Referred to a psychiatrist by your psychologist? Learn why referrals happen, how to prepare for the appointment and how your therapy can continue alongside it.
In the last minutes of the session, your psychologist says in a calm voice: "During this process, I would also like a psychiatrist to assess you." After you leave the room, the journey home feels longer. Questions chase each other through your mind: so my situation is even worse than I thought. Doesn't she want to work with me? Are they going to give me medication, and if I start, will I ever be able to stop? If you, too, are thinking "my psychologist referred me to a psychiatrist, so what happens now?", you are not alone. In this article I explain step by step what a referral means, in which situations psychologists take this step, how you can prepare for a psychiatry appointment and how your therapy can continue from here.
My Psychologist Referred Me to a Psychiatrist: What Does It Mean?
Let us first answer the most frequently asked question: a referral is, most of the time, not an alarm but a step towards building a team. A clinical psychologist assesses what you are going through at the level of thoughts, feelings, behaviours and relationships, and conducts psychotherapy. Medication assessment, medical diagnosis and ruling out physical causes, however, are the domain of a doctor. When your psychologist realises that a form of support that could be useful for you falls outside their own area of expertise, they say so openly. This is a sign of professional responsibility and of the value placed on you.
A referral does not mean the following:
- It does not mean therapy is over. In most cases psychotherapy continues where it left off; the psychiatric assessment becomes an additional form of support.
- It does not necessarily mean medication will be started. After the assessment, the doctor may not see a need for medication.
- It does not mean "your situation is very serious". Sometimes the reason for a referral is simply that your sleep has been disrupted for weeks and this is making it harder for you to make progress in therapy.
- It does not mean your psychologist has given up on you. On the contrary, they are trying to build a broader support network for you.
If you are curious about the differences in training and authority between the two professions, you can find detailed information in the article on the difference between a psychologist and a psychiatrist.
In Which Situations Do Psychologists Refer to a Psychiatrist?
Every client's situation is different, but behind a decision to refer there is usually one or more of the following reasons.
If the intensity of symptoms is clearly disrupting daily life
If basic tasks such as getting out of bed, going to work, eating or looking after your children have been difficult for weeks, medical support that reduces the intensity of symptoms can give you back the energy and focus you need in order to work in therapy. This is especially common in moderate and severe depressive episodes.
If progress remains limited despite regular therapy
Sometimes client and therapist put in the effort and sessions continue regularly, but the symptoms do not budge. In such a picture, also addressing it from a medical perspective can open things up. In intense obsessive thoughts or frequently recurring panic attacks, for example, combining therapy with medication can at times be more helpful.
If sleep has been disrupted for a long time
Being unable to sleep more than three or four hours a night for weeks seriously affects both mood and the ability to think. Until sleep improves, applying what you learn in therapy can become very difficult.
If there are marked fluctuations in mood
If, between long periods of low mood, there are periods in which someone sleeps very little for days yet feels no tiredness, talks very fast, spends excessively and feels extraordinarily powerful, it is important for this picture to be assessed by a doctor. This is because treatment is planned differently for such fluctuations.
If there are experiences suggesting a weakening connection with reality
Hearing voices that others do not hear, believing that special messages are being sent to you, or intense and unshakeable suspiciousness fall into this group. In these situations, a psychiatric assessment is the priority.
If there are thoughts of self-harm or of ending your life
These thoughts can and should be talked about in therapy. However, a doctor may also need to be involved in assessing risk. If such thoughts intensify and you do not feel safe, do not wait for an appointment: call 112 (emergency services) or go to the nearest emergency department.
If a physical cause needs to be ruled out
Thyroid problems, some vitamin deficiencies, hormonal changes or certain medications can cause symptoms that resemble anxiety and depression. A doctor can assess these possibilities by requesting tests if needed.
If a diagnosis or an official assessment is needed
A doctor's assessment also comes into play in situations such as suspected attention deficit in adults, alcohol or substance use that has got out of control, or official procedures that require a medical diagnosis.
