How Many Hours Before I Switch Psychiatrists?

Again and again, I meet patients who arrive at my office with depression or panic disorder or alcohol dependence or marriages in disarray who are questioning whether the help they've gotten from their psychiatrists or psychologists has been everything they've needed. Not infrequently, these men and women report that they feel "a little better" or "about the same, but no worse" since beginning treatment. When I ask them how long they have been working with their therapists, they often say it has been years, or even a decade.

I know that the physician-patient bond is a powerful one. And I've even wondered whether a significant percentage of people who have stayed with their therapists (or psychopharmacologists) for years, despite little progress, would have gotten worse without the care. Maybe the status quo was actually a victory for some of them. But I don't think that people with diabetes would stay with endocrinologists who don't normalize their blood sugar. I doubt that people with hypertension would stick by internists who can't get their blood pressure under control. I'm not at all sure that those with chronic back pain would keep visiting orthopedists or pain management specialists who give them little relief. So why is it different with psychiatrists and psychologists and their clients?

One reason may be that the physician-patient bond in psychotherapy is especially powerful. That bond may remain strong, even when therapeutic results are weak. Another reason may be that the work of psychiatrists and psychologists occurs with such privacy, and often with such ill-defined goals from the outset, that patients can find themselves in a kind of maze, looking for a very long time for the way out-or at least a window on other options.

In order to help cut through whatever resistance leads people to linger with their pain, rather than find a different partner in healing to help defeat it, here's my way of thinking about what kind of results to expect from psychotherapists and psychopharmacologists-and how to respond_

1. You should feel very much better after not more than three months working with your clinician.

2. You should have the sense that your clinician is actively striving to defeat your symptoms, not merely observe them or comfort you while you live with them.

3. If you do not feel very much better after three months, ask your clinician what can be done to dramatically accelerate your recovery (or improvement in your outlook or relationship or other presenting "symptom").

4. If you do not feel very much better after four months, visit with another psychiatrist or psychologist to determine if someone else might be a better fit for you or more expert or creative in delivering effective help for you.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, "Living the Truth: Transform Your Life through the Power of Insight and Honesty" has launched a new self-help movement including Dr. Ablow can be emailed at