20 Things That Therapists Hear Quite Often But Many Patients Find It Unsettling To Talk About Them

There is still so much stigma attached to mental health that people hesitate to open up about their problems, even in front of their therapists. It’s very common for people to hide things from therapists due to fear or embarrassment, and that sometimes hinders the effectiveness of therapy.

#1

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“That they do not know what they enjoy doing. Often they have people in they’re life, including therapists, say “try to do something fun today” or ask “what do you like to do when you have free time?”. Many people I work with do not know what those are. Once I explain that I dislike these statements /questions because they assume people should know the answer, and that many people don’t, I can watch as they relax, take a deep breath, and say something to the effect of “oh my, that’s so good to hear. I have no idea what I like to do. That’s part of the problem.”. More often than not they feel like they should know and that everyone else their age has it figured out. They are embarrassed to say that they don’t know when in fact not knowing is very common. I couldn’t even try to count how many clients I’ve had this conversation with.”

#2

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“I have heard some variant of “This is probably weird, but I feel if I am my true self around others than they won’t like me” more times than I can count. As I explore the formative situations to this belief alongside my clients it definitely pulls at my heart strings.”

#3

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“Imposter syndrome is present in nearly every client I’ve worked with (hundreds over the years), and it sometimes is hard for people to recon with that they feel incompetent in work or life. It is super common to feel like everyone else has it figured out, and that you are the only one flailing. The biggest thing that I’ve learned in transitioning to adulthood and in getting an in depth look into so many people’s lives, is that we are all just trying to figure it out, and a lot of energy goes into trying to make it look like we know what we are doing and fear of being found out.”

#4

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“That they “hear voices”. I’ve found that a lot of people aren’t familiar with their own internal dialogue or “self talk” and that this is typically “normal” internal processing. A lot of people think that they are “hearing voices” and hallucinating. There are some pretty simple questions we can ask to determine if it’s hallucinating or just internal dialogue, and most often it’s the latter.

Edit: I want to clarify that not everyone has am internal “voice”. Some have none at all, some have more of a system of thoughts that aren’t verbal, feelings, or images. That’s normal too!”

#5

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“Missing their depression after their mood starts to improve.”

#6

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“A common one in the time I was a therapist was simply “I don’t know”. You’d be surprised how reluctant people are to admit that they don’t know why they’re feeling how they are. But that’s exactly why you’re (or were, I’m not a therapist any more) sat there with me; so we can figure out why together. It always put me in mind of a line from America by Simon and Garfunkel:

“Kathy, ‘I’m lost’ I said, though I knew she was sleeping. ‘I’m empty and aching and I don’t know why’.””

#7

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“Two topics come up with regularity: when someone discloses to me that they were sexually abused as a kid, and/or when some is experiencing suicidal ideation. Both are something I hear from clients every single day, and so I don’t find it weird at all. But, when I have someone in front of me who’s talking about it for the first time, I know it’s important to validate the fact that even though I might be talking about this for like the fifth time that day, they have never talked about this EVER, and are in need of gentle care to feel safe.”

#8

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“Clients become quite fearful of admitting that they weren’t successful since the last time they had a session. This could include not succeeding in using a coping skill that they’re learning about, or not being able to complete a homework assignment I gave them. Humans aren’t robots, and therapy is a lot of work.

That being said, I don’t expect people to be perfect as they start to work on themselves in a positive way. It takes time to really commit to change, especially in relation to trauma or conflicted views that an individual holds. I feel as if the client doesn’t want to let me down as their therapist, but these “failure” events are just as important to talk about as successful moments!”

#9

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“Licensed Professional Counselor here.

Pretty much everything. But a common one is “secret feelings.” Secret resentment towards a spouse or the difficulties of being a parent. Lost attraction in a spouse. Private daydreams and sexual fantasies. Seems like every time someone tells me “I have this really weird daydream I’m always having…”, they then tell me their variation of the Suffering Martyr Daydream. So common it has a name!”

