Deciding to start therapy is a courageous step toward improving your mental well-being. The therapeutic relationship is a unique partnership built on trust, honesty, and vulnerability. To get the most out of your sessions, it is essential to be as open as possible with your therapist. However, it can be difficult to know what is important to share, especially when dealing with feelings of shame, fear, or uncertainty. Some topics may feel too embarrassing, too trivial, or too dark to bring up, leading you to withhold information that could be key to your progress.
A therapist’s office is a confidential and non-judgmental space designed to help you explore your thoughts and feelings safely. Your therapist is not there to judge you; they are there to help you understand yourself and develop healthier coping mechanisms. The more information they have, the better they can tailor their approach to your specific needs. This guide outlines ten crucial things you should always feel empowered to tell your therapist. Sharing this information will not only strengthen your therapeutic alliance but also accelerate your journey toward healing and personal growth.
1. Your Full Medical History and Medications
It is crucial for your therapist to have a complete picture of your overall health, not just your mental state. Your physical and mental health are deeply intertwined. Certain medical conditions, such as thyroid disorders or chronic pain, can present symptoms that mimic or worsen mental health issues like depression and anxiety. If your therapist is unaware of a physical ailment, they might misinterpret your symptoms and be unable to provide the most effective treatment. Sharing your full medical history allows them to consider all potential factors contributing to how you feel.
Likewise, you should always disclose any medications you are taking, including prescriptions, over-the-counter drugs, and even herbal supplements. Many substances can have side effects that impact your mood, energy levels, and cognitive function. A new medication could be the source of recent anxiety, or a supplement might interact with psychiatric medication your therapist is considering recommending. Providing a complete list of what you are taking allows your therapist to make informed decisions and collaborate more effectively with your other healthcare providers, ensuring your treatment plan is safe and holistic.
2. Any Thoughts of Self-Harm or Suicide
This is often the most difficult topic to bring up, but it is unequivocally the most important. If you are having thoughts of harming yourself or ending your life, your therapist needs to know immediately. Many people hesitate to share these thoughts out of fear of being hospitalized against their will or being judged as “crazy.” However, therapists are trained to handle these disclosures with care and professionalism. Their primary goal is to keep you safe. Sharing these thoughts does not automatically lead to hospitalization; in most cases, it opens up a conversation to create a safety plan. This involves identifying coping strategies, support contacts, and steps to take when these feelings become intense.
A therapist can help you understand the root of your suicidal thoughts and work with you to address the underlying pain and hopelessness. They can provide you with tools to manage these overwhelming emotions. Remember, expressing these thoughts is a sign of strength and a critical step toward getting the help you need. Professional Mental Health Services exist for this very reason—to provide a safe harbor during your darkest moments. Withholding this information prevents your therapist from providing the life-saving support they are trained to offer, putting you at serious risk. Honesty in this area is not just helpful; it is essential.
3. Your Experiences with Trauma
Trauma, whether it is from a single event or a series of experiences over time, can have a profound and lasting impact on your mental health. It can manifest in ways you might not even connect to the original event, such as anxiety, depression, anger issues, or relationship problems. You might be tempted to avoid talking about past trauma because it is painful to revisit or because you feel you have “already dealt with it.” However, unprocessed trauma often remains a powerful undercurrent in your life, influencing your behaviors and beliefs in subtle ways.
Telling your therapist about any traumatic experiences—even if you do not think they are a “big deal”—gives them critical context for understanding your current struggles. Therapists who are trained in trauma-informed care can help you process these memories in a safe and structured way, reducing their emotional power over you. They can use specific techniques, like Eye Movement Desensitization and Reprocessing (EMDR) or Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), to help you heal. Avoiding the topic only allows the trauma to maintain its control. By bringing it into the light of therapy, you can begin to reclaim your sense of safety and peace.
4. Substance Use and Other Addictive Behaviors
It is common to feel shame about substance use or other addictive behaviors, such as gambling, overeating, or excessive shopping. You might downplay how much you drink or avoid mentioning your reliance on a particular substance altogether. However, these behaviors are often deeply connected to the emotional issues you are in therapy to address. Many people use substances as a way to self-medicate or cope with underlying pain, anxiety, or depression. If your therapist does not know about your use, they are missing a huge piece of the puzzle. This is especially true for new parents who may be struggling with Postpartum Depression and turn to substances as a coping mechanism.
Being honest about your substance use allows your therapist to assess whether it is a symptom of another issue or a separate disorder that needs its own focused treatment. They can help you develop healthier coping strategies and, if necessary, refer you to specialized addiction treatment programs. Without this information, the therapy might stall because the root coping mechanism is not being addressed. Your therapist is not a law enforcement officer; they are a healthcare provider. Their goal is to help you, and knowing about all your coping strategies—both healthy and unhealthy—is essential for them to do their job effectively.
5. Your Relationship Dynamics and History
The relationships in your life—with family, friends, and romantic partners—are fundamental to your mental well-being. How you interact with others, the patterns you fall into, and the conflicts that arise are all rich sources of information about your core beliefs and emotional triggers. Be open with your therapist about the state of your current relationships. Discuss the arguments you have, the people you avoid, and the dynamics that leave you feeling drained or unfulfilled. Sharing details about your support system helps your therapist understand your resources and the stressors in your daily life.
