May I bring my personal schema to therapy?

January 12, 2011 11:04 AM

AskMe has finally convinced me to seek therapy. I'm scared, so I've typed up an outline. For the sake of not vastly exceeding my allotted time I can condense it to a short statement. Is it completely inappropriate to show up with three pages of numbered and bulleted woes?

I'm uninsured and broke, so I'm going here. I have an initial "intake" interview to talk to one of the graduate clinicians, who will then, with the help of a psychologist, decide with whom I should ultimately be working or refer me somewhere else. The person who scheduled the appointment seemed unwilling/unable to discuss anything specifically, saying that the graduate clinician would go over everything, but I'm asking about that initial appointment itself. The $30 really is dear enough that it has to "count" (heck, the $5 is dear enough that I'm doing this anonymously rather than through a sockpuppet).

Anyway, I now have this jauntily-titled list of my problems and me! and I think it's pretty comprehensive. The contents are largely irrelevant to this question, but what I would distill from it is, "I feel really incredibly sad sometimes, and when I do, I self-injure physically and occasionally have pre-suicidal thoughts. While I can still function at a basic level and am doing reasonably well at the moment, this keeps happening and I want it to stop."

The outline itself is a an extremely honest and open compendium of years of personal notes/observations, and specifies problems I don't have (mania, hallucinations), things I've done that have/haven't helped, how all this makes me feel, my fears/concerns about therapy, and discusses themes from my childhood (primarily, being raised by alcoholic parents) and how I see them affecting/having effected me. It's not defensive in tone, though it does lean toward spewing PROBLEMS! rather self-consciously/deliberately. It is literally three single-spaced pages long right now; I could pare it down to probably one-and-a-half if the loss of content/detail would be worth it. Or I could scrap the whole document.

What I'd hope to gain by having it with is to show I really have already put a lot of thought/effort/contemplation into this, and don't want to go over everything "as if for the first time" unless someone specifically decides that's for the best. I kind of am picturing reading from it, but I promise I wouldn't be all robotic and reference "section 3-C-ii-a" in lieu of actually communicating. The main reason I wrote it, however, is that, if just asked how I am/what is wrong/what brought me in, I'm extremely liable to blithely lie and downplay everything to the point that I seem maybe just a bit glum and in need of bucking up and acting like an adult*, and I think the outline would keep me honest. But maybe the therapist will want to do things her/his own way?

I trust you people. Through answers to countless others' questions, you have already helped me immensely, and given me the confidence to do this thing in the first place. So, given that I have a really long self-report that could be useful but might also be vastly overkill, or - I worry - make me come off as way more self-obsessed/defensive than I am and set the tone to one of breaking down my perceived "walls"*, what should I do with it?

Thank you all so very much.


*The first time I seriously tried to seek help, I felt that the doctor was being condescending and telling me exactly that; I agreed and stopped going because I was ashamed and felt guilty for wasting resources.
**As seen with school guidance counselors back in the day.

posted by anonymous to health & fitness (25 answers total)

Don't sweat it. Really. Plenty of people bring notes to appointments, e.g. doctors, dentists, lawyers, car mechanics, wedding planners, etc. if only to make sure they remember to ask all of the questions they need to ask. It's a good and useful thing to do.

Don't obsess about it or read mechanically from it. Refer to it if you need to. But bringing a folder in to the appointment won't look strange at all.
posted by valkyryn at 11:07 AM on January 12, 2011 [3 favorites]

Actually, this seems like an excellent idea for me. The therapists I know have a larger larger problem with people not opening up to them. This will give them a solid jumping-off point.
posted by Astro Zombie at 11:10 AM on January 12, 2011 [5 favorites]

Oh, lord, I bring notes to everything. My therapy appointments and my hair stylist and every place valkyryn mentioned. You will not be unusual or inappropriate at all, seriously.

Best of luck to you.
posted by Sidhedevil at 11:12 AM on January 12, 2011 [1 favorite]

I think it's extremely awesome. Personally I'd print out two copies and hand one to the doctor to peruse at the beginning of the appointment. (You could always highlight in boldface the most important things/section headings/whatever, for easier skimming, if you think that's necessary.)

I have taken both printed-out things to give the doctor, and hand-written notes on a notepad to ask the doctor (then taken notes). Not one has ever thought this is weird and more than one grateful nurse responsible for entering medical history into the system has been grateful that I gave them a sheet with the relevant information and we didn't have to spend a lot of time on back-and-forth and spelling things. :)

Good luck!
posted by Eyebrows McGee at 11:14 AM on January 12, 2011 [1 favorite]

It's appropriate and great. It's really easy to get sidetracked or completely forget about something important during a therapy session.
posted by Metroid Baby at 11:14 AM on January 12, 2011

I've done this. The therapist seemed to appreciate having my issues pre-sorted and summarized for her convenience.
posted by Serene Empress Dork at 11:16 AM on January 12, 2011 [1 favorite]

I used to do this with my shrink in college, who was THE BEST (I wish I could clone her for everyone who's having a hard time - for anyone who's reading this and doubts that there are amazing, genuinely wise and warm therapists who can help you move from Being Nuts to being pretty together: they're out there.) Every appointment, she would say "So what's up?" and I would say "Well-!" and flip open my notebook.

