@SarahSweden - Thank you for sharing your struggles in treatment with us.

I think there are different goals for different types of therapists with different kinds of modalities. Intake is not necessarily the same as therapy, so in essence, you are able to critique how you felt the intake went, especially if the intake process lasts more than one session. A recap on the previous session is a "friendly suggestion" you could offer at the next session, indicating that jumping into a new topic of inquiry may be challenging for you.

If, however, your intake sessions lead into treatment with the same therapist, then I would question that process if it isn't right for you. If you prefer different kinds of treatment that don't begin with intake questions, mental status examinations, and the like, you can state that.

Whether or not your insurance would cover different treatments is another story altogether, and a challenge that many of us face.

Your question concerning the "appropriateness" of criticizing a therapist during an intake session is something that you could actually discuss with your therapist during the intake session. You could say, "I don't know if what I'm about to say is appropriate or not, as it entails some criticism about what I'm feeling and observing during this intake session, but I really feel a need to discuss this with you at this time, and to figure out if there are alternative options." You could also state that you are concerned about their misdiagnosing you based on your suggestion or fears of the intake process, even though mental status examinations during intake look at everything - including what you say, how you say it, how you sit, what you are wearing, the history you mention about yourself, etc. It's best to be honest, up front, and open to suggestions during the intake process, but perhaps part of your disability includes having a hard time with that, which they will detect in conjunction with your other symptoms and historical accounts you present to them.

Guidelines for treatment vary across different therapeutic modalities and therapists. The therapist-client relationship is an important one, so expectations and boundaries should be stated up front - from both the therapist and the client. The first few sessions could address that in conjunction with the reasons what brought you to therapy. If an intake session is required in order for them to fit you with the right therapist, they should tell you that up front. If the intake process will take multiple sessions, they should tell you that up front, too. They may not reveal all that the intake process entails, as they are evaluating you to see what your needs are and presumably who you might be best paired with if not the intake therapist. If you feel uncomfortable with the intake process or the intake therapist, you could ask to speak with someone else instead, or figure out if they can recommend other services that are equally as feasible or that accept your insurance. You have rights as a consumer and a patient, which should be explained to you as well.

It sounds like you are new at this, or somewhat experienced in what your expectations are from a therapist. Regardless of what some people might assert with regards to their own therapeutic experiences and/or professional opinions, the treatment you are seeking is entirely your decision, and it needs to feel right and jive with you - within limitations. For example, if you are seeking treatment as a way to vent only, without desiring to make any effort to work on changing aspects of yourself, or if you have a difficult time with trusting anyone to share your story with but are needing time to build trust before working on trauma or behavioral problems (or both), then that should be stated up front. If you need a therapist to be empathetic and have a certain personality that works well with yours, that is also a viable request. Sometimes good therapists who are well trained aren't a good fit with certain clients. For example, a minority person who has dealt with race-based traumatic stress and daily microaggressions from peers and/or colleagues may request to speak with a therapist who is not only trained in those specific stressors and their sequelae, but also a therapist who is a minority. Additionally, a female trauma victim may request to speak with only female therapists, or a child maltreatment survivor of abuse from his or her mother may request to speak with only male therapists. A person who has dealt with many interpersonal traumas may request to speak with a therapist who is empathetic, warm, understanding, patient, etc. It's okay to assert your needs when seeking therapy. If anyone pushes you to choose something you don't understand fully (without any disclosure about what treatment or modalities are being offered, and what the process could look like or entail), then I'd look elsewhere for a facility that does explain those things up front. You don't need to know everything about CBT, DBT, EMDR, psychopharmacology, psychotherapy, Jungian approaches, Freudian approaches, Gestalt methods, etc., to understand what a therapist is trained in and how they can help certain populations experiencing certain symptoms. You have a general idea of what you are seeking and what issues you are dealing with. You also have a general idea of what your fears are, what kinds of things you are uncomfortable with, and what circumstances affect you deeply - those things can be stated up front to help you figure out the best therapist for you.

I hope these tips help in some way. Take what you can and chuck the rest.

Lillib