10 Things Your Therapist Probably Won't Tell You

My journeys as both a therapy client and therapist have taught me a lot along the way. Situations I may have viewed one way as an adolescent client, for example, a therapist watching as I chose which of her many toys to fidget with as we talked, I view differently now. At the time, I thought she was creating some grand psycho-analytic interpretation of my behavior. She was probably just curious.

I believe that psychotherapy is in ways a sacred profession. We are invited into dark corners of others' lives, permitted to ask questions that often go unasked, and have a chance to be a part of someone's healing. Of course, there are limits. As therapists, we are as much human as any other person. These are 10 things your therapist might not tell you, but that you might like to know.

1. We're glad you're here. It takes strength to dedicate time to work on themselves. The fact that you have chosen to do that in our presence is a compliment. We are glad that you have decided to set out on this journey and often look forward to your sessions.

Before I became a therapist, I often assumed my own therapists might find some of my revelations as a burden. It seemed too good to be true that anyone would want to talk to me. But I find myself jazzed before sessions, looking through notes and preparing interventions. Most therapists I know genuinely appreciate their work.

2. We guess that there are some things you don't tell us. Seeing the stereotypical sketch of a therapist hidden behind a wall of degrees and interpretation, I assumed often that the people treating me felt they knew more about my situation than I did.

While it's true this may have sometimes been the case, I think more often therapists are aware that therapy is at the mercy of our client's willingness to disclose. Psychotherapy requests an uncommon level of emotional intimacy. We have no right to anything you are not ready to disclose. Still, almost everyone walks around with some secrets. We recognize that there are likely traumas you have not revealed to us, and we hope that as time moves forward your comfort will rise.

3. We hope you come to your sessions. I often did not understand why my therapist would bother my mom about missed sessions as a teenager. I assumed they would appreciate the open hour.

Yet most therapists take their work seriously. Therapy only works if it happens. We do care about your healing and hope you attend your sessions. If something is preventing this, such as if you feel that therapy is not relevant to you, we want to know. There are many people in need and a missed session hurts not only the client, but others who might need that slot.

4. We aren't any more "enlightened" than you (and we don't think we are). Therapists are every bit as human as everyone else. We don't have access to any sort of enlightenment magic. We find ourselves intimidated at times. There are times we feel stressed. You might even catch one of us in a club now and again.

What we offer is a skill in presence, compassion, and psychotherapeutic techniques that we have built over the years. No doubt, our craft is developed. Still, in the end, we are fellow travelers in life.

5. We appreciate when your feedback is honest. As a youth, when a therapist asked me a question, I often assumed there was a "right" answer or one they wanted to hear. I gave my therapists too little credit.

Most of us will ask questions like, "How was this session for you?" We know that there may be pressure to say, "fine"—but still, if it's ever anything other than fine, we hope you will tell us. We aren't asking for a grade.

Common factors research shows us that therapeutic alliance is the best predictor of outcomes in therapy. It accounts for progress in therapy more even than the type of therapy being applied. If we want to be of service to you, we need to know how things are going.

6. Your therapist is probably in therapy. It's difficult to take someone where you haven't been yourself. Most therapists see (or have seen) their therapist.

In earlier years, any difficulty on the part of the therapist was seen as a liability. Today, we recognize the strengths of therapists who have worked through their own recovery as well as the reality that all people have struggles. Ignoring our own challenges is an act of self-deception which is much more detrimental.

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In recent years, the Jungian archetype of the "wounded healer" has been celebrated with the voices of lived experience more welcome in clinical, research, and academic circles (Martin, 2010). Many therapists identify with this. We have been through our own battles. What we have faced often has given us added compassion and insight to offer in session.

7. Your healing is worth more to us than your copay. Unfortunately, affording therapy is a major barrier to access to services. Sometimes people drop out of therapy because of their inability to pay.

We don't want this! Many therapists offer sliding scales and payment plans when money is a challenge. Even if we can't offer this, we hope you will discuss with us any financial obstacles so that we can problem-solve with you and discuss resources.

8. We have a treatment plan that evolves as your therapy progresses. I remember, usually in the first or second session, my providers handed me and my mother a "treatment plan" to sign. Sometimes they would gloss over it, sometimes they wouldn't. I honestly never thought much of it, assuming it was one of a million requirements Medicaid set for us.

Indeed, insurance typically requires that a formal treatment plan be created for every client at the outset of services. This is a structured outline of your treatment. But it's also an ethical requirement.

Effective psychotherapy is intentional. Research shows that when intention setting is part of therapy clients are more likely to attend (Sheeran et al., 2007). As we get to know you and what you are seeking, new objectives often appear. We may discuss with you changes in a treatment plan that could involve added modalities, additional goals, or checking off objectives you have accomplished or no longer see as relevant to your treatment.

9. There's quite a bit of "behind the curtain" work in therapy. As a client, I assumed therapists thought little of me between sessions. How could they? Surely they had a lot of clients.

While it is true that your therapist is likely not daydreaming of you throughout their day (that would be a bit intrusive), most therapists do take time to prepare between sessions. Effective psychotherapy is often intentional. Just as we may give you tasks to take part in between sessions, we take time to sharpen our skills and build ourselves so that we can be present and skillful in our practice. We attend training, read, consult other therapists, process, and take part in a range of self-discovery activities so that we can be at our best.

10. You can ask us questions. Perhaps out of "respect," as a teen client, I had many questions for therapists that I kept to myself. I made my own assumptions instead, which I now recognize can be detrimental to therapy.

Decades ago, therapists were advised against self-disclosure. It was believed that any kind of self-disclosure could lead to a slippery slope landing us in an ethically problematic situation. Today, the consensus is that when self-disclosure is for the benefit of the client it is permissible. If you have questions about us or your treatment, please ask. If there are questions that we cannot answer, the responsibility is on us to draw the boundary.

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