“Things will go smoothly with your teen’s psychiatrist if you understand the assessment process as well as how to best communicate with him or her.”A first-time meeting with a psychiatrist can be nerve-wracking. You may be concerned that they will misjudge the situation or give you unwelcome news or, worse, leave you feeling like you wasted your time. Bear in mind that you and the doctor have the same goal: to help your teen. Things will go smoothly with your teen’s psychiatrist if you understand the assessment process as well as how to best communicate with him or her.
Your Teen’s Assessment
The initial appointment may take as long as an hour because the doctor will request a thorough history about your teen. Later, appointments may be only fifteen minutes or so, but for now the doctor will need to ask your teen a long list of questions. As tedious as this may seem, it is only for the first visit and it will help them to get a broad picture of your teen. Hold off on asking questions until they have had a chance to talk to your teen. They will then ask you for a family history, including any family members who may have had a mental illness.
Your Many Questions
Many parents come to an initial assessment wanting to tell the psychiatrist every detail about their child and what they have been through. This is understandable because we don’t know what it all means and we often feel like the doctor has to hear everything. Try to be patient and let them ask the questions. They can put things together more quickly than you would imagine. After they have gone through their questions and gathered a history from you, go ahead and mention the two or three items that you think they did not cover and that will help to complete the picture.
Try to let your teen do as much of the talking as possible. You may think you know how they will answer every question, but if you sit back and let them speak, some surprising things may emerge. Besides, the psychiatrist must establish a rapport with your teen. In a few years, they will be coming to these appointments alone, so now is the time to begin building the necessary trust and rapport.
In fact, do not be surprised if the psychiatrist asks to speak to your teen alone for a few minutes. This is a smart move on the doctor’s part because your teen may be withholding important information that they do not want you to hear. Try not to worry that something serious may be going on; your teen is in the hands of a professional now.
Your Teen’s Medicine History
If your teen has taken any psychotropic medicines, including ADHD medicine, write down the dates, dosages, and your teen’s reactions to the medicine. Bring the list of your teen’s medicine history with you to the first appointment. It is important for the doctor to know what has or has not worked so that they don’t waste time trying the wrong medicine. If any family members take psychotropic medicine, and it has worked well for them, bring the name of the medicine to the doctor. Sometimes families members do well on the same medicine.
If your teen has not taken any psychotropic medicine, you may be worried about letting them start. Bear in mind that the doctor may not start medicine. They may choose to give the situation more time while they continue to evaluate your teen. If they do think that some medicine is appropriate, listen to their explanation of why they are choosing the particular drug. They will give you instructions for how your teen is to take the medicine. Often, the dose is very small for the first few days, followed by a gradual increase. Write the instructions down and don’t be afraid to clarify. Make sure your teen gets the opportunity to ask any questions they may have about the medicine. Sometimes parents are surprised to leave the doctor thinking they have a plan only to discover that their teen wants nothing to do with the medicine.
If the doctor tells you that your teen does not need medicine, try not to appear disappointed. Often, we place hope in medicine and may feel let down when it isn’t offered. The psychiatrist may decide that therapy alone is the most appropriate treatment for now. Sometimes parents are surprised to hear the psychiatrist suggest that the parent see a therapist or psychiatrist. Try not to feel insulted. They are seeing something that they feel you should address in order to help your teen.
Practicing Patience
Psychiatry, more than any other branch of medicine, requires patience. There are no blood tests to guide the doctor toward a diagnosis or appropriate medicine. Over time, they gather more information as your teen continues to report symptoms. Medicine is tested on a trial-and-error basis. Most of the medicines used in psychiatry take several weeks to begin working. This can feel like an eternity, especially if the first medicine does not work. Remind yourself that for every failed drug trial, your doctor scratches one off of the list. They will find the right solution. If your psychiatrist is methodical and communicative and your teen trusts them, give them a chance to get it right. Meanwhile, progress will continue to occur through therapy and the coping strategies your teen is learning.
Communicating with the Psychiatrist
Your teen may struggle or even reach a crisis point in-between appointments. Call the psychiatrist’s office and ask for the doctor’s voicemail. Prepare, ahead of time, a description of the problem. Try to anticipate what the psychiatrist will ask you when he calls so that you can save him time with a succinct, thorough message. For example:
“Doctor, I’m calling about my son, Jeffrey Smith. You saw him last Tuesday and increased his Prozac from 20 mg. to 30 mg. He’s also taking 100 mg. of Lamictal. He hasn’t missed any doses and there haven’t been any new stressors in his life, but he hasn’t gotten out of bed since yesterday. I believe his depression is worsening, although he told me this morning that he has no suicidal thoughts. The receptionist told me that the earliest opening you have is next Wednesday, so he’s scheduled for that day. Will you please call me at the following number…”
Let your teen know that you have made the telephone call since this will reassure them. You may also feel that your teen should see their therapist if they are struggling.
Coordinating Treatment with the Therapist
A good psychiatrist will be very interested in communicating with your teen’s therapist, especially during times of crisis. Although you and your teen can explain what is happening to the doctor, a few words from a clinician can really give a psychiatrist the full picture. For this reason, they may have you sign an agreement giving them permission to speak to your teen’s therapist. In order for the therapist to communicate back, you will need to sign a similar agreement with the therapist. Professionals who take the time to follow this extra measure are special, so be sure to thank them for taking the extra trouble.
Why Hasn’t My Teen’s Psychiatrist Made a Diagnosis?
As frustrating as it may feel, it is actually a good sign if your teen’s psychiatrist holds off on providing a diagnosis. Mental illness tends to emerge slowly in teens, and sometimes it is just an emotional blip that clears up with a brief intervention. Then again, it may hint at something that will develop further down the road. A symptom may be a “disguise” or manifestation of something currently hidden. For example, let’s say your daughter has lost a great deal of weight. She may be anorexic, or she may be so depressed that she cannot eat. Similarly, a boy may be getting into frequent fights, leading you to think he has an anger problem. But some people, especially boys and men, exhibit irritability or anger when they are depressed. They may not be sad or weepy like we would expect. Similarly, teens with bipolar disorder may not display mania for years; instead, they often suffer from one or two long stretches of acute depression.
The most important question to ask yourself is whether you think your child’s treatment is helping. If the doctor’s care is addressing their symptoms, try to relax and see where things go. The doctor may provide a working diagnosis, a “best-guess” about what is going on. In this case, you may want to read about the symptoms and treatment for the specific illness just to flesh out your knowledge. But try not to get too hung up on the name. Neither of my kids’ illnesses were truly diagnosed for about two years, but their doctors and therapists accomplished some good work with them during that time.
“In addition to providing an important history, the medicine log can also give you insight.”