So we want you to share a little bit more about who you are, but why we wanted you to be on this podcast is 'cause we feel like you are a really unique [00:03:00] psychiatrist and have felt that way since we met you, which is that you really take the time to explain, not just to your patients, but to us, about why things are the way they are, how they work, and you know, when we ask you a question.

You don't just give us an answer, you actually make us think. And you usually ask us questions, which is how we learn. And I think it's what makes your patients feel so taken care of. So thank you for the work you do in general for us, and I'll let, I'll, I'll let Jess and you kind of share a little bit more about our experience together and then we can learn more about you.

Thank you. Yeah, and I just wanna reciprocate that the honors mind to be able to work with. Engage and you, and to be part of the team has been invaluable for me, so, and it's made me a better psychiatrist as well. How long has it been? I think it's been about four or five years maybe. It's been a little time.

Gosh, it has to be longer. 'cause when I met you I was working in [00:04:00] admissions and that's been like well over seven years. Wow. Yeah, because you had just moved here when you started like. Working with us in different ways. Right. Maybe not in the role you are now. Definitely about seven years. Yeah. But definitely you had just come into town, I think.

Yes, and I was working in admissions and yeah, I still remember that. Like you were just such a different psychiatrist than anything we've worked with before. Yeah. Yeah. Maybe I showed up in shorts or something. Probably. Yeah. Yeah. With a baseball hat and, yeah. Which is part of what's refreshing about you is that you're a human being.

Absolutely. First and foremost. Um, so yeah. Um, I really like that title, look for the Helpers because I often ask myself, um, how can I help this person? Um, and I think we as mental health professionals, um, align with how we think we can help people, but oftentimes we don't take into consideration. How patients think they, we can help, but we can help them.

So I think [00:05:00] that if we always keep that in mind, it can broaden our horizons of, you know, how we are as a mental health professional, what we can offer. Um, but yeah. Um, I think for me, what I've noticed is that, um, psychiatry is obviously a lot more than just about prescribing medicines. It's about meeting people where they are.

And upstream of that is. Allowing people to feel safe. Um, because there are a lot of stereotypes and preconceived notions about psychiatrists, and there's a lot of anxiety, a lot of misconceptions and, and fear and, and it's good to have a healthy dose of fear, I think, when you're walking into the office because you're embarking on a journey, you know, and it's, it's, it's no, uh, light matter to, to, you know, just start a medicine, you know, you have to really give it a lot of thought.

So it involves a lot of conversation, a lot of openness and safety. I really appreciate that. 'cause we have a lot of families that come in and you know, their first thing is like, please don't suggest medication. We're not open to [00:06:00] that, which we respect. Um, do you still work with families that are not open to psychiatric medication?

Is there still a way that you can support them in your practice? Yeah, absolutely. I think a lot of how I can support people is just by. Answering questions and being present with them and, um, also not making them feel like I have an agenda, but I'm there for them just to support them. Mm-hmm. And maybe that means referring them to other resources mm-hmm.

That are more appropriate so that they don't feel like they're walking out, um, being tied down to seeing the psychiatrist forever, but maybe that there was something better for them that I had offered them. So I think that's really important as far as establishing trust, really thinking about what's in their best interest.

Right. I agree. I think that's one of the many ways that we align in how we work is that I think even, you know, when we meet a family same, we try to see if we can help them and sometimes we can, and sometimes we're not the best fit. So you're right. Working together. And [00:07:00] that's another reason why we're excited about this podcast is 'cause we are working together all the time with, um, people in our community that are better fits for people sometimes and sometimes it's working together.

Right. Sometimes it's about sending someone to you and saying, okay, we're gonna do our part, but Rob, can you do the psychiatry part? And we communicate. And I think that's so valuable that it doesn't always happen. You know, I'd be surprised that, that sometimes other professional, other professionals are not as open as As we would like.

As we are. As we are. Yeah. Okay. Strive to be. Um. I mean, I wanna go back a little bit. What brought you into psychiatry? Like, what drew you to want to work in that field? Yeah. Um, I think it was my own life experiences growing up in an interesting family. Um, and also partaking in interesting, um, exp uh, uh, having interesting experiences outside of my family.

So. I [00:08:00] had a lot of mental activities growing up. Um, I was involved in tennis and piano. Um, for me, they were high pressure, performative things, and really the outcomes were really determined by my mind, you know, not so much anything else because I was able to put in lots of hours of practice, but not, uh, the, the results were inconsistent actually, and it gave me an appreciation for the value of my own mind.

And so. Given that my mind was so, um, interesting to observe amidst all of these activities growing up, I became interested in neuroscience. Unfortunately, it was the, the real motivation at the time in college was to, to prove myself to the world. Like, Hey, I'm gonna major in neuroscience and, and show everybody just how great I am.

But what I realized in the process of studying it was that, you know, it was a really interesting thing and, um, I learned a lot about myself and science, but then. I realized in college that there were, was sort of a parallel approach where if I looked at Buddhism, it was almost like this ancient form of [00:09:00] neuroscience.

So I kind of became interested in that. And then that was a launching pad for, um, just getting involved in other, uh, things like meditation and yoga and breathing ways that I could find to still my own mind so that I could understand myself better, which has obviously helped me as a psychiatrist because it helps me connect to other people.

So that explains a lot about you. I didn't know this. I'm glad to learn it. Your calmness and, yeah. Yeah. Like the grounded presence that you bring. I didn't realize comes so, so goes so far. Yeah. I mean I think that it's just so important not only for psychiatrists, but for, for all of us to have a way to manage our mind and manage stress and to relax, you know?

