Honesty, genuineness, and forthrightness are invaluable elements to the psychotherapeutic process. Most individuals familiar with therapy would beg the question – if you aren’t going to be honest with yourself and your therapist, then what is the point? This means to say that if you are going to withhold (important or relevant) information from your therapist, then what is the purpose of attending therapy?
Last week, I wrote about what you can expect when scheduling and attending your first therapy session. You likely already know that therapy is about opening up and disclosing information that is personal (yes, to a complete stranger, but more on that below). While the thought of doing so might feel uncomfortable or perhaps lead to hesitancy to seek therapy, the inherent value of honesty in therapy cannot be overstated.
So perhaps you are wondering “will I have to tell the therapist everything as soon as I meet him/her?” The simple answer to this is “no,” but this is twofold: first, time constraints will prohibit this (after all, you can’t possibly share your life’s history in a 50 minute appointment). Second, “everything” is probably not relevant. You will find that the disclosure process is a give and take – when content, memories, emotions, or experiences seem important, the therapist will ask the questions to guide those disclosures and/or you will naturally share such information.
During the first few sessions, it is of course important for you to provide your therapist with an understanding of your struggle so they can formulate how to best approach your treatment. However, this does not mean sharing everything that has ever happened to you. Rather, it means sharing information that is important or helpful for the therapist to know so that, in turn, they can help you.
Many patients unfamiliar with therapy are hesitant to make the call and schedule their first appointment due to concerns about how their information may be used by the therapist, who at this point is probably a complete stranger. However, therapists’ work is guided by a strict adherence to confidentiality guidelines set forth by the individual professions (i.e., psychology board, social work board, etc.) and code of ethics. The intention of confidentiality ethics is to protect the patient’s right to privacy by ensuring that content disclosed to a mental health professional cannot be shared with others without the informed consent of the patient.
Most therapists explain confidentiality and its limitations at the outset of treatment (typically at the beginning of the first session during the informed consent process). Generally speaking, the therapist is bound to not disclose anything about you or the content of your sessions unless 1) you are a threat to yourself or others, 2) you share that a child, elderly, or disabled person is being abused or neglected, or 3) a judge issues a court order for the release of your records.
It is, however, important to note that confidentiality cannot be guaranteed when you are using your insurance for mental health treatment. I wrote extensively about this topic on my post about reasons why you shouldn’t use health insurance for mental health treatment. Again, self-pay is the way to go – in this context, it protects your disclosures as your therapist does not have to release your information to the insurance company to approve a claim. This provides you with additional mental and emotional security during the therapeutic process.
In addition to understanding confidentiality, it is equally important that you begin to develop trust and comfort speaking with your therapist. For some individuals, this happens fairly quickly as they feel an instant sense of ease with a particular therapist, however sometimes it takes a few tries to find the “right” therapist. For others, it can take time to develop trust with any therapist, which is often a result of past experiences or hurts that have resulted in trust difficulties.
Some patients hesitate to disclose information for fear of being judged, criticized, or coming off as “weird.” However, therapists hear it all. They are trained to be objective and it is unlikely they will be shocked by your disclosures. Therapists are also typically very open-minded individuals, which is one of the factors that guided them to the profession in the first place; this means it is highly unlikely that your therapist will judge you.
After all, therapy is the place where you say the things that you probably wouldn’t say in your everyday life. And if you want genuine results, you should disclose those things.
In therapy, honesty means being genuine to create lasting change. If you are not honest with yourself or your therapist, then how can they help you? There are times when you will want or feel its necessary to reveal information that is uncomfortable, taboo, or that would be off-putting in a conventional setting. In therapy, it becomes especially important that you do so. We have all experienced those moments in life where we want to say something but then figuratively “bite our tongues.” If you have a nagging sense that you are biting your tongue about something important that your therapist should know in order to understand you or a situation better, then that is a very strong indication it is important that you share it.
Sometimes patients are hesitant to share certain thoughts aloud due to their own attempts at self-preservation and protection. This means they don’t want to share certain content as this may then mean it is “true” or it would be an acknowledgment of their own quirkiness. Moreover, this can happen as an attempt to pretend things are different than they really are. However, being dishonest with yourself, and your therapist, doesn’t lead to change. If it seems relevant, share it. You can’t work through something unless you attend to it, which in therapy means discussing it.
Disclosures in Individual and Couples Therapy
It is incredibly important to open up. Without full disclosures on your behalf, therapy cannot be as effective as you would like. By withholding relevant information from your therapist, you are really doing yourself the disservice. If you are in couples therapy, you are also probably doing more harm to your relationship and your partner.
A therapist is not a mind-reader; if they do not have all the information relevant to the situation, how can they possibly work with you to move past it?
Take for example for this situation:
A husband and wife come in for a marital therapy session. The husband voices his concerns that the wife has been emotionally distant and working later than usual, and ultimately expresses concern that his wife is having an affair. The wife initially reacts awkwardly to this assertion, but then becomes defensive. The therapist discusses the importance of such concerns with the couple, and provides multiple opportunities and avenues for both partners to disclose any affairs. Both partners continue to deny extra-marital relationships. During each session when the husband mentions his belief that his wife is having an affair, the wife makes eye contact with the therapist in a way to suggest guilt and ‘not-knowing’ how to address the situation. However, the pattern continues where verbal denials are made, leaving the therapist only able to work with the content that is being shared.
In the above example, it seems possible that the wife is having an affair, but that she is extremely hesitant or fearful of disclosing this information. A therapist can try to ask the “right” questions and encourage disclosure, but ultimately cannot read another person’s mind, should not make strong verbal assumptions contrary to what is being stated, and certainly should not make accusations about the character or integrity of a patient.
If, in fact, the wife has been unfaithful to her husband, it would be incredibly important for this disclosure to be made in therapy. Without doing so, the couple can only work through so much; while it is possible for some meaningful change to occur, the change would be largely superficial as they are not discussing significant aspects of their relationship involving trust and honesty.
Of course, most patients often find it easier to be honest and disclose information in individual therapy than couples therapy (for obvious reasons). It may be more difficult and create more stress to be forthright in couples therapy, but it is a necessary component of effective treatment in all modalities.
We’re Here to Help
The process of opening up to a complete stranger may initially seem uncomfortable. However, nine years of experience as a therapist has shown me that even individuals who initially feel that discomfort grow to appreciate the objectivity and neutrality of speaking with a therapist. Those who are willing to be revealing in ways that are instrumental to their cognitive, emotional, and social growth always reap the most rewards from their therapy journey. At Tampa Therapy, we strive to provide a relaxing environment with acceptance, open-mindedness, and non-judgment. We would love to help you make significant changes in your life. If you are wanting help and at least somewhat willing to open up, give us a call.