Your Questions, Answered

Answers to common questions about my practice, treatment approach, and what you can expect when working together.

  • Threshold Integrative Mental Health provides comprehensive outpatient psychiatric care for adults through a combination of psychiatric evaluation, medication management, and psychotherapy.

    Rather than separating medication management from psychotherapy, treatment is tailored to your individual needs and may integrate both approaches within the same therapeutic relationship. Care is informed by evidence-based psychiatry while also considering the psychological, relational, medical, cultural, and existential dimensions of your life.

    Common areas of focus include:

    • Depression

    • Anxiety disorders

    • Bipolar disorders

    • Obsessive-compulsive disorder (OCD)

    • Adult attention-deficit/hyperactivity disorder (ADHD)

    • Binge-eating disorder

    • Grief and serious illness

    • LGBTQ+ mental health

    • Identity development and life transitions

    • Psychedelic preparation and integration

    My practice is grounded in psychodynamic psychiatry, logotherapy, and integrative mental health care, with the goal of treating the whole person rather than simply reducing symptoms.

  • Threshold Integrative Mental Health is located in Portland, Oregon, where I provide in-person psychiatric care and psychotherapy for adults.

    I also offer secure telehealth appointments for patients located throughout Oregon and Washington, in accordance with applicable licensure and telehealth regulations.

    Whether we meet in person or virtually, my goal is to provide thoughtful, collaborative psychiatric care in a setting that allows time for meaningful conversation and careful treatment planning.

  • Getting started is simple.

    You may request an appointment by selecting Request Appointment anywhere on this website and completing the secure appointment request form.

    If you're unsure whether my practice is the right fit, I also offer a complimentary 15–20 minute introductory phone consultation. This conversation provides an opportunity to discuss what brings you to treatment, ask questions about my approach, and determine whether scheduling a full psychiatric evaluation makes sense.

    The introductory consultation is informational only and does not include diagnosis, psychotherapy, medication recommendations, or treatment.

  • The initial psychiatric evaluation is scheduled for up to 90 minutes.

    This appointment allows us to develop a comprehensive understanding of your concerns rather than rushing to a diagnosis or treatment plan.

    During our conversation we may discuss:

    • Your current symptoms and concerns

    • Previous psychiatric treatment and medications

    • Medical history

    • Sleep, appetite, and energy

    • Family psychiatric history

    • Relationships and support systems

    • Childhood and developmental experiences

    • Work, school, and daily functioning

    • Alcohol or substance use

    • Personal strengths and goals for treatment

    By the end of the appointment we will discuss diagnostic impressions, recommendations, and whether medication, psychotherapy, or an integrated treatment plan appears most appropriate.

    Sometimes additional appointments are needed before a diagnosis becomes fully clear. Psychiatry is often a process of careful understanding rather than immediate certainty.

  • Most follow-up appointments are scheduled for up to 60 minutes.

    Unlike brief medication visits commonly found in many practices, these appointments provide time to discuss both psychiatric symptoms and the broader context of your life. Depending on your needs, appointments may include medication management, psychotherapy, or both.

    This allows treatment decisions to develop from a fuller understanding of your experiences rather than focusing solely on symptom checklists.

  • Treatment frequency depends on your clinical needs, treatment goals, and stage of care.

    Some patients benefit from weekly psychotherapy, particularly when exploring longstanding emotional patterns, trauma, grief, or significant life transitions.

    Others are seen every two to four weeks for integrated psychiatric care that combines psychotherapy and medication management.

    During periods of medication adjustment, diagnostic clarification, worsening symptoms, or major life changes, appointments may be scheduled more frequently. Once treatment has stabilized, visits may gradually become less frequent.

    Together, we will determine a schedule that balances clinical effectiveness with your personal circumstances and long-term goals.

  • Not necessarily.

    Some individuals seek consultation regarding diagnosis or medication and require only brief follow-up. Others benefit from longer-term psychotherapy that allows for deeper exploration of emotional patterns, relationships, identity, and personal growth.

    Treatment is collaborative and regularly reviewed. We will discuss your goals together and adjust the frequency or duration of care as your needs change.

  • Many psychiatric practices understandably focus on diagnosis and medication management. My practice takes a broader approach.

    I believe effective psychiatric care begins with understanding the person—not simply identifying symptoms.

    That means considering:

    • Biology and brain health

    • Relationships and attachment

    • Personal history

    • Trauma and resilience

    • Physical health

    • Identity and culture

    • Spiritual or existential concerns

    • Values, purpose, and meaning

    Medication can be an important part of treatment, but it is rarely the whole story.

