Honesty and Openness in Therapy

Honesty and openness shape what therapy can do. What your therapist knows about your life is largely what you tell them, so what you leave out shapes the work as much as what you say.

Why Honesty Matters in Therapy

Building Trust

Therapy depends on trust, and being honest is part of how that trust is built. As it develops, most people find it becomes easier to say things they would not say elsewhere.

The working relationship between a client and their therapist, usually called the therapeutic alliance, is one of the most heavily researched features of psychotherapy. A meta-analysis of 295 studies covering more than 30,000 patients found a consistent positive association between the strength of that alliance and how treatment turned out, holding across different treatment approaches, measures and countries (Flückiger and colleagues, 2018). That is an association rather than proof of cause, and it says nothing about how any one person's therapy will go. It is, though, part of why therapists treat the relationship itself as something to attend to rather than a backdrop to the real work.

Accurate Assessment

What you say openly is what your therapist has to work from: it is how they come to understand your experiences and difficulties, and how they judge what to offer you. Without it, they are working from an incomplete picture.

Challenges to Being Open in Therapy

Emotional Vulnerability

Opening up in therapy can leave you feeling exposed, because it often involves personal and sometimes painful material. Feeling nervous about that, particularly in the early sessions, is common, and a normal part of the work rather than a sign that something has gone wrong.

Fear of Judgement

Many people fear judgement or rejection when they consider being completely open with another person, including their therapist. Therapists are trained to hold sensitive material with care. Their work is to understand what you bring, not to pass judgement on it.

Strategies to Enhance Openness

Preparation for Sessions

Preparing beforehand can make it easier to open up during a session. Writing down what you want to discuss, or any specific difficulty you are facing, means you are less likely to forget it once you are in the room. This preparation can also make it easier to start conversations about difficult topics.

Setting a Comfortable Pace

You can take things at a pace that suits you. If saying something feels like too much, you can tell your therapist, and the two of you can decide to approach it more gradually.

Pacing and avoidance are not the same thing, and the difference is worth asking yourself about honestly: "Am I pacing myself, or am I avoiding the things I need to talk about?" You can ask your therapist to help you decide.

Benefits of Open Communication

Deeper Insights

Sessions that stay with the immediate difficulty tend to stay there. When you are able to speak about longer-standing patterns as well, those become available to the work too.

Enhanced Personal Growth

Honesty in therapy is not only about settling a presenting problem. Speaking openly about your reactions and your motivations is how people come to understand them better, and that understanding is often what changes how they act.

Managing Emotional Intensity in Therapy

Tolerating Emotional Intimacy

The closeness of therapy can feel like a lot to hold, and a wide range of feelings can come up as you address painful areas of your life. Learning to bear those feelings is part of the work, and the steps below can help.

Techniques to Manage Intensity

• Breathing Exercises: Slow, deep breathing can help settle anxiety during an intense discussion.
  
• Grounding Techniques: Grounding techniques can help you stay present during a session, particularly when discussing traumatic events.
  
• Post-Session Self-Care: Plan something calming after therapy, such as walking, listening to music, or journalling.
  
• Take time to build trust: Meaningful honesty asks for a meaningful relationship. Many people find it easy to tell a stranger on the bus something intimate, precisely because they will never see them again. That can bring relief, and sometimes shame, but change of the kind therapy works towards usually asks for a relationship that lasts.

Role of the Therapist

Your therapist has a part in how the emotional side of therapy is managed. They provide a setting in which you can look at your feelings with someone else present. Therapists are trained to notice when you may be overwhelmed, and can adjust the pace of sessions with you.

Staying on Track

Regular Feedback

Telling your therapist how you are finding the process lets them adjust their approach, and lets you say when the depth or direction of a session is not sitting right.

Therapeutic Goals Review

Revisiting your goals with your therapist from time to time helps both of you see where the work has got to, and whether what you want from it has changed.

Emotional Check-ins

Starting a session by saying how you have been since the last one gives both of you a useful reading of where you are and what you have capacity for that day.

Key Takeaways

• Emotional intimacy is part of therapy: Feeling close to, and exposed with, your therapist is a normal feature of the work rather than a problem with it.
  
• Use coping strategies: Deep breathing, grounding techniques and post-session self-care can help you manage the intensity of a session.
  
• Communicate openly with your therapist: Saying how you are finding the sessions is what lets your therapist adjust them.
  
• Adjust pace as needed: The pace of therapy can be matched to what you have capacity for, and that is a conversation to have openly.
  
• Stay focused on goals: Reviewing your goals regularly keeps the sessions connected to what you came for.

FAQ

How do I know if the pace of therapy is right for me?

If you are often overwhelmed or drained after sessions, the pace may be too intense. If sessions feel like they stay on the surface, it may be too slow. Either way, that is worth raising with your therapist directly.

What can I do if I feel too overwhelmed during a session?

You can tell your therapist you need a moment. You can ask for a short break, move to something else, or use a coping strategy. Your therapist can adjust the discussion or slow it down with you.

Is it normal to feel worse before feeling better in therapy?

It is common to feel worse for a period. Therapy often involves facing difficult emotions and memories, which can be unsettling at first. If that period continues, or deepens, say so in the session. It is information your therapist needs.

How can I make sure I am being open enough in therapy?

Being open in therapy means saying what you think and feel as honestly as you can. It helps to notice whether there are topics you keep away from or play down, and to bring that observation itself into the session.

Can being too open in therapy be harmful?

Openness generally helps, but disclosing something before you are ready, or without enough support around you, can be counterproductive. You should feel reasonably safe and supported in therapy, and be working at a pace that does not lead to retraumatisation or increased distress.

Additional Resources

Baskin, J. H. (2019). Honesty Versus Openness. Psychology Today, Cell Block blog.

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The Alliance in Adult Psychotherapy: A Meta-Analytic Synthesis. Psychotherapy, 55(4), 316-340.