What Thoughtful Psychiatry Means: A Better Approach to Mental Health Care
By Brandon Gimbel, M.D.
He came to me because of his relationship with his son.
Conflict, all the time. Distance. He loved his son deeply, but every conversation ended in frustration. Underneath it all, I could feel his grief — and soon, we named something else: shame.
Shame that he was a bad parent. Shame that he couldn’t connect. Shame that something had gone wrong, and he didn’t know how to fix it.
As we continued, I realized something. The core issue wasn’t insight. It wasn’t communication. It was dysregulation — his own.
He didn’t need insight-oriented psychotherapy, at least not right now. He needed DBT.
So I paused. We talked. And I connected him with a colleague.
He’s been doing the work, and the relationship with his son is already shifting.
That’s thoughtful psychiatry: listening closely, slowing down, and being willing to change course — even if it means stepping aside.
Why Thoughtfulness Matters
Psychiatric care often starts with a question: “What’s wrong?”
But thoughtful psychiatry doesn’t stop there. It continues: “What’s really happening here — and what would truly help?”
The problem with much of the medical system is that it incentivizes speed over depth. Psychiatrists, especially in large systems, are often expected to see four or more patients per hour. For some patients, this model may suffice: a clear-cut presentation of depression or anxiety, a fortunate medication match, and symptoms improve.
But what if the presentation isn’t straightforward? What if the response isn’t immediate — or doesn’t come at all?
At North Star, we operate differently. We have the time and space to meet with every patient for at least 25 minutes — often longer. Our initial consultations unfold over hours, not minutes. We listen. We reflect. We float ideas and consider possibilities before we commit to a path.
As in the example above, our recommendations often emerge slowly — not because we’re uncertain, but because we’re careful. Each patient’s story is unique, and the path forward often reveals itself only when we create enough room for it to unfold.
What It Looks Like in Practice
In our initial visits, we meet with patients for an hour. For children and adolescents, we often meet over the course of two hours. And if more time is needed, we take it. We ask questions. We stay attentive. We don’t rely on checklists.
With permission, we reach out to therapists, pediatricians, internists, and family members. These conversations often surface critical insights that no intake form could have captured.
We remain collaborative and curious throughout the process, always offering patients the space to say, “This doesn’t feel right.”
Sometimes, that leads to small course corrections.
Other times, it leads to a more difficult but honest conversation — the recognition that we may not be the right person to help, and the responsibility to act on that.
Thoughtful psychiatry doesn’t mean sticking to a plan.
It means recognizing when the plan needs to change — and having the courage, and humility, to change it.
Another Glimpse into Thoughtful Care
A young woman came to see me after years of struggling with anxiety. She had been working with a fantastic therapist but had hit a ceiling. Her symptoms — especially contamination fears tied to obsessive-compulsive disorder — weren’t letting up. She was exasperated. Hopeless. And scared.
She wasn’t sure about medication. She was afraid of what it might mean — afraid of side effects, afraid that once she started, she’d never be able to stop.
Over time, we explored it all:
The meaning — we talked about self-criticism, and about the possibility of self-compassion.
The side effects — we named them, clearly and without pressure. Knowing what to expect gave her confidence.
And then, most importantly, we talked about autonomy — her ability to stop at any point, with my full support.
She chose to try a low dose.
Slowly, the anxiety began to quiet. The obsessive thoughts became less consuming. The weight on her chest started to lift.
When she returned to therapy, something had shifted. She could go deeper. Engage more fully. And over time, we gently increased the dose as she felt ready.
For her, at this moment in her life, medication helped.
Thoughtful psychiatry didn’t push her toward that decision.
It walked alongside her, until she was ready.
An Open Invitation
Thoughtful psychiatry isn’t a technique. It’s a mindset — and a promise.
It’s the way we work at North Star Behavioral Health.
And if you or someone you care about is looking for thoughtful psychiatric care, we’d be honored to be part of that process.