Physician's Corner

Making Effective Therapy Referrals

Depression ranks among the top 10 chronic health problems in the United States and up to one in four primary care patients suffers from depression1. Drug therapy has become the most popular course of treatment - often ignoring the evidence-based options represented by psychotherapy. Many physicians are highly skilled and even intuitive in identifying how depression, stress and anxiety are impacting their patient's physical health but they aren't always as comfortable in making referrals to therapy.

Here are a few simple tips for making an effective therapy referral.

  1. Start with the mind-body connection. Examples: I'm wondering if stress could be causing your headaches? or The symptoms of MS can be worse with depression or anxiety about MS. Do you think that could be happeing with you?
  2. Emphasize that the patient does not deserve to have these symptoms. Normalize the symptoms to reduce stigma. Examples: You don't deserve to have this kind of pain every day and it's got to be affecting the quality of your life. or You deserve to have the best possible symptom management with MS. It's normal if you're feeling depressed right now with all you've got going on in your life but you don't deserve to suffer. or Many people who have had a stroke experience symptoms of depression or anxiety afterwards. You deserve the best recovery possible.
  3. Focus on the symtom and relief. Generate enthusiasm and hope. Examples: Getting support from a good therapist and learning how to cope with stress might relieve your headaches. or I want to make sure that we're maximizing your chances of recovery from the stroke and we can do that by including a good therapist on our care team.
  4. Provide referral options. Example: I know a few psychologists in the area who can really help with stress. May I give you some referrals?
  5. Get a commitment and follow-up. Example: Does this sound like something you'd be willing to try? Will you let me know how it goes at our next visit?

Put it all together and it might sound something like this:

I'm wondering if you're under more stress lately and if that could be causing some of the headache pain you've been experiencing. You don't deserve to suffer like this and it sounds like the headaches are really impacting your quality of life. Therapy can be a good resource for learning how to cope with stress. I know of some therapists in the area who are really good and easy to talk to and I'd like to give you their names. What do you think? Can we follow-up on this at our next visit? I'd love to know if it was helpful to you.

If the patient is resistant, consider using Motivational Interviewing techniques. The spirit and philosophy of Motivational Interviewing is highly appropriatre when discussing therapy as a type of behavioral change. If you are not familiar with Motivational Interviewing, the basic concepts are to 1) identify where your patient is today in his/her willingness to make this change, 2) support and roll with any resistance - do not put the patient on the defensive, 3) ask about pros and cons to making the change, 4) explore any ambivalence and 5) and follow-up next visit.

Additional Resources

Insomnia Tips - Download or copy the audio recording Sleep Secrets: 25 Tips to Cure Insomnia by Dr. Kleppe. This resource is made available at no charge to your patients who suffer from insomnia.

Please check back for frequent updates to Physician's Corner. If you have any suggestions for mental health or behavioral health online resources, that would be helpful to you and your patients, please send me an email.


1 www.nimh.nih/gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#MajorDepressive