“How do I talk about difficult things in therapy?”

Catherine Comiskey, LCSW
Nov 4, 2021
3 min read

Updated: Jun 11

“One of therapy’s impossible tasks is to help build resources that

make it possible to tolerate therapy.” - Michael Eigen

Talking about difficult things in therapy can feel surprisingly hard.

Many people start therapy wanting help, but then find themselves avoiding certain topics, minimizing painful experiences, or worrying about being judged. Opening up to another person, even a therapist, can feel vulnerable, uncomfortable, and anxiety-provoking.

That reaction is normal.

Why Is It So Hard to Open Up in Therapy?

Being open and honest in therapy is an essential part of the therapeutic process. But building enough trust to talk freely doesn’t happen instantly.

We don’t enter most new relationships expecting ourselves to trust fully, reveal deeply personal parts of ourselves, and hold nothing back. It’s no wonder that entering therapy, a uniquely intimate kind of relationship, can bring up anxiety.

Many people worry:

“What if my therapist judges me?”
“What if this sounds strange?”
“What if I say too much?”
“What if I don’t know how to explain it?”

These fears are more common than most people realize.

Feeling Safe in Therapy Matters

Feeling emotionally safe is crucial to being able to talk freely and openly in therapy.

If you scroll through therapists’ websites or bios, you’ll probably notice many mention “creating a safe space.” Some people feel this phrase is overused, but therapists emphasize it for a reason.

Part of a therapist’s role is to create an environment where people feel comfortable expressing and exploring experiences, thoughts, feelings, fantasies, fears, and vulnerabilities that may feel difficult to discuss elsewhere.

Therapists help create safety by clearly establishing the “ground rules” of therapy.

If you are confused about confidentiality, ask your therapist to clarify. If you are unsure why your therapist asks certain questions, feel free to ask how those questions may help you and your therapy.

As you become more comfortable with the structure and framework of therapy, anxiety about discussing difficult topics often begins to lessen.

Building Trust With Your Therapist Takes Time

Developing a comfortable and collaborative relationship with your therapist is also an important part of being able to discuss difficult things in therapy.

Trusting that your therapist accepts you and genuinely wants to help you usually does not happen overnight. Give yourself time to build trust gradually within the therapeutic relationship.

It can also help to remember that therapists are trained professionals.

Just as people may disclose embarrassing physical symptoms to a physician and trust that the doctor can respond professionally and helpfully, therapists are trained to work with the full range of human experiences, including experiences that feel painful, shameful, confusing, or difficult to say out loud.

You Can Tell Your Therapist What You Need

When anxiety shows up in therapy, it can help to focus on what you do have control over.

You are allowed to communicate what helps you feel safer during difficult conversations.

For example, you might say:

“I’m going to share something that feels scary.”
“I need to pace myself.”
“Please don’t interrupt me while I’m saying this.”
“If I get stuck, it would help if you asked questions.”
“I’m embarrassed to talk about this.”

Letting your therapist know what you need can make difficult conversations feel more manageable.

Therapy Is Not About Being “Good”

Sometimes people unconsciously experience therapy as though they are reporting to an authority figure who expects perfection, honesty, or progress.

But therapy is not about performing, getting everything right, or revealing everything immediately.

Instead, sharing during therapy can be understood as part of the healing process itself, a way of understanding yourself more deeply, working through painful experiences, and creating meaningful change.