“I’ve shared more in my blog than I could ever tell my therapist.”
“I wish my therapist could read this online support group. Then they might begin to understand what I’m really going through.”
You’ve gathered up the energy and resources to start psychotherapy. It’s a big step and you’re excited to begin. But you find yourself unable to talk in therapy. What’s the point of talk therapy without the talking? We find it so incredibly easy to open up online, but when we’re in the therapy office, we become suddenly mute.
There are many strategies to help “open up” and be able to talk more freely while in psychotherapy. Here are a few.
1. Write it down.
One of the easiest ways to help overcome your fear or inability to talk in therapy is to write down some things that are important to you to talk about before session. Jot it down on a piece of paper, or keep a “therapy journal” even of topics or areas of your life that you want to talk about, you just find it difficult. Bring it to session, open it up, and pick a topic for that session.
2. Let the therapist guide you.
A psychotherapist’s main job is to act as a guide in your recovery and healing process. They are not there to necessarily give you all the answers, but help you find your own way to those answers (often with specific skills and techniques they can teach to help you better understand your interconnected moods and thoughts).
3. Reset your expectations.
Some people believe you need to go into your weekly therapy session with a “topic” to discuss. While sometimes that may indeed be the case — especially if the therapist has given you “homework” on a specific topic — it may also be that each session may already be full. Therapy would be of little benefit if you go into every session and talk non-stop for 50 minutes.
Remember, you’re not there to entertain your therapist, or to tell stories to maintain their interest. You’re there to do real work, some of which is going to involve talking about the past week in your life, but not to such an extent or in so much detail it overshadows the reason you’re in therapy to begin with.
4. Prepare for each session.
Sometimes people put off preparing for each therapy session. Either it becomes too unwieldy, or it becomes too much like real work. Well, psychotherapy is real work and is often hard. If you prepare for each session beforehand, you’re more likely to be ready to have a topic to talk about.
Not preparing for a therapy session or waiting until the last minute may inadvertently make it more difficult to talk. Imagine going to a conference or big meeting where are you the main speaker, and you only prepare your speech minutes beforehand. Naturally you’re going to be more flustered and less likely to speak well. Preparation is key. Not just for speeches or meetings, but for anything worthwhile in life.
5. Think of your therapist as the closest confidante you can ever share anything with.
In childhood, we often have a best friend or two we felt like we could share anything with. Sometimes we maintain these friendships, and other times they fade away for whatever reasons.
Therapists are your adult equivalent of someone you can share almost anything with (except for some things that are illegal, like murder, or suicide). That is a part of the special joy of a psychotherapy relationship. Here is a person who can tell them anything you want about yourself, and they won’t judge, they won’t insult or berate, and they won’t just leave you unexpectedly (within their abilities, anyway). It’s such a valuable and unique relationship that’s to your benefit to take advantage of as much as possible.
6. Ask your therapist to read your online blog entry, Facebook page, or support group posting.
I would do this very rarely indeed, but it’s okay to share the occasional blog entry or support group posting, if you feel like it indeed puts into words you can’t bring yourself to verbalize in session. Keep in mind that most psychotherapists are fairly busy — as is anyone in a full-time job — so they’re not going to have time to read all of your blog entries dating back from 5 years ago.
However, if you pick out one entry or one posting that really expresses how you feel or what you’re grappling with at that moment, that’s fine. Most therapists appreciate that additional insight into their patient, especially for one who may be having trouble talking or opening up in therapy.
As I’ve written previously about, though, don’t open up just to lie to your therapist. Little benefit comes from lying about your true feelings or how well you’re actually doing (versus the mask you may put on for your therapist).
One last thing — silence is okay once in awhile too. Although for most of us, an extended silence between two people engaged in a conversation can be uncomfortable, it’s something you can learn to become comfortable with in time. Therapists often won’t rush in to fill the silence, because most are comfortable with it. Don’t feel the need to say something just to fill the void, either. Give it some time, and perhaps the words will find themselves.
