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How to Talk to a Therapist

How to Cope When Social Anxiety Makes it Difficult to Talk to a Therapist

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Updated July 07, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

It can be hard to talk openly with a therapist if you have social anxiety disorder (SAD). The reason that you are going to therapy is because you are afraid of people; and yet therapy requires you to open up and share your innermost feelings with a complete stranger. Particularly for those with generalized SAD, therapy may initially be as difficult as the social situations that you fear. It is a catch-22 that is somewhat of a unique problem that those with social anxiety face.

Many people who enter therapy for the first time may have trouble opening up. This problem may be particularly severe for those with SAD. You may find it hard to confide during therapy sessions. You may be afraid to appear vulnerable, and your inability to trust someone else enough to open up could become a barrier to the successful completion of therapy. You may even feel like quitting, or actually quit going to sessions.

Unfortunately, this problem plagues many who suffer from social anxiety. In addition, many people are too ashamed to tell their therapist how they are feeling, and so the anxiety is never resolved.

What can you do if you are feeling this way?

It is not an impossible situation. Below are some tips to help you better cope with opening up in therapy.

  1. Give it time

    Although it may be difficult to imagine, over time you may become more comfortable with your therapist. This process may take several weeks or even months to develop, but if the relationship is a good fit, it is possible that it will become easier to open up as time goes on. On the other hand, if you are in short-term therapy, or if there is a disconnect between you and your therapist, giving it more time may not make sense.

  2. Write Things Down

    If you are someone who finds it easier to share feelings on paper than in person (as is true for many with social anxiety), you might want to consider writing down how you feel before a session and giving it to your therapist. What you write is up to you. It could be a list of topics to talk about, a journal of your thoughts for the week, or even a full letter explaining how you feel in detail. If you feel uncomfortable watching someone read what you have written, you could even email it to your therapist before the session. Expressing your feelings in writing is a good way to initially feel safer in therapy, and may help you to more easily engage with your therapist as treatment progresses.

  3. Consider Online Therapy

    Online therapy is becoming more popular and for a good reason: The ability to talk to someone in an email or chat format about personal issues instead of in person is appealing to many. For those with SAD, it may be a better introduction to therapy than face-to-face encounters. For those who have started in-person therapy and quit prematurely because of anxiety, online therapy may be a particularly good alternative. Ultimately, engaging in online therapy may make it easier to eventually speak to a therapist in person.

  4. Join a Peer Support Group

    Although it may seem counter-intuitive to participate in a group setting when you are afraid of people, peer support groups have many advantages for those with SAD. In a peer support group, you have the option of sitting and listening quietly without speaking. You can hear about how others have also been afraid to open up in therapy and how they overcame this obstacle. If you do decide to join a peer support group, make sure that it is one that is for people with social anxiety or sensitive to the challenges of people with SAD.

  5. Confess Your Anxiety

    If you have given it time, and you believe that your therapist is a good fit for you, it may be time to confess how you are feeling. Whether you do this in writing, by email, or in person is up to you. What you need to do is come clean and tell your therapist that your social anxiety is getting in the way of you opening up in therapy sessions. Your therapist's job is to help you work through these issues, and it is important that he knows what you are really feeling. You may be surprised at how telling the truth about your anxiety in therapy makes it easier to open up.

  6. Change Therapists

    What if you have done all of the above, and still don't feel comfortable? Sometimes, the match between a therapist and client just isn't a good fit. Is your therapist warm and friendly? Does she encourage you or intimidate you? Is she knowledgeable about SAD or does she minimize your concerns? If there is something about your therapist that makes you uncomfortable, you may be better off with someone else.

    Although opening up in therapy is never easy for those with SAD, the rewards of doing so can be great. Find a therapist that you trust, give it enough time, write things down when you feel the need, and try to be as honest as you can about your feelings. Doing so will make the most of your time in therapy.

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