Although the practice of psychiatry has long been dominated by the image of the psychoanalyst – a Freudian figure who sits behind a patient reclining on a couch and recounting everything that happened to her since birth – the fact is psychiatry is a dynamic field that encompasses much more than just exploring childhood traumas.
“Psychiatrists treat disorders in mood, thinking and behavior. They evaluate and treat any psychiatric disorders or mental illness,” says Dr. Eileen P. Ryan, interim chair and professor of psychiatry and behavioral health at The Ohio State University Wexner Medical Center. These disorders and illnesses include a constellation of specific problems, including depression, anxiety, bipolar disorder, schizophrenia, autism spectrum disorders, obsessive compulsive disorder, eating disorders, post-traumatic stress disorder, substance abuse issues and personality disorders.
Psychiatrists have a number of tools in their arsenal to help patients cope with disorders that may be disrupting their lives, such as medications and psychotherapy. These medical doctors have gone through four years of college, four years of medical school, residencies, internships and often years-long fellowships. Highly trained, these physicians can have a huge impact on a patient and their family by offering support and solutions in times of crisis or just helping people deal with the day-to-day stressors we all face at times
Not everyone will need a psychiatrist, but mental health problems are quite common. The National Institute of Mental Health reports that “nearly 1 in 5 U.S. adults lives with a mental illness.” Although the range of illnesses and their severity varies widely, a psychiatrist can be a major help if you’re struggling with such a condition. The NIMH reports that in 2016, 19.2 million adults with any mental illness received treatment.
Dr. Dinah Miller, co-author of the book “Shrink Rap: Three Psychiatrists Explain Their Work,” is a psychiatrist in private practice and instructor at Johns Hopkins School of Medicine in Baltimore. She says that when looking for a psychiatrist, it’s important to think about what you want to get out of the relationship and what your needs are.
“One of the key things that people should know and don’t understand is that some psychiatrists see people for therapy and some don’t.” In many cases, patients see a psychiatrist for medications while psychotherapy or counseling comes from another source, such as a psychologist, a social worker or another therapist. Unlike psychologists who typically do not have a medical degree and usually can’t write prescriptions, psychiatrists are medical doctors. These specialists often work in concert with another mental health provider who offers additional interventions such as cognitive behavioral therapy and other talk-based treatments.
With that said, if all you need is a prescription, and other elements of your treatment are being managed by a non-prescribing mental health care provider, can your primary care physician take care of the prescriptions? Miller says many primary care physicians can and do fill this role, but in more complicated cases or instances where multiple medications have been prescribed and failed or side effects have been problematic, it may be best to seek the help of a psychiatrist.
If it’s time to seek out a psychiatrist, Ryan says it’s useful to have an understanding of what you want to accomplish with seeing this doctor. Is the goal to treat your depression? Or are you seeking a second opinion about a diagnosis, such as bipolar disorder, for example? “You may want to have a specific question in mind in terms of what it is you want.” Understanding what you’re after can help guide your selection.
Dr. Tristan Gorrindo, director of the division of education at the American Psychiatric Association says your primary care physician is a great place to start when looking for help with mental health issues. Gorrindo subspecializes in child psychiatry and says, “I personally have a number of pediatricians that I work with very closely. We trade patients back and forth all the time,” and most doctors will have similar networks they can plug you into. Some medical practices that use a collaborative care model may have a psychiatrist on staff. The APA also offers a Find a Psychiatrist feature on its website.[
In addition to asking your doctor for suggestions, try asking friends and family, too. Ryan says starting from scratch in finding a psychiatrist can be challenging, but a recommendation can help you feel more confident making that first appointment. “Much of what [psychiatrists] do is in private. When people ask me to recommend a psychiatrist, I typically will recommend people that I know well enough to know the quality of their practice or how they practice. These are people I have worked with or have communicated with enough about mutual patients to know how they go about their business.” Getting that kind of insight from another provider, friend or relative can help you make a good choice.
Psychiatry is one of many specialty medical fields that’s experiencing a shortage of practitioners. Some patients report difficulty in finding a psychiatrist who’s accepting new patients, and your ability to get in to see a psychiatrist can vary significantly depending on where you live in the country. Some regions, such as the Northeast, have many more psychiatrists than other more rural parts of the country. Still, if you need help and are having trouble finding it, “keep trying,” Miller says.
