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A Letter to My Therapist, From Your Atypical Patient

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Hello there,

My name is Dora. Before we get to the actual therapy content, I understand that rapport is important. To help us both establish strong rapport, here are a few things I have found helpful before, which I hope might help us now.

Having had prior bad experiences in therapy, I have come to realize I value a psychologist who validates my experiences. I don’t expect you to always understand, but empathy will definitely go a long way. When you say, “That’s unusual – but I see why your experiences cause you to feel this way,” it gives me permission to accept my experiences as real. More so, it allows me to acknowledge my past experiences, and this anxiety disorder which has resulted from them, aren’t necessarily my fault.

It’s not always going to be easy caring for me – and I apologize in advance for the days you’ll continually realize I’m quite atypical and may have unusual responses to therapy in general. I’m not too hard to understand though, if you pick your battles wisely.

For example, if I’m not talking in the appointment, I’m most likely feeling insecure or afraid. This is usually not personally directed to you. I have, on prior occasion, told my previous psychologist that I would not be talking in the entire appointment, because it was too overwhelming that day. I explained why I found worth in paying for an hour of silence – in an extremely authoritarian household, coupled with working as a primary school teacher, silence is hard to come by. Even if I wanted to, it wasn’t always something I could pay for and be assured of getting in return.

I might get around this adamant refusal to talk by writing my thoughts on paper – please don’t be too surprised if I do this, and even more so – I hope you’d be accepting of my doing this, too. That’s because it gives me some distance to communicate my thoughts, which is the information you need, regardless of the medium through which I communicate them to you, isn’t it? Admittedly, writing in place of talking is possibly slightly quirky, but that’s still a good alternative compared to having a client who won’t talk out of insecurity, and who also ends up losing her trust in you because you’re pushing her too hard by forcing her to talk.

Flexibility in tweaking therapy norms is key, because this makes me feel safe – when you help me feel safe, it helps me trust you, too!

I am also hugely dependent on feeling emotionally secure — this means sometimes when I meet you, I will either hug the cushion on your couch, or my bag. This helps me feel safe. After all these months in therapy, sometimes I wonder if I shouldn’t be relying on this safety mechanism anymore; nonetheless, for now, it gives me a fair amount of emotional safety to try doing or talking about a difficult thing. While I am learning to gradually keep decreasing the use of this safety mechanism, I hope you will be accepting of the times when I do need to use it, too.

Equally importantly – I thrive on routine, much as it may be tempting to give me partial autonomy of decision-making in sessions. As we grow increasingly familiar with each other, please continue to remember you are still in authority for decision-making towards my treatment plan. I will trust your professional judgment, and we can look for solutions together if a certain strategy doesn’t work. Part of the reason I treasure therapy is because the fixed routines and structure give me plenty of emotional security that is lacking in other aspects of my life – please keep these structures in place as much as possible.

But above all – during my days of teacher training, it was always reiterated to us that our pupils wouldn’t care how much we knew until they knew how much we cared. Since starting therapy, I’ve realized this is equally true in this context. You might be rather daunted to realize how upfront I am about being a potentially challenging client, even before we’ve started. But with sufficient patience, empathy and validation, I will gradually let down the walls I’ve built, and allow you to share in my world.

I promise.

Much love,


Originally published: April 13, 2016
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