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August 16, 2011 2:43 PM   Subscribe

I am about to see a psychiatrist for the first time for some anxiety-related issues. I am...anxious about this. Naturally. What can I expect, and what should I look out for?

I have lately come to the crashing realization that I suffer from a fair degree of anxiety, likely stemming from the much larger issue of massive and crushing abandonment issues.

I am so very tired of this cycle of self-doubt and co-dependency torpedoing every good relationship I have. I am in a relationship currently with the best, most awesome and amazing woman ever, and I DO NOT want to repeat history...at least inasmuch as it is in my control to not do so. I have decided to schedule an appointment for a psychiatrist.

What should I expect?
posted by Caligula's Idiot Cousin to Health & Fitness (16 answers total) 3 users marked this as a favorite
Psychiatrists pretty much just deal with medication. If you want help with your abandonment issues, self-doubts and relationships, you need a psychologist or clinical social worker. Your psychiatrist should be able to refer you for counseling, but if you are not specifically seeking medication, don't go to a psychiatrist first.
posted by Wordwoman at 2:53 PM on August 16, 2011 [3 favorites]

Do you want us to understand this question as though you're asking about what to expect from talk therapy, not medication? Because at the psychiatrist, you will mostly do the whole medical intake form as at other doctors, talk a little about what's going on (sometimes not even that) and then you'll get a prescription.
posted by sweetkid at 2:57 PM on August 16, 2011

You can get a psychiatrist to do some therapy. Just ask everything that comes to mind and write down his/her answers.

Be mindful that at some point you'll come back for another appointment and will be asked, "so how are things going in therapy?"

On your way out of your first appointment, ask his secretary for a list of local mental health resources; most of them have something like it. See if you're able to afford therapy and psychiatric treatment at the same time.

If you're able to try out a psychologist or clinician at the same time, please do so.

If not, IIRC (and I am not your doctor) studies seem to show that medication is most helpful when used in conjunction with therapy. Many report that they are happier with therapy given a choice between the two, so be sure to try it out if you haven't already.
posted by circular at 3:03 PM on August 16, 2011 [1 favorite]

Response by poster: I see. I was under the impression that a psychiatrist was basically a counselor with an MD (and therefore better!). I will seek out a regular counselor as well. Any other suggestions?
posted by Caligula's Idiot Cousin at 3:06 PM on August 16, 2011

Psychiatrists pretty much just deal with medication.

In no way is this universally true. In all my years of talk therapy with five different practitioners in three countries (US, UK and ROI), I have only once seen someone who was not a psychiatrist. You can find people who practice in all kinds of ways but you need to know what you want and which kind of service they offer. I find it convenient to get talking and drugs in one place. When I just want drugs I see my GP.
posted by DarlingBri at 3:06 PM on August 16, 2011

I don't know about the psychiatrist/psychologist thing, but I see a licensed professional counselor. I just recently started seeing her and was spurred, also, by the fear of losing a relationship due to my own anxiety and co-dependency.

So, for me, I spent like two weeks in denial that I was actually going. I kept thinking, "Therapy? No big deal! Just breeze in, blah blah blah." When I got there, though, I was so scared I thought I would die. I didn't even want to LOOK at the counselor. She gently prompted me to talk about why I was starting therapy. I burst into tears within six seconds and talked about my problems for two hours. I detailed my current issues and my childhood and other things while she went down a list of questions. I remember her asking me about my relationship with food, sex, and other relevant day-to-day things. I talked A LOT more than I expected to.

I still feel dread when I go, and I am tempted to lie a lot, but it was ultimately a pretty good decision for me. I can see the difference in my anxiety already. Of course, I've been honest and intentional, and admitted some challenging things. So you've got to be willing to go there, I guess.
posted by amodelcitizen at 3:09 PM on August 16, 2011 [2 favorites]

Any other suggestions?

Sounds like this thread shall be doomed to offer conflicting information. My two cents says you're on the right track. You've identified some issues that you want to deal with and you're taking the key first step of booking an appointment with a pro. Whether it's the right pro or not, you'll quickly find out. Just ask questions and, if necessary, ask for a referral to an appropriate counselor.

Good luck.
posted by philip-random at 3:26 PM on August 16, 2011

I have seen a LCSW and a MFT for similar issues. I can tell you what to expect in a talk therapy type setting. The people I have seen initially want to know what brought you to seek help. Sometimes they have intake questionnaires that cover things like mood and lifestyle. And then you get to the talking. I tend to want to work with women who have a more conversational style. I would REALLY not like to work with someone who let there be long silences and if that happened, I would seek a different provider.

So, after the initial session when you lay out what it is you want to work on (anxiety, abandonment, relationships, whatever!) then in subsequent sessions you will talk about those issues. How they impacted something that happened recently (like, you got in a fight with your GF and you freaked out about X because it felt like Y or it reminded you of Z). Don't worry. You might just know you got in a fight and not why you freaked out. The therapist will help you figure out why you freaked and also what you can do to change your response the next time. You might cry or get angry. Some stuff might make you feel pretty uncomfortable. For me, (and this is totally personal) when I come to the stuff that is really uncomfortable or I don't feel like I can say what I am really thinking, that's when I KNOW I have hit on the crux of the issue.

Sometimes my therapist gives me "homework." It can be writing about something or maybe just trying to change a behavior. Therapy has really helped me deal with similar stuff. I feel like anxiety and fear of abandonment don't rule my life or relationships anymore. Don't be afraid to try different providers. But truly don't be afraid to really look inside yourself and do the hard, uncomfortable work of undoing past hurts.

