Being vulnerable in psychotherapy can be hard. But there are some actionable steps you can take if you’re feeling a little tongue-tied in front of your therapist.
In fact, one well-known 2015 study found that 93% of people admitted to lying to their psychotherapist. A 2018 study found that 84% of people have omitted things, like details about their sex life or having suicidal thoughts.
If the idea of someone asking you a bunch of personal questions brings up mixed feelings, you’re not alone. Everyone has a chapter of their story they might prefer not to speak out loud.
You may have secrets you’d prefer not to share, especially not right away. But when it comes to therapy, opening up can make all the difference.
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Being honest in therapy can strengthen the therapeutic alliance and allow for a tailor-made treatment plan. It can also lay the groundwork for opening up about other painful or hard truths in the future. Even if it doesn’t exactly get easier, at least the process will become more familiar.
“Therapy is not a one-size-fits-all approach, which means that I want to know even the things you don’t think are important so that I can best help you,” Schwehm says.
The more they know, the better they can understand you and help you reach your goals.
That’s when missed opportunities can occur. When you omit certain facts or distort the truth, a therapist may believe that an issue is more or less important than it actually is, which can impact the kind of support you receive.
“Even though you may be able to tell yourself logically that this is a safe space, it’s easy for that little part of your brain to say, ‘Be careful! Don’t say that!’” he says.
The more you put into it, the more you’ll likely get out of it. Yet it’s a challenge to open up to someone who is, essentially, a complete stranger, says Dr. Andrew Schwehm , a licensed psychologist in New York City.
About 75% of people who go to therapy experience some benefit from it, according to the American Psychiatric Association.
“Outside of a few important things that we may need to report — abuse or neglect of dependent people, suicide, and homicide — your secrets are safe with us,” Schwehm says. “I can’t even tell my wife about the well-known people I’ve worked with.”
No and no. It may help to think of your therapist as a professional secret keeper, or a vault. What goes in will not come out.
Many therapy clients worry about what will happen with the information they share. It’s natural to have a few questions and concerns about your privacy. Will your therapist tell their colleagues about your issues over coffee? Will they write about your life in a book or a study?
Being honest in therapy is easier said than done, but here are some psychologist-approved tips to help make it easier:
- Create a game plan.
- Ground yourself.
- Pick an optimal appointment time.
- Get clarity around privacy.
- Start small.
- Send a letter.
- Practice in the mirror.
- Let your therapist take the lead.
- Bring in something to reference.
- Ask about other approaches.
- Challenge yourself.
- Know you’re not the only one.
1. Create a game plan
If you don’t know where to begin, it can take some pressure off if you jot down a few talking points on a notecard or in your phone. Between sessions, write down significant events, experiences, or feelings you want to bring up in therapy.
2. Ground yourself
If you have time, it might be a good idea to take a moment to mentally prepare for your session. You can take some deep breaths, meditate, or listen to calming music. You may also want to try saying this mantra in your head or out loud: “I may not 100% enjoy this process, but I am safe.”
Don’t be afraid to show up a little early either, says Ryan Howes, a clinical psychologist in Pasadena, California.
“Since the therapy hour is typically 45 or 50 minutes, I invite clients to ‘take the whole hour’ by showing up early for their appointment to relax, get settled, and focus on what they’d like to cover in their session,” Howes says.
“Sometimes this is enough to help them decide to tackle the tough issues,” he says.
3. Pick an optimal appointment time
It can be difficult to let your guard down if you’re trying to squeeze in therapy between meetings at work, or while you’re out running errands around town. If you and your therapist have some flexibility, work out a time when you’re more likely to feel calm and ready to get to work.
4. Get clarity around privacy
It’s OK to ask your therapist about what they’re going to do with the information you share, even if you’ve already gone over it.
For peace of mind, you can ask your therapist to review their confidentiality policy with you. You may ask them directly what information they would have to report to an outside party. You can also refer to Section 4 in the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct.
5. Start small
It takes time to build trust and a rapport. Each session will help fortify that bond.
Until you feel more at ease, you could talk about topics that have a less emotional charge. For example, you may talk about an argument with your partner rather than your childhood trauma.
“Just like you’d want to test a rickety footbridge before charging ahead, you may want to try disclosing smaller items first to see how it feels and how your therapist handles them,” Howes says.
“The big topic from your past may feel too heavy for now, so maybe start with lighter concerns and build up to the bigger topics,” he says.
6. Send a letter
Writing down your thoughts can feel less intimidating or intrusive. Think about grabbing a pen and paper and getting it all out. Then, you could hand the letter to your therapist in your session.
If they’re OK with it, you can even send them a letter beforehand to provide a heads-up or some context.
7. Practice in the mirror
Just like when you were a teenager, perhaps preparing to ask someone out on a date, it may be helpful to rehearse what you’d like to say out loud, well before you have to.
Hearing our own words, then repeating them, may release tension and help us develop confidence.
8. Let your therapist take the lead
Don’t worry, no one expects you to know exactly what to say. This is especially true if you come from a culture or family that doesn’t like to talk about their struggles.
That’s what a therapist is there for.
Rather than engage them with small talk until you get to the core issue, consider letting them take the lead on this.
You may allow them to create a welcoming, safe space and ask the right questions to guide you into a conversation.
That’s what they’re trained to do.
9. Bring in something to reference
If you’ve seen something that relates to what you’re going through, or you’ve shared about your experience somewhere else (like a blog or on Instagram), you could read that content out loud in your session.
This will help the therapist understand how you interact with the world.
10. Ask about other approaches
There’s more than one way to get a message across, even without words.
It may be a good idea to ask your therapist whether art therapy, sand tray therapy, or other mediums are a possibility. They may also assign you creative homework projects to bring in for the next session.
11. Challenge yourself
There’s no getting around it: Therapy is hard work.
It may be helpful to remember that it’s natural to feel a bit stretched beyond your comfort zone. In fact, that’s where the growth happens.
If you need motivation to open up, come back to your “why.”
Consider asking yourself these three questions:
- What brought me in here?
- What am I hoping to accomplish?
- What kind of life do I want for myself?
When we remember the reasons we called a therapist in the first place, it can give us the push we need to be a little more vulnerable.
12. Remember: You’re not the only one
No matter what you’re coming in with, remember: You’re not the only one.
When we keep things to ourselves, it’s easy to think that we’re alone in our experience, but that’s simply not true. Chances are, your therapist has heard similar stories from other clients. The sooner you open up about what you’re going through, the sooner your therapist can help.
“Know there isn’t anything you could say that would shock or horrify us,” says Dawn Friedman, a licensed clinical counselor in Worthington, Ohio. “Really, we’ve heard it all.”
Pause for a personal anecdote
I recall a time when I was scared to tell my therapist about an issue in the news that was spilling over into my social life. “There’s something I want to tell you, but I’m afraid you’re not going to want to work with me anymore,” I said. “I feel so alone, because my family and I are on different sides.”
My therapist’s reaction surprised me, and instantly set my mind at ease.
“Hilary,” she said with warmth, taking a break between notes. “I work with people across the social and political spectrum; the labels don’t matter to me. What matters to me is how you feel about it.”
I took a deep breath and told her my opinions. She didn’t look upset. She didn’t kick me out. She didn’t even bat an eye. None of my fears came true. For all I know, she might’ve felt the exact same way as I did on this particular issue.