'cause we're not taught that in school or at home. So if we can, yeah. Yeah, you can teach me how to relax. Yeah. I'm like, am I feeling relaxed right now? Yeah, maybe I feel more relaxed. How did you look for the helpers growing up? You know, I didn't, [00:10:00] um, you know, and I didn't even realize I needed help. Um, growing up, I, I actually thought everything was okay.

You know, things were so close to my face that I thought that, that I didn't see anything wrong with myself or with anyone else. That was perhaps part of the, part of the problem. So. Um, I only started looking for help, I would say more in college, uh, by way of friends and different friendships initially, and, um, professors, teachers.

But it was only after college that I became really honest with myself and said, okay, I have a lot of anxiety, so, and I'm, I'm not even yet in medical school, so this isn't gonna be a good combo. I need to like somehow manage myself before I embark on this long, hard journey. Um. So I, I started to just really become appreciative of, of different ways of managing mental health, you know, and as I became a psychiatrist going through the different stages, I never lost sight of that fact that there's more to mental health than drugs.

And [00:11:00] so back to your earlier point about how do you work with families? Well, one of them is also to talk about non-medication ways of helping people, which is to have some sort of education. And imparting that to families about what else can you do, you know, whether it's supplements or nutrition or diet or, um, alternative things.

But, you know, I think as psychiatrists we have to use our best judgment about who needs meds and who doesn't. And not everybody needs meds that come, come in wanting meds. And I think that we have to be a little, um, you know, cognizant of, of, of that as well. And knowing what you do, you're connected to multiple treatment programs in different ways.

What draws you to that level of care? Well, I kind of like doing different types of psychiatry. Um, I, like I, I've worked in the emergency room. I don't do that anymore. Um, I, I, there's something about meeting people in a crisis that can be. Healing, you [00:12:00] know, if, if I can be a certain way for them in, in a crisis, I think that can leave a lasting impact in a moment of, you know, true despair.

But, um, I just like meeting people at different stages of their journey. And so I, I work in an outpatient private practice and then I work at Engage with their IOP, with you guys and then at some residential centers as well. Mm-hmm. And it's just a real privilege to, to cut across all these levels of care and see people at different.

Points in time. Yeah. Adelina and I talk a lot about working in an IOP level of care and we're just the first point of hope sometimes in that moment of crisis for families, and there's just something special about giving give, offering some support. Yeah. And I think that people come to us and that sometimes they're very scared and maybe, and I think we hear a lot like nothing works.

Everything. We tried everything. It doesn't work. Medi medication doesn't work. And there's a lot I've learned from you that there's a lot of questions to ask in follow up. Like, you know, when did you take this [00:13:00] medication? How often did you take it? And, and you've helped us discover sometimes, you know.

There's a prescription for a PM and someone's taking it in the AM for example. Mm-hmm. And it's a simple, it seems like a simple little error, but it ends up showing up in our care. Like, you know, someone's falling asleep in program or they, they, they say they don't feel better, they feel worse. And then you're, you kind of help us to realize, well, yeah, they, they're tired.

Mm-hmm. Because they're supposed to be taking this at night. You know, it's things like that that I think are the. The details and the slowing down enough to notice that. Um, and yeah. When people are in crisis, they also come to, to us sometimes from the hospital and sometimes they've been prescribed a lot of things.

To manage that setting that maybe is not applicable for at home and ongoing, um, for management. Exactly. So that's another thing you've helped us a lot to, to help our, our clients to manage. [00:14:00] Yeah. A lot of people don't take their meds because of side effects, but you need to ask the right questions to really elicit those side effects.

And a lot of patients aren't even aware of what the side effects are, so they're not even aware of. Really why they're discontinuing the medicine. Other than that, they, they don't feel well. Mm-hmm. So we have to really ask a lot of questions about their aversion to, to staying on meds, which can be justified if they're not feeling well in certain way.

And there's a tricky thing, which is sometimes it takes a while for a med to like kick in. Mm-hmm. And right. Sometimes there's the side effects that start at the beginning but then dissipate after some time. So all of that education. I think helps people feel more comfortable. Absolutely. And I really appreciate what you said.

'cause I agree that it's a kind of a serious matter to be putting a medication into your body, whether it's a new one or not. Mm-hmm. So I think that alone really makes people feel respected when they feel like, okay, my psychiatrist respects the fact that this is my body and you know, [00:15:00] we're gonna be cautious about it.

Absolutely. Working with adolescents, something that we do at Engage is we treat the whole family. It's not just the adolescent coming in, doing the therapy and then going home and just being better. We incorporate family therapy, parent groups. You know, assessments with the parents as well. How do you involve the parents into this process?

Or do you just meet with the teen? Yeah. You know, I typically work with people who are not younger than 16 or 17. Mm-hmm. So of the 16 to 80 year olds I work with. I would say the vast majority, the per greatest percentage are above 18, in which, um, clients will either sign a release, allowing me to talk with their families or not.

So if they don't allow me to talk to their families, sure, then I'm not talking to the families. But if they do want me to talk to families, it's just simply taking the extra time to, um, answer their questions. And, you know, oftentimes, um, I think they just want to. [00:16:00] Uh, feel heard and have an understanding of, of my thought process and make sure that I know that they know that I have their best interests for their child.

You know? And so it's really just, again, a matter of trust. Mm-hmm. Listening to them and, and making them feel heard. So that's the biggest thing. And I can't do what you guys do, so. I am so grateful to have you in the background as a means to provide that comprehensive support to families because, um, what's clear to me is that you care so much, care deeply.

