Therapist talking with clientAccording to a 2012 meta-analysis, 20% of clients prematurely leave therapy. For many, difficulties opening up and sharing their emotions motivate the decision to drop out.

Successful therapy depends on a client honestly sharing their experiences and behavior. Yet many clients have spent a lifetime avoiding or concealing the very things they most need to discuss in therapy. Many people harbor secret thoughts, feelings, and shame. Sharing these with a stranger, even a therapist, can be difficult. It takes time for a therapist to earn a client’s trust, and therapists should not expect that all clients will immediately open up. 

Mandy Rubin, a licensed professional counselor in Denver, Colorado, explains how therapists can help clients feel comfortable from the start of their first session. "At the outset of therapy, it is vital to level the playing field—openly ask for the client’s expectations for therapy and gently correct any misinformation about the therapeutic process," she advises. "Continue that openness by sharing how the process might unfold; initial sessions can be far less comfortable than future ones."

Rather than seeing clients who won’t talk as “difficult,” therapists should devise strategies for building a safer and more supportive therapeutic environment. With patience and the right approach, therapists can help their clients talk openly about their lives. 

What Causes Clients to Feel Tense in Therapy?

Numerous issues can make clients feel anxious or tense in therapy. Some of the most common include: 

  • Reluctance to seek treatment. Many clients pursue treatment at the behest of someone else, such as a partner. If a client is only seeking treatment because of someone else, they may not believe in the process or want to openly share their feelings. Clients receiving court-ordered treatment may fear that what they share in therapy will be shared with third parties, or they may be resentful about the treatment. Children may worry the therapist is on their parent’s “side” or that the therapist will not respect their confidentiality
  • The client’s mental health diagnosis. Some mental health conditions make it more difficult to trust a therapist. A person experiencing paranoid delusions may struggle to trust the therapist or worry they are an agent of a third party. A client with posttraumatic stress (PTSD) may fear sharing their story requires reliving their trauma. 
  • A history of bad therapy. Some therapists are unskilled or abusive. A client who has seen several therapists in a short period of time may have experienced abusive or ineffective therapy. This can make them reluctant to open up again, though the decision to give therapy another try points to their hope for a different outcome this time. 
  • Therapist anxiety and experience. Clients are more likely to discontinue therapy when a therapist is new or unskilled. New therapists may feel anxious in therapy, and those feelings can affect their interactions with clients, making it more difficult for the client to share. Some therapists do not know how to help clients open up. Others feel unusually anxious around silent clients or find these clients trigger their own feelings of insecurity or fears of inadequacy.  
  • Trauma. A history of trauma can make it difficult for a client to trust others, including their therapist. 
  • Therapist’s body language. Clients do more than listen to what a therapist says. They also observe a therapist’s body language for signs of judgment, discomfort, or boredom. If a client thinks the therapist is not listening or is silently judging them, they may quickly shut down. 
  • Fear of judgment. It’s natural to fear judgment, even in therapy. People who seek therapy may never have told anyone else the things they discuss in therapy. It takes time to warm up, and it’s critical that a therapist never make a client feel judged. 
  • Client-therapist mismatch. Not all therapists are a good match for all clients. While therapists and their clients do not have to share the same personality or values, they must be able to establish a shared baseline. When the therapist and client have radically different worldviews or approaches, there may be a mismatch. For example, a very conservative Christian client may fear judgment from a very liberal atheist therapist, while the therapist may not know how to help the client live up to their own values.  
  • Discomfort in the therapeutic environment. Subtle issues with the therapeutic environment itself can make it more difficult to open up. If the room has thin walls, a client may worry about privacy. A draft, feeling too cold or hot, physical discomfort, and other easily remedied issues may also play a role. In some cases, decorations or other features in the room can undermine a client’s confidence. For example, a client who sees a book that contradicts their own values or that stigmatizes mental health may be reluctant to share. 
  • Cultural or religious norms. A person’s views about their own emotional experiences can affect their ability to talk about their feelings. Men who endorse a rigid view of masculinity may have difficulty discussing how they feel, for instance.

Therapists should be willing to address barriers to opening up before asking the client to share the intimate details of their life. Treat discomfort as the first therapeutic issue to be tackled, and listen with an open mind about how therapy makes the client feel. 

