Therese J. Borchard - Talk Therapy: How Honest Are You?

Good article - the usefulness of talk therapy depends entirely on how willing the client is to be honest with the therapist.

Talk Therapy: How Honest Are You?

By Therese J. Borchard
November 22, 2009

I pay my therapist $120 every other week. I should, theoretically, feel like I can tell her anything.

But I don’t.

Because I want her to like me. It’s part of being a stage-four people-pleaser.

I didn’t realize the extent to which I was holding back until, the other day, when I mentioned to my therapist something that I had told Dr. Smith–the psychiatrist that I see every four to six weeks–about positive thinking just not cutting it when you plummet to such a low depression.

My therapist asked me to back up and tell her more about that. Because either I hadn’t said anything about that to her in the last month or so or else she had missed it.

I stewed on that for a few days: Did I omit my frustration with self-help books and cognitive-behavioral techniques or maybe not express how depressed I have really been? And I realized that I divulge more to my psychiatrist about the status of my depression and anxiety than I do with my therapist.

Why?

When I’m sitting on my doctor’s couch, I believe the most significant culprit to my bad mood is my illness. I’m somewhat like a diabetic going in to get her insulin levels checked.

However, when I perch myself across from my therapist, I feel more accountable for my moods … that I if I am unable to implement cognitive-behavioral adjustments, and thereby some find relief, that I am somehow to blame. Moreover, if I’m pulled back into addictive and destructive thoughts and behavior, I have gotten there by choice.

It’s nothing she says that makes me feel that way. She’s a wonderful therapist.

It’s just the nature of therapy versus psychiatry. By far, the easiest part of my recovery is taking my prescriptions and getting blood work done once a month or so. The real warfare takes place at the battlefield of my mind, where I must adjust my thoughts constantly, sometimes as much as ten times a minute, so that they don’t steer me into a dangerous and sticky place. My therapist is my coach, my captain, in that challenge. And so when I feel like the negative intrusive thoughts are winning 10 to 0 and it’s only halftime, I feel as though I must have, in some way, let her down.

Crazy, really, isn’t it?

But I’m not alone. According to a 2005 study published in the “Journals of the British Psychological Society,” of the study’s 85 respondents, 54 percent withheld significant information from their therapist, 42 withheld information related to depressive symptoms and behaviors. Nearly 75 percent said they did so out of shame. Like me, they wanted their therapists to think well of them.

But John Grohol of PsychCentral has some great perspective from a therapist’s perspective in his blog post called “Why Would You Lie to Your Therapist?”:

If you lie to your therapist, especially about something important in your life or directly related to your problems, then you’re wasting your and your therapist’s time. If you tell your therapist all about your depression, but leave out the fact that your mom just passed away last month, that’s an important, valuable piece of information that would be helpful for the therapist to know in order to help you better. If you tell your therapist you have low self-esteem or always feel insecure about yourself, yet leave out the fact that you purge after eating almost every meal, again, you’re only impeding your own recovery and treatment.

These are plain and simple lies, called lies of omission. And they prevent a person from moving forward in treatment.

I believe the reason many people leave out this kind of information is the same reason we have trouble mentioning embarrassing things to our family doc — we’re embarrassed by what we need to say, and feel the doctor might pass some sort of judgment on us. Whether it’s a rational fear or not doesn’t really matter, does it? One of the reasons many people seek out psychotherapy in the first place is to help combat irrational thoughts and fears, so in that context, it makes sense many of share this fear of being judged or embarrassed.

And yet, if you do nothing else in therapy, you should find some kind of way to share this sort of pertinent information with your therapist. It doesn’t have to be in the first session. But it does have to happen at some point.

Your therapist won’t judge you, and they won’t be embarrassed by what you tell them. They won’t criticize you for not sharing this information with them sooner. All they will do is use it to find a way to better help you and help you move forward.

Therese J. Borchard writes the daily Beliefnet.com blog Beyond Blue (voted by Psych Central as one of the Top 10 Depression Blogs) and moderates Group Beyond Blue, the Beliefnet Community online support group for depression. Her memoir “Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes” will be released in January of 2010. Subscribe to Beyond Blue here or visit her at www.ThereseBorchard.com.

Tags: Psychology, therapy, Therese J. Borchard, Talk Therapy, How Honest Are You?, World of Psychology