How to Open Up to Your Therapist and Why It Matters

About 75% of people who go to therapy experience some benefit from it, according to the American Psychiatric Association.

The more you put into it, the more you’ll likely get out of it. Yet it’s a challenge to open up to someone who is, essentially, a complete stranger, says Dr. Andrew Schwehm, a licensed psychologist in New York City.

“Even though you may be able to tell yourself logically that this is a safe space, it’s easy for that little part of your brain to say, ‘Be careful! Don’t say that!’” he says.

That’s when missed opportunities can occur. When you omit certain facts or distort the truth, a therapist may believe that an issue is more or less important than it actually is, which can impact the kind of support you receive.

The more they know, the better they can understand you and help you reach your goals.

“Therapy is not a one-size-fits-all approach, which means that I want to know even the things you don’t think are important so that I can best help you,” Schwehm says.

Being honest in therapy can strengthen the therapeutic alliance and allow for a tailor-made treatment plan. It can also lay the groundwork for opening up about other painful or hard truths in the future. Even if it doesn’t exactly get easier, at least the process will become more familiar.

Many therapy clients worry about what will happen with the information they share. It’s natural to have a few questions and concerns about your privacy. Will your therapist tell their colleagues about your issues over coffee? Will they write about your life in a book or a study?

No and no. It may help to think of your therapist as a professional secret keeper, or a vault. What goes in will not come out.

“Outside of a few important things that we may need to report — abuse or neglect of dependent people, suicide, and homicide — your secrets are safe with us,” Schwehm says. “I can’t even tell my wife about the well-known people I’ve worked with.”

Being honest in therapy is easier said than done, but here are some psychologist-approved tips to help make it easier:

• Create a game plan.
• Ground yourself.
• Pick an optimal appointment time.
• Get clarity around privacy.
• Start small.
• Send a letter.
• Practice in the mirror.
• Let your therapist take the lead.
• Bring in something to reference.
• Ask about other approaches.
• Challenge yourself.
• Know you’re not the only one.

1. Create a game plan

If you don’t know where to begin, it can take some pressure off if you jot down a few talking points on a notecard or in your phone. Between sessions, write down significant events, experiences, or feelings you want to bring up in therapy.

2. Ground yourself

If you have time, it might be a good idea to take a moment to mentally prepare for your session. You can take some deep breaths, meditate, or listen to calming music. You may also want to try saying this mantra in your head or out loud: “I may not 100% enjoy this process, but I am safe.”

Don’t be afraid to show up a little early either, says Ryan Howes, a clinical psychologist in Pasadena, California.

“Since the therapy hour is typically 45 or 50 minutes, I invite clients to ‘take the whole hour’ by showing up early for their appointment to relax, get settled, and focus on what they’d like to cover in their session,” Howes says.

“Sometimes this is enough to help them decide to tackle the tough issues,” he says.

3. Pick an optimal appointment time

It can be difficult to let your guard down if you’re trying to squeeze in therapy between meetings at work, or while you’re out running errands around town. If you and your therapist have some flexibility, work out a time when you’re more likely to feel calm and ready to get to work.

4. Get clarity around privacy

It’s OK to ask your therapist about what they’re going to do with the information you share, even if you’ve already gone over it.

For peace of mind, you can ask your therapist to review their confidentiality policy with you. You may ask them directly what information they would have to report to an outside party. You can also refer to Section 4 in the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct.

5. Start small

It takes time to build trust and a rapport. Each session will help fortify that bond.

Until you feel more at ease, you could talk about topics that have a less emotional charge. For example, you may talk about an argument with your partner rather than your childhood trauma.

“Just like you’d want to test a rickety footbridge before charging ahead, you may want to try disclosing smaller items first to see how it feels and how your therapist handles them,” Howes says.

“The big topic from your past may feel too heavy for now, so maybe start with lighter concerns and build up to the bigger topics,” he says.

6. Send a letter

Writing down your thoughts can feel less intimidating or intrusive. Think about grabbing a pen and paper and getting it all out. Then, you could hand the letter to your therapist in your session.

If they’re OK with it, you can even send them a letter beforehand to provide a heads-up or some context.

7. Practice in the mirror

Just like when you were a teenager, perhaps preparing to ask someone out on a date, it may be helpful to rehearse what you’d like to say out loud, well before you have to.

