This quarter at school, I’m enrolled in a number of classes geared towards a pre-professional student. Of course, I’m a psychology undergrad, and to be a counselor or therapist, graduate degrees and/or certifications are required. However, at this point my class load is centered around learning theoretical orientations, practicing micro-skills (don’t cross your arms at a client), writing up psychosocial histories of imaginary clients, looking at standardized tests of mental functionality.
Simultaneously with this, I’m restarting therapy at a new location. I write about the first interview with a new client…and then I go to my first interview. We talk about effective note-taking techniques….and I observe my therapist’s legal pad of blue scribbles and arrows and diagrams. I plan my first psychology internship…and then give permission for an intern to sit in on my session.
In discussions with peers and classmates and friends considering finding therapists, I notice a sort of mystery surrounds therapy. Everyone’s sure you sit around and talk about things eventually, but how do you get one? What about all the forms? How do you start with someone you’ve never met? And, in the case of friends applying for reduced or free sessions (at community or university health clinics, who have limited therapists, and often take only some of their possible clients), what are all the questions looking for?
I can’t tell you how every therapist works. I can’t tell you how to get taken on for free or reduced-fee treatment. I can’t tell you that the first therapist you see won’t be homophobic or transphobic or non-skeptical. There’s bad therapists and therapists that you just don’t like because they’re too loud or too boring or too patronizing or too unsure. But I can de-mystify the process a little. I can tell you what I know of each side. I can know that I felt safer, more relaxed, when I knew what would happen beforehand, and hope that I can offer you a little of that.
Not considering therapy* because brain-wise, you’re just peachy? That’s spectacular, but as I ranted to Facebook friends today, you aren’t handed an Always Mentally Heathy Certificate at birth. You aren’t the Okay side that gets to pity the Other. Life is messy, and those lines are blurry at best.
So. The Intake Interview. The dancer in me thinks of this as an audition: trying to figure out what treatment and whether or not the two of you can work together. It’s unethical for a therapist to take on a client for whom they aren’t qualified, so some of this is them feeling out what you need from them. Intake has other ethical obligations; the counselor tells you when they would have to break confidentiality (harm to self or others). They have to check for suicidal ideation, because your life trumps it all. They have to get a handle on what you might be dealing with.
This means a lot of questions. Direct, sometimes uncomfortable questions. Were you abused? Do you think of suicide? (In my case) How much food have you had today? Yesterday?
Then there’s my least favorite: Why are you here? I loathe it. How do you start? What do you say? I want to say how well I’m doing, how much I’ve improved…and that’s not what they want. They want all the bad, six years of eating disorder that morphed into disordered eating and out-of-control exercising. So I run through it. I’m never linear; I stop and go back, and gesture, and leave out names and clarify and repeat and confuse. I’m never satisfied with my explanation, and I trail off until they finish scratching out notes.
Intake is…unpleasant. It’s scooping out your guts along with your life story. You offer up this blobby mass of tears and feelings and facts and say, “This is me. Help, please?”.
And it’s worth it. You do it once, and you have this terribly unproductive session, but it’s over and there’s a file and you don’t have to retell it ever again. You can move forward. Therapy starts. You come back and there’s a plan.
Therapy doesn’t work for everyone. It’s not a cure-all, and I don’t want to represent it as that. A lovely friend reminded me after my Friend Manual posts that it’s important to talk about psychology’s bad side: the side that tried to “cure” and diagnose homosexuality, a side that still does problematic gatekeeping, that still has practitioners that treat their own clients with therapy that isn’t empirically based.
Furthermore, not everyone CAN access therapy. Transportation, the cost of insurance, cultural norms, inability to take time from work or life or caring for family are all problems we need to and should address.