A patient sat in my office last spring, fidgeting with her car keys, and finally said it: "I think I need to talk to someone, but I don't even know where to start." She'd been white-knuckling her way through months of worry and low mood, assuming therapy was something you had to figure out alone. It isn't. That conversation is often where a good CBT referral begins.
I'm Dr. Avivah Golian, and in my Direct Primary Care practice here in Los Angeles, helping patients find the right therapist is part of the job. Cognitive Behavioral Therapy is one of the best-studied, most practical tools we have for depression, anxiety, and the kind of stress that won't let go. Let me walk you through what a referral actually involves.
What is CBT, and why does my doctor recommend it?
CBT is a structured, skills-based form of talk therapy that helps you notice the link between your thoughts, your feelings, and what you do about them. It's not years of open-ended reflection. It's focused work, usually over a set number of sessions, on patterns that are keeping you stuck.
I recommend it because it works, and because it gives you tools you keep. A patient learns to catch a spiraling thought, question it, and respond differently. Those skills don't expire when therapy ends.
CBT can stand on its own, or it can pair with medication. For some patients, I'll discuss SSRI or SNRI therapy alongside a referral. Many people do best with both. We decide that together.
How do I know if I actually need therapy?
If your mood, worry, or stress is interfering with sleep, work, relationships, or how you feel most days, that's reason enough to ask. You don't have to be in crisis to benefit.
In the office, I often use brief, validated questionnaires to get a clearer picture. A PHQ-9 depression screen or a GAD-7 anxiety screen takes a couple of minutes and helps us talk about specifics instead of vague feelings. These aren't tests you pass or fail. They're a starting point.
Some signs I take seriously:
- Persistent sadness, emptiness, or loss of interest in things you used to enjoy
- Worry that feels constant or hard to control
- Trouble concentrating, irritability, or sleep that's off for weeks
- Physical symptoms with no clear medical cause
If you ever have thoughts of harming yourself, that's not something to wait on. Call or text 988 in the U.S. for immediate support, and tell me so we can act quickly.
What happens when you give me a CBT referral?
A referral from me is more than a name on a sticky note. I try to match you with a therapist whose approach, specialty, and logistics actually fit your life.
That means thinking about a few practical things together. Do you want in-person sessions or telehealth? Does insurance matter, or are you paying out of pocket? Are we treating anxiety, depression, grief, or something more specific like panic or trauma? A therapist who's excellent for one may not be the right fit for another.
Because I run a small practice, I know the clinicians I send people to. When something gets lost in the shuffle, which happens in a big medical system, I'm the one following up. I'd rather coordinate care than hand you a list and hope for the best.
Will I still see you while I'm in therapy?
Yes. A CBT referral doesn't hand you off and close the door. I stay your primary care doctor throughout.
That coordination matters more than people expect. Stress and mood affect blood pressure, sleep, appetite, and chronic conditions. If your therapist and I are both in the loop, we catch the overlaps. Sometimes managing anxiety improves a patient's sleep or even their numbers at the next physical, and I want to see that whole picture.
I also check in. How are sessions going? Is the fit right? If a therapist isn't clicking after a few visits, that's useful information, not a failure. We adjust.
How long does CBT take to work?
Many people start noticing a shift within several weeks, though it varies and depends on what you're working through. CBT tends to be shorter-term than people assume, often a defined stretch of weekly sessions rather than something open-ended.
The honest answer is that it takes some effort. CBT asks you to practice between sessions. The patients who get the most out of it are the ones who treat those small assignments as seriously as they would any other prescription. The payoff is real, and it lasts.
If you've been wondering whether it's time to talk to someone, you don't have to sort it out alone. Reach out to my office and we'll start the conversation, figure out what kind of support fits, and find you a therapist worth your time. That's exactly the kind of care a small LA practice is built for.