Tell me about your mother...

August 18, 2014 1:12 PM

First appointment with a psychiatrist tomorrow morning. Soooo... what's that like? Snowflakes inside...

Posting with a sock puppet account for anonymity.

Because I've met you people, I'm skipping the part where I list my problems and ask how to deal with them. I already know I have significant, life-affecting health anxiety, including panic attacks at fairly regular intervals, with increasing frequency. I may also be depressed - it's kind of hard to tell what's going on behind the constant crushing dread. I talked to my PCP about it, and got a short scrip for lorazepam and a list of psychiatrists to choose from. My first appointment with the psychiatrist is first thing tomorrow morning.

What kinds of things will he ask me? Are there any wrong answers? Is there anything I can do to increase my odds of being taken seriously?

It's been pointed out to me that I have a tendency to downplay significant symptoms in the presence of medical professionals. I need to make it clear that I need help because I am having real problems coping with my anxiety -- but there's a strong likelihood that I'll come across as a charming, smart person with great coping mechanisms in perfect mental health, if left to my own devices. (My current coping mechanisms are to spend every minute I'm not at work watching tv shows or movies, or playing video games, or or eating everything in sight. Or sometimes, all of those things at once. Most nights I have to "cope" like this late into the night, resulting in very little, very poor sleep.)

If it helps to know what's going on, my main issue is an overwhelming fear of death due to undiagnosed illness. I tend to be extremely preoccupied with cancer, but any terminal disease not immediately visible will do. I overuse my doctors and the ER. I regularly spend hours self-diagnosing random unexplained aches/pains/symptoms, and then spend hours trying to comfort myself by researching on line to "prove" to myself I don't have anything serious. This misguided attempt at self–soothing doesn't work, often makes things worse, and is becoming obsessive. I also spend a lot of time crying in despair because I'm certain I'm dying. This is a cycle that repeats itself over and over. For a while it was every few months, then every few weeks, and now...it feels fairly constant. I really, really need it to stop. So far it's not affecting my work, but it's affecting just about everything else.

So... Is this the kind of thing the psychiatrist will want to hear? Or something else? Or......?

posted by antimony_hayes to Health & Fitness (20 answers total)

Print this question out and bring it to them.
posted by Jairus at 1:18 PM on August 18, 2014

Agree with Jairus. Those two main paragraphs (from "It's been pointed out..." to "..just about everything else") are perfect to just print out and give to the doc. Also feel free to spend the rest of the day and tomorrow morning writing down every question you can think of or that pops into your head that you might have for the doc and bring that to the appointment also.

As for answers to their questions, be honest with your responses -- including when the answer is "I don't know" or "it's hard to talk about now". Think about (though you definitely don't need to have an answer to this before you see the doc) what your goals are, and what your desired outcomes would be, and discuss those with the doc. Be open to different treatment options and ask for advice.
posted by brainmouse at 1:24 PM on August 18, 2014

Just be yourself and ask yourself if you feel like you could trust this person, do you feel understood, do they have experience helping people with anxiety? You won't solve your problems in the 1st session, you can't possibly explain your life's history of anxiety in one session, but you'll get a sense of whether this therapist is a good fit for the work you're about to do.

In my case 1/2 hour before my first session I suddenly became overwhelmingly convinced.... that I was just fine and really was over-blowing this therapy thing and I should probably just call and cancel; I felt happy, calm and peaceful, and certain that there were no major problems. (I ended up with a doozy of a diagnosis so clearly yes I did need the help.)

Yeah so if you feel that way, my advice to you is to just go ahead with it anyway.
posted by serenity soonish at 1:28 PM on August 18, 2014

...but you'll get a sense of whether this therapist is a good fit for the work you're about to do.

Please keep in mind a therapist and a psychiatrist are two totally different professionals. A therapist is a counselor who you speak with and work through your problems by talking about them and taking their advice and making progress in understanding how you think and feel and why.

A psychiatrist is a medical doctor. They went to medical school just like a GP or a cardiologist or a neurologist. Some psychiatrists do therapy as well but generally you're not there to lay on a couch and talk out your problems. You'll speak with your psychiatrist long enough for them to give you an idea of what's up, and they'll either prescribe medicine for you to try, or tell you that you should see a therapist first and come back if therapy isn't effective.

