Ever wondered what an appointment with a Psychiatrist is like????

Ok; for starters - it depends what country you reside in.

Secondly, a lot depends upon how rich you are, even if you are in an affluent country, and whether you have health insurance.

Thirdly, there are different sorts of psychiatrists: many are mostly medication tweakers; some engage in talking therapies such as CBT (cognitive behavioural therapy), DBT (dialectic behavioural therapy); others ask how your life has been since last you saw them.

Then there are the Psychotherapists: they can engage in hypnosis to uncover your subconscious or root feelings which govern many of your ongoing reactions to life, or they can get you to lie on a couch and ramble for an hour then they unemotionally reflect back what is at the core of your issues (eg: desire to return to the womb, to be taken care of, to refuse to grow up).

Finally......as I said first up: it depends what country you reside in.  These examples above are from my personal experiences with psychiatrists and the like from Melbourne Australia from 1995 to the present.  By no means is it a full (or even accurate) picture of what exists in Melbourne, let alone Australia or America (where to my perception a lot of people see a 'therapist' who seem to have relatively mild symptoms; not a good or bad thing, just an observation) or other countries around the world.  I can only tell you what I've experienced, so here 'tis.

The most common session with a psychiatrist goes like;

(1) Turn up on time, check in at reception, wait in the crowded waiting room between 15-45mins to be seen;

(2)  You greet him or her as "Dr. xyz"...they prefer that generally than to to be called by their first name; in turn they tend to call you by your full christian name, 

(3)  He searches for your file then sits in his chair with you opposite; he studies his notes from the previous couple of sessions and nods and says:  "Hmmhmm...ok.  So....how have you been?".  It is up to me to have salient points from the past few weeks since I last saw him; I generally think these through when I am in the waiting room.

The topics which get visited time and again are: sleep patterns (good/poor); diet and weight loss (required due to me stacking on weight since I hit 30 whilst on certain medications as do a lot of people due to the medications drastically increasing your appetite); exercise efforts (assists general and especially mental health, especially for people with mood disorders like bipolar, schizoaffective disorder and depression); alcohol usage/abuse (dual diagnosis/co-morbidity); whether I have isolated too much or made an effort to socialise; self-care (showering, dressing, cooking, cleaning); job issues (ability to cope when employed; efforts to jobseek when unemployed); family issues; distressing incidents; any achievements etc.

(4) Medication usually gets discussed; moreso when just starting a new one and it's side-effects; also when altering the level of dosage.  I had a previous psychiatrist describe his role as "having me on the least amount of medication possible whilst having me be mentally and physically as well as I can be".  That's a pretty decent aim in my book; the therapy or practical assistance side tends not to ever come from the doctor; that is what social workers, psychologists, outreach workers, drug and alcohol counsellor etc. are there for.  I'm lucky that my current psychologist (a clinical psychologist, although she doesn't administer mendication) writes a 6 month summary of our hourly sessions and sends them to my psychiatrist.  We joke that he never reads them, but I can't assume that.  I see my psychologist every 3-4 weeks, and we go into much the same as point (3), but also include past feelings and more depth.

(5) While my appointment says its for half an hour on the receipt I get when I pay at reception, I generally spend around 15-20mins with my current doctor.  The longest I've spent with a Psychiatrist is an hour-long session, and those were with the psychotherapists (which were short-lived).  A lot of Australian psychiatrists will see you only for half an hour, often less.  I pay $130 for my 15-20min glimpses, then get back $112 cash from Medicare; so my doctor isn't that unreasonable.

One thing about my doctor: he always seems rushed; he works at the adjoining private psychiatric hospital, and often dashes across the road to see a client .  He works six days a week, and is always available on-call.  With his European manner and accent he can seem very abrupt, cold, brusque and rude.  Yet I stick with him for his ability to manage my medication, and in spite of his manner I believe him to be a very ethical man.  He has my brain chemistry in his hands; I've trusted 2 other doctors before and they have got the medication part terribly, terribly wrong; so much so that I ended up in hospital twice because of their medication miscalculations.  I took what they said me to take and ended up very unwell.  Not so my current doctor, who has made some changes but always in the aim of helping me be as physically and mentally as well as I can be.  That in my eyes is a good Psychiatrist: I'm a type 2 diabetes risk, so losing weight just has to happen, no question.  I've been on the same anti-psychotic (olanzapine) for 3 years now.  There are newer antipsychotics around which are, as my Psych says "weight-neutral", but can have worse side-effects than the olanzapine, which I've thus far tolerated well, aside from getting the midnight munchies from time to time.  So hopefully we can make a medication breakthrough in terms of the hunger-pangs sometime in the near future.

So......yeah...sorry, I reverted to my current doctor instead of a "typical" session with a psychiatrist.   I guess all I can say is there is no typical session, other than the points I highlighted in bold in subsection (3) above.  I hasten to add that this has only been in my experience, although I have compared notes with some people I've met along the way who have seen psychiatrists and have found some similarities between their sessions and mine (not that we went into details).

One thing which inevitably irks me is when you've been to your session with the shrink, and someone (usually a well-meaning family member) says:  "So what did the Doctor have to say?".  I have tried educating them that it is mostly the doctor asking me questions, not the other way around.  I guess it highlights the lack of understanding of psych issues generally; that people assume its like a general medical condition where you describe your symptoms and get told a course of action of what to do (eg: fill this prescription; see this specialist; get some rest etc).

Unlike a general physician, I've never had a psychiatrist tell me what I should do, not in black and white, not as an absolute.  They might recommend things, but aside from taking my meds on time there's precious little orders.  The exception is if my drinking gets out of control or if I am in hospital; then he treats me like I'm a child.


But that's another story.