Addiction 12 Things Your Therapist Knows That You May Not By Kristen Fuller, MD Kristen Fuller, MD Kristen Fuller is a physician, a successful clinical mental health writer, and author. She specializes in addiction, substance abuse, and eating disorders. Learn about our editorial process Updated on July 07, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Carly Snyder, MD Medically reviewed by Carly Snyder, MD Facebook LinkedIn Twitter Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments. Learn about our Medical Review Board Print Fiordaliso / Getty Images A mental health therapist can help you work through difficult situations and emotions. But if you're new to therapy, you might have a lot of questions. For instance, you may wonder, "How do I open up and tell my therapist what I really feel?" or "Will my therapist think I'm 'crazy' or a lost cause?" Even people who've been in treatment for years sometimes have unanswered questions. ("Can my therapist tell if I've relapsed?") If you have any issues or concerns about mental health therapy, here's what your therapist knows that you may not. Engaging in Therapy Doesn't Mean You Are Broken There is a stigma surrounding mental health. This can make you feel like going to therapy somehow means that you are broken and need to be fixed. But this isn't what mental health therapy is about, or even what it is. The American Psychological Association explains that psychotherapy is designed to "help people of all ages live happier, healthier and more productive lives." Notice that there is nothing about being broken in this definition. Instead, engaging in therapy is about gaining the tools needed to live a better life. Having an Addiction or Mental Health Condition Doesn't Make You a "Bad" Person Just as engaging in therapy doesn't mean that you are broken, having an addiction or mental health disorder doesn't mean that you are a "bad" person. These are merely issues that you face versus being a sign of your character or defining who you are. Many factors contribute to a person's mental health, including genetics, whether you've experienced trauma, and even your diet and level of physical activity. Several of these factors are outside of your control. Even the ones that aren't still don't make you a bad person. They simply make you human. Mental Health is Complex Your therapist understands that mental health can be rather complex. There are many different reasons for having certain thoughts and behaviors. Sometimes, multiple factors are at play, such as having a comorbid disorder (having two or more disorders at once). For instance, roughly 60% of people with anxiety also have depression. Additionally, about half of people with a mental illness also have a substance use disorder. A therapist can help you work through all your conditions and symptoms. There might even be some issues affecting you that you don't realize. This underscores how complex mental health can be, also highlighting the importance of getting a therapist's help. Not Every Therapist and Client are the Right Fit Finding the right therapist is like finding the right partner or spouse. It's important to find someone that you get along with, someone you feel like you can trust, and someone you are willing to be vulnerable with or it isn't going to work. Finding the best therapist for you can sometimes be a trial and error process. Go to a few sessions with a therapist and see how you feel. Ask yourself: Am I comfortable with my therapist?Can I talk openly and honestly with my therapist?Do I feel like my therapist understands me? If you can't answer yes to these questions, the therapist may not be the best fit for you. Keep looking until you find one that is. And don't worry about offending the therapist by going with someone else. They know that finding the right fit is important to the therapeutic process. A Therapist Doesn't Have to Agree With You to Be Able to Help Finding the right therapist isn't about finding someone who agrees with you. In fact, part of what a therapist does is to challenge the thoughts and behaviors they don't agree with—which are often the same thoughts and behaviors that are causing you trouble in your life. Because you tell a therapist your deepest, darkest feelings, you may come to think of them as a friend. But they're not. They are a trained mental health professional who can provide the strategies and tools for overcoming some of your biggest challenges. And they don't have to agree with you to be able to do this. What You Say in Therapy Stays in Therapy One of the barriers to opening up fully in a therapy session is a fear that what you say will be shared with the rest of the world. However, what is said in the therapy session stays in the therapy session. In fact, protecting a client's privacy is part of a therapist's code of ethics. If confidentiality is a concern, talk with your therapist about this beforehand. Let them know that you are worried about your privacy. This enables the therapist to put your fears to rest by reinforcing that they can't divulge what you say. It also helps them better understand why you may be a bit guarded with your private thoughts and feelings. The only times in which therapists can break confidentiality is if they suspect that you may harm yourself or someone else, if abuse or neglect is occurring, or if they