28 comments
Nice piece, John. I can tell you from both sides of the room, it’s a valid issue to address. Whether it’s a therapy or, say, medical appt; I find making a list of things I’d to discuss works very well. And from a clinical standpoint, I believe it’s, indeed, my responsibility to “guide” my client – as well as helping him/her feel more and more comfortable as our work ensues. Thank you…
“Therapists are your adult equivalent of someone you can share almost anything with (except for some things that are illegal, like murder, or suicide).”
It is possible to reinforce the misconception that clients cannot raise their suicidal feelings or even plans for self-harm to their therapists, which might not be what you meant. I volunteer in suicide prevention, and people who are in pain commonly have the fear that even mentioning the topic of suicide will have immediate and drastic consequences from their therapist. Other clients don’t want to bring up the issue for many other reasons, including worrying about their therapists.
Clients should indeed discuss suicide, murder, drug use, and other illegal activities, but with the awareness (laid out at the beginning of the therapeutic relationship) that in a few urgent situations, the therapist might need to break confidentiality, in order to protect the client and others. That doesn’t extend to all illegal activities, nor to feelings around self- or other-harm…and all of them are material a client should indeed trust their therapist with.
@Tom – actually John is right, if you discuss suicidal feelings with a therapist they can have you hospitalized or even arrested with the snap of a finger! These people don’t give a rat’s ass about helping anyone, they only care about themselves and getting paid. Suicidal people cannot benefit from therapy at all because the government has made suicide illegal (which is laughably stupid – apparently you can legally kill a 9 month fetus in this country but not yourself). The options for a suicidal person is to either to spend their lives in a hospital being drugged against their will or to die. Personally I think the last is most appealing. Don’t even waste your time with shrinks, they’ll steal your paychecks and do nothing to help you.
John One more thought along the facebook blog line – email blogs that have significance to the therapist as attachments
Rgds Bj
I have to agree with Tom that it sounds here like you’re telling people that they can’t discuss their suicidal feelings with their therapist. That’s pretty appalling! If people can’t discuss suicidal feelings with their therapist, then who can they discuss them with?
It was a parenthetical to quickly note that some things you can choose to discuss with your therapist — such as illegal activities or suicide — might trigger a mandated reporting requirement. Therapists in the U.S. are “mandated reporters,” meaning that the law requires them to report certain behaviors to law enforcement, including knowledge of a murder, abuse, etc. Suicide can fall into this category, depending upon the nature of the concern.
Yes, most patients can discuss suicidal thoughts and feelings with their therapist. But if those thoughts and feelings turn into specific, detailed plans utilizing readily available methods and attempts, then it’s likely the therapist will need to do something more active about it — such as getting the patient into the hospital.
I stand by the advice not to discuss serious illegal activities with your therapist. Because of the dual role the law puts upon therapists, I do not believe they are always acting in a patient’s best interests when having to adhere to the law with regards to reporting.
There’s simply no other way around it — either the therapist is 100% there for the patient, or they are not. If they are not because of the mandated reporting requirements, a patient needs to be aware of that and under what circumstances their trusted professional suddenly is no longer quite so trustworthy.
So you’re saying that if a patient has a detailed, specific plan for killing him- or herself in the very near future, it’s not in that patient’s best interest for a therapist to get that patient into a hospital?
I think you misunderstood the situation he is talking about, he’s not saying that letting someone commit suicide is in their best interest. He is talking about the kinds of topics that the therapist would be required to report if you talk about. If someone says that they are depressed and have thought about suicide the therapist doesn’t have to report it but he is also allowed to use his own discretion as far as deciding at what point he needs to report it and/or recommend that their client be monitored for there own protection, if someone tells them that they are going to kill themselves and start to go into detail about a plan of how they are going to do it or if they talk about having a plan to harm or murder someone else, not just talking about being mad at someone or if they say they have though about suicide the therapist is required by law to report it.
