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Therapy is and should be the one place where you can focus on getting better without worrying about the reactions of others. But even if you trust your therapist, depression can still be a complex topic to broach. So, what’s the best way to do it?
Here’s how to tell your therapist that you’re depressed:
- Be frank with your therapist about your depression.
- Be ready for referrals to other mental health professionals.
- Ask for a second opinion if it doesn’t go well.
- Find a new therapist if yours doesn’t take it well.
This article will explain why you should be frank with your therapist about your depression. You’ll learn about:
- Why fear about self-disclosure is common.
- The kind of reaction you can expect from your therapist.
- What comes after you tell them.
- Psychiatrist referrals, CBT, and group therapy.
- What you can do if your mental health professional won’t listen to you.
Be Frank With Your Therapist About Your Depression
Sigmund Freud, the founder of psychoanalysis, had a rule: “no matter how insignificant or shameful, speak what comes to mind.”
As a result, he learned that what his patients withheld was often the most painful, and finally speaking about it helped them heal. But unfortunately, not all therapists are dogged emotional detectives like Freud.
Most therapists can only interpret what you express to them. As humans, our experiences are too varied to guess. So, unless you tell them about your depression, they may not be able to help you.
Fortunately, fear of self-disclosure is common, and in session, your therapist will prioritize creating space for you to tell them.
Is Fear Over Self-Disclosure Common?
Research has found that around 50% of patients have secrets they’ve hidden from their therapist. Sometimes, they’re ashamed of what they see to be personal failures or mistakes. Other times, they don’t know how to bring it up or fear what’ll happen if they do.
Fear over self-disclosure is common, as most people who self-disclose fear being dismissed, humiliated, committed or even having their children taken. However, therapists should never brush you aside.
They also can’t admit you to the hospital involuntarily or take your kids unless you’re considering hurting yourself or others.
Most of us have experienced being dismissed or taken by surprise by someone else’s reaction during a vulnerable moment. Many of us have been told we’re being irrational or unreasonable. Afterward, some of us even obsess over how we express our thoughts, blaming ourselves for others’ unempathetic responses.
Sometimes, the people giving these responses are the people we trusted to help us.
We come by these fears honestly, but sometimes they hold us back from seeking help or relief when we desperately need it.
Do you often find yourself grappling with opening up? If you do, ask yourself whether you should lean into your fears. What makes you doubt your therapist? What are the pros and cons of telling them anyway?
Exploring a problem and questioning your anxiety can help you feel confident enough to be vulnerable with someone whose reaction you fear. It can also help you identify whether you’re truly in danger without having to ask someone else for a reality check.
What Kind of Reaction Can I Expect From My Therapist?
Have you ever wondered why it’s so hard to pinpoint what your therapist is thinking? Or why, when you tell them something, they don’t react? This will seem contradictory, but it’s because your therapist is centering you during your session.
The kind of reaction you can expect from your therapist is not to react, have opinions, or even give advice, but to ask more questions. That sounds counterproductive, but their goal is to help you explore, learn coping tools, process and unburden yourself.
To do this, they put themselves aside and act as your mirror for the duration of your session.
So, no matter how messy your self-disclosure is, your therapist isn’t going to judge you for it. They’ll ask you why you suspect you have depression, but when they do, it won’t be a call to defend or justify your reasoning.
All they’ll ask is for you to express it to them verbally. But if you can, and your mind goes blank, try closing your eyes and visualizing writing a bullet list while talking aloud or simply asking them for a moment to think.
Most people, not just your therapist, will give you extra time to respond if you ask for it.
You can expect your therapist to understand your hesitancy to speak up, even if they don’t express it. Having studied emotion, they know uncertainty and vulnerability are scary, but not only that, but it’s their job to help people struggle day-in and day-out.
They’ve seen it all before, and you can trust them not to react in ways that hurt you or to apologize if they do.
If your therapist ever hurts you, make sure to speak with them about it as soon as you can manage. Trust grows in a relationship when a rupture is repaired, and having a bond with your therapist will help you heal.
