April 5th, 2011
12:09 PM ET

How can I reveal painful things in therapy?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Thomas of Birmingham, Alabama

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?

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.

soundoff (25 Responses)
  1. psychology student

    I am sorry, but this answer is not very helpful at all.

    First of all, Insurance WILL pay for as much therapy as you need as long as they do not set limits on medical treatment. There used to be limited benefits for mental health concerns, but as of the beginning of 2010, thanks to the Mental Health Parity law, as long as your therapist thinks you need to continue you can get more sessions approved. So don't worry about "running out of sessions" unless you are self- financing and only have a small amount saved up or something like that. (if that's the case might as well find a cheaper therapist!)

    I suggest you wait a few more weeks until you feel more comfortable and then simply write down the issue. When you get to the session read the note or if that is too painful, you could simply hand him or her the note. If it's of pressing importance, then might as well take a deep breath and reveal the contents of the note. Another strategy is to come in to the session and say "I have something I want to reveal to you, but it's too painful and embarrassing" and steer the conversation there more directly. One thing that is helpful to remember is that they are trained to handle said situation and often what is personal and embarrassing for us is very common and possibly part of one of our disorders. Basically, they've most likely seen it before and know what to do about it. Also, you are paying for them to help you and they can't help you if they don't know everything that's going on with you.

    April 5, 2011 at 12:38 | Report abuse | Reply
    • psychology student

      Also, something else I wanted to add, if you are troubled enough by the issue, that you are writing in asking for advice, you should indeed reveal the issue. It's very likely going to be beneficial for your healing. Sometimes, it's even paramount. For example, what you reveal may give your therapist a very important insight into your psyche.

      April 5, 2011 at 12:46 | Report abuse |
  2. Ann

    As a psychologist for the past 20 years, I would also assure the writer that no matter how awful his personal issues are to him, he is very unlikely to shock his therapist with something the therapist has never heard before. This is what we do. Certainly, every patient's experience is unique, but we're ready to help you handle whatever you come up with. Go for it – there's not much to lose.

    April 5, 2011 at 12:44 | Report abuse | Reply
  3. Fuyuko

    I don't think you need to 'bare all' with a therapist. Your therapist CAN teach you coping skills to help with long standing issues on your own. Only if you can't deal should you talk more about it. There is no 'one size fits all' method of therapy or 'one way to do things.' Also, it is possible there is a reason you don't find this therapist easy to talk to. It is possibel another therapist might be someone you feel more comfortable wtih. Just my .02. I am not a licensed therapist or anything, but I never found it particularly helpful to tell my therapist 'everything' as his advice was usually the same.

    April 5, 2011 at 13:36 | Report abuse | Reply
  4. ashima

    For me, what helped when sharing difficult things was writing it down first. Then I would take the pages to my therapist and read it to her. Once, I couldn't even do that, and just handed her the sheet of paper to read. It helped me to be more open and gave me a way to bring things up that were hard ot say.

    April 5, 2011 at 13:43 | Report abuse | Reply
  5. anon

    Probably the intimate details of a situation do NOT need to be disclosed in order for an issue to be addressed adequately in therapy. It sounds to me as though the writer is concerned about how detailed she needs to be in disclosing some kind of abuse or assault. It should be enough for the therapist to know that a particular kind of abuse occurred, who did it, how long it went on, etc. There can't be much value in specifying particular actions of an abuser or assailant. As a trauma survivor, I am uncomfortable enough with talking about the details that I have not even attempted therapy because in the past, I've found that therapists like to sit back and listen to a thrilling tale instead of focusing on what I need here and now. I can't and won't talk about humiliating details of what happened to me, and it's not necessary. The events occurred, I now have symptoms of PTSD, and my treatment plan would not be affected by the details.

    April 5, 2011 at 13:53 | Report abuse | Reply
    • psychology student

      Are you familiar with Exposure therapy? Which is one of the most widely used and validated types of therapy for PTSD? Well in order to do exposure therapy, you NEED to tell the therapist about the particular details. This is so that you can be exposed to the details and eventually get over them. So, it's very important. But of course you have to feel comfortable with your therapist in order to do that.

      Also, if you have symptoms of PTSD because of it, then how is it not affecting your daily life?

