These are the sorts of questions that patients will ask you, often toward the end of the diagnostic interview. Clinicians eventually develop an effective approach to answering such questions in lay terms. Although patient education is rarely formally taught in training programs, from the patient’s perspective, it is often the most important part of the initial evaluation.

Educating your patient about his disorder is helpful for various reasons. First, education decreases his anxiety. As clinicians, we tend to take mental illness for granted, but patients are often terrified by their disorders. By giving an illness a name and showing that its prognosis and treatment are well understood and that millions of other people have experienced it, we can significantly decrease the patient’s anxiety.

Second, patient education improves adherence to treatment, both for medications and for therapy. Misconceptions about psychiatric treatment abound in our society; most people get their information about psychiatry from cartoons, television sitcoms, and news magazines, which leads to a mismatch between reality and fantasy. For example, many patients believe that psychotherapy is a long-term process in which painful family dynamics are rehashed for years on end. Such a misconception decreases the likelihood that patients will commit to therapy. When educated about the fact that
most present-day therapy is brief and focuses on current problems, patients become more receptive to referrals.

Misinformation about medications also abounds. Patients often believe that antidepressants are to be discontinued once they feel better, as opposed to the 6 to 12 months of continuous therapy recommended. Other patients consider antidepressants to be rapid mood boosters. One patient for whom I had prescribed Prozac for depression came back in a month reporting that she had only “needed to take” the Prozac four or five times. Her belief had been that the medication was to be taken only on those mornings that she awoke feeling very depressed.

In this chapter, I guide you through a commonly used strategy for providing patient education that can be applied to a wide variety of mental disorders.