What happens in the intitial interview? (Adult patients)
For adults, the first appointment is an opportunity for us to discuss the issues at hand, historical and medical information and current circumstances, and the results of previous evaluations and treatment, as well as to develop a diagnostic assessment and treatment plan.
Although my specialty is medication treatment, it is usually not an exclusive focus, since there is far more to a person than symptoms or conditions. Therefore, when I meet with an individual, I consider the total health, growth and development, education, and environmental circumstances.
Once we arrive at an understanding that encompasses the whole person, I may or may not ultimately recommend medication treatment.
Alternative or additional treatments including certain psychotherapy techniques such as cognitive-behavioral therapy, dialectic-behavioral therapy, and other protocols and settings may be recommended.
Subsequent visits may vary from 30 to 60 minutes, depending on the therapy modality involved. For medication therapy, visits may occur every two to four weeks or up to every one to three months as indicated.
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Why is it necessary for a parent to be present? (Child patients)
A parent must be present due to legal reasons, since children under the age of 18 cannot legally consent to medication or medication changes. In addition, since the child is brought to me by the parent, and rarely at the request of the child, it makes little sense to assess and discuss symptoms and treatment progress with the child alone.
However, please note that in most cases, children are more aware, willing and able to cooperate and actively participate together with their parent(s) if approached with the proper sensitivity and attention to the child's own concerns.
A fringe benefit of this format is that no one need be concerned that he or she is being talked about "behind his or her back".
There are, of course, exceptions to this format, since the wide variation in ages and conditions of children and adolescents demands a certain flexibility. For example, at times I find it useful to meet with parents alone as requested, or every two to four visits as indicated, for further clarification of parental observations and concerns, and of diagnostic and treatment rationale and process.
By at least the end of the second or third visit, we have arrived at a diagnostic determination and treatment recommendation, and often have already initiated treatment.
According to Massachusetts state law, only parents can consent to treatment of children under 17 years of age. At the age of 17, children can co-consent to treatment, but parental consent is still required. Of course this does not exclude a child of any age from active education and participation, depending on the child's condition, capacity for understanding and judgment, and level of maturity.
Although my specialty is medication treatment, it is not an exclusive focus, since there is far more to a person than symptoms or conditions. Therefore, when I meet with parents and children, I consider the total health, growth and development, education, and environmental circumstances.
Once we arrive at an understanding that encompasses the whole child, I may or may not ultimately recommend medication treatment. Alternative or additional treatments including certain psychotherapy techniques such as cognitive-behavioral therapy, dialectic-behavioral therapy, and other protocols and settings may be recommended.
What happens if medication treatment is recommended and initiated?
Patients are followed closely while medication trials are initiated. This means weekly to bimonthly visits and other communication when necessary to address any concerns about symptoms, medication, medication side effects when relevant, and other issues.
Once children arrive at a stable, symptom free condition and treatment regimen, monthly to quarterly sessions from 30 to 60+ minute meetings are the usual protocol (as distinguished from weekly visits with a therapist). As explained earlier, with the exception of the first two to three appointments, it is not necessary to meet as frequently with me as with a therapist since it can take up to two to six weeks to assess a child's response to a particular medication regimen.
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For More Information
I hope that this information helps you to understand the process of assessment and treatment. Of course, in order for you to get a sense of my style, as well as for me to get a better sense of your needs, a face to face interview is necessary.
Understanding that it is often very anxiety provoking to consider treatment for yourself or your child, please try to keep in mind that an initial visit is, first and foremost, a chance to see whether you, (or your family) and I, are a "good match", and whether my services can meet your needs. A first appointment is not necessarily a commitment to engage in treatment.
To schedule an appointment, please register here.
Anne Fenton, MD
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