Physician's Corner

Why PCPs Shouldn’t Hesitate to Give a Therapy Referral

If a patient walked into your office saying they were hearing voices or thinking about suicide, you’d likely send them to a psychiatrist. But not every case seems that critical. What if you have a patient who just mentions offhandedly that she’s having trouble concentrating at work? Or a patient complains of headaches… but you find no physical cause? After a deeper assessment, you may think that depression or anxiety is at play. 

What you do next, however, is important — especially considering your unique position as a primary health care provider.

“Currently primary care providers are the nation’s de facto mental health system,” said Dr. Geoffrey D.P. Kanter, Monitor on Psychology.1 “And pharmacotherapy is the most widely recommended treatment.” 

Indeed, drug therapy has become the most popular course of treatment — but it often ignores the evidence-based options represented by psychotherapy. 

Adding a therapy referral to your patient’s care plan can fill in gaps and address issues that you may not have the time, desire, or specialized knowledge to treat. Our team at Orange County Health Psychologists is here to partner with you, starting with some of the most common mental health issues your patients face today.

The Not-So-Hidden Causes of PCP Visits

One out of every four people is depressed2, while up to 7.6 percent of primary care patients in any given year suffer from generalized anxiety disorder.3

Childhood trauma often causes these issues. Plus, when you consider that nearly half of today’s U.S. children have experienced some form of trauma4 — such as emotional or physical abuse — it’s clear that the number of primary care patients needing mental health care will only increase.

What’s more, they likely won’t go directly to a mental health care provider. Instead, they’ll come to you. 

PCPs: The First Stop for Mental Health Care

Obviously, primary health care providers are often the required entry point to medical care. But while some patients do have direct access to specialists, they often still consult with their primary care physician or another M.D. first when they have mental health issues. Why?

One survey of 1,647 adults revealed that 49 percent of patients see their primary care provider first for a mental health issue for two main reasons5:

  1. Less stigma. Going to a psychotherapist can be a tough decision for some. Patients may feel hesitant to reach out to a mental health care provider directly due to shame.
  2. Trust. Patients often have an established relationship with their PCP and trust him or her to make recommendations based on their medical history. Some patients report that they don’t have the confidence to evaluate which psychotherapists are good, and would also prefer their PCP to determine the severity of their problem before they seek a therapy referral.

Therapy Referral: The Next Best Step

Some primary care physicians may choose to provide brief in-office counseling themselves rather than give a therapy referral, especially for mild mental health issues. 

However, not every PCP believes they have the same nuanced understanding as a mental health care provider would. In fact, in one survey 51 percent of primary care physicians rated their psychiatric knowledge as “average,” while 53 percent “sometimes” made a mental health diagnosis on a previously undiagnosed patient.6

It doesn’t have to be this way. A therapy referral can help round out your patient’s health care plan and be an extension of your patient’s relationship with you. Our experienced team at Orange County Health Psychologists is ready to step in at any time you need us.

—Written by Ekua Hagan for Orange County Health Psychologists.


1 Clay, Rebecca A. (2015). Going Big: Entrepreneurial Psychologists Explore Alternative Practice Models. Monitor on Psychology, May issue.

2 National Institute of Mental Health. The Numbers Count: Mental Disorders in America.

3 Kavan, Michael, Ph.D.; Elsasser, Gary, PharmD; Barone, Eugene, M.D. (2009). Generalized Anxiety Disorder: Practical Assessment and Management. American Family Physician, vol. 79, no. 9.

4 Benham, Barbara. (2014). Study: Nearly Half of U.S. Kids Exposed to Traumatic Social or Family Experiences. HUB (Johns Hopkins University).

5 Wun, Yuk San, MBBS, M.D.; Lam, Tai Pong, Ph.D., M.D.; Goldberg, David, DM; Lam, Kwok Fai, Ph.D., Li, Kwok Tung Donald, MBBS; Yip, Ka Chee, MBBS. (2011). Reasons for Preferring a Primary Care Physician If Depressed. Family Medicine, May issue, vol. 43, no. 5.

6 Oyama, Oliver, PA-C, Ph.D.; Burg, Mary Ann, LCSW, Ph.D.; Fraser, Kathryn, Ph.D.; Kosch, Shae Graham, Ph.D. (2012). Mental Health Treatment by Family Physicians: Current Practices and Preferences. Family Medicine, Nov-Dec issue, vol. 44, no. 10.

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 contact us.

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.


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

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 contact us.