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Guidebook to your Therapist: The first chapter

Choppo nervosa

There is this amazing phenomenon occurring globally at all hair salons. Customers pore excitedly over hairstyles and unicorn colors with the precise instructions on how to help their hairstylist achieve it. They imagine themselves perched precisely over the cushy chair, waving their hands at their hairstylist and presto!Blake Lively or Beyoncé. Or Dilraba Dilmurat, if they’re Asian. After the miracle, they walk away; heads higher and 5 inches taller.

But that never ever happens. Somehow the height of the chair is too high; customers end up clambering into it, all flustered. The hairdresser pays more attention to the next customer. Your appointed hairstylist takes a look at your desired hairstyle and says, “Nahh. Your shape/jawline/coloring/bleached hair/(fill in the blanks) does not suit that style.” BAM. Cowered and shriveled, you tell the hairstylist to “just trim the ends”.

There is a name for it — hairstylist anxiety. I call it choppo nervosa, the anxiety that overcomes a person when it comes to hair changes/haircuts. But then I ruminated further. Does it only apply to haircuts? What about other professionals — like clients meeting their therapists for the first time?

Hence, the guidebook to your therapist — the what-what-what-WHAT? on what to ask and how to ensure your therapist machine does not glitch.

The first chapter

There are several things your therapist must and should explain to you during the first session. Unfortunately, because of a phenomena similar to choppo nervosa, most clients get confused and neglect to ask important questions, sometimes at their own expense. They focus on how well they tell their story and present their problems (which is fine; you are supposed to tell your story) that they forget that they too can decide how the problems are solved. Too often, therapists are set on a pedestal of God-likeness and ethical breaches happen without clients being mindful of them.

Photo by Paweł Czerwiński on Unsplash

Informed Consent

Regardless of the setting, you are most likely to encounter informed consent twice — once in paper form, and once when your therapist waters down the terms of consent before you share your story. Remember, this has to be done before you start pouring out the deepest, darkest secrets of your heart, or else your therapist might not be legally bound to keep it to him/herself. On the rare event that your therapist does not bring it up, ask directly, “Can you explain the terms of informed consent for me?”

Informed consent is literally information presented to gain your consent. It tells you about the capabilities and limitations of your therapist in sessions (e.g. are they a trainee?), some requirements that may occur in session (e.g. is it recorded? For what purposes?), and what your therapist does with your information between sessions (e.g. do they burn their notes? Or use it as fuel for tea?). Once you sign the consent form, it is understood that you are clear on the above terms.

Confidentiality

Therapists are bound by law and their professional councils to keep all information or documents relevant to your sessions strictly confidential. It means that they can’t talk about your divorce in a casual dinner with their friends. “Hey, you remember Sally? She got divorced, tau*.” They can’t gossip about your affairs with the administrative staff who served you drinks when you arrived at the centre. They absolutely cannot use any information you provided on anything other than your wellbeing.

BUT, make sure you know who they are allowed to share with. In most settings, your therapist will likely discuss your case with their supervisors or peers in a case conferences to ensure that they are giving you the correct course of treatment, and for general growth in competencies. They are in no circumstances allowed to identify you as the case; therefore cases are simply considered anonymous. In some settings, the therapist may have obligations to your organization, your insurance company, or your parents who referred you for the sessions and pays for it. For your own benefit, make sure that you know what kind of information is shared and with whom.

Records

Your therapist takes notes in sessions. They may record your every movement in session, or their own movements in session (yes it’s weird but we want to scrutinize how well we did too) using fancy recording devices such as the latest iPhone. Someone else may be standing behind the two-way mirror observing the session. An intern may be scribbling noisily at the corner.

First of all, make sure that you have agreed to any of those situations happening. You have the right to say “no” to any other person except for your therapist being present to listen (Although, jangan lah*, let the others learn too). If you have kindly agreed to any of it, you still regain the right to stop any recording or observation at any time. For example, the session touched on something terrible that happened in your childhood. Yes, you can say, “I’d like to stop the recording”, or even “I want to stop the observation now.”

Secondly, do you know that therapists use your session notes as fuel when they want to make a cuppa tea? Well, they don’t. I was just joking, chilllllll. If you’re shocked, it means that this was not covered when you met your therapist. You are allowed to know what he/she does with the notes or recordings taken during the session. Some organizations have a timeline for exactly when they destroy their paperwork. You can always demand that your paperwork is destroyed immediately when you terminate your sessions, but it is good to have some documents around if you need other services in the future.

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Approach

Something about your therapist just doesn’t match up. When you talk about feelings, all they want to talk about is what you are thinking. I mean, didn’t Hollywood teach us that therapy sessions are all about “tell me how you feel about that”? When you try to compromise and talk about what you’re thinking, they say that there are thinking errors present. What?

In the above situation, there is no right or wrong approach in therapy sessions. Your therapist may be a cognitive behavioral therapist but you prefer an emotive approach. Before that happens, you can ask the therapist about their approach to your problem at the end of the first session. If you have a gut feel about them not paying attention to any part of your story, you can bring it up and remedy the situation. They are paid to listen and be aware of anything of emphasis according to you! Again, you reserve the right to ask for another approach if it doesn’t work for you.

Preferences

“What if I prefer a male therapist?”
“I think someone older will understand me better.”
“I need a female touch, I don’t want to be judged by men.”
“Can speak Cantonese, ah*?”

These are common preferences voiced by clients. You can list down your preferences before the session is even scheduled, or after you meet your therapist. As much as I advocate asserting your rights, I’d like to remind you that most therapists are females. Language barriers notwithstanding, give your therapist a chance before blowing them off. They have achieved the necessary training and qualifications (along with the hours for license renewals) that makes them more than worthy to work on your problems.

I dare you

At the end of the day, remember that you are equal partners with your therapist (for most parts; some approaches may not work like this) and you have POWER too! Whenever you feel uncertain about something that happened in session, ask. If you were offended in session, let your therapist know. If the session was extra satisfying, give feedback. I dare you to overcome the effects, however overpowering, of the choppo nervosa.

Photo by Joyce McCown on Unsplash

  • *Tau: a short form of the Malay word, tahu, implying “know”. In the context of this article, it means, “you know?”
  • *Jangan lah: A Malay word and slang for “Please don’t”
  • *Ah: A Malaysian slang that could express almost anything such as curiosity, anger, or understanding