      April 6, 2011 at 13:04 | Report abuse |
  6. tolerance3

    I've been a psychologist for over 40 years, and it sounds to me like the writer has been traumatized by his/her own shame. I would recommend that he/she find a therapist trained in EMDR (eye movement desensitization reprocessing) where it is not necessary to relate all the details of what might be embarrassing because the therapist is very mindful not to re-traumatize the client. The toxic material can be reprocessed non-verbally and the client will be free of self-loathing. You can find an EMDR-trained therapist in your local area by going to http://www.emdria.org.

    April 5, 2011 at 14:09 | Report abuse | Reply
  7. Bertomus

    I lost my brother to suicide, and one of the most shocking things was that after four years of therapy he never once disclosed to his psychologist that he was self-injuring frequently. Because it was such a major issue I just assumed that was the very _first_ thing they discussed, and that they had been working on it this entire time. He was too embarrassed to discuss it and as a result never got help for it.

    After his death I got grief counseling and the first thing I did was tell my therapist everything. I didn't want to repeat my brother's mistake and avoid discussing the difficult parts. Not only did it let me tackle my feelings of loss, but my therapist realized I had unrelated anxiety problems and was able to quickly put me on medicine that has made me feel completely normal again. I was able to clear up a number of personal issues in a short period of time, and while it wasn't easy I absolutely have no regrets about coming clean and getting proper help.

    I think giving your therapist a letter detailing the things you are too upset to discuss can be a good way of getting started. Then he or she will understand what you went through and can find the right way to discuss it.

    April 5, 2011 at 14:29 | Report abuse | Reply
  8. angela

    Look I go too. What is said between you and your dr. Is private and no one else knows

    April 5, 2011 at 15:16 | Report abuse | Reply
  9. help

    perhaps you could tell you therapist what you wrote here..." 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" your therapist should be able to give better advice than anyone here.
    Good Luck.

    April 5, 2011 at 15:18 | Report abuse | Reply
  10. Sarah

    I have been in therapy for several years and have slowly divulged big secrets that I found painful or too embarrassing at some point to talk about. But the one thing that I realized that has not been brought up in the other comments is the after math of sharing these details. There has never been anything that I have ever said in therapy that I regretted after. Usually I feel significantly better getting those thoughts and feelings out. Like others have said therapist are trained to deal with so much that there is very little they have not dealt with and most likely they can reassure you that you are not alone and that your issues are normal. My best advice has already been given. Either write it down or tell the therapist that you have something very private, but are not quite comfortable to share yet. Both of those have been very successful for me to share more.

    April 5, 2011 at 15:36 | Report abuse | Reply
    • patti

      I see a therapist and have for a few years. I have divulged many things, though I still feel there are some things maybe too shameful to discuss even though I trust him completely. Maybe @Fuyuko is correct. I think and hope I am learning coping skills to better help myself cope with problems, guilt or whatever...

      April 5, 2011 at 16:23 | Report abuse |
  11. Fuyuko

    Revealing everything can come back to haunt you. I faced a challenging situation years after I sough therapy because of a car wreck where I had been struck by a distracted driver, who hit a motorcycle and my truck and injured my back. I was suing him, and they subponead all my medical records including those related to my treatment at my therapist's office, because they wanted to make sure I had no pre-existing injury. It was horribly invasive, and had I known this info would be revealed to anyone outside my docs office, I would never have confided in him. I personally will never reveal anything to a therapist that I do not want others to find out since this situation caused me a great deal of anxiety.

    Plus in all honesty, my therapist really didn't do a lot about individual issues anyway except nod his head and take notes and give me general advice. So baring all didn't really help except make me feel stressed out to tell him and relieved that I had, but his answers were general advice and not related to my specific case.

    Therapists are all different and I do not intend to discourage anyone from seeking treatment, especially if they are in pain, but I find some of the best therapy is writing my issues out and reviewing them myself. I have been taught that by my therapist and self help books.