Um, we've talked about this over and over again about how you differentiate your program from everyone else in the Cujo Valley, probably in Southern California and beyond. But the level of care is really palpable, and that's why we align, right? Because we truly care about people. So I agree. We do. Yeah. I, and I think that, um, the work seems, we do [00:17:00] hard work.

We do a difficult job. We, we see people in, in difficult times, but I think when, when my family or my friends ask me like, how do you do this stuff? You know, you're working with suicidal kids and kids who are really not okay, a young adult that are not well. I think that, um, when you do it for that reason, it doesn't feel so draining.

It actually feels really powerful. Mm-hmm. And in a, in a weird way, um, it feels it's, well, it's very fulfilling. I guess that's what it is. And, and. But it, but it only works when you, you are aligned with the, with the other people that are doing it as well, so that the families can feel contained and there's consistency.

I think that's the other piece is that, you know, people come to us and they haven't experienced consistency in the mental health field, and that gets people a little down and a little, um, negative on mental health. Like when I say it did, it didn't work. It's [00:18:00] not working. They're not getting better. We hear that a lot from, from families and from clients actually.

Right? Like young adults. I think sometimes by the time young adults get to us, they're a little, they're a little down on stuff. Like my ther I've, I've been seeing a therapist for 10 years and I still feel this way. But, um, our hope is to be, be a little different. Well, if you think about young adults, they are.

In adulthood, but they are post COVID from being a teen. Yeah, that's true. You know when they were 16 or 17 in 2020. Now they're 22, 23 and they had such a different teen experience than most. So I wonder if that comes up when you meet with them. 'cause I definitely know it comes up in our young adult group just processing, being home, being online for school, and what that did to their mental health.

That's true. Yeah, I think it definitely comes up. I think the broader theme that comes up is like [00:19:00] self-efficacy and self-confidence and self-esteem and feeling capable. Mm-hmm. Um, that's a big thing that I see across the board as being like this common denominator for a lot of mental health troubles, which is not feeling good about one's.

Mm-hmm. Um, and how that ties into COVID, I'm not sure, but I don't think COVID made it any better. Uh, but. Um, but I wanted to touch back on a point of what you said about our work is an expression of who we are. Um, I, I, I think that that's what gives people hope and that's what people can latch onto as far as starting to feel better about themselves, is that there are people there who, whose work and whose mission is to be an expression of that, that, um, hope for them.

And, um, for us it's not about. What can we get from our profession? You know, how much money we make or how much, you know, uh, you know, recognition we have, but it's more about what we can give, right? Mm-hmm. [00:20:00] And I think that's an interesting concept to actually talk about with clients too, because, um, I would imagine that, um, especially for young adults, that in this day and age in social media, it's all about what can I do to make myself appear and look.

In a certain way. Mm-hmm. And I think that's also a big driver. And I think COVID magnified that. Mm-hmm. 'cause when people were home, they were more often to be on their devices. There was less social connections. So they looked to social media as a form of social connection. Yeah. And if they didn't already feel good about themselves, social media might've made them feel worse.

Right. 'cause you compare to what other people are putting out. And we know what people put out on social media is not the whole picture. Mm-hmm. So that's hard. Even as an adult, I think it, it's hard to not compare mm-hmm. To, you know, you're having a bad day and then you see somebody like in Italy on the, on the bridge and you know, and [00:21:00] enjoying a gelato and you're like.

It's just hard. It is hard. And then if you're a developing mind, like you said, and you're may maybe we're isolated during those years that were really important, then it makes it even harder. Mm-hmm. I think any a, I've, I've had this conversation like three times this week about COVID and how I actually think any age.

Was difficult during COVID and we're seeing it, you know, kind of later we can look back. Hindsight's 2020, right? It's easy to look back and be like, well, what if it wa there? We didn't have the pandemic. Would this person be any different? There was a time where I was doing admissions and almost every client when I would ask, when did your symptoms start?

They said, COVID. And it got me thinking, did their symptoms actually start in COVID O or were, did they notice them in COVID or did they get worse in COV? Because you know, and, and we can't know, and I would ask, but most of the time parents and the kids would say, [00:22:00] huh, I'm not sure. Because how can we know the difference?

I'll say, even for myself. I had a, I had a tough couple of years during COVID, but was it because of COVID or was it because it was a tough couple of years? Or both? We don't know, but it's, yeah. It's definitely a, a time in history that we now can mark as like pre and post. Are we post COVID? I don't know. I feel like I didn't even, good question my experience of it.

I was working in residential Yeah. At the time, and so I. It didn't stop. Like I had this paper that made it okay for me to drive and I would still go to work and we were still having clients come in 'cause they needed residential support. And so my experience of everyone else was they were sheltering, they were getting groceries delivered, they were doing all the things that everyone had to do.

And I was just like still doing my nine to five working with these kids that were really struggling. And so it's so interesting for me to try to [00:23:00] experience and empathize. I mean, I can empathize, but really try to understand because I didn't, yeah, have a, I had a really different experience of it. I remember talking to you and being super jealous.

Like you were driving, you were driving to work, and I remember being like, oh. I miss driving to work. I mean, hindsight's 2020, right? Yeah. So, I don't know, but it was, yeah, it was definitely interesting. I mean, even the clients that we got in residential during that time Yeah. Had a different, you know, precipitating event or, or thing that really made it hard for them to stay safe or, and during that time, I'm curious what you thought, but our experience here was.

