How much to disclose in new patient forms....

[whiteraven]

From a patient/client point of view, I understand the reluctance to share information. Absolutely. Fr...

While I totally agree it's important to provide information to a physician like medication, surgeries, whether or not you are suicidal, that sort of thing on an intake form and during an initial assessment, I think it is a completely different matter when it comes to "do you have a history of childhood sexual abuse?" or "were you ever raped?"" or anything remotely similar.

I went to a primary care physician for the first time and revealed on my forms (mistakenly, in hindsight) that I had a history of complex PTSD. During my appointment, she said (staring at my paperwork and jotting things down as she spoke), "Ok, so...what happened to you?" Seriously? I hadn't been with this 27 year old for more than 45 min and she wanted me to tell her something it took me 2 years to tell my therapist? I ended up responding with, "I have complex PTSD. That's multiple traumas." She dropped it there. And I view her with suspicion any time I have to deal with her or her office now.

I don't think anybody should ever be expected to reveal the nature of any trauma on a form or, for that matter, in the course of the initial sessions of therapy. That requires the development of trust, and you don't know if that's ever going to develop, until you spend time with that individual. Withholding that kind of information does NOT constitute being dishonest or lying; it is a matter of taking care of one's self and an extension of the survival response. And, if the therapist see it as dishonest and lying, I would absolutely seek out a different one.

 

[gealach]

To put it bluntly, how can a T or Pdoc treat you, if they don't know what your trauma(s) is/are? How can they, and you, know if they have the skills and scope to treat you? What if you have a history of csa/sa, but this doc has absolutely no training on that type of trauma? Checking the yes/no boxes on a form (which is what is being discussed here) will keep both of you from chasing your tails for 2 years. I'm absolutely not advocating for a full detailed disclosure on the first session, the doc doesn't need all that and that's what therapy is for. What I am advocating for, is to check the box on the form... yes or no, be honest because you're there for help, and you need to know if that doc has the skills and scope for that. It might take another 2 years to be able to discuss that checkmark, but at least you both know it's there and needs to be addressed at some point.

The first time I had to fill out forms for a Pdoc, I was literally shaking so hard I could barely hold the pen, for over 8 hours. I didn't want to admit to anything, "I'm fine, just fine''. But I wasn't fine. I checked the boxes, because I sincerely wanted help. Turns out that Pdoc is a complete twatwaffle who ''doesn't believe in ptsd'', and I never went back there. I was afraid, I checked the ptsd box, he doesn't treat for that, I never went back. I bawled for an hour on the side of the side of the highway in my jeep afterwards. I was glad, though, that I found out about his bias that day, before disclosing a bunch of difficult stuff. And I agree that your doc blurting out that question was pretty crass, I'd be looking at her sideways too, if I ever went back. She definitely could have used more tact there, and I'm guessing she has no skill with ptsd or trauma.

 

[Friday]

I've checked here and the initial, introductory sessions (not sure if that is different from an interview session?) are almost always higher in cost.

Yep. Different.

An intake, or introductory, session is generally between 1.5-2 hours long (as opposed to 1 hour), basically double the length of time of a normal session, and generally cost about twice as much although not always. They're usually really in depth overviews of everything about you via an about you Q&A period, plus the 2 of you designing or discussing a treatment plan (at least an initial treatment plan) with different goals, figuring out resources, scheduling, paperwork, a whole helluva lot of stuff.

An interview appointment is generally about half as long as a regular, session, free, & includes an "about me" show&tell bit from the therapist (their training and education, modalities they like working with and why, their general goals for therapy & their clients, how they like to operate / ethos / etc.), & is a time to really grill them about what you need and want from therapy, to see if that's something they do.

Essentially an interview appointment is all about them, to see whether or not you like them, can work with them, think they'll be helpful for you... Meanwhile an introductory or intake session is all about you, where they figure out how they're going to be helping you & what you're going to be needing.

Both of these are different from diagnostic appointments (generally at least 2.5 appointments, (roughly 5-7 hours in total) 1 where you do several hours of testing/interview, .5 where you go get an incredibly thorough physical (far more detailed than a normal physical, because they're looking for physiological causes/differentials that might be causing or exacerbating psych symptoms), and then a last 1 where there is a synthesis of the testing/interview & physical results, with a provisional diagnosis at the end of it (provisional because most solid diagnosis require a few months to be certain).

