For teenagers and young adults · Telehealth worldwide
You are not an illness. You are not a disorder.You are a remarkable human being in the middle of an initiation.
Together we write your origin story. I guide you through the hero’s journey you are already on. And you write your return. Psychiatric care and psychological midwifery, in one practice.
Request a consultation →A few questions, about five minutes. I read every inquiry myself and reply within two business days.
Looking for help for your teenager or young adult? Use the same form and tell me about them.
Where most young people are when they find me
By now you may have a stack of diagnoses, and a story to go with them.
- Anxiety
- Panic
- Depression
- Trauma
- ADHD
- OCD
- Can’t sleep
- Can’t eat
- Substances
Each name was probably accurate. Put together, they start to sound like a verdict. Something is wrong with me. I’m the problem. And underneath, the most frightening sentence a young person can believe:
Maybe this is just who I am.
It isn’t. It is where you are. No one should have to grow up believing their diagnosis is their name.
A truer story
Every culture on earth has known about initiation.
A young person is led out of the life they knew and into a dark place: a forest, a cave, a long night. The old ways of staying safe stop working. They meet there what they fear most. And if they are not left alone in the dark, they come back changed, carrying something the people they left behind will need.
When Joseph Campbell mapped the hero’s journey across a thousand myths, he named the dark middle of it Initiation. Not Breakdown. Not Disorder.
The diagnoses describe the country you are crossing. None of them is your name. Every symptom was once a solution: the watchfulness, the numbness, the bracing all began as ways a young nervous system kept itself alive. They deserve to be understood, and then, gently, relieved of duty.
What I believe
You already carry immeasurable loving-kindness, compassion and wisdom.
Everyone does, even in the darkest part of the cave. My work is to help you find yours, so that you become the author of your own story and the healer of your own life.
How we work together
Three movements. One story, and it’s yours.
Your origin story
Every hero’s story starts with where they come from. In our first sessions I gather your history, all of it, and write it back to you as an origin story: your life told through the hero’s journey and the oldest myths we have, with one myth chosen because it tells your story almost line for line.
It is the story of how you got your powers. You mark it up, and wherever I got it wrong, your version wins.
You receive: Where You Come From, a small book written for you alone. See a sample.
The pathway through
Then, as your guide, I write the road ahead, session by session. Each part has a teaching built around a story, a letter to you, and a practice small enough for an ordinary Tuesday.
Around it, the care you need: medication when it genuinely helps, psychotherapy that goes somewhere, practices for the body, and work with your family when that’s part of it.
You receive: A Lamp in the Cave, your pathway, in six sessions. See a sample.
Your next chapter
The goal is not a life without hard seasons. It is coming back up carrying something, and knowing the way back when you need it.
This part you write. I support your creativity and your courage as you write your own next chapter, and your return.
You write: Where I Am Going, a story about yourself that is true, in your own words. See a sample.
“I want to help you write your own origin story, to guide you along the hero’s journey, and to help you write your return.”
Request a consultation →What you’ll hold in your hands
We co-create three small books together.
These three are hypothetical books, examples of what I co-create with my patients. Yours will be entirely unique, tailored to your own history, needs and aspirations.
Where You Come From tells your life as an origin story. A Lamp in the Cave is the road through the dark part, written one session at a time. Where I Am Going is the one you write yourself: your return, in your own words, with me beside you.
Read the sample books in full: Where You Come From · A Lamp in the Cave · Where I Am Going
From a sample origin story
Written for a fictional young woman, to show what these books are like. No real patient’s story appears anywhere on this site.
Your world began in a gray town on cold water, in a house above a stony beach. Your grandmother, on the telephone from Japan, asked that you be named Akari. It means light.
When you were four your brother was born, and your mother went somewhere none of you could follow. At night your grandmother sat at the edge of your bed and told you a story about a sun goddess, her brother the storm, and a cave.
| In her words | In the myth |
|---|---|
| He’s twelve, I said. He doesn’t mean it. | The sun makes excuses for her brother, again and again, until she can’t. |
| Funny how quiet it gets / inside a rock | She goes into the cave, closes the stone door, and bolts it. |
| There’s someone in the mirror lately / I keep meaning to meet | Told there is a goddess more radiant than she, she leans toward the mirror. It is herself. |
The sun went into the cave because the storm was terrifying, not because anything was wrong with the sun. Her light never went out. It was only waiting for a mirror.
