What to expect at your first psychiatrist appointment, and after

What happens in your sessions

Seeing a psychiatrist can feel like a big step, especially when you don’t know what will happen. Here is the whole journey, from the first session to the last.

Written and medically reviewed by Dr. Yujal Man Singh, MD Psychiatry (NMC 9988), Level 3 Certified TEAM-CBT TherapistUpdated 12 October 2026

Cartoon of Dr. Yujal listening to a young woman in his office with bamboo chairs and plants
In shortAt your first psychiatrist appointment, in Kathmandu or online, we talk for about an hour about what brought you here, your past, your family and your health. I listen first, explain what may be going on in plain words, and we agree a plan together: therapy, medicine or both. Every session after that follows the same steps: a short mood check, listening, you choosing what to work on, testing the thoughts behind it with CBT tools, and your feedback.

How do I prepare for my first appointment?

Woman at home with laptop, headphones and old reports, ready for a session
  • In person: come a few minutes early to the clinic in Kuleshwor, Kathmandu.
  • Online: we meet on a video call. Find a quiet, private place and use headphones if you can.
  • Bring old prescriptions, medicine names and reports if you have them.
  • You can bring a family member or friend. You decide how much of the session they join.
  • You don’t need to prepare what to say. Many people arrive not knowing where to start, and that’s fine.
Doctor and patient relaxed in his office with a wall clock and cups of tea

How long is a session?

Most sessions are 1 hour. Some run 1.5 or 2 hours, or longer. A longer session gives us time to finish working on something important instead of stopping halfway, and sometimes a lot changes in one longer session. We agree on the length before we begin.

Woman filling in a short mood form with little mood faces around her

A short mood check, every time

Before each session you fill in a 2 minute form. It asks how sad, anxious, angry or hopeless you feel right now, and how happy you are in your close relationships. It also asks about thoughts of ending your life. We ask everyone this, and it is safe to answer honestly.

At the end you fill it in again, so we can both see what changed. You also rate the session: did I listen, did I understand you, did it help. Low scores help me most. A 2018 review of feedback studies found that therapy goes better when progress is checked like this every session.

What happens at the first appointment?

Woman talking with teary eyes while Dr. Yujal listens across the coffee table

The first session is about getting to know you as a person, not just your symptoms. I’ll ask about:

  • what brought you here, and when it started
  • how it affects your sleep, appetite, work, study and relationships
  • whether you’ve felt like this before, and what treatment you’ve had
  • your physical health and medicines
  • your family, growing up, school, work and marriage
  • alcohol, smoking or other substances
  • your strengths, and what has helped you cope

Before trying to help, I want to understand what this has been like for you.

Go at your own pace. You can say “I’m not ready to talk about that yet.” Crying is normal here. My main job in this session is to listen and understand what this has been like for you. A 2018 review and an earlier study by Dr. David Burns both found that feeling truly understood is strongly linked to getting better.

Near the end I’ll explain what I think is going on in simple words, and we’ll agree on a plan: therapy, medicine, or both. You’ll have time to ask anything.

What happens in each session after that?

Each session follows the same shape. Watch the short animation, or read the steps below it.

Plays by itself when you reach it. Tap to pause.

  1. Woman speaking with her hands while Dr. Yujal nods, fully attentive

    Mood check, then listening

    We look at your scores together. Then you tell me what has been hardest since we last met. I won’t rush to fix it. I’ll check I’ve understood before we move on.

  2. Woman thinking about two paths while Dr. Yujal offers an open hand

    You choose what to work on

    I’ll ask if you want help with this today, and with what exactly. It helps to bring one specific moment, like “Tuesday evening, when my husband didn’t reply.”

  3. Woman holding a storm cloud with a glowing heart inside

    The other side of your feelings

    I may ask what your painful feelings say about you that is good. This surprises people. Worry can show how much you care. Guilt can show your values. Then you decide how much you want each feeling to come down. It doesn’t have to be to zero. You stay in charge of how much you change.

  4. Dr. Yujal showing a worksheet while the woman looks at a dark thought cloud through a magnifying glass

    Working on one moment

    We write down the upsetting thoughts and how strongly you believe them, then test them. Is it true? Would you say it to a friend? I may play your negative thoughts while you answer back. For fears, we plan small steps to face them. The goal is not positive thinking. It is thoughts that are true and that you actually believe.

  5. Woman filling in a star rating card while Dr. Yujal waits warmly

    Mood check and your feedback

    You fill in the mood check again and rate the session. If something didn’t help, this is where you can say so.

Woman at home on a video call while Dr. Yujal shares a mood log worksheet on screen

Online sessions

Online sessions follow the same steps. I share the mood log on screen and we fill it in together, wherever you are. A 2021 review comparing video and in-person therapy found similar results for both.

What do I do between sessions?

Woman writing in a notebook on her bed at night beside a lamp and a cat

I’ll suggest something to practise, usually 15 to 20 minutes a day. Often this is a mood log, a worksheet for working through an upsetting moment on your own. I’ll give you private access to it online.

People who practise between sessions tend to improve more. This was found in an early study by Dr. Burns and confirmed in a 2016 review of many studies. If you don’t manage it one week, that’s okay. We’ll talk about what got in the way, without blame.

