A Therapist’s Dilemma: Telling the Whole Truth vs. Healing the Wound


Does anyone tell the “whole truth” all the time? No one, I suspect. There is a difference between answering direct questions honestly and offering opinions not requested. The therapist lives in the space between. He does not tell his patient everything he thinks about him.

This is no surprise. His job is to heal, not harm. Our best friends, for example, are careful not to say too much unless the information is essential. Indeed, many people will not offer any hard “truth” ever. Some are afraid of hurting the friend even if the buddy’s mate is having an affair of which he is unaware. As Shakespeare’s Othello says when he is led to believe his wife is sleeping with Cassio:

What sense had I of her stolen hours of lust? I saw ‘t not, thought it not, it harmed me not. I slept the next night well, fed well, was free and merry; I found not Cassio’s kisses on her lips. He that is robbed, not wanting what is stolen, let him not know ‘t and he’s not robbed at all.

Simply put, ignorance of the offense is bliss. Othello maintains the injury is not so much the infidelity, but the knowledge of betrayal. This is doubly true in his case, since the report of his wife’s affair is false.

To the extent a therapist is viewed as an authority, his opinion carries particular weight. Patients will, on occasion, request reassurance or ask what his assessment of them is. The counselor’s answer might be any of the following:

  • “Why are you asking?” The healer attempts to turn the conversation to the client’s motives.
  • “My opinion isn’t the one that counts.” The doc deflects the question, pointing out the need for self-esteem independent of anyone else’s viewpoint.
  • The shrink offers a few positives and tactful negatives (not couched as weaknesses or personality flaws), thus addressing the request as a diplomat might.

What if the therapist is in a position to provide information crucial to the patient’s well-being that he might not otherwise receive? For example, let’s say the client has body odor of which he is unaware. I suspect some therapists would shy away from anything as personal as this, but I recall an occasion with a supervisee when I dealt with it head on.

The trainee in her late-20s appeared well-groomed, but the scent always trailed her. Indeed, others on the hospital staff suggested I address the problem for the individual’s good, as well as to make contact with her less noxious.


Making matters even more delicate was the gender difference between this lady and me. Still, it was essential my supervisee be informed how others reacted to her. I was not eager to impart the information, but my responsibility was clear. This decent and intelligent young clinician could serve her patients well only if she knew what was common knowledge. Failure to inform her would have been a disservice.

Now imagine she’d been a patient in treatment because of dating failures and loneliness. Would it have been responsible to shy away from any mention of a body odor?

A very different situation is more typical. I treated many middle-aged people who were concerned about how an adult child, now out of the home, turned out. Some of these parents felt rejected by an offspring, were depressed, or angry at the child or former spouse to whom they assigned responsibility. Often these folks found little fault in their own errant parenting.

If the patient wanted to improve his relationship with his adult child, the conversation would then involve what he might do differently now. If the offspring blamed the parent for historical wrongs, then self-reflection would be grist for the mill. But what if the relationship was over? Would the patient profit from awareness of his imperfect parenting? What gain might follow from a fresh and excruciating knowledge of the irreparable harm he’d done? Most therapists, I suspect, would allow the person’s rationalizations about his behavior to go unchallenged.

A therapist is not a palace guard barring the way to some heavenly reward, weighing the good and evil in any life, opening or closing the door to the pearly gates. He is not a moral arbiter. The job of harvesting or harrowing souls is left to “fire and brimstone” preachers and others who claim a divine purity far above the counselor’s pay grade.

The healer must keep in mind what the client came for. Most likely he did not ask for administration of an ethical purgative designed to expunge imperfection and cleanse his soul of sins past and present. If the counselor does not remember that, then the therapist, not the patient, has lost his way.

The top photo is called The Mouth of Truth, located near Lipnice nad Sazavou in the Czech Republic. The author is Jarda 75. The second image shows “Michele Linger, left, Sexual Assault Response Coordinator (SARC), lending an ear to a Joint Task Force Guantanamo service member during a counseling session at Guantanamo Bay, Cuba, March 25, 2010.” It is the work of Army Spc. Juanita Philip. Both photos are sourced from Wikimedia Commons.

