How to Tell If a Psychiatrist Is Any Good in Twenty Minutes

You are in the chair. He is asking about sleep and appetite and whether anyone in the family has had anything similar.

Twenty minutes in, you have no idea whether this man is excellent or merely pleasant, and you are aware that the difference matters enormously and that you have no way to measure it.

I have been on both sides of that room for fifty-five years, and I am also the person who trained a good many of the people you might sit across from. Here is what I would tell my own family to look for.

First, what you cannot judge, and should stop trying to

The diplomas. Where he trained tells you he was capable at twenty-five. It predicts very little about whether he will be useful to you at fifty-five. I have known superbly credentialed men who could not hold a conversation, and I have watched people with modest training do excellent work for decades.

Reviews are worth reading and worth discounting. They tell you that somebody was helped. They cannot tell you whether that person was anything like you.

The four things you can judge

Whether he is actually present. A woman told me she knew within twenty minutes, and what she named was not insight, it was presence. She noticed that I was not taking notes and not producing the phrases you expect a psychiatrist to produce.

You can feel this. Everybody can. Is he here, or is he running a protocol at you with his attention half elsewhere. Do his questions follow from what you just said, or from a list. When you say something surprising, does anything change in the room.

Do not talk yourself out of this perception because you feel unqualified. It is the single best signal available to you and you already have it.

Whether he asks about your actual life. Sleep and appetite are necessary and they are not sufficient. A good first hour will get to what you do all day, who you live with, what you are frightened of, what you are good at. If nobody asks what you do for a living or whether you are happy in it, you are being assessed as a set of symptoms.

Whether anything is asked of you. By the end you should have a sense of what happens next, and it should involve you doing something rather than only returning. A treatment where the only requirement is attendance is a treatment you can attend for ten years.

Whether he can be disagreed with. Push back on something small. Say you are not sure about that. Watch what happens. You want a man who considers it, and either holds his position with a reason or says you may be right. What you do not want is one who becomes subtly cooler, or who folds instantly to keep you comfortable.

The most useful thing you can do in a first appointment is disagree with the doctor about something minor. His response in the following ten seconds will tell you more than the diplomas on the wall.

Two things people take as bad signs that are not

He asks a lot of questions and you leave slightly wrung out. That is what a real evaluation feels like. Nearly every patient I have ever taken on has remarked on the number of questions in the first hour, usually with some surprise.

He says something you did not enjoy hearing. Provided it is specific, and provided you can tell he has thought about how to put it, this is a good sign rather than a bad one. What you are entitled to expect is accuracy, delivered with judgment.

When you should choose someone else

I would rather be honest about this than pretend I am right for everyone.

If you want somebody to listen without ever directing you, do not come to me. That is a legitimate need and there are gifted people who provide it. I will start asking you to do things, and if that is not what you are looking for you will find it intrusive.

If you need weekly medication management inside an insurance network, I am the wrong economics and you should not be talked into stretching. Private-pay long-form work is a real cost and it is not the only path to getting better.

If you are in acute crisis, you need a hospital or a team with coverage at three in the morning, not a solo practitioner in Greenwich.

And if you sit down with someone and simply do not like him, that is sufficient. Fit carries most of the mechanism, and you do not owe anyone an explanation.

What the first session looks like here

Ninety minutes or thereabouts. A great many questions, several of them about periods of your life you did not expect to discuss.

At the end I will tell you what I think, in plain terms, including whether I believe I am the right person. Sometimes I am not, and I would rather say so in the first hour than in the eleventh.

An Invitation

You are allowed to interview the psychiatrist. Most people do not realize this, and arrive to be evaluated without noticing that the evaluation runs in both directions.

Come and ask me anything you like. That is a reasonable use of a first appointment.