How to Say Hard Stuff in Therapy

For many people, the hardest part about therapy is disclosing the secrets they’re so used to holding alone. Shame-encrusted secrets can be incredibly difficult to name. Often, though, that naming is exactly what marks the beginning of deep healing. In this post, I share:

In this little four-panel comic, I show the 4 steps that I’ve found myself describing a few times recently:

Comic-style illustration about how to say hard things in therapy. The first image is titled "Set Intention." The drawing shows a person's hand holding a phone. The phone is on a text screen that says, "I'm going to try to tell you something hard today..." The second image is titled "Ask for What You Need." It is a drawing of the outside of a therapy office's door with a text bubble coming out of it that reads, "Right now, it would be really helpful for you to support me by..." The third image is titled "Give Opportunity to Earn Trust." The drawing is a picture from someone's perspective as they look down at their hands. They are speaking, "Have you ever worked with someone who...? What would you say if...?" The fourth image is titled "Blurt our th Thing." The drawing shows someone with their mouth wide open to speak and their eyes closed.

How to Say Hard Stuff in Therapy

First, Set Intention.

Drawing of a person holding a phone showing a text message disclosing a plan to tell a therapist something.

Whether you want to call it setting a goal, setting intention, or just inviting gentle accountability, letting a therapist know you plan to disclose big info can be a nudge towards actually following through.

This might look different for everyone. Some examples of how you can follow up on this step include:

Sending your therapist an email a day or two before your next session. (Avoid waiting until just before your session. The therapist may not have a chance to see it before you meet!)
Texting your therapist (if you have permission to do so) to let them know you’re planning to talk about a secret in therapy.

Setting our intention to say something hard in therapy helps both the client and therapist. For clients, there’s a bit of accountability on follow-through if you said you would do it. As for therapists: when we know a client is trying to engage something specific and challenging, we’ll hang back on digging into other topics that might arise in the first few minutes of a session. Knowing that a client is working up the courage to talk about something tough means we can adapt and shift into a supportive role.

Next, Ask for What You Need.

drawing of the door of a therapy office, with a speech bubble of someone asking for support.

Sometimes, we don’t know what we need, but if we do, asking for it can help. For some, gentle verbal encouragement helps. For others, the space of silence can invite hard words.

Asking a therapist for support looks different for everyone. Some people may find gentle questions helpful to move towards disclosure, while other clients find silence helpful as they work up the courage. Even therapists get uncomfortable with silence sometimes. Letting them know you need that space can help them know how to support you.

Then, Make An Indirect Disclosure to Build Trust.

drawing of a person sitting on a therapist's couch asking a question.

For many people, it is much easier to ask a therapist how they might respond to a hypothetical situation than to admit we’re in that situation ourselves!

Sure, the question itself can show your cards, so to speak – but it can also be a gentle way to bring a topic into the room and gauge a therapist’s response. As one example, it’s easier to ask a therapist if they’ve ever had a client admit to having a crush on them than it is to tell our therapist that we love them!

“What would you say if…” or “Have you ever worked with someone who?” can be question-starters that bring the conversation near the topic you’re struggling to talk about.

An indirect disclosure like this helps ease into the experience of your therapist knowing the thing, without the suddenness of a blurting out. These preface questions can also help your therapist orient to the conversation – often cushioning the landing when you do finally feel able to tolerate the discomfort of saying the difficult thing.

Navigating these steps with care towards yourself can help you feel not so bad after therapy, even after a huge disclosure.

Tell Your Therapist Something Hard

drawing of a nonbinary person with their mouth open as they blurt our something.

After three steps, all that’s left is following through and saying the thing. With the care, support, and containment of the previous steps, it will likely feel more tolerable.

Big disclosures take big doses of courage. Admitting difficult things in therapy can be the hardest part – but it’s often the point where deep healing begins to take hold. They can also invite a vulnerability hangover or even a shame spiral. Before and after telling your therapist something hard, practice kindness and self-compassion.

Admitting difficult things in therapy can be the hardest part- but it’s often the point where deep healing begins to take hold.

Download a PDF of This Comic

Making Disclosures as Self Care, Not Self Harm

You’ve probably heard of the phrase “trauma dumping.” While it’s impossible to “trauma dump” on a therapist, 1 therapists do sometimes need to slow down a client’s disclosures. This isn’t a defense on the therapist’s part, but rather, good care. Good therapists help support clients as they disclose difficult information at a sustainable rate.

Why it’s Important to “Dump Trauma” in Small Loads 🚚💬

Every seasoned therapist has lost a client to a shame spiral induced by disclosing too much information too quickly.

