What does a psychiatrist, or even a primary care physician, do when she harbors doubts about the patient's psychotherapy? As I have opined previously I believe the advantages of independent psychotherapy and medication management (or other biological treatment, such as TMS) outweigh the disadvantages. But when the physician does not know the psychotherapist well because the patient chooses his psychotherapist or the physician does not know the psychotherapist well, problems can arise, for example when there is:
- No sign of improvement after extended treatment.
- Evidence of boundary violations or other impropriety in the relationship.
- Failure of the psychotherapist to respond to phone calls or other attempts to establish or maintain contact for coordination of treatment.
- Lack of evidence of effectiveness of the treatment approach for the patient's disorder.
- The physician has a vague negative sense about the psychotherapist from past encounters.
- The physician dislikes the psychotherapist.
- The physician knows that the psychotherapist dislikes her.