How honest are you with your therapist?

[David Baxter PhD]

Talk Therapy: How Honest Are You?
By Therese J. Borchard
November 22, 2009

I pay my therapist $120 every other week. I should, theoretically, feel like I can tell her anything.

But I don?t.

Because I want her to like me. It?s part of being a stage-four people-pleaser.

I didn?t realize the extent to which I was holding back until, the other day, when I mentioned to my therapist something that I had told Dr. Smith?the psychiatrist that I see every four to six weeks?about positive thinking just not cutting it when you plummet to such a low depression.

My therapist asked me to back up and tell her more about that. Because either I hadn?t said anything about that to her in the last month or so or else she had missed it.

I stewed on that for a few days: Did I omit my frustration with self-help books and cognitive-behavioral techniques or maybe not express how depressed I have really been? And I realized that I divulge more to my psychiatrist about the status of my depression and anxiety than I do with my therapist.

Why?

When I?m sitting on my doctor?s couch, I believe the most significant culprit to my bad mood is my illness. I?m somewhat like a diabetic going in to get her insulin levels checked.

However, when I perch myself across from my therapist, I feel more accountable for my moods ? that I if I am unable to implement cognitive-behavioral adjustments, and thereby some find relief, that I am somehow to blame. Moreover, if I?m pulled back into addictive and destructive thoughts and behavior, I have gotten there by choice.

It?s nothing she says that makes me feel that way. She?s a wonderful therapist.

It?s just the nature of therapy versus psychiatry. By far, the easiest part of my recovery is taking my prescriptions and getting blood work done once a month or so. The real warfare takes place at the battlefield of my mind, where I must adjust my thoughts constantly, sometimes as much as ten times a minute, so that they don?t steer me into a dangerous and sticky place. My therapist is my coach, my captain, in that challenge. And so when I feel like the negative intrusive thoughts are winning 10 to 0 and it?s only halftime, I feel as though I must have, in some way, let her down.

Crazy, really, isn?t it?

But I?m not alone. According to a 2005 study published in the Journal of the British Psychological Society, of the study?s 85 respondents, 54 percent withheld significant information from their therapist, 42 withheld information related to depressive symptoms and behaviors. Nearly 75 percent said they did so out of shame. Like me, they wanted their therapists to think well of them.

 

[Banned]

Wow can I ever relate to this article, especially this part:

However, when I perch myself across from my therapist, I feel more accountable for my moods ? that I if I am unable to implement cognitive-behavioral adjustments, and thereby some find relief, that I am somehow to blame. Moreover, if I?m pulled back into addictive and destructive thoughts and behavior, I have gotten there by choice.

I get the part about wanting your therapist to like you. That's crucial for me. I mean, why would I want to pour my guts out to someone if I don't even think they like me? I struggle with it constantly...I often don't like myself, so it's hard to expect someone else to like me. I just hope...hope that my therapist sees some good in me that I can't see.

 

[forgetmenot]

I often say to get 100 percent from you therapist you have to give 100 percent but that is not realistic. First off trust someone that totally no way even though my therapist is excellent I will never go down that road again. Also being a professional i want to be viewed as someone with coping skills, someone who can maintain control no matter what circumstance. Honestly i know is the best way to go but when you are put in such a vulnerable spot it is so hard so very hard to tell everything for fear you will be looked upon as someone not worthy of help or someone to be looked down on. Everyone wants to look postive in others eyes. right sorry if i am not making sense.

 

[Eye Stigmata]

Holy Smokes...I thought I was the only one who did this!

I hold back lots from my therapist in terms of how depressed I really do get and the thoughts that go through my head. I know for fact it's because I'm a people pleaser and I like people to think well of me. I trust her so much and admire her so much that I feel ashamed of my depression. I feel like if I tell her everything that's going on that she will think less of me or think that I'm creating my own problems or making them seem bigger than they are....

Hmm...interesting

 

[forgetmenot]

Turtle i am sure your therapist see only kindness in you and good things because that is what we see here. Take care.

 

[Into The Light]

there is something to be said for honesty in therapy.... it isn't easy to be honest and up front. in fact, it takes courage. your therapist will respect and admire you for it, not think less of you

besides, by being honest, you make their job easier (i like it when someone makes my job easier , so they will too!), and you will be able to get more effective treatment. if you are ashamed of something, tell them anyway but you can tell them beforehand you feel ashamed of this thing you need to talk about. your therapist (if they are worth their salt) will work through the feelings with you and help you with them. that's what your therapist is there for.

 

[Ryan Howes]

It's interesting, I find myself pulled to make comments on this topic whenever it appears at PsychLinks and I've written about it several times on my blog.