Five Things You Wanted to Know About Your Therapist but were Afraid to Ask: The Answers

psihoterapie-validTherapists sometimes reveal themselves despite their training not to. For example, in psychoanalytic treatment, Freud made himself a blank slate. He thought the patient’s troubles would become evident if he didn’t intrude upon the process. Remember, Freud sat behind the patient lying on the couch. Sigmund’s facial expressions and body language could not be observed. He said little, instead encouraging the analysand’s free association of thoughts. Then, if the client displayed positive or negative feelings about Herr Doktor Freud, the psychiatrist believed it due to underlying unresolved issues, usually about mom or dad. The heart of the problem having thus been uncovered, Dr. Freud could begin his “heart” surgery.

Still, patients wish to know “personal” things about the mysterious humanoid who treats them and will comment on the imbalance in unfolding that which is most intimate: the therapist gets to ask, the patient mostly does not. Spacefreedomlove, a provocative and prolific blogger, raised worthwhile queries in her post, Five Things You Always Want to Ask Your Therapist but are Afraid to Ask. I will try to answer, speaking only for myself. I encourage other therapists and clients to add or subtract by posting comments.

Question 1. “Do you ever wish you never met me or that you referred me out after the initial consult?”

A therapist works hard to find the best in the people he treats. This is a cliché, but it is true. You otherwise make both yourself and your patient miserable. I rarely if ever wished I had never met a patient, but occasionally thought later it would have been best to refer them. Careful readers will distinguish two questions here:

A. “Do you ever wish you never met me?”  The reason I’m glad I came to know my entire clientele is because they enriched me in knowledge and experience. I grew because of them. Many are wonderful people with whom it was a privilege to work.

With respect only to my enrichment, however, I would even say I found value encountering some nasty folks outside of work. Of course, I didn’t love those who did me wrong at the moment of injury. Strong feelings of anger and dislike touch everyone, therapist or thespian, “butcher, baker or candlestick maker.” A psychologist realizes he learns from some lessons only pain offers. Thus, if you ask me, “Do you ever wish you never met me?” I can pretty much say no, because you taught me about life, work, and myself. Past your tutelage, however, I might say I’d rather not meet you twice! This last comment refers to only a few people I met in the office, however.

B. “Do you ever wish you referred me out after the initial consult?” The simple answer is yes, but read on before taking the statement to heart. First, a different therapist might have worked wonders I did not. I remember one intelligent and sweet young woman early in my career who I didn’t diagnose as Bipolar Disorder until she arrived at the clinic with a bunch of “gifts.” The package included a box of condoms for me! She was hospitalized soon after. Had I been quicker to make the proper diagnosis, she might well have avoided being temporarily institutionalized. The young lady had some bad feelings about me as a result and I deserved them.

Therapists don’t predict the future without error. Only in retrospect do we realize an earlier referral was required. That said, I think the real issue being raised by spacefreedomlove is found in her second question:

Question 2. “Am I too much? Do I wear you out?”

The answer is yes, counselors get worn out, but not necessarily because of you. Once the therapist realizes he is exhausted, two more queries should pop up: a) Am I trying to do too much instead of allowing the patient’s own energy to carry therapy forward? b) Do I have some countertransference issues? Countertransference refers to the feelings the therapist has about the client, negative or positive. These can go back to the therapist’s own unresolved emotional concerns, so I’ll address this in response to Question 4. “Do I remind you of anyone from your past?”

As a young psychologist, I was keen to heal the world. This delusion is common among new therapists. Experience informs you of your inability to save everyone and, indeed, perhaps you can’t save anyone! By that, I’m thinking of the lifeguard who tries to rescue someone trying to drown himself. In other words, you need a person who isn’t going to fight your efforts every session and who has the therapeutic integrity to endure the pain of treatment. He must do everything he can to wrest a good life from the wreckage of his previous existence.

Therapists can burn out if they don’t recognize and calm their own frustration when progress is stalled. A counselor might exhaust himself by meeting his patient too early or late in the day, discounting fees to the point of feeling ill-compensated, and by overworking. Phone availability is still another potential complication, especially in non-emergency situations. Private life stressors create a trip-wire, as do multiple late cancellations without strong reasons.

