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Cognitive Behavioral Therapy

Five Tips on How to Talk About Yourself in Therapy

Talking about yourself and your problems in therapy is hard.

Photo by throw her in the water/Flickr
Source: Photo by throw her in the water/Flickr

It's hard to get much done in psychotherapy without talking about yourself. Yet, one of the most common problems for people in therapy is the feeling that initiating a conversation and talking about oneself is difficult.

Whether it shows up as difficulty standing up for oneself at work, crippling fear of small talk at social events, or problems being open and intimate with friends and romantic partners, many people seek therapy in the first place because of their difficulties in relating to other people and voicing their thoughts, feelings, wants and needs. As if talking about your day-to-day experiences weren't difficult enough, therapy challenges us to talk about tough topics such as sex, anger, or sadness.

Trouble talking about yourself in therapy can lead to some uncomfortable moments and awkward silences. This can make it difficult to seek out or stay in therapy and can be an obstacle to how well treatment works. The problem can be compounded when the therapist seems too passive, unstructured, and lacking in providing feedback or guidance.

Afraid of opening up or sharing your thoughts in therapy? Here are five things you can do:

1. Find the right kind of therapist for you.

In general, well-established and legitimately practiced brands of therapy (such as cognitive-behavioral, psychodynamic, dialectal-behavioral, or interpersonal therapies) are about equally effective for many problems and many people. However, as an individual, you may feel more comfortable looking for a therapist who practices one type of therapy versus another.

Some therapists are more active than others in initiating topics of conversation. One thing we know from psychotherapy research is that a therapist's theoretical orientation is often (but not always) a good predictor of this process: psychodynamic-interpersonal therapists frequently allow/suggest their patients to take the lead in initiating conversation whereas cognitive-behavioral therapists are more likely to actively lead and guide topics of conversation.

However, just because one type of therapy is known to be more structured and directive does not mean you should immediately run out to get that type of treatment. You have to be thoughtful about what you want out of treatment and what you hope to achieve. Cognitive-behavioral therapies (CBT) can be useful for focused and discrete problems like dealing with depression symptoms or managing social anxiety, but may not focus as much on emotional expression, linking patterns between past and present interpersonal experiences, or understanding and dealing with lingering concerns about experiences in your past. Psychodynamic or interpersonally oriented therapists tend to value the process of helping patients talk about themselves freely and openly (especially if their difficulties in talking about their feelings/wants/needs is one of the problems that led them to seek therapy in the first place).

In the end, a therapist's flexibility is important. Regardless of the type of treatment practiced, therapists tend to be more effective when they are flexible in meeting patients' needs about the level of direction or structure in the treatment conversation.

2. Talk to your therapist about the problem.

This may sound silly if the actual problem is talking to your therapist about your problems in the first place. However, one of the factors most strongly and repeatedly linked to improvement in psychotherapy is the quality of the relationship between a patient and therapist. One aspect of a strong psychotherapy relationship is confidence in the collaboration with the therapist. It's important for patients and their therapists to actively negotiate/collaborate on what they want from therapy and what the expectations/process of the therapy should be. In this process, flexibility in both the patient and the therapist is important as is the ability to maintain a reasonable and boundaried treatment frame.

3. Start a journal.

The act of writing down your thoughts, feelings, and experiences can be incredibly liberating, constructive, and healthful. Like exercise, journaling requires commitment and regularity. Set aside a time and special place for journaling (even if it's just 5-10 minutes!) and stick to it. Make it your goal to write down whatever thoughts and feelings come into your mind and try not to censor yourself. No thought is too silly or stupid. Lousy handwriting? Who cares! Forget your sixth grade English teacher! The blank page is your space to write what you want, how you want, spelled whatever way you want. No one has to see your writing. You don't even have to keep it! You can tear it up, trash it, or just hit delete. As you get more into the habit of honoring your time to write down what you think and feel, you'll get better at it. If writing comes easier to you, you might even consider bringing your journal with you to therapy and using your entries to jump-start the conversation.

4. Practice, practice, practice.

With time, attention, and practice, sharing your voice with others may become easier. This is not an easy process, and in fact, staying silent may be one coping skill you've developed over time to keep yourself safe from people like an overcritical parent or a demeaning boss. However, if you get into the practice of opening yourself up in ways that you still feel safe and with people you can trust, you just might be surprised at the results. You may end up feeling more confident, emotionally secure, and in greater control of your life and your relationships.

5. If therapy's broke, fix it.

Therapy is not supposed to be easy. Starting therapy is hard and even if you've been in therapy a while, you're bound to hit rough patches with regularity. In fact, "deep" sessions where you address and work through tough topics and interpersonal conflicts are generally more effective than "smooth" ones which gloss over important or difficult subjects. However, if therapy is a grudging experience week after week, something is wrong. Seen as early as after the first three sessions, the overall quality and strength of the therapeutic relationship is highly predictive of what the quality of the relationship will be throughout the rest of the treatment.

If you have a problem with the therapist or how the therapy is going, in most cases (except those of boundary violation or professional misconduct), the first and best thing to do is talk to your therapist. If you've been in therapy awhile and things had been going well, but seem to take a turn for the worse, you might just be working through a critical or difficult issue. If you've just started, you might be learning about or adjusting to the process of being in therapy. If you've talked to your therapist about the problems with the therapy and made efforts to work through it over a course of time and at least a few sessions and things still haven't improved, it may be time to consider a different therapist or approach. You should talk to your therapist about leaving and they can perhaps even suggest a referral to a new therapist or different treatment approach.

By Jared DeFife, Ph.D.
© March 29, 2011


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