Hearing our own words, then repeating them, may release tension and help us develop confidence.

8. Let your therapist take the lead

Don’t worry, no one expects you to know exactly what to say. This is especially true if you come from a culture or family that doesn’t like to talk about their struggles.

That’s what a therapist is there for.

Rather than engage them with small talk until you get to the core issue, consider letting them take the lead on this.

You may allow them to create a welcoming, safe space and ask the right questions to guide you into a conversation.

That’s what they’re trained to do.

9. Bring in something to reference

If you’ve seen something that relates to what you’re going through, or you’ve shared about your experience somewhere else (like a blog or on Instagram), you could read that content out loud in your session.

This will help the therapist understand how you interact with the world.

10. Ask about other approaches

There’s more than one way to get a message across, even without words.

It may be a good idea to ask your therapist whether art therapy, sand tray therapy, or other mediums are a possibility. They may also assign you creative homework projects to bring in for the next session.

11. Challenge yourself

There’s no getting around it: Therapy is hard work.

It may be helpful to remember that it’s natural to feel a bit stretched beyond your comfort zone. In fact, that’s where the growth happens.

If you need motivation to open up, come back to your “why.”

Consider asking yourself these three questions:

• What brought me in here?
• What am I hoping to accomplish?
• What kind of life do I want for myself?

When we remember the reasons we called a therapist in the first place, it can give us the push we need to be a little more vulnerable.

12. Remember: You’re not the only one

No matter what you’re coming in with, remember: You’re not the only one.

When we keep things to ourselves, it’s easy to think that we’re alone in our experience, but that’s simply not true. Chances are, your therapist has heard similar stories from other clients. The sooner you open up about what you’re going through, the sooner your therapist can help.

“Know there isn’t anything you could say that would shock or horrify us,” says Dawn Friedman, a licensed clinical counselor in Worthington, Ohio. “Really, we’ve heard it all.”

There are several reasons you may find it difficult to be honest in therapy.

For starters, a therapeutic alliance is a special kind of relationship. Though they may know everything about you, you may not know anything about them — even small things, like if they’re a dog or cat person, or what they do for fun. Naturally, this can make it difficult to trust a therapist.

In addition, there may be some fears about how your therapist will respond to what you share. Some of these concerns could include:

• rejection
• judgment
• being labeled
• being misunderstood
• upsetting the therapist
• saying the “wrong” answer
• not having a “big” enough issue
• being dismissed or not believed
• being seen as less than a “perfect client”
• what will happen with the information you disclose

If one of these rings true for you, bring it up in session. You can say something like, “I want to tell you something, but I am afraid of being judged.” Your therapist will know how to take it from there.

“One thing I like about therapy is it gives us the chance to get meta,” Friedman says. “In other words, you can actually talk about your discomfort, ask why your therapist is asking that question, share how you feel about the discussion, and be super transparent about what’s going on for you.”

If you’re still having a hard time opening up, it could be another issue. Perhaps there’s a lack of chemistry, or your therapist’s approach might not be the right fit for you. In that case, perhaps it’s time to consider switching therapists or approaches.

Bravo for making a choice to prioritize your mental health. That’s a huge deal.

The next step is to try to be as authentic as possible with your therapist. Help them help you, so that therapy can be a game changer.

No matter what happens in the “real world” when you disclose certain information, it’s going to be different in a therapist’s office.

Your therapist has likely heard it all, and the more honest you are about what you’re going through, the better they’ll be able to support you.

For more motivation on this topic, you might find it interesting to look into Dr. Brené Brown’s work on vulnerability and shame. You could watch her TED Talk on vulnerability or listen to her audiobook “The Power of Vulnerability.”

Lastly, be proud of yourself. You’re taking a bold step in the right direction. It shows.

These resources can also help if you’re considering changing approaches or therapists:

• American Psychiatric Association’s Find a Psychiatrist tool
• American Psychological Association’s Find a Psychologist tool
• Asian Mental Health Collective’s therapist directory
• Association of Black Psychologists’ Find a Psychologist tool
• National Alliance on Mental Illness Helpline and support tools
• National Institute of Mental Health’s helpline directory
• National Queer and Trans Therapists of Color Network
• Inclusive Therapists