The pathway, session by session
A map for the dark part of the journey.
Every pathway is written for one person. Here is the shape of one of them, so you can see what the work looks like.
- Where You Come FromYour story seen whole, and a name for what you’ve been carrying that is a map, not a verdict.
- The Watchful HeartThanking the part of you that never stops keeping watch, and finding rooms where it can rest.
- Tea with Your DemonsMeeting what is hard without fighting it, after the Tibetan yogi who invited his demons to stay.
- The Fire You Were Told to HideWhat your anger has been guarding, and how it is made of the same stuff as your strength.
- Your Own SeatYou don’t have to earn your place here. What happened was not your fault.
- Out of Tune, and Coming HomeYour power, your belonging, and the body you were born in, the first home you were given.
Each session: a teaching built around a story · a letter to you · a practice you can do in a few minutes · notes for when we meet. Read the whole sample pathway →
Your guide
A psychiatrist, and a psychological midwife.
A midwife doesn’t give birth for you. She has been present for a great many births. She knows the territory, stays beside you through the long night, keeps you safe, knows when to wait and when it is time, and is there to catch what is being born.
I am a psychological midwife, and I would like to help you open to your poetic imagination as a pathway for your transformation.
I have sat with a great many young people in the dark part of their story, and I have been in the dark part of my own. Whatever I teach, I needed first.
I’m a physician, trained at UCSF and Stanford, with subspecialty training in child and adolescent psychiatry, and I have worked with students at Stanford and at other universities and medical schools. Alongside that runs a contemplative path that began when I was sixteen, with my first Buddhist initiation, and has continued for decades with my teachers Dzigar Kongtrul Rinpoche and Pema Chödrön.
- MedicineMedication when it genuinely helps, offered as a bridge and never a verdict. Often more help early, then less as the work takes hold. I’m also a safe person to talk to if you want to come off medication.
- PsychotherapyTraining across CBT, DBT, internal family systems, psychodynamic and family-systems work, chosen for you rather than applied to you.
- Contemplative practiceTools from a thousand-year-old tradition, translated for a dorm room or an exam hall. No belief system required.
- The bodyA decade of bodywork, including a three-year apprenticeship with Marion Rosen. Trauma lives in the body, and the way home runs through it.
- Story, myth and poetryMaps people have used for thousands of years to find their way through the dark and back, and your own poetic imagination, which often knows the way before you do.
- FamilyA young person’s struggle is almost never only theirs. Parents, and sometimes schools, are part of the work.
How I work
In the old myth, nobody breaks the rock.
The sun comes out of the cave in her own time, toward her own reflection. Six commitments shape my work, and set it apart from conventional psychiatric care.
- The person, not the diagnosisI center the work on you, not on symptoms, diagnoses or disorders. A diagnosis can describe the terrain you are crossing. It never describes who you are.
- Immeasurable resources withinEvery person carries immeasurable compassion and loving-kindness, and immeasurable wisdom. We start from what is strong in you, not only from what hurts.
- Author and healerThe best position for you is to be the author of your own story and the healer of your own life. I am your guide and collaborator, not the author of your life.
- Agency and creativityWe build your agency and creativity, so you can draw on what is within you rather than leaning on experts, medication or other people’s advice. Medicine can help along the way, but the healing is yours.
- Poetic imaginationYour images, metaphors, poems and stories, alongside the myths of many cultures, are a pathway to transformation. Your imagination often knows the way before you do.
- Where intention meets actionTogether we find your greatest aspirations. Then you aspire to them, and apply them to your daily life, where intention meets action.
What you can count on
- No one will drag you out before you’re ready. The work goes at the pace your nervous system can take, and we widen that pace together.