You sound very self aware and nothing you wrote here would keep you from being taken seriously by a mental health professional. I definitely agree that reading this question verbatim would be a great way to start.
posted by griphus at 1:33 PM on August 18, 2014

(I feel a lot of people say "I went to a psychiatrist and they just tried to push medicine on me" which is odd because it is literally a psychiatrist's job to determine if you need medicine and prescribe it to you if you do.)
posted by griphus at 1:34 PM on August 18, 2014

Psychiatrists are generally more prone to thinking about what medications would be helpful to your condition(s), so (in my experience) the appointments are shorter and more to the point. You will give some history, but it won't be a deep-dive into your personal journey. You may be referred to a psychologist/therapist for that part of your therapy.
posted by xingcat at 1:44 PM on August 18, 2014

Why are you going? From your question

- crappy sleep
- constant health anxiety/hypochondria
- obsessive behaviors that disturb you
- crying and despair feelings that are increasing in frequency

Just because you are not exhibiting those symptoms at the time you are seeing your doctor does not mean they're not serious and deserve attention. It also doesn't mean that they're just something you have to always be the victim of. They can be managed, alleviated or maybe even completely gotten rid of. Did the lorazepam help? What are you hoping to get our of therapy?
posted by jessamyn at 1:47 PM on August 18, 2014

The psychiatrist will be interested in your symptoms. It can help to think about the nature of your symptoms (intense worry, preoccupation, crying etc), the intensity (how much does it interfere with your life - do you get out of bed? go to work?) the duration (how much time do you spend) and the frequency (how often does it happen) These can be very rough guesses but it will be easier to describe if you have thought about how the problem is affecting you. As said above, all answers are fine, including "I don't know" - you should be taken seriously regardless - just try to be honest since the doctor will be relying on what you say.

Also, most psychiatrist focus on medication management. (Usually they do some kind of talk therapy but they don't have the time, or at least their time is very expensive, to do the deeper work that can help you not only feel better but to resolved the underlying problems so you stay better after you stop taking the meds. In California, this would be a psychologist, a licensed clinical social worker or a marriage & family therapist - someone with any one of these credentials would be capable of helping you although you want to check their personal expertise in your area.
posted by metahawk at 1:53 PM on August 18, 2014

What kinds of things will he ask me?

Probably a lot of background information, what symptoms you need help with from her right now, and about your lifestyle/living situation. Don't worry about guiding the conversation, the psychiatrist will have lots of questions -- all you have to do is answer them. In my experience, probably the only time you'll have lots of questions for her is after she gives you her recommendations in terms of diagnosis/treatment and you have clarifying questions about the medication or timeline for treatment, etc.

Are there any wrong answers?

I don't think there are wrong answers per se, but the psychiatrist is going to be trying to tic off symptoms and figure out what kind of (provisional, probably) diagnosis to give you in order to best medicate you. So be concrete and don't get bogged down in random stuff that's bothering you but that isn't necessarily relevant to what you need the pdoc's help with. If you're having trouble with that, remember that this isn't a therapy session, this is an attempt to diagnose and medicate you to improve your *mood,* and therefore your function, more than anything else.

Write down all the symptoms *related to mood* that you want the pdoc's help with. Separate them out from the symptoms related to other disorders or issues that you have going on (though having a master list of symptoms you need looked at is a good idea, too). The pdoc is a medical doctor and so she's going to try and help you with whatever medical problem you show up with, but she is going to be looking for *psychiatric problems and solutions specifically* because that's her specialty, so she's not going to be that helpful w/r/t non-psychiatric ailments and giving non-psychiatric help. (When I say non-psychiatric, that includes possible neurological issues you might be having -- I know there can be A LOT of overlap between physical health and mental health, especially w/r/t anything neurological, but she's ultimately someone working in mental health *specifically,* so don't expect comprehensive full-body care from her, especially right off the bat). Way later in the game you can be more expansive about what symptoms you bring up with her and more informal in terms of therapy-related stuff, but that's not going to be her primary interest, and so, since this is the first time you're meeting each other, that stuff isn't what you should focus on or probably even bring up with her now. YMMV of course, but this is the advice I'd give myself if I could go back in time to the day before my first appointment with a psychiatrist.

Is there anything I can do to increase my odds of being taken seriously?

