Learning to trust a new psychiatrist after a bad one

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I'm a 44-year-old woman, I work in publishing, and I live in Boston. I have been living with schizoaffective disorder for sixteen years. I had the same psychiatrist for the first nine of those years. He was, in retrospect, not a good fit for me — and possibly not a good clinician for anyone — but I did not know that until I left him. I have had a new psychiatrist now for seven years. It took me almost two years to trust her. I want to write about how that trust was built, because I think people don't talk enough about how hard re-trusting is after a bad psychiatric relationship.

What the bad relationship looked like

My first psychiatrist was a man in his sixties who I will call Dr. K. He was on my insurance. He had availability. I started seeing him after my first hospitalisation when I was 28, with no information about what to look for and no energy to shop around.

Over nine years, the pattern looked like this:

• Appointments were 12 to 15 minutes long. Most of that time was him typing.
• When I described side effects, he often dismissed them. The akathisia I had on one medication was, he said, "anxiety." The sexual side effects were, he said, "maybe related to your relationship."
• When I asked questions about my medications, he often answered with "trust me, this is how we treat schizoaffective."
• When I had a bad month, he would increase a dose without asking what I thought was happening in my life.
• He never once asked me what my goals for treatment were.
• Once, when I cried in his office, he said, "Let's not get emotional. Let's stay focused."

I want to be careful here. He was not a monster. He kept me on medication, more or less, for nine years. I did not get hospitalised again on his watch. He may genuinely have believed he was doing his job. But he made me feel, every single appointment, like a small problem he was managing rather than a person with a life he was helping.

I left him after he laughed — actually laughed — when I asked about clozapine as an option for some symptoms that weren't fully responding to my current medication. "Clozapine is a last resort," he said. "You're nowhere near that." I was, by my own assessment, very near that.

The decision to leave

Leaving was harder than I expected. He had been my doctor for nine years. He held the prescriptions. He held the chart. The idea of starting over with a stranger, of explaining nine years of history again, was exhausting. I knew, in some abstract way, that finding a good psychiatrist matters, but the practical work of doing it felt impossible.

What pushed me was a conversation with a friend who is also a therapist. She listened to me describe Dr. K for half an hour and then said, very gently, "You are describing a psychiatrist who is not curious about you. You deserve one who is curious." I had never thought about psychiatric care that way. Curiosity. I had never had a doctor who seemed curious about me.

Finding a new one

I called my insurance. I got a list of in-network psychiatrists. I called twelve. I asked each one's office two questions: "How long are appointments?" and "Does the doctor have experience with schizoaffective disorder?" Most receptionists could not answer either question. Two of them transferred me to voicemail and never called back. One office was rude.

I eventually found Dr. M through a referral from a psychologist I had seen briefly. Her office said appointments were 30 minutes for follow-ups and 60 minutes for the first visit. That was already different.

What the first appointment was like

Dr. M was in her late forties, calm, and quiet. The first appointment was 75 minutes. She took a full history. She asked me about my goals. She asked me what was working in my current treatment, what wasn't, and what I wanted to be different. She asked what I had heard about clozapine and what I thought.

She did not, in that first appointment, change my medications. She did not promise me anything. She said, "Let's see how things go for a few months. I'd like to understand you better before we make changes." I left her office and cried in my car for twenty minutes. Not from sadness. From the strange, unfamiliar feeling of having been listened to.

Why it took almost two years to trust her

I want to be honest about this part, because I think it surprises people. It took me almost two years of seeing Dr. M every six weeks before I trusted her. Every appointment, for the first year, I waited for her to become Dr. K. I waited for her to dismiss something. To laugh at a question. To stop being curious.

She didn't. But the part of me that had spent nine years bracing did not relax on its own.

Specific moments that built the trust:

• Around month four, I told her I had been thinking of stopping a medication. She did not panic. She did not lecture. She said, "Tell me more. What's making you want to stop?" We had a real conversation. I did not stop the medication, but for the first time in years I had felt heard.
• Around month seven, she made a small mistake — wrote a prescription for the wrong dose. When I called her office, she called me back personally within the hour, apologised directly, and corrected it. I had never had a doctor apologise to me before.
• Around month eleven, I had a bad week. I called her office to ask for a sooner appointment. She moved a slot for me the next day. When I came in, she asked, "What's been happening in your life?" not "Are you taking your medication?"
• Around month fifteen, we did finally talk seriously about clozapine. She walked through the trade-offs with me carefully. She didn't push. We decided together to try a different switch first.
• Around month twenty-two, I told her about Dr. K. She listened. She said, "I'm sorry that was your experience. I can understand why this took time." She did not get defensive on his behalf. She did not minimise.

What trust in psychiatric care actually looks like

I had not realised, until Dr. M, that I had a clear set of unmet expectations. Trust, for me, looks like:

• The doctor is curious about me as a person, not just as a chart.
• The doctor takes my reports of side effects seriously, even when they are subjective.
• The doctor explains their reasoning when they recommend or change a medication.
• The doctor asks what my goals are and adjusts treatment in light of those goals.
• The doctor admits when something is uncertain or when they don't know.
• The doctor is willing to discuss medications they didn't initially propose.
• The doctor treats my time as valuable.
• The doctor responds to messages and crises in a reasonable timeframe.
• The doctor does not get defensive when challenged.
• The doctor remembers small details about my life from one appointment to the next.

None of these are luxuries. NICE guidelines for adults with psychosis specifically recommend collaborative, person-centred care, with shared decision-making and clear explanations. What Dr. K had given me was not a different style; it was care that fell short of what guidelines describe as adequate.

What I would tell someone in a bad psychiatric relationship

1. You are allowed to leave. Even after years. Even if your insurance makes it hard. Even if you have nowhere lined up yet.
2. Bring a friend or family member to a few appointments. Their outside ears can help you see what you have stopped noticing.
3. Make a list of what you want from psychiatric care. Curiosity, time, explanations, shared decisions. Decide it before you start interviewing.
4. Don't expect to trust quickly. Bracing is a learned response. It takes time to unlearn.
5. Tell the new doctor about the old one if it helps. Mine, when I finally told her, used it to understand my reactions. She did not get defensive on her colleague's behalf. That mattered.

Where I am now

I have been with Dr. M for seven years. We have changed my medications twice. I have not been hospitalised since I started seeing her. I trust her in a way I did not know was possible with a doctor. The trust did not come from anything dramatic. It came from many small appointments in which she remained curious, in which she took me seriously, in which she did not become Dr. K.

If your current psychiatrist does not feel like the one you can trust, please do not believe the voice that says you have to stay. There are Dr. M's. They are worth the search.

For more, see finding a good psychiatrist, getting a second opinion, and another patient story on switching prescribers.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.