Dr. Carl Feinstein is a nationally recognized leader in child and adolescent psychiatry, with decades of experience as a clinician, educator, and innovator in behavioral health. He is Professor Emeritus of Child and Adolescent Psychiatry at Stanford University and serves as Clinical Professor of Psychiatry and Vice Chair of Child & Adolescent Psychiatry at the University of California, Riverside School of Medicine. Board-certified in both Psychiatry and Child & Adolescent Psychiatry, Dr. Feinstein has devoted his career to advancing evidence-based care for young people and their families.
Over the course of his career, Dr. Feinstein has held numerous leadership roles in academic medicine and clinical practice, where he has focused on improving diagnostic accuracy, treatment quality, and access to care within complex health systems. He has been deeply involved in training the next generation of clinicians and shaping how behavioral health services are delivered across academic, community, and integrated care settings.
In recent years, Dr. Feinstein has brought his clinical and academic expertise to the health technology space. As a co-founder at Trayt Health, he helped guide the responsible integration of technology into behavioral healthcare, with a focus on patient-centered care that supports clinicians, improves outcomes, and addresses longstanding gaps.
Dr. Feinstein recently participated in a Q&A about the state of behavioral health, technology integration, AI, and the future of care. Read an excerpt from the interview below:
Q: What initially drew you to behavioral health?
I decided in college that I wanted to become a physician because it felt meaningful and useful. During medical training, I noticed that many people separate “physical health” from “behavioral health,” but I never saw that distinction as valid. There’s only one person. Mental and physical health are inseparable.
I was especially drawn to child and adolescent psychiatry. I loved pediatrics and working with families, and psychiatry gave me something unique: time to truly understand patients’ lived experiences. It wasn’t just about fixing a problem or prescribing a medication. It was about listening. That combination of brain science, psychotherapy, and long-term relationships made it the right field for me.
Q: Tell us more about understanding and listening to patients. Why is that important to you as a clinician?
At the turn of the 21st century, the importance of the Therapeutic Alliance, which is about building a collaborative relationship between patient and clinician, was not emphasized or systematically taught in clinical practice. There were, broadly, two dominant schools, which emphasized the premise that the “doctor knows best” and implemented a treatment regime with relatively little regard for the patient’s perspective or buy-in.
One of those was Behavioral Therapy where the therapist or psychiatrist directly took over changing patient behavior by changing the root causes, or by rewarding positive behaviors, or by altering environmental responses to actively discourage negative behaviors.
However, there has been a steady movement over time towards a variant of Behavior Therapy known as Cognitive Behavioral Therapy (CBT). In this approach, the therapist identifies maladaptive thought patterns and basically teaches the patient to think differently, in ways that are less distorted and more adaptive. While this approach still had a top-down pedagogical approach, it allowed for more active patient engagement.
Even more recently, some CBT therapists have adopted techniques, such as Acceptance and Commitment Therapy (ACT), to encourage more engaged therapeutic communication between patient and therapist in formulating treatment goals.
The other approach, Medication Management, involved psychiatrists who saw themselves as experts in evidence-based clinical trials and possessors of specialized knowledge in altering brain neurotransmitter systems. In this approach, the doctor is the expert, knows best, and “manages” the patient by prescribing a medication.
It wasn’t until a solid body of evidence-based treatment outcomes research proved more recently that the Therapeutic Alliance, in which the patient comes to trust their doctor as someone who listens to them, including their self-report of clinical status, is the single greatest mediating variable in improving patient outcomes.
This resulted in the ACGME (accrediting agency for medical education) explicitly stating in 2015 that the training in Therapeutic Alliance was the top priority in the psychotherapy training of residents in psychiatry. However, there is still a long way to go integrating the Therapeutic Alliance into the core practice of med management. Committees of the American Psychiatric Association have pointed to the urgency to improve medication management outcomes to overcome the chronic ongoing problems in poor patient medication adherence and a high rate patient dropout.
Q: How can technology help clinicians implement processes like the Therapeutic Alliance?
What I’ve been asserting is that if we want to improve outcomes, we have to improve the Therapeutic Alliance. The evidence base is clear on that. And improving the Therapeutic Alliance requires measurement-informed care.