The typical problem - clients having a difficult time disclosing to their therapist. My typical response - don't fear our (the therapist's) response; we've heard it all before, we entered this field for a reason, we view your personhood and your problem as separate, if we can't take it we shouldn't be in this line of work, etc., etc.

But what Therese and many of you highlight is just as important: it's not only about fear of being rejected by the therapist, it's about the pain of confronting the internal shame. It's looking at a thought/feeling/belief you wish was not there, and in fact hate that it is. It's looking at it, acknowledging its importance and power and putting it into words, which always makes things seem so much more real.

And it's not just saying it in the car alone (which is difficult enough), or to an MD (who can sometimes feel aloof and detached). No, it's saying it to a therapist, who will listen close and not forget and probably want to ask 14 more questions about it to fully understand. The whole process makes it even more real, shines a spotlight on a painful, shameful place, and could become the focal point of your work for God knows how long.

It makes a lot of sense. It's not only fear of rejection that keeps clients from speaking up, it's a very normal, very human resistance to pain. The pain of confronting an issue contaminated with shame, verbalizing it's power and opening it up to investigation. No wonder many avoid it.

But there is a payoff if you do. It's the kind of payoff that can make all this hard work worthwhile. Freedom, understanding and empowerment are often the result of such disclosures. Earned at a high cost with no guarantees, but strong incentives.

 

[forgetmenot]

You are seeing and hearing: the lines "confronting an issue contaminated with shame" actually having to hear it but relive it again with no guarantees that doing so will ever bring you some kind of peace and understanding exactly. The total confusion one goes through it is as if you lose yourself in all of the disclosures That is how i feel wanting to go there but truly afraid of who i will be in the end of all of it. Thank you for your post

 

[Domo]

What an interesting thread.

I am always honest with my therapist. I am not always comfortable sharing certain things of course, so generally i just take her what i have written during the week. That way she knows what is in my head but i don't have to look her in the eyes when she is reading it :lol:

One thing i struggle with, and i know it's sounds rediculous and i have never said anything to her about it. But, i have this thought in my head that i want to stand out to her. Like i want to be the client she thinks about more then the rest. And i don't mean that in a creepy way. Just the thought that maybe i am the kind of person to 'get' to her. That maybe there is something about me that sets me apart from the others. That maybe she cares about me more.

And i know it will never happen, nor would i know if it did happen. I don't know why i want it either.

Wow reading that back i sound creepy haha.

 

[Murray]

Hi domonation,
I also find handing my therapist my journals to be much easier for me. Unfortunately, I can't always resist the need to edit the stuff that I'm ashamed of out of my journals. It is something that I am trying to get better about.

As far as wanting to stand out to your therapist, I think that is probably normal (at least I hope it is). I think we all want to feel special. In therapy you are exposing so much of yourself that I think it is natural to hope that your therapist will see the "real" you and that they will connect with you. I think since they have such a huge impact on our lives we want to feel that we matter to them as well. I know in my case, as much as I hate myself most days, I hope that somehow my therapist can see beyond all of the stuff that I loath about myself to see something worth liking.

 

[Banned]

You don't sound creepy, Domonation. I think it's normal to want what you want. We all want to feel valued, needed, wanted, respected, admired, etc. We sometimes take it where-ever we can get it. If we are pouring our guts out to someone, we want them to think all those wonderful things about us. Perfectly normal.

 

[David Baxter PhD]

One thing i struggle with, and i know it's sounds rediculous and i have never said anything to her about it. But, i have this thought in my head that i want to stand out to her. Like i want to be the client she thinks about more then the rest. And i don't mean that in a creepy way. Just the thought that maybe i am the kind of person to 'get' to her. That maybe there is something about me that sets me apart from the others. That maybe she cares about me more.

As far as wanting to stand out to your therapist, I think that is probably normal (at least I hope it is). I think we all want to feel special. In therapy you are exposing so much of yourself that I think it is natural to hope that your therapist will see the "real" you and that they will connect with you. I think since they have such a huge impact on our lives we want to feel that we matter to them as well. I know in my case, as much as I hate myself most days, I hope that somehow my therapist can see beyond all of the stuff that I loath about myself to see something worth liking.

Yes, I think it is normal, or at least quite common. And the reality is that while you are in a session, you are the most important client at that moment to your therapist. That's what is required for the therapist to give you his/her full attention and connect with you sufficiently to guide you through the process of therapy.

 

[Domo]

Hi domonation,
I also find handing my therapist my journals to be much easier for me. Unfortunately, I can't always resist the need to edit the stuff that I'm ashamed of out of my journals. It is something that I am trying to get better about.

