Thank you for your post SE. I love it that you reminded the poster of their rights to control their treatment. I think that's so important. I just wanted to add something to the legally mandated to refer part...

Every person over the age of 18 years old who is maintaining power of attorney over their individual rights (meaning no one has taken them to court to declare them incompetent) has the right to refuse medication for all disorders at any time, for any reason in the United States. (only speaking to US, of course, and what has been held up in national precendent -- I have NO experience in international health so I don't want to give anyone false info about what those clinicians face)

As such, referrals for pharmalogical or medical follow-up are no more than fancy suggestions unless they are court ordered... and those are usually when a patient has received inpatient treatment/incarceration and the judge orders continued care as a condition of their release.

The only legally mandated referrals would be ones in states with laws that require for duty to warn such as if a client explicity states intent to harm self or others or if it falls under neglect/abuse laws for children/elderly/incapacitated adults.

If the therapist refers a patient for psychosis simply as a suggestion for medication, there's nothing guiding that clinician other than his/her interpretation of best practice.

So, that's all, I just wanted to say that referrals to a psychiatrist are not typically legally regulated unless it's part of a court ordered discharge agreement or there's abuse/neglect/danger... If the therapist said anything to the contrary, I'd definitely request clarification to see why he is required to refer his clients out... could be agency policy, could be some jacked-up collusion with the drug companies, etc.

To the original poster: I think everything you are experiencing is 100% normal from someone facing similar challenges. I would worry too that I'd lose the good with the bad.

I think it's helpful to generalize it to other situations. Any time we make a decision, there's risk involved. I'm trying to decide whether to prioritize career, family, or friends right now and with every plus involved... I lose something as well.

I've got input from family who want me to choose them... friends who want me to choose them... and from my banks/creditors/landlord who want me to choose them and go where the money is best. All of those things are helpful but in the end, I'm going to have to trust my gut, I guess, as to what is best for me.

If you feel that you are no longer able to make the best decision for you, then you need to find someone you trust and ask them to help you with that decision process. Committing to pharmacological treatment of a disorder is a big step whether it's chemotherapy for an autoimmune disease or atypical antipsychotics for a psychotic disorder.

As far as the tests, first, you will have to fill out a ton of paperwork. It will likely include at least one survey type assessment. The questions will be varied and will ask you about your usual behaviors or what you are feeling right then at that time. If you aren't able to focus on something until you finish, I'd suggest you bring someone with you to help finish the paperwork.

Depending on the clinician, he will either ask you for your version of events or he will go into his exam mode. Some clinicians do strict testing where you will sit with a pencil and fill in circles or write short answers. Some clinicians do old-style movie-type assessments such as perception tests where you look @ a picture and report your response. Some clinicians do a free flowing interview where they use your responses to gather as much information as they can gather. Some clinicians will use the same interview for every client for the first session. Some clinicians won't ask you any questions, will write you a prescription, and send you out the door (be wary of these...) Some clinicians won't even see you that first day...and will reschedule you for later.

You probably won't leave that day with any firm answers. Proper assessment and diagnosis is continuing/ongoing... it's not final. You can't just do it once and it never changes. As people change, so do the disorders they face. Some heal, some worsen, some new ones pop up, and it's possible that some clear out entirely. If you do get a name for your problems that day, use it as a tool and not as the model to build your life around... if you do, you might miss out on opportunities to change and grow because of that self-imposed ceiling.

You write very well and very clearly so I don't doubt that you aren't very intelligent. As the other poster said, use that in your favor to educate yourself about the possibilities/alternatives for your challenges. Did you know that a lot of times anxiety disorders are misdiagnosed as psychotic disorders? Disturbing intrusive thoughts that are unimaginable for most of us (sex with demons, murdering babies, etc) were always treated as psychosis until recently. Now, lots of clinicians/researchers are viewing them as obsessive compulsive behaviors/thoughts... no different than washing your hands 100 times. It turns out they respond to the SAME treatments as OCD (often non-medicated).

There are tons of answers out there and that's great but it's too much for one person to ever learn... so it's helpful if you share things with your therapist/psychiatrist. Ask questions, stay aware, and communicate your true symptoms... It's my personal belief that the more empowered people are over their own care, the more well managed their symptoms will be for a lifetime.

Good luck and thanks for sharing. Please keep us posted.