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13+ Things Your Therapist Won’t Tell You

Whether or not you're part of the 25% of adults who've seen a therapist, these insider secrets will give you a dose of mental medicine.

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Illustrated by Eddie Guy
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1. Sometimes, when we say, “That’s interesting,” it’s really not.

We say that when we get caught thinking about something else.

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2. Don’t take it personally if you see me outside the office and I ignore you.

If I’m with someone, introducing you as my patient would violate patient confidentiality.

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3. Do we talk about you at cocktail parties? Absolutely.

The stranger your story, the better.

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4. Mental illness can damage the brain. You can’t just wait for it to go away.

The longer you wait to get treatment, the worse it will get and the greater the chances that prescription drugs won’t work.

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5. Anyone can call him- or herself a psychotherapist or a therapist.

You want a psychologist, a psychiatrist, a clinical social worker, or a marriage, family, and child counselor. You have to be licensed to use those titles.

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6. It never hurts to ask for a lower fee.

Some of us will say yes.

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7. Long-term therapy makes some patients much more self-absorbed.

Some start to believe that every thought and dream they have is important.

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8. I might exaggerate a diagnosis to get an insurance firm to pay for more coverage.

I use a diagnosis I call adjustment disorder, which means you are having trouble adjusting to your life. That can apply to almost anybody.

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9. Sexual fantasies about patients? Unfortunately, it happens.

When it does, it’s very distracting and troubling.

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10. The people who pay for their therapy themselves seem to get better faster.

The patients who rely on insurance are typically not as motivated.

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11. Sometimes I tell you to do the opposite of what I really want you to do.

For instance, I might tell you that this week I want you to be really depressed, to think about all the reasons you are depressed each day. It works for two reasons: First, nobody likes to be told what to do. And it helps you realize that you have a choice in how you feel.

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12. Please don’t ask things like “Don’t you agree?”

If you’re looking for approval, you’re not going to get it. A good counselor is not there to say yes to everything.

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13. No matter what you tell me, I’ve probably heard it before.

You aren't going to shock me.

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14. Unlike with cancer and heart disease, people with mental illness often think it’s their fault.

So when they get better, they’re proud of themselves for conquering adversity when, really, it was just the Prozac.

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15. Get it straight: Psychiatrists are doctors who go to medical school. Psychologists usually have a doctoral degree.

Both of us can do therapy, but in most states, only psychiatrists can prescribe medication.

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16. If you feel isolated and alone in the world, I probably can’t cure you in psychotherapy.

That is the main issue for a lot of the patients I see. But the best thing you can do is go out in the world and help people.

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17. Today I’m on this side of the couch, but tomorrow I could be on that side.

A lot of us have our own issues.

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18. In expensive cities like New York and Los Angeles, if you want a good psychiatrist, you’ve got to pay cash.

The best psychiatrists don’t take insurance anymore, because they don’t pay us enough. If you go through your insurance, what you’ll get is a five-minute med check, not therapy.

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19. Yes, I may think you’re crazy.

But if you ask me, “Do you think I’m crazy?” I’m never going to tell you that.

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20. Pharmaceutical companies love to give us free samples of the newest drugs.

But a lot of the new drugs—at a much higher price—are very similar to drugs that have been around for a while. So if the first drug your doctor gives you is a new, expensive one, ask if you can try something generic first.

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21. Most of what you say is confidential.

But if you admit to me that you committed child abuse or that you’re planning to physically harm yourself or someone else, I’m legally bound to report you.

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22. It makes me crazy when patients call me at all hours to have a chat.

The fact that you can’t remember what it was I told you you’re supposed to do in a certain situation is not an emergency.

Sources: Psychologists and psychiatrists in California, Washington, Pennsylvania, and Texas

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Your Comments

  • Anonymous

    So you can just say you are a psychotherapist and you need no training or no proof?

    • Shu-yuki

      no, you do need training, but not doctoral level training.

    • BrittanymarieX3

      No, they must have master degrees and be LPC certified. These people are ignorant have have no idea what they are talking about.   