    My goal is to create a practice where thoughtful psychiatric evaluation, psychotherapy, and collaborative treatment planning work together to help people not only experience symptom relief, but also develop greater self-understanding, resilience, and freedom over time.

Treatment Philosophy & Approach

  • Psychodynamic psychiatry combines psychiatric evaluation and treatment with an understanding of how emotional patterns, relationships, formative experiences, and unconscious ways of coping may influence present-day symptoms.

    This approach asks not only, “What symptoms are occurring?” but also, “Why might these symptoms have developed, and what keeps them going?”

    Psychodynamic treatment does not mean blaming the past or interpreting everything symbolically. It involves noticing recurring patterns with curiosity so that you can better understand yourself and have greater freedom in how you respond.

    Symptom relief remains important, but the broader goals may also include improved relationships, emotional flexibility, self-understanding, and lasting psychological change.

  • Logotherapy is an existential and meaning-centered approach to psychotherapy developed by psychiatrist Viktor Frankl.

    It begins with the understanding that human beings are deeply motivated by a need for meaning and that emotional suffering can intensify when life feels empty, directionless, or disconnected from what matters.

    Logotherapy does not claim that suffering is inherently meaningful or ask people to simply think positively. Instead, it explores how a person might:

    • Identify values and responsibilities that remain available

    • Respond to circumstances that cannot immediately be changed

    • Reconnect with relationships, creativity, work, service, or spirituality

    • Move toward a life that feels more purposeful

    I draw from logotherapy particularly when working with grief, serious illness, demoralization, identity transitions, mortality, and existential anxiety.

  • Psychodynamic therapy and logotherapy ask different but complementary questions.

    Psychodynamic therapy explores how your emotional and relational patterns developed, how they continue to shape your present life, and what may be happening outside immediate awareness.

    Logotherapy explores what matters to you, what gives your life direction, and how you might respond meaningfully to circumstances that cannot be fully controlled or changed.

    Together, these approaches allow us to consider both the origins of suffering and the direction in which you want your life to move.

  • Integrative mental health care considers the many factors that can influence emotional well-being rather than treating symptoms or diagnoses in isolation.

    These may include:

    • Biology and genetics

    • Physical health and medications

    • Sleep, nutrition, and substance use

    • Personal history and trauma

    • Relationships and attachment

    • Identity, culture, and community

    • Work and daily environment

    • Spirituality, values, and meaning

    Treatment may include psychiatric medication, psychotherapy, behavioral changes, coordination with other healthcare professionals, or a combination of approaches.

    At Threshold Integrative Mental Health, “integrative” does not mean replacing established psychiatric care with unproven alternatives. It means placing evidence-based treatment within a broader understanding of the whole person.

  • Yes.

    As a board-certified Psychiatric-Mental Health Nurse Practitioner, I evaluate psychiatric symptoms and prescribe medication when it is clinically appropriate.

    Medication decisions are collaborative. We will discuss the potential benefits, risks, side effects, alternatives, and your preferences before making changes.

    Medication is viewed as one possible part of treatment rather than automatically the sole focus. Whenever appropriate, prescribing is integrated with psychotherapy and a broader understanding of your health, relationships, and life circumstances.

  • No.

    Seeking psychiatric care does not obligate you to take medication.

    Some patients come primarily for psychotherapy. Others want help reviewing an existing medication regimen, clarifying a diagnosis, or considering whether medication might be useful. Some benefit from combining medication and psychotherapy.

    Recommendations are individualized, and you remain an active participant in every treatment decision.

  • Yes.

    Psychotherapy is central to my practice and may be provided either as the primary form of treatment or alongside medication management.

    Depending on your needs, therapy may address:

    • Emotional and relational patterns

    • Anxiety, depression, or mood instability

    • Grief and serious illness

    • Identity and life transitions

    • Shame and self-criticism

    • Meaning, values, and purpose

    • Trauma and longstanding coping strategies

    • Relationship or attachment concerns

    When psychotherapy and medication management are integrated within the same appointment, medication decisions can be informed by a deeper and more continuous understanding of your life.

  • Yes.

    I provide psychotherapy focused on preparation before and integration after psychedelic experiences.

    Preparation may include exploring intentions, expectations, psychological readiness, personal and family psychiatric history, medication considerations, potential risks, and the support available before and after an experience.

