Note: This post mentions sensitive topics including sexual assault, substance abuse, suicidal thoughts, abuse, and PTSD.
For some, deciding to go to therapy is the hardest part of the process. For others, it's finding an affordable therapist. Nevertheless, once you make it onto your therapist's couch, you might find the hardest part is actually opening up out of fear your therapist will think you're weird. In reality, therapists have heard it all. In order to normalize these conversations and make people feel more comfortable sharing, mental health professionals across BuzzFeed and Reddit shared the most common thing their clients have been afraid to tell them that they really hear all the time:
1. "Anything having to do with sex. There's so much shame, sexual abuse, sexual fantasies and fetishes, erectile dysfunction, infidelity, becoming sexually assertive, etc."
"Psychologist here. I try not to have a strong reaction to normalize the discussion."
2. "I'd say a common one is believing that there's something innately, irreparably wrong with them that makes them unable to ever truly 'fit in.' For a lot of people, it's such a deeply ingrained belief that it can be extremely painful to acknowledge or express, regardless of the level of personal success in their lives."
3. "Unwanted intrusive thoughts are normal and do not mean you are a bad person. By definition, these thoughts are unwanted because they go against your values and highlight what you don't want to do. However normal these thoughts are, the moral nature of these thoughts means that people often experience a lot of shame and take many years before they first tell someone about them."
"Yes, that includes intrusions of sexual, religious, and moral themes — like a religious person having unwanted blasphemous images pop into their mind or a new parent having unwanted sexual thoughts about their new baby.
The occurrence of these thoughts, images, and urges is normal. The best way to 'manage' them is to accept that they are a normal (albeit unpleasant) brain process. They are a sign of the opposite of who you are and are, therefore, very unlikely ever to do.
Let the thought run its course in the background while you bring your attention back to (insert something you can see, feel, hear, taste, or touch). I usually say something like, 'OK, mind! Thanks for that, mind! I'm going to get back to washing the dishes and the sound or sensation of the water while you ponder all the nasties. Carry on!' I literally say it to myself with a slightly amused tone because I am always genuinely amused at all the wild stuff my brain can produce!"
4. "I am a psychologist and would add that people are often scared to talk about the way they feel about the treatment itself or their therapist. I highly recommend opening up about this part of your experience. It is very useful information as it is part of therapy; it's a secure environment to reenact past traumatic or troubling relationships or experiences."
5. "I have heard some variant of, 'This is probably weird, but I feel if I am my true self around others, then they won't like me,' more times than I can count."
"As I explore the formative situations to this belief alongside my clients, it pulls at my heartstrings."
6. "Complicated grief and survivor's guilt. This often comes up in relatives of those with substance abuse disorders and in caretakers. For instance, complicated grief can come when families lose someone suddenly due to substance abuse. It can also arise when caretakers experience a feeling of relief — both for themselves as their life had revolved around the person needing the care, and for the person they cared for since they're now free from suffering and pain. This relief then triggers guilt. I spend a lot of time showing clients how they can hold several feelings and thoughts in their minds and hearts at the same time."
"You can feel profound loss and sadness along with a lifted weight and optimism for the future. People are sometimes so afraid to admit they've had these feelings, but they are more common than you'd think."
7. "The number of people I see who feel like they should be grieving a 'certain way' and are afraid that they 'must not have loved someone,' or 'must not have cared.' People grieve in all sorts of ways. The five stages of grief are bullshit."
"I was consulting with another clinician who was seeing a couple whose daughter had died. The wife was convinced that the husband must not have cared about her because he 'wasn't grieving out loud.'
In reality, while she had been going to support groups and outwardly expressing herself, he had been continuing to work in a garden that he and his daughter had kept when she was alive, using that time to process and grieve as he did.
Both were perfectly fine ways of grieving; however, one's grief is expected to be more than the other. They both ended up working it out. He began driving her and others to their weekly support group, and she attempted to work in the garden with him on the condition that they didn't talk. It was really sweet."
8. "They 'hear voices.' I've found that many people aren't familiar with their internal dialogue or 'self-talk.' This is typically 'normal' internal processing. A lot of people think that they are 'hearing voices' and hallucinating. There are some pretty simple questions we can ask to determine if it's hallucinations or just internal dialogue, and most often, it's the latter. I also want to clarify that not everyone has an internal 'voice.' Some have none at all; some have more of a system of thoughts that aren't verbal, feelings, or images. That's normal, too!"
9. "That they don't like their family members, are angry, want to stop communication with their parents, etc. There is deep and profound shame in this. When we find that line of, 'Oh, it might be that your parents are toxic to your mental well-being or trigger your trauma,' many of my clients get visibly angry with me."
