Things You Should Not Say To Your Therapist?

[EmmaOwl]

On a different thread, I've stated that I believe a patient/client ought to tell a therapist *everything*, on the grounds that is the best way for therapy to go forward, and help a patient/client more (and if on the off chance the therapist can't deal with it, it might be time for someone new).

But are there things that are better left unsaid? Or in a more confidential way (like on a big, busy message board). I've been mulling over this all weekend. When I left therapy Friday, my therapist said, "You know, what you said before, don't repeat that to anyone, okay?"

It was a passing remark that I probably should have known better than to say. I think it is safe enough for me to say anonymously enough here: I said "It occurred to me I have enough medication to kill a person. I have enough to kill myself."

(NB I do not wish to kill anyone, nor do I wish to kill or even injure myself. This is absolute serious here. And the last part is, that's an important improvement for me (as I used to self harm on occasion), and I don't want anyone to think otherwise. No violent thoughts at all. However, I'm aware that any mention of suicide or other types of violence must be taken very seriously.)

The thing is I didn't MEAN it... It really was a passing thought brought on by a book or tv show or something. It sounds terrible, but it was a fleeting thought that I blurted out to my therapist... because I'm accustomed to blurting out things to him

When he said "Better not to repeat" I said, "Of course not!" Which, during my drive home, made me wonder if I really should not have said that at all. This weekend I've been wondering if somehow my therapist is a mandatory reporter of some sort.

Another important point to add here specifically for people on this site - saying "Don't tell" has never been a trigger for me. My therapist knows me well enough to know that. I realize that others on this board might be uncomfortable with being told such a thing due to past traumas and so on; I apologize if that is the case for anyone reading this.

I still believe the more info the better, in a good therapeutic relationship...but it occurred to me that, had my therapist not been working with me for years, this could have gone badly. It didn't even occur to me until he said that. In fact, I texted him earlier today, double-checking that he himself was not planning to report anything. (He is not planning to do so - honestly that was a bit paranoid of me... But one of those questions that made me feel panicky and unresolved.)

So should I have said that, or not? Would you say it, or not? Are there some people you could tell this stuff to, without fear of scaring them? I mean, I'd never say it to my psychiatrist. He's a great, caring person but he does not know me anywhere close to how well I know my therapist of multiple years. I can think of therapists I've had in the past who would want to wash their hands of me at such a comment. But now that I'm in a good therapeutic environment ... I don't know. I was a little surprised that my therapist would caution me, but now that I go over it in my mind, I see his point and I realize that in many cases, any mention of violence must be reported.

Thoughts? Do you threaten violence or self-destructive behavior, or have you in the past? Do you feel violent thoughts that you don't tell your therapist about? Obviously this situation that was quite minor to me at the time, has now been enlarged into an "issue" - though objectively I know that was not my therapist's point. I know he has my best interests at heart.

I'd appreciate any insight or opinion to these questions... I've been mulling it over - intrusive thoughts - and it's not going away anytime soon.

 

[Seasounds]

From what I know, most mental health providers where I live are taught, and are mandated to assess and/or immediately refer their client to a suicide prevention specialist whenever their client mentions anything in the realm of harm to self or others.

Their license depends on it; no joking matter. They are taught 'better to report than to not report'. It is often a game changer. If the provider knows you well, there may be the exception, like you experienced.

 

[aut555]

On a different thread, I've stated that I believe a patient/client ought to tell a therapist *everythi...

Or say l am feeling this way, but l know not to act on this. This is a serious legal issue for therapist, md etc. should a client do something.

 

[joeylittle]

I don't think there's anything one shouldn't say to a therapist.

But, there are consequences to saying certain things.

I've been good about vetting my therapist and psych for how direct I can be with them, when discussing suicidal thinking. We have very very transparent conversations about what kinds of situations would warrant hospitalization, and we have a shared understanding of that.