      • cmarie

        It’s true; you have to be LICENSED to be a LICENSED professional counselor (LPC); likewise with a psychologist, LMCH, LADC, LMFT, etc. (it it’s got an “L” in it, a license is required).  It’s also true that anyone can call themselves a psychotherapist, regardless of training.  It’s a buyer-beware market.  Otherwise, I would say that numbers 2 and 21 NEED to come up during the informed consent process in the first session.  So yes, some of these remarks are ignorant, but sadly, not the one about anyone being a psychotherapist.  Hope that clarifies some things for you. :)
        -a doctoral student in clinical psych.

      • Lori Quaresimo

        No, they do not need a masters degree. They can be a social worker and be your counselor without a license or a masters degree

  • Vincent Busby Jr.

    Hi… I’m Psycho, THE RAPIST!!!

  • Vincent Busby Jr.

    Hi… I’m Psycho, THE RAPIST!!!

  • Vincent Busby Jr.

    Hi… I’m Psycho, THE RAPIST!!!

    • rayn.Y

      oh great English showoff  。。。。。 but….

  • Vincent Busby Jr.

    Hi… I’m Psycho, THE RAPIST!!!

  • Socialworker2

    #21…not a secret. anybody in a clinical setting must tell their patients the limits of confidentiality before beginning.

  • Deddrie

    “…they’re proud of themselves for conquering adversity when, really, it was just the Prozac.”  …Okay… and when someone goes to talk therapy and isn’t immediately on medication yet *gasp* gets better?  That wasn’t them doing any work at all??  What the Hell is this crap?  You’re generalizing both clients and therapists, which is exactly what a good therapist of any kind would never do.  

  • Deddrie

    “…they’re proud of themselves for conquering adversity when, really, it was just the Prozac.”  …Okay… and when someone goes to talk therapy and isn’t immediately on medication yet *gasp* gets better?  That wasn’t them doing any work at all??  What the Hell is this crap?  You’re generalizing both clients and therapists, which is exactly what a good therapist of any kind would never do.  

  • Deddrie

    “…they’re proud of themselves for conquering adversity when, really, it was just the Prozac.”  …Okay… and when someone goes to talk therapy and isn’t immediately on medication yet *gasp* gets better?  That wasn’t them doing any work at all??  What the Hell is this crap?  You’re generalizing both clients and therapists, which is exactly what a good therapist of any kind would never do.  

  • Beagle

    Thanks Reader’s Digest for keeping even more people in pain from getting the help they need. 

    • Theshafto

      Copy that, beagle.

  • K4

    There are also Liscenced Clinical/Professional/Mental Health Counselors. These are people with specialized master’s degrees in counseling who have comparable clinical training to those of psychologists and clinical social workers.

  • Jennifer Frank, Ph.D.

    A lot of these things are misleading or wrong. Starting with #2: we discuss a number of things in advance with you and usually even give you a written copy of it, including information like the fact that we do not acknowledge you first in public, for confidentiality reasons. #3: ethical therapists either do not discuss patient material socially or do so in a way that does not reveal any identifying information about you. #4: we will TOTALLY tell you anything about your mental health that will benefit you, like the fact that you can’t usually wait for a mental illness to self-correct. #5: we’re not hiding anything from you, at least, not ethical therapists. You should be aware of the credentials of anybody you plan to work with and be careful about seeing people who have little training.  On the other hand, training is just a part of the picture: you need a therapist you feel understands you and you can work with. #7: yes, this is true for some people, but many people need a long time to work on painful or forgotten problems.  It isn’t self-absorbed to try to understand yourself better and get along better with others. #8: we tell you what your diagnosis is, and it’s on your billing forms. Insurance is a problem because it sometimes forces us to fit you into categories that will be covered, rather than just letting us work with the problems at hand.  Insurance also means that many people without psychological training and knowledge will be seeing your paperwork and making ill-informed judgments about your needs.  You and the therapist have more freedom to do the work when the insurance companies are not involved. #12: this is correct, in the sense that we are not there to simply agree with your opinions.  On the other hand, we are there to support you, and if we agree with you, we will tell you so. #14: Like #4, this is one of the things we tell you early and often: mental illness is NOT your fault and therapists know it is helpful to convey this to our patients.  #15: we will totally tell you what our title is, and we are happy to explain what it entails. #16: BIG problem with this one!  Being isolated is painful and difficult, but people in this position often need a lot of help to get over it.  Therapy can be incredibly helpful for people who are struggling with social connection!  #19: If I think you’re crazy I will tell you, if I think it will help you to know.  People who are suffering from hallucinations and delusions are often relieved to get calm, knowledgeable reality-testing. #21: it is a legal and ethical requirement for a licensed therapist to report a few things, everything else you say, including past crimes, are confidential.  We discuss this with you before we start therapy (see #2). #22: We WILL tell you this.  Most of us are available outside of therapy sessions for genuine emergencies, but we will clarify some ground rules with you if it seems like you are calling for non-emergency reasons.