    Integration focuses on making sense of what occurred and considering how insights, emotions, memories, or changes in perspective might be incorporated into everyday life.

    Threshold Integrative Mental Health does not prescribe, provide, supply, or directly facilitate psychedelic substances.

  • IMy approach emphasizes depth, collaboration, and continuity.

    Rather than focusing only on diagnosis or symptom reduction, treatment considers the biological, psychological, relational, medical, cultural, and existential dimensions of your experience.

    Medication may be helpful, but it is rarely the whole story. Psychotherapy may address deeper patterns, but it also remains grounded in practical concerns and present-day functioning.

    The aim is not only to help you feel better in the immediate term, but also to support greater insight, resilience, agency, and freedom over time.tem description

Some Commonly Seen Experiences

  • Yes.

    Depression can take many forms. Some people experience persistent sadness, while others notice emotional numbness, loss of motivation, irritability, changes in sleep or appetite, difficulty concentrating, or a sense that life has lost meaning.

    Treatment begins with understanding the type of depression you are experiencing and the factors contributing to it. This may include medication, psychotherapy, or a combination of both. In addition to reducing symptoms, our work often explores the psychological patterns, relationships, and life experiences that shape depression over time.

  • Yes.

    Anxiety disorders are among the most common reasons people seek psychiatric care. Anxiety may present as excessive worry, panic attacks, social anxiety, health anxiety, physical tension, obsessive thinking, or difficulty tolerating uncertainty.

    Treatment is individualized and may include psychotherapy, medication, or both. Rather than focusing solely on symptom reduction, we also explore the emotional, relational, and psychological factors that contribute to anxiety so that treatment creates lasting change rather than temporary relief.

  • Yes.

    I evaluate and treat Bipolar I Disorder, Bipolar II Disorder, cyclothymia, and other mood disorders. Because bipolar disorder is sometimes mistaken for depression, anxiety, ADHD, or personality disorders, careful diagnostic assessment is essential before beginning treatment.

    Treatment may include mood-stabilizing medications, psychotherapy, education about mood patterns, sleep regulation, and strategies to reduce future mood episodes while supporting long-term functioning and quality of life.

  • Yes.

    Obsessive-compulsive disorder involves more than repetitive behaviors. Many individuals experience intrusive thoughts, persistent doubt, excessive responsibility, perfectionism, moral or religious scrupulosity, relationship obsessions, or fears of causing harm.

    Treatment often combines psychiatric medication with psychotherapy tailored to your specific symptom pattern. My approach also explores the underlying emotional conflicts and meanings that can contribute to obsessive thinking while helping patients gradually develop greater flexibility and freedom from compulsive patterns.

  • Yes.

    Adult ADHD often affects attention, organization, motivation, emotional regulation, and executive functioning. Many adults reach adulthood before recognizing that lifelong difficulties with concentration or procrastination may reflect ADHD rather than laziness or lack of discipline.

    Evaluation includes a careful review of developmental history, current symptoms, and other psychiatric or medical conditions that may contribute to attentional difficulties.

    Treatment may include stimulant or non-stimulant medications, psychotherapy, education, and practical strategies that improve daily functioning.

  • Yes.

    Binge-eating disorder is a medical and psychiatric condition—not a failure of willpower.

    Treatment focuses on understanding the biological, emotional, and psychological factors that contribute to binge eating while reducing shame and developing healthier relationships with food.

    Depending on your needs, treatment may include psychotherapy, psychiatric medication, nutritional collaboration with other professionals, and work addressing stress, emotional regulation, self-esteem, and longstanding coping patterns.

  • Yes.

    Before specializing in psychiatry, I spent many years practicing hospice and palliative medicine. That experience continues to shape my work with individuals living with serious illness, chronic medical conditions, caregiving responsibilities, anticipatory grief, bereavement, and questions surrounding mortality.

    Grief is not something to be "fixed." Rather, it is something to be understood, integrated, and carried differently over time.

    Our work may address sadness, anxiety, identity changes, family relationships, spiritual concerns, existential questions, and the search for meaning during difficult periods of life.

  • Yes.

    Threshold Integrative Mental Health is committed to providing affirming psychiatric care for LGBTQ+ individuals.

    Many LGBTQ+ patients seek treatment for concerns unrelated to their identity. Others wish to explore the effects of minority stress, family relationships, identity development, gender, sexuality, spirituality, or experiences of discrimination.

    My approach does not pathologize identity. Instead, treatment recognizes the psychological impact that social experiences, relationships, and culture can have while supporting each person's authentic development and overall mental health.