Kids wanted to be in higher level of care. Yeah. For the first time ever, they were begging to to come. Yeah. Whereas normally, you know, there was soccer and any excuse to get outta the house. Right. Yeah. So for, for the first time ever, it was the kind of flipped for us where Yeah, because it was the, the connection, the need for connection was so strong.

And we were in person [00:24:00] too, but it was just, you know, it was different for us because everyone was going back home. You guys were more, you know, in a, in a contained environment, they didn't wanna leave. Yeah. They're like, I don't wanna go home and shelter in place and do school and online and not be around peers and not be around like 12 other teens my age.

Mm-hmm. I don't wanna do that. I wanna stay. Yeah. Which was kind of such a different experience than typical. You know, just, I was just thinking, I'm gonna shift gears a little bit. Yeah. Um, I was just thinking we didn't really like give a background of who you are Oh. And what you've done and how'd you get here?

Yeah. Talked about our childhood, but we don't know who, about my childhood. We kind of skipped the part of like. What, what? Yeah. How'd you get here? Yeah, so let's see. Let's see. So I'll kind of weave in like some factual stuff and maybe some more personal stuff. So, um, yeah, uh, growing up I was, I was, uh, [00:25:00] just, you know, always interested in, I think understanding people.

I found that my role within my family was one of discerning how people are feeling, um, and being aware of that and making sure that. Um, people were okay and, you know, being a helper and not so much a caretaker, but just, um, just, uh, you know, lending an ear. And so, um, I think that combined with, uh, my interest in the mind just led me down a path of psychology.

And so I was actually in college at Amherst College. I was sort of like gonna major in psychology and then, um, the world of physiology and biology, you know. Opened my eyes to, to greater possibilities. And the idea of a psychiatrist was interesting to me and I actually went into medical school, um, believe it or not, knowing I wanted to be a psychiatrist, I think, which is rare.

I don't know how often that happens, but maybe it happens often, I don't know. But, um, part of it was because prior to med school I was [00:26:00] working at MGH, mass General Hospital, doing an internship. And I worked in a bipolar clinic and it was a clinical trials clinic. Um, and I had to learn how to administer the skid and the case a, which are two diagnostic clinical interviews to diagnose people with bipolar and or rule people out as not having bipolar.

And so I remember, um, there was a little 11-year-old kid and he was with his grandmother and he was trying to enroll in this bipolar study, and his whole family wanted him enrolled because he had tried all these bipolar meds, but nothing was helping. And while we were in the waiting room, this little child sadly, was taking her mother's cane and trying to stab her grand, her, sorry, her grandmother's cane trying to stab her grandmother, his grandmother's foot, because he was very angry and kind of dysregulated.

But meanwhile, he, he reflected some remorse in the waiting room, like, sure, I don't know what I'm doing. I dunno why I do this. I really wanna be part of your study. And it [00:27:00] turned out that we had to turn him away. Because it was deemed that he had a different diagnosis and an 11-year-old, um, who was heartbroken in the waiting room.

And it felt like I was a decision maker, even though I really wasn't. But he looked at me as a decision maker and almost as if this fateful opportunity had passed him and that I had failed him. So for me, um, in that moment, working as a research assistant in this. Really amazing institution having failed this little kid and probably changed the tra trajectory of his life.

Not intentionally, but just unwittingly feeling helpless and powerless really made me feel like, okay, if I'm a psychiatrist, whether or not I work with kids, how can I like, um, make these sorts of experiences more powerful in a better way for people? Like, how can I. How can I, um, do the best possible job as a healthcare professional?

Uh, rendering the best possible [00:28:00] diagnostic, you know, treatments, and I guess just really wanting to help people. Mm-hmm. And feeling that that moment, um. Translated in a big way for me. So anyway, I went to medical school, um, was really fascinated by, um, all the different populations I saw. I really enjoyed working with veterans who were overseas, who at a VA hospital.

I went to Yale for residency, um, and I worked at a VA hospital affiliated with Yale. And it was just such a, an amazing experience getting close to those veterans and really understanding their experiences. The way trauma works and, and also seeing how medication interfaces with trauma. Mm-hmm. Looking at how meds failed people and how meds help people.

And then incorporating other things to help people, like alternative treatments. But I've just felt so blessed and honored to be able to be in this position where I can share in the most vulnerable moments with people. And I think you, you would all appreciate that as well. Um, it's been such a gift to, [00:29:00] um.

Yeah, just get to know people, um, make them feel safe and heard and comfortable and, uh, help them leave feeling, um, like their, their connection to mental health treatment is restored mm-hmm. In some way. You know, like, it's like I feel safe, I feel better, I feel like I want to go down a, a path where I can trust people.

Yeah. Right. Things can be better for me. Exactly. Can you tell us more about the time with the veterans and the trauma? And how trauma and medication do or don't sometimes work together. Yeah, it's, it's so tricky and I think that this speaks to the general limitations of meds, but in the Vietnam veterans whom I worked with, unfortunately as residents we would.

Rotate every year. So we would get to know them and it would be heart wrenching for them because eventually we'd have to leave them. And this was the same thing every year. And they're already a little reticent. Sure. They're already really like, you know, not to, um, sometimes [00:30:00] they didn't wanna open up if they knew that someone was gonna leave them.

And so it was always a challenge to try to provide that safety for them. And if you have trauma, that seems kind of counterintuitive. I know it wasn't the best system, but it's the system in residency. Nationwide. But, um, but it was interesting because I inherited a lot of people who were taking benzos like Klonopin or Valium or Ativan every day of their life for the last 20 years or Ambien.

