welcome everyone we are here today with Dr Joseph W during and I am honored to have him here on this channel as you know I make a lot of content based off of medications and different treatments for mental health and Dr Joseph here is actually an expert in tapering in fact uh Dr Joseph WT during is a psychiatrist and he's renowned for his expertise in the field of drug tapering and withdrawal management with years of experience in clinical psychiatry he has developed a particular interest and specialization in assisting patients with the safe and effective tapering of psychiatric medications his approach is patient centered focusing on individualized plans that prioritize the patients's well-being and functioning so welcome Dr Joseph how are you today I'm very well thanks thank you so much for having me yeah yeah absolutely it's an honor my uh clients here or customers subscribers here at level headed mind are used to medication videos and understanding how medications work and maybe not so much about tapering off or getting off of medications which isn't really U down the line of conventional Psychiatry so how did you get into this line of work yes so it's a long story um and I'll give give you like the the major points so heads up for the the listen here I I come at this from a probably a different perspective than you may have may have heard about from other psychiatrists but when I when I entered the field there are a few things that really bothered me with Psychiatry if I'm going to give you the the real context um you know I don't like the idea that at least in Psychiatry our diseases are not really not really diseases in the way that other medical conditions are diseases and and I don't mean that in a way that there not suffering with psychiatric symptoms I mean it that there's no real um clear biological understanding you know it always kind of bothered me that we defined things like depression with a lists of symptoms that were quite arbitrary um and and I also noticed um that we were treating people with a lot of um I mean we were mostly treating people with medications and we were telling them that they had I guess uh you know diseases in a way you know you've got this major depressive disorder and we were always talking about in this very biological way in terms of it was stemming from their brain and I feel like we we kind of stray pretty far from Our Roots at least with what I was seeing in my training and and while there's a lot of social reasons that people get depressed and unhappy whether it's poverty and problems with jobs or you know problems within the home you know and and there's also I mean there are just simple uh just very common things that people become unhappy about like you know problems dysfunctional relationships and all types of things I felt like that was really getting erased because the way I was trained in many ways not not not by what they said but what what I saw happening in front of me in my training was that people would come in and they would say they're unhappy and they would uh you know meet criteria for a disorder and they get put on the medications um not because I think Family Medicine doctors and psychiatrists are are nasty people just and they just want to medicate things away but because it was expedient and it was less resource intensive um and so I found myself kind of observing what I thought was a system that really wasn't designed to help people in the way that they deserve to be helped um where because it was expedient we were diagnosing People based on like lists of symptoms and essentially just putting them on meds and we really didn't have a well-developed infrastructure to help people with the real problems that they were experiencing and so doctors really weren't getting to know their patients very well and um that really bothered me and as I started looking into the downsides of that I realized that a lot of the drugs um they have side effects um that are pretty bad um and there were side effects we weren't telling people about um and I'm sure jelle may ask me about some of these later like protracted withdrawal which is a type of neurological uh injury or damage that happens when people come off There's issues like pssd which are what I would say are very uncommon but if they do happen to you this series pssd is a form of persistent sexual dysfunction when you come off the meds um and then there were also other issues with the medications where some of the side effects of the drugs they could they could actually make people um worse in a way I I say you know I was also seeing doctors Miss problems with the drugs you know they we would have people on five or six different medications and they would be really blunted and you know i' would be sitting there and they'd be adding more and more medications and I'd see this a lot and I just get this person's not getting any better and the doctors would commonly say hey this is just um treatment resistant depression but then later on in my career when I was taking people off these medications they started to get better and I realized that there's also an issue of just drug stacking going on where we can actually make people pretty mentally ill by just the drug effects of these medications and and miss them I guess the narrative that that that's out there that you know that there's there's all these these terrible mental illnesses and and brain diseases out there and you know we really need to get everyone on these these medine I know it's not said like that but sometimes it feels like that um that really wasn't um meshing with what I was seeing and in fact I think a lot of people were oversold on how how safe they were and and and lots of people got on medications who really deserve support in other ways that were less risky and and probably the hardest thing about this um and what is eventually the answer to your question jelle is we were telling people that these meds were easy to come off you well maybe not easy you know the withdrawal