As far as wanting to stand out to your therapist, I think that is probably normal (at least I hope it is). I think we all want to feel special. In therapy you are exposing so much of yourself that I think it is natural to hope that your therapist will see the "real" you and that they will connect with you. I think since they have such a huge impact on our lives we want to feel that we matter to them as well. I know in my case, as much as I hate myself most days, I hope that somehow my therapist can see beyond all of the stuff that I loath about myself to see something worth liking.

With my writing, i never read it back. That way by the time i get to my next session i have usually forgotten all i have written. Then when she reads it we address what needs to be addressed. It's easy to forget they have read and heard everything before we came along.

You don't sound creepy, Domonation. I think it's normal to want what you want. We all want to feel valued, needed, wanted, respected, admired, etc. We sometimes take it where-ever we can get it. If we are pouring our guts out to someone, we want them to think all those wonderful things about us. Perfectly normal.

Yes, think this is spot on, i hadn't quite thought of it like that.

Yes, I think it is normal, or at least quite common. And the reality is that while you are in a session, you are the most important client at that moment to your therapist. That's what is required for the therapist to give you his/her full attention and connect with you sufficiently to guide you through the process of therapy.

Yes but we are important because we are paying you to see us...

 

[Jazzey]

Yes but we are important because we are paying you to see us...

For me, it has to be a cooperative partnership. It's not just about paying another human being, it's about respecting them enough to hear their opinions, to listen to their perspectives and recommendations. My only concern at diminishing it to financials is that we forget that cooperative arrangement. It really is about developing that rapport and trusting that other person enough to give you the objective feedback that you need, at that particular time. The money aspect of it...just a necessary evil - choose your therapist wisely. If you don't have that rapport, go to another.

 

[Into The Light]

no, our being important isn't because we are paying, actually. with a good therapist we are important because they care about this kind of work, they want to help others. they need to be paid because like the rest of us they need a roof over their heads and food on the table. nobody goes into this profession for the big bucks, i suspect

i can tell with my therapist she really does care about how i am doing and what i am going through. i can also tell she loves what she does. we are important to them.

 

[David Baxter PhD]

but we are important because we are paying you to see us...

No, I think you'll find that for most therapists it goes way beyond the fee. For one thing, I see clients for reduced fees or even pro bono (as do many other therapists). For another, like many therapists, my fees are below what the professional associations recommend as "the going rate", and I, for one, haven't raised my fees in I think 4-5 years. I was actually considering raising them last January but with a recession looming I thought it would be ill-advised.

 

[Domo]

For me, it has to be a cooperative partnership. It's not just about paying another human being, it's about respecting them enough to hear their opinions, to listen to their perspectives and recommendations. My only concern at diminishing it to financials is that we forget that cooperative arrangement. It really is about developing that rapport and trusting that other person enough to give you the objective feedback that you need, at that particular time. The money aspect of it...just a necessary evil - choose your therapist wisely. If you don't have that rapport, go to another.

Oh yes, don't get me wrong, i adore my therapist. I trust her completely.

Like i know she wouldn't be in the business if she didn't care.

I think i just overthink it sometimes and get paranoid.

 

[Jazzey]

Oh yes, don't get me wrong, i adore my therapist. I trust her completely.

Like i know she wouldn't be in the business if she didn't care.

I think i just overthink it sometimes and get paranoid.

Yes, it's really easy at times to be a little paranoid about what others will think of us. That's why the rapport with the therapist is so important. I do not share with people easily. And yet, with my therapist, I've found myself sharing things that I couldn't imagine sharing with anyone.

I know she cares. Irrespective of the fact that this is her 'business' so to speak. She listens. Today, she was telling me about what she'd been thinking about this past week, with respect to me and future plans. I know that was genuine.

For her, this isn't just a business. This is her passion and I can respect her for that. From my perspective, I also have a job that enables me to be passionate about people. So it's very easy for me to look at her and appreciate that she is also passionate about people. It makes that particular rapport all the more worthwhile and 'safe' for me, if you know what I mean.

 

[Domo]

Thanks everyone, that's really put it in perspective for me.

I need to stop over thinking and analysing everything

 

[Domo]

I just got back from my session and i think in regards to my questioning and paranoia i have final 'got it'.

I think this thread made me more aware of my relationship with her and actually notice the things that shows how much she does care and not to question them.

For example, at one point in time she used the word friendship when describing our relationship. Then to get a point across to me she told me something personal about herself. And i don't mean in any innapropriate way such as her dumping her problems on me. It was just a subtle reference that made the world of difference in what she was saying.

And she does only charge me for a 50 minute session when i am usually in there much longer. And she does look at me with empathy and puts her hand on my shoulder when she's walking me out the door.

Anyway i am probably rambling but i feel like i have made a breakthough with her (even though she wasn't aware of it :lol.

I think things can only get better.