So, either a family member or a doctor (or perhaps even yourself) has indicated you should see a psychiatrist to get psychotherapy or an evaluation for medication. It seems like a fate worse than death, or the last stop on a slow train bound to nowhere. Actually, it is neither, but what should you expect?

A psychiatric consultation is a primarily a conversation between you and the psychiatrist to figure out what might be wrong and to come up with a "treatment plan" to correct the problem. Since establishing the correct diagnosis will lead to the proper treatment, the conversation begins with what is presently wrong --- Why do you come to the psychiatrist's office today when you could be anywhere else on the earth? And, what complaints do you have?

Other pertinent information will be asked about, including: family history, medical history, prior psychiatric history (if any), and if you have ever been tried on any kinds of psychiatric medications before. A review of comprehensive psychiatric symptoms will occur next, to fill in details about common psychiatric disorders like panic, insomnia, anxiety or depression and to get a sense of your present level of functioning. Questions will also be asked to get some information about what kind of person you are, and about your interests and background. Often, the above takes close to an hour to complete.

All the information is used to reach a tentative diagnosis and then used to discuss the initial components of treatment: psychotherapy and/or medication . Occasionally, blood work may be obtained to rule out other overlapping medical problems such as low thyroid, or anemia.

It may not be reasonable to expect a person to have to decide their course of action at the conclusion of the first session if they are uncertain, want to do research, want to discuss it with family members or need time for further consideration. The decision regarding treatment can be discussed then, or at our next appointnent. Pros, cons, benefits and side effects of medication treatment under consideration are reviewed. Other activities may be recommended such as aerobic exercise, yoga, meditation or journaling.

Medication therapy is also compared to the obvious choice of doing nothing. If medication treatment is begun, a follow up appointment is scheduled approximately 2 weeks after the initial appointment to assess the early benefits of the medication prescribed and to make whatever adjustments are necessary. It is never assumed that anyone, by the mere fact of walking into a psychiatrist's office, will have to take medication, never mind for the for the rest of their life. The length of time needed for medication treatment is determined by a number of factors, particularly, how long have the symptoms been present?

When the agreed upon length of time on medications has passed, and the original complaints are resolved, the medication will be tapered and discontinued to see if meds are no longer needed to keep the symptoms treated. Your condition and symptoms will be closely monitored and followed regardless of the diagnosis or treatment pursued. Each person's treatment is individualized with a reasonable amount of time between appointments to allow for adequate practice of certain psychotherapeutic techniques or enough time for a medication to begin to work. Collaboration with other medical providers or a psychotherapist is always part of the ongoing treatment.

Office visits are scheduled for different lengths of time, to allow for adequate observation, communication, assessment, exhange of information and decision making. No question, concern or problem is ever too minor or unimportant to be discussed during an appointment or in quick phone call as psychiatric treatment is an active collaboration and evolving decision making process between two persons.