Advice For First Therapy Session?

[theshadowoftheliving]

Later this week, I have my first therapy session after a near ten year hiatus from dealing with this stuff. I'm so nervous and hoping to get advice. I only have twelve sessions with this therapist, then will have to reavaluate, potentially shift course, etc (tricky insurance situation that I can't even begin to describe). Therefore, I have no time to go through a lengthy stabilization/trust building period - that could be the entire course of treatment.

So, any advice on how to hit the ground running, so to speak, without falling apart? How to bring up traumas immediately, but in a safe way? My gut instinct is to shut down/dissociate the minute that something hard comes up, and I just don't have the time for that.

I know this is a bit of a vague question, but I'm hoping for strategies, etc so I can make the most of this opportunity.

 

[Changing4Best]

My therapist gave me her email address and I filled her in on the basics of my history by email. Then we met a second time and she had an idea of where I was coming from. Also, she had me fill out a lengthy form on my first visit, so she had that too. So we sort of hit the ground running and then we caught up on more as we went along. I see her once a month now. That is all I need. My insurance pays for it. I am on Medicare.

 

[WillyKat]

I think @SheilaKathy has a great idea. I would also add:

• Go in with a list of things you want to accomplish, your biggest concerns. Think in terms of what one, two or three things you would like to work on in your 12 sessions. You may only get to one, but I think if you spell out what they all are, it may help you to get one. Most likely they're all related somehow.
• Have an agenda every session. Keep your list fairly short; you'll only likely get to talk about three or four things.
• Put together a reading list for private study.
• Stay on this forum.
• Figure out one or two activities that put meaning into your life and take part.

 

[Suzetig]

12 sessions isn't going to be enough to deal with PTSD in terms of processing trauma - I agree with the idea of picking two or three things you want to accomplish, maybe think about the symptoms that ause you most problems day to day and focus on skills for managing them or one particular area you want to focus on. Trying to do this work too quickly can be very counter productive so stretch yourself by all means but know when you need to put the brakes on.

Is your therapist a trauma specialist?

 

[WillyKat]

Just a thought: I would go in there with the attitude that this will help. No, twelve sessions may not be a lot, but it can help. I remember the first few visits when seeing my first good counsellor. Those things still stick with me. So 12 can do you some good. There are also many cases where people make 1 call to a crisis hotline and it saves their life.

 

[theshadowoftheliving]

All good advice, thank you. I guess I'm worried about a couple of things, the primary one being dissociating during the sessions instead of staying grounded.

In the past, therapists would just stop if they saw me start to dissociate, instead of just letting me push through it. But I think I'm dissociated most of every day. So this isn't a great strategy, you know? I guess I'm looking for advice on how to communicate this effectively to them, that, for me, I can be pretty broken up and messy but ultimately totally fine. Not happy. But fine.

Also, I know that there might be no advice other than the usual grounding strategies, but I'm asking in case there is. I can't spend the whole sessions zoned out just because I'm nervous.

Im not quite sure what I'm asking, maybe. I'm pretty spacey and disconnected just thinking on talking about all of this with her.

And yes, @Suzetig, she is a trauma specialist.

 

[Chava]

First, insurance can be such a piece of sh#t sometimes.

I relate to the dissociating and spacing out....also takes a very, very long time to trust anybody. 12 weeks would be not even getting started. I don't know how you can "push through" dissociating....in my mind, that just means...dissociating. Like talking about the trauma even if you are disconnected. You can't force this sort of thing.

Hopefully the therapist has some process for good intake and that you can talk about goals. I don't know if you can resolve your trauma in 12 weeks or not. If you've been dissociative for a long time, that doesn't seem really likely, but I don't want to disappoint you either. I understand you want to jump right in and get through the nerves to some degree. Can you write this out for the therapist...that #1 you are afraid of being nervous and also dissociating or spacing out? That would be really valuable information right away in the initial assessment. It sounds really helpful that you know this about yourself.

Then you'll probably have to ask the therapist directly what he/she images can happen in that time period. Maybe they can advocate for an extension with the insurance or help formulate goals that will help you at least feel a little more empowered and not more spaced out for having entered into the trauma stuff without adequate recovery (that's legitimately scary, I know).

Bring lots of notes and questions with you...that helps me a lot when I'm worried my head will get all jumbled and fuzzy. Good work deciding to ask for help and go back to therapy. You have every right to wonder about the process and how it will work for you within the limitations of your insurance company.

 

[theshadowoftheliving]

@Chava If it's the type of disconnected, floating-on-the-ceiling type dissocoation, there's nothing I can do to push through. But I'm speaking on the day to day fuzziness and confusion I feel all the time. I can sometimes push through that. I feel like I have to, or I'll just be disconnected allll the time. I don't know if I can resolve everything or not, but I'm ready to try, I think, rather than just perpetuating this pattern of surviving.

I'm tired of being a mess and I don't want to take it slow just because I only have twelve sessions; hell, I need to go fast and just suffer through whatever consequences BECAUSE I only have twelve sessions .....

 

[Chava]

Just don't beat yourself up if you can't fix all difficult patterns in a few months. Hopefully you can feel set on a hopeful path though. Load up on all of your best tools for taking care of yourself.

 

[theshadowoftheliving]

@WillyKat What kind of reading do you mean? Like, on the disorder itself, in order to understand? I'm already the spaz that searches and reads peer-reviewed journal articles on this stuff….

 

[Suzetig]

The thing with dissociation is it interrupts the contact you need to have with your therapist for any kind of therapy to take place. If you're someone who reads, have a look for Margaret Warner's writing on fragile process and dissociated process. She writes from a client centred approach but her work holds water for other modalities too, while its possible to work "through" dissociation, it's not a quick process simply because its a defence mechanism against the experiences you've had and so kicks in when you feel under threat.

You may find these 12 sessions help with basic management and give you a clear direction for the next part of your recovery. Do talk to the therapist about what they feel may be possible in a short space of time and be guided by them.

 

[rightkindofme]

I come in with most of the information about my traumas written down. I bring in many sheets of paper to my first appointment. I bring in a Cast of Characters with brief biographical information on everyone I will be talking about (so the therapist doesn't have to waste time saying "Who was that again?) and a sheet of paper with a brief autobiography. One line per year of life with the major things that happened to show the shape of my life.

I go in with a list of my problems on another sheet of paper: self harm, depression, anxiety, food regulation issues, etc.

Once I have all of these bases covered then I decide "Right now I'm struggling most with _______." Then I ask New Therapist "Is ______ within your range of ability to discuss?" Not every therapist can handle everything and I've overwhelmed enough that I know to ask in advance now.

Good luck. 12 weeks is a fair bit. You can do a lot if you organize yourself and don't wait for them.