Therapists Archives - Ascent Psychiatry https://ascent-psychiatry.com/category/therapists/ Concierge Psychiatry Services Wed, 05 Aug 2026 17:55:57 +0000 en-US hourly 1 https://wordpress.org/?v=7.0.6 https://ascent-psychiatry.com/wp-content/uploads/2025/12/favicon.svg Therapists Archives - Ascent Psychiatry https://ascent-psychiatry.com/category/therapists/ 32 32 The Two-Month Wait: What Psychiatric Referral Delays Cost Your Clients https://ascent-psychiatry.com/psychiatric-appointment-delays-usa/ Wed, 05 Aug 2026 17:38:44 +0000 https://ascent-psychiatry.com/?p=1813 There is a moment in therapy when a client says yes — yes to the evaluation, yes to getting more help, yes to the thing they have been resisting for months. Every therapist knows that moment. And every therapist in Pennsylvania knows what too often happens next: the yes goes on a waitlist.

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The Numbers Behind the Frustration

In a 2023 mystery-shopper study published in General Hospital Psychiatry, researchers called 948 psychiatrists across five states posing as new patients. Fewer than one in five — 18.5% — were available to see a new patient at all. The most common reason was the simplest one: the practice was not taking new patients, full stop. For callers who did find an open door, the median wait was 67 days for an in-person appointment and 43 days for telepsychiatry.¹

For context, the average wait for a new-patient appointment across other medical specialties is 26 days.² Psychiatry is not a little slower than the rest of medicine. It is two and a half times slower — for conditions where motivation itself is a symptom.

What the Gap Actually Costs

  • Readiness decays. The client who said yes in your office was at a motivational peak. Ambivalence reasserts itself within weeks — especially in the avoidant, the anxious, and the executively challenged, which is to say, the clients who most needed the referral.
  • Symptoms compound. Two months of untreated escalation can mean a lost semester, a job in jeopardy, a marriage further eroded — outcomes a timely evaluation existed to prevent.
  • The therapy stalls with them. You spend sessions managing the holding pattern instead of doing the work. The treatment plan is hostage to someone else’s calendar.
  • Trust takes the hit. You recommended this. When the system fails to deliver it, some of that failure lands — unfairly but inevitably — on the recommendation, and on you.

What to Tell Clients While They Wait — and How to Shorten It

“The wait you’ve heard about is real, but it’s not universal. Practices differ enormously in how fast they can see you. Before we accept a two-month timeline, let me point you to options that can move within days — because the version of you that’s ready today is the one I want in that first appointment.”

— Sample language for the client staring down a waitlist

Practically, the levers are: prefer telepsychiatry, where median waits run weeks shorter¹; call promptly while motivation is high rather than “sometime this month”; and know, before you need it, which practices in your referral network can actually move. The last one is the difference between a referral that happens and one that evaporates.

The Ascent Answer to the Two-Month Wait

Ascent Psychiatry was built specifically to close this gap. Referred clients speak with a dedicated Care Navigator who handles scheduling, paperwork, and records, and the first appointment — extended, unhurried, with a physician who has more than twenty years of experience — happens within a week. Statewide, via telehealth, anywhere in Pennsylvania. The moment your client says yes is the moment we are designed for.

Referring Is Simple

Have your client call (215) 876-5015 or email info@ascent-psychiatry.com and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.

 

Sources

  1. Sun CF, Correll CU, Trestman RL, et al. Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US. General Hospital Psychiatry. 2023;84:12–17. Mystery-shopper study of 948 psychiatrists in five states: 18.5% available to see new patients; median wait 67.0 days in person vs. 43.0 days telepsychiatry; most frequent reason for unavailability was not taking new patients (53.9%).
  2. AMN Healthcare / Merritt Hawkins. 2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. Average of 26.0 days to schedule a new-patient physician appointment across 1,034 physician offices in 15 major U.S. metro areas.
    Ascent Psychiatry provides personalized, accessible, compassionate psychiatric care across Pennsylvania, with first appointments within a week.

Integrative Psychiatric Care at Ascent Psychiatry

Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.