"We deal with this almost daily. I work in Ukraine, which is more culturally collectivist, so not wanting anything to do with your parents makes you an asshole in the current cultural sense.
Cultural psychology is also very important. When I first moved here, I had my American/European hat on, and, oh boy, did I need to adjust."
10. "As someone in the substance abuse field, I know that it's difficult for clients to tell me they got high with a parent, but it's something I get told fairly regularly."
11. "That they do not know what they enjoy doing. Often, they have people in their life, including therapists, say, 'Try to do something fun today,' or ask, 'What do you like to do when you have free time?' Many people I work with do not know what those are. I couldn't even count how many clients I've had this conversation with. Once I explain that I dislike these questions because they assume people should know the answer and that many people don't, I see them relax, take a deep breath, and say something to the effect of, 'That's so good to hear. I have no idea what I like to do. That's part of the problem.'"
"More often than not, they feel like they should know and that everyone else their age has it figured out. They are embarrassed to say that they don't know when, in fact, not knowing is very common."
12. "Being tired of being a mother. There's this social thing of loving your kids and them being the first thing in your life, but having a child is messy and really hard work. It is normal just to want to take a break once in a while from all that responsibility."
13. "That they haven't had sex with their partner in years and don't know how or if they will ever have sex with their partner again. There is so much shame around sex in the US that a lot of people are scared to talk to their partner about their sexual needs. Time goes by, and suddenly, they haven't had sex in three, five, or 10 years. It starts for a lot of people in their 40s and 50s."
"Similarly, a lot of people (falsely) believe there is something wrong with their marriage because they fantasize about people other than their partner."
14. "Clients become quite fearful of admitting that they weren't successful since the last time they had a session. This could include not succeeding in using a coping skill that they're learning about or not being able to complete a homework assignment I gave them. Humans aren't robots, and therapy is a lot of work. I feel the client doesn't want to let me down as their therapist, but these 'failure' events are just as important to talk about as successful moments!"
"That being said, I don't expect people to be perfect as they start to work on themselves positively. It takes time to commit to change, especially about trauma or conflicted views that an individual holds."
15. "I work with a lot of anxiety and trauma clients. Whenever I ask if they would describe their experience as being anxious about being anxious, I usually get, 'OMG, yes.' Anxiety has such a physical impact on the body (heart pounding, trouble breathing, feeling faint or cold, tunnel vision, etc.) that we become aware of our body's reaction before we notice the anxious thoughts triggering the reaction. We then panic about why our bodies are flipping out when we're not aware of feeling threatened, and the anxiety compounds on itself."
"Anxiety is like an alarm system in our bodies to signal the presence of actual or perceived danger. What would you do if your alarm was going off at your house?
Check to see if there's a real threat (scan your environment or situation to ground yourself in the present), turn off the alarm (breathing exercises do help, along with mindfulness techniques like body scans), and then investigate what tripped the alarm (process thoughts around the situation that read like a danger to you).
It's also important to note that danger doesn't need to be getting a gun pulled on you. Panicking during a presentation that could impact your job and threaten how you pay your bills and afford your life can feel pretty dangerous if you think about it."
16. "I do a lot of trauma work. Many people who have experienced molestation or sexual assault feel ashamed and confused because their bodies responded. Having an erection or lubrication or even an orgasm does not mean you wanted the sexual contact, and it is still assault."
"Clients often hold a lot of shame and confusion about this. They wonder if it means they wanted it or something is wrong with them. It is a tough thing to work through because of this. Assault is assault. Sometimes human bodies respond to sexual touch even when we don't want that touch."
And a response to this, "Someone once said it's like tickling. You laugh when you get tickled even though you don't want someone to tickle you."
17. "Hallucinations. So many people think if you see or hear things, then that's it for you — immediate straight jacket. First off, disorders in which hallucinations are common (schizophrenia, schizoaffective, etc.) are not life sentences. Most people live perfectly normal lives with therapy and/or medication. Second, hallucinations are a symptom of so many other common mental conditions. Manic episodes can bring audio and visual hallucinations, as well as deep depressive episodes. You'd be amazed at the weird shit your brain will do if you're anxious enough! There are also spiritual and cultural connotations. In many religions and cultures, it's normal and even good to hear the voice of your god or departed loved ones."
"As long as it's not causing distress or harm to anyone, it's not a problem. If it is distressing, tell your therapist. We'll deal with it like we would any other mental health symptom."