Common Worries After a Referral
After hearing about a referral, many people find similar worries coming to mind. Addressing them one by one may help you decide more calmly.
"If I take medication, I'll never be able to stop." This is a very widespread fear in Turkey. A large proportion of the medications used in psychiatry are not addictive; some medications that do carry a risk of dependence are planned carefully by the doctor and for a limited period. How long a medication will be used, how it will be reduced and when it will be stopped are discussed with the doctor. What matters is not to start medication on your own and not to stop it on your own.
"My personality will change, I'll feel numb." You can tell your doctor about this worry directly. The aim of treatment is not to turn you into someone else but to ease the burden of symptoms so that you can live as yourself. If there are side effects, sharing them with your doctor is important so that treatment can be adjusted.
"What will my family say if they find out?" In extended families, remarks such as "medication is poison, get out and about a bit and it'll pass" or "this kind of thing doesn't happen in our family" are often heard. Such remarks usually come from love and fear, but they can make it harder to see what you need. Whom you tell, and how much, is entirely your decision.
"My psychologist is tired of me." A referral does not mean the relationship is over. If this thought crosses your mind, saying it openly to your psychologist in the next session will be reassuring and can also be the start of a valuable conversation in therapy.
A referral does not mean "I can't work with you"; it means "for your sake, I want to bring a colleague alongside me."
Going to a Psychiatrist in Turkey: Old Fears, Today's Realities
In many people's minds, psychiatry still sits alongside images of locked wards from old films and the weight carried by the phrase "mental asylum". A neighbour whispered about in the neighbourhood as having "bad nerves", or a period a relative went through years ago that was never talked about in the family, feeds this image. Today's psychiatric practice, however, consists largely of outpatient consultations, follow-up without admission and treatments that support people in carrying on with their daily lives.
If you look at the people sitting in the waiting area of a psychiatric outpatient clinic, you will see that most are ordinary people like you, trying to keep up with their work, their studies and their children. A young mother who has not been able to recover after giving birth, a civil servant who cannot sleep because of pressure at work, a retired person who moved away from the earthquake zone and still wakes with a start: they all wait in the same corridor.
So you do not have to feel squeezed into a label just because your psychologist referred you to a psychiatrist. Just as going to a cardiologist for heart palpitations or to a neurologist for persistent headaches is natural, going to a psychiatrist for long-lasting psychological symptoms is just as natural. The only thing that changes is the name of the field concerned.
How Can You Prepare for a Psychiatry Appointment?
Psychiatric consultations can be short, especially in busy state hospitals. A little preparation helps make that short time productive.
- Plan your appointment. In state hospitals you can book psychiatric outpatient appointments via the Central Physician Appointment System (MHRS), online or on the ALO 182 line (the national appointment line). Private hospitals and private practices are also an option. Your psychologist may suggest a suitable doctor. For more information on public options, you can read the article on seeing a psychologist at a state hospital.
- Write down your symptoms briefly. When did they start, how often do they occur, how are your sleep, appetite and energy, and how do they affect your work and relationships? A note of a few bullet points rescues details you might forget in the moment.
- List the medications and supplements you take. Including blood pressure, thyroid or contraceptive medication, herbal teas and vitamins.
- Think about whether there is a similar history in the family. A history of depression, mood fluctuations or addiction among family members is important information in the doctor's assessment.
- Prepare your questions. Asking questions such as "Is medication necessary, and why?", "When will I see an effect?", "Which side effects should I watch out for?" and "Should I continue therapy?" is entirely appropriate.
- Bring someone with you if you like. A person you trust can both lift your spirits and help you remember what was discussed.
After you leave the appointment, one small step also makes things easier: note down straight away what the doctor said, any tests recommended and the date of the next check-up. Sharing these notes with your psychologist in your next therapy session helps the two forms of support move forward without becoming disconnected. If questions occur to you later, you can add them to your list for the next check-up.
What Happens in a Psychiatric Consultation?
