How to Open Up to Your Therapist When You're Not Sure What to Say

Co-authored by Natalia S. David, PsyD

Last Updated: March 1, 2023 References

Speaking with Your Therapist

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Making the Most of Therapy

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Making Progress

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Expert Q&A

You've made the decision to talk to a therapist, and that's a big step! And it's totally normal to feel a bit nervous. Talking to someone about your intimate troubles and concerns isn't something that comes naturally to most people. The good news is that's exactly what a therapist is trained to do, and they'll help you open up at your own pace. In the meantime, we'll offer some insights and tips so you can make the most out of your therapy sessions.

Things You Should Know

Think about and practice what you'll say beforehand to avoid coming up blank during your session.
Tell your therapist your goals for therapy so they can help you achieve them.
Don't sugarcoat or conceal your thoughts. Your therapist is a trained and trustworthy confidante.

Part 1

Part 1 of 3:

Speaking with Your Therapist

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Practice what you are going to say beforehand. Get the tough stuff out as soon as possible. Plan out what you’re going to say and how you’re going to say it before you attend your sessions. You may have learned to stay silent as a coping mechanism or to keep yourself safe, but you don’t have to do this with your therapist.
- For instance, you might practice by introducing yourself and stating the reason you came. "Hi, I'm Matthew. I came in because I have been having trouble fitting in at school."
- Therapy is a safe place in which you are able to speak about how you feel in an open and supportive environment. Over time, you’ll likely find that opening up will become easier.^{[1]
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2
Express what you hope to achieve by attending therapy. Talk about the problem you want to overcome, the area in your life you want to improve upon, or whatever it is that brought you to therapy, during the first or second session.
- When you talk about your goals and expectations with your therapist, you can create benchmarks that you can use to measure your success along the way. For example, you might say, “I came here because I have problems socially. I would really like to have more friends and go out more.”^{[2]
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Share your thoughts and feelings openly. Don’t hold back. Talk to your therapist about everything you are feeling, even if you think it is unimportant. Not divulging everything could be detrimental to your recovery. Intentionally leaving out facts that you are embarrassed about or feel shy revealing could hinder you. If you’re not completely open with your therapist, you are essentially wasting your time.
- Be open by saying what you really feel--it's the only way your therapist can truly help. For example, say "I feel like a total loser because I'm always be myself when everyone else is always hanging out with friends in a group."
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Think of your therapist as your closest confidante. And, remember that he or she is bound by law to protect your confidentiality. Know that you can tell your therapist anything and you won’t receive judgment or criticism. However, keep in mind that your therapist is bound by law to intervene if you express an intent to harm yourself or another person. Keep in mind that this is in your best interest.
- And also know that your therapist won’t leave you unexpectedly. The therapist/patient relationship is special, and one that can be comforting and beneficial.^{[3]
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Part 2

Part 2 of 3:

Making the Most of Therapy

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Find the right therapist for you and your needs. Look for a therapist who treats people who have problems similar to yours. Experienced therapists have seen the problems you are facing again and again, and will likely have a good idea about how to help you.^{[4]
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- For instance, many specialize in areas such as depression, eating disorders, anxiety, and so on.
- Finding a good therapist comes down to a mixture of factors, such as ensuring that the professional has experience with treating your issue, finding out their unique therapy style, and going for an initial session. If you find that you and the person get along well, and you feel better after your sessions, you may have found the right therapist for you.
- Meet with a few therapists to get a feel for their different styles and personalities. Don’t be discouraged if you don’t find your perfect fit at first; it’s important to take the time to find someone who is a good match for your needs.
- When comparing therapists' profiles, look for therapists who don't say that they can do everything, as it likely means they won't have the depth of expertise needed.
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Ask your therapist to thoroughly explain the process. Talk to your therapist about the techniques and methods that will be used in your sessions. Don’t be afraid to ask questions; even if you feel they are personal.
- For example, if you are concerned about your therapist’s own life experience or beliefs concerning your treatment, you might say, “Are you religious? It’s important for me to talk to someone who believes in a higher power.” Although you may not receive a direct answer, you’ll receive an explanation as to why not, which may help you understand your therapist better and learn his or her boundaries.^{[5]
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- Ask the therapist to explain any business policies that might affect your work together, such as fees for cancelling appointments or talking after hours.
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Have an open mind. Know that there isn’t a set time for how long you may need therapy, or that there is a method that works the best for everyone. Realize that although you may think what the therapist asks of you won’t work, you should still give it a chance. You never know, you may be pleasantly surprised.
- Be willing to go along with what the therapist suggests, even if it is outside of your comfort zone. Doing so may help you finally experience the breakthrough you’ve wanted.^{[6]
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- Some therapists like to assign “homework” or work you do between sessions to advance your skills or understanding. Try to complete these assignments and take them seriously to see personal growth.
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Let your thoughts flow by journaling about them first. Write down your feelings, fears, anxieties, frustrations, and whatever else is on your mind on that blank piece of paper. You’ll probably be surprised at how liberating it feels to get what is going on inside of you out into the open.
- Then, bring your journal to a session. You may find that reading your entries to your therapist helps get the conversation going easier.^{[7]
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Part 3