18. "I work in an older adults service for people with dementia and mental health problems. I see a lot of family members and carers feeling ashamed of the fact that they are finding it incredibly difficult to care for someone who has dementia or a chronic mental health problem. Carer burnout is a real issue, and people need to know that it's not easy to see someone you love struggling every day or slowly fading away month by month."
"Carers and family members desperately need time for themselves and to know it's okay to feel the way they do. No one is superhuman, and we all have our own needs. It's why we have therapy groups for carers. It's okay to struggle to look after someone, and you should not feel ashamed of having those feelings."
19. "Intrusive thoughts about sex with family members or, in their mind, 'nymphomania' as a result of childhood or adult sexual trauma. Hypersexuality isn't often discussed as one of the PTSD symptoms, so people walk around with so much shame about it."
20. "To name a few: 'Compulsive' masturbation; fears of being a pedophile/rapist (this is a common OCD fear); hoarding; sexual performance difficulties; history of sexual abuse or sexual assault (unfortunately, it is very common); drug use; the amount of money spent on various things; having an ASD diagnosis; going back to an abusive relationship or staying in an abusive relationship; grieving years and years after a loss; self-harm of all sorts..."
"...wanting to abandon their current lifestyle (for example, to have more sex, to escape responsibility or expectations); history of gang violence or crime; their sexuality (or asexuality); gender identity; the impact of racism and racial trauma; paranoia; hallucinations; feeling uncomfortable in therapy; not believing in therapy; difficulty trusting a therapist; fear of psychiatric medication; fear of doctors in general.
I'm a psychologist in the US. At this point, I don't recall a time a patient said something in therapy where I was shocked or even thought, 'Oh, that's new.' And, in my opinion, if you surprise your therapist, that is okay."
21. "A common one is simply, 'I don't know.' You'd be surprised how reluctant people are to admit that they don't know why they're feeling how they are. But that's exactly why you're sitting there with me; so we can figure out why together."
"It always put me in mind of a line from 'America' by Simon and Garfunkel: 'Kathy, I'm lost,' I said, though I knew she was sleeping. 'I'm empty and aching, and I don't know why.'"
22. "A common one is 'secret feelings.' Private daydreams and sexual fantasies. Seemingly, every time someone tells me, 'I have this weird daydream I'm always having...' they tell me their variation of the Suffering Martyr Daydream. It's so common it has a name!"
"Other secret feelings include resentment towards a spouse, the difficulties of being a parent, and lost attraction toward a spouse."
23. "OCD gets misunderstood a lot. It's not just having a clean house or liking things to be organized. Common intrusive thoughts can include violent thoughts of harming children and other loved ones, intrusive thoughts of molesting children, fear of being a serial killer, etc."
"My clients can feel a lot of shame when discussing the thoughts or worry I will hospitalize them."
24. "Some of the most common ones have been visual and auditory hallucinations and suicidal thoughts. I usually hear, 'I don't want to be put in the hospital,' or, 'I don't want you to think I'm crazy.'"
25. "With adolescents, they are extremely anxious to tell me if they've relapsed or aren't doing well. They're worried I'd be disappointed in them. It usually becomes a discussion about policing other people's feelings and tolerating emotions. I explain that I care about their well-being, and it's my job to monitor my emotions and reactions, not theirs."
"For example, they cut one night or were suicidal. They're having a lot of negative self-talk or panic attacks. They'll come in, pretending everything is okay. It's usually in the last 10 to 15 minutes of the session that they'll say something and reveal that they worried they'd let me down."
26. "Two topics come up with regularity: 1) When someone discloses to me that they were sexually abused as a kid; 2) When someone is experiencing suicidal ideation. Both are something I hear from clients daily, so I don't find it weird at all."
"However, when I have someone in front of me who's talking about it for the first time, I know it's important to validate the fact that — even though I might be talking about this for the fifth time that day — they have never talked about this ever and need gentle care to feel safe."
27. "I've had clients too scared to tell me their accomplishments. They think they should only bring their problems to case management and that if we see them getting better, we won't care or prioritize them as much."
28. "Recurring intrusive thoughts about harming others. They can be about hurting or killing someone or sexual fantasies about children or relatives. People usually take a while to admit those. You are probably terrified that you might be dangerous, but the reality is that if you are having them frequently, you likely aren't dangerous."
29. "I was a mental health professional, not a therapist, who did case management work. The big one for me was always drug use. My clients would go through so much to hide it from me. I kept telling them I did not care if they were using; I just wanted to ensure they got the help they needed if it became dangerous. I'd also often get, 'I haven't told my therapist this,' before a long monologue about the abuse they suffered or what got them into drugs (usually a parent who did drugs with them). The other big one people always try to hide is relationship problems. They'd feel like a failure if another relationship went bad or if they ended up with another problematic partner. Honestly, I was only ever worried about ensuring they were okay."