Insurance, Fees & Practical Questions

  • Threshold Integrative Mental Health is currently in-network with:

    • Aetna

    • CareOregon / Oregon Health Plan

    • Medicare

    • MODA Health

    • Providence Health Plan

    • Regence BlueCross BlueShield

    Credentialing is currently in progress with:

    • Optum / UnitedHealthcare

    • PacificSource

    Insurance networks and individual plan benefits can change. Before beginning treatment, please verify that Threshold Integrative Mental Health and Asher Bar-Nes Caldwell are in-network with your specific plan.

    You can find the most current information on the Fees & Insurance page.

  • Current private-pay fees are:

    • Brief Phone Consultation / Introduction, 15–20 minutes: Free

    • Initial Psychiatric Evaluation, up to 90 minutes: $450

    • Follow-Up Psychiatric Appointment with Psychotherapy, up to 60 minutes: $225

    Payment is due at the time of service.

    Private-pay care may be appropriate for people who do not use insurance, have a plan with which I am not contracted, or prefer not to submit their psychiatric care to insurance.

    Please see the Fees & Insurance page for the most current fee information.

  • Possibly.

    Some insurance plans reimburse a portion of the cost of care received from an out-of-network clinician. Upon request, I can provide a superbill that you may submit to your insurance company.

    Reimbursement depends entirely on your plan and is not guaranteed.

    Before beginning treatment, consider asking your insurer:

    • Do I have out-of-network outpatient mental health benefits?

    • What is my out-of-network deductible?

    • How much of the deductible has already been met?

    • What percentage of the allowed amount will the plan reimburse?

    • Is prior authorization required?

    • How do I submit a superbill?

    Your insurance company may reimburse based on its own allowed amount rather than the full fee charged by the practice.

  • Yes.

    Secure telehealth appointments are available for established and prospective patients who are physically located in Oregon or Washington at the time of the appointment, in accordance with licensure and applicable regulations.

    In-person appointments are also available in Portland, Oregon.

    Telehealth may be appropriate for psychiatric evaluation, medication management, and psychotherapy. In some circumstances, an in-person visit, physical examination, laboratory testing, vital signs, or coordination with another healthcare professional may be recommended.

  • YAvailability changes over time.

    The best way to determine whether I am currently accepting new patients is to select Request Appointment and complete the secure inquiry form.

    You may also request a complimentary 15–20 minute introductory phone consultation before scheduling an initial psychiatric evaluation.

    Submitting an inquiry does not guarantee that the practice will be able to accept you for treatment. Clinical fit, scheduling availability, treatment needs, location, and insurance participation may all affect whether care can be established.

  • The complimentary 15–20 minute phone consultation is a brief introduction for prospective patients.

    It gives us an opportunity to:

    • Briefly discuss what you are seeking

    • Review the general services I provide

    • Answer practical questions about the practice

    • Consider whether an initial psychiatric evaluation appears to be an appropriate next step

    The consultation is not a psychiatric evaluation, psychotherapy session, or treatment appointment. It does not establish a clinician-patient relationship and does not include diagnosis, medication recommendations, prescribing, or emergency assessment.

    A formal initial evaluation is required before clinical recommendations or treatment can be provided.

  • The therapeutic relationship is an important part of psychiatric care.

    My practice may be a good fit for you if you are seeking:

    • Thoughtful psychiatric evaluation

    • Medication management that allows time for careful discussion

    • Psychotherapy integrated with psychiatric care

    • A psychodynamic, existential, or meaning-centered approach

    • Attention to relationships, identity, culture, physical health, and life circumstances

    • Collaborative rather than prescriptive treatment planning

    The introductory phone consultation can help determine whether the services I provide appear consistent with what you are seeking. The initial evaluation then gives both of us a fuller understanding of whether working together is likely to be helpful.

    At times, another clinician, treatment setting, or level of care may better fit a person’s needs. When possible, I will communicate that directly and respectfully.

  • Select Request Appointment on this website and complete the secure appointment-request form.

    You may request either:

    • A complimentary 15–20 minute introductory phone consultation, or

    • An initial psychiatric evaluation

    After your request is reviewed, you will receive information about availability and next steps.

    Please avoid including urgent or highly sensitive clinical information in ordinary email or unsecured website messages.

    Threshold Integrative Mental Health is an outpatient practice and does not provide emergency, crisis, inpatient, or after-hours psychiatric services.

About the Practice