Maybe it’s a small thing. Your therapist said something that didn’t sit right, and you nodded along. Maybe it’s bigger: weeks of sessions that feel like they’re going nowhere, or a sense that you’re not being understood. You notice it on the way home. You think about mentioning it next time. And then, next time, you don’t.
Many people never say it. They keep going for a while, feeling a little worse about it each week, and then they stop booking sessions. Sometimes they conclude that therapy just doesn’t work for them.
I want to suggest something different. That uneasy feeling is worth taking seriously. And saying it out loud, to your therapist, might be one of the most useful things you ever do in therapy.
The Things People Don’t Say
If you’ve ever held something back from a therapist, you’re far from alone. In research by Barry Farber, Matt Blanchard and Melanie Love, 93 percent of people surveyed said they had lied to a therapist at least once. Most often, it was out of embarrassment. But some of it was something else: wanting the therapist’s approval, or not wanting to cause problems. In other words, the same people-pleasing that brings many people to therapy in the first place can follow them into the therapy room.
It doesn’t help that therapists aren’t as good at noticing when something’s wrong as you might hope. In one well-known study, therapists were asked to predict which of their clients would get worse. Out of 550 clients, they predicted three, even though they’d been told that around 8 percent of clients in their clinic usually did.
So if you’re waiting for your therapist to notice that something isn’t working, you might be waiting a long time. That’s not because they don’t care. It’s because what goes on inside you isn’t always visible from the other chair.
Why Saying It Can Help
Here’s what I find most interesting about this.
Researchers who study the therapy relationship, particularly Jeremy Safran, Christopher Muran and Catherine Eubanks, have looked at what they call “ruptures”: moments when the connection between client and therapist strains or breaks down, through a misunderstanding, a disagreement, or a sense of not being heard. You might expect ruptures to be bad for therapy. But their research suggests that when a rupture is noticed and worked through together, therapy tends to go better, not worse. The evidence is still fairly small, but it points in an encouraging direction.
I see why in my own work. For many people, telling their therapist “that didn’t feel right” or “I’m not sure this is helping” is the first time they’ve ever said something like that to someone who matters to them, and had it heard rather than punished. If you grew up learning to keep the peace, to avoid disappointing people, or to hide your needs, then saying it in the therapy room isn’t a detour from therapy. It’s therapy, happening in real time.
A good therapist will welcome it. They may feel a flicker of discomfort, as anyone would, but they’ll be curious rather than defensive. And how they respond will tell you a lot about whether this is the right person for you.
Comfort Isn’t the Whole Story
It’s natural to look for a therapist you feel comfortable with, and that matters. But “comfortable” can be a little misleading.
Good therapy isn’t always comfortable. Sometimes it touches on things you’ve spent years avoiding, and that’s going to feel uneasy, at least for a while. Feeling uncomfortable isn’t necessarily a sign of a bad fit. Sometimes it’s a sign that you’re getting somewhere.
The difference is in how the discomfort feels. Uncomfortable but safe is one thing: you’re finding something hard, but you feel respected, heard and free to slow down. Feeling judged, dismissed, pushed too fast or not taken seriously is something else. That’s worth paying attention to.
A few questions can help you tell the difference. Do I feel listened to? Do we agree, roughly, on what we’re working on? Does the way we work suit me, or am I fitting myself around their approach? Could I tell them if something wasn’t working? If the answer to the last question is no, that in itself is worth exploring, with them if you can.
What Experience Does and Doesn’t Tell You
It’s easy to assume that the more years a therapist has been practising, the better they’ll be. The research is more surprising.
In a 2016 study, Simon Goldberg and colleagues followed 170 therapists working with more than 6,500 clients over as many as 18 years. On average, the therapists’ outcomes didn’t improve with experience. If anything, they declined very slightly.
That doesn’t mean experience counts for nothing, or that new therapists are better. Some therapists do keep improving, and specific training matters a great deal for some difficulties, such as trauma or eating disorders. But it does mean that years in practice on their own aren’t a reliable guide. It’s more useful to ask how a therapist keeps learning, how they check whether therapy is helping, and whether they’ve trained in what you’re looking for help with.
Checking the Basics
There are a few practical things worth checking before you start.
In the UK, “counsellor” and “psychotherapist” are not legally protected titles. In theory, anyone can use them. The best safeguard is to check that your therapist is registered with a professional body that holds an accredited register approved by the Professional Standards Authority, such as the BACP, UKCP or National Counselling and Psychotherapy Society. You can search each organisation’s register online. Registration means they’ve met training standards, follow an ethical framework, have regular supervision, and that there’s somewhere to turn if something goes wrong.
It’s also reasonable to expect a clear agreement at the start: how often you’ll meet, what it costs, the cancellation policy, and how confidentiality works, including its limits.
And then there are the everyday practicalities: whether session times fit around your life, whether the cost is sustainable, and whether the location, or online sessions, work for you. These matter more than they might seem. Therapy that’s hard to get to is hard to keep up.
One thing worth knowing: most therapists in private practice aren’t able to offer support between sessions in a crisis. If you need urgent help, you can contact your GP, call NHS 111 (in Wales, 111 and press 2 for mental health support), or call Samaritans any time on 116 123.
If It Still Isn’t Right
Sometimes, even after talking about it, the fit just isn’t there. That’s OK. It’s not a failure, on your part or theirs. People are different, and so are therapists.
If you decide to end, it can help to have a final session to close things properly, rather than just stopping. Many therapists are also happy to suggest colleagues who might suit you better. And when you start again with someone new, you’ll know more about what you need, which is useful in itself.
A Relationship Worth Getting Right
The relationship with your therapist is one of the strongest predictors of whether therapy helps. That makes it worth paying attention to, and worth speaking up for.
At Trueform Therapy, I offer one-to-one sessions in person in Cardiff and online across the UK and EU. I’m a registered member of the BACP, and I’ll regularly check with you how the work feels and whether it’s helping. If something isn’t working, I want to know. If you’d like to see whether we’d be a good fit, you’re welcome to get in touch for an initial conversation.
If You Want to Explore These Ideas Further
If you’re curious about what goes unsaid in therapy, Barry Farber, Matt Blanchard and Melanie Love’s Secrets and Lies in Psychotherapy explores why clients hold things back, and what helps. It’s written for professionals, but it’s readable.
For a sense of what a good therapy relationship looks like from the therapist’s side, Irvin Yalom’s The Gift of Therapy (2002) is short, warm and full of practical wisdom.
And if you’d like to look at the research directly:
How to check a therapist is registered in the UK: Therapy Route
Why people lie to their therapists: TIME
Do therapists improve with experience? (Goldberg and colleagues, 2016): Society of Clinical Psychology summary
Alliance ruptures and repair in therapy (Safran, Muran and Eubanks-Carter): summary (PDF)