When big disclosures come before a foundation of trust, safety, and attachment, there is a risk that it will be too difficult to return to the next session.

Often, therapy clients ghost following a “trauma dump,” even if the therapist did everything right.

What’s the solution? Therapists and clients working together to engage trauma and big disclosures at a sustainable pace. For clients, this can sometimes be perceived as a therapist shutting them down or being uninterested – but it’s actually good care.

Starting therapy by talking about boring stuff (work, school, relationships, and other important-but-not-traumatic aspects of life) has dual purposes:

  1. Circling less important topics at the beginning of a therapy relationship helps a therapist gauge a client’s ability to handle difficult emotions.
  2. It also helps clients develop the trust needed to disclose hard things to their therapist without falling headfirst into a shame spiral.

Strategies for Clients Telling a Therapist Something Hard:

Whether it’s disclosing a trauma history or admitting a struggle with intrusive thoughts, before blurting it out, check in with yourself to make sure that the difficult step is one toward recovery, not an act of self-harm in itself.

Escalating the disclosure through the first three steps can be an effective way to judge the therapist’s response each step along the way. If your therapist responds negatively to you naming your intention or voicing a request for what you need, it may be a sign that it’s not time to say the difficult thing to your therapist just yet.

How to talk about trauma in trlationships.

While this post addresses disclosures in therapy, it’s not my first art about saying hard things!

Here’s my guide to how to tell a friend or partner about traumatic things you’ve been through.

See the entire image series and learn more here.

What We Don’t Say

Secrets in therapy are common – but they don’t have to be. The most effective therapy outcomes come when clients are truthful with their therapist. 2 According to one study in 2002, people in therapy are least likely to talk about sexuality and “procreation,” “but were most likely to disclose negative emotions (anger, disgust, etc.) and intimacy.” 3

The APA recognizes that the most difficult topics to talk about (and those most often avoided) include “sex, substance abuse, suicidal ideation, trauma, feelings about the therapist and the progress of therapy.” 4 A 2021 study by the APA found that only half of clients experiencing suicidal thoughts told their therapist about these experiences 5 and a University of Maryland study found that while most people have made a difficult disclosure to their therapist, about 50% of clients kept a secret from their therapist 2.

IMPORTANT: If you are in crisis or need help creating a crisis plan urgently, reach out to a mental healthcare provider, contact the crisis text line by texting “home” to 741741, or call the National Suicide Prevention Lifeline by dialing 988. The educational resources included on this site are not therapy and do not replace mental health treatment or crisis services.

Image Description for Screen Readers:

Comic-style illustration about how to say hard things in therapy. The first image is titled “Set Intention.” The drawing shows a person’s hand holding a phone. The phone is on a text screen that says, “I’m going to try to tell you something hard today…” The second image is titled “Ask for What You Need.” It is a drawing of the outside of a therapy office’s door with a text bubble coming out of it that reads, “Right now, it would be really helpful for you to support me by…” The third image is titled “Give Opportunity to Earn Trust.” The drawing is a picture from someone’s perspective as they look down at their hands. They are speaking, “Have you ever worked with someone who…? What would you say if…?” The fourth image is titled “Blurt our th Thing.” The drawing shows someone with their mouth wide open to speak and their eyes closed.

References:
  1. “The very structure of psychotherapy is meant to encourage disclosure of one’s most shameful and distressing thoughts: It is confidential and private, characterized by a relationship with a caring, interested other.” Farber, B. A., Blanchard, M., & Love, M. (2019). Clinical and empirical perspectives on secrets and lies in psychotherapy. American Psychological Association. []
  2. Baumann, E. C., & Hill, C. E. (2016). Client concealment and disclosure of secrets in outpatient psychotherapyCounselling Psychology Quarterly29(1), 53-75. [][]
  3. Farber, B. A., & Hall, D. (2002). Disclosure to therapists: What is and is not discussed in psychotherapy. Journal of clinical psychology, 58(4), 359-370. []
  4. Farber, B. A., Blanchard, M., & Love, M. (2019). Clinical and empirical perspectives on secrets and lies in psychotherapy. American Psychological Association. []
  5. Love, H. A., & Morgan, P. C. (2021). You can tell me anything: Disclosure of suicidal thoughts and behaviors in psychotherapyPsychotherapy58(4), 533. []

One Comment

  1. This is a great topic to address and a wonderful approach-both visually and descriptively. This isn’t easy, especially more taboo topics, and your drawings respect the levels of difficulty behind sharing this type of intimacy w/a therapist.

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