would be mild and self-limited was the phrase that I heard a lot that you know there wasn't really a downside to getting off and it was quite easy to unwind and that um and that may be true for some people but for others for reasons that we don't understand it can be extremely difficult and um that group of people I think have been um just um dismissed or or their their suffering coming off the withdrawal has been written off as their underlying condition and and they end up on medications that they were trying to stop but now they get told that they need to be on them forever and so that's a really long answer kind of my my background and my train of thought as as to how I ended up here uh and yeah yeah so it sounds like it was a very patient driven like your experience of seeing these patients suffering made you realize like wait a minute like this isn't the patient's fault this is actually the medications that are doing this and so your eyes were opened in that in that type of way and so you looked for alternative approach to helping these people which which is very admirable most um psychiatrists are are stuck in this conventional narrow way of thinking that medication is the only answer and so I think that that's uh you know very commendable of you to step outside of the box and really disrupt the the Norms here um and then there's several you know people out there that are doing that and I I appreciate the work um that is being done out there because we are making a shift and we are changing the way that uh these medications are viewed now um do you believe that uh with with this taper approach that everyone should be coming off of their psychotropic medications or you know when do you think is a good time to have uh the conversation or if there's a patient listening who's thinking man I'm on five or six medications like should I be tapering um what would you say to them what's a good guide to to let people know that maybe they should be tapering I think we have to think about like I guess why why we're taking the medication to begin with right so in general my stance is that uh the drug should be used for the least amount of time uh possible um and the reason I believe that is that there is some uncertainty about the long-term effects of these medic medications and and what I do see happen is uh someone will get on a medication and it will work great at the start maybe even for the first couple of years but slowly over time they become tolerant to it and then they need higher and higher doses um and so this eventually leads to a situation where people tend to accumulate the medications um which is kind of digging a deep hole because eventually you end up on a lot of meds and and you become tolerant to the to the drug effect doesn't happen to everyone but it I do see it happen frequently enough so whenever I'm working with patients on medications we're always thinking well is there anything else that we could be doing and when you start asking that question you need to you know we're also thinking about you know why why is this person depressed and so we we we also want to look at the person's life I mean the things that make people unhappy I feel like we focus a lot on genetic issues but there can also be real things going on in people's lives um whether it's challenges with their relationships uh uh jobs that they don't like and and they can be supported to to improve those things and if if we just um but but that doesn't mean necessarily that we can't have some mental health conditions that maybe are stemming from whether it's a biological thing or it's happening after a you know traumatic brain injury or there's some genetic loading and so it it needs to just be informed by by what are we what are we trying to achieve with this medication and are we are we confident that we've looked at all the other possibilities that are contributing to the symptoms because from my perspective I mean if if you've been really Vigilant about your mental health and you know you've looked at your relationships and and and work and you've got people helping you and there therapists and you get to the point where you say well you know I've done everything and I'm still feeling terrible um you know you've looked at diet as well and you've ruled out other medical conditions if you've done all of that and you're still suffering from mental illness there's no there's no issue to take medications in fact that's a that's a good thing to do you know let's um use the rewards of Medical Science the people who I do think should be questioning medication usage other ones who may have this this sense you know that they're legitimately wrong with with the life and the way and the way they're living and something that they do need help with overcoming because in those situations then addressing that issue is is it's going to be a much better thing to do so um you know that's for the person who's not having any side effects and such but sometimes the issue is forced all right and and even if you You' tried multiple things and the drug is working for you you start to develop a neurotoxicity or some severe reactions and you need to come off um but yeah so I'll stop there I mean those are my thoughts on on that issue yeah and so um so basically when when someone may be experiencing some negative side effects from it or perhaps um they're looking at their life and thinking maybe you know my depression was stemmed from this life circumstance that I really didn't get uh a chance to resolve in therapy or doing the work so to speak or like you briefly mentioned diet and lifestyle um I believe those things are very important for people to look into um as well as you know the DSM you know I I used to always think it was flawed and then I was reminded that one of the areas in the DSM that gets ignored across the board is the ruling out of medical conditions and so making sure that they're checking for those things right and making sure it's not hypothyroidism or hyper thyroidism