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How can I reveal painful things in therapy?

Asked by Thomas, Birmingham, Alabama

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I have been seeing a therapist for several weeks, and I am having trouble disclosing several issues. These issues are extremely personal and embarrassing. Do you have any suggestions to help me talk about these extremely personal, painful things?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Thomas,

I bet there isn't one of us who can't relate to your situation. Imagine coming to someone to get help for emotional pain, and knowing that to do this, you had to reveal several very private, very embarrassing things about yourself that you'd probably never told anyone. True, the therapist is there to help you, but on the other hand, he or she is a complete stranger. Because the therapist has no idea what you need to disclose, he or she has no way to really make it easier for you by gently bringing up the general subject. So it's all on your shoulders.

Just typing out this scenario makes me a little nervous, so I really feel for you. So let's think the dilemma through.

The first thing I notice in your question is that you've been seeing the therapist for only a few weeks. We live in such a sped-up world that I think we often lose track of the fact that important and difficult things often take time to accomplish. So my first suggestion is that if you are planning to see this therapist for at least a few months, I'd take a deep breath and try to relax. If you've got the time and the therapy goes well, there will come a time when it will be easier and more natural for you to bring up your difficult personal issues.

Nowadays, insurance will often pay for only brief (usually two-month) courses of psychotherapy. If you are in this situation and have only a few more sessions with the therapist, you've got a tough choice on your hands. First, you have to ask yourself whether revealing these inner (and painful) secrets will be of any benefit given the fact that you won't have much time to work on them with the therapist. Only you know the answer to this question. Sometimes, it can be more distressing to open up emotionally and then not be able to follow up than it is to just keep things inside. Other times, just telling another human a painful secret can provide immediate and huge relief.

If you know in your heart of hearts that it is important for you to tell your therapist about your personal issues and you don't have much time, there is no other course of action than to gird yourself to the task and just go tell him or her. Everyone is different in approaching these types of difficult revelations. The only way I would be able to do it would be to just march in, sit down and start the session by saying, "I need to talk about some things that are really hard for me to talk about."

But that's just me. If you prefer to finesse these types of matters, then your task will be to find a way to gradually lead your conversation into these private aspects of your life.

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