Recently, I was sitting in session with a patient, Jesse, a sixteen year-old boy who had started seeing me only three weeks before for a problem with thoughts that he said were very unpleasant. So far, we hadn't gotten very far, as he still couldn't seem to tell me anything about them yet. He sat there nervously, playing with his sneaker laces and looking at the floor. "I don't know if I can tell you about my thoughts yet," he said. "They're really bad, and if I tell you you'll probably think I'm crazy and won't want to work with me any more. I don't just mean 'bad' thoughts. These are the worst ever."