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What to tell your therapist first time you meet them

The thought of seeing a therapist for the first time can be anxiety provoking, even if you saw other therapists before. For many people a big part of this anxiety is wondering what to tell this new therapist during the first session. While obviously this depends on what do you want from them, there are a couple of ideas below - not to use as directions, but simply as an invitation for creativity. Maybe reading what other people discuss with their therapists on first session would help you clarify what is it that YOU want (or don't want) to talk with your new therapist about.

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Post-Traumatic Stress Disorder

Abuse is a serious psychological trauma, often involving threat to life, so it's not surprising that many of us struggle with PTSD, the same condition that's experienced by many combat veterans. PTSD is not a weakness, and cannot be overcome by willpower, i.e. sucking it up and pretending you're fine till it passes. It's a mental health condition that needs to be diagnosed and treated by a mental health professional. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria for PTSD include a history of exposure to a traumatic event (that meets specific stipulations), and symptoms of four different types: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Symptoms of each type need to be present for more than one month, causing significant distress or functional impairment (e.g. loss of employment), and cannot be due to medications, substance abuse, or other illnesses. This page lists and illustrates the four types of PTSD symptoms, so that survivors would seek professional help if they need it, and supporters would better understand what their loved one is going through and why they act the way they do.

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Emergency Escape Plan

Being involved in a violent relationship is kind of like living on top of a volcano. Some people leave once they realize it and never look back. Others run off during the eruption, wait out the danger, and come back once things calm down. Many go back and forth a few times, but eventually leave for good. Whatever your long-term plan is (staying or leaving), it's crucial to ensure your basic safety in the here and now, while you're still sharing the house with your abuser and the volcano can erupt any minute. The beauty of an emergency escape plan is that you don't have to hide it, because it's applicable in any emergency: fire, flood, earthquake, burglary, etc. Any reasonable person would commend you for being conscious of safety, your partner won't question your motives, and your friends and family won't suspect abuse (if you wish to keep it secret). You can even disguise your plan as a joke, a game, or a hobby (e.g. zombie apocalypses). It consists of simple adjustments that are easy to implement, but that would drastically increase your chances of surviving violence at home, and eventually escaping it.

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Physical Abuse

Physical violence is a crime, regardless of the age of the target, their relationship to the perpetrator, or any other circumstances. However, it affects children differently than it affects adults. First, children are completely dependent on their abusers (legally, financially, physically, and psychologically); they can't divorce their parents and move out, which leaves them no option but to suffer the abuse until someone rescues them. Second, children aren't fully developed physically; their bodies are more fragile because they are still growing, so a light smack on the back of a head, which would be of no consequence to an adult, can cause traumatic brain injury and death to a child. And third, children aren't fully developed mentally; they can't form an accurate understanding of their situation, which results in serious psychological trauma and various maladjustments, sometimes life-long. Many perpetrators of child abuse take advantage of this, presenting their actions as a perfectly acceptable parenting technique, punishment for the child's misbehavior. This page might be hard to read, as some people subject their children to torture, as defined in The United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. However, avoiding this topic doesn't work, because survivors of this type of abuse often end up unsure what to call their experience, whether it's OK to talk about it, and whether it ever happened to anyone else....

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Emotional Abuse

All humans need to be treated with dignity and respect, regardless of age. Parents have legal, physical, intellectual, emotional, and financial power over their children in order to care for them, to ensure their safety, welfare, appropriate development, etc. Using this power for any other purpose is wrong, just like it's wrong to mistreat prisoners of war. Children are in an even more vulnerable position because they don't process information the same way adults do; their brains are still developing, so what might be a stupid joke to an adult can cause serious trauma to a child. Young children believe what their parents tell them, and emotional abuse can cause them to draw very inaccurate conclusions about themselves and their place in the world. Older children understand that they're being mistreated, but have no recourse: they can't yell back, cut their parent off, or sue for harassment. They are stuck without options, forced to endure maltreatment. Taking advantage of this vulnerability is abusive. Emotional abuse of children is usually a part of any other type of abuse (e.g. physical, sexual, or neglect), and is mostly treated as an aggravating factor rather than a separate crime. It lacks legal definition, which makes it hard to address when it's the only type of abuse inflicted on a child. It's nearly impossible to prosecute in criminal court, but Child Protective Services work independently of law enforcement, and might remove the child from their parent's custody...

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Financial Abuse

Financial abuse is a situation where someone robs you of your money or other assets by playing on your vulnerability or taking advantage of your trust. For example, convincing you to give them your paycheck, stealing your cash, draining your savings account, maxing out your credit cards, making you sign over your house, or using your name to open loans. Sometimes it's done openly (e.g. "sign your house over to me now or I'll kill you"), but often it's disguised as "helping you manage your finances". Financial abuse usually happens in domestic relationships, i.e. between spouses or adult children and their elderly parents, but can also happen between friends, siblings, dating couples, remote relatives, neighbors, etc. It results in financial troubles (like getting evicted from your own house), stress and anxiety, shame, and damaged family relationships. Financial abuse is a crime, but rarely gets reported and prosecuted because it's painful to admit, embarrassing to talk about, and very confusing. However, avoiding the problem doesn't solve it; the more you know about it, the better protected you are.

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Tips for Attention Seekers

Attention can be a hard subject for abuse survivors. It's a basic human need, like food and water, but during abuse attention often resulted in pain. We want to be noticed, but we're scared of getting hurt; we want to rely on others, but we're afraid of rejection; we want to reach out, but we don't know how to do it constructively. Some people seem to get by with very little attention: they view it as a valuable resource, are frugal with it, and spend it wisely, only asking for the exact type of attention that they need. Others can't seem to get enough, asking for any type of attention they can get, which frustrates everyone around them and drowns them in negative backlash, destroying their self-esteem. Getting the right type of attention is a skill like any other, it takes trial and error, and a lot of practice. This page lists a few basic tips on how to make it work.