There is a distinction between measurement-based care (MBC) and measurement-informed care (MIC). MBC has utility for tracking treatment outcomes. It is based on the patient completing highly structured evidence-based rating scales. These scales are most commonly viewed by the clinician (if ever) after the clinical appointment. This approach does nothing to support the Therapeutic Alliance. To accomplish that, we need measurement-informed care where the reporting by the patient of their issues and concerns is shared and discussed with the doctor during the actual clinical appointment. That is what supports the Therapeutic Alliance and mediates improved patient outcomes.
From the beginning of Trayt Health, what we wanted to do was get the doctor and the patient on the same page. First, by giving patients an easier way to share their perspectives about how they—or their child—were doing. But that alone wasn’t effective because doctors still weren’t looking at the information. So, we realized we had to build an entire system of care around it.
That’s where technology comes in. What we’re working on now is using technology to provide clinicians with real-time, easy-to-access patient information. Instead of the doctor sitting there transcribing notes and not fully engaging, both doctor and patient can focus on the same information together. That’s the main point: putting them on the same page to strengthen the Therapeutic Alliance.
Q: Where else can new technology potentially help clinicians?
Clinicians are overburdened. Too much of today’s technology is designed for billing and documentation rather than improving care. Progress notes justify medical necessity, but they don’t necessarily track meaningful progress.
If technology adds burden instead of saving time, clinicians won’t adopt it. It must make information easier to access, not harder. The key is designing systems that truly support clinical work rather than administrative requirements.
Likewise, the future of technology must make it easier for patients to capture status information, which in turn is easy for clinicians to see and act on immediately. Too often today, data is collected but not meaningfully used because clinicians and patients are overwhelmed. We need to flip that, so data brings value and understanding in a way that calms and grounds both clinician and patient.
Q: Where can AI help behavioral health clinicians?
First, does the technology improve measurement-informed care? Does it strengthen the patient-doctor relationship and improve real-time decision-making?
Second, does it genuinely reduce burden?
AI should assist clinicians, not create new tasks. It should function as a supportive partner in workflow and knowledge access. It can synthesize and help prepare a better report, it can go into specific symptoms and other comorbid diagnoses or medical conditions that the patient could have.
More importantly, AI can help patients communicate more effectively. It can process patient inputs like journals, spoken reflections, symptom descriptions, and organize everything into meaningful summaries for clinicians. That can strengthen the Therapeutic Alliance.
But privacy is absolutely critical for this to work. Sensitive information could be misused in ways that affect employment, insurance, or marginalized communities.
Any AI system used in healthcare must have rigorous protections. This is not optional. The ethical obligation to protect patient confidentiality is fundamental.
Q: Why did you join Trayt Health?
After a long academic career, I met Trayt Heath’s CEO Malekeh Amini. At the time, in the mid-2010s, we had different experiences and perspectives within behavioral health, but we both saw the same challenges and frustrations that could be solved by technology. It was this shared vision that led us to co-found Trayt Health, to use technology that supports measurement-informed care, aligned with what we believed for years was missing in our health care system. I joined as Co-Founder and Chief Medical Officer to help translate clinical principles into technology.
Our initial idea was simple: improve how patients provide information to doctors, and have both patient and doctor look at the same screen, literally have them be on the same page. But the problem was that doctors often weren’t engaging with information. That was true in 2015, and it’s still partially true today, which is why we’re continuing to improve how the doctor and patient interact with measurement-informed care.
I also joined Trayt because the company truly believes in improving access to care, which is something that is still foundational today.
Q: How can technology companies best support clinicians going forward?
Technology must add real value by improving patient outcomes, not just collecting data or facilitating billing. If it only tracks outcomes without influencing care, it’s not enough.
The focus should be on improving clinical effectiveness and strengthening the working alliance between patient and provider.
We face serious risks ahead. Provider shortages, cost pressures, and the possibility that mental health becomes further stigmatized or carved out from the rest of healthcare.
The future depends on recognizing that mental health is health. Technology can help make care more accessible and effective, but it must be implemented thoughtfully. The challenge is large, but so is the need.
