Got Bipolar? 3 Steps to Find the Right Psychiatrist
I’ve had bipolar disorder since 1990. It wasn’t until 2005 that I found a doctor who helped me to recover. During that time, I had six manic episodes, a severe depression, three hospitalizations and six ineffective doctors. I spent thousands of dollars on treatment that didn’t restore my health and lost fifteen years of my life. I hope to help you avoid the suffering I endured with this guide to finding the right psychiatrist for you. Consider these three steps and you will greatly improve your chances of finding a good connection the first time.
1. Look Within
I repeatedly overlooked this step. When I received my diagnosis nobody told me to think about myself in relation to prospective doctors. When I finally asked myself these questions, I found a clinician who guided me into recovery and ultimately changed my life. Before you can find a good fit with a doctor you need to know a little about yourself. By asking a few questions first, you can clarify what your situation is and what you hope to achieve in treatment.
You don’t have to be in treatment to begin the recovery process. And that process is a journey of self-discovery, so it makes sense to begin as soon as possible. A gut-wrenching self-analysis is not necessary, though that may be helpful if you’re so inclined. Some simple considerations will suffice. Ideally, do this process during a period of relative stability. If you are in crisis, ask a friend to help you think through these questions. If you are already working with a doctor, ask yourself if your treatment is in line with your answers.
Why are you seeking treatment?
What exactly are your symptoms? Has your life become unmanageable because of them? Maybe a friend or family member has suggested you need help. Knowing your reasons for treatment will help your doctor help you. Be as specific as possible.
What do you expect from treatment?
Do you want to return to, or improve, your work life? Do you want to repair damaged relationships? Do you simply want to feel well again? If you have specific goals at the outset you will be better able to gauge your progress in recovery.
How have you changed since you began to feel sick?
Create a detailed “before and after” picture of yourself. What’s different now and what needs to change to make you feel better? What signs will indicate that your condition is improving? Your doctor needs to know what you should be like when you’re well. By describing your baseline, your normal self, you provide a target to aim for in treatment. With this in mind, you’re less likely to be undertreated.
This is the key question that I didn’t know to ask myself for fifteen years. I never gave my doctors a clear picture of what I was like before I got sick. As a result, I didn’t receive proper treatment and became stuck in a low-grade depression, when I wasn’t manic. My doctors had no idea what I was like when I wasn’t depressed. After a while I forgot as well. I was finally able to convey my baseline when I enlisted the support of my parents. They remembered what I was like before I was sick and talked my doctor and me through it.
A good doctor will probe for this type of information, but not all will. If you’re prepared when you interview doctors, you’ll be sure to discuss these important matters. For more questions to think about, see the Depression and Bipolar Support Alliance’s (DBSA) Finding a Mental Health Professional.
2. Get Referrals
Early on in my treatment, I sought out the best-credentialed doctors from the most respected psychiatric hospitals in Chicago and Hartford, CT. I wound up with ten years of highly ineffective mental health treatment. I was actually doing better on my own before I began working with these doctors. I finally found the doctor that turned me around through a real estate client of my mother. My doctor worked quietly on her own, 20 miles outside the city. Within a year, I was back on my feet, wondering how I could have suffered through such bad treatment for so long.
The best way to identify a potentially good fit is word of mouth. Ask friends, family, members of support groups, even co-workers if they have had a positive experience with a psychiatrist, or know someone that has. Your general practitioner, employee assistance program and current psychiatrist, if you have one, are also good sources for referrals.
Allen Doederlein, President of DBSA, a national advocacy agency run by and for people with mood disorders, points to the internet as a source for referrals. There is a wealth of information about mood disorders online, including resources for finding a psychiatrist. DBSA has a Find a Pro search engine that generates contacts based on positive peer reviews of doctors. You can search geographically and by other factors. You can also find a multitude of resources through the Mental Health America website.
While the internet is not as personal as a direct referral, it can provide a working list of candidates. With that list in hand, you’re ready for the final step.
3. Do Interviews
This is where all the background work pays off. You know what you want and you know who to ask for it. Now ask. Think of this process as a job interview for your doctor. You are, after all, hiring him or her to do very important work for you. Mr. Doederlein recommends being persistent, tenacious and honest when interviewing doctors. You have specific and personal needs that are unique to you. Your doctor should strive to meet those needs, as you have explained them. This does not mean you are not asking for the doctor’s advice. Rather, you are creating a partnership in which you each contribute to the recovery process. It is your responsibility to be open and forthright, and to advocate for yourself. This process begins in the initial consultation.
One very important consideration is whether the doctor does both psychotherapy and medication management (also known as integrated care) or if he or she does only meds while a psychologist or social worker does therapy (the split treatment model). Split treatment is the prevailing model, with only about 10% of all U.S. psychiatrists doing both therapy and med management, according to Daniel J. Carlat, author of the 2010 book Unhinged, a compelling argument in favor of integrated care.
In the split model, a patient typically sees the psychiatrist for fifteen minutes to check on symptoms and how the medication is working with them. The doctor considers things like moods, appetite, sleep patterns and side effects from the meds. In a separate appointment, a social worker or psychologist does therapy with the patient, and ideally the clinicians communicate their progress to each other.
Besides being inconvenient for the patient, who has to coordinate visits to two providers, one problem with this model is that often communication between the clinicians is not effective, or sometimes non-existent. Gaps in treatment may develop from both providers. This is a serious drawback. As Carlat states in his book, “The fact is that medication treatment and therapy treatment interact with one another. The more I know about my patient’s psychology, the better my medication decisions will be.”
Given the paucity of psychiatrists currently doing integrated care, it may not be possible to find one in your area. However, in my experience it’s worth looking for a doctor who does meds and therapy. My first long-term doctor-patient relationship was with a split model psychiatrist and a social worker doing therapy. The doctor didn’t believe psychotherapy had any benefit. He made all his decisions based on our 15 minute med checks. During five years of treatment with him, I had two manic episodes, including a hospitalization, and recurring depression between episodes. Since I switched to the right integrated care doctor six years ago, I have been completely stable. This was not the only factor in my recovery, but it’s worth noting.
Which model to choose is ultimately a personal decision, but I urge you to at least consider integrated care.
DBSA’s Finding a Mental Health Professional suggests asking the following questions as well:
What is your training and experience?
What is your treatment philosophy and methodology?
How often and how long are appointments?
How much does an appointment cost?
How can I reach you in an emergency?
After talking to a doctor you will have a feeling about him or her, based on the information you’ve gathered and on your personal interaction. Trust yourself. If you’ve done the prep work, you’ll make the right choice and you’ll be on the road to recovery. This process requires more work up front, but it could save you years of poor treatment and suffering. For me, it was worth it.