The point he is trying to make is that it depends how the client words or phrases something regarding death or a crime to determine if he doesn’t have to report it, if it is left up to his discretion, or he has to report it
Thinking something ======not
__________________required to report
Starting to sound
like they are============therapist’s
planning a crime ect. Discretion
Plan formed you
Tell them you are going to go through =============required by law
with murder or suicide
My phone messed up but I’m sure u can understand the graph I was trying to make
Hi all, As a psychotherapist, I appreciate the advise to clients on how to maximize their use of therapy. As a clinical supervisor to other therapists I teach clinicians to give their clients an informed consent form at the intake appointment.This form details what topics are reportable, etc. Not to minimize the need for suicidal patients to talk to their therapists, because most do -but some don’t, typically these clients make less than 5 percent of a private practitioners case load. For the majority of clients, the outlined self- regulated theme of this article is much needed and appreciated. Thank you.
Nice piece. I opened up about something very difficult that I had struggle with for years (dissociative and post-traumatic symptoms) about half a year ago, and I feel very relieved that I did. It is helpful indeed to write it down, but when first coming out, I used a different strategy: I told a nurse first and had her help me come out to my psychologist. I also indeed find it helpful when people read my blog, although my blog is not a personal journal or anything. They can still figure out what I’m into and that opens doors.
I agree with all the point made by DocJohn, but I know that when I visit depression and/or bipolar boards (the only ones I have first hand knowledge of) I hear constant, “…so I left because the doc didn’t understand me and didn’t want to hear what I had to say. So, I left and found a new doc and that one did the same thing.” Which translates into, “I didn’t like what I was hearing, so I gave up.” How do you help people to understand that, no, you may not be hearing what you WANT to hear, but there is a reason why it is being said to you.
As to discussions about suicidal ideations, I get what DocJohn is saying. Personally, I do take care with these thoughts, but I trust my psychologist and my meds-only psychiatrist to know me, which they both do, and before jumping to the phone, talk to me. I have only been “threatened” once with if you say those words one more time, I will have to call intervention; I don’t look good in handcuffs. I will admit to self-admission to a hospital twice in my life, so I understand better than some.
As to mandated reporting requirements, I would expect both to be in control of any mandates for both me and for themselves, and I respect that if a call must/needs to be made, then I have made that mandate necessary by way of my thoughts, words and actions. Only I have control of my thoughts, words and actions in therapy, but I also realize I can only seek an end to my issues/pain if I am honest and open with the therapist and with myself.
@Casper – Newsflash: those people on depression/bipolar boards are telling the truth when they say the psychologist won’t listen to them. Personal example: I saw a psychologist when I was 20 and whenever I told him about my problems he would tell me to go ask my parents for financial help (even after I repeatedly told him they died when I was a child). To dismiss everyone who says their shrink doesn’t listen to them by saying “You don’t like what you hear” is frankly stupid. I have had shrinks say the dumbest things to me and it is laughable how stupid these “professionals” are.
Thanks for the piece and the discussion points. Some of this rests on the level of trust and honesty in the therapeutic relationship. Opening up is a good beginning.
I printed John Grohol’s article and will share with my clients. Thank you!
So after opening up to a therapist as I would to “my best childhood friend” for 2 1/2 years, the therapist goes and triple bills my insurance company for sessions we didn’t have. The Licensing Board said that insurance fraud had nothing to do with the treatment I received and therefore there was no standard of care violation.
I was supposed to be able to trust the thief? What do you think?
So much for opening up and being vulnerable…much of it was distorted by the therapist and his attorney and was used against me. (There were other issues in the case and they can be found at
http://wisdomovertime.wordpress.com/page/2/
Hello,
I learned the hard way to keep my mouth shut about when I feel suicidal. 9 times out of 10 even the mention of being suicidal, or just thinking about the topic can get you place in the psych ward. This one therapist I shared with her I was feeling suicidal. It was simply thought, no action. She told me “excuse me for a moment, I need to get some water”. She came back with 2 security guards who took me to another part of the therapy center where the psych ward was located. Just for having thoughts.
Another one in NY did a similar thing. I was going through some problems with self injury. She wanted me to agree to never self injure again. I knew at the time that I wouldn’t be able to not self injure and declined to sign her “no harm” form. She calls me up on the way home to tell me she called the local mental health center and that they are not going to do anything and that I should not worry. 20 minutes later I get a phone call from home saying there are two police cars at the house and the police are banging on the door looking for me. My advice, don’t mention ANYTHING about being suicidal to a therapist. Keep it to yourself unless being admitted is what you want to happen. Because talking about it WILL get you put in a psych ward for at least 3 days. Just my experience with the mental health field.