I thought of it as an agenda for a meeting about my brain.

Do it!
posted by thehmsbeagle at 11:22 AM on January 12, 2011 [3 favorites]

notes are ALWAYS good

If you're still worried it's too long, I like your summary here - "I feel really incredibly sad sometimes, and when I do, I self-injure physically and occasionally have pre-suicidal thoughts. While I can still function at a basic level and am doing reasonably well at the moment, this keeps happening and I want it to stop." - print that, too, on its own sheet and put it on top as an intro.

I hope the visit is a good one, that you get directed to appropriate treatment, and that you start feeling better soon.
posted by hms71 at 11:25 AM on January 12, 2011 [1 favorite]

Therapist here: not strange at all. Good luck.
posted by OmieWise at 11:26 AM on January 12, 2011 [2 favorites]

This sounds like an excellent idea for many reasons. In fact, some therapists even ask you to do this before or after the first session. It helps you structure your thoughts, makes sure you don't forget or downplay stuff and it is also a very helpful document to look back on (say) a year or so from now.
So, if the graduate clinician you speak to thinks it's odd that you brought notes, don't let that discourage you! In that case, they're the ones that are making things unnecessarily complicated, not you.
posted by Ms. Next at 11:38 AM on January 12, 2011

I'll do you one more -- I've taken notes from my partner that explains my symptoms better than I could ever put it into words. Did this feel weird and horrible and awkward at the time? Hell yes. Did it help? Double hell yes.

In other words, I think this is a great idea and if you feel weird, there's probably much weirder examples out there so don't sweat it and do what's best for you.

The thing that's easy to forget about therapy -- or any doctor/patient relationship -- is that they are there to help you. So you should do what helps you. It sounds really easy, but is so easy to forget in practice.
posted by MCMikeNamara at 11:42 AM on January 12, 2011

If you are having an initial intake through a graduate program at a research university, it is possible (even likely) that the interviewer will be using a structured instrument (like the SCID). This is basically a long booklet which contains questions about every psychiatric diagnosis. If you endorse some key symptoms of a particular diagnosis, the interviewer will go into more detail about that. The benefit of a structured interview is that the interviewer asks about EVERYTHING. It's a very thorough way to arrive at an accurate diagnosis, which will work in your favor in terms of getting the specific help you need.

That being said, in the context of a structured interview there may not be much time for you to go through your outline (the SCID can take a while). HOWEVER, I really think the interviewer will appreciate the level of thought you've put into what's going on for you, and will probably request a copy of your outline if you're comfortable with that. It definitely helps to get a picture of your symptoms in your own words and outside of the structure of the interview itself.

It may be that the interview is more informal that what I've presented here, but I just don't want you to be thrown off if it's not. There are a lot of good reasons why clinics are beginning to move toward a structured intake, but that does not mean that you shouldn't share your outline. The more information you can provide your clinician, the better.

Good luck to you.
posted by Bebo at 11:42 AM on January 12, 2011

I had several pages of hand-written notes in a journal that I started solely for my mental health treatment that I brought with me to my first appointment. I second making an additional copy for the person to peruse later in case you don't have a chance to get through everything. (My first appointment I was already crying while in the waiting room.)

You might want to think about bringing something to take notes with during the session(s). I find it's easier to write things down when my brain gets all teary than to try and remember them later.

Good luck!
posted by sperose at 11:44 AM on January 12, 2011

I think the stones balanced one on the other in the logo of the therapy center, says it all.

Things are built on shaky foundations. We get comfortable and then things get rattled. It is the same for all of us, including the therapists.

So by all means take your notes. In fact, the only thing you have to watch out for is saying it all in one go.

Stretch it out - make it a give and take - a conversation.
posted by Quillcards at 12:00 PM on January 12, 2011

As long as you're not using these notes in expectation of controlling the therapist or therapy ("I will not discuss my relationships", "Therapist may not look me in the eyes or wear open-toed shoes during the session"), this is a great idea. Organizing your thoughts is very useful.
posted by Lyn Never at 12:01 PM on January 12, 2011

Well, I'm going to come from a different angle. Definitely take your notes but be flexible in your approach to using them -- if you feel a good connection and you want to set them aside and just talk -- even ramble -- that's useful too. I appreciate your wanting to get as much as you can out of the sessions, but sometimes the most important things don't rise to the surface until needed. And sometimes we don't even know they're in there to be surfaced. Good luck.
posted by thinkpiece at 12:06 PM on January 12, 2011

The main reason I wrote it, however, is that, if just asked how I am/what is wrong/what brought me in, I'm extremely liable to blithely lie and downplay everything to the point that I seem maybe just a bit glum and in need of bucking up and acting like an adult*


*The first time I seriously tried to seek help, I felt that the doctor was being condescending and telling me exactly that; I agreed and stopped going because I was ashamed and felt guilty for wasting resources.

