can I ask this of a new therapist?
March 2, 2022 9:52 AM   Subscribe

I'm starting with a new therapist tomorrow and I want to know if I can sort of pre-direct her during the intake or if that is a faux pas.

I have a lot of mental health issues and I know a therapist needs to cover a lot of ground during the intake and indeed in the first couple of sessions. That said, the reason why I need therapy NOW has very little to do with a lot of my existing diagnoses. I am experiencing major anxiety and I strongly suspect I have Rejection Sensitive Dysphoria. Can I begin the intake by telling her that I want to mostly cover this during our sessions since it is having a major impact on my relationship and is really the only reason why I sought out therapy to begin with?

I just don't want to go down the rabbit hole of my childhood trauma, my mother's passing when I was young, my family history of bipolar disorder that I inherited. I mean, I know that she needs to know those things and I won't hide them from her. But I've done trauma therapy, I've talked about my mother endlessly, and I don't want the bulk of our work to begin with rehashing well-trod territory for me therapeutically. I want to start with the potential RSD and the problems with my partner, and how to cope with those and fix the maladaptive behavior patterns I've developed, and then of course if it links to the childhood stuff then of course we'd talk about that.

Basically I want to solve the immediate problem before going back and spending 10 sessions talking about my mother and cancer and grief and stuff.

Is it ok to "direct" a therapist this way during an intake or do I need to let her follow her process at first before moving on to what I perceive as the "real problem" right now?
posted by nayantara to Health & Fitness (13 answers total) 3 users marked this as a favorite
Best answer: Every therapist I've dealt with has welcomed this sort of input, and I wouldn't hire one who didn't. "Why are you here and what do you hope to accomplish" is the first thing they should be asking you.
posted by fingersandtoes at 9:55 AM on March 2, 2022 [20 favorites]

Not everything can be fixed at once, and I believe it's a sign of health to have an idea of how you want to prioritize things. You're the one paying, after all. It's also OK to include stuff outside of your now-issues that are deferred (or described however much you want). Saying something relates to "X, which I'll want go into more detail later but for now is still a factor," is something I've used that allows me to talk about one thing without digressing into 10 sessions about something that contributes to it.
posted by rhizome at 10:07 AM on March 2, 2022 [1 favorite]

Best answer: Strongly agree with fingersandtoes that this input should be welcome. I'd even phrase it just the way you've put it here, which feels like a good concise summary of your priorities, goals, and background w/r/t therapy. (If a new therapist made me feel like this was unwelcome or a faux pas, that'd be a big red flag for me that this wouldn't be a great person to work with.)
posted by miles per flower at 10:15 AM on March 2, 2022 [4 favorites]

Not a faux pas at all. And the therapist's reaction will be very useful as you decide whether to continue with them. I wouldn't lead with the name of the disorder, but rather talk about what you're experiencing that makes you suspect RSD. Some therapists clench when someone seems to be self-diagnosing.
posted by wryly at 10:21 AM on March 2, 2022 [1 favorite]

Best answer: I had a first session recently, and I said, "I have a pretty complex history, and I want to get into that in the future, but I have an immediate problem I need help with. Can we focus on that for today?"

The therapist was fine with that.
posted by champers at 10:23 AM on March 2, 2022 [10 favorites]

Best answer: I'm a therapist and appreciate when clients do this. It's good to know the broad strokes (e.g., "I did X type of therapy a few years ago to deal with Y"), and totally reasonable for the client to say, "I've done a lot of work on that, and would rather focus on Z with you."
posted by theotherdurassister at 10:37 AM on March 2, 2022 [6 favorites]

That’s very reasonable and a therapist should be able to help you with a current crisis.

On the other hand I expect that at least some of your history will inform choosing the right strategies for you, so you should probably leave room to talk about it a bit.
posted by Tell Me No Lies at 10:53 AM on March 2, 2022

Best answer: I would be wary of a new therapist that didn't let you lead the conversation in the beginning.
posted by archimago at 11:06 AM on March 2, 2022 [1 favorite]

Best answer: I've done this exact thing with two therapists. For Therapist A, I wound up discontinuing therapy with them after getting a handle on the initial acute daily-impact issue that was the reason I'd sought therapy - didn't feel comfortable unpacking the metaphorical family heirloom matching 12 piece set of baggage with that specific provider at that specific time. For Therapist B, after I made some progress on my initial concerns, we pivoted to working through relevant older issues as they came up. Neither therapist seemed at all bothered or surprised by this approach.
posted by Ann Telope at 12:33 PM on March 2, 2022

Agree with everyone that this is totally fine. You could even just show them this question (print, email, just hand them your phone, whatever feels easiest at the moment) if you like.
posted by Snarl Furillo at 1:54 PM on March 2, 2022 [1 favorite]

Best answer: I have anxiety and depression mostly from childhood trauma, but with my last therapist, I explicitly said during the intake call that I didn't want to talk about my childhood or my parents as the starting point of therapy. I re-iterated that during our first meeting, and she respected that. Instead we spent most of the first few sessions on what was bothering me in the most immediate sense (work). We did eventually loop back around to other things because it was related, but I agree, it's a red flag if the therapist insists that their "way of work" is more important than your individual needs.
posted by sm1tten at 3:55 PM on March 2, 2022 [1 favorite]

This seems very normal to ask of a therapist. In particular, it's increasingly common for therapists to be part of corporate EAP plans that only cover a limited number of sessions a year and are explicitly designed around treating a specific mental issue.

I've only seen therapists covered by my job's plan in the past few years and they are extraordinarily goal oriented, because they are used to dealing with patients who only get ten sessions a year. With ten hours to try to help, not to put too fine a point on it, they don't give a shit about your childhood unless you bring it up.
posted by potrzebie at 10:41 PM on March 2, 2022 [3 favorites]

Response by poster: Just had my session with her, she was totally receptive to me wanting to direct the intake towards what I need to work on now. She's awesome and I feel like we already have a great rapport. (I'm a WOC and so is she - this is the first time I've had a therapist who isn't white and I think that that actually is helping put me at ease immediately.) She does a lot of journaling excersizes in her practice and I'm a writer so I think this is going to be a really good fit. I feel optimistic - genuinely, not cautiously - for the first time in a long time.

Thanks to all of you who have provided kind words and support to me over my past few questions about my struggle to find a therapist and my general mental health issues. You really helped galvanize me to keep working hard to find a therapist who could take me and not give up. This is an example of this place truly being the best of the web. I thank you all so, so much.
posted by nayantara at 3:47 PM on March 3, 2022 [2 favorites]

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