-Stanley
So who is a client to call when the therapist tells the client he has experienced suicidal thoughts throughout his life? I s the client supposed to ask “are you having those thoughts now”?
Hey Stanely,
Thank you Stanely for sharing your feelings and thoughts. It must have been a very horrible experience for you being admitted in a ward. I definitely see your perspective and it’s sad that the counselors didn’t ask you weather you had a plan and strategy to take your own life. And weather you have set a date and time to go through with the plan. As a welfare worker myself, I guess the counselors were working in the best interest for you and them at that time. In this line of work, it’s dammed if you do and dammed if you don’t
In my experiance with a lot of different therapists, when I’ve made it very clear that the suicidal thoughts are just that, thoughts, the therapists don’t automatically send me to the psych ward. There have also been times when they’ve called the cops, because then I’ve had a plan and needed to be there cause my judgment is not good at those times and I’ve needed someone to save me from myself. Even then they’ve always asked me first if I think I need to be in the hospital. If I had taken this advice not to tell the therapist about my suicidal thoughts and plans, the therapy probably wouldn’t have done me any good and I might not even be here at all! I think that people NEED to tell their therapists about something as serious as suicidal ideation or they will never get better keeping it a secret. Just be sure that the therapist understands they are just thoughts.
It’s of great amusement to me how many people forget that therapist like any other professional person in a role are HUMAN. They have their own baggage, emotions, anxietes and even the more so for therapists because they have more contact and dedication to the human.. the good and the bad and potentially ugly.
it’s sad when there are therapist who really need to work out some major issues themselves and end up hurting their clients as a result. not having effective/sufficent training much often not their own fault but the nature of the educational systems.
generally, no therapist should tell a person to stop self harm immeidately or else? or if a client says they are feeling suicidal.. theys hould be trained to handle that. I mean.. i was trained in handling that as a undergraduate peer counselor! But just the same, loosing someone to suicide… loosing a patient…. must be hard. i klost my best friend to suicide and i suppose if i were a therapist this might make me a little more reactive to people feeling suicidal and wanting to keep them safe even if it means i overreact to it because i havent dealt with my own baggage and control issues? lol.
Anyways, I tend to feel that people expect way to much out of therapist who are human like the rest of us. i think we dont hold them to the same standards as other medical doctors for instance. when we have prohems with medical doctors we don’t tend to decide every doctor is out for money and is horrible! but with therapist we do and i know a lot of that goes back to vulnerability required.
i think articles like this can help people choose a good therapist IF they seek out research to find one vs just assuming they are all good or all bad.
ive had my share of not so great and even bad therapist but ive also had good and awesome ones and wow its the difference between day and night. i gave up for awhile.. trust was hard.. it was hard to open up but i eventually did and have and it has been rewarding for me.
I completely agree with Maureen, 100%.
Looking for help from a therapist/counselor is a terrible and potentially dangerous thing to do. I’d like to think otherwise, but it’s just not the case. Most of the “support” for these people is simply advertisement and self-agrandizing. It’s really sad, and very harmful to people who are honestly looking for human aide.
I’m torn btwn talking about how I felt in the past because I’m scared I might start reliving those feelings in the present even though I’m not at the present feeling the way I did back in the past. I’ve journalled and I do need to experience the emotion with my therapist to move on in my life. But there’s also the legality to think about. What do I do?
I want to start by saying that by no means am I claiming to be professional in the field of psychology, or trying to say my opinion is always right. I believe that I have a basic understanding of psychology, stemming from my work experiences which are; helping to motivate coworkers, being placed in a management / lead position for the 1st time and age / respect issues that were mostly age related, and doing my best to try to resolve arguments between coworkers before small issues or disagreements have a chance to escalateto larger problems.
