Blurts & Spasms

In answer to Quora question: "Are there any limits on what a client in psychotherapy should share with the treatment professional? Could some content be too disturbing?"

Question details: Some people might avoid revealing certain things in fear of unknown reactions. What, if anything, is too much to share?

Nothing is "too much." Any professional who chooses to enter into a therapeutic relationship that confronts difficult material - material that may extremely traumatic or uncomfortable for their client - has to have well-developed ways of dealing with that content...no matter how disturbing it may be. The therapist should have the training and confidence to set necessary boundaries with their client - and to continually negotiate, clarify and reinforce those boundaries over time. But again it is the responsibility of the therapist/counselor/coach/practitioner to do this. At the same time, I think it's very helpful for any client to be sensitive to this issue as they enter into a therapeutic relationship...so kudos for that!

In my own coaching work with individuals and couples, I have been subject to all sorts of challenging situations. People have been sexually inappropriate, violently angry, have collapsed onto the floor wailing in grief, became extremely detached or dissociated, threatened to harm themselves or someone else...or me. I had to make a judgement in those situations about whether these reactions were healthy catharsis, unhealthy decompensation, therapeutic resistance or avoidance behaviors, an underlying psychosis...and so forth. In some cases, it became clear that my client needed an intervention (psychological, pharmaceutical, educational, medical, etc.) that I was not qualified to provide, and I would refer them to an appropriate specialist. Sometimes this meant ending our relationship, but that's how it works.

I think what this really points to is an important principle, which is that service providers need to do a much better job of triage and referring to the right specialist, so that people can receive the appropriate help. Our current health system (in the U.S.) is fairly broken in this regard; it does a terrible job of triage for emotional and psychological issues especially (and their underlying physiological causes). Years ago I was a patient advocate and was astounded by the level misdiagnosis and inappropriate or destructive treatment patients received. We have a medical system built on fee-for-service, and that tends to create the wrong kind of incentives for ideal health outcomes. Yes, there are good people doing good work in our system - but the system itself is flawed.

So for now, unfortunately, it falls on clients (or patients, as the case may be) to self-educate, self-advocate, and to large degree find the best resources for help, guidance and treatment without relying on a faulty system to help them do this. For emotional and mental health concerns, that means shopping around for the right kind of therapist - that is, one whose approach works best for a given condition or circumstance, and who is experienced and competent in that approach. In a commercially driven healthcare environment, this can feel like an antagonizing responsibility for the person seeking help...especially if they are in crisis ...but that's where we are right now. In any case, here is a link to something I wrote about finding the right resource: https://www.integrallifework.com/resources/How-to-Select-Mentor-Coach-Therapist.pdf.

My 2 cents.