Be Ready For Referrals To Other Mental Health Professionals
As I said before, your therapist shouldn’t dismiss you. Unless you’re considering hurting yourself or others, you won’t be committed or have your children taken away. But, what will happen?
You can expect them to ask why you feel depressed and about any trauma to understand your struggles better. And, if you’re willing, you may be referred to a psychiatrist for medication to help control your mood.
You may also be asked to attend Cognitive Behavioral Therapy (CBT) or attend group therapy.
Your Therapist Might Refer You to a Psychiatrist
Psychiatrists are medical doctors that specialize in treating mental illness. Their focus is solely on diagnosing and prescribing medication instead of counseling, and they generally use the Diagnostic Statistical Manual (DSM) as a guide.
If your therapist refers you to a psychiatrist, you’ll receive a phone call from a counselor or nurse from their office.
They’ll work with you to fill out an intake questionnaire about your current state of mental health, after which you’ll book an appointment for a later date. Because they’re potentially prescribing medication for the first time, this appointment is likely to be in-person at their office.
However, they may not be located in the same office as your therapist.
At your first appointment, your psychiatrist will ask about you and your family’s medical history and whether you’ve taken any previous medications. In addition, they may ask about any medications that have worked well for your family members. They’ll also ask whether you’ve experienced any trauma.
However, you’re under no obligation to recount your story for anyone, especially if you’ll find it hard to cope.
Even so, if you’ve experienced a traumatic event, no matter how far back in your history, it would be a good idea to mention it briefly. But if you’re asked to recount it in full, you can simply inform them it upsets you deeply, and you want to work on it in a controlled setting, like therapy.
After that, they’ll ask you to explain your symptoms in full, then maybe, if there are signs it’ll help, they’ll prescribe a medication that works well with your set of symptoms.
However, medication isn’t the magic fix; it was marketed as in psychiatry’s infancy. We now know that unhealed trauma, unprocessed emotions, biased opinions, and unaddressed issues in one’s life cause mental illnesses, not solely by chemical imbalances in the brain.
So while it’ll lessen the physical symptoms as you work through their cause in therapy, medication won’t change what’s lacking in your life. This means the problems aren’t solved, and your depression may return or even worsen, and for this reason, some people go in and out of the mental health system for years before they receive the help they need.
For this reason, it’s essential to continue therapy, even if you feel better after starting medication and feel you no longer need it.
The medication’s calming effects may even help you make better progress with your therapist.
You Might Also Be Asked To Attend CBT or Group Therapy
Cognitive Behavioral Therapy (CBT) is a subtype of therapy that teaches healthier coping methods, thereby reducing unhelpful behaviors and ways of thinking that can cause anxiety and depression.
Sometimes, you may be able to undergo CBT one-on-one with your therapist, doing worksheets and other exercises during your sessions. This can also be done by email, Zoom meetings, and over the phone. Other times, you might be asked to attend a group lecture to learn CBT concepts alongside other patients.
Either way, you’ll learn about cognitive distortions, which are inaccurate ways of thinking, and learn to use your problem-solving skills to work through them and feel better, strengthening your emotional resilience.
In addition, you can find CBT textbooks and workbooks both in bookstores and online. If you have a binder or folder, you can print them at home for your own personal use. Meanwhile, group therapy is a therapist-led meeting where you can talk and work through your issues with other patients present.
Some well-known examples include Alcoholics Anonymous and Al-Anon.
Group therapy is beneficial when dealing with isolation or low self-esteem because connecting with others can help lift and heal you in a way talking to someone by yourself can’t.
Group therapy could be more effective for you than working one-on-one if you fear people. It’s also effective for those suffering from agoraphobia because it will regularly give you opportunities to leave your comfort zone. However, if you have this condition, you might want to start slowly, as you could get worse instead of better.
Undergoing therapy with others present is intimidating, especially if you fear being criticized or feel uncomfortable with vulnerability. If you’re offered group therapy, talk to your therapist regarding your feelings about it beforehand.
They can help dispel any fears or myths, helping you feel more at ease and better prepared to attend. In addition, they can also provide additional therapy or coping tools before you begin attending.