One of the issues with psychiatric services is that not all psychiatrists take insurance, so check with your insurer as to who’s in network. Miller also notes that outpatient mental health clinics exist in many communities and may be able to offer psychiatric services to patients facing financial barriers.
To help make your first visit as productive as possible, Miller says she asks her patients to bring all the medications they’re on – including any supplements or over-the-counter medications – so she can see exactly what they’re taking. “I want to look at the bottles and see who’s prescribing what and make sure there’s no interactions and that the symptoms they’re experiencing aren’t caused by the medications.” Miller also suggests that patients bring a loved one to the appointment if they want support. It’s not mandatory, but some patients find it helpful.Play VideoPlayUnmuteLoaded: 0%Progress: 0%Current Time 0:01/Duration 1:02
It’s also important to know your family history of mental illness. “There are a lot of psychiatric disorders that aren’t caused by anything in the environment, but rather that people are biologically predisposed to in the same way they might be biologically predisposed to other medical illnesses like diabetes,” Ryan says. Therefore, knowing your family history can be an important part of the puzzle.
Similarly, knowing your own history is important, too. When and how did your symptoms begin? Have they changed over time? Which medications have you tried in the past? Did you have any allergies to any medications or other complications from any treatments you previously received? Your psychiatrist will likely ask all these questions and more, so being prepared with answers can help make your meeting more productive.
In addition to bringing medications and your history, it’s important to bring a willingness to be open and honest about what’s going on in your life, Gorrindo says. “People are very afraid to share what’s really going on in their inner world. But I can tell you that psychiatrists have seen it all. There’s almost nothing you can tell a psychiatrist that will surprise him or her.” It’s important to know that when you’re seeing a psychiatrist, “this is a safe space. My job is not to lock people up in an institution. My job is to help you get better and you need to share with me all the things that are really hard to talk about that maybe you’ve never shared with another person before.”[
Miller agrees, saying that being comfortable sharing private information with a psychiatrist is the key to a care relationship that will get results. “Even if you’re just seeing them for medications, if you’re not comfortable telling them honestly what you’re feeling and what’s going on in your life, they’re going to be limited. It’s like practicing with an arm tied behind your back.” Psychiatrists aren’t mind readers, after all, and you have to tell them what’s going on for them to be able to help you.
These fears of sharing what’s really happening may result from the stigma that still stubbornly exists around issues of mental health, but Gorrindo wants patients to know that being willing “to share the details helps the psychiatrist zero in on the right diagnosis and be able to help you.” And it’s important that you feel heard. “The qualities that make for a good psychiatrist are the same qualities that make for a good physician in general, which are someone who’s willing to sit, listen and hear your story and understand your symptoms in the context of your overall medical and mental health. They also need to be willing to collaborate with you in terms of figuring out which treatment approach makes the most sense.”
If you’re meeting with a psychiatrist and something doesn’t feel quite right or the doctor seems rushed, ask for clarification. “I always think it’s good to be assertive about what’s not working,” Ryan says. Speaking up if something doesn’t seem right or you have questions that haven’t been addressed can help you determine whether this is the right doctor for you. If you ask for more detail about pros and cons of a particular medication or other treatment options, for example, the doctor “can respond to it and the relationship can get significantly better. If they blow you off, then find somebody else,” she says.
Lastly, when it comes to finding the right doctor to treat more complicated diagnoses or severe illnesses, Gorrindo says it’s less important for patients to seek out a subspecialist for their specific condition than it is to just simply get into the system. “In some ways, psychiatry is a bit like internal medicine. Most internal medicine doctors can treat diabetes, hypertension, arrhythmias and pneumonia – all those kinds of things,” but when there’s a particularly complicated case, they will refer the patient on to a specialist. “Just reaching out and engaging with any psychiatrist is the right first step,” he says. “Any psychiatrist can treat substance abuse, psychosis, depression, PTSD, etc. And they’ll tell you if they feel like you need to see a psychiatric subspecialist. I don’t think people should have to find the exact subspecialist that matches their diagnosis. Just getting into the system and starting that conversation” is the best thing you can do when you need help.
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