Once you've given me consent to treat you, the floor is yours. I usually start with, "Where would you like to start?" For some, the floodgates are unleashed; if you've been carrying something extremely painful--all by yourself--and haven't found the words or the opportunity to tell a close friend or spouse, there may be alot that comes spilling out. For others, there can be issues with self-esteem or a deep underlying shame that makes it too difficult to utter the words that express the core issue; and so, there is a gradual "warm-up"where you, the client, regularly take the temperature (and assess the safety) of the room to determine how much you can tell this person you met only minutes ago.
In either case (flooding or reserve--or a multitude of variations in between), eventually, most clients find it safe enough to talk about the issue that brings them to therapy and the distress it is bringing to their lives. From there, your therapist will be looking for ways--therapeutic interventions--to help.
If not in that first session, then soon after, I'll gather a bit more information about you that will help me understand more about you. The questions may seem a bit mundane, possibly intrusive to some, but let me share the rationale behind them. It's not idle curiosity--I need to understand the person on the couch (you) as much as possible to do the best possible work with you.
Aside from your name, I need to know your date of birth, just in case you want me to file insurance for you--most companies require it. Also if your physical appearance isn't in sync with your biological age (you appear significantly younger or older than you are), then I need to have an idea of the time span you've spent on earth to understand what world events you've experienced: WWII? Kennedy's assassination? The summer of love? 9/11? World events can shape our world view, and it helps to understand yours.
I also ask for your address. Again, most standard insurance forms ask for this. I rarely send communication through the mail to your home (and only with your express permission) but if I need to do so, your address will come in handy.
I ask for an emergency contact person and a way to reach him or her. In case you should become ill in session and need medical attention, it helps to know who you would like to be informed, either to assist you or to provide them with information--because they care.
I ask who referred you. I always appreciate referrals; and, while I cannot thank your friend for referring you (confidentiality!) it's nice to know they feel good enough about our work together to send a friend to my see me. Also, I have a website and use selective advertising from time to time in order to publicize my practice. It's helpful to know where people find me.
Your marital status may or may not be germane to our immediate conversation, but it tells me about your history of loss (divorced? widowed? separated?), and who may or may not be in your life to support you when things are difficult.
I ask the reason that brings you to therapy, and more specifically what made you decide to come for treatment now? I find that people carry different levels of distress for differing periods of time. If there has been a recent event or life change that made therapy a viable option for help, it helps me to know this.
I ask about previous therapy. If you've been in therapy before, I would like to know what worked for you in past therapeutic sessions, as well as what didn't. If you're new to therapy, I can be alert to your concerns about how the process works; as well, I can take more time to explain our work if it seems like this will be beneficial.
Don't be surprised--or offended--but I ask every client about alcohol and/or recreational drug use. I've worked for many years with drug offenders in the legal system who are mandated for treatment, and I've found that the connection between numbing out and psychological distress is often strong. I don't judge anyone's use: the quantity, the reasons you use or any of the distress you may report associated with your use. But it helps me to know more about how you may or may not use substances as a coping mechanism. I will also ask that you not come to session under the influence. It's almost always a poor use of your time in session if you're not completely present.
Finally, I'll ask a little about your medical history, as well as any prescribed meds you're currently taking. While I'm not a physician and cannot dispense medical advice, I may refer you to your physician to rule out any organic (physical) causes of the distress you describe.
Seems like alot to ask, and yet it takes very little time. For some clients, it provides warm-up conversation that's easier to tackle than the deeper, more weighty stuff. Most importantly, the answers come from the person with the most accurate information and expert understanding of you: you.
In future blogs we'll explore more of how the therapeutic process unfolds. For now, I believe our time is up. Thanks for listening.
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