What can I expect during my first appointment?

Reader: What comes to mind when you think of visiting a psychiatrist’s office? Something anxiety-provoking depicted in a movie or TV show? A dread filled image based upon an experience shared with you by a friend or loved one? Or, perhaps the image of a patient lying on a couch, expected to free-associate into the void while the therapist mutely looks on, with a bust of Sigmund Freud peering out from a nearby bookshelf. Or, if you’ve been to therapy before, perhaps you picture something more specific… and perhaps even more dread-inducing: a psychiatrist looking directly at you with a cold, blank stare, forcing you to sweat, stutter, or even cry as you figure out what you’re supposed to do or say—and feeling painfully self-conscious about what the psychiatrist must be thinking about you as you falter! I’ve heard so many uncomfortable stories and predictions like this from my patients—both real and imagined—that it’s no wonder the practice of psychiatry is still cloaked in a shroud of mystery. This isn’t just my hypothesis: the uncertainty around what the first appointment will be like is one of our prospective patients’ most-asked questions. I think it’s about time we debunk the myths and clarify what a first session might actually look like. And, in the third post of our “you ask, we answer” series, that’s what this blog post will set out to do.

Your First Appointment Expectations – Root Cause Analysis and Precision Psychiatry

Our Psychiatrists recognize that it takes great courage to book that first appointment, and first and foremost they will treat you with empathy, compassion, and respect. And rather than embrace a “trial and error approach” to diagnosis and treatment, our doctors embrace what is known root cause analysis as and precision psychiatry to get to know you and your concerns, and to build out a unique treatment plan based upon the specific underlying causes of your emotional distress. We don’t just treat symptoms, because we understand that conditions like ADHD, depression, bipolar disorder, OCD, PTSD and anxiety are multifactorial, meaning they frequently result from multiple causes that need to be identified and systematically addressed. Examples include genetic variations, the gut microbiome and leaky-gut syndrome, vitamin and nutrient deficiencies, hormone imbalances, and of course “traditional” factors such as childhood or recent trauma, and toxic home or workplace relationships. We believe that human beings are extraordinarily complex, and there is simply no one-size-fits-all treatment. Given the great diversity of the emotional needs, backgrounds, and identities of our patients, each initial appointment will uniquely meet the individual “where they are,” but rest assured that the root cause analysis framework helps us form the context for our questions, our reflections, and our conversational approach more generally; and we fully understand that you want to feel better and function more effectively as quickly as possible.

Feel Better Faster Through Genetic Testing

Through genetic testing provided by a simple cheek swab, we can help you feel better faster, at a lower cost. Genetic testing can reduce the cost of treatment and improve quality-of-life in patients with depression and other conditions. And in patients with mood or anxiety disorders three months following the use of genetic testing information, 87% showed clinically measurable improvement; and for those patients with two or more prior treatment failures, 91% showed clinically measurable improvement. Patients also reported significant decreases in medication side effects.

As national experts in the use of genetic testing to restore mental health, we have performed DNA tests in over 2000 patients for the past eight years. Our genetic testing blogs have been read in 206 countries around the globe, and they rank #2 in the nation among all psychiatry blogs.

We Evaluate and Treat You as a Whole Person

And we evaluate and treat each individual as a Whole Person, not just a collection of symptoms, taking into consideration your biology, your psychology, and your sociological context—each of which deeply informs the person who you are today, and informs what you might respond to in treatment. In your first session, we will help guide you in the telling of your story, and you can expect us to ask questions that fit this approach, such as what have you been suffering from and struggling with recently, when did it start and what may have triggered it, and how is it affecting your work life and your love relationships? This may include the use of standardized rating scales to better delineate depression, anxiety, trauma, ADHD, and other possible conditions based upon what you describe. We will ask about the history of your emotional symptoms and important relationships, as well as underlying physical and medical concerns, including any current or past medications used (prescribed by all of your physicians). Family, workplace and medical history is also gathered.

If you are the parent of a child seeking evaluation and treatment, we will listen to and address any and all of your concerns, involve you in every step of the evaluation and treatment process, and are exquisitely sensitive and attuned to any concerns you may have about prescription medications—and not uncommonly we will be able to recommend supplements, lifestyle changes, and other less-intrusive therapeutic interventions based upon the results of your child’s genetic testing.