Bring up very concrete and easy-to-verify facts about how things have changed and how your symptoms manifest. Be specific! If she asks about other people's (friends', family's, co-workers', whoever's) perceptions about your problems/symptoms/behavior DO NOT DOWNPLAY THINGS. In her mind, your account is likely to be suspect and she's going to think that their account (even delivered second-hand through you) is more reliable. Remember that in general -- she's likely to take everything you say with a big grain of salt, even if you're completely upfront and honest with her. So yes, be upfront and honest, but make sure to back up your statements/account with verification from other people or with concrete facts so that she takes what you're saying seriously and doesn't handwave it as you just being [insert diagnosis here]. Also, don't lead her down rabbit holes in terms of your emotions or perceptions or anything, because you want to be trading in external and verifiable perceptions and facts as much as possible, since that's the information she's going to privilege.

You can trust her to want to help you, BUT you can't trust her to listen to what you say. So you're probably going to have to prove yourself and give more evidence than you would for other doctors. In the pdoc's defense, she's going to have to diagnose and treat based largely or exclusively on behavioral criteria and not on more straightforward things like blood tests or scans, so it's not that she's just being an ass or disrespectful or arrogant when she takes that position, it's a practical thing above all else. But when you talk to her, and when you're deciding what to talk to her about, keep in mind that you're going to have to give external evidence if you want to be believed and that she's ultimately going to be diagnosing and treating you based on her own professional discretion and not an objective measure.
posted by rue72 at 1:55 PM on August 18, 2014

I asked a not dissimilar question when nervously anticipating my first therapy appt... I re-read all the replies while I sat in the waiting room! Therapists are on your side and want to help you.

My thread is in my question history ;)
posted by jrobin276 at 2:10 PM on August 18, 2014

Seconding the thing about the psychiatrist being a medical doctor whose roles are a) diagnose and b) prescribe. I didn't really GET this until I started seeing my current psychiatrist, who is pretty no-nonsense about these two roles and sticks to them. At first I was offended (she doesn't like me and can't be bothered to fake it!) and then worried I wasn't getting the care she was supposed to give me (all she wants to do is tweak my prescriptions, what about my FEELINGS?) When I figured it out I felt a bit silly--I work in a mental hospital after all! Fact is, the old idea of the psychiatrist who wants to know all your feelings and your entire history is just not how it is anymore. "Talk therapy" is now done by licensed therapists, social workers and psychologists.

Something no one has mentioned: don't make jokes about serious things, even though some people employ this as a coping mechanism when they are nervous. Just like you shouldn't joke about plastic explosives in the airport security line, it is not helpful to anyone--and can backfire on you--if make jokes about suicide or about violence towards others. This kind of offhand comment WILL be treated as serious by any mental health professional, and will up the urgency of the situation immediately. Best case scenario, your doctor realizes your illness is more serious than he/she thought, and will work with you to find strategies for if you feel this way again. Worst case, if you make repeated references to suicide or violence, or you also seem distraught/hopeless to the psychiatrist, they may suggest hospitalization--or if they have reason to think you are an imminent danger to yourself or others, you may find yourself hospitalized, period. Not that hospitalization is always a bad thing--but I'd imagine you don't want to go there if you don't have to!

That having been said, if you DO have feelings that you might want to harm yourself or others (and there's no reason you would need to tell us if you did!), it is best to tell the psychiatrist, without joking. Other commenters stressed honesty; I would too. Mental health professionals are trained to deal with people who are freaking themselves out with their own thoughts and actions, and they will not make fun of you or label you as "crazy". They know what to do to keep you safe and help with your pain. They have heard it ALL, and it can feel good just to get it out there and let someone else deal with it for a change.

Last bit of advice, left over from when I was a consumer health librarian: ask questions and take notes. And if you forget something or can't figure what you meant in one of your notes, call the doctor's office and ask to speak to a nurse or to the doctor him/herself, just like you would with a "regular" doctor. You are not "bothering" them with your questions--it's their job to answer them. Understanding your own health, and what you need to do to take care of it, is extremely important no matter what kind of health issues you have.
posted by gillyflower at 3:28 PM on August 18, 2014

It's like a first date, mostly. Awkward. Uncomfortable. Opening up to a total stranger.

Unlike a first date, however, this person's entire job--the only reason you are going to see them--is because they want to help you help yourself get better.

