Ask the Psychiatrist: What to Expect at Your First Appointment

While awareness of mental health issues and resources have become more mainstream in recent years, a South Florida psychiatrist says that many people who could probably benefit from therapy are reluctant to seek care because they have such deeply ingrained feelings about, well, sharing their feelings.

“A lot of people have fears about seeing a psychiatrist,” acknowledges Rachel Rohaidy, M.D., a psychiatrist with Baptist Health Primary Care. “In many cultures, even talking about mental health is considered taboo.” Dr. Rohaidy, who also serves as medical director of The Recovery Village at Baptist Health, hopes to dispel any concerns people may have about seeing a psychiatrist. She believes that people would be more likely to seek help if they had a better understanding of the process.

“Every psychiatrist has their own way of developing patient relationships and everyone’s evaluation style is different,” Dr. Rohaidy notes. “For example, I prefer in-person appointments, which I believe provide better opportunities for the doctor and patient to get to know each other. But I realized during COVID-19 that, for many of my patients, online appointments, or telehealth visits, were crucial for providing continuity of care.”

Dr. Rohaidy advises prospective patients that therapy isn’t a quick fix, it’s a process. A patient can expect to see their psychiatrist once a week for a couple of months or longer, if need be. And for it to be truly effective, therapy also requires “homework” – devoting some time every day to introspection and putting into practice new coping strategies or new ways of thinking.

Because therapy typically entails developing a long-term relationship with your psychiatrist, Dr. Rohaidy says it’s important to interview several different professionals and to go with the one you feel most comfortable with. Once you do, be patient and trust the process. “It can take time for a psychiatrist to earn your trust, to peel away some of the protective layers you’ve built around your emotions and to help guide you to an understanding of what’s really driving your thoughts and behaviors,” she says.

Dr. Rohaidy says she practices a holistic approach to treating patients with mental health issues.  “In addition to the questions I ask in your first appointment, I’ll want to know about your nutrition, your exercise, your water intake, your vitamins,” she says. “I believe that your mental health and your physical health are closely connected. And I also believe that exercise is effective medicine for many conditions – physical and emotional.”

Dr. Rohaidy goes on to share other information she needs to gather during your first appointment:

Why are you here?

Was it your spouse, mother, significant other or maybe “Dr. Google” who suggested you come in? Is there a situation with drug and alcohol abuse? Sex or gambling addiction? What has been done before? Why didn’t it work? Have you had any hospitalizations? What were the circumstances? Dr. Rohaidy says she’ll ask these and other questions that could be difficult or embarrassing to talk about. “I need to get a sense of what’s going on in your life,” she says. “I’m not prying or judging but I need to know as much about you as possible so that I can provide a thorough psychiatric assessment and an effective treatment plan. What you share with me in our first meeting becomes the foundation for your therapy, so it’s really important that you be honest with yourself,” she advises.

How do we get started?

The first conversation will be open, calm and easy-going, assures Dr. Rohaidy. “Our first meeting will be an in-depth conversation which takes about 30 to 45 minutes,” she says. “It’s an opportunity for me to understand what you’re feeling and what you hope to gain from therapy. It’s also an opportunity for you to see if you’re comfortable with me as your psychiatrist.” By the end of your appointment, Dr. Rohaidy says she can provide a preliminary diagnosis. “I say ‘preliminary’ because your diagnosis may change as your therapy progresses.”

What’s your medical history?

Be prepared to talk about your previous or current health issues, and to bring with you a list of your medications – including dosage, frequency and why and for how long they’ve been taking them, Dr. Rohaidy advises. “I may be prescribing medications for you as well – some of which might have harmful interactions with other drugs – so I want to be careful not to interfere with any medications you’re currently taking.”

Who’s your primary care physician?

As your front-line healthcare provider, your primary care physician monitors your general health and provides lab work, EKGs and other tests which Dr. Rohaidy says are essential to identifying high blood pressure, diabetes, thyroid disease, hormonal imbalances, kidney function and calcium levels – all of which may affect your mental health. “Many people don’t realize this but primary care physicians actually prescribe more mental health medications than do psychiatrists,” she adds.

How do you feel about therapy?

Therapy can be intense, Dr. Rohaidy cautions, and there may be tears or times when you feel uncomfortable talking about painful events from your past. “I need to know what’s happening now or what happened in your past,” she says. “Does your family have a history of depression, anxiety or suicide that might be affecting you? Is there a trauma that may have happened in your childhood that has resurfaced and is affecting you now? Again, I’m not prying or judging, but I need to know what I’m treating you for so I can determine a plan of action that is tailor-made for you.”

What about medications?

At the end of your first session, Dr. Rohaidy will discuss medications – specifically, which ones might help with your condition, how they work and what your expectations are with starting a prescription regimen. With medications, she explains, it can typically take three to four weeks before you start seeing a change in your mood. “Keep in mind, too, that not everyone reacts the same way and some medications have side effects, although these are usually insignificant for most people,” she says.

What about subsequent visits?

Your second appointment will be shorter – 15 to 30 minutes, says Dr. Rohaidy – and the conversation will be all about you. “We’ll do a quick medical check to see how you’re doing and if you’re experiencing any side effects,” she says. “I’ll also ask if you’ve noticed or made any behavioral changes with your sleep hygiene, eating habits or other routines.”

On your third or fourth visit, Dr. Rohaidy says she might ask you to bring in some people close to you. While most psychiatrists don’t want other people at their patient’s appointment, she feels that those closest to the patient can provide an important perspective. “Although you may not notice any progress or improvement since you started taking your medication, your spouse or partner or caregiver is usually better able to notice such changes,” she says. “There are also times when I need to speak to the caregiver if the patient can’t speak for themselves,” she adds.

How can I help you?

Every psychiatrist does their assessments differently, Dr. Rohaidy reminds patients, but the goal is always the same – to help you recognize problematic patterns of thought and behavior that are interfering with your life or relationships at home or at work. “Remember, you have to feel safe with your psychiatrist,” she says. “If you’re not comfortable, try another one – it’s perfectly okay to shop around. Your feelings are important and you have to come first.” Most important is that you get the help you need, she emphasizes. “There are plenty of mental health resources available here at Baptist Health and throughout South Florida. Don’t be afraid to take that first step.”