And um, you know, you could see through time maybe how these meds were impacting them cognitively. And so it was kind of this hard thing where how do we help them, um, long term but also not take away what's sort of. Keeping them hanging on by a threat mm-hmm. As well. So that was always a little tricky, but, um, but meds, meds can be helpful.

They can take the edge off that hyper arousal, that, those intrusive thoughts, that hypervigilance. Um, but, but it's just tricky because, uh, [00:31:00] their side effects sometimes and sometimes they stop working. So it's just a journey, you know, we have to kind of have an ongoing conversation about how people are doing.

Meds, is it really, um, dependent on the person? Like, like let's say Jess and I, our body, our composition, we may, maybe we take the same medication, but it metabolizes differently. Yeah. So there are these, um, genetic tests that exist these days that help psychiatrists understand how drugs are metabolized in a very.

Personalized way. And our liver, our livers are all different from one another in that we have, um, a set number of enzymes and some of them are hyperactive or underactive or normal. And there's a variety of combinations of these enzymes and how active they are. And so everyone has like this unique signature that's gotta make it so hard to do your job.

Yeah. You know? How do you do it? I don't even know. Yeah. Um, well, the truth is that there are only a finite list of men. That's that every psychiatrist has access to and the meds either [00:32:00] work or they don't. And you just march down that list. Okay. And you use these genetic tests as a way to kind of further fine tune how you're doing things.

But I would say for me personally, the genetic test is in scripture. It's not the end all be all, um, but it is, sounds like it's just information. Well, it is. Does it help? Like eliminate some so you don't have to go through the whole list? It does. It gives you an idea of what maybe you should steer clear from.

Mm-hmm. But unfortunately, a lot of times people have already tried all the good ones before the test comes. Right. And then the test comes and then we're left with all the ones in the red category. And so we have to try those. And sometimes they work and so it's kind of like, well, was the test worth it anyway?

Mm-hmm. But um. But yeah, it's hard. I've heard that discussion. Sorry. No, go ahead. I've heard that discussion about is the, is the test worth it? Mm-hmm. The genetic test, not everyone does it. Some people don't think it's worth it, but it sounds like you use it as a tool. Yeah. In my experience, I think it depends on the type of person I'm working with.

So if [00:33:00] they personally feel it's important and they put a lot of value in it, and they feel like it's gonna be crucial to their journey, I wanna leverage that. Sure. Because I think that. For that sort of person, it will be important. So I take that seriously. Yeah. I was thinking back to what you were saying when you worked with veterans, how you would only work with them for a short period of time and then you would rotate.

And it kind of relates to what we do in IOP. You know, we're with our clients for like a three month period, more or less, and then we have to have them go off into their individual therapy, who's long term, you now work with clients more long term, right? Mm-hmm. You might see them more and more at the beginning, but do you typically follow them for multiple years?

Um, yeah. It depends. I'm very much open to that. Um, a lot of young adults. You know, go to college outta state. I can't legally see them across state lines, but, but I, I follow them for as long as they wanna follow, be followed. That's nice. I try not to show up at their doorstep pleading that they don't leave me.

You [00:34:00] don't move from state to state as they do? No, no. Well, I have multiple residents for that reason, but, uh, yeah. Uh, you know, I, I work with people for as long as they wanna be worked with. Nice. Yeah. I mean, that's what we try to do, connect our clients to long-term support. Whether it's therapy, psychiatry, community groups, or anything like that.

'cause we're only a short period of time. Yeah. And we know that's what works. Mm-hmm. Is that long-term consistency. It's kind of like working out, right? Like you could get really fit for a marathon or something, but then if you don't keep going it's gone. And I feel like sometimes that's what we are. We're like that intensive.

Piece of the puzzle. And we really want people to maintain it so that they don't have to get to a place again. And it's interesting, you know, I've had some clients where they, they don't actually use my psychiatric services, but they, they, they come to me to almost see intermittently if they need my services.

Oh yeah. It's almost [00:35:00] like checking in. Where do you, what do you think of me, doctor Feely? Like, do I, do I need medicine, do I not? And it, it's sort of like this. Conversation that isn't is fluid and it's, it's not like, um, I'm there, um, saying they have to do something a certain way, but it's more like this honest back and forth, uh, letting them express themselves and, and it's, it's almost like them expressing their anxiety about possibly missing out on an opportunity beyond meds and then getting my opinion about it.

So it's kind of an interesting thing, but I think that speaks to the trust. That you've built with, with people that they wanna come back to, to consult. Like, I trust that you're gonna tell me either direction, what's best for me. Mm-hmm. So I think that's really beautiful. Yeah. They, they know they're tethered to you, so whether they see you frequently or not, they know they can.

And that feels reassuring. You know that rope that the little kids use? Mm-hmm. That's what we have in our office and we all kind of walk out together with the little loops on each of them. That are numbered, that's make sure we have everyone [00:36:00] with us. That's really nice. I'm glad you do that with your young adults.

Right, right. What do you think are, is like the, the most common misconceptions about meds? Because we get a lot of fear and I know for me, culturally growing up and, and even still to this day, a lot of people in my world are like afraid or they're taking medication means like you're. Crazy, something's wrong with you or you're gonna get addicted to it.

Oh, that's the biggest one. Yeah. I don't wanna get addicted, so I'm not gonna take it. And I know I don't have a lot of room to talk 'cause I don't even like taking Advil and I have a headache. So I'm one of those people that's like really stubbornly in this. I don't know, I a little bit of, I guess, fear or some hesitancy about medication and what it does to your body, so, yeah.