Exact same thing happened to me. It sucks. You have a right to receive help from these people, and it is part of their job take you seriously and try to figure out what kind of help you need.

I also stewed for a very long time before going to my university's mental health offices and thusly had a lot to say at my intake appointment. I made it to the second visit, and the clinician looked at her notes and said "Oh, you're the one who could be her own therapist!" Please don't say this, counselors/therapists of MeFi.



posted by heyforfour at 12:20 PM on January 12, 2011

I've had a therapist ask me to do exactly that: write out a list of issues I'm dealing with, and examples of how they manifest in my life. Do it. Good idea.
posted by IAmBroom at 12:54 PM on January 12, 2011

If you're the type of person who'd feel better going into a therapy session with a 3 page bulleted outline of your issues, than that's the type of person you should feel free to be in front of your therapist. During the course of therapy, you will from time to time find yourself compelled to hold something back of yourself, whether it's not sharing something you're thinking or not feeling entitled to ask questions about your therapy, what you're getting out of it, how it's different from your expectations, and even whether you're "doing it right." As often as you can, push through it, and say exactly what you're thinking and ask questions about exactly what you want to know.

A good therapist should make you feel safe enough in his/her office to do this, but you need to meet the doctor half way. If doing or saying something, like bringing in your notes, makes you nervous, than lead with your nervousness -- walk your therapist through your dilemma. It's all grist for the mill, as they say.
posted by patnasty at 1:08 PM on January 12, 2011 [4 favorites]

Great idea, and good for you! I wish you the best. I hope the first meeting is constructive for you.
posted by scody at 2:24 PM on January 12, 2011

I did intake and admissions for a psychiatric hospital for 4 years (not counting all the ones I did while interning for my Master's degree). Please bring a copy for the clinician to keep and one for yourself to reference if needed. It will go into your file and will be a great reference for your assigned clinician to look at before meeting with you. It will probably also help with treatment planning (i.e. what issues to talk about first vs. what issues can be dealt with later). I'd love a client who would give me such insight about themselves...and having it all written down helps keep things on track.

However, keep in mind that your intake appointment will probably follow a structured interview. For example, working at the hospital I had a 6 page assessment form that I had to fill out. It included a checklist of symptoms (if you told me you had crying spells, then I would ask how often? how long have they been going on? what triggers them? etc) to get an overall picture of what your issues are, what treatment approach would be best, and in the case of the hospital would give us an initial diagnosis to start with (although that could change...it wasn't a "binding" diagnosis). When I first started working there I went down the checklist in order, but as I got more familiar with the document I could easily skip around and check things off based on what the client was telling me (it wasn't long before I had the whole thing memorized anyways). Depending on who is doing your intake appointment, they may be brand new and will follow the assessment form rigidly, or they may be familiar enough with it to make the whole thing seem more conversational. Don't freak out if they are going line by line through the checklist...just follow their lead. When you are assigned a therapist you can get into more detail about what you need to.

You should also not expect to necessarily get any initial "work" done at this session. In other words, it's an information gathering session...they most likely won't start processing things with you during intake. That will happen when you meet with your assigned therapist. In other words, if you aren't particularly pleased with how the intake session goes, at least do your best to meet with your assigned therapist at least once or twice before deciding that therapy isn't for you. The intake session and the actual therapy sessions are very different.

Best of luck and I'm glad to see that you are making the decision to take care of yourself! You deserve it!
posted by MultiFaceted at 2:24 PM on January 12, 2011 [1 favorite]

I would take two copies: the full 3 page version for yourself, and the pared-down 1.5 page version to hand to the therapist. I think it's more likely he/she will have time to read the 1.5 page version (and/or maybe be more easily able to refer back to it during subsequent appointments), but you want to be able to add in details when you are talking, and it might be easier to do so if YOU can refer to the longer document.
posted by lollusc at 3:40 PM on January 12, 2011

I opened my first therapy session by handing my therapist a bulleted list explaining everything I was going through. She read it while I filled out some standard forms that I would have had to fill out anyway. It was helpful and the timing worked out perfectly. Go for it.
posted by prefpara at 4:30 PM on January 12, 2011

Yeah, during your intake or initial appointment they're going to want a complete history, so this is a great idea. It's a good way to make sure you don't forget to mention something important.
posted by IndigoRain at 8:42 PM on January 12, 2011

Well, I'll nth everything people have said. Great idea. And if you need to write down stuff once you have actually therapeutic sessions, so for it. Some of the issues I was dealing with were so difficult, there were times I just handed my therapist a paper to let him read. I couldn't say the things out loud. Then he would gently help me talk though them.
posted by kathrynm at 12:11 PM on January 14, 2011 [1 favorite]