The doctor usually asks about your reason for coming, the course of your symptoms, your medical history, the medications you take and any history of illness in your family. If necessary, they may request tests such as blood tests.
At the end of the assessment, several different paths may emerge:
- No medication is needed, and psychotherapy is recommended. Many people are surprised and relieved by this outcome.
- Medication is recommended in addition to psychotherapy. The doctor explains the aim of treatment, the expected duration and possible side effects. You make the decision; you can keep asking about anything on your mind.
- Monitoring is recommended. The doctor may want to reassess the course of your symptoms a few weeks later.
- A further assessment is requested. If a physical cause is suspected, you may be referred to another specialty.
If you would like to read in more detail about how medication and psychotherapy are combined, the article on psychotherapy and medication can guide you.
My Psychologist Referred Me to a Psychiatrist: How Does Therapy Continue?
After a referral, the healthiest picture is one in which the two practitioners work towards the same goal. Your consent is fundamental to this collaboration: your psychologist and your doctor share information with each other only if you allow it. And the information shared is limited to what is needed for your treatment.
During this period, the following topics may come up in therapy:
- If medication has been started, how you feel in the first weeks, and changes in your sleep and energy.
- As symptoms ease, beginning to take steps you previously found difficult: returning to work, meeting friends, dealing with tasks you had put off.
- Working on the thought and behaviour patterns that keep the distress going; while medication reduces the intensity of symptoms, therapy focuses on changing these patterns.
- When reducing medication comes up in the future, preparing a plan for what you can do if difficulties return.
Say a client has been unable to get out of bed in the mornings for months and cannot take any of the small steps discussed in therapy. After the doctor's assessment, as their energy slowly returns, the steps planned in therapy become workable for the first time. Here you can clearly see how the two forms of support complement each other. You can read how therapy is planned for mood-related difficulties on the depression and mood page.
What Can You Do If You Don't Want to Go?
You may not be able to say "yes" to the referral straight away; this is very understandable. In that case, the most useful thing to do is to talk openly about your reservations with your psychologist. You can ask why they recommended a referral, what they expect from the doctor and how therapy might proceed if you do not go.
In some situations, your psychologist may suggest continuing with therapy alone for a while longer and monitoring the symptoms closely. However, if there is a risk to your safety or the symptoms are worsening very quickly, a doctor's assessment may be a step that cannot be postponed. A psychologist who works ethically will tell you openly when they believe therapy cannot be continued safely.
Remember, going to a psychiatric outpatient clinic does not mean you have to make a decision. The first consultation is only an assessment; listening to the doctor's recommendation and thinking it over, asking questions and, if necessary, getting a second opinion are your rights. During the period when you are undecided, you can also continue with therapy and talk about your dilemma in sessions. Often, behind the question "should I go?" lies a deeper fear: of losing control, of being seen as different, or of asking for help being considered a weakness. Naming that fear also makes the decision easier.
Frequently Asked Questions
Can a psychiatrist force me to take medication?
No. Apart from emergencies and special circumstances, the doctor recommends a treatment; whether you accept it is your decision. It is entirely ordinary to ask about the reasoning behind the recommendation, the expected benefit and possible side effects, and to ask for time to think.
Can I keep seeing my psychologist after going to a psychiatrist?
Yes, in most cases therapy continues without interruption. The doctor's assessment is thought of as support added to therapy. Telling your doctor that you are in therapy helps your treatment to be planned as a whole.
Will what I tell the psychiatrist be passed on to my psychologist?
Health professionals are bound by the principle of confidentiality. Information is shared between the two practitioners with your consent and only to the extent necessary for treatment. You can state clearly what you do not want to be shared.
Should I go to a private hospital or a state hospital?
Both are possible. In state hospitals it is easier to access a consultation financially, but consultations may be short and follow-up intervals long. Private options may offer longer consultations, but the cost is higher. Your budget, the waiting time for an appointment and your follow-up needs are the deciding factors.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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