The Hardest Things to Say in Therapy, and Why You Should Say Them

Disclaimer: This is for informational purposes only and does not constitute therapeutic advice.

A quick note before we begin: my perspective is shaped by my clinical practice and the psychodynamic psychotherapy paradigm (which includes modalities like psychoanalysis). I'm currently training in Transference-Focused Psychotherapy (TFP), an approach that deeply values the relationship between client and therapist. While I believe these principles are widely beneficial, they may not align perfectly with all therapeutic frameworks, such as cognitive-behavioral therapy (CBT).

What do you think is the strongest predictor of success when it comes to long-term therapy? Of course, your therapist needs to be educated, but it isn't about the specific technique; rather, it's the therapeutic alliance (the trust and partnership between you and your therapist), and what is happening between you and your therapist—how you feel about them and what they say or ask—is where real transformation begins.

This means that uncomfortable feelings (like annoyance, misunderstanding, or even anger toward your therapist) are not signs of failure. This is crucial information. Bringing these feelings into the open is where some of the most profound work can happen.

It can be challenging to voice these thoughts. You might fear being seen as "difficult" or worry about being judged. But a skilled therapist will see this feedback as a gift. It strengthens your alliance and unveils patterns that might be deeply rooted in your psyche. For example, you start to feel annoyed with your therapist because they are not giving you direct advice on how to deal with a difficult situation or feeling that you have. You can see it as unprofessionalism, or you may even feel abandoned by them. 

Getting this information out could be really helpful to understand this inner pattern, which can be, for example, “When I’m not being strictly guided by others, I’m being abandoned by them,” making the healthy independence in a relationship feel impossible and painful. And this is how a moment of frustration highlights a core theme to explore together.

Use a simple framework:

Examples: "I left feeling annoyed last week, and I’d like to understand why," or "I was upset when you interrupted me. It felt dismissive."

A good therapist will welcome this dialogue. If they become defensive or dismissive, that itself is important information about your therapeutic fit. We hope this helps to answer the question about what to do in therapy if you feel like it’s not quite working. So, what's the hardest thing you've ever told your therapist? Or what are you still holding back from saying? What do you think of this approach?

If you are interested in psychology, learn when ADHD symptoms can actually be a sign of a personality disorder here.