The post The Two-Month Wait: What Psychiatric Referral Delays Cost Your Clients appeared first on Ascent Psychiatry.

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Adult ADHD or Anxiety? Untangling Overlapping Symptoms in Your Clients https://ascent-psychiatry.com/adult-adhd-or-anxiety/ Thu, 30 Jul 2026 11:03:04 +0000 https://ascent-psychiatry.com/?p=1798 A client presents with restlessness, poor concentration, disrupted sleep, and a mind that will not stay where they put it. That cluster fits generalized anxiety. It also fits adult ADHD. And — more often than either textbook would suggest — it fits both at once. Getting this differential right matters, because the treatments diverge and the wrong frame can cost a client years.

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Why the Two Get Tangled

Both conditions produce inattention, but by different routes. Anxiety hijacks attention: the client cannot concentrate because their cognitive bandwidth is consumed by worry, threat-scanning, and rehearsal. ADHD fails to deploy attention: the client cannot concentrate because the regulation system itself is inconsistent — including when they are calm, including for things they care about. The downstream behavior looks identical in a fifty-minute session. The history rarely does.

And frequently the question is not either/or. In the National Comorbidity Survey Replication, nearly half of adults with ADHD also met criteria for an anxiety disorder.¹ Some of that anxiety is independent. Some of it is secondary — the accumulated dread of a life spent missing deadlines, losing keys, and disappointing people for reasons the client could never quite name. Treat only the anxiety in those clients and you are bailing water without patching the hull.

Questions That Sharpen the Differential

  • Timeline. “Tell me about fourth grade.” ADHD is neurodevelopmental; the trail runs back to childhood, even when it was never named. Anxiety more often has an onset, a context, a before-and-after.
  • Attention in calm waters. “When you’re relaxed and reading something you chose — what happens?” The anxious client can often sink in; the ADHD client drifts even on vacation.
  • The flavor of restlessness. Anxious restlessness is driven by dread and quiets when the threat resolves. ADHD restlessness is constitutional — it is there on good days too.
  • What worry is doing. Anxious clients worry ahead of events; ADHD clients are more often ambushed by them. “I knew it was due and couldn’t make myself start” is a different sentence from “I couldn’t stop thinking about it going wrong.”
  • Response to structure. External scaffolding, like deadlines, body-doubling, accountability, often transforms ADHD performance. It soothes anxiety much less.

Raising the Possibility With a Client

“Some of what we’ve been calling anxiety might have a second layer underneath it. The way you describe your attention — even on calm days, even for things you love — makes me want a proper evaluation, because if there’s an attention piece, treating it could make everything else we’re doing easier.”

— Sample framing when ADHD may be hiding under an anxiety presentation

Self-report screeners and a strong clinical hunch are a starting point, not an answer. A thorough psychiatric evaluation takes the developmental history, rules out mimics — thyroid disease, sleep disorders, substance effects, trauma — and sequences treatment when both conditions are present. That sequencing is where expertise earns its keep: stimulants started in an untreated panic disorder can pour fuel on it, while SSRIs alone in an unrecognized ADHD picture treat half the problem and get half the credit.

This differential is the daily work of Dr. Modan’s practice. With fellowship training in child and adolescent psychiatry — where ADHD assessment is core curriculum — and more than twenty years of clinical experience across the lifespan, he evaluates the whole picture rather than the loudest symptom. Appointments are long enough to take a real history, because this particular question cannot be answered in fifteen minutes.

Referring Is Simple

Have your client call (215) 876-5015 or email info@ascent-psychiatry.com and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.

Integrative Psychiatric Care at Ascent Psychiatry

Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.

The post Adult ADHD or Anxiety? Untangling Overlapping Symptoms in Your Clients appeared first on Ascent Psychiatry.

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What Collaborative Care Should Actually Look Like Between Therapist and Psychiatrist https://ascent-psychiatry.com/therapist-and-psychiatrist/ Sun, 12 Jul 2026 19:41:51 +0000 https://ascent-psychiatry.com/?p=1788 Ask a room of therapists about their experiences coordinating with psychiatrists and you will hear the same story in different keys: the referral disappears into a void, the medication list changes without warning, and the only update arrives months later — from the client, secondhand, half-remembered. “Collaborative care” is on every practice’s website. It is in very few clients’ charts.