#10

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“I’d say a common one is believing that there’s something innately, irreparably wrong with them that makes them unable to ever truly ‘fit in’. For a lot of people it’s such a deeply ingrained belief that it can be extremely painful to acknowledge or express, regardless of the level of personal success in their lives.”

#11

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“Basically, anything having to do with sex. There’s so much shame. Sexual abuse. Sexual fantasies and fetishes. Erectile dysfunction. Infidelity. Becoming sexually assertive. I’ve been told that I have a good “psychologist’s face.” I try not to have a strong reaction to normalize the discussion. With adolescents, they are extremely anxious to tell me if they’ve relapsed or aren’t doing well. They cut one night or they were suicidal. They’re having a lot of negative self-talk or panic attacks. They’ll come in, pretending everything is okay. It’s usually in the last 10-15 minutes that they’ll say something. They’ll reveal that they worried they’d let me down. That I’d be disappointed in them. It usually turns into a discussion about policing other people’s feelings and tolerating emotions. I explain that I care about their well-being and it’s my job to monitor my emotions and reactions, not their role.”

#12

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“I do a lot of trauma work. Many people who have experienced molestation or sexual assault feel ashamed and confused because their bodies responded. Having an erection/lubrication or even an orgasm does not mean you wanted the sexual contact and it is still assault. Clients often hold a lot of shame and confusion about this. They wonder if it means they wanted it or if there is something wrong with them. It is a tough thing to work through because of this. Assault is assault. Sometimes human bodies respond to sexual touch even when we don’t want that touch.
Someone once said it’s like tickling. You laugh when you get tickled even though you don’t want someone to tickle you.”

#13

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“Recurring intrusive thoughts about harming others. Can be hurting/killing someone or sexual fantasies about children or relatives. Usually people take a while to admit those. The reality is that if you are having them frequently you aren’t dangerous. You probably have OCD and are terrified that you might be dangerous.”

#14

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“I work in an older adults service for people with dementia and mental health problems. I see a lot of family members/Carers feeling ashamed of the fact that they are finding it incredibly difficult to care for someone that has dementia or a chronic mental health problem.

Carer burnout is a real issue and people need to know that it’s not easy to see someone you love struggling every day, or slowly fading away month by month. Carers and family members desperately need time for themselves and need to know that it’s okay to feel the way that they do. No one is superhuman and we all have our own needs. It’s why we have therapy groups for Carers. It’s okay to struggle to look after someone and you should in no way feel ashamed of having those feelings.”

#15

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“Being tired of being a mother. There’s this social thing of loving your kids and they should be the first thing in your life, but having a child is messy and a real hard work, is normal to just want to take a break once in a while from all that responsibility.”

#16

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“The relief one feels when a loved one dies after a prolonged illness. It’s very normal and common, yet a very guilt laden emotion. It’s perfectly okay and normal to feel this even amongst the grief and sadness.”

#17

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“Husbands sexually abusing their wives. It’s f**king heartbreaking every time I have to explain to my clients their husband’s actions are textbook sexual assault.”

#18

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“Speaking to their departed loved ones. Thankfully, theories now support this and don’t consider it to be a sign they’re not “moving on with their lives”. I encourage my clients to explore the continuation of their relationships with the deceased.”

#19

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“That they haven’t had sex with their partner in years and don’t know how/if they will ever have sex with their partner again. There is so much shame around sex in the USA that a lot of people are scared to talk to their partner about their sexual needs. Time goes by, and suddenly they haven’t had sex in 3, 5, 10 years. It starts for a lot of people in their 40s and 50s.

A lot of people (falsely) believe there is something wrong with their marriage because they fantasize about people other than their partner.”

#20

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“That they don’t like their family members, are angry/want to stop communication with their parents etc. I work in a country which Is more culturally collectivist, so not wanting anything to do with your parents makes you an a**hole in the current cultural sense. We deal with this almost on a daily basis. There is deep and profound shame in this and when we find that line of “oh, it might be that your parents are toxic to your mental well being/trigger your trauma” many of my clients actually get visibly angry with me. Cultural psychology is so important, cause when I first moved here I had my American/European hat on, oh boy, did I need to adjust.

EDIT: I’m in Ukraine”