Good for you for seeking assistance! Best wishes for your journey.
posted by rachums at 3:54 PM on August 16, 2011 [3 favorites]

amodelcitizen's comment reminded me of my very first therapy appointment. Depending on your relationship to experts and authority, things can feel funny. My first person was basically just all "Mmm. Uh huh. Hmmm." and I left feeling like a specimen, like Exhibit A of Someone Deeply Screwed Up. You can also run into some real bozos, like the guy whose third question to me was about my sex life. But! Those were two so-so experiences out of (counting phone calls I made in finding good therapists at different times in my life) maybe fifteen people. Most of the people were just wonderful: caring, empathic, smart, professional.

The best advice I can give you is to try meeting with a few people, pay attention to how you feel, and then go with your gut. I've heard that the research says that the therapeutic relationship itself is a big part of what helps, which makes sense. If you don't like someone, you're not going to be open to seeing a different view. The relationship could grow to feel like one with a trusted friend who also happens to be really wise and knowledgeable.
posted by salvia at 3:55 PM on August 16, 2011 [3 favorites]

In the U.S. I have only once seen a doc who was a trained therapist, and 'marketed' themselves that way, in addition to being a psychiatrist. Otherwise they are generally medicine-prescribers-and-monitors. I am told this is rare.

Finding good medical professionals of any kind (that you like!) can often be difficult, but I think particularly the ones dealing with mind and mood.
posted by bitterkitten at 4:28 PM on August 16, 2011

Er, 'rare' that is, for a doc to be both a licensed therapist of some kind, as well as a psychiatrist.
posted by bitterkitten at 4:28 PM on August 16, 2011

I do talk therapy with a psychiatrist, just to add one more isolated anecdote to the pile.

In general, I think you can expect the doctor to ask what prompted you to request an appointment, what concerns you have about your mental health, some examples of how the problems that you've identified have affected your life and well-being in the past (and the present), and what you hope to achieve through treatment, i.e., what will be signs to you that you are coping much better with anxiety than you've been able to do thus far.

It can be very helpful to share real-life examples of how your anxiety is presenting obstacles in your life, and potentially your current relationship, but you don't need to share your most painful memories or scary feelings right up front if you don't feel like it. Just be honest, including honestly saying that there are some things you're not quite ready to talk about yet.

The doctor will make sure you're using your time together well, so don't expend too much effort now trying to prepare or anticipate or worry that you won't do it "right." You've already done so much for yourself just by acknowledging that you want (and deserve) for your life to be better, and now it's time to let an expert do his/her thing.

As others have said, please do keep at it if you don't feel like you're the right fit with the first (or next) person you speak with. And best of luck.
posted by mauvest at 4:30 PM on August 16, 2011

Let me put in a good word for cognitive-behavioral therapy; that + meds have worked wonders on my anxiety.
posted by nonasuch at 4:48 PM on August 16, 2011

Aaand, let me put in a word to say that neither cognitive-behavioral therapy or meds were my thing. But trying a non-CBT therapist and doing a few years of more psychodynamic talk therapy have turned my life and relationships around. I say this not to add to your pre-appointment anxiety (I sympathize, but just think of what a kindness you're doing for yourself!) but to let you know that YMMV, always.

So if the first person doesn't work for you, keep looking. It's so worth it to be happier!
posted by ldthomps at 5:15 PM on August 16, 2011

A few tips:

A) Be honest. Painfully honest, if need be. The less you hold back from your therapist, the more helpful they can be. Sometimes it may be uncomfortable to talk about something, but if that is the case it's better to say "I would rather not talk about that right now" than to lie.

B) Don't expect instant results! Perhaps obvious, but therapy takes time. At its core, therapy isn't about someone else "fixing" you, but about someone else providing an objective, outside perspective to help YOU understand and fix yourself. And that takes time.

C) Different therapists have different styles, so if your therapist isn't jiving with you much after a few sessions, no fear! You can always try with someone else. I had a therapist for two years who I didn't really think was too helpful, but I stuck with him because I didn't want to reinvest in a relationship with a different therapist. Eventually he moved away and I was forced to meet with someone else, and I probably moved forward more in the first month than in the two years with the first guy! (I will say, though, that communicating with your therapist is also important. If something they are doing isn't working for you, tell them; it might be that they are doing it on purpose as some sort of technique, but they might also change to help you more.)

I, too, was very nervous about my first meeting with a therapist, but it was one of the best decisions I ever made! Good luck, and I hope you find it helpful and fulfilling.

(And yes, generally psychiatrists don't deal much with talk therapy. Because they have an MD, generally insurance costs for appointments are pretty high, so they themselves can't afford to do much talk therapy. Still, they can probably point you in the right direction!)
posted by shabaabk at 6:55 PM on August 16, 2011

Any other suggestions?

Everyone else has great advice. My additional $.02. If you wind up with anxiety medication, you will likely go through some long stupid period of being too worried about the medication to take it. This is normal, but if I were you [and I have been you] I'd try to cut to the chase and try the medication even though you are half-sure you'll have an adverse reaction and wind up in the hospital. You won't. You'll likely feel either 1) nothing 2) sleepy or 3) like a huge weight has been lifted from your shoulders and mildly chagrined that it took you this long to take steps towards getting better. Good luck.
posted by jessamyn at 7:06 PM on August 16, 2011 [1 favorite]

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