How Therapists Can Strengthen the Therapeutic Alliance 

There’s no one-size-fits-all approach to helping clients feel comfortable in therapy. To strengthen the therapeutic relationship, therapists must first identify factors that undermine it. Some strategies that may help include: 

1. Help the client feel more welcome.

Consider specific steps that might make therapy more welcoming for the client. Is the room too cold? Would a white noise machine help the client feel less anxious about privacy? Is your body language standoffish? Tailor the structure of each therapy session, as well as the room itself, to the needs of your client. 

2. Know that relationships take time.

The therapeutic alliance is a relationship, and ideally a close and trusting one. Relationships take time to build. Your first few sessions may be fairly surface-oriented, built on small talk and only occasional disclosures. Your investment in these early interactions is an investment in the trust that will ultimately help a client open up. "The therapeutic bond can be strengthened with authenticity in-session by sharing genuine reactions to the client’s story—when appropriate, of course," says Rubin. "A constantly neutral presence in the room increases emotional distance rather than closing the gap to allow the client to feel authentically heard."

3. Never judge the client.

It’s nearly impossible to go through life without judging people. Judgment, however, is therapy’s death knell. While all therapists strive to be nonjudgmental, clients can pick up on the slightest hint of judgment. Avoid giving advice that might feel like a condemnation or giving insight that is outside your scope of practice. For example, therapists should not generally give religious or medical advice. If you feel yourself judging the client, the client may feel it, too. So work to keep your own feelings in check. 

4. Manage your own emotions.

When a client won’t open up, therapists may feel anxious before therapy. This can erode trust. Commit to managing your own emotions. Meditation, validation exercises, and planning ahead for each session can prevent your emotions from intruding on the session. 

5. Talk about what the client wants from therapy.

The client’s goals for therapy might be very different from what you assume they are or think they should be. Talk to the client about what they hope to get from therapy. Then use these goals as guideposts. When the client clams up, explain to them how discussing a particular topic can help them achieve their goals. 

6. Ask more or different questions.

Asking a single question or two may not be enough to get a client to open up. Sometimes you may need to ask more questions, different questions, or present the same question in a different way. Ideally, your questions should feel like an interview by an interested person, not an interrogation. Respond warmly and empathically, and follow the client’s lead. Stoic silence when the client laughs or a light-hearted approach to something the client takes seriously can make them clam up. 

7. Don’t make the client feel rejected.

People seeking therapy are vulnerable, both because they may struggle with mental health issues and because they are sharing their most intimate thoughts and experiences. Make the client feel interested and heard. Don’t trigger feelings of rejection by daydreaming, shutting down their ideas, or dismissing their values. 

8. Refer to another therapist.

If you feel ill-equipped to help the client, are not an expert in their specific challenges, or foresee a serious personality mismatch, refer the client to another therapist whom you believe might be a better match. Don’t just make a blind referral. Spend time seeking out a therapist who is equipped to support this specific client. Then make sure the client knows the referral is an admission of your own shortcomings, not a condemnation of the client. 

9. Plan questions ahead of time.

Good therapy doesn’t just happen. It demands planning, research, and diligence. Plan your conversation with your client ahead of time, and jot down some questions. This ensures therapy follows a productive path. If you’re struggling, consider seeking insight on your plans for therapy from a supervisor or other trusted advisor. 

10. Focus on the client’s needs.

Therapists are human beings with their own emotional baggage, just like their clients. It’s easy to feel rejected or judged by a client who does not talk. Remember therapy is for the client, and the only needs that matter are the client’s needs. Don’t make the client feel like they’re harming you. Talking with another therapist or a supervisor can help you sort through your own emotions about a client who doesn’t want to open up. 

Therapy demands a lot from therapists. Compassionately serving clients isn’t always easy, especially when you’re not sure why a client won’t open up. A GoodTherapy membership offers access to a wide range of resources, including continuing education seminars, that can help you build and strengthen your skills as a therapist. 

References:

  1. Clay, R. A. (2017). Coping with challenging clients. Monitor on Psychology, 48(7), 55. Retrieved from https://www.apa.org/monitor/2017/07-08/challenging-clients
  2. Cynkar, A., & Schwartz, D. (2007). Facing your first clients. GradPSYCH Magazine, 9. Retrieved from https://www.apa.org/gradpsych/2007/09/clients
  3. Meyers, L. (2014, August 18). Connecting with clients. Retrieved from https://ct.counseling.org/2014/08/connecting-with-clients 
  4. Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547-559. doi: 10.1037/a0028226