How do you approach a first appointment with someone you have never met?
A first appointment with any specialist or therapist is bound to stir up emotions for us, whether you walk in trembling or if you enter like you own the place. Few of us are unaffected by that experience of waiting at a door or desk for the first time. And then, when we finally navigate the waiting area and meet our clinician for the first time, what happens? (Note: I will use the term “clinician” to describe any practitioner, whether medical or therapeutic, and “client” to also imply “patient”).
The fear of being dismissed
For some people, there is an anxiety that they won’t be taken seriously or won’t be believed. Maybe they have been rehearsing their lines for days, to try to not look foolish. They worry that they may be told that their presentation is no different from most people’s and will be left feeling that they are being treated as an attention seeker. When this happens, it’s known as medical gaslighting, and it can feel very shaming. I had this experience as a young man going to see my GP about headaches and being told I was being too introspective.
Sometimes our worry turns into a self-fulfilling prophecy and the clinician is unconsciously drawn into that role which gives the power to shame. How might someone navigate this? One solution might be to name the elephant in the room and state clearly to the clinician something like “I have a history of feeling that I’m not being taken seriously. I would like you to know that.” This doesn’t guarantee that the response will be the outcome that the person is looking for, but it will hopefully alert the clinician to respect their client and to express feedback respectfully.
The relief of finally being seen
After putting off making an appointment, and then waiting days or even weeks and months, finally getting to see the clinician may be overwhelming. It’s not unusual for people to burst into tears or express endless gratitude. It’s also possible that there will be anger that they have had to wait so long. And fear that the diagnosis might be the worst case. Those tears of relief might feel embarrassing, but clinicians have seen them hundreds of times before and are much less concerned that their client. What happens next depends on the purpose of the appointment.
As a counsellor, I see tears of relief, or indeed any tears such as tears of distress, as part of the emerging relationship. I accept them as being a valid expression by my client. We may talk about what the tears might mean or what it’s like to be seen crying. It’s all part of coming to know and accept who you are.
In a more clinical setting, there is a task to do. There will be details to be taken, relevant examinations and diagnoses to be carried out, and a treatment plan to be put into practice. Emotions, unfortunately, rarely come into it. Some clinicians are more empathic than others in emotional situations, and it might be that the client is drawn to a clinician with whom they feel emotionally secure. A simple “It’s quite normal for me to cry/squirm/get words wrong” might be enough to remind both people that neither should see overwhelming emotions as a barrier, especially when a difficult condition is diagnosed, and always when the benefits of the treatment are being felt.
The bravado of the consumerist client
“I am the one paying, so I set the rules” is the attitude of the client who blusters in shamelessly and demands answers. They treat the clinician like an employee (at best) or a slave (at worst). The psychology behind this presentation isn’t necessarily about being a jerk. It’s a defence mechanism against being rejected or shamed. In such situations, the clinician might feel intimidated or angry. Because anything they offer is going to be subject to brutal scrutiny, especially if it’s different from what the client was expecting. Because this client is always right!
The challenge for the clinician, and the client, is to move to a collaborative middle ground where neither needs to feel defensive. Just as a competent clinician recognises the anxiety and the overwhelm discussed previously, so will they recognise the defensiveness of this type of client. As a counsellor, I only occasionally see this presentation. After all, why would such a person think counselling would help? But some valuable work can be done if given the chance. A client who recognises themselves in this presentation would do well do acknowledge this and say “I probably come across rather as being rather rude, but I am eager to explore what you can offer”. That way, the client will get the best out of the clinician.
Conclusion
An appointment is successful not when you present perfect behaviour, but when you feel safe enough to be honest. It’s impossible to cover every situation, but hopefully the reader will identify with at least one of these presentations. Each contains a possible advocacy script. Do any of those resonate? What might you say at your next appointment?
Adrian Tupper is a practising psychotherapist supervisor and counsellor based at Eyre Place Osteopathic Practice and Space for Therapy in Newington. Sessions at Eyre Place are sometimes bookable online. Otherwise to find out more, visit adriantupper.co.uk.