Same Same, but Different

What You Can Expect from Your First Visit with a Psychiatrist

In my experience, one reason people delay seeing a psychiatrist is all the unknowns surrounding what seeing a psychiatrist is like. People tell me they worry about what they will be asked, if they will say the “right things,” if they will have to talk about things they don’t want to, and if they will feel uncomfortable.

I understand these concerns. Although psychiatrists are medical doctors, our offices look nothing like the doctors’ offices people are accustomed to seeing since childhood. And, for a long time, mental health care was so stigmatized that people did not openly talk about seeing a psychiatrist, which only increased the mystery. Add the TV depictions of uptight psychiatrists staring down their clients, and it’s really no wonder some people are hesitant to reach out for care!

To demystify the process of starting mental health care, I will lay out what you can expect from your initial visit with a psychiatrist. Some providers may do things differently, but, generally, this is what you can expect.

Step 1. “What brought you in today?” – Just like any doctor, a psychiatrist will start your first visit with trying to understand what led you to seek care. At first this will start with general questions like “What brought you in” and “Can you tell me more about that” and then eventually will get more specific. The more specific questions will include how long you have been experiencing what brought you in, if there have been any life changes or stressors surrounding that timeframe, and if you are experiencing any other symptoms. This will likely include some questions about symptoms of physical illness as many physical illnesses can impact mental health. Your psychiatrist may also ask questions about your current lifestyle habits during this time such as how much you have been sleeping, what your diet is like, if you drink alcohol or use drugs, your stress management strategies, and how much you exercise.

Step 2. “The History” – After getting a full understanding of what you are currently experiencing, the psychiatrist will then ask about your past medical, mental health, and social history. During the medical history, you will be asked about past medical issues, any allergies you may have, and what medications you take. It is helpful if you can bring a copy of your most recent physical exam with lab results as well as a list of your current medications, including doses. During the mental health history, you will be asked in-depth questions about any prior mental health issues and mental health care as well as history of trauma. During the social history, you will be asked a few questions about childhood as well as questions on living environment, schooling, and employment.

Step 3. “Anything Else” – Most psychiatrists will leave time to ask if there is anything else you want them to know that they have not asked you about directly. This is your time to tell them anything they did not ask about or to add additional details you want to share. It is also your time to bring up any questions or concerns.

Step 4. “Impressions” – At the end of your initial visit, the psychiatrist may give you some initial thoughts about what may be going on. They may explain that there are a few options for what may be going on (officially called a “differential diagnosis”). They may discuss additional information, including information from other providers or labs, that they need to determine the diagnosis, if there is one. They might also start discussing recommendations, which may include therapy, lifestyle adjustments, or medications. If they need additional information before making recommendations, they may save specific recommendations for a follow-up visit. It is also possible that the psychiatrist makes a recommendation for something they don’t offer in their office. In this case, they will connect you to an appropriate specialist. While making recommendations, the psychiatrist should always include risks, benefits, and alternatives (officially called “informed consent”). They should also make sure that you understand the information and let you ask any questions you may have about their impressions and recommendations.

Although information is helpful for the psychiatrist, you can put limits on what you share during your first visit. For example, you might decide to let the psychiatrist know you have had a traumatic experience but say that you are not ready to discuss the details. It is enough for the psychiatrist to know that there is a history of trauma without knowing more at the first visit. There are no “right things” to say or obligation to give details you don’t feel comfortable giving. If you end up continuing care with that doctor, you may need to develop a relationship (officially called a “therapeutic alliance”) before sharing certain things, and that is OK.

This is not to say you might not feel uncomfortable at all during your first visit. Some people have never put words to their feelings aloud to anyone before, let alone a stranger. This can be an uncomfortable experience. Some people don’t expect to cry, but do, and this can also feel awkward for some. You can rest assured though that, although this experience may feel new and uncomfortable to you, we are accustomed to it.  There is no judgment, no grading, no shock.

Also, rest assured that this first visit is primarily about gathering information. Some people enter the initial visit worried they will be “therapized” and some leave disappointed that they weren’t! No therapy or treatment will start without the psychiatrist discussing the options with you first and you agreeing to them. The first visit is a starting place.