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

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

    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.

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

    The stranger your story, the better.

    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.

    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.

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

    Some of us will say yes.

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

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

    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.

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

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

    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.

    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.

    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.

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

    You aren't going to shock me.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

    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

    • Chole

      I actually googled “do I need to go to a counselor?” And this completely put me off. I feel like I need help, but these have made me think twice. Thanks. I’ll just suffer in peace because that sounds much better than this.

      • guest

        Please do not let this idiotic, mindless article put you off from going to therapy! If you feel like you need help, follow that instinct and don’t think twice about this article. There are people out there who can help you and who truly care.

    • Green

      That’s the thing. Unless you’ve got some serious trauma or illness, these people aren’t going to tell you things you don’t already know. Although when I was a kid I visited a psychologist for something. At the end of the session the guy said nothing was wrong with me. He was angry because I’d never took his advice and wanted to cut our sessions. However, the psychiatrist kept giving me medications to take. If nothing is wrong with me? Why are ya’ll giving me medicine? Now, I’m worse off then what I was. I don’t have a normal adult life. I often wonder why the psychologist didn’t pick up on some bad behaviors I had and address them? It is not about treating severe mental illness. I would think it is about correcting behaviors.

      • Green

        Correction, it is not always about treating severe illness. I had two psychologist. The first one was just practicing while getting her masters. Sometimes I could sense an attitude off of her, like she was annoyed with me. Once I told her I was depressed. She told me, can you get up and brush your teeth in the morning, take a bath, etc? I said yes. She told me, then you’re not depressed. I have patience that can’t even get out the bed in the morning? The more I think about that the more pissed off I get! Just because I get up in the morning and do what I am supposed to do! Does not mean I am depressed. It just means I’m going to get up and help myself no matter what! If something wasn’t wrong, then why on earth would I even be at the psychiatrist????? For fun????? That made me so mad. It was as if, they don’t take you seriously unless you have a chemical imbalance. Sometimes you just need help with your life that your folks can’t give you. Maybe I should have gone to a counselor.

        • Green

          I meant to type * Just because I get up in the morning and do what I am supposed to do, does not mean I am NOT depressed.*

          I also meant to type *patients*

          Then they kept giving me all this paxil. They even gave me a greater dosage.

    • concernedforafriend

      Other than Child Abuse and threatening/planning to harm themselves or someone else what is a therapist, psychotherapist, etc. legally bound to report? If someone was a little too “hands on with girls in public” when they were younger or watched porn and child porn popped up and the patient feels bad, is that something that would need to be reported?

      • ?

        about the porn no it doesn’t need to be reported

    • Mike Petragnani

      No point in seeing a shrink nowadays. They can’t help anyone.

    • 00000

      “We talk about you at dinner parties” Oh, great, that’s all I need.

    • hlanae

      This is terrible. Whoever wrote this list should seriously reread their ethical guidelines and rethink their profession of choice. The best therapists only accept cash!?! Ridiculous. You are perpetuating the stigma surrounding mental health counseling and feeding untrue information to the public.

    • disappointed reader

      This is an extremely irresponsible, repugnant article.

    • missy

      I would like to give my 2 cents. I have been working in the field for awhile. Some therapists such as the ethical one’s keep stuff confidential. Based upon my experience, MOST of the mental health providers DO NOT provide confidential services. I do believe that independent private practice providers tend to keep things much more confidential that community mental health providers. Confidential information regarding clients often leak during supervision and auditors (who read the entire chart) EVERY Community Mental Provider that I know of for violates HIPPA daily. 1. I know of a psychiatrist the meets with clients with the door wide open. 2. I know of some professionals that talk about their clients at employee dinner parties, drug rep luncheons, and happy hours. And they often provide names. Also, not in the form of supervision, but to make fun of the clients. 3. I know of some professionals that share confidential info to non-employees such as family members and friends. 4. Also, some employees have obtained info that they should not have access to such as people that are not even their clients.

    • codyepic

      “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” what if we tell you about a crime we know of someone else committed, do you have to report it?

      • Dedicated Grad Student

        It depends upon the crime and when it occurred. For example, if you tell me that your brother murdered someone last week, I cannot report it. If you tell me that you bought a gun and have a plan to break into your ex’s home and lie in wait to shoot him or her that night, I have an obligation to report (and, most likely, to activate a 72-hour hold to keep you and your ex safe).

        Generally speaking, crimes against property are not reportable.

        My understanding is that the purpose of the exceptions to confidentiality are to:

        1. Protect clients and others from immediate and genuine danger of harm or death.

        2. Protect vulnerable individuals who cannot reasonably be expected to protect themselves (e.g., children and, in some states, elderly or compromised adults) from past, future, or ongoing maltreatment.

        3. In some states, we are also required to disclose some kinds of information regarding deceased clients to coroners.

        Beyond that, we are neither required, nor permitted, to break confidentiality without written consent given by the client or legal guardian if the client is not eligible or able to give informed consent.

        That said, there are other kinds of information that are disclosed within the bounds of legal confidentiality. Third party payors (e.g., insurance companies) can request diagnostic information and progress notes. That does NOT mean that they can have access to every bit of information in your file. What is required/restricted varies by state. In general, the professional ethics of each discipline state that only the minimum of information required to fulfill a lawful request may be provided.

        Hope that helps!

    • prometheus complex

      So you admit you lie and don’t see how exaggerating someones issues or trying reverse-psychology could be extremely dangerous.. and is deeply immoral in every conceivable possible way? Gee, I wonder why real scientists call all of this bologna. Why is it that idiots like you claim to be intelligent and trustworthy while also having completely psychotic sets of values? This is unbelievable. I wonder how much pain and suffering you’ve caused. I mean admitting you’re a liar and thinking that it’s a good thing… is… unbelievably stupid, short cited, and is probably based off of some narcissistic bias that your stupid ideas are probably secretly brilliant.