Well I think a lot of people, um, see. Uh, the experiences that other people have on meds mm-hmm. Like their friends or their parents and, and, and, and internalize that as thinking that that'll [00:37:00] happen to them. For example, I hear a lot that people will think, well, my, my friend was very nauseous, or they, they got more depressed.

So like, I really don't want to try this. Um, so I think it's really being, um. It's hard for people to be open when they already have these, um, preconceived notions. And so being able to leave that at the door is hard for any of us. Mm-hmm. It's, it's the same thing. Like if you hear that a movie isn't so good and your partner's trying to drag you to that movie, you, you kind of just, you're hesitant.

Yeah. It's like, well, I don't know. I heard it wasn't good. You know, do I really wanna sit for two hours through something? Yeah. Waste my two hours. So the power, that's a really good analogy. Yeah. Yeah. So the power of someone's suggestion. And, and experiences is, uh, hard to shake sometimes. I think the cultural piece is tough, um, because a lot of times the cultural piece, you know, you're born into that and so you're witness to that for many, many years, usually before you show up to a psychiatrist's office.

Mm-hmm. So that, [00:38:00] that is deeply conditioned. Um, the myth that meds are hard to get off of. Yeah, partially true. It depends on the med right? You know, and I think that's where a more nuanced conversation has to be had, which is whi Well, which med are you thinking about? Which meds have you heard are hard to come off of?

Um, you know, it, it's similar to coffee. Um, you know, if coffee is helpful for you and you want to get off of it, you won't feel as good for a period of time. And similarly, if a med makes you feel better and you try to get off of it, maybe you won't feel as good for a period of time, but it doesn't mean you can't not be on a med.

It just means you have to get off of it in the right way. And I think actually quickly just to highlight this, a role of a psychiatrist is also to know how to de-prescribe, right? So it's how do you safely get people off of meds? And we're hearing more and more about that because it's, it's trendy of course, because it's important.

There's been a New York Times article, uh, discussing this idea of, um, you know, how do we, [00:39:00] how do we safely get people off of meds? And, and it's a skill, it's an art. You know, and there can be, um, a lot of people who don't do it, right. Psychiatrists or patients, and then people have a bad experience. Mm-hmm.

And then they tell their friends and those friends and they think they're addicted to their meds. And then it's this whole thing. Right? I think the piece of culture, I mean that's a big reason that brought me into this field is just understanding culture and differences, but also similarities across cultures.

And I've seen over time, both personally and professionally now. How it's changing. It is changing a little bit. Um, that I think cultures that were not very open are maybe a little bit more open. What do you think? Yeah, well, um, you know, actually, and the generations, I feel like the new gener absolutely.

Well, I think there's more awareness around it through social. And, um, you know, there's no, yeah, I, I, I just think there are a new set of stressors with this generation that maybe weren't [00:40:00] present with the last generation that are being magnified by social media. And I think it's all coming to a head, especially in our younger population where there are a lot, you know, there's just a lot more, I think, anxiety because there's a lot more self preoccupation.

Mm-hmm. And I think that that is stressful. You know, through social media. So parents are sort of like wondering how to handle this. And I think also how to, how to navigate the balance of how much time kids can spend on social media and what kids are allowed to do on their own in this dangerous age creates this really complicated parent child interaction where there can be like this heightened sense of control from the parent.

Point of view, and then the child feeling like this lack of autonomy and it creating more stress in the family. You know, it's not like the 1970s or eighties where you could ride your bike down the street and not really worry. You know, I live in a community that's very safe. My [00:41:00] 11-year-old daughter wants to go out and, and I, I don't want her to, you know, I think she's really young, but, um, she feels strongly about it.

So I think that, um, just a lot more stress this day and age more. Interesting situations that are arising for families to think about. So it's true. I dunno how I got into all that. No, it's true. I mean I think about how much informa, like two generations ago, right? No matter about the cultural background.

Two generations ago the information about the medication was different with the medication was maybe even different, right? Like even you mentioned earlier about what other things there are like supplements and you know, lifestyle changes that can, um. Be added to the, I don't know, prescription if you will.

Um, some of those things are ancient and have been around a really long time Yeah. But maybe haven't been used or thought to be used in the way that we're using them today. Yeah. And I think there's maybe less fear because people have more access to, you can [00:42:00] look it up. Mm-hmm. You could very easily look up the side effects, whereas maybe one generation ago we really couldn't do that.

You had to go to a doctor to. Find out if it a medication is addictive. Right. For example. So maybe that's contributing and, and these medicines have been around for that much longer. Exactly, yeah. Decades more research hopefully. Right? Yep. And, and I would say more and more people are on medicines and so, so there's more data.

Yeah, more data. And, um, yeah, and, and to your point about holistic things, um, I think that my experience is that. Y you can't deny the, um, importance of certain practices because they've persisted throughout the ages and they seem so, um, evident as being helpful, like looking at your breath, going inwards.

These are things are intuitively, you know, not surprising that they could help you. So I put a [00:43:00] premium on this and one thing I wanted to share, um, that I didn't share about myself was that I actually traveled to India after college and I. I, I was just so interested in, in, in that area of the world as far as, you know, the, the origination of these practices.

And I studied there for a bit and I became a meditation and breath work instructor. Of course. Yes, of course. And, um, I have to say that that's, that's in addition to family, in addition to self-care. I mean, that is, that is, I put a premium on that because if I am not feeling a hundred percent. Nothing else will be a hundred percent.

