It's time to re-imagine the first therapy session. Therapy intake has become downright strange.
Sometimes before I think about myself as a therapist, I like to think about myself from the perspective of a client. I also am a client. It’s your first session. A stranger sits across the room from you, you know nothing about them. Or it’s virtual, it maybe feels even more distant.
The therapist that you’ve carefully vetted is immediately asking you about the worst thing that has happened to you, sexual trauma, addiction, and mental illness in your family. You are being asked to disclose information you haven’t perhaps shared with close friends or even family members.
You don’t know this individual and you’re unclear what has made them deserving of this new information.
It feels even traumatizing to go over the worst details of your life, and not only is it traumatizing but it’s question after question, blow after blow. Sexual trauma? Addiction? Family Trauma? Experience with suicide? The session ends and you’re left raw and uncomfortable. You may have even been pressed to share things you aren’t ready to yet with a stranger who hasn’t earned it. Should you return to your next session? What does this stranger think of you knowing the worst highlights from your life without any of the context? Are you unredeemable? Are they truly nonjudgemental?
I then like to think about this from the perspective of a therapist.
Not only is it deeply “trauma uninformed” to go about the intake process this way, but it’s also so deeply unartistic, lazy, and to be a bit contrarian because this is the internet- idiotic.
Safety is important.
Once you find out that in the first session your client is not suicidal, homicidal, or a danger to themselves or others in any form- why on earth are you asking them about whether or not they had sexual trauma as a child? Do you think you’ll get honest responses? What has earned you the right to gain access to such private interiors already?
Yeah- it’s downright strange, actually.
When I say that it’s unartistic and lazy, I think an interesting part of the therapeutic process is discovering. of course, my bias here as a psychodynamic or more analytic clinician will show. But isn’t it more interesting to find out whether or not there was constant and incessant screaming in your client’s home due to them telling you a story about how their boss perhaps berated them which triggered them to think of their home life? Isn’t it more interesting to hear about why your client doesn’t live with any pets or family members after you’ve learned that not only has their family proven to be deeply distrusting, but they were even attacked by their neighbor’s dog as a child?
I’m just saying. When we cut to the chase, we don’t only rob the client and make them feel weird. We rob ourselves in our own role.
It’s time to re-imagine the intake process, not for just the client, but also for us.
*the hypothetical scenarios I use are entirely made up and not from clients, duh.
Michele Quiles is a fourth generation New Yorker from Astoria, Queens of bicultural descent and a first generation college graduate. She is supervised by an OCD specialist and receives frequent consultation from an NYU trained Psychoanalyst.