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The frustrating part is that we know coordination works. This post lays out what the evidence shows, what real collaboration looks like in practice, and the questions worth asking any psychiatrist before you send them your clients.

The Evidence: Teams Beat Silos

The best-studied model is collaborative care for depression in primary care. In the IMPACT randomized trial — 1,801 patients across 18 clinics — team-based care, in which a psychiatrist, care manager, and treating clinician actually communicated about shared patients, produced a response rate of roughly 45% at twelve months. Usual care produced 19%.¹ Same patients, same medications available, same evidence base. The difference was the structure: someone owned the follow-up, and the clinicians talked to each other.

Therapy-psychiatry collaboration is a different setting, but the mechanism transfers: shared patients do better when their clinicians operate as a team rather than as two strangers who happen to bill the same person.

What Real Collaboration Looks Like

  • A closed loop after the first visit. With the client’s consent, you should hear that the appointment happened, what the working impression is, and what was started or changed. Silence after a referral is not neutrality; it is a coordination failure.
  • Medication changes you hear about from the psychiatrist, not the client. You are watching the client weekly. If a dose changed, you are the early-warning system for both benefit and side effects — but only if you know.
  • A reachable human. When you observe something concerning — activation, sedation, a mood shift — you need a channel that answers within a day or two, not a portal message into the dark.
  • Respect for role boundaries in both directions. The psychiatrist does not restructure the therapy; you do not adjust the medication. Each of you knows what the other is doing and why.

Questions to Ask Before You Refer

“After my client’s first appointment, what will I receive from you, and when? If I notice a concerning change between their visits, how do I reach you — and how fast do you respond?”

— The two questions that separate real collaborators from websites that say “collaborative”

A psychiatrist who welcomes those questions is one you can work with. A practice that cannot answer them concretely is telling you, politely, that you will be coordinating by carrier pigeon. Given that only 18.5% of psychiatrists are reachable and available for new patients in the first place,² it is worth being selective about the ones who are.

How Ascent Closes the Loop

Collaboration is built into Ascent’s model rather than bolted on. Every referred client has a dedicated Care Navigator who knows who referred them and keeps that channel open. With the client’s consent, you receive an update after the first visit — they were seen, here is the plan, here is how to reach us — and you hear about medication changes from us, not from your client’s best recollection. Dr. Modan’s appointments are longer by design, which means there is time to actually read what you send and incorporate it. Your client stays your client. We are the medication arm of a team you are already leading.

Referring Is Simple

Have your client call (215) 876-5015 or email info@ascent-psychiatry.com and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.

 

Integrative Psychiatric Care at Ascent Psychiatry

Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.

The post What Collaborative Care Should Actually Look Like Between Therapist and Psychiatrist appeared first on Ascent Psychiatry.

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How to Raise the Medication Conversation Without Undermining the Therapy https://ascent-psychiatry.com/medication-conversation/ Thu, 02 Jul 2026 20:53:44 +0000 https://ascent-psychiatry.com/?p=1770 You have decided a psychiatric evaluation makes clinical sense. Now comes the harder part: saying it out loud. Raised clumsily, the suggestion can read as a verdict — therapy failed, you failed, here is a pill instead. Raised well, it lands as what it actually is: a way to give the work you are already doing together more room to succeed.

The post How to Raise the Medication Conversation Without Undermining the Therapy appeared first on Ascent Psychiatry.

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This post offers language that works, language that backfires, and a way to handle the most common objections without turning the session into a debate.

Why the Framing Matters More Than the Facts

Clients rarely object to medication on the evidence. They object to what they believe a referral means about them: that they are broken, that their effort did not count, that their therapist is giving up on them. If the framing does not address those meanings directly, no amount of outcome data will move the conversation. Three frames consistently keep the therapy central:

  • Information, not commitment. An evaluation is a conversation with a physician — an hour of expert input on a question you and your client have been circling for months. The client decides nothing today except whether they want more information.
  • Augmentation, not replacement. The evidence backs this framing literally. In the NIMH MTA study, combined treatment doubled the success rate of behavioral treatment alone — 68% versus 34%.¹ Medication did not replace the behavioral work; it made the behavioral work land.
  • Team, not handoff. The single most reassuring sentence you can say is some version of: “I am not going anywhere.” Clients fear losing you more than they fear the appointment.