I once was seeing an additional psychiatrist, and I said something that I would not consider reason for concern - but when I overslept an appt he sent the police to my house, even though pat of what he was treating me for was sleep disturbance. He believed he had cause to worry and he acted according to his own barometer.

I would never attempt to emotionally blackmail my therapist by threatening suicide; one, because I don't have that kind of dysregulation - and two, because there would be a real consequence, in that he might discontinue therapy.

Sometimes we actually want the consequence. There are people who will admit certain things, with a vague understanding that it might mean an intervention will happen. Sometimes the client isn't even conscious of this motivation - but it can be there.

So, I would say - the more in crisis you are, the more it's worth it to just disclose what's happening. When you are more regulated, it's good to have clear conversations about your symptoms and how they might necessitate a reaction from your care provider. Ideally, you will be comfortable with their approach and they, in turn, will trust your willingness to answer questions honestly.

 

[Freedomfighter]

On a different thread, I've stated that I believe a patient/client ought to tell a therapist *everythi...

Well in my humble opinion your T may have been self conscious after you said that he prescribed enough pills for you to kill yourself. In my opinion you merely stated a fact, a startling but true fact. If the T takes offense or seems to think you should keep that hush hush then I would wonder what else should not be said?

Frankness is only helpful in our situations, even when sometimes the wrong words come out. That was a huge lesson I learned very recently. By making mistakes, albeit triggered by PTSD, I actually found out about myself and what I was really thinking and feeling. Rather strange, but effective.

And on that note I would love to send a HUGE hello to all those abusive people that want to hurt me because I tell the truth. Apparently they think that I am insulting them.

A true fact is not an insult!

 

[Deleted member 34328]

I think this is actually a complicated or touchy question. I would generally say that it's better to feel free for "full disclosure" within the realms of your trauma. Not whether you enjoy pulp in your orange juice. If you're always second guessing whether you should share, then I would wonder about 1. the right therapist chemistry and 2. what is your goal in therapy if you won't share your trauma or concerns.

I throw out passing remarks all the time with my therapist. He knows me very well (4 years) and also has walked with me during this journey - still is. There was a time when he would take that comment seriously and keep an open radar on me, but also knows where I'm at now. I had issues with that very comment a year or so ago. Not anymore. I have a good and solid relationship with my therapist - but I do know he too will be proactive should he feel it necessary for the safety of his client or those around them.

So being free to be yourself - whether venting, some humor or whatever should be open and free, but still within the bounds of therapy for the most part is true. However, a therapist is there for a reason. You don't seek therapy from your neighbors, so you don't talk about trauma related things with them either.

 

[Hope_N_Highwater]

Therapists are mandated reporters in most states. They are not priests, where what you say in confession has a sacred confidentiality attached. I believe they can be fined for not reporting IF it gets discovered. Some therapists may choose to not report a disclosure, and risk the fine instead, because the trauma it can cause their client. This is especially if he/she has known you for a long time or in the past has gone through the hell it creates of reporting a client. That being said, discussing a serious desire to hurt yourself or someone else can land you in a facility for evaluation, if the therapist thinks your are a serious threat. Mentioning being a past or current perpetrator of child sex abuse can land you in jail. Even if it's something that happened years ago, an investigation can be started to determine if you are safe to be around children (including your own).

The forms you signed/received when you first started going to the therapist are required to disclose their mandated reporting policy. Tread carefully if these are issues you want to disclose, especially if your therapist is newly licensed and trying to follow the letter of the law.

 

[NoWhereKnowWhere]

Well what did he say when you said that? Clarification should be first and then he can properly assess the situation.

If I said that to my T she would ask straight out if I was suicidal and had I made any plans. If I said yes then she absolutely would report. If I said no I was just saying or just ideation type stuff nothing I can't handle no plans and the like. Then she wouldn't report. I always find its best to be straight to the point with suicide type issues, best to just be upfront with asking and discussing.

