*The following article contains discussion of suicide/self-harm.
Those who seek professional counseling are there because they want to improve their mental health and need guidance.
However, getting some patients to open up on their first meeting seems to be a challenge because they are struggling with their self-imposed shame.
Curious to hear about the things patients finally opened up about in a therapy session, Redditor Music-and-wine asked:
“Therapists, what is something people are afraid to tell you because they think it’s weird, but that you’ve actually heard a lot of times before?”
Redditors who are in the field provided their insights.
“Intrusive thoughts. Nearly everyone has thoughts about pushing the old lady onto the subway train, swerving into opposing traffic, or stabbing their loved one in the stomach while cooking dinner with them.”
“Some folks, however, take these thoughts very serious that believe that they might act them out. It’s called thought-action-fusion. Most of us are able to brush them off, though.” – vedderer
Normalizing A Common Tendency
“Unwanted intrusive thoughts are normal and do not mean you are a bad person (yes, even intrusions of sexual/religious/moral themes).”
“By definition, these are thoughts that are unwanted bc they go against your own values and highlight what you don’t want to do (eg, a religious person having unwanted blasphemous images pop into their mind, or a new parent having unwanted sexual thoughts about their new baby).”
“However normal these thoughts are (over 90% of the population), the moral nature of these thoughts mean that often people experience a lot of shame and take many years before they first tell someone about them.”
“Edit. Because this is getting more visibility that I realised : The occurrence of these thoughts/images/urges are normal.”
“The best way to ‘manage’ them is to accept that they are a normal (albeit unpleasant) brain process, and a sign of the opposite of who you are and are therefore v.v.unlikely to ever do.”
“Let the thought run its course in the background while you bring your attention back to (insert something you can see/feel/hear/taste/touch). I usually say something like ‘ok mind!”
“Thanks for that mind! I’m going to get back to washing the dishes and the sound/sensation of the water while you ponder all the nasties.”
“Carry on!’ I literally say it to myself with a slightly amused tone bc I am always genuinely amused at all the wild stuff my brain can produce!!” – cbearg
The Thing About Grief
“The amount of people I see who feel like they should be grieving a ‘certain way’ and are afraid that they ‘must not have loved someone,’ or, ‘must not have cared.’ People grieve in all sorts of ways. The ‘5 stages of grief’ are bullsh*t.”
“I was consulting with another clinician who was seeing a couple whose daughter had died. The wife was convinced that the husband must not have cared about her because he ‘wasn’t grieving out loud’.”
“In reality, while she had been going to support groups and outwardly expressing, he had been continuing to work in a garden that him and his daughter had kept when she was alive, using that time to process and grieve as he did.”
“Both were perfectly fine ways of grieving, however it is expected that ones grief is more than the other. They both ended up working it out however, he driving her and others to their weekly support group, her attempting to work in the garden with him on the condition that they didn’t talk. Really sweet.”
“To that same extent, the amount of people who are unaware of their own emotions and emotional process is astounding. So many people feel only ‘angry’ or ‘happy’ and worry something must be wrong with them otherwise.”
“Normalizing feeling the whole gamut is just as important. Recognizing what we’re feeling as well as what it feels like in our body when we’re feeling is incredibly helpful for understanding how we process and feel.”
“As a whole, how we treat emotions as a society is kinda f’ked. Thanks for coming to my Ted talk.” – sredac
Feeling Out Of Place
“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.” – GuidedBySteven
“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.” – HighKeyHotMess
What Makes People Happy
“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.” – ljrand
Not Knowing Where To Start
“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’.” – kutuup1989
The Stigmatization Of Sex
“Psychologist here. 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.” – MyDogCanSploot
The takeaway from this thread is that psychologists and other therapists have heard it all and they are there to help patients, not judge them.
While it’s easy to say patients should shed their guilt when opening up about their issues, they should be proud for taking that first step by showing up.
If you or someone you know is struggling, you can contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
To find help outside the United States, the International Association for Suicide Prevention has resources available at https://www.iasp.info/resources/Crisis_Centres/