It's a Menu, Not a Recipe:

How I Think About Treatment in Integrative Psychiatry

By Patricia Pop, MD | Board-Certified Psychiatrist | San Francisco, Half Moon Bay, Menlo Park

When someone comes to see me for the first time, I don't hand them a prescription. I hand them a menu.

Not a literal paper menu (though I do have a document I share). More of a framework. I walk every new patient through six domains of wellbeing and say: here is the full landscape of what we could work with. Not all of it applies to you. Not all of it applies right now. But I want you to see the whole picture so we can make real decisions together, instead of defaulting to whatever felt most familiar or most urgent in the first fifteen minutes.

I call it "the mental health menu" because the metaphor does a lot of work. A menu means you choose. A recipe you have to do all of these things and in the right order - or else you don’t get the cake! In my experience, the people who do best in treatment are the ones who feel like active participants in it, not passengers.

Here is what is on the menu, and how I actually think about each piece.

Pharm: Medications, Supplements, Genetics, and Bloodwork

Let me say this plainly: medication is not a crutch, and it is not a magic fix. It is a tool, and like any tool, it works when you use the right one for the right job.

When I prescribe, I start low and go slow. I want to know how your body responds before we push the dose. Side effects are not failures; they are information that helps us adjust. I also want to understand your biology beyond the prescription pad. That means bloodwork (sometimes your thyroid or iron levels are doing more damage than you realize), and sometimes pharmacogenomic testing. However, most of the time, genetic testing doesn’t tell us more than careful clinical judgement and trial - and is sometimes just wrong.

I also think seriously about supplements, but I hold these to the same standard I hold pharmaceuticals: what does the evidence actually show? Not the wellness blog evidence. The real evidence. I like to say: I’m not “pro” or “anti” supplement - I’m pro eyes wide open. That means, I want to be clear with you about relative lack of evidence (which doesn’t always mean ineffective or a poor choice), hidden side effects - like cost on your wallet for what subtle or theoretical benefit, and dangers (hoping it contains what it says it does, and not other things - like heavy metals, contaminants, stimulants like caffeine just because people like to “feel” like something different is happening, even though they might not realize that’s not from the advertised ingredient).

I am not going to recommend something just because it is "natural." Arsenic is natural too! What I will do is look at your labs, your symptoms, and the research, and tell you honestly what I think could help and what is probably noise.

Psych: Therapy, Coaching, Groups, and Skills

I am both a psychiatrist and a psychotherapist. Many psychiatrists stopped doing therapy years ago; the insurance reimbursement model pushed them toward 15-minute med checks. I chose a different path because I believe the combination matters, and I love it. Medication can stabilize the soil. Therapy is where things actually grow.

But "therapy" is a huge umbrella, and the fit matters more than the brand name. CBT works well for some people and feels like a homework assignment to others. Brainspotting (which I use extensively in my own practice) accesses subcortical material in ways that talk therapy alone sometimes does not reach.

I sometimes joke that brainspotting and certain types of breathwork can be "psychedelics sober," because they use focused attention to access non-logical, body-based processing that parallels a lot of what is actually working in psychedelic experiences.

What I do is help you understand the options, think about what fits your brain and your life, and make sure your therapy and your psychiatry are actually talking to each other. (You would be surprised how often they are not.)

Lifestyle: Movement, Nutrition, Sleep, Substances, and Tech

This is the domain that sounds the most obvious and is the most underserved in traditional psychiatry. Your psychiatrist probably asked about your mood. Did they ask about your sleep habits? Your caffeine timing? How many hours of screen time you are getting before bed?

I am not going to lecture you about lifestyle. I am going to have an honest conversation about what is actually happening in your day-to-day, because these things directly shape your neurochemistry.

Sleep is often the single highest-leverage intervention I can make, and it does not come in a pill bottle (though sometimes a short-term prescription helps us break a bad cycle so we can build better habits).

Movement is medicine, but only if you actually do it, which means it has to be something you don’t hate. I am far more interested in you walking your dog for 30 minutes than white-knuckling through a HIIT class you dread.

And yes, we can talk about substances and screen habits. Not to judge you, but because these are neurochemical inputs just like everything else, and affect how we think and feel.

Mind-Body: Meditation, Yoga, Breathwork, Acupuncture, and Somatic Practices

The research on breathwork and vagal toning is real, and when someone's autonomic nervous system is stuck in overdrive, sometimes the most efficient path forward goes through the body, not through a conversation about the body.

That said, I am honest about what I practice and what I refer for. I use brainspotting extensively, which has a strong somatic component. For breathwork, yoga, acupuncture, and other body-based practices, I collaborate with practitioners I trust rather than pretending to be an expert in everything. The menu is not "things Patricia does." The menu is "things that might help you, and here is how we think about which ones."

Transcendence: Spirit, Perspective, Awe, Meaning, Values, and Purpose

This is the domain that makes some clinicians uncomfortable and that I think is non-negotiable. Not in a prescriptive, "have you tried gratitude journaling" way. In a "what actually gives your life meaning and are you connected to it right now" way.

I sit at a particular intersection. I am a board-certified psychiatrist who has also trained extensively in psychedelic-assisted therapy (CIIS certificate, three years of ketamine-assisted psychotherapy, psilocybin research facilitation at UCSD). I have personal engagement with contemplative and plant medicine traditions. I hold complexity here without collapsing it into a simple position, because it is genuinely complex.

For some patients, transcendence means reconnecting with a faith tradition. For others, it means spending more time in nature, or finally addressing the existential questions that have been sitting under the anxiety all along. For some, it means exploring psychedelic-informed approaches with proper preparation, integration, and medical oversight. I do not push any of these. But I do ask the questions, because clarifying your values and purpose is not a soft add-on. It is often what gives everything else a direction.

Social: Relationships, Connection, Community, and Support Systems

Loneliness is a health risk factor on par with smoking. I did not make that up; that is the Surgeon General's assessment, and the data behind it is robust. Yet most psychiatric intakes spend about thirty seconds on "do you have a support system?" before moving on.

I want to know the quality of your relationships, not just whether they exist. Are there people in your life who see you clearly? Are you able to ask for help? Are your boundaries working for you or isolating you? (Boundaries are a form of connection, not a wall. When they are working, they actually make closeness safer.)

Community and belonging matter too. Whether that is a therapy group, a faith community, a climbing gym, or a Discord server where people actually know each other, the specific container matters less than whether you feel like you belong somewhere.

Why a Menu and Not a Protocol

I could give you a protocol. Step 1, Step 2, Step 3. It would feel clean and certain and probably look great on Instagram. But here is what I have learned in practice: the patients who do best are not following a script. They are making informed choices from a range of options, adjusting as they go, circling back to things they initially skipped.

Healing is not linear. I use the metaphor of a spiral staircase. You come back around to the same views, but you are higher up each time. The menu is how I hold that complexity in a way that empowers patients rather than overwhelming them. We start where you are. We go at your pace. And the menu is always there for when you are ready for the next thing.

Patricia Pop, MD is a board-certified psychiatrist (Columbia, Stanford) practicing integrative psychiatry and psychotherapy in California. She specializes in working with high-functioning adults navigating ADHD, anxiety, and psychedelic integration, combining careful medication management with brainspotting, lifestyle medicine, and a whole-person approach. Her practice is based in San Francisco, with telepsychiatry available throughout California.

To explore whether this approach might be a fit for you, book a free introductory call.