Lastly, remember therapy requires you to be open and willing. If you go into a therapy session and aren’t ready to participate and be vulnerable, it’s unlikely to benefit you.
So, if you decide to attend CBT or group therapy, make sure you’re calm and ready to share.
Ask For a Second Opinion If It Doesn’t Go Well
What do you do if you tell your therapist, and they don’t believe you? Or if you see a psychiatrist, but you disagree with their conclusion?
Mental health professionals are people too, and sometimes, they may go by the book to the point of handing out misdiagnoses, misunderstanding you, or even being burnt out. In addition, they may have personal biases against the existence of certain disorders.
If you encounter this and can’t get through to them, you can ask for a consult or second opinion or find new mental health professionals to treat you.
You Can Ask for a Second Opinion
If your session doesn’t go well and your therapist doesn’t believe you, you can politely ask them for outside consultation or a second opinion regarding your depression.
When you ask for a second opinion, your mental health therapist will refer you to a consulting psychiatrist or therapist to be re-evaluated. This consultant may ask you about your concerns, or they may just evaluate you without delving into it.
But if they do ask why you’ve asked for a second opinion, you should be as polite and respectful towards your current therapist as possible. In addition, some locations have small mental health systems, and if you reencounter them, you’ll want them to listen to you.
Even mental health professionals can have trouble tolerating someone who talks poorly of others, which can affect your care.
Once you’ve been assessed, you’ll be sent back to your previous psychiatrist or therapist. After you leave, the consultant will send them a letter with their findings, either agreeing or disagreeing with their assessment of you, as well as detailing their suggested course of action.
It may take two weeks or so for your therapist to receive the consultant’s letter. When they’ve read it, their office will call you and book an appointment to go over the results. However, whether your therapist listens is up to them.
If they choose to discard the consultant’s opinion, you may need to find a new mental health professional to care for you.
Find a New Therapist If Yours Doesn’t Take It Well
If you don’t trust your mental health carers, or they’ve ignored a consultant’s opinion, it might be better to find new ones who are more willing to listen to you.
However, you must speak to them about leaving first if you decide to do this. While it’s easier to stop coming to appointments, they need to know. Not only is it a sign of maturity and respect, but once you do, they can refer you to someone better able to help you, saving you weeks or even months of reassessments and referrals.
If you decide not to tell them anyway, or they didn’t or weren’t able to give you a referral, the best way to find a new mental health professional is to contact your general practitioner.
Your GP knows your location’s health system and can give referrals, getting you back into the system sooner. They may even know someone who could better help you or have resources you could pursue. In addition, they’ll give you direction during the process and monitor your well-being during the transition.
They may even refer you for a consultation to get you onto medication so that you can cope better in the meantime.
If you fear you may hurt yourself or others at any point during your wait, or if your symptoms worsen, phone your general practitioner’s office. They have helplines for you to contact and may give you an urgent referral to an on-call psychiatrist in your area.
Whether you suffer from recurrent mental health issues or not, don’t be afraid of reaching out to your doctor in a time of need. Anxiety shouldn’t be used as an excuse to dismiss you.
If this is happening, find a new general practitioner or visit an urgent care clinic.
It can be distressing to tell your therapist you’re depressed. Fortunately, fear of self-disclosure is common and well-understood. In addition, your therapist should never judge, no matter how messy your self-disclosure is.
So, it’s best just to tell them, even if you have to blurt it out.
After you tell them, you can expect to be referred to a psychiatrist, or CBT, or even group therapy. If your psychiatrist or therapist doesn’t listen to or investigate your concerns, you can ask for a second opinion or find new mental health practitioners through your family doctor.
- ResearchGate: Patient Self-Disclosure: A Review of the Research
- Scholar Commons: Emotional Invalidation: An Investigation into Its Definition, Measurement, and Effects
- PsychologyToday: To Give or Not to Give Advice
- Posttraumatic Stress Disorder: How Do I Choose Between Medication and Therapy?
- Posttraumatic Stress Disorder: What is Cognitive Behavioral Therapy?
- American Psychological Association: Psychotherapy: Understanding group therapy