and things of that nature because that can really mimic psychiatric conditions and and this anxiety symptomology or depression symptomology and um even nutrient deficiencies can do the same thing so looking for root causes um would definitely be good to make sure that you're taking care of those things but certainly uh when you start stacking psychotropic medic medications one after another you can end up with this type of neurotoxic state and I see this a lot in patients with the in the benzo Community or the benzo diazines who are then trying to taper that is that something that you often see as well with the the type of neurotoxicity that is seen out there with the patients on psychotropics is it more exacerbated in that group or do you feel that it's kind of shared across the psychotropic medications well neurotoxic kind of a state um so do you feel like that state is related to more of the patients with the benzodiazapines or anti-depressants like is there a hierarchy so to speak of these types of medications and creating this type of neurotoxic you know burden on on the patients yeah so when we're talking about medications which I really see is having the potential to hurt people when they come off them and by hurt I mean developing a condition called protracted withdrawal where if the person experiences severe withdrawal symptoms that they can have lingering neurological problems afterwards uh it does appear to be select um to happen much more frequently with certain drug types and so it happens mostly with the benzodiazapines um and the Z drugs so like ambient sinat and such and it also happens with um ssris snris and and metazine um and so drugs which I don't see causing enduring withdrawal problems are antis psychotics mood stabilizers uh well Butrin ADHD medications and so what this means for me is uh a lot of caution is needed with the ssris snris and benzos um I think I mean all drugs should be tapered slowly because we don't want people going into severe withdrawal but with the um uh with that group of anti-depressants and the benid aines I I really believe a lot more caution is needed because once someone that develops the protracted withdrawal issue then that's that's life-changing absolutely it can be very debilitating yeah absolutely agree and the gab of penano would be considered in that same class as well um they similarly act on those receptors so like gabip pet and then prabin or lria um I have a couple patients who have been suffering from lyrical withdrawal in a in a protracted State now um and it's very difficult but very similar to those benzos just because the way it works in the brain and so um when when patients get into this state of neurotoxicity um that's when we tend to get this push back um you go to Conventional psychiatrists they're going to say just get back on the medication you were doing so much better on this medication why not just go back to the medication um and often times then they start blaming the patient and the patient's mental illness so um what do you say to these critics you know in Psychiatry who are saying that you know the tapering is is doing more harm and that these patients should just be on the medications for life like they think this is a sign that the person needs to stay on the medication I think it's really reasonable to to have that thought if if it works right but but with protracted withdrawal when people go back on the medications the symptoms don't go away so you'll have a patient go into withdrawal become very unwell and then the doc says well you know could be your underlying mental condition and yeah they might they might be right because a lot of the protracted withdrawal symptoms are severe anxiety and panic among other things but if you put them back on the drug and then they don't get better um and on top of you know having the severe anxiety um and panic all the time they start to Pace they have ringing in their ears they have light sensitivity they start to develop neuropathy in their hands and feet then they start to suffer from a range of gastrointestinal problems like in like IBS style symptoms with food sensitivities and diarrhea and constipation and such you know we we're looking at a different clinical entity at that at that point it's looking more like protracted withdrawal which is recognized as an adverse reaction at least by Royal College of psychiatrists in the UK and with the Benz of aines um in the drug labeling at the FDA and so what I think the issue is is a lot of the doctors uh don't actually recognize that it is an adverse drug reaction that that's occurring and and you can't recognize what you haven't learned about or or seen and um I know for a lot of patients they say what this is crazy these incompetent doctors you know why don't why don't they know these things but I I never learned it when I went through school these were things that I learned because I'm particularly interested in drug side effects and they' and at least with the benzo protracted withdrawal in the US was only added to the labels in 2020 and so unless someone is sitting there reading these labels they're they're not going to have the most upto-date information and so these These are well-meaning people trying to help their patients who do not have the who have not been or informed about these things and so they they miss them yeah absolutely agree there's a lot of uh work that needs to be done in the education space and I would agree that in as a psychiatric nurse practitioner we're heavily trained in medications and psychopharmacology and there was some you know information about tapering but it was going by stalls you know basically and he he most of his stuff he'll St cut by half for a couple weeks weeks cut by half you know that approach which we know can be very dangerous and so um so yeah we we certainly need more education in our space because I I do believe that other providers are you know doing what they're they were taught and and believing what they were taught