- Medication is a tool, never a verdict. We’ll be honest about when it helps and when it doesn’t, and decide together.
- You won’t be told to just meditate about it. The practices are small, concrete, and come with a psychiatrist attached.
- Nothing asks you to adopt a belief. The myths are maps, not doctrine. Use what fits and leave the rest.
- You won’t be left alone in the dark. Every pathway includes a plan for the hard hours and for what to do when it’s too much.
- Where my version of your story is wrong, yours wins. You read everything I write about you, and you have the last word.
For parents
When it’s your child in the cave.
You may have been told to wait it out, or handed a prescription and a follow-up in six weeks. You may be exhausted and frightened, and quietly wondering what you did.
In the oldest telling of the myth, the sun comes out of the cave because the people outside it gather, make a plan, and make it safe enough. Nobody argues her out. That is your part, and you don’t have to work it out alone.
For teenagers, the initial evaluation includes time with parents and, with permission, contact with the teachers, therapists or pediatricians who know your child. At the start I’ll explain plainly what a parent will be told and what stays private, so everyone knows where they stand.
Request a consultation for your teen →What a return looks like
Not a life without hard seasons. A way back up.
- The alarm turns down enough for you to hear your own mind.
- The things you were ashamed of turn out to be gifts trained in a hard school: your sensitivity, your watchfulness, your intensity.
- The hard seasons still come. You know the way back up.
- You can tell a story about yourself that is true, and it isn’t a diagnosis.
- You find out what you came back carrying, and who needs it.
- You know what you most aspire to, and you live it on an ordinary day, where intention meets action.
About Jim Ashe, M.D.
Two educations, running side by side for a lifetime.
One is conventional and rigorous. The other began at sixteen, when I received my first formal Buddhist initiation from the Sixteenth Karmapa, and has run alongside my medical life ever since. I have spent most of my career noticing how precisely the two map onto each other.
I’ve written about that overlap in a book, From Fog to Clarity.
- M.D., University of California, San Francisco
- Psychiatry training, Stanford University
- Subspecialty training in child and adolescent psychiatry
- Master’s degree in clinical psychology
- Board certified in psychiatry and neurology
- Psychiatrist to students at Stanford and other universities and medical schools
- Co-taught the Healer’s Art course at UCSF with Dr. Rachel Naomi Remen
- Hospice work in San Francisco during the AIDS epidemic, including the Zen Hospice Project
- A decade of bodywork; three-year apprenticeship with Marion Rosen
- Student of Dzigar Kongtrul Rinpoche and Pema Chödrön
The practice
How we begin.
- A few questionsA short, secure form: what’s brought you here, what you’ve already tried, what you hope will be different. About five minutes. I read every inquiry myself.
- A conversationIf it looks like a fit, a free 15-minute call. No obligation on either side.
- Your origin storyA full initial evaluation, where your story begins to take shape on paper.
- The journeyOngoing sessions at the rhythm that fits you: psychotherapy, medication visits, or both.
Where
Telehealth by secure video, worldwide. Origin stories and guidance along the journey are open to young people wherever they live.
Psychiatric care, including diagnosis, medication and psychotherapy, is for people physically in California at the time of the appointment, where I’m licensed.
Who
Teenagers and young adults, including college students, and the families around them.
Fees
$450 per hour
The first 15-minute call is free.
Insurance
I don’t bill insurance directly. I can give you a superbill to submit for out-of-network reimbursement, which many plans pay in part.
Cancellations
Please give 48 hours’ notice; later cancellations and missed sessions are charged the full fee.
Between sessions
Message me through the secure client portal for anything non-urgent. I reply within one or two business days.
Current patients
Scheduling, forms, secure messages and video sessions are in the client portal. Open the client portal.
You are not an illness. You are not a disorder.You are a remarkable human being in the middle of an initiation.
I want to help you write your own origin story, to guide you along the hero’s journey, and to help you write your return.
Request a consultation →Prefer to talk to a person first? Call 415-762-2700 and leave a message. I return calls within one or two business days.
Telehealth worldwide. Psychiatric care and prescribing for people in California, where I’m licensed.