Alexandra Baluna, MD

Dr. Gotsche is a board-certified adult psychiatrist who is dedicated to helping individuals navigate their mental health journey. Originally from Illinois, she completed her undergraduate studies at Illinois State University before earning her medical degree from Kansas City University. She went on to complete her psychiatry residency at the University of Oklahoma. Following residency, she worked at the Kansas City VA Medical Center where she primarily focused on outpatient mental health. Outside of her clinical work, she enjoys cooking, reading, cycling, and hiking.

Dr. Gotsche takes a holistic, integrative, and evidence-based approach to mental health care. She emphasizes the importance of building a strong therapeutic alliance and working closely with each patient to ensure treatment fits their unique needs and goals. She is experienced in treating a variety of psychiatric conditions including mood disorders, anxiety, trauma-related disorders, and ADHD. She is committed to providing comprehensive care in a supportive environment.

Dr. Gotsche will conduct a thorough evaluation to learn each patient’s medical history, current symptoms, and treatment goals. She values open communication and a collaborative approach, ensuring that patients are actively involved in the decision-making process. An individualized treatment plan will be developed which may include medication management, psychotherapy, or referrals to additional services as needed. Her goal is to provide integrated, patient-centered care that promotes long-term well-being.

Dr. Kristina Foreman is a board-certified psychiatrist and child and adolescent psychiatrist who earned her medical degree from St. George’s University and completed both psychiatry residency and fellowship at the University of Vermont Medical Center. She served for four years as an attending on a high-acuity inpatient adolescent unit in Denver, leading a multidisciplinary team in the care of complex cases. She also presents nationally on Positive and Lifestyle Psychiatry and has taught these approaches to fellows and residents.

Her style is open, thoughtful, and relationship-focused, creating a space where patients feel safe sharing what matters most. She brings a therapeutic mindset to every encounter and practices strengths-based care to help people connect with resilience and agency. Trained in the Vermont Family-Based Approach, she values family involvement and blends medication management with therapeutic principles and lifestyle psychiatry to support emotional flexibility and values-driven change.

Dr. Foreman begins by gaining a full understanding of each patient’s history, strengths, challenges, and hopes for treatment. She builds individualized plans that may include medication, lifestyle strategies, psychotherapy-informed tools, and family participation when helpful. She incorporates ACT, DBT, CBT, and positive psychology concepts to foster insight and skill development. Follow-up visits focus on refining the plan so progress feels steady, collaborative, and aligned with patient goals.

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Dr. Gregory Marc Varhely is a board-certified general adult psychiatrist. He grew up in Austin, Texas, and attended Texas State University, where he earned a BA in Psychology and a Master's degree in Biology/Biochemistry. After graduating from medical school at Ross University, he completed his residency in Psychiatry at the Medical College of Wisconsin. Dr. Varhely has served as an outpatient psychiatrist at the Department of Veterans Affairs and acted as an attending physician for resident psychiatrists at Texas A&M and UT Dell Medical Schools. He then acted as a sole proprietor of an outpatient psychiatric medication management and psychotherapy practice in Georgetown, Texas and later started contracting for North Central Health Care Mental Health Clinic, applying psychotropic medication management expertise to community-based treatment facilities in Wisconsin. Dr. Varhely's approach is rooted in forming meaningful connections with his patients. He wholeheartedly believes that psychological suffering stems from a blend of biological, psychological, social, and environmental factors. Dr. Varhely works together with his patients to uncover these factors and create treatment plans tailored to their specific needs using an eclectic blend of the latest in psychopharmacology, as well as psychodynamic, supportive, and cognitive-behavioral therapy.

Dr. David Wait, MD is American Board of Psychiatry and Neurology certified and a fellow of the American Psychiatric Association. A skilled psychopharmacologist and psychotherapist, he has over 30 years’ experience successfully helping people overcome a diverse range of emotional, psychiatric, and addiction challenges.

David was born in Sioux Falls, South Dakota, and is a graduate of Augustana College. He obtained his MD at the USD School of Medicine. His residency was at the University of Arkansas for Medical Sciences (UAMS) in Little Rock where he was trained in both psychotherapy and biological management of psychiatric challenges.

Following residency training, Dr. Wait continued to work with UAMS and the State of Arkansas in research and program development focusing on implementing and then teaching novel strengths focused care for people with severe mental illness for the first 12 years of his career.

Later, Dr. Wait moved with his wife and three children to Coeur d'Alene, Idaho. He has since been in clinical practice and leadership roles in inpatient, outpatient, and telehealth psychiatric care settings.

Rather than focus primarily on illness or problems, Dr. Wait’s approach is to first evaluate his patients comprehensively, then utilize what’s learned from this to treat and empower them to make and then practice choices that lead to improved health and well-being, using an integrative model that recognizes that mental, physical, social, and spiritual health are one.

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Dr. Anna Ostrovskaya is a board-certified psychiatrist with over 20 years of experience working with adults of all ages. She earned a bachelor’s degree in psychology from NYU, a medical degree from Rush Medical College, and completed her psychiatry training at Yale. Dr. Ostrovskaya has practiced in inpatient, consultation-liaison, and emergency psychiatry settings, though her primary passion is outpatient care, where she builds long-term therapeutic relationships. She has worked in private practice and clinic settings and serves on the faculty at Yale’s Psychiatry Department, teaching and supervising trainees. She treats a wide range of conditions, including anxiety, OCD, ADHD, PTSD, depression, bipolar disorder, and more, with experience across diverse populations.

Dr. Ostrovskaya emphasizes integrating therapy and medication management. She creates a warm, safe, and respectful space where patients feel understood and supported in their journey to recovery. Her approach focuses on treating the whole person, recognizing that everyone’s story is unique and informs the best path forward.

She conducts thorough evaluations and uses evidence-based prescribing while incorporating psychotherapeutic modalities such as CBT, executive skills training, insight-oriented approaches, and motivational interviewing. Understanding a patient’s history, current symptoms, and treatment goals is central to developing an effective plan and building a strong therapeutic relationship.

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Darcie Farrell is an ANCC Board Certified Family Psychiatric Nurse Practitioner.  She has worked exclusively in the field of psychiatry during her forty-year nursing career.  She has worked in many care settings, including as a psychiatric Home Health Nurse and as a Certified Case Manager (CCM) in Psychiatry at Blue Cross Blue Shield. During her time at Excellus Blue Cross Blue Shield, she realized the urgent need for psychiatric nurse practitioners, so enrolled in the BSN/MSN program at the University of Rochester, graduating in 2016 with her BSN and in 2018 with her MSN.  She has strong skills and experience in Motivational Interviewing, having worked as a Motivational Counselor for a University of Rochester's Pediatric Research Program.   She has worked for the past seven years as a Nurse Practitioner in Geriatric Outpatient Psychiatry.

Darcie Farrell is a compassionate provider who is client centered. I rely on evidence-based scientific research when determining the best treatment options for clients.  

Darcie Farrell has a very relaxed process for working with patients which allows the client to provide information that is pertinent to their goals for care.  Then, together, we determine which treatment options are likely to be best for the client.

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