Psychotherapy · Solutions Psychiatry
Online psychotherapy with a clinician who knows your whole picture
Real therapy, not check-ins: unhurried sessions with a psychiatric clinician trained across a deep bench of methods, on secure video across 35 states and Washington DC.
Solutions Psychiatry is the full practice: therapy and medication care from one clinician. If you want medication management only, that care has its own home at PsychMed Care.
Therapy is half of what this practice does
Most psychiatric care splits in two. A prescriber manages medication in short visits, and a separate therapist hears the rest, with your story retold in fragments and context lost in the handoff. This practice was built the other way. Karel Winner, DNP, PMHNP-BC, is a psychiatric clinician who provides psychotherapy and medication management in the same course of care, so the conversation and the prescription live in one room.
That changes what therapy can do. What surfaces in a session can shape a medication decision the same week. A medication change can be judged against how you are actually sleeping, working, and getting through the day, not against a checklist read cold. And when therapy alone is the right tool, it stands on its own, with no pressure to add a prescription.
Sessions run on secure video for adults and older teens (17+). The work is steady, direct, and never rushed: patterns get named, not circled, and you stay in the driver's seat throughout.
Expect to be known. Notes here are not a symptom log; they are a running understanding of your history, your people, your pressures, and what has and has not helped. That is what one clinician, over time, makes possible, and it is the quiet advantage of doing therapy inside a practice rather than renting it by the session.
The toolkit
A deep bench of methods, matched to you
Years of formal training across the approaches below means your care never has to bend to fit the only tool available. The method fits the person, and it adapts session to session. Depth matters as much as range: Level 3 IFS and five phases of BrainSpotting are not weekend certificates, and the judgment to choose among them is the real credential.
Internal Family Systems (IFS), Level 3
The highest tier of IFS training. For the parts of you at war: the inner critic, the protector, the part that shuts down. Trauma, shame, and stuckness respond to this work when nothing else has.
BrainSpotting, Phases 1, 2 and 5
Where you look affects how you feel. A brain-body method for trauma and performance blocks that talking around the problem never quite reaches.
Somatic Experiencing
Trauma and stress live in the body's responses, not just the story. We work with sensation, activation, and settling, so your nervous system learns the danger is over.
Exposure and Response Prevention (ERP)
The gold standard for OCD, done with a steady hand and a clear map. Intrusive thoughts lose their grip when you stop negotiating with them. The full picture, including how ERP is sequenced with medication, is on the OCD page.
Acceptance and Commitment Therapy (ACT)
Unhook from the thought, turn toward what you value, and take the next committed step. Especially powerful for anxiety and avoidance.
Cognitive Behavioral Therapies
The evidence backbone: patterns, beliefs, and attention. Trauma-focused and mindfulness-based variants when they fit the picture.
Motivational Interviewing
For ambivalence and substance use. Change that lasts is change you chose; the work is helping you hear your own reasons clearly.
Solution Focused Brief Therapy
Small wins, concrete next steps, and evidence that you are already moving. Ideal when you want progress you can measure.
Psychodynamic and attachment work
The history under the habits: how you learned to survive then, and what that strategy costs you now.
Seeking Safety
Trauma and substance use treated together instead of in sequence. Present-focused and skills-first.
Two further pieces round out the bench. In Colorado and Oregon, the two states where this care is legal, Karel Winner is a trained, licensed psychedelic-assisted therapy facilitator, with preparation and integration support available everywhere else. And as a certified life coach (CLC), he folds goals, structure, and accountability into treatment when what you need is forward motion, not just symptom relief.
How it works
From first conversation to steady work
1. A real first conversation
The 60 minute Comprehensive Initial Appointment covers what brought you in, your history, your physical health, your sleep, what you have tried, and what a good outcome would actually look like for you. Share as much or as little as you are ready to.
2. A method chosen for you
Your clinician matches the approach to the problem and to you, and explains the reasoning. Nothing is applied by habit.
3. Active, engaged sessions
Expect questions that reach beneath the surface and patterns named plainly. This is collaborative work, not a weekly monologue into a notebook.
4. Review against your outcome
Progress is measured against the outcome you defined at the start. When the evidence says adjust, the plan adjusts.
Who therapy here is for
People arrive with a diagnosis, a suspicion, or just the knowledge that something is not working. Therapy here commonly serves depression that flattens everything, anxiety that will not stand down, OCD with its loops and rituals, PTSD and the long tail of trauma, insomnia, substance use, and the stuck patterns underneath all of them: the inner critic, the shutdown, the protector that will not retire.
It also serves people whose charts look fine. Professionals carrying more than they show, new parents, people in grief or in the middle of a major transition often do their best work here, precisely because the clinician across the screen can also speak to the medical side: sleep, labs, medication history, and the physical contributors that talk therapy alone cannot reach.
The intention we work from
Care starts with a short treatment intention agreement: the intention we start from, what your clinician commits to you, and what the work asks of you. Your signed, dated copy files into your chart. It is a small document with an outsized effect. Both sides know what good care looks like here, and what to do when the work gets hard, which it sometimes should.
Between sessions, existing patients reach the practice through the patient portal and Spruce, and scheduling runs on IntakeQ once your forms are complete. Online care, run this way, is not a lesser version of the office. It is the same standard, with the commute removed and the context of your actual life, your home, your schedule, your state, built into the work.
When medication joins therapy
Sometimes conversation is enough. Sometimes the biology needs help before the conversation can land. Because your therapist can also prescribe, that decision happens inside the therapy, with full knowledge of your story: read when medication joins therapy on this site's medication page. There is no referral, no second Comprehensive Initial Appointment, and no starting over with a stranger.
The door swings the other way, too. If you would rather focus on medication alone, that care has its own dedicated home: medication management without therapy at PsychMed Care, run by the same clinician. Moving between the two is straightforward, because it is one practice.
Therapy here serves people working through depression, anxiety, OCD, PTSD and trauma, insomnia, substance use, and the weight of long-standing patterns. If you are not sure whether therapy, medication, or both fit your situation, the first conversation is where that gets sorted out, honestly.
One clinician for the whole conversation.
Start with a 60 minute Comprehensive Initial Appointment. Your insurance is verified before the visit, and you leave with a plan, not vague reassurance.