which a lot of the education I believe one of your videos you mentioned this how um the education that we receive is actually driven by Pharma you know big Pharma and you know and their agenda is obviously you know medication driven so we have to uh you know hopefully break that I think that's where um a lot of the work will need to be done in this space is in the education space and and getting those practitioners educated on this uh which I believe we're we're starting to head that direction so I want to pick up on that point because I think it's I think it's I think it's interesting I I do think there's a couple things that maybe in Psychiatry make us slower to recognize problems with the drugs and you know the first one is obvious I mean the pharmaceutical industry they have a um incentive to to make doctors see the drug in the most positive light and so when there can be an interpretation or a slant on an issue it is going to slant towards hey this is not as big of a problem as you think because they they don't want doctors to to be so worried about their drug that you know they're going to pick a competitor drug and so they they have an incentive to do everything they possibly can to kind of make doctors see it in the best possible light without saying anything illegal and I know that because I worked in I've worked for a couple pharmaceutical companies and I've been been in those meetings and that's just that's just Commerce but the the other thing is um Psychiatry as a field uh is particularly offensive about uh medications um and this has this has a long history you know and um uh unlike other Medical Specialties where you know you could have you know bacterial problems and you know you can look at them under a microscope and give a medication to make it go away um the psychiatric illnesses are a lot well the psychiatric problems are a lot more complicated and we've had people attack the field um in the past I mean there was a guy called Thomas um who was saying uh quite effectively so I think in the 70s that um a lot of mental illness is not actually brain problems the way we're telling people it's it's actually people who are responding to a sick society and while I do believe some mental illnesses can can come from the brain I do I believe the majority of them the vast majority of of of mental illnesses do actually come from things things in the world and that was really threatening to to the field you know when people were saying these aren't real illnesses you guys are acting more like uh police in fact and you know people who are um get taking away inconvenient people or people who are unhappy about illegitimate things do medicalizing them and putting them on meds and so we've had this this ongoing kind of attack uh against the legitimacy of what psychiatrists are doing and it's made people defensive it's made people double down at least within Psychiatry to say no these are real medical conditions and um the drugs they work don't you know don't criticize the drugs you know you're stigmatizing people and I I actually think it's biased people to the point where um rather than being objective about psychiatric interventions they're trying to advocate for them which has a bias there they're trying to say you know we need to advance this notion that these medications are safe and mental illness is real all the time and I think it comes from a place of defensiveness um uh against some criticism which is valid and and and so yeah I do believe as a profession we are more hesitant to to really look at some of these more uncomfortable issues uh about the medications absolutely totally agree and um when it comes to uh this criticism um a lot of provid ERS will say you know with the the tapering slow taper is just maybe a couple of months um but you know in reality that can be dangerous so um when you're looking at someone that's on several medications what do you consider to be a safe taper or slow taper like how should they start should they just go along with their psychiatrist and start cutting by half and sure yeah what I will say is and the thing that makes this difficult is that there's a lot of variability and what people can tolerate in terms of tapers I've seen some people be on these drugs for 5 years and come off in a couple of months without much issue but for whatever reason the brain is plastic to a point where when you remove the drug it was rapidly able to readapt to its absence and stabilize the person um that's it I've seen some people take these medications for 6 months and have a hell of a time coming off when they start to remove the drug they have a lot of symptoms and so the first thing is that is that there there are variables which we can't identify in advance that that may make someone have a more challenging taper and so the real rule I mean the principal rule is move as fast as you can handle um uh because the goal is to get someone off without uh disabling withdrawal symptoms um because you don't want to do this Sort of hope and prey thing where you say okay they're going to be really disabling and I'm just going to grip my teeth and bear it for two weeks um and hope that they pass I mean that can be dangerous and it could be harmful and so I mean in general you kind of want to you know someone has been on for like three months I think you get them off in probably like I don't know 6 weeks or something like that maybe even less if they've been on them for 6 months maybe your tape is going to be 3 months something like that but once you cross the year mark you know once your brain has really adapted to it we switch over to tapering people between 5 to 10% a month um and and then that's at least the initiation so you might do a 10% reduction the first month and if you do well with that reduction you could say well maybe I'm going to try 15 you could bump it up and if you do well with that reduction then you'd say I'm going to stay here for a little bit and just go down at that rate but eventually you you're going