Say It With Love, But Say It

Why Honesty (Even the Brutal Kind) Belongs in the Therapy Room

Each week I host clinical supervision for a group of associate licensed clinicians. In addition to reviewing their current caseload and talking through diagnoses, treatment plans, and clinical decisions, we also make space to discuss broader topics around ethics and practice orientation. These meetings offer a chance to share perspectives, reflect, and help newer clinicians build their professional identity and therapeutic approach.

This past week, we had a particularly interesting conversation and I’d love to hear what others, therapists and non-therapists, think about the topic. Here’s the question:

Are therapists too nice? Are there moments when we need to be real and tell our clients a truth that might hurt their feelings? Or do we withhold judgement and allow our clients to come to conclusions on their own?

You know that friend who complains about the same thing over and over again but never makes any changes? When you offer suggestions or encourage action, they sidestep it every time?

Or maybe you know someone who’s the perpetual victim. Nothing in their life is their fault, but yet everything in their life is falling apart. Even when you gently suggest they reflect on their role in their life patterns, they refuse.

Yeah… well these folks come to therapy, too.

And we’re trained to work with everyone. There are clinical strategies for navigating these kinds of dynamics. But yet, sometimes even we, as therapists, get to the point where we want to say the quiet part out loud: it’s you. You are responsible for making changes in your own life.

Personally, I’m a “call it like I see it” type of therapist. Direct and to the point. By the second or third session, I’m usually saying something like: “Are you here to talk about what’s wrong with everyone else in your life, or are you ready to make some changes to better manage your emotions and improve your own life?”

Many of my clients chose to work with me because they appreciate that kind of blunt honesty. Others have stopped coming because the directness of my tone makes them uncomfortable. I’ve made peace with knowing that I’m not the right therapist for everyone.

My goal is to help those I’m working with build lives aligned with their personal vision and values. Along the say, we’ll process trauma and difficult life experiences, learn to set boundaries, and how to communicate our needs clearly. I allow for limited space to complain about the world and instead encourage clients to grieve reality, so that we can develop strategies that are responsive to what we painfully know to be true.

(For those curious, this is all part of Acceptance and Commitment Therapy or ACT, one of the modalities I most often use.)