Part 3 of 3:

Making Progress

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Speak up if you don’t feel understood or heard. Give your therapist a chance to understand what you are saying by going into more detail or explaining the situation in another way. If you feel like your therapist is misconstruing what you say, or isn’t “getting” you, don’t give up right away.
- Tell him or her your frustrations and feelings and work together to develop a plan that helps you become understood. “No, you don’t understand. What I’m trying to say is…” is a good start to clearing up a misunderstanding.^{[8]
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Apply what you learn in sessions to everyday life. Use the tools your therapist and sessions have given you during your everyday life. Therapy works best when you are able to use it outside of the confines of the therapist’s office. Plus, by using what you’ve learned, you may be able to explore other areas of your life you were afraid to before.^{[9]
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- For example, if your therapist has challenged you to put your new social skills to the test at school, you should do it. Think about the strategies you have learned, and try to put them into practice. Go up to someone and start a conversation. Join a new club or organization.
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Make the decision to leave, if you need to. If you are not comfortable or making any progress, you may need to choose a different therapist. Know that it may take several different therapists until you find the one who is right for you.
- You may not feel comfortable with the way the therapist speaks to you, or you just may not feel in your gut that this therapist is right for you. Don’t be afraid to leave if you aren’t happy with your experience.^{[10]
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- Make sure to talk with your therapist about the reason why you are ending your therapy with them. This will provide closure for both of you, and your therapist may even be able to recommend someone who can better meet your needs.
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Know when to seek additional help. Therapy may be effective on its own, but you may need to seek additional help if your symptoms are interfering with your daily life or affecting your quality of life. Talk with your primary care provider or therapist if you are having trouble coping with your symptoms using therapy alone. You may need to seek the help of a psychiatrist.
- A psychiatrist is a medical doctor who is trained to treat mental health disorders. After a psychiatric evaluation, they may prescribe a medication to help with your symptoms and act as a complement to your therapy.

Expert Q&A

Question

What should I ask my therapist if I think I may be mentally ill?

Padam Bhatia, MD
Board Certified Psychiatrist
Dr. Padam Bhatia is a board certified Psychiatrist who runs Elevate Psychiatry, based in Miami, Florida. He specializes in treating patients with a combination of traditional medicine and evidence-based holistic therapies. He also specializes in electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), compassionate use, and complementary and alternative medicine (CAM). Dr. Bhatia is a diplomat of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association (FAPA). He received an MD from Sidney Kimmel Medical College and has served as the chief resident in adult psychiatry at Zucker Hillside Hospital in New York.

Padam Bhatia, MD

Board Certified Psychiatrist

Expert Answer

If you really think you may be mentally ill, I'd just recommend being open and honest with your therapist about what you're feeling. A lot of people shy away from their feelings due to the mental health stigmas we have. Do your best to just be open about it. Your therapist will be able to help you out and I assure you that they'll be understanding.
Question

How do I establish boundaries with my therapist?

Allison Broennimann, PhD
Clinical Psychologist
Dr. Allison Broennimann is a licensed Clinical Psychologist with a private practice based in the San Francisco Bay Area providing psychotherapy and neuropsychology services. With over a decade of experience, Dr. Broennimann specializes in in-depth psychotherapy to provide solution-focused treatments for anxiety, depression, relationship problems, grief, adjustment problems, traumatic stress, and phase-of-life transitions. And as part of her neuropsychology practice, she integrates depth psychotherapy and cognitive rehabilitation for those recovering after traumatic brain injury. Dr. Broennimann holds a BA in Psychology from the University of California, Santa Cruz, and an MS and Ph.D. in Clinical Psychology from Palo Alto University. She is licensed by the California Board of Psychology and is a member of the American Psychological Association.

Allison Broennimann, PhD

Clinical Psychologist

Expert Answer

It's great to come up with a plan with your therapist. For example, if you're getting overwhelmed going to see your therapist in person, you can agree to do a phone or video session. You can make an arrangement with your therapist if you're starting to see yourself back away from the work that you need to do to heal. It can be hard to establish boundaries before you understand your own defenses, so I really recommend working with the therapist to come up with those boundaries together. That's a mutual learning process.