And some people call it selfish, but, you know, um, but it is, it is, uh, it's really important to have a way to ground yourself every day, you know? Um, it's, we have a lot of bullets coming our way every single day, and if we don't have a way to deflect all of these, these, this aggression that happens around us, it's hard.[00:44:00]

Mm-hmm. So, so how do you do that? Do you have like a morning practice? We have a morning and evening practice. Um, definitely. So that's the experiential part. And then there's this interesting thing where, um, like a Rolodex, when I drive down the highway, I, I go through these certain key points that are also yogically derived.

So they're called, perhaps for a separate podcast. I'll just briefly say that they're called the Yamas and the Niyamas. For anyone who's listening, who has knowledge of these things. There are 10 points in life to get the most out of your life. So these things were delivered thousands of years ago as being the most crucial things to stay grounded and connected to your core, non-aggression towards others and yourself, verbally, behaviorally, or mentally, right?

How we think about ourselves, how we think about others. How we physically treat people, how we physically treat ourselves, how we talk to people. This is a big one for me with my daughter. You know, [00:45:00] sometimes she in the morning getting her ready for school. Do I raise my voice? Do I not raise my voice? Do I get too easily upset?

So really monitoring my speech. Wow. The next one is, truthfully, I love this truthfulness and honesty in relationships. Mm-hmm. Right? And by the way, I'm going into all this because for me, what I feel like is. If we all have a value system, guardrails for how to live our life, life is easier. It's almost like a moral kind of framework.

Mm-hmm. Right. So, and having that I think reduces a lot of anxiety. So if we can control our aggression and we can manage to be truthful and honest in our relationships, and we cannot steal, not just physically, but also. Not taking what's not ours, not being jealous of people trying to bring them down, right?

So non stealing, non-aggression, truthfulness, restraining our senses, right? So if our senses, our five senses go rogue, like with [00:46:00] our phone or with food, or with socializing, guess what? It's taxing to our mind, right? So if we have a way to restrain our senses, not like. In a severe way, but we have control over them.

That's a good thing. And then the fifth one. Fifth one is non accumulation, which means not accumulating insults, not even accumulating praise. So those are called the yamas. So you think about all this when you're driving Yeah. Down the highway. Can you believe it? Yeah. Yeah. You, you also work in addiction, right?

Right. I, that reminds me of like what you wanna instill in people in recovery. Yeah. It's like you're not just trying not to use the thing, it's. Mm-hmm. Are you in recovery with your words and your, and your actions and your behavior? Exactly. And so all of those points, really that's what I connected to, is it's not about just not doing the behavior of using the substance.

Right. So, I mean, I imagine hopefully those are the things that you work with your clients on who are trying to [00:47:00] Absolutely. Work with and, and I say some of these things and they're like, wow, where did this come from? And I'm like, yeah, I know. It's almost like they're so self-evident that you wouldn't even ever think about 'em.

Mm-hmm. Um. I'll just quickly go through the last five. It won't take more than a minute. Yeah, please. But those were the social ethics, meaning don't be aggressive towards people or yourself. Be honest. Don't steal, restrain your senses so you don't get into all sorts of trouble and don't accumulate things from the environment or insults, all that stuff.

Now, the five personal practices that I also go through in a rolodeck, in my mind, very important cleanliness, not just taking a shower, but internally. What's going on, right? We have a box within ourselves and what's happening in that box and, and, um, you know, just being aware of that. Number two is contentment.

Contentment is really hard because if you wipe everything off the table, all your hopes and dreams and fantasies, expectations about the future, and you can be content [00:48:00] with how things are now, who does that? Not many people, right. Thinking about if nothing went my way, starting now in perpetuity, can I be content with who I am?

I know that a lot of the youth can't, right? Mm-hmm. Because as a youth myself, at one point in time, I was so fixated on the next step getting into the college of my choice, or that friend liking me or that thing happening that I wanted to happen, so, so contentment. The next one is willingly enduring challenging situations.

The key is willingly, right? The cool thing is, thousands of years ago they wrote challenging situations that meant that was common to humanity, that they knew that this was just pervasive. So, but willing, right? Willingly stepping into it, being okay with it, knowing that it's gonna happen. The next one is self-examination.

Being honest with yourself, right? And the last one is faith in something. And yoga says [00:49:00] Faith in the divine. But you could say faith, at least in yourself. Right. So putting your faith in something either bigger than yourself or yourself, and knowing that you've got this and you're gonna be okay. So imagine if you worked on these 10 things every day meticulously.

I took a course where I, I learned all these things and there was a survey that said, how meticulously are you doing these things? And before the course, it was a zero out of five. And then after the course I was like, wow, this is so interesting. And so every day I ask myself how meticulous, and of course I fail, but I try not to be aggressive with myself about it.

Do you feel like some days you're more meticulous than others? It depends on my energy. And that's where stress management comes in, right? That's where the practice of relaxing comes in. 'cause if you're stressed out, you're not even gonna think to not be aggressive. You're gonna be like, pick that up. And then like, you know.

Kicked them out the door, you know, so it's, uh, I've never kicked anyone, but, you know, so [00:50:00] figuratively. What are ways that you unwind? I mean, I hear that those are your practices, but are there any other ways that you kind of work through all the Yeah. Energy that you hold? Yeah, so, so you should see me when I come home.

I'm wound up, I'm twisted like this, and then someone, two people get around me and they unwind me. Um. But in all seriousness, um, now obviously that's a big component of it. Um, I find that going on walks are important. Um, I have a beautiful loving family who's extremely important for my wellbeing. Um, my beautiful wife and daughter are just integral for my wellbeing.

