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6 Things Your Psychiatrist Wants You to Know

We don’t just hand out meds to everyone we see. ByJessi Gold, MD, MS

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Despite what you may have heard, psychiatrists aren’t all old white dudes in bowties, but they’re also (hopefully not) boundary-less people who blur the lines between personal and professional with their clients (Thanks every TV show ever!). I’ve been a psychiatrist for nearly 10 years and I hear these misconceptions all the time, so I figured I should clear some of them up for you.

For starters, we’re not all the perfect picture of mental health all the time. I just released my first book, How Do You Feel?, which is inherently about taking care of ourselves as we care for others, and making time for you in the delicate balance of work and life. But even in this process of book promo, which should be exciting, I struggled. I had planned to be busy with my book and my new job as Chief Wellness Officer for the University of Tennessee System, but I hadn’t planned for my dog, Winnie, to be unexplainably sick, causing us both to lose sleep. I was trying to do press and prepare for this book release, acting like everything was fine. 

It wasn’t. I realized that to be true to my book and its mission (and, honestly, to myself and my core value of authenticity), I had to say that out loud. And I had to give myself time and space to be sad or anxious, even if it felt like I had no time or space for it.

Maybe it surprises you to hear that from a psychiatrist, but maybe that’s the point. We need to talk more about what it means to do the job, and how it affects us. I am happy to start.

So, whether you currently see a psychiatrist or you’re curious about what it’s like, here are a few things I think you should know: 

1. We don’t just hand out mental health medications to everyone we see. 

A lot of people who don't have experience with psychiatrists (or who have had bad experiences with one), think our job consists of seeing you for five minutes, asking you a few questions, giving you drugs, and saying bye. And I've always hated that perception because that’s not what I do or what I was trained to do. 

Providing medication is part of what we do and is something that differentiates us from other mental health providers (see: psychiatrists vs. psychologists), but it's not all we do. Most psychiatrists don’t offer traditional psychotherapy (or hour-long sessions of talk therapy) because of insurance reimbursement limitations, and because there are fewer psychiatrists than there are therapists. So, yes, the people I see are people who need mental health medications, but if someone doesn’t need medications, I’m not going to prescribe them. I might suggest they see a therapist instead, unless they’re OK with checking in on a less frequent basis.

2. Even if we aren’t your therapist, we do want to hear what else is going on in your life. 

A lot of psychiatry sessions also involve some therapy. Because you can’t just medicate life experiences away. For instance, if you come in and say, “I don't know if this med is working, and also my boyfriend just broke up with me,” my job is not to just increase the dose. My job is to talk to you about how this breakup is affecting you and help you consider if and when to adjust your medication to your current situation. I’ll also teach skills, hand you cognitive behavioral therapy worksheets, and help you challenge thoughts, feelings, and behaviors when it makes sense. Side effects matter, sure, but so does your lived experience. Understanding a patient’s story is central to finding a treatment plan that works. 

Also, there's no problem that’s too small to bring up. Sometimes I wonder if patients think we have competitive trauma Olympics, and that their problems have to be at a certain level to qualify to be brought up in a session. I've had patients say, “Gosh, I'm so boring for you.” And while you never need to worry about that, you should also know that we appreciate a “boring” session every once a while!  

3. We fully acknowledge that there is no magic pill for your mental health. 

Sometimes people come to me convinced that a certain medication will fix them. Unfortunately, our medications are imperfect in so many ways, even though I have seen them save lives. Finding the right mental health medication is a lot of trial and error, and we make decisions based on the specific person we’re seeing. Your health, your medical history, your lifestyle, your genetics, and your vulnerability to certain side effects (among other things) all come into play. 

Time is also a big factor. According to the data, it’s recommended that you stay on one dose for six to eight weeks before messing with it. As a psychiatrist, it’s really hard to tell someone that it might be a few weeks before they feel a difference—or before we can reassess the dose or the type of medication. Especially when they are incredibly depressed and finals are next week. And yet, we try to find the balance.

In the meantime, we might make regular check ups with you to assess for side effects and hear how things are going, supporting you along the way. We might not always change a med or a dose, but we can still help (or at least validate your frustration!).

4. We’re not your friend, but we also don’t hate you. 

Despite what you may see in TV shows and movies, your psychiatrist probably won’t take you out for coffee and a hike—and that doesn’t mean they don’t like you! But boundaries are key to successful therapy and psychiatry. I think about my patients all the time, but it's not because they're my friends, it's because I care about them as people. And you can care about people and want to help them succeed without wanting to go have a drink with them or wanting to hang out with them. Even if you seem friendly with your therapist, there is an inherent unequal power dynamic there. 

If you see us in public, know that we’re not going to blow up your spot and that we’ll follow whatever lead you set (all mental health professionals are taught this, by the way). So you can choose to come up to us and say hi or ignore us entirely. I’ve had it all ways, so just know we don’t ignore because we hate you—we ignore because we’re supporting your privacy.

5. Don’t be embarrassed to bring up something you saw on social media. But do keep an open mind. 

I get it, you’re scrolling on TikTok and the algorithm shows you video after video about the same mental health condition or symptoms you can relate to. So you go to a psychiatrist and tell them you’re pretty sure you have this diagnosis and need this medication. 

I appreciate that you researched this, that you got curious about yourself, and that you’re bringing this to a doctor—which is a very important step because a lot of people just take the label and run with it. But, when you take that step, be aware that we might not tell you what you want to hear, and that might feel invalidating but that’s never our intention. 

When someone comes to me with a diagnosis they heard about on social media, I’ll ask them what it was about the videos that resonated with them. I really value the fact that you have access to more mental health information, but the way that something is talked about on social media (or even in your conversations with friends) isn’t always how we would talk about it clinically. And that doesn’t mean that we’re questioning your experience or what you heard or saw. 

I love when my patients are informed and curious, but I also know that the internet can be a noisy, crowded place with a lot of opinions and personal anecdotes that don’t always line up neatly with the data. So if you saw something online that resonated with you, don’t be afraid to bring it up in a session, and try to keep an open mind. 

6. Psychiatrists are real people with real problems too. But that doesn’t mean we can’t be there for you. 

Your psychiatrist probably sees a therapist and/or psychiatrist too. We all need to unload on someone, and even the professionals can’t (and shouldn’t) treat themselves. I’ve learned that just because you know and believe in something, that doesn’t mean you can easily apply it to yourself. I don't stigmatize patients who are on medications, but it turns out I stigmatized myself and had to work on that. Similarly, I was really burned out and I—just like many other people—was convinced it had to be a physical illness, despite the fact that I swim in mental illness all day and give talks on burnout weekly

You might read my book and think, Geez, mental health pros are not OK. My problem’s not important enough to add to theirs, or My problem's too much and they're not going to be able to handle it. But here’s what I want you to remember: We do this job because we chose this job. And if we show up, it’s because we can. 

There might even be times when your psychiatrist discloses something that’s going on with them (like if they have to take time off for a death in the family) or times when you know they’re going through it too (like in a worldwide pandemic). It’s natural and normal to ask how we’re doing, but you also don’t have to—this time is yours, and if we showed up to work, it’s because we feel equipped to help you. 

And, personally, I would want to see a psychiatrist who got meds if they needed meds and got therapy if they needed therapy, because it shows that they actually are taking care of themselves too. 

It might have taken me a little while to practice what I preach, but it has made me a much better doctor for it.