Language That Works

“You’ve been doing real work in here, and I want to be honest with you about what I’m seeing. Your symptoms are working against you harder than skills alone can fix right now. I’d like a physician’s eyes on this — not instead of what we’re doing, but in support of it. Would you be open to one conversation?”

— Sample framing for the referral conversation

Notice what the framing does: it credits the client’s effort first, names the observation without judgment, positions the evaluation as serving the shared goal, and ends with a small, reversible ask. One conversation. Not a diagnosis, not a prescription, not a new identity.

Language That Backfires

  • “I think you need medication.” Too conclusive. It does the psychiatrist’s job in advance and gives the client a verdict to resist rather than a question to consider.
  • “There’s nothing more I can do for you.” Even when meant humbly, this reads as abandonment — and makes the referral feel like a discharge.
  • “It’s just a chemical imbalance.” Oversimplified, increasingly contested, and it strips the client of agency. You do not need a mechanism story to justify a consultation.

Handling the Common Objections

  • “Medication will change who I am.” Acknowledge the fear, then reframe what change means: untreated symptoms are already changing who they get to be. The goal of treatment is more access to themselves, not less.
  • “If I take medication, it means therapy didn’t work.” Point gently at the evidence: combined treatment outperforms either alone in the conditions you most often refer for.¹ Two tools beat one tool. Nobody concludes a carpenter failed because they picked up a second tool.
  • “I’ll think about it.” Take yes for an answer — and reduce friction. This is where the practical barrier matters: nationally, the median wait for an in-person psychiatric appointment is 67 days, and fewer than one in five psychiatrists are taking new patients at all.³ A client who agrees in March and is seen in June often is not a client who is seen at all. If you refer to a practice that can move within a week, the window of willingness stays open.

How Ascent Helps the Conversation Land

When you refer to Ascent Psychiatry, the path you describe to your client is short and concrete: they call, a dedicated Care Navigator handles all the logistics, and their first appointment — an extended one, with a physician who has more than twenty years of experience — happens within a week. With your client’s consent, you hear back after the visit. The frame you offered in session — information, augmentation, team — turns out to be exactly how the process feels.

Referring Is Simple

Have your client call (215) 876-5015 or email info@ascent-psychiatry.com and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first, about a specific client or just to know who you are referring to, we are glad to set up a brief introduction call.

 

Integrative Psychiatric Care at Ascent Psychiatry

Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.

The post How to Raise the Medication Conversation Without Undermining the Therapy appeared first on Ascent Psychiatry.

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When Therapy Isn’t Enough: Knowing When Your Client May Benefit from a Psychiatric Evaluation https://ascent-psychiatry.com/therapy-plus-medication/ Wed, 17 Jun 2026 10:44:26 +0000 https://ascent-psychiatry.com/?p=1699 You know your clients better than anyone else on their care team. You see them week after week. You know when they are doing the work, showing up, practicing skills, engaging honestly, but something is still in the way. Sometimes that barrier is biology, and no amount of excellent therapy will move it on its own.

The post When Therapy Isn’t Enough: Knowing When Your Client May Benefit from a Psychiatric Evaluation appeared first on Ascent Psychiatry.

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Deciding when to raise a psychiatric referral is one of the harder judgment calls in outpatient practice. Refer too quickly and you risk medicalizing a problem the client could work through. Wait too long and your client spends months white-knuckling symptoms that a thoughtful medication evaluation might have eased. This post offers a practical framework for spotting the signals, raising the conversation, and choosing a psychiatric partner who will support your work rather than complicate it.

