Dr Wirthlin's Approach

My goals are to build a therapeutic treatment relationship, to provide good care, and to foster personal growth. I believe strongly in patient autonomy. Treatment and life are based on choices. Finding the right provider fit for you is a key to victory. This document attempts to clarify some of my expectations of patients and what I hope you can expect from me.

Positive Relationship

Often arriving at a correct diagnosis and effective treatment is more of an ongoing process than a single event. Our ability to work as a team is critical for success. My goal as your provider is to offer you choices, make recommendations, and explain the risks and benefits; and the pros and cons of various choices. In addition to discussing this with you, I may also refer you to written materials, books and the internet and encourage you to explore these more at length. Even if we disagree on which choice is best, usually we can continue to work together provided there is a plan to monitor outcomes in an ongoing way. If I feel we are not able to build a positive relationship, I will refer you to another provider in hopes of helping you find a good fit for treatment.

Medication Treatments

Woody Hayes, a great former football coach, used to hear complaints from alumni about his boring style of football (i.e. running the ball up the middle or off tackle most plays). To their complaints, he would reply “when you pass the football three things can happen—and two of them are bad”. Similarly, when we try a medication three things can happen – two of them are bad (side effect, no benefit, vs. improvement in symptoms). Be aware that generally when there is symptomatic improvement it is usually not 100%. Substance abuse, i.e. alcohol or illegal drugs, can interact negatively with prescribed medications or overuse of prescribed medications can negatively impact treatment. Medication treatment may involve drug screening.

It is my expectation that we see each other at least once every two months.

Non-Pharmaceutical Treatments

In general, non pharmacological treatments and lifestyle changes should be considered and attempted as a first line of defense (i.e. exercise, journaling, therapy). In other cases, medications can be considered. Medications should be thought of as complimentary interventions (i.e. facilitating non pharmacologic treatments and lifestyle changes).

Generally treatment will involve homework, monitoring symptoms, establishing goals and working towards achieving those goals. I often ask patients to carefully monitor for symptoms, (i.e. sleep, mood, anxiety level, energy level), clinical benefits and side effects. In the past some patients have also found it helpful to work from a workbook—i.e. manual based therapy or bibliotherapy.

Commitment to Treatment

Successful treatment often demands attention, energy, and effort on the part of the patient to change habits and improve behavior. This often can be a “two steps forward, one step back” process, requiring patience and determination. If you cannot commit to treatment and complete my recommendations, then, like practicing the piano for lessons, we may not be able to continue working together.

Contacting Me:

Due to my work schedule, I am not always immediately available by telephone. I will make every effort to return your call promptly (within 24 hours). If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room or dial 911. If you are calling regarding routine, non-urgent matters, you may leave a message on the answering machine. If you will not be carrying your phone with you, please leave numbers where I will be able to reach you when I return your call.

If I will be out of office for an extended period of time, I will carry my phone with me for urgent matters. You may contact me by phone, or if you have an emergency, you should call 911 or go to the nearest emergency room.

Emergencies:

There are very few cases in which people can be forced into treatment in the State of Washington and generally these cases are not under the aegis of medical doctors but rather under the authority of the courts and county designated mental health professionals--CDMHPs. Generally these are cases in which someone is a threat to themselves or others or unable to care for themselves. In such an emergency, a Spokane area number by which these professionals can be reached is a crisis line 1-877-266-1818 (“First Call For Help”). In such a situation, you could also call 911 or present to your nearest Emergency room. In general we will also discuss a safety plan (i.e. for worsening of symptoms).