    • Sugarbush43

      Thank you for your post. I found many of the points made in this article off-putting and arrogant. You sound much more like my counselor (a LSCW) who is honest, upfront, and has a lot of integrity. At the very beginning of our first session, he discussed pretty much everything you said, Jennifer, such as what LSCW means, what is and is not confidential, etc. He doesn’t serve up b.s. and is brutally honest, but he’s never condescending or rude. I’m thankful I have the counselor I have rather than the person who wrote the article.

      To others, please don’t let this one article deter you from getting the help you need. There really are good, professional, caring, honest counselors/therapists out there.

      • cristalexi

        You must have the one truly caring therapist because I have non-clinical professional dealings with these people and a lot of them are extremely arrogant and narcissistic, thinking the world revolves around them. They treat non-clinical people as though we are morons which is probably the real reason for ignoring their patients in public. After all if the person doesn’t mind whether others know why should the therapist. The same probably applies to some of the other points. It took me a long while to get used to their ways as I had never come across such arrogance and condescension in my life. When I first had contact with them they were constantly trying to control and manipulate me. As I said, my dealings with them were in no way, shape or form clinical, so they absolutely had no right to start therapising me. They have backed off now but I’m pretty sure they think I am crazy.

  • Jennifer Frank, Ph.D.

    Oops, forgot to finish up with #14. People deserve to feel proud of themselves for conquering any kind of adversity: be proud of yourself for surviving cancer and be proud of yourself for coping with mental illness!  Especially with mental illness, it’s rarely meds alone that make a difference.

    • Darkshin

      I’m glad you replied. Most students that have taken Psychology 101 should be able to spot most of the ethical issues and sheer exaggerations in this article. Thanks for taking the time to respond.

  • Adaves

    How in the world was this list contrived? Maybe you interviewed 50 “therapists” and picked the ones that would make for most interesting reading? I know this was not a scientific study. Very harmful for folks who are our most vulnerable AND society’s most dangerous
    People need help, and there are more ethical helpful therapists than not.

  • http://profile.yahoo.com/NPV6W5YYILPHQCUPWGBKNJPECM Writes4evr

    It’s not that simple. If you claim you’re a psychotherapist, you better have at least a Master’s degree in psychology, supervision by a licensed psychologist or be licensed as a professional counselor (LPC). Each state board of health different but most require training and some kind of license or supervision with a licensed MH person. If you hang up a shingle and claim your a psychotherapist and dont know what you’re doing (everyone thinks they can give advice), your “patients” could sue you.  You also need malpractice insurance. Companies won’t insure you if you can’t provide proof of significant training, education, and license or supervision by licensed professional.  

  • Hill

    Adjustment disorder – Glad to find out your view. I was discharged from the service after six years (and a failed eye test showing a degerative disorder) because I was said to be “unable to adjust” to military service. No blemishments on an otherwise very good evaluations and a good conduct medal to boot. Thanks for the vote of over-confidence and exaguration.