Signals That Stalled Progress May Have a Biological Component

No single sign is decisive, but when several of these cluster together, a psychiatric evaluation is worth considering:

  • Skills that won’t deploy. Your client can describe their coping strategies perfectly in session but cannot access them in the moment. When baseline anxiety is high enough, the physiological alarm overrides everything you have built together. Medication can lower that floor so the skills finally have room to work.
  • Attention symptoms interfering with the therapy itself. The client loses the thread mid-session, forgets homework not from avoidance but from genuine working-memory failure, or has a lifelong pattern of starting strong and trailing off — in jobs, relationships, and now in treatment. With roughly 4.4% of adults meeting criteria for ADHD and most cases going untreated,³ ADHD quietly undermines therapy more often than it gets credit for.
  • Vegetative symptoms. Persistent sleep disruption, appetite change, or a fatigue that rest does not touch. These respond unevenly to psychological intervention alone.
  • A true plateau despite a strong alliance. Good rapport, good adherence, an approach that fits the presentation — and yet the symptom severity has not budged in months. That pattern deserves a second set of eyes.
  • Family history. A first-degree relative who responded well to medication raises the likelihood your client will too.

Raising It Without Undermining the Work

Many clients hear “maybe you should see a psychiatrist” as “therapy failed” or, worse, “you failed.” The framing that works best positions medication as something that serves the therapy, not something that replaces it:

Key distinction: “You’ve been working hard, and I can see it. I’m wondering if your anxiety is sitting at a level where it’s hard for any of this to stick. An evaluation wouldn’t change what we’re doing — it might just make what we’re doing work better.”

— Sample framing for the referral conversation

Two points tend to land well. First, an evaluation is information, not a commitment — the client is agreeing to a conversation with a physician, nothing more. Second, the evidence supports the team approach. In the landmark NIMH MTA study of childhood ADHD, 68% of children receiving combined treatment were rated as successfully treated at the end of the 14-month trial, versus 34% with behavioral treatment alone.⁴ In anxiety disorders, the evidence varies by diagnosis, but when physiological arousal is high enough to block exposure-based work, reducing it pharmacologically is often what lets the therapy succeed. A referral is not a handoff. You remain the anchor of their care.

What to Expect from a Good Psychiatric Partner

Every therapist in Pennsylvania has lived the frustrating version of this story: you make the referral, and your client joins a months-long queue. In a 2023 mystery-shopper study that called 948 psychiatrists posing as new patients, fewer than one in five were available to see a new patient, and the median wait for an in-person appointment was 67 days¹ — more than double the 26-day average for new-patient appointments across other medical specialties.² Momentum dies in that gap, and some clients never go at all.

If that has made you hesitant to refer at all, the bar you should hold a psychiatric practice to is simple:

  • Fast access. A referral made at the moment of readiness should be seen within days, not months. Readiness is perishable.
  • Real appointments. Long enough to take a genuine history — not a fifteen-minute medication check with a stranger.
  • Communication back to you. With the client’s consent, you should know the patient was seen, what the plan is, and how to coordinate. You should never have to chase a psychiatrist for an update.
  • Respect for the therapy. A psychiatrist who tells your client they can stop therapy because the medication is working does not understand the evidence — or your role.

How Ascent Works with Referring Therapists

Ascent Psychiatry was built around exactly these frustrations. When you refer a client to us, they speak with a dedicated Care Navigator who handles every piece of logistics — scheduling, paperwork, testing, follow-up — and their first appointment happens within a week. Appointments are longer by design, because people are much more than a diagnosis, and a treatment plan should be built around a person’s life, values, and priorities.

Dr. Modan brings more than twenty years of clinical experience, with fellowship training in child and adolescent psychiatry at Dartmouth and addiction psychiatry training at NYU. We treat children, adolescents, and adults across Pennsylvania via telehealth, with particular depth in ADHD and anxiety — the two presentations most likely to be sitting, partially hidden, in a therapy caseload.

And we close the loop. With your client’s consent, you will hear from us after the first visit: they were seen, here is the plan, here is how to reach us. Your client stays your client. We are simply the medication arm of a team you are already leading.

Referring Is Simple

Have your client call (215) 876-5015 or email info@ascent-psychiatry.com and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.

Integrative Psychiatric Care at Ascent Psychiatry

Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.

The post When Therapy Isn’t Enough: Knowing When Your Client May Benefit from a Psychiatric Evaluation appeared first on Ascent Psychiatry.

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