What Is Thoughtful Psychiatry?

Most psychiatric care is built around speed. In large systems, clinicians are expected to see four or more patients per hour. Evaluations run twenty minutes. Treatment plans emerge quickly, from symptom checklists, and are adjusted at brief follow-ups.

That model works for some patients. For many, it doesn't — particularly when presentations are complex, when previous treatment hasn't helped, or when something in the clinical picture doesn't fit the obvious diagnosis.

North Star was built on a different premise: that psychiatric care done well requires time, and that time changes what's possible.

How we work

Initial consultations last an hour. For children and adolescents, we typically meet over two hours — separately with parents and with the child. We don't begin with an agenda. We begin by listening.

With permission, we reach out to therapists, pediatricians, and family members. These conversations surface things no intake form captures. We remain in communication with other providers throughout care, not just at the start.

We don't rush to diagnosis or treatment. We hold uncertainty when the picture isn't clear. When we recommend medication, we explain what to expect, address concerns directly, and make clear that patients retain the ability to stop at any point, with our support. Treatment is a choice, not a conclusion.

We also refer out when we're not the right fit — and we consider that part of the work, not a failure of it.

"People don't come to therapy to optimize themselves or build resilience. They come because they're in pain."

— Brandon Gimbel, M.D., The Hard Work of Healing

Why private pay

Operating outside of insurance allows us to see fewer patients, spend more time with each one, and make clinical decisions without external pressure on how care should proceed. It removes a structural constraint that shapes care in ways most patients never see: the incentive to hold patients, to bill visits at minimum viable length, to treat what's reimbursable rather than what's present.

Private pay is not for everyone. For those it fits, it changes the conditions under which care happens.

The writing

The books and conversations below reflect how this practice thinks — not as marketing, but as an extension of the clinical work itself.

Staying in the Work traces what psychiatric care actually looks like over time: mistakes, repair, the decision to stay present when things don't resolve quickly. The Hard Work of Healing brings together therapists, clergy, and mindfulness teachers reflecting on what healing requires across different disciplines. Just Right Here extends that thinking to children — through stories about presence, boundaries, and quiet connection.

If this approach resonates, here's how to begin.