Engaging with a new doctor can be nerve-wracking, especially when you’re ill and fearing for the worst. Imagine entering a strange office with faces glued to computer screens behind glass windows; on the patient’s side of the room you can almost hear people worrying, “Will it be good news or bad?”
Seeing a psychiatrist only heightens the ante, for our patients bring far more than their symptoms to the office; they carry their innermost hopes and deepest dreads through the doorway. “Is there anything he or she can do to help? Will the doctor judge me,” our patients wonder, knowing full well that if the encounter is to be meaningful, they have to reveal their private thoughts and feelings.
Regression, the phenomenon of slipping—sometimes tumbling—down the ladder of time into earlier ways of perceiving and coping, happens under stress, and oftentimes kicks in automatically when we seek advice and counsel from someone perceived as an expert. For many stressed or depressed individuals, meeting the psychiatrist awakens the child within: the part of us that craves comfort and reassurance from an all-knowing parental figure with magical powers to make things right; or the part of us that dreads being interrogated and humiliated by an austere authority who scolds and humiliates.
The paradox built into the doctor-patient relationship is that we (as patient) need to believe our expert (the psychiatrist) knows as much as can be known about the condition for which we seek his opinion. Otherwise, why consult him in the first place? So even before uttering a word, depending on the chemistry between psychiatrist and patient, the initial encounter can be very intimidating.
For the patient, the challenge is to retain one’s adult self and perspective in the face of the (re)emergence of the hopes and fears of childhood. Here’s how:
Before anything, remember that the person on the other side of the room is human, just like you. Although he or she knows more about the brain, body and its disorders than you do, no one knows you better than you. The doctor is not just probing for weak spots, he’s trying to learn how you think and cope. He’s put in hours and years learning his craft. Psychiatrists—indeed all doctors—need continuing education. They do their homework. The session will go better when you do yours.
Even before the appointment, get a notebook. I like it when a patient arrives notes in hand. It tells me he or she has thought seriously about what they want to cover. I don’t mind one bit if a patient pauses during a session to write something down; actually it’s a compliment, validating that something important transpired. Then again, if there’s something I want my patients to remember or look up, it’s best if they‘re prepared. Here’s what you can do:
First: It’s natural to check out your psychiatrist ahead of time. If a friend, therapist, or another doctor refers you, ask what the referrer knows and has heard. Search the internet. Knowledge is power. You’re interviewing each other. There’s no need to worry that you’ll intimidate a good psychiatrist if you inquire about his credentials and clinical experience. It’s okay to ask what makes him qualified to help you.
Second: Before arriving, try and write down what you want to accomplish in the initial encounter. For most people, putting thoughts and feelings into words is inherently therapeutic. The very act of self-reflecting engages the cerebral cortex—the thinking part of the brain—which gets people in a mode to talk about their intimate thoughts and feelings, the sharing of which is the cornerstone of trusting one’s psychiatrist. Refer to your notes during the session, too, if you feel you’re forgetting something.
Third: Think about the “Why now?” of seeking treatment. What forces have brought you to seek expert advice at this point in life? Did you get so preoccupied you couldn’t concentrate on reading? Did you lose your temper with your boss or family? Did frightening thoughts intrude into your mind? Are you in a troubling relationship but you’re not sure where the problem lies? Are you having trouble coping with a disturbing loss or conflict? The more details you supply the psychiatrist, the more quickly he can assess the situation.
Fourth: List your strengths. This is very important. It is so easy to focus on the negatives—people naturally assume that’s what they’re there for! In the rush to tell the doctor what’s wrong, people lose sight of what’s right, and often leave the initial session feeling the doctor didn’t get to know them.
Fifth: If you’ve taken psychiatric medications previously, write down their names and the dates you took them, and what you did and didn’t like. It doesn’t necessarily help to say, “I’ve tried everything,” if everything means two or three antidepressants that were discontinued after a few days because of side effects. Also, make sure to note if the pills or capsules changed when the medication became generically available. That can make a huge difference. List all medications, including over-the-counter herbals and vitamins you take. That can be the key to unraveling hard-to-explain symptoms caused by drug interactions.
Sixth: Be honest about substance use. There’s no bigger waste of time and money than trying to get help for anxiety, trauma or depression when burdened with toxic loads of alcohol or marijuana, or stimulants. It’s very common for people to self-medicate, trying to solve their issues by themselves. You may not be proud that you’re poaching pills, but in order to help, the doctor has to know about it.
Seventh: Take a moment after the initial session to write down your impressions. If the doctor made a diagnosis, how did you feel about the way he delivered it? Was he open-minded or doctrinaire? Was he wishy-washy or did he inspire trust? It’s good to like your psychiatrist, but it’s just as important to respect him. Trust your gut. Positive feelings about the initial encounter predict successful treatment.
Following these seven guidelines helps one stay in the present. This, I know for sure: good psychiatric care helps more than 90% of patients! So if the connection doesn’t feel right, keep going until it does.
True, it takes effort to employ one’s adult self in the face of feeling ill and longing for the comfort that some all-knowing authoritarian can provide. That is how children think, but remember you are no longer a child.