And the issues I have dealt with in my personal life which are; overcoming personal anger issues, resolving arguments between friends and trying to remain unbiased and not side with one person or the other, and also trying to being there for my friends whether the just needed someone that would just listen to what they had to say or trying to help them with personal issues if they asked for my advice, most of the issues were relatively minor, compared to issues such as suicide(thankfully none of my friends had or have faced these kind of issues, if they would had I would have done my best to get them to talk to a psychiatrist or psychologist who could help them better than I can)
Also to anyone who has training or an education in, or who has more experience than myself, if I do say anything that has been proven false please let me know, I am always willing to learn and discuss opposing views.
I want to reiterate that I try to remain as open-minded as possible, and that I am simply offering my opinion for discussion, I am not saying that anyone else’s opinion is invalid or wrong, I know that I do not understand or know the personal experiences anyone else has had to face or issues they are currently facing.
P.S. Thank you if you took the time to read the all of the opening paragraphs, sorry if it seemed like I was rambling I just wanted to give a brief explanation of where my opinions come from and what types of things formed them.
I’ll start with my opinion of whether or not to discuss suicidal thoughts or plans with your therapist is a good idea or not. In my opinion you any thoughts or plans of that nature should definitely be discussed, I feel like I can relate it to my problems with anger issues in the past. I feel that the only way to work past any problem is to discuss it with someone or multiple people. Keeping any feeling bottled inside will not help, no matter what the issue is, bottling it up will just make the pressure of that emotion or problem build up until you hit a breaking point. In my experience with anger issues I used to be so worried about trying to avoid a conflict with friends or coworkers that I made the mistake of not talking to anyone about any issues I had with them, instead I just kept bottling them up until I couldn’t contain them, because I let go of all the anger at once instead of resolving the issue before it reached that point sometimes the issue that would push me past the breaking would be miniscule and very unimportant. In the worst cases it would jump straight to the point that myself and/or my bosses felt that there was no way to resolve the issue which led to me either getting fired or quitting the job after arguing with a coworker and letting my emotions get the best of me and ruining the work relationship or walking away from the job instead if trying to resolve the issue. I know this is a completely different scenario from suicide, but I feel that someone who has dealt with one may be able to relate to the other.
One of the points against talking to your therapist about suicide is that sometimes the therapist will automatically have you hospitalized and monitored there. I understand why this would be a big enough issue that someone would feel as uf they would be better off to deal with it alone and not mention it to the therapist for fear of being placed in the hospital for only mentioning suicide. Therapists are human too, experiences from each person that they are working with or have worked with in the past factor into what point they are going to consider placing someone under observation in the hospital for their own safety.
I saw a comment that said they psychologists don’t really care about the welfare of the people they are counseling, for the most part I have to disagree. It’s not fair or an accurate representation of a group to judge and form your opinion of the entire group solely from personal experiences or a group of people or an entire profession solely on your personal experiences that are positive or negative. I do however ag
There are however always people in any given profession who are only interested in money, I would recommend always researching as many psychologists as possible to increase your chances of finding someone who specializes in helping people with what ever you are seeking counsel for.
I also saw a few comments asking “what is the client supposed to do when the psychologist says that they are having suicidal thoughts. I understand that it meant to be lighthearted, but it really is something that could be more serious than people realuze, like I said in my last comment and some other people have mentioned they are human too. Which means they have to deal with stress just like anyone else. For the therapists who truly love their job and chose that career because they want to help people I think that the stress would build up quickly to if they have a patient who they have been seeing regularly for any amount of time and something happens to them from someone who is trying to get off of drugs relapsing or someone dealing with stress feels that there is nothing they can do and commits suicide, most likely it will affect them in some form or another. Considering the stress that can come with the job and the stress from smaller things in everyday life, I could see how they could be just as stressed as some of their clients at some points everyone has to deal with stress at some point in their life. It’s not fair to them to forget about the stress tgat they could be dealing with in their own lives and automatically assume that stress doesn’t affect them because they are trained to help people deal with stress. I could understand if they ever felt like they needed counseling that they could be faced with a dilemma, I’m sure there are some people who don’t consider the fact that everyone deals with their own issues that cause stress and could overreact if they found out their therapist was a patient of another psychologist. I hope that more people than not would understand therapists deal with stress also, but I can understand if a therapist would be hesitant to become a patient of another therapist for fear of losing their credibility as a therapist themselves.
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