I find getting started in the right direction is exceedingly important. If one starts with limited information and chooses an insufficiently specific direction, then backtracking can take a lot of time. Thus, for an adult, I set aside a 2-hour block of time for the intake. I need to know the patient’s development from conception on and the family psychiatric history on both sides. I need to understand the nuances of your family life and understand what school was like. The details of the development of your symptoms and their response to whatever interventions you have tried are clearly critical. If medications have been utilized, I’d like to know what doses were tried and their effects. If generics were used it can even be helpful to know what company manufactured the particular generic utilized although in many situations this information may not be readily available. Since everything from sleep to exercise to diet can influence your psychiatric state, understanding your lifestyle contributes a good deal of relevant information. Understanding the use of substances such as tobacco, alcohol, supplements and illicit substances is, of course vital.

Once we have gathered all this information, we can discuss treatment options which include psychotherapy, medications tailored to the symptom complexes you find most problematic, supplements such as Omega-3 fatty acids, and possibly some adjustments of life style, e.g. sleep and exercise. A discussion of medications usually requires resolving potential ambivalence driven by common misinformation on the web. Laboratory studies will likely be needed to establish baselines and detect any deficiencies.

For children and young adults, I obtain the parent’s perspective on all of the above topics. I conduct this interview without the child present because I need explicit information not modified by attending to a child’s sensitivities nor omitted because of the complexity of relevant adult issues. This interview frequently produces enough information that a discussion of treatment options is warranted. A goal of this discussion is to make sure the parents are comfortable with the possible therapeutic approaches and can subliminally relay this comfort to the child.

With this more objective information in hand, I interview the child. Depending on the level of development, their level of comfort, and their desire for independence, this interview may begin with or without a parent in the room with the child. At some point, I will need to interview the child alone because it is not infrequent that a child has not fully informed a parent of all that occurs in his/her mind.