In 1952, Ross met Prestige Records owner Bob Weinstock, who asked her to write lyrics to a jazz solo, in a similar way to King Pleasure, a practice which would later be known as vocalese. The next day, she presented him with “Twisted”, a treatment of saxophonist Wardell Gray‘s 1949 composition of the same name, a classic example of the genre. She later said of the inspiration for the song:

“The title was infinite possibilities. You could marry anything to it and it was the name signified, “Twisted.” And it just occurred to me that it would be good as a kind of song about an analyst.”