Rough numbers (for my area)

Interview : 30-60 minutes. Free. Mostly about the therapist.
Regular Appt : 50 minutes. $125
Introductory : 90-120 minutes. $175-$250. About you.
Diagnostic : Many hours over many days. $700 (not including medical costs)

 

[whiteraven]

Hm.. @Friday - Never, in all my years of therapy and pdocs and even medical stuff had anything more than a regular appointment. Thanks for all of that. Introductory appointments were always all about me, but never more than the regular length but almost always at least twice the cost of the regular appointment (this is usually mostly the case with pdocs, although occasionally with therapists, as well). No therapist or pdoc ever did anything diagnostic. Or suggested anything. As a matter of fact, I have had to make any and all suggestions for diagnostic workups myself. And have discovered a few things in doing so. Fortunately, at least until lately, I've had primary cares and neuros who were willing to take me up on those suggestions.

 

[GWhizz]

As a healthcare professional myself I actually disagree that you need to share everything in this situation. Share the basics that are relevant for now. I don't see how your last menstrual date is pertinent unless you have hormonal issues and this T is going to go down the route of treating it. It's not necessary that a patient tells me they broke their arm 20 years ago. Unless it's still affecting them in some way or they had a reaction associated with the treatment at that time.

My last T pressed to know who I saw briefly before her. I refused to tell her because I live in a small locality and worried she'd know this T and that my biased negative opinion of the prior T could affect my other T's opinion of her also.. It seemed unfair and unnecessary as I was only making the point that I'd tried therapy once before for several sessions but quit because that T kept crying every time I mentioned something minutely upsetting about my past when I couldn't even connect to the emotions about it myself!

My current T it took me 2 years to disclose! My GP did send a general referral outlining the nature of my trauma. I met with a psychiatrist who I couldn't open up to and so my T (part of his team) took me on and gave me infinite time before diagnosing me and getting into any details. She still doesn't know much if any other personal medical details.

I wonder what exactly you have discussed about your reasons for seeking therapy with this T? If you've already outlined that it's trauma related I don't know why they need more detail just now. I have worked with psychiatrists before and any client presenting with PTSD, we are advised not to even try to get into any of the individual's details. That it's like opening a can of worms and triggering them. I would just complete what you're comfortable with for now. And be frank that trust is essential before sharing anything that causes you discomfort/distress. I don't agree that help seeking should require one to jump through hoops first. Not within reason at least!

 

[whiteraven]

To put it bluntly, how can a T or Pdoc treat you, if they don't know what your trauma(s) is/are? How...

Therapist or psychiatrist does not need to know specifics of trauma. You need to know if they treat *trauma*. And you shouldn't even have to make an appointment to find that out, if they are worth their salt. I have DID. I need to know before I go see a professional, if they treat DID. Or, more specifically, if they believe in DID. As it turns out, they sometimes lie about that, so it doesn't really help to ask in that particular instance, but I digress. For some people, it's just too hard to reveal certain traumas. For others, they are not *aware* of what kind of traumas they've had.

 

[EveHarrington]

Therapist or psychiatrist does not need to know specifics of trauma. You need to know if they treat...

But it also works the other way around. A client may think, based on credentials, that a therapist/Doctor is a good fit, but the therapist/Doctor also needs to know some specifics in order to determine if he/she has the right expertise to treat the client. A true assessment runs so much deeper than simply analyzing a resume.

 

[gealach]

I'm absolutely not advocating for a full detailed disclosure on the first session, the doc doesn't need all that and that's what therapy is for. What I am advocating for, is to check the box on the form... yes or no, be honest because you're there for help, and you need to know if that doc has the skills and scope for that

I think some people missed this. I don't mind people disagreeing with me, all opinions and points of view are valuable, just please disagree with what I actually wrote.

OP, did you have the appointment? If so... what did you decide to do with the paperwork? how did the session go for you?

 

[whiteraven]

I think some people missed this. I don't mind people disagreeing with me, all opinions and points of...

I didn't miss anything.

 

[whiteraven]

But it also works the other way around. A client may think, based on credentials, that a therapis...

Agree. I think if the therapist has issues in dealing with certain areas, that's on him/her to bring up in the first session, or in the interview, so the client knows his/her limitations.

 

[Guest]

I havent had the appt. yet.

I have filled the forms.

About previous Therapist, I decided not to disclose anything. Because i really dont want to talk about my experience with prev. T at all. I can see that it will be helpful to discuss as to what worked and didnt work...it was my first therapy experience and i didnt know what to expect. I guess it was a warm up. Now i am better prepared and ready to get to work.

I decided not to disclose CSA , as that is not my primary concern right now.
another question was age first sex experienced. i am not sure what that means? does CSA come under that? does it count if one had no idea what was happening? i am just curious...the answer to that question is not so simple and admitting CSA on paper is very hard.

Self harm i just indicated as mild. So if things go downward, T is aware that SH is one of my coping strategies.

I left the page completely blank for health issues as i am not going for medication. He is a psychiatrist and MD as well.

Thank you everyone for your insights and input. I will update after my appt. how it all well.

 

[GWhizz]

Age of first sex experienced?! Wow, what an off-putting question for anyone!