I don't know the law in the US so it could be different. Just ask him. My T explained to me what she is and isn't legally obligated to report.

I don't think there's anything you shouldn't talk about in therapy if you want to discuss it then it's probably important.

Saying that when I have been quite unwell and have had plans I didn't tell her because I've always felt like suicide has been my back door out of all this. I struggle with feeling suicidal quite often. And what's time to panic and not being safe for someone else isn't the same as it is for me. When I'm in trouble I've asked for help not before I don't want to worry people unnecessarily. I know by now where the line is and when it's time to get help and having plans can still be passive for me not proactive. But I know she legally has to report if I have plans.

 

[EmmaOwl]

There are a bunch of thoughtful posts! I'm sorry it took me so long to get back here. (Thankfully, it did NOT turn into a round of intrusive thoughts.) It's interesting to see how there are certain threads that run through everything - e.g., legal issues, true threats and even manipulative behavior.

I'm aware of very strong legal and just plain safety issues, and "better to report than not". I'm also of the mind that a good setup includes being "utterly transparent".... It's been years since I've needed to do so, but I have checked myself into psychiatric hospitals when I felt in danger of harming myself in any way - and would do so again if need be. I would tell my therapist this if it were so, and he knows that. However, I agree with everyone that says "better safe than sorry!" and I also agree that anyone who is thinking seriously should definitely tell a therapist or any medical professional or ANYONE, to keep safe.

I wanted to add a couple of things to the comments here. I'm in the U.S. and the setup I've got, I have an MD who I see only every couple of months for psych meds, other doctors every few months for other health problems requiring medications,I've got a number of health problems and several specialists. So I wasn't just looking at psychiatric meds - and yes, all my prescribing doctors know all meds, I have a good local pharmacy, etc. Am careful as can be while also being a functional human being.

They are in contact with one another as needed. But, unlike the specialists, I see this therapist weekly. I wouldn't say such a thing no matter how jokingly/offhandedly to anyone in charge of actual medications, but my therapist knows me and my moods best. I agree that it would be *incredibly* awkward to say even in an offhand manner a doctor that prescribes medications! But if it felt like a TRUE danger, then yes a person should certainly say that to anyone they can find.

I'm probably a mix of @joeylittle and @stp2012 - utter transparency with all my docs, MD or not. (Even my eye doctor knows the worst, because some of my meds affect my sight.) And someone said , "You've got to take into account what is said afterward" and that's a really good point! In this case, where I'm talking about someone I've worked with for nearly ten years, the first 6 years of those twice a week, now once a week, well we know each other pretty darn well! (Please, if you think that is too long to be a good therapeutic relationship, this is not the place to say so. Thanks in advance.)

So what was said immediately after my comment, in this case, was something like, "Yep," in the middle of some other story. And so when maybe half an hour later I was heading out, my therapist's comment was about as offhand as my own, not any kind of dire warning. Mentioned in the middle of chitchat we normally have while we walk to the door. He would never in a million years suggest that I keep a true feeling like that THAT to myself; it would be irresponsible and I would not want to work with someone who would do this. That's why he said it low-key. He figured I'd have the sense, but he wanted to make sure I didn't end up in a situation where had paramedics showing up at my door or something, due to something so random and what was said so innocently on my part.

A threat would be terrible! I can't imagine a doctor OR a therapist, whether they prescribe meds or not, sending a patient home after a statement like that if there was even a hint at the tone of things, or if it was a doctor that didn't know the patient very well. Lastly on this, I didn't know that priests were NOT mandatory reporters. That surprises me... but I don't know a lot about organized religion.

The tone in my case was... well I've had only the most mundane communications with my therapist this week - texting him that yes, I am going OUT to see a movie instead of staying home where it is "safe" and watching a movie. Right now, I'm working to avoid some agoraphobic tendencies, I just do not want to allow that to happen to me. So, that's my story for today! Things will be different tomorrow, and next week etc but I'm thankful not to have such heavy issues going on right now and can work on more day-to-day things.

