Do You Always Tell Your Therapist the Whole Truth?

Patient Expert

I have to admit that I haven't always followed the advice I give others about therapy. It only works, I say, if you tell the therapist the truth of what you're going through. If you don't trust the therapist to be completely honest, find a new one. You have to be open, truthful, trusting - that's the only way to do it.

I guess I'm so emphatic about it now because I often told my therapists a little less than the whole truth or sometimes anything but the truth.

Talking about the past was not the problem. I could summon up all the turbulence and pain I'd gone through long ago from the safe distance of time. It was the here and now that stopped me. Telling them the full emotional truth of the present was the hard part.

I've been making a list of "excuses" I've told myself for holding back. They're fine examples of the strange beliefs depression encourages - the very ones that therapy is designed to help me change. From one session to another I might cycle through several variations, each one giving me a different rationale for not being open about what I was feeling.

A recent comment by one reader brought all this back to mind. She wrote that she couldn't reveal how depressed and suicidal she often became because she didn't want to disappoint her therapists. I could immediately understand what she meant. Just as I often did, she needed to have the therapists believe that she was a "good" patient, always making progress, never slipping back into a deadly relapse.

My need to get a therapist's approval often overshadowed the need to be helped. For me, approval was heaven, disapproval hell. Why? I think it was the shame I felt during depression about being so worthless and inadequate. I needed to feel justified about being alive. Since I didn't feel that way on the inside, I had to get it from the outside. I couldn't feel OK unless people thought of me as a model of whatever role I was trying to play, and that included being the model patient in therapy.

So when a therapist asked how I was doing, I'd often say "fine" or "not so bad, just a couple of low days," but the truth could be the opposite. I might really have felt despairing and believed that everyone would be better off without me.

But I was certain that if I told him I was feeling worse, he wouldn't think well of me. I was quick to interpret any gesture or look as a sign of impatience or disappointment. I was desperate to head them off. If he wasn't saying much in response to what I told him, I'd be sure that he'd given up on me.

That wasn't the only worry restraining me. There were times when I felt so completely lost in shame that I couldn't imagine having anyone's approval for anything I did or said. At those times, my thoughts went like this:

  • I'm not depressed enough to be here - I'm just a fraud, pretending to be sick.

  • I can't think of anything to say. I can't do therapy any better than I can do anything else.

  • I'm so boring - it's the same thing over and over. He doesn't want to hear this yet again.

  • I'm a rotten failure, and I'm tired of hearing myself talk.

  • Whatever I say isn't worth listening to. What's the point of trying?

Feeling so numb and empty was one problem, but there were other times when I was overwhelmed with strong feelings. I had a powerful fear about letting myself express them. I had to hold them in check and not say anything about the turmoil inside.

It was an automatic reflex to stop any spontaneous rush of feeling in a therapy session, especially an urge to cry. Something in me always reacted faster than thought. It was more than a censor, it was a builder of strong barriers that walled the feelings in and me with them.

Depression carried with it a soul-deep dread that intense feelings on the loose would release a terrifying force I'd been keeping in check. I didn't know exactly what it was, but eventually I gave it a recognizable face. My own hideous and violent Mr. Hyde was waiting to spring free, and that I could not allow.

I knew that was a crazy thing to believe, but on a depressed and primitive level it felt like truth for many years. Mr. Hyde was everything half human and monstrous that my depressed mind told me I was. Presenting an outward calm became a permanent state, no matter what was happening to my feelings. Sometimes, I took perverse pride in making it impossible for a therapist or anyone else to read my feelings.

So there were many motives and half-understood drives to be less than honest when talking to therapists. These were professionals I did trust, at least most of them. Since I've been in therapy for decades and moved around the country, I've seen quite a few. Except for two or three, whom I didn't stay with for long, they were compassionate, highly experienced and skilled, only too ready to work with me closely.

I had many powerful insights with their help, mostly in understanding patterns of thinking and behaving I'd internalized while growing up. But I've rarely been fully present emotionally or capable of discussing anything that I hadn't processed before the session. I did talk with them about this problem but never overcame it completely. I'm a lot freer about opening up now, but I still have a long way to go.

How about you? Have you been able to open up emotionally in therapy sessions? If you have held back, has it been a problem of not trusting   your therapist or has it been your own resistance? Thanks for any insight you can offer.