There are no wrong answers. "I don't know" is both a valid and helpful answer; it helps pinpoint areas to explore.

Just be honest. It takes time to develop the emotional intimacy required in a therapeutic relationship. But it's time worth investing.

And yes, print this out and bring it with you.
posted by feckless fecal fear mongering at 3:54 PM on August 18, 2014

Just to echo a bunch of people above, it doesn't sound like your psychiatrist is also going to take on the role of your therapist. I really wouldn't expect it to require emotional intimacy. Talking about the symptoms of anxiety and depression is a hard thing to do, but having a good bedside manner is part of any doctor's job. If it's awkward and uncomfortable, find a new psychiatrist. If you're interested in therapy, your psychiatrist will have recommendations, as well as an opinion on if it would benefit you.
posted by likethenight at 4:06 PM on August 18, 2014

I don't usually say this but I think, as mentioned above, that you really should actually print your question out and hand the paper to the doctor in the morning.

Walk in, sit down, and say something like "I'm kind of nervous about this appointment. I wrote this question asking for advice about the appointment, and I thought I should show it to you as a starting point." The doctor will most likely read it and then proceed with the appointment and start asking you questions.

It can be intimidating, nerve-wracking, and plenty of similar things, to talk to a psychiatrist, psychologist, or really any other doctor for the first time, and that effect can make a person less articulate and/or able to clearly express oneself. Printing and showing your question to the doctor will give him or her a good background on your overall emotional state and the reasons for your visit. This will give the doctor a good start on his or her lines of inquiry to find out more about your troubles.
posted by Juffo-Wup at 4:18 PM on August 18, 2014

Absolutely do bring the question with you, it will be very helpful. It is always okay to bring notes, take notes while you're there, jot notes between sessions for next time, log activities you think might be important for them to see, etc.

But this first visit will probably be about half administrivia - your medical history, any medications you're currently on, a description of how this doctor/practice works, anything you need to know about billing and stuff.

And then you will talk about why you're there. That's why you print your question and bring it with.

There's no wrong answers. Your basic rules are a) don't hurt the doctor or their belongings, b) try very hard to be honest. You are speaking to a professional who can only help you accurately if he knows the truth. If there are things you already feel like you know you're going to minimize, write them down now.

You will be taken seriously because that is the doctor's entire raison d'etre. That's what they do for a living. This is not a battle, this doctor is not your opponent. The doctor is your coach, your tour guide, your translator. This is not a person guarding treatment until you prove worthy. This is just a person who needs to know what your particular set of manifestations is in order to pick the right treatment. Now, we all know that this is not an exact science, and changes may need to be made going forward - that's why you're going to go back routinely - and that's okay, that's not incompetence on their part or some failure to cooperate on yours, it's just neurobiology.

You are clearly suffering and unhappy and that is the only criteria you need to fulfill. Do not worry about being "sick enough" or "good enough" to deserve treatment (this is a really common fear among people with anxiety and depression, it's kind of like the disease's defense mechanism).

You will be fine. You will be nervous and it's fine to say so, most people are. But it's not a meeting with the Queen, it's just a person who has studied stuff that is useful to your situation. Psychiatrists who practice with the general public tend to be pretty amiable people, they like working on the ground instead of say in research or a clinical environment, they're going to be interested in what you have to say. You will be welcome there.
posted by Lyn Never at 5:00 PM on August 18, 2014

Write things down. It's one of my strategies when things are too tough to say out loud. Your question is a perfect start.

It's okay to take a second to think about your answers to the questions. I also tend to downplay symptoms (see my recent question about voices).

Trust is a two way street. I know it takes me a while before I trust the doc. I was told that I should always trust the doctor without evidence to the contrary. BS. They need to earn my trust as much as I need to earn theirs. Or maybe I'm cynical and burned one too many times by shitty doctors.

Take the prescriptions (if you get them). But you don't have to fill them. Give yourself permission to cool off for a day if you start freaking out. Related, give the meds a fair trial. That'll be different for each type. Side effects generally disappear in the first couple of weeks.

Hopefully, if you get meds, you'll have a follow up fairly quickly. Press for no more than a month, two weeks if possible. Once you get established with a doc, it does get easier to get in.

You (most likely) will be nervous. It's okay. It's even okay to tell the doc that. It's nothing to be ashamed of. It's human nature.