Through the use of our customized electronic medical record system, not only will we be detailing the history of what you are describing, we will enter your list of medications while simultaneously seeking out drug-drug interactions. We will be building a “personal database” on you to begin to uniquely identify problems and symptoms we need to address, and to prioritize alleviating them based upon your personal priorities. Our most immediate objective will be to reverse a downward emotional spiral, stabilize your condition, rapidly address and resolve symptoms, and improve your functioning; and once we have begun to improve the “biological you”, we will address the important relationships in your life (including your relationship with yourself).

At the end of the first session we will present you a roadmap for your treatment, not uncommonly recommending a genetic test (based upon a simple cheek swab), and a comprehensive blood test that we have developed to uncover the common medical causes of emotional problems (available through LabCorp or Quest, and we can even send a phlebotomist to your home to draw the blood!) We have created many blogs (easily searchable by keywords) that describe these tests and how we will use them to identify and treat the root causes of your emotional distress. We will answer your questions. We will restore your hope.

What does a First Appointment Look Like with a Psychotherapist?

Perhaps you prefer to see a psychotherapist, to talk through your issues without undergoing a medical evaluation. In your first session with one of our therapists, they will “meet you where you are” and in a caring and empathetic fashion begin to take a history of your emotional distress. As you are a unique individual, their approach will be individually tailored to your presenting problems. If you are suffering from an acute crisis, your therapist will provide emotional support and compassion, while exploring the immediate underlying causes. A more complete gathering of your history will come later, after you have begun to feel less crisis ridden. If you are not feeling overwhelmed by an immediate crisis, your therapist will gather history about your important relationships at home, in the workplace, and from childhood; to begin to develop a deeper understanding of how these relationships play a role in your current emotional distress. At the end of your first session, your therapist will provide their initial understanding of what you are experiencing and recommend a path forward.

What does a First Appointment Look Like on Zoom?

Now, before we go any further, I want to address the elephant in the room: We are now almost a year into the coronavirus pandemic, and many of us are unlikely to see our regular offices anytime soon. While this pandemic has disturbed countless segments of our society, it’s been a particular challenge to many practitioners in the health care world. Fortunately, we have been delivering care remotely for some years now, and had already implemented numerous medical platforms and HIPAA-compliant communications technologies prior to COVID-19. Please rest assured that we can implement any evaluation and treatment plan, no matter how sophisticated or complex, remotely to you in the comfort of your own home.

There are also many advantages to remote versus in-office visits. First of all, a virtual visit saves you the time, cost, and energy of making your way to our office. Second, it gives you a home-field advantage. We have found that many of our new patients are more comfortable speaking to us from the comfort of their own home—and the screen provides something like a safety net, when in-person proximity might feel overwhelming. Third, whatever context cues may be missing in the Zoom environment are more than made up for through the tests we administer which give us a wealth of information about the genetic underpinnings of your mental health.

Let me explain that third point, because it is important. In an effort to treat you as a whole person, our practice advocates the use of genetic tests like Genomind’s Professional PGx and Mental Health Map to tell us more about what genetic factors may be contributing to your mental health concerns. And we never test for any gene unless it can be favorably addressed by medication, supplements, or lifestyle changes. Whether in person or on Zoom, walking you through the results of these tests can empower you to begin to take control of your own health. We’ve seen it time and again: knowledge is power, and testing gives us vital knowledge we need to treat you holistically. All of this and more are yet another item you can expect to discuss during your initial appointment!

Should I Feel Nervous About My Appointment?

Reader, whether you’ve seen another psychiatrist or you’ve never seen one before, the single point we want to underscore about your initial appointment is this: our doctors are here to put you at ease. At Potomac Psychiatry, we are compassionate listeners and clear communicators. We tell you what we see, what we know, and how we can help. We are in this profession

because we are passionate about helping you lead a fuller, happier life. And in your first appointment, our greatest goal is simply for you to leave knowing one thing: No matter what, we are on your team. And we will do whatever it takes to help you feel well, recover your health, improve your relationships, and determine your destiny.

Related Information

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