Um, I have a very unique, uh, Siberian cat who, um, I'm sure some of you in out there have a Siberian cat maybe, but she is more like a dog than a cat, but she's so. Loyal and loving and emotional. And she even gets overtly depressed if I don't give her Oh, wow. 15 minutes, twice a day of undivided playtime.

She's [00:51:00] probably banking on your energy. Literally. Yeah. Maybe. Maybe, maybe. But, uh, what's her name? Chia Cha. Yeah. Gia. Shout out to Chia. Yeah, shout out to Chia. She's not listening right now, but It's okay. She'll know you talked about her. But it's also outlets like this, you know, being around particular people.

Um, an amazing social community of like-minded people who value the same things that I value. So surrounding yourself with an uplifting group of people is very important for all of us, and I think that's hard to find sometimes. 'cause Good point. I really do like those 10, what would you call 'em, tenants.

Yeah. You could say tenants. Yeah. I like them because they're, they're all very attainable. Yeah. Practical. They're practical and they, you can tell they've been around a really long time and there's something comforting about that for me. Yep. That it's not like new. It's not like this new idea. It's just, it's really ancient.

Yes. And [00:52:00] um, part of what I related to is there was one about just like, that really feels grounding, which is, um, to just. They kind of let things roll off. Mm-hmm. Essentially is, is how I translated it. My, one of my old supervisors used to tell me to imagine like a cloud, you know, like a cloud. Like sometimes when people are mean or jealous or like, you know, treating you badly.

That it could be, um, it could come at you and it could go into you and it can just tear you down and weigh you down. Or you can imagine it like a cloud and it goes through you and to, you know, behind your chair and over to the next thing like a cloud does. Yeah. And that image has really helped me to have a little bit more of that, that you were describing of not holding, accumulating.

That was the one. Yeah. Yeah. Not accumulating the, the bad, if you will, and just letting it kind of go. 'cause. Yeah, life keeps going. I hold like a [00:53:00] rock in my pocket when I'm at work the whole day. Sometimes it's a different item, but it's always an item and then I leave it in the office when I leave and it's, so for me it's like everything is like going into that rather than into me.

I love that. Yeah. I didn't know you'd do that. Yeah. I talk about it with associates and stuff and trainings, but And you leave it at work? Yeah. So it doesn't come home. A stone wall outside. That's why. Yeah. That's why I throw them. It's blame a lot. Yeah. But it's just something that like is tangible that I can imagine everything being in and you leave it there and I just leave it and it stays there and it, it.

It's also like for all of my clients to know that like I'm holding it, but I'm not carrying it around with me. It's good role modeling. Yeah. I love that. I used to have a colleague that would wash her hands before leaving as a figurative like, and I'm leaving everything here and I'm going home to with freshness.

I mean, I think that that's what our therapy rooms like are to our [00:54:00] clients is this space where they put it all in and then they get to leave and they just know it's there. My little clients think I sleep in my office. They're always like, where's your bed? Yeah, because you belong there. Yeah, because that's what they know.

It's a teacher. You know when you're little, I remember running into a teacher outside of school and being like, but you're not in your classroom. That's where you belong. That's, I guess, how it is for us too, especially with the littles. I really appreciate learning more about your learning. Yeah. Because you know, when we're in meetings and we're consulting about a case, we don't get to have this.

Yeah, that's true. This level of conversation and although it shows through Totally. Yeah. Our interactions. Thank you for that qualification. Yeah. None of it is surprising. Agreed, agreed. But like what a pleasure to have the time to like learn more and then to share it hopefully with people that maybe will gain something from it as well.

That's our hope. Yeah. Is that we can for sure. Share the wealth that we get to have. Yeah. This is universal knowledge and it's, [00:55:00] it's a wealth to be distributed to everybody. And sometimes it's interesting to just think a little differently for a minute, you know? And, and when you describe that, I would say it's not so different than what, what I try to do, but it's certainly different in how, um, structured it is and how, like the word meticulous, like I would say I am not meticulous.

It's always stuck with me. That word. Yeah. Yeah. 'cause it, it, it, you know what it is? It shows the dedication to it. I think, and it's probably like with, like, with anything, the consistency mm-hmm. That makes it so powerful. Mm-hmm. Absolutely. When you joked that people see it as, could be seeing it as selfish, but you're not just doing it for you, you're doing it for everyone else.

That's right. So it could also be selfless. That's right. No, that's, that's that's why I'm doing it. Yeah. I wouldn't be doing it otherwise. Yeah. Yeah. It's, it's directly impacting all my family members, all my patients, uh, everyone I interact with. Us. So you guys, a hundred percent. I I haven't thrown my left, my famous left hook yet.

Lisa, [00:56:00] it's your left hook. Yeah. Right. My side. Exactly. It's all me. I mean, no, I, I'll say that, you know, there's been tough times and tough days and your presence does ground me. Mm-hmm. When I, even if we're not talking about what's all the other stuff that's happening, but thank you. I will say that over these years, you know.

My family and engage have gone through stuff. Mm-hmm. And when you come in and you're joining us in a meeting and just you're, the way you say hello and your walk, it, it, it is, it's grounding and it feels safe. So I appreciate it. And well, it's, whenever I walk by the stone wall, it's somehow my walk actually, you're welcome.

Just right before I can You're welcome. But thank you. Yeah. Yeah. Well, thank you. I don't know if you guys have. No more. That was wonderful. Thank you so much. You're very welcome. It's a real pleasure.