HANK YOU for choosing me as your psychotherapist. Before we begin our working relationship, I would like to gain a preliminary insight into your thoughts and concerns. Please complete the application below, and mail in the enclosed prepaid envelope two weeks prior to our first visit. I look forward to meeting with you soon.
Please provide a short description as to why you are seeking therapy at this time. If putting your feelings into words is a new or anxiety-provoking experience for you, I have provided an actual response, with kind permission from one of my clients:
"Perhaps no issue is currently more pressing than my compulsive need to use the French article "je" in place of the corresponding article in English. Je can't tell you what this has done to my personal life. If only je could get past it! As irrational as this may sound, however, j'am haunted by a terror of dying should je speak the English article. Doctor, does je share this affliction with others, or is it just moi? Oh, dear."
1. Which one of the following song titles best describes your current mood?
Wichita Lineman
By the Time I Get to Phoenix
Galveston
Rhinestone Cowboy
2. What do you hope to achieve during our time together? (Again, a sample is provided, with kind permission of another client.)
"Recently I had a dream of immense moment. In it, I learned that the meaning of life is contained within the formula that defines a straight line. I have since completed a 506-page thesis that explicates my theory, and I wish to present it to the world. The only impediment I face is my crippling lack of confidence. That's where you come in."
3. Please choose the most logical word pair from the following:
automobile : pastry
telephone : buffalo
mango : wheelchair
sex : elevator
4. Which one of the following animals best describes you?
the timorous chihuahua
the water-logged capybara
the good-for-nothing mole rat
the promiscuous bonobo
Before our first visit together, please read chapters 1 - 5 of The Prime of Miss Jean Brodie, and be prepared to discuss the following:
Why does Jillian kill her hamster?
How does Eric's father know what happened to the chifforobe?
Describe how the themes "organza" and "redemption" intersect.
Who is "Alistair" really?
5. If you could be any article of clothing, what would it be and why? For example, one of my clients (kind permission) chose a poncho because "it makes a square when you lay it out on the floor, and then there's a circle in the middle of the square. So you get two shapes out of it."
6. Has anyone in your immediate family been diagnosed with any of the following conditions? If so, please indicate the familial relationship(s) next to the condition:
Hypertension
Acid Reflux
Mania
Dipsomania
Beatlemania
Whore Mongering
7. Please answer true or false to the following statements. Don't spend too much time on each one; your answers could thus become irremediably flawed, and I would need to send you another set. These statements, by the way, are extremely difficult to compose, so finely are they calibrated to elicit the subtlest of psychological clues. Not to worry! Just answer as honestly and rapidly as is humanly possible.
My friends would describe me as a positive, energetic SOB.
People are trying to sell me things over the phone.
I mumble while balancing my checkbook.
Foreigners know my VIN number.
No one knows what I'm thinking when my computer is on "sleep."
Cats howl, but dogs are selfish little bastards.
Anthony Hopkins did not scare the bejesus out of me in Silence of the Lambs.
Some of my clothes definitely require alterations.
I wish I was in Dixie.
If I could count to a billion, I would.
I am plagued by unwanted thoughts of cutting Donald Trump's hair.
"White chocolate" is just one example of poor communication.
Give most Europeans a centimeter, and they'll take a kilometer.
© 2006 Kate Heidel