  • Shark

    It depends on the state but you do have to have a license. I am a Licensed Professional Counselor (LPC) which is not mentioned here and I had to go through very stringent schooling, exams, and internships which are all regulated by the State. I am allowed to use the term counselor, therapist, psychotherapist, etc. There are additional certifications that can also be earned within particular areas such as EMDR, DBT, and so on. 

    • Theshafto

      I would urge you to be cautious with the “psychotherapist” moniker. Those Ph.D.s can be a bit territorial ; )

  • DisappointedDoc

    Wow, this is really rude. Overcoming mental illness is more than just prozac. Prozac fixes a chemical imbalance in some people, but the majority of serious mental illness is more than that and requires more than a little pill once a day, it requires a lot of hard work, to suggest, as many of the slides here do, that mental illness is just being favored by doctors, is hurtful, inaccurate, and offensive. I love reader’s digest, and have for years, and to see something this poorly written, inaccurate and rude on this site, is disappointing to say the least.

  • DoveLogic

    #3, if it is true, that’s illegal and should NOT be happening. I would hope reputable therapists would not talk about their patients. It’s against the APA guidelines.

  • http://www.facebook.com/people/Thorne-Kontos/100002208655723 Thorne Kontos

    Get a good friend, sit down and talk out your problems. Saves you a bundle of cash.

    • Sugarbush43

      This is not the case for those with actual mental disorders, though. For example, there’s a vast difference between feeling “down” and being clinically depressed.

  • Trisha McMaho, LPC

    13 Things Your Therapist . . .  Unfortunately, the article left out another licensed counselor, LICENSED PROFESSIONAL COUNSELOR under #5.  It should have read:  . . . a clinical social worker, or a profesional, marriage, family and child counselor.  A Licensed Professional Counselor is licensed to treat all of the above.  Trisha McMahon, LPC, Mesa, Arizona.

  • Trisha McMaho, LPC

    13 Things Your Therapist . . .  Unfortunately, the article left out another licensed counselor, LICENSED PROFESSIONAL COUNSELOR under #5.  It should have read:  . . . a clinical social worker, or a profesional, marriage, family and child counselor.  A Licensed Professional Counselor is licensed to treat all of the above.  Trisha McMahon, LPC, Mesa, Arizona.

  • Trisha McMaho, LPC

    13 Things Your Therapist . . .  Unfortunately, the article left out another licensed counselor, LICENSED PROFESSIONAL COUNSELOR under #5.  It should have read:  . . . a clinical social worker, or a profesional, marriage, family and child counselor.  A Licensed Professional Counselor is licensed to treat all of the above.  Trisha McMahon, LPC, Mesa, Arizona.

  • Pdflores525

    My sister has been seeing a therapist for over 20 years it hasn’t helped her it only makes her more self centered she does not have a conscious has no empathy and has a sense of entitlement is this normal for a therapist to let her believe this is ok?

    • Sugarbush43

      Therapists work on a two-way street. If your sister is unwilling to help herself, her therapist cannot do anything. However, I believe that if her therapist realizes this, the therapist has an obligation to end the relationship.

      • ccristalexi

        So if the patient gets better the therapist gets the credit but if the patient doesn’t get better it’s the patient’s fault. Okaaaaaay

        has nothing to do with what the therap

  • Bbrock_angel

    therapist are evil

  • dani

    this was hilarious. i think i’m crying

  • Neil Armstrong

    Going to see a counselor and following his advice destroyed my life, it was the dumbest thing I have ever done. First he demanded that I be placed on an antidepressant, by the 2nd week on it I was in a state of psychotic mania, he told me that is how normal people feel and act all the time. I got arrested 3 times in about a month’s time, which cost me my career, friends, reputation, and everything I have ever worked for. Then he tried to get me to believe that this was nothing new and that I must have always been in a state of psychotic mania. I had maintained the same friendships throughout life, many from grade school, I had never even had a speeding ticket and I had never been fired from a job.

  • Lori Quaresimo

    #18 is wrong. I have insurance and I get an hour session with my counselor. Well, now my ex-counselor because she turned out to be an idiot. I also go to the psychiatrist to get my paxil. Again I don’t see him anymore because he is in the same building.