to hit a point where you have symptoms and then you need to scale it back and so okay 15 was too much now now it's back to 10 might do that for a few more months woo that you know I felt that um and then you would go down to five and so on so you always I mean the main rule is that you just want to listen to your body and only move at the level that you can tolerate and when you do that most people even if they've been on the drugs for you know 5 years 10 years they can get off between maybe a year and a half to to two years sometimes a little bit more if they're moving at a pace sometimes it's longer sometimes it's shorter but that's generally what I see yeah yeah I agree and um the thing with um honoring your body and listening to what your body is showing you within you know these symptoms of of withdrawal can get clouded for people um and I and I think that that's where um the need for a practitioner who can be objective in these things step comes into play um I'm not sure if you noticed that but um you know when I see patients that are coming off of medications they get super hyp focused on every little symptom and sometimes that drives fear and they have a hard time seeing the big picture uh from when they started to where they are now and so we got to look at things more objectively and and and start focusing on cluster symptoms do you um have the same experience with patients when you're when you're tapering them when where they get hyperfocused and then it's hard for them to see you know the forest through the trees so to speak yeah yeah I do um and what I will say is tapering people of psychiatric medications is incredibly difficult and it's really time consuming um because I mean we're effectively putting people in in many cases into high anxiety States because um that that's what drug withdrawal is you know we are in a safe way putting someone into a high uh state of withdraw that their brain can readapt to and when you do that they they're understandably going to be very panicked about things um and you know not only that is um we're also starting to deal with some of the original problems that led to someone uh being on the medications before um and so I I think that the easy stuff with drug withdrawals actually just like the math and the tapering and the doing all of that uh the labor intensive stuff is just the reassurance uh because you need to you know use all those non drug skills that you have of of giving people hope and sitting with them in intense uncomfortable states that make you feel weird because well we's not the right word when when you're with someone who's really suffering and their high anxiety and they're they're in a panic I mean this energy is um you know it's IT projects onto you and and it is uncomfortable and you need to fight against trying to get away you know or like get on the medications and you need to walk into it and sit with them and you need to get you know step into their state of mind and just be like this must be terrifying you know what's going on and and that's why I think a lot of people can't do this work because you have to be really comfortable with people who are full on in a panic sometimes they're feeling really depressed they're feeling really hopeless they have no other choice but to come off and you need to be not afraid of it you have to be able to sit with them and if you just do that long enough they get better but it's really time intensive um and you have to be available at least I find um sometimes you have to be available quite a lot you know if someone is having a difficulty you may drop what you're doing and see them that night or or the next day and so it's not like treating something like some dermatologic procedure you know that could wait wait a couple of weeks these people need help right now and then then they will ask for it um and so yeah I mean that's my take on it I I I I never think I don't ever think that tapering is going to going to be a mainstream thing that that people are going to enjoy doing because it's just so it's it's just so time intensive once you have a few of these patients you'll just you'll either love it because you're passionate about it or you'll you you'll kind of become quite frightened yeah yeah you burn out very quickly yeah i' I learned that I learned that the hard way um how difficult it is and um how time consuming it is which unfortunately is why a lot of practitioners who go down this road of helping people come off of medications are outside of insurance because there's no way insurance is going to cover or pay you know for an hourlong session for medication management they don't understand you know the you know and there's no amount of codes that you could do to to Really value the work that you're doing not only in that hour session but outside of that session like you mentioned the the the messages that come through the constant reassurance that oh let me set up a another uh emergency session here I can squeeze you in on Friday or I could squeeze you in here um you know to help with that extra support that they need and so so yeah absolutely a lot of um providers like yourself and and others are outside of this insurance model and so that brings me to to ask you know with your tapering Clinic specifically um you know what sets you apart um from you know other providers who may say yeah we can taper you or you know we'll do a taper for you what what really sets you apart from from the mainstream or even other practitioners who are doing similar things it sounds like you have more of a team approach yeah what what sets us apart is um I guess we we really focus on the problem I mean you know I I haven't had a horrific drug withdrawal but a lot of the people that I work with have and so what a lot of what we do is homegrown by people who have have gone through it and they know what is needed um I mean my program is far from perfect but every single day we you know we sit down and we think about how can we do it better how can we