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Psychotherapy: When to refer to a specialist
- Complicating comorbidity (significant substance use problems, severe personality disorder, complex anxiety disorder such as posttraumatic stress disorder or obsessive compulsive disorder), severe eating disorder
- Severe presentation (serious suicidality, psychosis, bipolar disorder, especially bipolar I with manic episodes)
- Refractory to 12–16 sessions of combined treatment with medication and pharmacotherapy
- Concern about maintaining professional boundaries with the patient