Getting to a Psychiatrist

Some suggestions for finding a psychiatrist if you don't know where to start.

1

Check with your friends

You'd be surprised how many of them know therapists for one reason or the other. And like all services, word of mouth referral is the best type. If this doesn't get you an answer, or if you are uncomfortable with the idea of asking your friends, there are a few options.

Ask your doctor.

Call up your local hospital or health centre. Many of them will have a system for dealing with patients who need psychiatrists, and if there is not one on staff, they may have a list of psychiatrists they work with. If you are in college, check the college's medical department. Tell them that you have been feeling depressed and that you would like to see a therapist / psychologist / psychiatrist.

Call up the local "emergency help line" (the ones you can call at 2 am because you need someone to talk to). Tell them that you have been feeling depressed and ask if they have a list of therapists / psychologists / psychiatrists.

There is always the yellow pages, but then you have no references as to if they are good or not so good. Check under Psychologist or Psychiatrists.

If you are in your teens, tell your parents you are having problems and would like to see a therapist. Insist on it if necessary. Or use any of the above ideas.

Which one should you visit, a therapist or psychologist or psychiatrist? Initially, I think it's somewhat irrelevant for the first few visits which one you go to. Check out my notes on Should I Take Therapy or Pills for some of my ideas. But if you are looking for or need medication, you will need to go to a psychiatrist - they are the only ones qualified to issue prescriptions (in the rest of the document, for brevity I use the word "psych" to mean therapist or counselor or psychologist or psychiatrist).

If you procrastinate a bit in trying to find help or make an appointment, don't worry - it comes with the territory. But don't put it off forever either. Give yourself say, two weeks to make the first try.

When I was first trying all this I was somewhere between embarrassed and ashamed and I found it easier to call by telephone so the person on the other end didn't see me. If you want to, you can give the receptionists a fake name. You can always sort it out when you reach their office. Tell them you were embarrassed - they'll understand.

Don't worry if you fail to make the appointment. Psychs are probably used to it. However, it might help if there is a friend who can go with you to the first appointment. Having someone else accompany you makes it a lot harder to skip out at the last minute.

When you walk in a psych's office for the first time, you are going to feel as if there is a huge red sign hanging around your neck with the words "mad person" written on it, and you are going to feel as if everyone is staring at you and whispering about you.

Relax. They aren't.

First of all, your presence at a doctor's office isn't that important to other people. They have their own problems to deal with. The second thing is most of the people who will be at a psych's office, including the receptionists, see therapy as just another medical treatment - same as if you were going to get your eyes checked. They don't assign any negative thoughts to it. So don't think they think you are crazy. Nevertheless, expect to feel nervous and a bit like a fool the first time you go. That's normal.

Talking to the Psych for the First Time

Very often, not all that much tends to happen the first time you visit a psychiatrist. You are likely to be defensive, the psych is trying to figure out both the surface and underlying problems and both you and the psych are trying to become comfortable with each other. Assume that you may be a bit disappointed with the first session.

Nevertheless, as best as you can, describe what you are feeling and ask for advice. You are not likely to be particularly honest in the first session, after all it is difficult to talk about personal problems to a complete stranger. However, try to be if you can.

Talking to a psych is good generally, but you may feel as if visits are not productive for the first three or four times. That's normal. It can take that long for you to feel comfortable with the psych, so it is worthwhile to stick with visiting them for a while. Do not simply give up after one or two visits.

Therapy is not like going to a doctor to get a diagnosis and pills. It is much closer to a discussion between you and the psych and you do have the right to query anything they are saying. In fact, because it is difficult to diagnose someone as manic depressive, you should ask the psych all the questions you need answered and you should make sure that whatever is being said to you sounds reasonable (see also my page on Is My Diagnosis Correct?). Dealing with being bipolar is a collaboration between you and the psych, with both of you contributing equally.

When you are talking with the psych make sure you are comfortable with the ideas presented and suggestions made, and if you are prescribed medicine, make sure you feel you have had a complete diagnosis.

If what is being told to you does not seem reasonable, go to someone else for a second opinion. Although I have said that it may take a while for you to get productive results with a psych, you have no obligation to stick it out with a psych you do not like or trust. If you do not like them, you will not be able to get the support you need to deal with any of your problems and you are doing yourself no favours by accommodating them. Change the psych if you are not comfortable and do not let the psych bully you into something you are not comfortable doing.

If you are in an outpatient program or under medical insurance, insist on being provided an alternative psych. You do not need any reason better than "I am not comfortable talking to him/her, I do not think they are helping" to make the change.

Do not start medication unless you are convinced that what is being said makes sense - the medications create problems of their own. Psychiatrists may prescribe medication on the first visit, which I dislike. Unless the session lasted at least 1 1/2 to 2 hours and you described in substantial detail what you have been going through and it is very clear that you are bipolar, be wary of taking any medication after a first visit to a psychiatrist.

When you start taking medication, remember that they can take a few weeks to work. If after this time, you don't think the drug is doing anything for you, insist that it be changed, or the combination rejigged. I had to beat on my psych a bit and refuse to take the lithium before I was switched to Depakote. Which worked.

I've also found out recently that small changes in dosage can make for big changes in side effects. You can ask if you can cut back on dosage of a drug that is otherwise working for you. Don't forget to change only one drug at a time. If you change three, you'll never know which one is the problem drug.

Above all, make friends with you psych and work on this together. It's a team effort. If your psych plays doctor and you play patient, you are being shortchanged proper help.

You should also remain with counseling. I've used the two people for two different purposes. I used the psychiatrist to deal with drugs and the issues dealing with drugs. And I've used the counselor / therapist to help me pull my crazy world together and learn to cope. They are two different needs you have.

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