I really liked reading and pondering what everyone had to say here, seeing how widely people are treated for psychiatric disorders, and kind of slap-dash, in terms of not everybody gets the same thing, the need for caution and legal troubles, medication use and types of therapy... In fact, very few people seem to get the same thing. But psychiatric/mental health care is cobbled together in the U.S., and from what I've read around here, that seems to be true no matter what country you live in.
The common denominator is, no one should attempt to hide any true feelings from their therapist or other doctors, no matter what...and things like tone, and truly knowing who you are working with, can be vital in recovering from PTSD or any mental health disorder.

Happy days to all!
-Allie

ETA: I didn't mean for my post to be so long! But I don't know what to edit out, so I did my best.

 

[EmmaOwl]

If the T takes offense or seems to think you should keep that hush hush then I would wonder what else should not be said?

I'd like to clarify this one point.... There was nothing clandestine, no air of "hush hush" or hiding involved - only matter-of-fact communication. Reminding me, yeah I can blurt to my therapist but might not be smart to blurt out widely. Like here on this forum. :)

 

[Deleted member 34328]

Just to emphasize the need for real transparency, I got myself into quite a mess BECAUSE I couldn't fully disclose. It was probably one of the first times his being a man played a big role in why I couldn't bring myself to say what a bigger problem was. As a result, it ended up being one of those explosive sessions and I left vomitting. He needed to intervene so that I could safely drive home.

Later, as he had been thinking things over, there was no way he could properly connect the dots because he didn't have all the facts.

I know this reply isn't the intent of the original post, but this type of transparency has been brought up in a few responses. In my case, it's taken another session and finally an emailed journal entry today to finally disclose the real problem. A lot of confusion and painful weeks might have been avoided had I taken the plunge and tried to express a huge stressor that was already active when I went into the office. He might have been able to help speak into it instead of being left in the dark and have to draw other conclusions.

Off handed remarks or talks about nothing in particular are actually sometimes helpful to end off a session. I often wind down by switching gears about a hobby or just something stupid I'd heard - or vise versa. He'll say something outrageous sometimes related, sometimes not. We also have a strong trust relationship. So although I stand by what I originally said in my prior post, I did want to clairfy that I can relate @Allie D. in throwing offhand remarks that I would never say to anyone else.

 

[Laurie2001]

I am a psychologist (albeit with PTSD). As a patient you can tell you therapist about suicidal and homicidal thoughts, you can have fantasies, wishes, etc, and the therapist needs to assess them - unless you immediately explain these are what I'd like to do but would never do. These feelings, thoughts fantasies are OK. And there are some people - close friends who may get it. So a good therapist should be able to evaluate whether there is a risk involved and should, and if there isn't, they should be able tolerate the the thoughts you have. For instance, it is totally reasonable to want to seek revenge against a perpetrator and to make them feel like you felt. This can lead to all sorts of fantasies and those fantasies can be a relief. It does not mean you'll act on them and its important to be able to talk to one's therapist about it.

I'll just add, in terms of violent thoughts - they can be positive in that you are not turning them on yourself. In terms of any thoughts, they are meaningful and it would be important to explore why one is feeling it now, why that particular thought, it can open up feelings that need to be addressed.

That being said you therapist just might have gotten nervous on the way out because he is just a person. We should always be able to talk to our therapist about comments they make that affect us as well.

The exceptions are of course if there is indeed a significant risk - then the therapist is required to act. If he or she feels you are likely to hurt someone they have a duty to warn that person and probably call 911 and the police. If they feel you are at real risk of hurting yourself they have to act to ensure safety even if it is against your will.

Finally, one issue that is undebatable have to report - mandated to - is any suspected child abuse or neglect. And in some states that can include you mentioning a neighbor that the therapist doesn't know. The laws are really strict and the therapist is legally obligated.