Your first appointment is only a few days or hours from now. You’re probably feeling at least a little bit nervous. You may be picturing a scene in your mind of a square brown room with a couch made of hard leather and a balding, bespectacled man with a goatee perched imperiously on a stool next to it, wielding – gasp! – a clipboard. “Lie down right here and make yourself nice and vulnerable,” the man says, gesturing towards the couch. “Tell me all your deepest, darkest secrets. Start with the sex stuff.”
Good grief, who wouldn’t be nervous?
Listen, try and relax. Your psychiatrist may very well be balding and wear glasses and have a brown office with uncomfortable seating (which may or may not include a couch), but he is not going to ask you any really, deeply personal questions on your very first visit. Those types of questions belong in a therapy session, not an initial evaluation. As a matter of fact, the first thing you can expect your psychiatrist to do is to greet you, briefly make some innocuous small talk (“Isn’t it nice outside?”; “Man, I’m glad the Vols won the game last night”, etc.), and then ask you how you’ve been doing lately. The small talk is to prove that he’s just a human being and not a pod person – in other words, it’s meant to put you at ease.
Let’s back up a step, though, because one of the most important things to remember is to be on time for your appointment. As a matter of fact, be ten minutes early. They usually have some pretty good magazines in the waiting area, or you can fill the time by fiddling with your smartphone. If you show up late for your first appointment, not only does it set a really bad precedent, but sometimes they won’t even see you. I read a complaint on an online forum yesterday about someone who waited months to get an appointment, showed up ten minutes late, and then had to reschedule for several more months down the road. Psychiatrists are busy people, and you should respect that their time equals their pay. They’re not trying to be evil witch doctors by canceling an appointment you show up late to; they’re making sure that all their other patients get seen on time, because they want to make sure they help somebody each day. Trust me, there’ll be a day when you’re hanging out in the waiting room for an hour (no, seriously, an entire hour – sometimes longer) before being seen because someone who had an appointment earlier in the day showed up late. Don’t be that someone.
Oh, that reminds me, if you show up early they’ll probably give you an inventory, which resembles a survey in that you have to indicate which items are relevant to you and your symptoms. The inventory may have items like, “I feel anxious and worried,” “I have trouble falling asleep,” and/or “I have no interest in things I used to enjoy,” and you’ll be asked to mark which response applies to you: every day, most of the time, some of the time, or never. If you followed my previous advice, this should be fairly quick and simple because you’ve already described your symptoms in written detail. This is standard procedure because not all patients have taken the time to nail down and describe their symptoms as carefully as you have, and the survey helps the doctor determine the nature and severity of their problems. It also provides the doctor with evidence of each patient’s current state of mind, so he can use the inventory to easily gauge the patients’ progress over time. It’s a valuable tool and a big help to your psychiatrist, so go ahead and do it even if you already have your issues written down.
Okay. Ten minutes early; check. Inventory filled out; check. Doctor introduces himself, appears to be human. Check. Small talk out of the way; check. It’s time for… the clipboard.
But first, the couch. Or maybe not; it may be just a chair. In my opinion, chairs are preferable to couches because lying down makes me feel vulnerable and exposed. Whenever I’ve had to use a couch in the past, I’ve found myself adopting the Burt Reynolds pose so I can still see my psychiatrist’s face. (Although I did keep my clothes on, for the record, thank you very much. By the way, I hope you didn’t open that link at work.) Actually, according to some therapists and psychiatrists, it’s better if the patient can’t see the doctor’s face; part of our nature as human beings is to tailor our behavior based on perceived reactions from other people, which means a patient might perceive a change in his psychiatrist’s expression and decide to withhold information related to a potentially controversial issue that he or she is experiencing – even if it turns out the doctor just has an itch in his eye. Psychiatrists and therapists also point out that when a patient is lying down, the brain may enter a more relaxed, almost dreamy state that allows the patient’s thoughts to be expressed with less inhibition or interference from outside stimuli. If you’re like me, however, and you just don’t think you can relax enough to open up if you can’t see who you’re talking to, your psychiatrist will probably allow you to sit up until you get to know him well enough to know him.
Okay. So you’ve situated yourself comfortably on whatever type of furniture your psychiatrist intends for you to light upon. Now it’s time for… the clipboard.
Actually, your psychiatrist may not even have a clipboard. Mine doesn’t; he takes notes when I leave (I know because he shuffles through them at the beginning of every appointment). My therapist has a clipboard, and I’m assuming she also knows some form of shorthand, because apparently everything I’ve told her in the three years I’ve known her will fit on two sheets of paper. (I’m kidding. Obviously she only writes down the important stuff. As a matter of fact, I tell you what: The next time I go to see her, I’ll ask her what sorts of things she writes down so I can relay the information to you. It might put your mind at ease to know your therapist isn’t writing down every embarrassing thing you say.)
So you may get lucky and not even have to face off against… the clipboard. And by this point, you’ve already done all the really hard work – deciding to get help, making all the necessary phone calls, scheduling an appointment, showing up for said appointment – and if your doctor isn’t morphing into a squishy clone of you by this point, it’s pretty safe to say he’s not a pod person. Now all that’s left is the final hurdle – talking about your symptoms. As I mentioned in a previous post, depending on how nervous you are, you can imagine the psychiatrist as an android, recording your data in his computer-brain so he can determine and produce your diagnosis. I did this the first time I saw a therapist and it worked great. (I was 9 and a big fan of Data on Star Trek: The Next Generation – he was my favorite action figure.) If you prefer a more grown-up approach, remind yourself that your psychiatrist suffered through medical school to get to where he or she is right now. That’s not an ordeal people undertake unless they really care about helping people get better. Besides, if you followed my advice about preparing for your appointment, you should have a list you can refer to when answering his questions, and if your nerves fail you utterly you can just read straight from it the way you did in the Thanksgiving play in second grade (or was that me?).
Before you leave, think back to your primary objective for this mission: the diagnosis. At the end of your session, make sure you ask your psychiatrist what he thinks is causing your symptoms. You should ask him to write down for you the name of the condition, the names of the medications he is prescribing (in my experience, prescription slips are usually illegible), and any books you can get or websites you can visit for information and support. Don’t just leave the office going, “Welp, looks like I’m bipolar” (or schizophrenic, or borderline personality disordered, or whatever). This information is a tool to help you determine what, exactly, that means for your life. Do some research. Reach out to some people who share your condition. Knowledge is power you can use to take your life back.