    April 5, 2011 at 18:24 | Report abuse | Reply
  12. Frederica

    Thomas, I suggest you to read the Bible, books related to your painful experiences and also on human abuses and atrocities done in history, at wars and in present restricted nations. You'll know your experiences were relatively nothing and can share your story or may become no need of therapists then. Know that God Himself, Jesus, suffered pain and shame for you. Be strengthened and use your energy to help more miserable, truly voiceless humans around you, around the world.

    April 5, 2011 at 20:59 | Report abuse | Reply
  13. noshells

    I had some things to tell my therapist and I wrote him a letter. I addressed it to him only, personal and confidential. It worked great for me. He THANKED me for trusting him so much. We went over the things in the list I wanted. Saved some things for later, that I have now talked about. I felt exposed for a bit, but we talked it out. He did not judge me or even acted surprised. It was all matter of fact. What did I want to talk about first. He also gave the letter back to me to do what I wanted with it. I LOVE that man, he has helped me so very much. I am learning how it feels to be content and happy. New feelings for me and I'm starting to like them. Good luck to you, do what you feel is best for yourself.

    April 6, 2011 at 02:23 | Report abuse | Reply
  14. studdmuffins

    Therapy....Silence was golden until therapists came along turning it into profit. Deal with your problems and know not everything needs to be aired. When will the national pity party end?

    April 6, 2011 at 06:24 | Report abuse | Reply
    • Sing and Dance!

      Way to go, telling people who are trying to learn to overcome things from their past and move forward in a positive way NOT to seek that help. Very helpful, Mr. Duddmuffin.

      April 6, 2011 at 09:13 | Report abuse |
  15. Thomas

    This question was submitted a while ago and since then I was able to open up to my therapist and move past these issues.

    April 6, 2011 at 16:10 | Report abuse | Reply
    • Alexis

      I think that's wonderful, Thomas. I'm hoping to be able to do the same. I recently went to my first session. It went okay, I did a lot more talking than I thought I would and felt really embarrassed for doing so, but I didn't touch base on the big issues. I know a lot of people (well, just "studdmuffins") may think that it's a joke. I think it's not for everyone. I don't know if it's for me or not quite yet, but I think it is great that you've overcome those personal issues and that you found something to work for you.

      April 7, 2011 at 23:39 | Report abuse |
  16. Jessica

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    Other recent MS patients who have had Autologous Stem Cell Transplantation (ASCT), or stem cell therapy have posted videos and comments on YouTube. http://www.youtube.com/watch?v=jFQr2eqm3Cg.
    Dr. Avneesh Gupte, the Neurosurgeon at Noble Hospital performing the procedure has been encouraged by results in Cerebral Palsy patients as well. “We are fortunate to be able to offer the treatment because not every hospital is able to perform these types of transplants. You must have the specialized medical equipment and specially trained doctors and nurses”. With regard to MS patients, “We are cautious, but nevertheless excited by what patients are telling us. Suffice to say that the few patients who have had the therapy through us are noticing recovery of neuro deficits beyond what the venous angioplasty only should account for”.
    Dr. Unmesh of Noble continues: “These are early days and certainly all evidence that the combination of liberation and stem cell therapies working together at this point is anecdotal. However I am not aware of other medical facilities in the world that offer the synthesis of both to MS patients on an approved basis and it is indeed a rare opportunity for MS patients to take advantage of a treatment that is quite possibly unique in the world”.
    Autologous stem cell transplantation is a procedure by which blood-forming stem cells are removed, and later injected back into the patient. All stem cells are taken from the patient themselves and cultured for later injection. In the case of a bone marrow transplant, the HSC are typically removed from the Pelvis through a large needle that can reach into the bone. The technique is referred to as a bone marrow harvest and is performed under a general anesthesia. The incidence of patients experiencing rejection is rare due to the donor and recipient being the same individual.This remains the only approved method of the SCT therapy.

    July 5, 2011 at 08:16 | Report abuse | Reply
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  18. Rachel

    I recently saw a therapist for the first time, and like Alexis said, did a lot more talking than I had expected to. I left feeling strange that I had just told a total stranger much of my life story. However, one of my main reasons for seeking therapy is for a very big issue, but I feel too embarrassed to bring it up, as it's hard to talk about. It's great that you've been able to open up and move past the issues. I hope that I too can do the same!

    January 21, 2014 at 17:39 | Report abuse | Reply
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