provide better training um and really make this the best possible experience for someone going through something as Dreadful as psychiatric drug withdrawal so in that sense I mean we do try and be available for people every day and so because we know that there's so much intense fear and high anxiety during this I mean we do groups uh uh Monday through Friday we have several group meetings where people could drop in for reassurance and for questions people have these constant questions about their taper you know should I do this should I do that and it's driven from this um neurological fear you know um and also fear about their situation which is just valid because some people are quite disabled and so make sure that we're there for them um and we we have people and so we've had to do our staffing in a way where we can you know afford to have people there every day uh Monday through Friday to to meet with people just in drop-ins and so I'd probably say that that part of it really knowing the condition and knowing what the people need is sets us apart I mean we've got I mean we know the drugs we know how to taper but there's a whole book out there you know Mark horo it's is De prescribing guidelines the the information is out there but it it's really the the fact that um we try and build a program around the the the people and the problem rather than trying to fit it to to maybe a more conventional psychiatric setting where you where you know someone calls and it's an emergency and it's like ah the doctor will see you in 2 weeks that doesn't really quite cut it with this because what I do see is people panic and then they make changes to their meds and they hurt themselves because they're in such fear so we we're trying to build it around the the the problem um that that's what I think makes us different yeah I think that's great that the team approach and and making it around the patient as far as you know understanding their needs it sounds like you really have a grasp of the needs of patients who are tapering um because uh their needs are are certainly more fear driven more heightened um and I often think that unfortunately though there are other support groups groups and forums out there that when patients are in these types of forums they're they're hearing a lot of negativity they're they're Gathering a lot of information or research about this that and the other and um then they come back to you with oh you know but but I saw this this person was doing it 5% and they got sick and they you know what if that's going to happened to me or I saw someone had to go up and this happened to them and and so it's it's driven by that and it sounds like you're creating this um space for them to come and ask questions of professionals and and not just blindly have to go into a forum where you know who knows what kind of information they're going to get there um so it's more driven by the practitioner which I think is great yeah and a few more things on that you know that now that you're asking about this and and this is why it's important I think as it to see medical professionals because sometimes people think that they're having withdrawal problems but um there you know there's other issues there there's medical issues sometimes there's issues with drugs that they're not withdrawing you know I see people trying to come off benzo aspin while they're taking stimulants and it's like it's never going to happen there is a certain sequence of things um to to how you do this that can make it a lot more comfortable and a lot smoother and if you go into a forum people don't know your full medical history you know they they don't know all the drugs that you're on and the doses and the time course of it and and your different conditions and all of that is really important to to strategically taking people off the medications um so this is this that one side of it which is why it's important to see a medical practitioner you know like myself or like yourself Jazelle and and then also to you know to be with someone that has the experience of working with people where they can provide reassurance CU if if you go on the Forum sometimes it just feels like oh my God we're all going to die you know cuz it's just so like it's just all of the people there are the ones who are still unwell because the healthy ones have moved on and you need people to just say hey I've helped a whole bunch of people with this and they're better now they're moving on with their lives and people need to hear that hope and this is one thing that I haven't done well that but I need to do well on our YouTube channel is just grab all of the recovery stories from the people that I've interviewed interview I I interview people recovering from drug withdrawal and some people in the midst of it but to get a list of the people who have recovered and make a playlist of that because people latch on to those things uh for for Hope because it can be so dark when you're there absolutely and that's the fear of tapering um that all you know patients and practitioners have is is you know um will my patient you know suffer to a point where you know they they decide to end their life you know that is a reality obviously it's a reality when someone's going through a severe depression Etc um but more so when they're suffering through um withdrawal and they feel like there's no hope or they're going to these places and and getting negative comments and feedback um so it's important to be supported in a positive way and and that's what I like to you know get my clients and looking at hey you know try try going to to places where you're going to get positive feedback let's start talking to people friends family and and find a support group that's going to support you in that way positively and not all negative um because that can be very uh triggering for someone who's going through you know the the the depths of of withdrawal or or if they're in protracted State obviously that makes it difficult for them and so