Issues That Patients Are Often Reluctant to Reveal to Their Therapists

There are certain topics that patients/clients are often reluctant to discuss in therapy. However, they can be central to the professional making a proper assessment and planning a successful intervention.
Issues That Patients Are Often Reluctant to Reveal to Their Therapists

Last update: 29 May, 2022

If you’ve ever been to therapy, you’ll know how difficult it can be to start talking about certain topics. In fact, there are some issues that patients are often reluctant to reveal to their therapists. That’s because, despite the fact that a good volume of emotional work is produced in therapy, in order to talk about certain topics, a kind of trust might be required that doesn’t yet exist between the therapist and client.

As a matter of fact, opening yourself up emotionally to a stranger, actively confronting your problems instead of ignoring them, and making yourself vulnerable is anything but easy. Indeed, it can feel really strange, embarrassing, or even frightening to confide your secrets and deepest thoughts to someone else. For this reason, many people withhold certain details.

The need to keep certain things to ourselves is natural. We’re not forced to tell others everything about ourselves. That said, it’s worth keeping in mind that the purpose of therapy is to give you the opportunity to tell the therapist everything that’s happening to you in confidence.

As a rule, the therapist only wants what’s best for their patient. They have no interest in judging them. Nevertheless, they need certain information to be able to assist them.

Everything said in a therapy session is confidential. It’s a safe space where patients and therapists should be able to talk openly. That’s one of the aspects that makes therapy so effective. However, there are some topics that patients are reluctant to reveal to their therapists. Have a look at the list, maybe you identify with one or more of them.

Worried woman in therapy
In psychological therapy, the principle of confidentiality is paramount.

1. Sex life

Many therapists say that sex is a topic that most patients avoid. Nevertheless, a patient’s sex life is, along with other factors, a good indicator of their quality of life.

Although it’s not always the case, the therapist can often better understand the patient’s problems when they know what they’re like in this most private of spheres. Furthermore, sexuality can be a major source of stress, as well as a key to achieving certain reinforcers. This is something that the therapist will take into account when devising an intervention plan.

2. Sexual abuse

Talking about this topic is usually difficult for victims. However, today we know that the consequences of a sexual assault in a patient’s history produce dynamics, both of thought and behavior, of which they themselves are often unaware.

In fact, the abuse continues to harm them, even though they may think they’ve overcome it. After all, we don’t need to consciously think about an event for it to influence us.

Therefore, in cases where there’s been sexual abuse it’s often really important to get the full story. The therapist can help a lot in this regard but needs to be aware that there’s been a potentially traumatic event. They also need to know the full story with which the client/patient will later work.

What happened is as important as how the story is told. A police report or a description made by another is of little value compared to the victim’s own testimony. The testimony of a victim is also useful if the patient is the aggressor, for the purpose of their reintegration.

3. Money

We live in a society where money is a source of quarrels and envy. Therefore, it’s hardly surprising that some people are reluctant to bring up the subject, even in therapy sessions. However, it’s important for the therapist to know certain details regarding the patient’s money.

They might ask their client if they manage to get to the end of the month without running out. Are they able to save? Does the subject of money generate a great deal of stress for them? They’re questions that could be extremely relevant since the answers can explain many maladaptive behaviors.

As a matter of fact, knowing how a patient manages their resources can be extremely revealing. That’s because there are often connections to other areas of their life where spin-off problems can be identified. For example, the patient’s education regarding money can transcend the relational sphere, conditioning the way in which they choose their partners.

4. Health problems and illnesses

Physical and mental well-being strongly depend on each other. While some people may find it uncomfortable to talk about pre-menstrual syndrome or gastrointestinal issues, it’s important to do so, especially when it concerns a condition that might be upsetting or stressful for them.

In addition, physical symptoms can negatively affect mental health. For instance, if the patient has an overactive thyroid, they may experience symptoms of anxiety. Consequently, any intervention would be rather different.

5. Reflections on the course of therapy

The patient may often feel frustrated, sad, or disappointed yet find it difficult to tell their therapist. After all, giving negative direct feedback is quite uncomfortable. However, therapy is meant to offer the patient the perfect setting to work on their conflict and become more assertive.

Encapsulating and avoiding their feelings isn’t a good idea. Also, if the therapy isn’t going well, they should say so. Then, the therapist will be able to make the necessary adjustments to redirect its dynamics.

It may also happen that the patient and the therapist aren’t on the same wavelength. That’s fine and doesn’t have to be a problem. The important thing is to communicate the fact. Indeed, therapists are used to these kinds of situations and have the resources to act accordingly.

6. Food

Some people feel uncomfortable talking about their relationship with food and their body image. It’s usually because of the false assumptions that a good part of society has concerning problems with diet and lack of willpower.

Consequently, it can be unpleasant for the patient to discover patterns of behavior related to nutrition that need to be changed and taken care of.

Woman in therapy, depicting the subjects that patients are reluctant to reveal to their therapists.
Talking about eating habits can be complex, especially if the patient is struggling with them.

7. Identity

The term identity can refer to gender, ethnicity, sexual orientation, or religiosity, among others. It may sound rather obvious, but these points are extremely important in order to understand who a person is, what they’ve lived through, and what their values are.

Even if some aspects of their identity are visible or they mentioned them during their first session, they should bring them up again during the course of therapy, so that the therapist can get a complete picture of their life.

8. Uncomfortable stories

Everyone needs to be loved and accepted. In some cases, this unsatisfied need could be an obstacle to the success of the therapeutic process.

In therapy, many stories are heard in which the narrator is responding to social expectations of good behavior. That’s because we tend to shape our stories to fit performances that we think are adaptive.

This is also logical because admitting mistakes isn’t that easy. However, it’s important to also talk about these experiences if positive change is sought. In fact, the honesty of the patient/client is essential for the therapist to be able to carry out a good evaluation and make any adjustments to the intervention to optimize its results.

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  • American Psychological Association (2013). Orientación sexual e identidad de género. Recuperado de: https://www.apa.org/topics/lgbtq/sexual
  • Echeburúa, E., & Corral, P. D. (2001). Eficacia de las terapias psicológicas: de la investigación a la práctica clínica. Revista Internacional de Psicología clínica y de la salud1(1), 181-204
  • García Laborda, A., & Rodríguez Rodríguez, J. C. (2005). Factores personales en la relación terapéutica. Revista de la asociación española de neuropsiquiatría, (96), 29-36.