A few years ago, I wrote about some of the secrets your therapist won’t tell you. It’s about time we revisited that topic and shared 10 more things your therapist likely won’t tell you about therapy, treatment of mental illness, or their profession.

I share these things not to scare you away from trying psychotherapy — I think everyone should try it! — but to help you understand that therapists are humans too. It’s always better to be fully informed and educated before starting any treatment regimen.

1. I may talk about you and your case with others.

Generally, a professional therapist will severely limit how much they talk about their clients to others. Some will only do it with other professionals, for the sole purpose of getting a second opinion or some advice on how to better help you. But other, less-professional therapists may share the details of your case with non-professionals or their partner. (It may be of some comfort, however, that nearly every therapist who does this does it without ever mentioning your name.)

2. If I’ve been practicing more than 10 years, I’ve probably heard worse.

Some people who start psychotherapy for the first time are afraid of sharing their innermost thoughts and feelings, or their life experiences, because they’re afraid of shocking the therapist with the outrageous details. However, if a therapist has been in practice for more than 10 years, it’s likely they’ve pretty much heard it all. There is very little you can say to a therapist that will shock them.

3. I may have gone into this profession to fix myself first.

It’s a badly kept secret that some therapists (no matter what the specific profession) went into the field to better understand themselves first and foremost. Students in the same graduate school class can usually identify those people who are in training to fix themselves. That doesn’t mean those students don’t end up being great therapists, just that the profession has probably more than its fair share of people with their own mental health issues to contend with.

4. Not everything you tell me is strictly confidential.

When you start off with a new therapist, they’ll go over some paperwork that they’ll have you sign, one of which will describe the limits of their confidentiality with you. Confidentiality with a therapist isn’t absolute. If you talk about illegal activities, child, domestic or elder abuse or neglect, or wanting to harm yourself or others, the therapist may be obligated by law (in the U.S.) to report you to the police. Each therapist is different, however, so you’ll want to flesh out those limits with your therapist before you start bringing up these kinds of topics.

5. I say, “I understand,” but in truth, I don’t.

Many therapists have a set of go-to phrases they’ll use when needed, one of them being “I understand” (or some variation thereof). The truth is that nobody can truly understand your experiences except yourself. Your therapist hasn’t lived your life, had your childhood, or experienced your hurt and losses — nobody has. Only you can truly understand yourself. Your therapist is there to help you with that.

6. I need to diagnose you even if you don’t qualify for a diagnosis.

Sadly, because of the bizarre health insurance landscape we’ve created in the U.S., all patients in psychotherapy will likely receive a diagnosis — whether the need or qualify for one or not. It’s the primary way that therapists get paid by an insurance company. Without a diagnosis, you’d have to pay the bill out of your own pocket. (If you pay cash, you can avoid this problem.)

7. Transference is sometimes a two-way street.

The concept of transference is used to describe a patient’s feelings that they have for a past significant figure in their life (often a parent) that are placed (or transferred) onto the therapist. Therapists get these feelings too — called counter-transference — toward their patients. Professional therapists know how to properly deal with them outside of the therapy session. Unprofessional therapists may violate the therapy relationship’s boundaries and try to deal them directly with the client.

8. Some people think we go into therapy practice for the money, but nothing could be further from the truth.

Most therapists in the U.S. are not as highly-paid as some people imagine. Rarely have I met a therapist I thought was in it for the money. While psychologists and psychiatrists generally make a little more than the average U.S. worker, other kinds of therapists (like clinical social workers and marriage and family therapists) generally make much less.

9. Change is hard. A lot harder than most people think.

By the time most people come into therapy, they’ve already tried changing some aspects of their life to feel better. It usually hasn’t worked (hence the reason they’re trying therapy). While psychotherapy can indeed help chart a more effective path leading to durable change, it’s not guaranteed. All of the hard work will still be done by you, and it will require a lot of willpower and effort on your part.

10. Some people use us as a paid friend.

Psychotherapy is an active process that requires effort to understand past thoughts and behaviors to better effect change in future thoughts and behaviors. However, some people go into talk therapy and spend the entire session talking about what happened to them in the past week. While it’s fine to devote 10 or 15 minutes of every session sharing, the bulk of your time in psychotherapy should be used for working on change.

For further reading

10 Secrets Your Therapist Won’t Tell You