having this team approach this drop in approach that you offer it sounds like you're really um hitting you know that area and and so um I I think that's really amazing that you're offering that because I know for for myself as a single practitioner trying to do this on my own kind of a thing um that's where I I feel like I lack I don't have the time to just drop everything and yeah yeah let me you know let me see you like yeah sure you know and and um and it's also very draining as well um and like you mentioned the the transference and C transference that can happen within session um can be overwhelming you know for a practitioner as well so doing your approach um you know using other practitioners who've been through it and and um I believe you have coaches as well when I was looking at your program um that also helped to integrate this process so that way the patient is being supported by a group of people so that it's also supporting um you as a practitioner you're not the only one you know having to take the burden of all of of you know what's going on with with your patient so I think that's amazing and um like I mentioned before insurance doesn't cover it so there is a cost to it and it can you know be costly to have some type of uh group you know this type of of setting where you're supported by multiple individuals right you have to pay multiple individuals to work around the clock and to do all the things that they're doing so of course that comes with the price now because insurance doesn't typically recognize this kind of work or maybe if they do out of network they may not get much back do you ever offer payment plans for patients to help make it affordable for them or do you work with patients in that way um as far as that's concerned personally I don't do any payment plans um and I I hate to say it like this but well actually no I don't and this is this is totally okay really it's we are in a development phase at the moment the way I see it is we are developing almost a new medical specialty at the moment and at least because of that with my practice our fees are are high now I don't think they're high in relation to the problem that we're solving in fact I think it's great value because people who are having this problem are it's a serious problem um this is not a little problem this is a problem that has people essentially disabled um but it isn't something that you're going to use your insurance for and because of that um I mean so much of our time is spent doing development I mean we're we're building training curriculums to train new staff um on how to do this because it cannot be something that I I simply you know handhold everyone and train them on how to do so we're building infrastructure we're training people how to run the groups how to diagnose the patients how to taper them how to recognize all the things going on and there will be a time where uh when it will be a lot more accessible and when the price will come down because we will have gotten to a point where uh it's not just hinging on on one person you know who who's torn in a lot of different directions to to do things it's going to be really accessible and um I mean we'll probably throw it up all on YouTube all of the the ways that we look at the problems and how we want to train them because we want everyone to be able to do this I mean there's and people say you know you know why put all all of the ideas out on YouTube and such like that but it's like this work is so challenging I I I really don't think there's there there there's going to be people lining up to do this work even if we share everything I mean we're we're I mean we're going to do it uh because it's it's it's the right thing to do but um you've got to love drug tapering to to do it because man oh man is it um is it challenging but long long story short right now it's small it's a boutique practice um uh we we don't do payment plans or anything like that and so much of what we're doing is just a product development we are trying to make the best product that we could teach others how to how to do at the moment yeah you know there's also um you know ways to to create like a a payment through like a PayPal or something like that where you still get the payment but the uh patient can use PayPal pay later as an option so there are other ways to kind of go around it um in that regards you know because I understand the the risk you take with that as well you know the financial risk of of doing a payment plan yourself but if you use other sources that could be something to to um to offer in the future for sure but um but yeah I I understand completely um being in this space the the time because I think one thing that um patients may not understand and I think that you understand it 100% is that what you're seeing in in the price that that Dr Joseph's clinic is set up at you may think oh sticker shock that's too much whatever however everything that you're getting is not just what he's offering that you get oneon-one in in the in the actual sessions the groups all the coaches Etc it's the time that he's putting in outside of the session you see practitioners have to prepare to do this kind of work to help you with tapering they have to look at your Labs if they're doing Labs do an analysis figure out everything every every little piece of the puzzle and a lot of that is done outside of session so they can prepare to see you and then you know directly an you know ask certain questions to bring about like what exactly is going on underneath the hood so to speak in in your specific individualized situation and so I believe that when when clients and patients are looking at you know that to think of the value you're getting not just the fact that you can which is amazing that you can say hey I need to drop in to one of these groups that you're offering you know Monday through Friday ask questions but also the fact that all the work that you're putting in underneath to build uh this program to make it individual