You can say (almost) anything to your therapist

This week, in my series about what to expect from therapy, I want to dive into what may be off limits to talk about with your therapist. The short answer is, pretty much nothing!

There are exceptions to this of course: if your therapist thinks you’re going to hurt yourself or someone else, or that you already have harmed someone, they’re obligated to do something with that information. But otherwise, you get to say whatever you want. You don’t have to be on your best behavior when you’re talking to your therapist. Therapy is a relationship but it’s not a friendship or a conversation at a cocktail party; you don’t have to come armed with your best stories or convince anyone of how delightful you are. In fact, once some trust is established, you can be on your worst behavior if you so choose. In therapy, you get to explore the darkest and meanest parts of yourself. It’s safe there.

Still, it feels risky to open up to someone, even a professional. On the one hand, you’re seeking out therapy because you need to talk to someone and presumably, you’re ready to do just that: talk. On the other hand, there may be a fear that you’ll say something so dark, your therapist just won’t like you anymore. Generally, we want people to like us; we’re only human. So it can be difficult to drop the social niceties we’re practiced at performing. For instance, hearing “how are you?” from your therapist is different than hearing the same question from a co-worker. And yet, for many of us, the automatic answer is the one that comes out: “Fine, thanks, how are you?”

This isn’t to say you can’t be nice to your therapist. Believe me, we’re happy to be asked how we are, even if we won’t tell you the actual answer. I’m only saying that in that therapy session, you are released from surface-level social stuff. You can talk about whatever you want.

Which brings me to another caveat: you can also NOT talk about whatever you want. You don’t have to recount every dark thought that has ever entered your mind. You don’t have to review every embarrassing moment or delve into something that feels too tricky to explore. In that session, you get to decide where to begin and where to stop. When your therapist asks how you’re doing, you can tell the truth. And if the conversation starts to go somewhere you aren’t ready to go, you can say no. You don’t have to worry; you can say (almost) anything to your therapist.

When your body betrays you

Last week, I wrote about grief. I was mostly referring to the grief we experience when someone we love dies. But there are losses throughout our life cycle that don’t necessarily have to do with death.

For the majority of my career, I’ve worked with people experiencing life-changing and often chronic illness. The prognosis doesn’t have to be terminal for the symptoms of being ill—of having a body that doesn’t do what it used to do—to be devastating and isolating. Your friends and family can’t understand what you are experiencing. It’s difficult to explain pain or fatigue or some other unquantifiable symptom to someone whose body is not sick. In a misguided attempt to help, these family members and friends may tell you that your situation isn’t as bad as it could be; that you just have to push yourself harder; that you need a second, third, fourth opinion.

Their hearts are in the right place. They’re hoping that the power of positive thinking will do the trick and cure you. But not everyone is helped by the relentless positive thinking memes that social media throws at us: believe you’ll get better and you will! Trust your body! Mind over matter! Et ceterra, et ceterra, until you start to doubt your own feelings. Among these feelings, of course, is the grief of what you have lost.

Because although you are still here, your body has betrayed you. Illness takes from us. Maybe you aren’t able to exercise anymore, or even get on the floor with your kids or grandkids. Maybe you can’t drive anymore. Or your brain fog is making it hard to concentrate at work or school or in social situations. Those are big losses to bear by yourself.

Therapy is not going to cure your illness. Further, your therapist will not be able to tell you how long you’ll be sick or if any of what you’ve lost will be returned to you. Your therapist can’t tell you that everything is going to be ok. What therapy can do is meet you where you are. You can grieve. Then you can start to rethink and rebuild your life. Then grieve some more and then rebuild some more… You can be hopeless and hopeful both at once. And you do not have to walk this path alone.

Where do we start?

How does therapy… start?

Some people come to therapy fully ready to spill: they’re like a pot of water ready to boil over. Those first two or three sessions are just full of words and feelings and sometimes tears. That’s been my personal therapy experience and it’s one I really understand: talk until you can’t talk anymore and then we can figure out where to go next.

But not everyone is like me (thank God). Some people enter therapy reluctantly or cautiously; they are not in fact ready to spill their guts to a stranger. It’s not that they don’t know why they came, it’s more that they don’t know how or where to begin. Or they start and then get stuck. Or—and this one is the toughest for me as a clinician—they want an immediate answer.

There’s good news and there’s bad news, here. The bad news is, I do not possess a magic wand. I can’t make sisters or lovers or children behave better; I can’t bring back a loved one from the dead; I can’t give you a secret code that will make your anxiety disappear into thin air. But—and here’s the good news I promised!—there are going to be answers. We can find them together, by sifting through the past and the present. We can find a way to set boundaries with the misbehaving family members; memorialize the dead loved one; understand and quell the anxious thoughts that plague you. In short, we can start wherever you are that particular day, that particular moment, and see where we end up. We just have to start.