7 Tips for Opening Up in Therapy
Originally published on February 22, 2018 via WordPress
When you open up in therapy, it can be magical. It can lead to change, growth, insight, recovery, and healing. But being able to go “deeper” than surface-level topics can be challenging, especially if you’ve been hurt, dismissed, or embarrassed in the past, or if you’re having a hard time coming to terms with a piece of truth (and ironically, these are often the reasons a person comes to therapy in the first place!)
I’ve compiled a list below of tips to help move the process along and overcome whatever barriers are holding you back:
1. Clarify your goals. It’s impossible to know what the destination will look like (or to know if you’re even on the right track) if you don’t have a roadmap. Work together with your therapist to create a clear picture of what you’re seeking from treatment. This might be a specific goal to work towards, like a change in behavior, or it might be that you want to better understand a certain topic, gain and practice new tools for managing emotions, communicate more effectively in your relationships, or improve self-esteem. If you can’t quite articulate what you want, but you know things are feeling “off,” it’s okay to ask your therapist for some help with finding the words to explain what you’re looking for.
2. Clarify your feelings. I’ve been on both sides of the couch, so I know how overwhelming it can be when there are a billion thoughts and feelings swirling around as you sit there. It can be challenging to find language that pinpoints what you’re experiencing, and most of us haven’t been taught a very robust “emotional vocabulary” from a young age. Plus, feelings can’t always be explained by a single word. Often, our feelings pop up in conjunction with one another, and we need several words to fully encompass what’s happening. Other times, we might "feel" in visual imagery, shapes, or physiological sensations (like nausea, chest tension, or butterflies in the stomach), or in a metaphor.
3. Write it down. If you know there is something you want to express but it’s hard to say it out loud in the presence of your therapist (or maybe it’s hard to say in front of anyone), try writing it down ahead of time. This is also a useful method for making sure you aren’t going to forget to bring something up. Write it down in a journal, or create a bullet-pointed list in a notebook or in the notes on your smartphone to bring into session. This can help you address a topic when you’re feeling urges to avoid it.
4. Give your therapist a “head’s up.” If they’re open to it, send an email or text to your therapist between sessions to let them know what you want to talk about. This is useful if there’s something you don’t think you’ll have the guts to say out loud. This can be an effective way to hold yourself accountable and to “let the cat out of the bag” before you even come to the session, especially if you’re someone whose anxiety tends to build in anticipation. A word of caution: it’s important to only do this if you have explicit agreement from your therapist. The policies and rules regarding how, when, and about what topics your therapist is able to communicate with you outside of session can vary for different providers, so be sure to ask if this is something they are open to doing.
5. Tinker with your therapy environment. Although therapists work hard to make sure their space is warm and inviting, it’s possible that the setup doesn’t suit your needs. If it’s too hot, cold, or bright in the room, or if you feel too pressured when you’re making direct eye contact, you might have a hard time opening up. Many people feel more at-ease if they’re fidgeting, doodling, or gazing out the window. I keep small objects, worry stones, or silly putty for clients to mess around with while we’re chatting, since occupying the hands can help some folks feel calmer. Try to sit or lounge comfortably, which can help you loosen up. Perhaps you’d feel more comfortable laying down, or sitting on the floor with your legs outstretched. I’ve noticed some people feel safer while hugging a throw pillow.
At my practice, we also have a “walk and talk” consent form that clients can sign if they’re interested in the option of walking around outside together during sessions. It’s important that your confidentiality is protected, so if your therapist’s office is in a busy, crowded, or high-traffic area, consider whether you’d be bothered by the risk of being seen or disrupted by passersby. If you have the ability to walk somewhere secluded and peaceful, though, it could be just the switch you need to start talking.
Overall, if you can take a creative approach to identifying your needs, it’s likely that your therapist will be supportive of these modifications. There’s no “wrong way” to settle in to the space, so think about what works well for you and then ask if it’s an option.
6. Ease into the session. It can sometimes feel abrupt to sit down and start talking right away. It can help to spend a few minutes at the beginning by shifting into the space and mindset of therapy. Ask your therapist if he/she would be open to guiding you through a relaxation exercise. This might mean engaging in a mindfulness meditation, guided imagery, deep breathing, or a body scan. These can be powerful ways to slow down and clear your mind. Starting with a meditation sets up your “baseline” so that if you do become emotionally activated when exploring difficult topics in session, you can always return to the soothing activity again to calm down. It can also help to end session with a similar grounding exercise, so that you feel rooted and stable before going back out into the “real world.”
7. Consider your relationship with your therapist. In order to be vulnerable in someone’s presence, you have to feel safe. The nature of the client-therapist relationship might take some getting used to, and at first it might feel like you’re opening up to a stranger. It can take time to get to know their personality and establish trust.
Therapy is different from your social interactions in “normal life.” Typically, you might be used to a certain back-and-forth exchange in your conversations: I ask you a question, and you answer it and then ask me a question and I answer it. This becomes second nature to us, so you might feel “rude” or just strange if you don’t ask a follow up question when your therapist asks you something. However, therapy is designed to be entirely focused on you, the client, so the therapist typically does not reveal much personal information, and this can be hard to adjust to.
If you find you’re having a hard time trusting your therapist, think about the factors contributing to the barrier. Do they seem too stiff, formal, or unexpressive? Or, do they respond to you in a way that helps you feel cared for, respected, and understood? Do you notice you’re censoring yourself or holding back out of fear of how they will react, or desire to influence how they perceive you? After all, we all want to be liked, so it’s hard to speak about things we feel guilty or ashamed about, even when we know the person won't judge us. It’s natural to struggle with all of these things. As awkward as it might be to discuss them, by being honest you and your therapist can work together to facilitate a stronger connection.
At the end of the day, therapy is about you getting what you need, so it’s only going to be effective if you and your therapist are able to foster the right context for you to open up. If you look into all of these factors and you still don’t feel able to share, it’s possible that your therapist is not the best fit for you. Therapists come from a variety of backgrounds, educations, training, theoretical models, and clinical styles, so there’s no “one size fits all” approach. On top of that, every therapist is still just a person, and not every personality is the best fit for you. If you’re considering “breaking up” with your therapist or trying to figure out what you need, check out this blog post I wrote on the subject last month.
What helps you to open up in therapy? Feel free to share in the comments below or on my IG account (@mindful.drpaula) with any additional tips of your own, and let me know what works best for you!