Now for the 2nd in our "No Big Deal" series: What is it like to see to a psychiatrist or go to psychotherapy/"talk" therapy/"counseling" appointment?
All together now, "It's No Big Deal."
I am trying to remember my first counseling appointment. I think I actually saw a psychiatrist (a psychologist with a M.D. who can prescribe medication) first, back in 1997. Then I saw a University-employed psychologist for talk therapy. Additionally, I did group therapy at the University (usually a small group that meets with a psychologist-leader all together). After that I graduated and wasn't seeing anyone for a while, then I went back to seeing a (new) psychologist. Then I moved here, got off medication and was on my own for several years. I saw a psychologist while I was pregnant just in case I got post-partum depression, which I did. I then came to be a patient of my current psychiatrist (a M.D. and Ph.D. who specializes in women's mental health). I switched to a new psychologist and also joined a women's Cognitive Therapy group that meets twice a month. So my experience with this adds up to: two psychiatrists and five psychologists.
Although I never did a bunch of research into the different kinds of psychotherapy when choosing a therapist, I was simply too much in need of help to be terribly picky, I think it worked out OK. I imagine it is always good to be an informed consumer however, so if you are interested in all the different kinds of therapies and therapists, Wikipedia has a pretty good listing with cross-references to pages on different specialties and schools of thought. I highly recommend Cognitive Behavioral Therapy, as that's what my experience has been with. I find it to be highly effective, especially when combined with medication when necessary. Freudian psychoanalysis has been out of favor for quite a long time now, so please don't discount therapy as bunk thinking that everything's going to be blamed on your potty-training or something.
After you make your appointment you might be sent a form or two to fill out and bring to your first appointment, so bring those. You'll get there, walk in and probably sit in a waiting room for a little while (everyone's always a few minutes late). Then your therapist should stick his or her head into the room and ask if you are you and welcome you and invite you back to their office. I enjoy psychologists' offices. Often they are homey, interesting places full of clocks and chatchkes, figurines, books, art, pillows and boxes of tissues. There's usually a big comfy couch, loveseat or chair for you and a chair the therapist will take. You sit across from each other and they will say something along the lines of, " So what brings you here today?" or "So what is it that you would like us to accomplish here?" or " How are you? Can you tell me what's brought you here today?" Something like that.
I would give you only one rule: be scrupulously honest. Do not let yourself tell the therapist what you think they want to hear. You are not there to make a good impression. You do not need to please this person! If any of this is to help you, you need to let the therapist know what you are really thinking and feeling and not play games with them. If the answer to their questions is, "I don't know. I just can't stop crying." or something like that, that's fine. The therapist will lead you along, asking questions and letting you answer them. You will begin to pick apart what it is that is having such an effect on your mental health. For me, I knew that my problem was a chemical imbalance in my brain ignited by external circumstances, but not solely due to them. So we often will strategize on how to minimize stress in my daily life and tackle day-to-day problems.
The therapist is on your side no matter what. They may tell you things you do not want to hear, but if so, it is only because doing so is in your best interest. The therapist is your champion! They will do battle even with your own habits and automatic thoughts to help you reveal and nurture your inner self. This is a person you can tell your innermost thoughts to and they will not judge you or condemn you. The only caveat is that if you admit to illegal acts or plan to harm yourself or others they are obligated to intervene.
What if you decide you don't like your therapist or that this particular person is not helping you? See someone else! You won't hurt their feelings, they know that sometimes people just don't click. They may even be able to give you a good list of other therapists to consider. I had to leave a therapist that I found to be too passive for me. She was so gentle and grandmotherly that I was just going and talking but not being given assignments or challenges to help change my behavior, which is what I needed and wanted. So I asked my psychiatrist whom she would recommend and then I began seeing a different therapist. Trust your gut. If someone you are seeing meets the standards I laid out above, but is making you do exercises that are difficult and kind of a pain, that is still OK. If you are intimidated by the person, or the person is too passive for you, or some other reason that you cannot work with someone, that's OK. Just move on and choose someone else.
At the end of the session you may be given an assignment or task to complete during the interim until your next appointment. Try your best to complete the task. This is the way to maximize your investment in therapy. It is also helpful to keep a journal or use an app or notebook to track your symptoms, mood, sleep, meds, exercise, etc. The more information you have to give to a provider, the better they can help you.
Finally we schedule our next meeting and I pay for the session by writing a check. I currently pay my psychologist $115 per session and submit a monthly invoice to my insurance for reimbursement. She is out-of-network, so I only get a percentage back and do not have a co-pay. I don't know the range of fees in this profession, but I imagine this is on the beginning of the high end.
Pretty much everything I said above applies here. The difference here is that the person is a medical doctor and can prescribe medication, if necessary. I found that the forms sent to you to fill out before the first meeting were much more extensive for the psychiatrist—lots of surveys. These are diagnostic tools that help determine what your symptoms are and how much insight you have into your condition. Take the time to complete each form and be sure to bring them with you. In my experience the first appointment was much longer than a regular visit and was very much an interview with verbal questions like those in the surveys I'd filled out. They ask some of the same questions many different ways in order to make sure that they understand your symptoms and are not seeing some reflection of the way a particular question was worded. All of this goes toward making a diagnosis.
Ideally, if you are seeing a psychiatrist, you would also be seeing a psychologist and the two would keep in touch over your case. I am currently seeing a psychiatrist and psychologist that share a suite of offices with other mental health professionals, and so communication between the two is pretty effortless. My psychiatrist and psychologist both know and respect each other, which is ideal. Lucky me! It just worked out that way, but if you can seek this out, I say do it.
So when I go to see my psychiatrist, which is every month or so, though you can stretch your appointments out however is best for you, it's the same deal as above. I get to the waiting room. There she has a quick survey of depression symptoms for me to fill out that cover the past week, so I do that. Then she invites me back to her office and asks me, "So how are you?" I tell her about the symptoms that I've had since I last saw her and we decide whether to tweak medications, get blood tests done, change medications, etc. She explains what she wants to do and why and I ask any questions I have. I certainly have veto power over any of her suggestions, but I have grown trust her completely and usually go with what she suggests.
I maximize my return on my investment by recording my mood and symptoms daily, as mentioned above. I use an app on my iPad to do this, but it's easy enough to do in a notebook. This way I can tell her how my mood has changed and what external stimuli correlated with those changes, how much sleep I was getting, my energy level, the time I took my meds, how much exercise I'm getting, etc. I highly recommend the mood tracker app I have listed on my Resources tab above, if you have a smart phone or tablet. Otherwise, your psychiatrist can suggest to you their preferred way of tracking things. Tracking mood and symptoms is important because in depression it is often true that how you feel in the moment is how it seems you have felt forever. This makes it hard to really tell your provider what has changed since your last visit with any detail, especially if you're switching medications and experiencing side effects, etc.
My psychiatrist, it seems, is exceptional in that she provides a bit of talk therapy in addition to handling medication. For a while I had one hour appointments so that I could talk to her and also deal with medication. Now we are on a "maintenance" schedule with half-hour appointments every three to five weeks or so. At the end of the appointment we schedule the next appointment and I write her a check for $125. I know, not cheap, but she is worth it. Again, I submit her receipts to my insurance for partial-reimbursement.
That's it! No Big Deal! The only hook might be finances, but if you see an in-network provider, that shouldn't be a life-altering issue. Right now most medications take several weeks to start working, but you can begin working on how you think with your psychologist right away, which feels good. It is good to have a plan, to be taking action to change your reality for the better.