Good luck. You'll do fine.
posted by kathrynm at 5:21 PM on August 18, 2014

Thank you all for your suggestions and advice. I did show the doctor the two paragraphs above about what's going on with me.

Unfortunately, the visit was completely horrible and I won't be going back. I may not go back to any psychiatrist ever again.

He spent 10 minutes taking an extensive and deeply personal history, which you had all prepared me for. Then he spent 20 minutes trying to sell me a self-recorded relaxation CD of his own voice, for $30. He said it would be "an investment in the rest of my life." Then he said because I was overweight he couldn't recommend any antidepressants, and wrote me a scrip for lorazepam.

I'm now sitting at my desk shaking with rage and humiliation. I feel like I've got slime all over me. I went in there expecting a doctor and got a salesman -- to whom I revealed intimate details of my past before I realized what was going on.

This was a doctor I chose from a list of recommended psychiatrists in my PCP's "system." I know she just pulled a list of local pdocs in her system from the computer, but now it's making me re-think the PCP altogether, even though I liked her when I met her. I'm just horrified, and embarrassed, and feel worse than ever.

And needless to say, I did not buy his fucking CD.
posted by antimony_hayes at 8:18 AM on August 19, 2014

Then he spent 20 minutes trying to sell me a self-recorded relaxation CD of his own voice, for $30. He said it would be "an investment in the rest of my life."

Ugh, I'm so sorry. If it makes you feel any better, that's probably some (at least ostensibly) CBT prop. I've had therapists try to unload dumb CDs like that on me before as part of a CBT course. Personally, I also have no desire to listen to some rando's voice telling me what to think about or visualize or whatever when I'm trying to relax, and have never taken or used the CDs either, but it's not a *completely* out-of-left-field thing.

This was a doctor I chose from a list of recommended psychiatrists in my PCP's "system." I know she just pulled a list of local pdocs in her system from the computer, but now it's making me re-think the PCP altogether, even though I liked her when I met her.

I don't think this is reason to re-think your PCP -- she probably doesn't even know this guy from Adam, they just happen to be on the same insurance system/plan or something. I *would* complain to the "system" (your insurance system/plan?) about this pdoc, though, if you really found him egregious. I've done that before with a dentist, to get him off the "recommended list," because I didn't want anyone else to get scammed like I did -- and the insurance company actually did take it seriously.

I'm just horrified, and embarrassed, and feel worse than ever.

You don't have to feel embarrassed, it's not your fault that this guy decided he was going to leverage the position of trust he holds as a doctor to try to turn a quick buck off of you (UGH HORRIBLE. Total lack of integrity on his part). And of course you feel horrified, you just had your trust betrayed! I'm so sorry. And can entirely relate, if that helps at all. I don't think this is a reason not to go to another pdoc, though. If you need psychiatric help then you need it and you're going to have to try again to get it, dumbass CD shills be damned.

If you are on good terms with your PCP, then you might want to call the office to ask for a telephone consult with her, so you can tell her how horrified you were with the pdoc and whether there is anyone she *knows* is a good pdoc who she can recommend off of that list she gave you. I would emphasize that you *want* to see a pdoc but that now that you've had a bad experience you're nervous and you need her help with choosing one.
posted by rue72 at 8:43 AM on August 19, 2014

Jesus Christ, I am so sorry that happened to you.

I don't know how big a town you're in, but Yelp can be a surprisingly useful reputation check. Please please please do not write off treatment because of this - as horrible as it was.

Do you have anyone around you you trust to help you with this? I know it's hard just working through the stupid provider list and then maybe trying to find if they have websites or reputation of any kind, though at least you can do that online. But then the final step should be for someone to call on your behalf and say, "Hello, I am calling to help my friend make an appointment, but I need to tell you the appalling story of what the last doctor did and if the same thing is going to happen here we can just skip making the appointment."

Hell, I'll do it if you want me to. I will put the hammer down.
posted by Lyn Never at 11:14 AM on August 19, 2014

I'm a psychologist (not yours) and am pretty grossed out by this relaxation tape salesman! also plenty of overweight people take antidepressants!

Please don't blame your PCP. I agree with others that she most likely had no knowledge of this guy.

Please try another psychiatrist.
posted by DMelanogaster at 6:12 PM on August 19, 2014