Therapy is one place you can talk about anything you want. There's no need to censor yourself, be overly polite or avoid conflict. Still, many clients have a lot to say and don't. Why?

I've heard a ton of complaints about therapy. Friends, acquaintances and strangers upon learning I'm a shrink spill their guts about the misunderstandings and miscommunications they've experienced in their own therapy. Things like "I don't see her point" and "why would he say that?" and "what does she think about me?" and "I hate the way he clears his throat." I always respond with the same question: "Did you mention this to your therapist?" Unfortunately, the typical answer is no.

Throughout this blog I've done a lot of talking about client empowerment and helping people get the most out of their therapy. One key point is this: if a problem arises in therapy - talk about it. Unspoken questions/gripes/concerns result in wasted time and money, unnecessary frustration, and may even draw therapy to a premature end.

What kinds of roadblocks am I talking about? How about when your therapist:

- says something that makes no sense to you
- tends to be late for sessions
- made a face, gesture, or comment that brought up a strong emotion for you
- has an annoying quirk
- is taking therapy in a direction you don't want to go, or don't understand why
- seems too chatty, or says too little
- reminds you of someone you love or hate
- didn't seem to get your point
- looks like he's got something else on his mind
- etc.

The list could go on and on. Basically, any time something occurs and you feel like talking about it, you should feel free to do so. This is easier said than done.

For example: my client Jane was upset with how the last session ended. She gave me a compliment as she walked to the door and I didn't seem to acknowledge it. My "stoicism" is frustrating for Jane, and she has been thinking about this all week. In fact, she's frustrated with a lot of things about me: I don't make small talk with her, I don't offer up a lot of details about my life, and when she asked me a direct question about her boyfriend I didn't give a direct answer. She's been talking a lot with her friends, griping about me and therapy. But when she shows up for our session, I hear nothing. She's ten minutes late and seems a bit reserved, but when I ask if there's anything wrong she says no and launches into a recap of her week. When we end this session, I have a vague feeling something isn't clicking between us, but I have no idea what the problem is.

There's so much great material for us to dive into. We could explore why she feels frustrated and how she copes with disappointment, find other places in her life where she feels similarly, examine how she tends to react and when she learned to respond that way. We might discover that what she is feeling in therapy is similar to how she feels in many relationships - frustrated with others for not giving enough, frustrated with herself for needing too much. We could see how her past contributes to this frustration, and how some of her thoughts and behaviors perpetuate it. We could crack this case wide open.

But not if Jane doesn't talk about her frustration, we won't. Not today, anyway.

Every meaningful relationship encounters roadblocks. Misunderstanding, miscommunication and stepping on toes is inevitable. Therapy, being all about communication and intense emotion is no exception. In fact, therapy is so intense there may be more of a risk, and therefore more need to discuss these slights and understand them. Many clients do feel free to vocalize their questions and concerns, but certainly not everyone. Why not? Here are some possible reasons:

Confrontation is scary: Telling your therapist his interpretation makes no sense, or you think he charges too much, or you're afraid he's falling asleep is a confrontation. I'm not surprised if it raises your heart rate a little. But keep in mind a few things. By telling the therapist how you feel, you're giving him more information about you, helping him to understand you better. Also, facing conflict may be a part of your problem, and therapy can be an ideal laboratory to learn to practice confrontation in a healthy way. Finally, you're the customer, and if you're not getting the service you want you have every right to speak up. Most therapists know how to handle confrontation in a non-reactive, non-defensive manner. And if they don't, you can always take your business elsewhere.

"She's the expert:" Some clients keep quiet because they figure the therapist must know what she's talking about. Who are they to question someone with a doctorate and years of experience? So the therapist continues to use jargon and miss the point and the client feels increasingly lost. Yes, therapists have a certain amount of clinical expertise, but if you're not tracking with her, then she has yet to attain expertise in communicating with you. By speaking up, you're teaching your particular owner's manual - the ways in which you learn, communicate and relate the best.

It's impolite: You may be going against the etiquette you use at dinner parties, church or the courtroom - but therapy doesn't play by those rules. The purpose of this time is better understanding your thoughts, feelings and behaviors, which occasionally means talking about issues you would overlook in other social situations, particularly the ones that create a visceral reaction in you. I'm not suggesting you mock or act blatantly rude to your therapist, just say what's on your mind.

Vented already: Jane had plenty of gripes about me, but after venting to her friends for a week the issues didn't seem as pressing. Sure, she was still upset, but by blowing off steam the issues weren't urgent enough for her to confront me. Sometimes it's best to keep the energy of these minor frustrations between you and the therapist, rather than dissipating them by running them by the committee. Certainly, for major conflict (to be discussed in a future blog) a second opinion would be warranted; but the minor frustrations mentioned here are best handled directly with your therapist.

Ignore it, it'll go away: They say the little things that bother you early in a relationship tend to grow into big things later on. This is true for all relationships. Whether it's your second session or 200th, if there's something bothering you I encourage you to bring it up.

I already did: You've already told your therapist you need to end on time because you have to return to work, but he keeps letting the session run over. You're afraid to bring it up again because it feels futile. If it's a problem that is getting in the way of your work together, I suggest you bring it up again. Therapists are human, with as much fallibility and forgetfulness as the next person. There's a chance this reminder might help you get the desired outcome, or perhaps you can find another solution together (set an alarm?). Either way, you've taken care of yourself by talking about it, as uncomfortable as that may be.

Need help getting started? Try this:

"I'm a little uncomfortable bringing this up, but when you _____, I felt _____."

Hopefully you'll see it's not so bad. At the very least, you've spoken up, faced a fear and gotten something off your chest. At best, you've taught the therapist something about you, initiated a change in the therapy, and created an opportunity to learn more about yourself.

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