It is also important to discuss your relationship history. Past relationships, starting with your family of origin, shape your attachment style and your expectations for how others will treat you. If you consistently find yourself in similar types of unhealthy relationships, exploring your past can help you understand why. Talking about these patterns can illuminate fears of abandonment, difficulties with trust, or a tendency to people-please. This information is vital for individual growth and is the entire foundation of specialized work like Couples Therapy, where understanding each partner’s history is key to healing the current dynamic.
6. Your Feelings About Therapy and Your Therapist
Therapy is a professional relationship, but it is a relationship nonetheless. It is completely normal to have feelings about the process and about your therapist. If you feel that therapy is not working, that you are not making progress, or that you are not “clicking” with your therapist, you should say so. It may feel awkward or confrontational, but providing this feedback is incredibly valuable. Your therapist can use this information to adjust their approach, clarify your goals, or explore what might be getting in the way. Sometimes, a feeling of being “stuck” is a sign that you are on the verge of a breakthrough.
It is also important to share if you feel judged, misunderstood, or unheard by your therapist. A good therapist will welcome this feedback and use it to improve the therapeutic alliance. If you find yourself having strong feelings toward your therapist—whether positive or negative—this can also be important to discuss. This phenomenon, known as transference, can reveal a great deal about your patterns in other relationships. Honesty about your experience in the therapy room itself can turn the session into a real-time laboratory for practicing communication and resolving conflict.
7. Your Financial and Work-Related Stress
Stress related to your job and finances can be a significant burden on your mental health. You might feel that these are “practical” problems that are not relevant to therapy, but they are often deeply connected to your sense of self-worth, security, and identity. Worrying about paying bills, feeling undervalued at work, or dealing with a toxic boss can lead to chronic anxiety, depression, and burnout. If you are struggling to make ends meet, that financial insecurity can create a constant state of high alert that makes it difficult to focus on emotional healing.
Tell your therapist about your work environment and any financial pressures you are facing. They can help you develop strategies for managing workplace stress, improving communication with colleagues, or navigating a job search. They can also help you untangle the emotional components of your financial situation, such as feelings of shame about debt or anxiety about providing for your family. A therapist can provide a space to explore how your career and financial life align with your values, helping you make decisions that support both your bank account and your mental well-being.
8. Secrets You Are Keeping from Others
Secrets can be a heavy weight to carry alone. The act of holding onto a significant secret—whether it is about your identity, a past mistake, or a hidden struggle—requires a great deal of mental energy. This can lead to feelings of isolation, anxiety, and shame. The therapy room is a confidential space where you can finally put that weight down and examine it without fear of judgment or repercussion. Sharing a secret with your Mental Health Therapist can be an incredibly liberating experience. It allows you to speak the unspeakable and process the emotions you have been suppressing.
Your therapist can help you understand why you have kept the secret and what fears are associated with revealing it. They can work with you to explore the potential consequences of telling others and help you decide if, when, and how you might want to do so. Even if you decide never to share the secret with anyone else, having one person who knows and accepts you unconditionally can drastically reduce its power over you. The relief that comes from unburdening yourself can free up the emotional space needed to work on other areas of your life.
9. Your Goals and Aspirations for the Future
Therapy is not just about fixing what is broken; it is also about building a life that feels meaningful and fulfilling. Your therapist wants to know about your hopes, dreams, and goals for the future. What does a happy life look like to you? What do you want to achieve in your career, your relationships, and your personal growth? Sharing your aspirations helps your therapist understand what truly motivates you. It provides a positive focus for your sessions and helps to shape a treatment plan that is not just about reducing symptoms but about moving toward a life you value.
Sometimes, mental health issues can obscure your vision for the future, making it difficult to dream or set goals. In these cases, your therapist can help you reconnect with your passions and values. They can assist you in breaking down large goals into small, manageable steps, making them feel less overwhelming. Working toward a positive future can be a powerful antidote to the hopelessness that often accompanies depression and anxiety. By making your goals an explicit part of your therapy, you and your therapist can work together to build the skills and confidence you need to create the life you want.
10. Any Physical Symptoms You Are Experiencing
Mental and emotional distress often manifest in the body. You might be experiencing physical symptoms like chronic headaches, stomach problems, muscle tension, or fatigue without realizing they are connected to your mental health. This is known as somatization. If you are only telling your doctor about these physical symptoms and only telling your therapist about your emotional symptoms, neither provider has the full picture. It is crucial to inform your therapist of any persistent physical issues you are experiencing.
This information can provide important clues about the nature and intensity of your emotional state. For example, constant stomachaches could be a sign of underlying anxiety, or chronic fatigue could be a symptom of depression. Your therapist can teach you techniques like mindfulness, deep breathing, or progressive muscle relaxation to help manage these physical manifestations of stress. They can also help you explore the emotional triggers that might be causing your physical discomfort. Bridging the mind-body gap is a key part of holistic healing, and being open about your physical symptoms is the first step.
Conclusion
The therapeutic process is a collaborative journey that thrives on open and honest communication. While it can be daunting to share your deepest fears, secrets, and struggles, doing so is the key to unlocking the full potential of your therapy. By being transparent about your medical history, your thoughts and feelings, your relationships, and your goals, you provide your therapist with the necessary tools to guide you effectively.
Remember that therapy is your time and your space for healing. Your vulnerability is not a weakness but a strength that allows for genuine connection and profound change. The more you are willing to share, the more your therapist will be able to help you navigate your challenges and build a healthier, more fulfilling life. Trust in the process, trust in your therapist, and most importantly, trust in your own courage to be open.