Woman climbing a winding hill trail toward the sun

How progress usually looks

Progress isn’t a straight line. Some people make a big change from one session to the next, which researchers call a sudden gain. Others improve slowly. Because we check your mood every session, we can both see what is really happening and change the plan if something isn’t working.

Facing fears or painful memories can make you feel worse for a short time before you feel better. Please tell me if this happens.

How does therapy end?

Woman walking out into a sunrise with her family waving

When your scores are low and stay low, we plan the end together. We’ll:

  • look back at what helped most
  • write down your early warning signs
  • practise what to say to yourself when bad days come back, because they will
  • plan what to do if things slip, including a booster session

A 2005 study found the benefits of CBT tend to last after therapy stops.

Dr. Yujal's empty office seen through a slightly open door

Your privacy

What you share stays between us. The rare exceptions are a serious risk to your life or someone else’s, or when the law requires it. If that happens, I’ll talk to you first wherever I can. When family is present, you decide what is shared.

Questions people ask before their first visit

What should I say at my first psychiatrist appointment?

Say what is bothering you in your own words. There is no right way to start. It helps to jot down three things before you come: what changed, since when, and how it affects your sleep, work or relationships. Add any medicines you take. Nothing you say will shock me, and I will guide you with questions.

Will I be given medicine at the first visit?

Not always. Medicine is suggested only when it is likely to help, and only after we talk it through. Many people start with therapy alone. If medicine makes sense, I explain why, what to expect and for how long, and you decide.

Is it normal to feel nervous before the first appointment?

Yes, very normal. Most people feel nervous, and many almost cancel. You can tell me you are nervous at the start. The first few minutes are just about settling in.

How many sessions will I need?

It depends on the problem and the person. Many people notice change within a few sessions, and others need longer. A 2020 review of routine therapy services found the same. We’ll look at your scores together and decide.

Dr. Yujal showing a falling score line on a tablet
Is online as good as in person?

Studies comparing therapy by video and in person find similar results. Many people living abroad prefer it.

Split picture of the same session in the office and on a video call
Will I need medicine too?

Sometimes. For depression and some anxiety problems, a 2014 review found therapy plus medicine often works better than medicine alone. As a psychiatrist I can advise on both, and we decide together. Every medicine is explained.

Dr. Yujal explaining a balance scale with tablets on one side and a notebook on the other
Does this work for Nepali people?

Yes. A 2016 review found therapy works across cultures, and works better when adapted to your language, beliefs and family life. Sessions can be in Nepali, English or Hindi, and your family and faith are welcome in the conversation.

Woman at home with prayer beads and a stupa outside the window
What if I don’t know what to say?

That’s common. I’ll guide you with questions. Silence is fine too.

Woman with an empty speech bubble while Dr. Yujal waits patiently
Can my family come?

Yes, for part of a session if you want. You decide what they hear.

A family session with parents and daughter in Dr. Yujal's office
What about teenagers?

I see young people from age 13. Parents usually join part of the first session. The rest is private, with the same safety exceptions.

A teenage boy and his mother talking with Dr. Yujal
What if I don’t feel comfortable with you?

Please tell me, on the feedback form or in person. It won’t upset me, and it helps. If we’re not a good fit, I’ll help you find someone who is.

Woman raising a hand to speak honestly while Dr. Yujal listens openly
How do I book and pay?

Message on WhatsApp (+977 9851347591) or fill in the booking form. We find a time that suits you, in your own time zone if you live abroad, and tell you the fee. You can pay by card through a secure Khalti link, by bank transfer (SWIFT), or a family member can pay in Nepal by Fonepay, eSewa or Khalti. Please pay before the session to confirm it. More details are on the online consultation page.

Woman at home with laptop, headphones and old reports, ready for a session
What if I need to cancel?

Please give at least 24 hours’ notice by WhatsApp or phone.

Woman sending a message on her phone beside a calendar

Myths, and what’s true

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Studies mentioned

  1. Lambert MJ, et al. Collecting and delivering progress feedback. Psychotherapy, 2018. PubMed
  2. Elliott R, et al. Therapist empathy and client outcome. Psychotherapy, 2018. PubMed
  3. Burns DD, Nolen-Hoeksema S. Therapeutic empathy and recovery from depression. J Consult Clin Psychol, 1992. PubMed
  4. Burns DD, Nolen-Hoeksema S. Homework compliance and the effectiveness of CBT. J Consult Clin Psychol, 1991. PubMed
  5. Kazantzis N, et al. Homework compliance and outcome in CBT. Behavior Therapy, 2016. PubMed
  6. Tang TZ, DeRubeis RJ. Sudden gains in cognitive therapy of depression. J Consult Clin Psychol, 1999. PubMed
  7. Hollon SD, et al. Prevention of relapse after cognitive therapy. Arch Gen Psychiatry, 2005. PubMed
  8. Robinson L, et al. The dose-response effect in routine psychological therapies. Psychotherapy Research, 2020. PubMed
  9. Fernandez E, et al. Live psychotherapy by video versus in-person. Clin Psychol Psychother, 2021. PubMed
  10. Cuijpers P, et al. Adding psychotherapy to antidepressant medication. World Psychiatry, 2014. PubMed
  11. Hall GCN, et al. Cultural adaptations of psychological interventions. Behavior Therapy, 2016. PubMed
  12. Hofmann SG, et al. The efficacy of CBT: a review of meta-analyses. Cognit Ther Res, 2012. PubMed
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