A wise doctor will discuss issues during appointments, but not before healing himself or seeking his own outside support if the problem is his, not the client’s. Psychologists need to set limits. Being “on call” day and night can feel like guard-duty in wartime, causing sleeplessness and fatigue to the point of being less good when it really counts, in session. Remedies might include talking about the patient’s level of determination; a change to the time, day, or frequency of sessions; renegotiating the fee or the cancellation and phone policy, etc. Without improvement, referral is another option.


Question 3. “What do I bring up for you? What do you struggle with in our sessions?”

As stated earlier, I only speak for myself. The best answer I can give is a long one, so I will refer you to a post called, What is Your Therapist Thinking? In addition to what is contained there, I struggled with how best to be helpful. Were a patient decompensating (getting worse) as the session progressed, I considered how to get the train of treatment on track to a safe place. The post I linked illustrates the manner in which your “doctor” head can be in a number of different places depending upon the flow of the therapeutic encounter as it happens. After the appointment, the counselor needs to reflect upon his efforts and whether they helped, were ineffective, or indeed caused the decompensation.

An inexperienced healer risks identifying with his patient’s pain so much that both he and the client are adrift at sea, and he is unable to offer a steady hand from the shore. Experienced therapists, on the other hand, risk becoming jaded to the point of equally worthless emotional distance. I believe I was eventually able to find solid ground in the middle.

Question 4. “Do I remind you of anyone from your past?”

Much like parents who are better suited to raising one child than another, counselors are not equally well-suited to each client. This can be a matter of skill, temperament, age, experience, or background. The question, however, seems to suggest you (the therapist) suffer issues from your past impinging upon your relationship with your patient in the present: your patient’s resemblance to someone else is the trigger. I remember a 16-year-old victim of sexual abuse. Her face reminded me of an old girlfriend, who I met when she (the girlfriend) was only a year older — 17. In the session during which the abuse surfaced, the client’s pain contributed to my own. While this was not a unique experience (my eyes can moisten hearing such stories), I was more than usually touched because of the invisible presence of tender feelings toward someone I’d not seen in many years. Nonetheless, my emotions settled and did not appear to derail treatment progress.

A few patients reminded me of my mother, with whom I had a “complicated” relationship. Please do note the euphemism! Once, however, I resolved my “mom” issues, I observed such similarities without undue emotion interfering in treatment. So, at least, I told myself.

Question 5. “What would you say to me if you were not my therapist?”

I am a pretty direct person. Not undiplomatic (most of the time), but direct. From childhood I found it almost impossible to be false. Should you care to know more, an amusing post on this congenital failure describes a kindergarten catastrophe: Gone in Sixty Seconds: How to Lose Three Girlfriends in a Minute. I don’t take full credit for my discomfort with being disingenuous (since I seem to have been born with it). Nonetheless, because of the trait, my client heard whatever I thought was most important to say. I tried to hold a mirror so that he might better recognize himself. If his vision was cloudy and it was essential that he perceive more (in my opinion), I often said more. I made good use of Socratic dialogue, asking questions designed to lead to self-awareness. Telling someone he is missing something is rarely helpful. A therapist says things like “What does that way of being cost you?” in the hope of allowing the patient (upon answering and thereby taking responsibility for his behavior) to grab the therapeutic initiative to change. The same comment in the form of a statement, by comparison, might cause him to feel scolded. It is easier to reject the therapist’s conclusion than your own.

No one gets to know every thought a therapist or a friend thinks about him. The truth of the previous statement does not mean, however, you would hear more from me as a friend than you would as your therapist.

In the end, as worthwhile as the above questions are, I believe it is most important a therapist know the truth of what Leo Tolstoy described in War and Peace — the role of medical doctors in early nineteenth century Russia:

“They satisfied that eternal human need for the hope of relief, the need for compassion and action, which a human being experiences in a time of suffering. They satisfied that eternal human need — noticeable in a child in its most primitive form — to rub the place that hurts.”