"I also knew their therapists wouldn’t judge them and would be able to provide far more help than I could."
30. "Hidden sexual dreams and fantasies about family members. They are more common than people think. They often stay that way and don't interfere in the person's close relationships unless they allow it. Many things we dream or think are unconscious and involuntary, and the root of such things is often nonsensical."
31. "Usually, it's sex-related. Shame about their desires or kinks is common. Gender questioning is another. Some people are ashamed of things they did in childhood or adolescence and have never told anyone, thinking they'll be horrified."
"We have heard everything. Everything. I'm always compassionate and understand why we do what we do. I've yet to have anyone bring something I don't 'get.'"
32. "Sex therapist here: Your fantasies are normal. No matter what you fantasize about, you're not the only one, and it's probably way more common than you realize. A huge part of my work is helping people normalize their sexuality and desires. Don't be afraid to talk about it; I've heard it all."
33. "The number of people who are unaware of their own emotions and emotional process is astounding. So many people feel only 'angry' or 'happy' and worry something must be wrong with them otherwise. Normalizing feeling the whole gamut is just as important."
"Recognizing what we're feeling and what it feels like in our body when we're feeling is incredibly helpful for understanding how we process and feel. As a whole, how we treat emotions as a society is kinda fucked."
34. "Speaking to their departed loved ones. Thankfully, theories now support this and don't consider it to be a sign they're not 'moving on with their lives.'"
"I encourage my clients to explore the continuation of their relationships with the deceased."
35. "Everything, dude, everything. You name it, I've heard it. Do you regret having your child and wish you never became a mom? OK. Do you love your spouse but don't know how you can go through the fight again if their cancer comes back? Yeah, I get that. Hard drugs? Shit, it's been a hard year. Do you want to quit your well-paying job to sell carved soap figurines? OK, well, let's talk through what that might look like. Do you like to collect teddy bears because they give you a special little tingle in your nether regions? I don't kink-shame."
"Seriously. We've heard everything. EVERYTHING. Unless it's someone new to the field (less than five years), it's generally not going to shock us. Whatever it is, even if it does seem a bit of a unique circumstance, we'll get the underlying feeling behind it.
Ultimately, everyone wants the same overall things — to feel heard, be loved, take care of their loved ones, manage stress, etc. Humans do the best they can, and therapists are there to help. But we can't provide guidance if you don't give us a chance, which means opening up.
I know it's scary, and some therapists do suck. It's a lot like dating. If you don't click with the first one, move on until you find one you do click with."
If you need access to mental health resources, please see the following:
• The National Alliance on Mental Illness helpline is 1-888-950-6264 (NAMI) and provides information and referral services; GoodTherapy.org is an association of mental health professionals from more than 25 countries who support efforts to reduce harm in therapy.
• The Rape, Abuse & Incest National Network (RAINN) offers a National Sexual Assault Telephone Hotline (call 1-800-656-HOPE (4673) or chat online) to connect you with a trained staff member from a sexual assault service provider in your area.
• The National Suicide Prevention Lifeline is open 24/7 to provide free, confidential emotional support to people in suicidal crisis or emotional distress across the US.
• Befrienders Worldwide is a global network (available in 32 countries) that will connect you to a hotline in your area. They aim to provide a safe, open space for you to talk via telephone helplines, SMS messaging, face-to-face, internet chat, outreach, and local partnerships.
• The Trevor Project specializes in providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people under 25. They can be reached 24/7 by phone (1-866-488-7386), text (if you're in the US or Canada, text TALK to 741741 for free; if you're in the UK, text TALK to 85258; and if you're in Ireland, text TALK to 50808), or chat.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) helps you find treatment if you're struggling with substance abuse (in which case, you can call their National Helpline at 1-800-662-HELP (4357)); experiencing stress, anxiety, and other depression-like symptoms (call their Disaster Distress Helpline at 1-800-985-5990); or are a veteran in crises (call their Veteran's Crisis Line at 1-800-273-TALK (8255)).
• The National Eating Disorders Association helpline is 1-800-931-2237; for 24/7 crisis support, text “NEDA” to 741741.
Did these help normalize any feelings you may have or make therapy seem less daunting? As these therapists have attested to, you're not alone. Feel free to share your thoughts in the comments below, and if you're a therapist, let us know if there's anything not on the list that you'd add.
Note: Responses have been edited for length/clarity.