are compelled by a court order to do so. Your Results Are Dependent on You Simply showing up to your mental health therapy session isn't enough. You have to want help with your addiction, mental health disorder, or other challenges you face. You also have to be willing to put in the work to get the desired results. If you are telling yourself, "I'll just go in and my therapist will fix what's wrong with me," this isn't how therapy works. Instead, your therapist is more of a guide. They will give you the tools you need, but the results you achieve are dependent on how committed and engaged you are in the process. You Are in the Driver's Seat, Not the Therapist There is a huge misconception that a therapist is there to tell you exactly what you need to do to start feeling better mentally. While they can certainly help, they aren't in the driver's seat. You are. They are more a passenger who is holding the GPS. The goal of therapy is to help you find (and decide) the best course of action for you. This involves asking you questions to help you better understand yourself and recognizing where faulty thought processes may exist. The therapist can provide the steps to get where you want to be but you are always in the driver's seat. You're Not the Only One With Your Specific Issue If you are struggling with addiction or have a mental health issue, it's easy to feel like you are alone. You may fear that "If I tell my therapist what's really going on, they'll think I'm crazy or beyond help." Yet, the reality is that you're not the only person who is dealing with your specific issue. Therapists spend their days working with people who face similar challenges. Although your situation may be unique in some regards, you're not likely to say something during your session that the therapist hasn't heard before. Finding a therapist who is experienced with your addiction, mental health condition, or the struggles you face can help ease concerns that you'll shock them with your thoughts or behaviors since they've worked with others like you. Recognizing Your Triggers Is Key We don't exist in a vacuum. This means that what goes on around us has the ability to impact how we think, feel, and behave. Creating more positive thoughts, feelings, and behaviors often begins with recognizing what triggers us to go the other way. Your therapist can help you realize what people or situations in your life are triggering your unhealthy thought and behavior processes. Finding ways to avoid these triggers can help, as can coming up with healthier responses when they do occur. Your therapist can help with both. Therapy Isn't a Linear Journey Some people believe that once they get into therapy, things will suddenly improve and they will feel better and better with each session. Unfortunately, this isn't reality as therapy isn't a linear journey. It generally contains several ups and downs along the way. You may leave some sessions feeling better and you may leave some feeling worse. Both are part of healing and recovery. Sometimes you have to bring negative emotions to the surface to deal with them. Knowing this beforehand can keep you from thinking that your therapy isn't working if you don't always feel good. Your Therapist Can Tell If You've Relapsed Relapse is common, with between 40% and 60% of people with substance use disorders relapsing at least once. If you have a mental illness, you might also relapse by returning to old behaviors that make your symptoms worse. While you may be tempted to hide a relapse, your therapist can probably tell anyway. A mental health professional is trained to recognize the signs of relapse. Plus, being honest with them about your actions and feelings is critical to helping them help you. If you aren't truthful about what it is you're facing, they can't help you find solutions. A Word From Verywell Understanding what a therapist does and doesn't do can help you have reasonable expectations about the process. Finding a therapist that you feel comfortable with and can talk to openly is also important and helps you know that "my therapist is the right therapist for me." Remember that a therapist is there to help you create a healthier, happier, and more productive life. They do this by providing you with the tools and strategies that are effective for the conditions you face. In the end, it's still up to you to use those tools and strategies to create a better life—which you can do with your therapist's help. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychological Association. Therapy. National Library of Medicine. Mental health. MedlinePlus. National Alliance on Mental Illness. The comorbidity of anxiety and depression. National Institute on Drug Abuse. Comorbidity: Substance use disorders and other mental illnesses DrugFacts. American Mental Health Counselors Association. 2020 AMHCA Code of Ethics. American Psychological Association. Protecting your privacy: Understanding confidentiality. National Institute on Drug Abuse. Drugs, brains, and behavior: The science of addiction. By Kristen Fuller, MD Kristen Fuller is a physician, a successful clinical mental health writer, and author. She specializes in addiction, substance abuse, and eating disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Get Treatment for Addiction Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.