for them I think is hands down like that's that is is what good care is all about it's about the work the provider is doing behind the scenes to help support their patients and their clients and that's something that a lot of people don't factor in they don't they're just looking at that one hour time frame or more sometimes it goes over right um that they're with the provider but then forget that hey when we hang up when we're finished with you we're now creating your plan we're doing all of these things and that's all offline that's off you know a call and so there's a lot of work that goes into into what you do what I do and other practitioners do and so um I think that it's is well deserved well thank you and um you know it's um I I have conversations with people because there there is stick of shock sometimes and it's just like well you know I I usually see my doctor and I pay you know I pay a $50 co-pay and you know why why is it like this and you know the question is how invested is that doctor in helping you um you know Bingo did you did did you really get to where you wanted to go using this method and because the the truth is that um I don't think we've really you know with the insurance model it's churn and burn you know a lot of the doctors are incentivized to see people really quick and uh it's not incentivized to get you the result it's incentivized to how do I care for you within 20 minutes and I know some people go above and beyond and they're great but in general I think most people would relate to an experience where it does feel like in and out and if you have a complicated problem um you want someone invested with you when people work with me when they sign up to my program I mean we are we are massively massively investing in helping them I mean they're paying us they're paying us to do that and then and so we we really turn up for them and and sure we get them the result that's what because that's what's different about us here I mean the way I like to think about it is if if you come to me we're here for the result you know it's not just uh you know seeing you in a visit it's like we're going to get you off the drugs and get you well yeah absolutely yeah and it's not just that quick exchange that happens with the the turn and burn you know it's like a conveyor belt of Psychiatry you know and uh I understand that all too well having worked in Community Mental Health before kind of veering off on my own um and and yeah you can't get anything done you know productively you're just switching medications real quick well let me try this let me try that throwing other things adding to the deck and creating chemical labotomy you know that's what I say you end up treatment resistant no you created a chemical labotomy for this person awful but uh but yeah I'm glad that that you have your clinic that you're invested in what you do um that you're creating these uh systems to to make it even better and I do appreciate the fact that you do provide the education you do on your channel um because it helps practitioners like me um and other practitioners who feel like maybe they're alone in this whole Space um to help you know guide us and to maybe we're stuck on someone who's protracted or you kind of give us some some tips you know to help them through through their uh their taper so I appreciate what you do and it's it's only going to get better we're putting together a full-on provider training at the moment which we're going to post and so really really kind of drilling into the whole process of it um and so in the next three months something a lot more robust for people all over the world to use uh it's aimed at prescribers and how to help people with protracted withdrawal Ines and other other tapering so that's what we're doing in the background and and we love it yeah yeah that's amazing and it shows in your videos very quality you know use your humor and some of them and but I love it it's it's very very good in all that you do so I'm excited to um be able to you know watch these videos in the future uh and look forward to it now when it comes to patients who want to uh work with you um how can they reach you um you website or yes so it just comes to the website taper clinic.com that's um I have an accent so I'm going to spell it out that's t a p r c l i n i c do taper Clinic one word and um uh if you go on the homepage just click the I think it's a red button that says learn about the program you'll watch a video that discusses our tapering philosophy and if that meshes with you um you'll be given an option to book a call with me wonderful yeah and so you're also at the taper clinic on YouTube um so you have a following there and also I believe uh Instagram is that also at the taper Clinic um Tik Tok yep y so we're we're across all platforms um uh Tik Tok Facebook Instagram Twitter I think we're on threads as well and okay um and so it's either going to be taper Clinic or Dr ysep uh that's German spelling j o SF um and uh yeah we're yeah we're we're we're there talking about uh psychiatric drugs and tapering issues wonderful and I'll make sure to Blink all of that down in the description below for all of you so that way you can um go ahead and click on those links and and learn more about Dr Joseph and also um if you want to work with him feel free you know to go to that webs it thank you for having me on and uh um being so kind about the things that you've said about uh what we're doing yeah absolutely yes I'm honored to have you here and I want everyone to learn what's out there and to get more information about tapering from an actual uh doctor a psychiatrist you know from from a source that is um you know very well educated and resourced and researched in this field and actually working in the field I think think that's very very important so make sure to check out those links and I thank you all for being here as always um I I wish you well on your mental health care journey and look forward to seeing you all next week