The harm caused when therapists don’t tell you what they’re really thinking

When therapists secretly don't believe you

I don’t want to make you scared of therapists.

Because I am a therapist.

And I know many incredible therapists.

But it’s also because I am a therapist, I feel I must name some atrocious therapist behavior.

This is not about throwing any single therapist under the bus. I have no interest in destroying someone’s career or attacking a person.

This is about a collective behavior pattern I see throughout the therapy profession.

We could blame it on Freud, who advocated that psychoanalysts sit quietly while their clients go on and on. The therapist does not interject. The therapist does not share anything of themselves.

Therapy has come far from those days, but we still see elements of this:

• Letting the client guide the session

• Not giving any personal opinions about the client

• Not divulging anything about yourself

• Solely asking questions so the client comes to their own conclusions

These things may all sound like positive things, but they can quickly go wrong.

I was reminded of this today when I read an article written by a therapist (I am choosing to not share the name of the article as to protect the identity of the therapist). The therapist discussed the rise of self-identification of autism, and how he felt it was largely misguided.

He talked about a client who came to him and self-identified as autistic. He enumerated the reasons she was not actually autistic. And then, he stated he couldn’t actually tell her that. He didn’t want to be “cruel” and take away an identity that brought her “community and an explanation for her struggles.”

All I could think was, “My god, I wouldn’t want that man to be my therapist.”

I wouldn’t want my therapist to think everything I shared was false — and not even tell me.

It means the person I turn to for support and guidance with my mental health doesn’t even believe me. It means all of his questions will be geared toward helping me realize his “truth”: that I am not autistic.

But let’s be the devil’s advocate and play out the scenario in which the client isn’t autistic. Let’s pretend the therapist is right. Even in that instance, the therapist should let the client know. The client does not have the clinical knowledge that the therapist has. How are they supposed to know they don’t actually meet diagnostic criteria? How are they supposed to reason their way out of a diagnosis they don’t fully understand?

Perhaps I feel so strongly because this very thing happened to me.

When I initially went for help for the crushing depression I experienced, I was given the diagnosis of Borderline Personality Disorder (BPD) after a 20 minute meeting with a psychiatrist.

I had to go home to look up what it even meant. I was horrified by what I read. I quickly realized I needed more help and went to a BPD specialist. Over the course of the year, she worked with me, primarily just asking me questions and listening to me.

During this time, I also started graduate school for mental health counseling. As I learned more and more about mental health, it became very clear to me that I did not have BPD.

After a year of seeing my BPD specialist, I asked her if she felt I had BPD. She shifted in her seat and looked visibly uncomfortable. She replied, “It’s more important what you think.”

I rattled out my reasons why I felt I didn’t meet the criteria. It was only then she said, “I agree, you do not have BPD.”

I looked at her, astonished and said, “Then why didn’t you tell me?”

She fumbled over her words and said, “It wasn’t my place.”

How was it not her place to tell me when I was in “treatment” for a disorder that I didn’t even have?

I was so stunned that I couldn’t say any of that. I simply didn’t return.

Artwork created by me

It was absolutely her place to tell me.

To clarify what BPD is and why I didn’t meet the criteria. It would have dramatically change how I conceptualized myself, as well as what kind of treatment and support I sought.

Three years later, under the care of a different therapist, it was suggested I might be autistic. A year later I met with a psychologist and was formally diagnosed. It was only when I saw myself through the lens of autism and received neuro-affirming therapy that my life began to dramatically change for the good.

My journey with misdiagnosis and therapy shape how I show up in the therapy room.

I am direct with my clients, just as I would want my therapist to be with me.

I say the things that I feel will benefit the client, even if they are painful to acknowledge.

If a client goes off on a tangent that takes us too far from our therapy topics, I will interrupt and bring us back to the things at hand.

I share personal examples of how autism impacts my life, so that my clients can have a concrete example, as well as de-stigmatize the impacts of autism (I specialize in working with late-identified autistic adults).

I do these things because a client doesn’t always know best — contrary to the mantra that many therapists like to live by.

This is especially true of my autistic clients. They often hold harmful misconceptions of themselves. I don’t want to sit back and let them “guide” the session as they ruminate about their “mistakes” for an hour.

No, I want to jump in. I want to reframe their experience. I want to point out things they may not be able to see. I want to explain how autism is showing up. I want to help them see themselves in a different way.

I’m an active therapist. I am a straightforward therapist. I am transparent and real — just as I am asking my clients to be when they show up.

That’s the kind of therapist I want — and the kind of therapist I hope many others get to experience.

I don’t know what poor client met with the therapist who withheld his clinical assessment, but I hope she eventually gets the therapist she deserves.

Thanks for reading!

Here are 3 ways to connect with me more:

1. Sign up for my free FUNletter. I share a weekly list of all the things I find fun as an autistic.

2. Become a therapy client. I work with autistic adults from all over the world and am currently accepting new clients.

3. Download my short book “For the Autistic Going through Times”

It’s available for available for purchase on my website (buck the system… support artists directly!)