When the Therapist Shares Too Much 

Claire was working on her licensure, and she asked that I supervise her throughout the process. I’ve been lucky to have strong clinical mentors across my career, and so it felt like an honor to be asked for help. I was surprised to receive a text message from her first thing on Monday morning, “Can we touch base soon? I think I really messed up.” 

My stomach tightened. I wondered how badly things could have really gone. Claire was a new therapist, but she had strong clinical skills. I hadn’t expected the urgency of this request. Soon after, she came into my office holding back tears. “I’m too close to one of my clients,” she spoke in low volume. “I don’t know how it happened. It’s not romantic, but I’ve told him about my family and my own problems. Now when we talk… it feels like a friendship. He’s been giving me advice. I screwed up and I don’t know what to do.” 

I took a breath, “You made the right choice.”  

“I know,” she said. She mistook my response for sarcasm. “I don’t know how I let this happen.”  

“No. That’s not what I meant. You had a choice between embarrassment or secrecy. To share this with me or keep it to yourself. It’s a hard choice, but you made the right one.” 

We explored the reasons why the relationship with her client had changed and what to do next. Her willingness to feel embarrassed, and to admit her mistake, was the first step towards repair. It was the first of many such conversations I’ve had since, both with new therapists and advanced ones, too. It’s also a conversation I’ve had with myself. 

Leaving Our Post: Why Unskillful Self Disclosure Occurs 

Unskillful self-disclosure is common; probably more common than we think when considering how many clinicians choose the path of secrecy over embarrassment. Choosing embarrassment by admitting our mistakes means walking against the wind, and so many therapists choose to have the wind at their back.  

But how does this happen? Despite our good intentions, why do we leave our therapeutic post? There are probably many reasons, but the first is that the rules of healthy relationships are broken in good therapy. These are the rules of give-and-take, or reciprocity. When reciprocity is absent in our personal relationships, we tend to conclude these relationships aren’t desirable. Whether giving without receiving, or receiving without giving, these are usually signs that something has gone terribly wrong. If someone talks about themselves but never asks a question in return, we notice it. Somewhere in the back of our mind there’s an accountant who keeps tabs. And if this accountant doesn’t count every penny, they help us determine if our relationships are in general balance. 

In therapy, our job is to fire the accountant. While reciprocity is beneficial in personal relationships, in therapy it undermines our ability to maintain focus on a client’s problem. So, we learn new conversational habits. We temporarily adopt a non-reciprocal style of relating to help our clients. It’s strange to acknowledge, but dysfunctional behavior outside of therapy is useful behavior within it. 

Of course, some therapeutic approaches do emphasize mutuality and appropriate therapist disclosure. But even within these frameworks, disclosure serves therapeutic goals, not the therapist’s emotional needs. This distinction matters. If good therapy requires temporarily implementing this imbalanced dynamic, it shouldn’t be surprising that we struggle to make this adjustment. We’re asked to do something that, at its core, just feels wrong. Our inner accountant balks.  

A second reason unskillful self-disclosure occurs is connected to the first, and it can relate to the problem of therapist loneliness. We are not like other professionals and therapy is not like other jobs. While our individual temperaments vary, most of us become therapists because we’re drawn to people for one reason or another. This draw towards others might seem like a good fit for a career in therapy, and sometimes it is, but other times, therapy can be a lonely place. Back-to-back appointments in empty office buildings or remote work from available bedrooms can bring with it a great silence. 

And this silence isn’t only environmental. In our conversations with clients, we’re required to strategically deprioritize many of our reactions. This doesn’t mean these relationships are insincere, but that large parts of ourselves don’t participate in our discussions. When personal reactions aren’t in service to a client’s goals, we do our best to restrain them. We ask them to hide. 

While we all have a strong interest in human connection, we’re met with more environmental and relational silence than expected. Loneliness is what happens when longing meets absence, and in therapy, there can be a great amount of both. 

Returning to Our Post: The Art of Repairing Unskillful Self Disclosure 

Understanding how unskillful self-disclosure happens is only half the task. The harder part is knowing how to return to the therapeutic framework without damaging the relationship. Once we’ve come to the realization that a clinical relationship has lost its professional shape, what can be done? This problem is difficult because while solving it, we simultaneously introduce three new risks into the therapy. 

The first is that many clients enjoy having insider knowledge about their therapist. They may feel this is the basis of their rapport. To have insider knowledge is to feel special, and to lose access means losing this feeling of specialness. With open doors now closed, the sound of turning locks can create feelings of rejection. Feeling pushed away can damage the therapy, even while we’re trying to repair it. 

Another risk is introduced when clients are more comfortable with the reciprocal dynamic. They may prefer to share the spotlight rather than feel its bright circle pointed at them alone. Reducing self-disclosure will increase the number of empty spaces in the conversation. There will be more silence, and with more silence, more discomfort. When we start walking back to our clinical post, new intensity emerges. 

The last risk is that a client might decide that they’re to blame. They might conclude there’s something uniquely wrong with them if their therapist behaves differently with them than with other clients. Sensing that they lie at the center of their therapist’s dilemma, they might experience shame. It’s a shame that tells them that somehow, they’ve hurt their helper. 

Whatever steps allow us to walk back to our clinical post, it’s important to think about managing the risks of rejection, new intensity, and shame. There’s no perfect script for this conversation, each therapeutic relationship requires its own approach, but one framework I’ve found useful centers around four steps: 

Step 1: “I haven’t done a great job protecting your therapy…” 

Expressing this step demonstrates that our aim is to protect their therapy, and to implicate ourselves at the heart of the problem. To name that we’ve failed to guard their therapy lessens the chances the client will blame themselves. 

Step 2: “and so I’m going to pull back on how much I talk about myself…” 

This signals the incoming adjustment. This statement is directive in nature as we’re not asking the client for permission with this new course of action. We’re telling them it’s happening. This is the first act of stepping away from the reciprocal dynamic, and instead, returning to the clinically imbalanced one. 

Step 3: “but I want to let you know how to interpret this change.” 

This step is particularly important because it helps reduce, though not eliminate, the new intensity that can emerge in the therapy. The client is being prepared to understand what new interactions mean, but also what they don’t. 

Step 4:  “The truth is that my enjoyment of our work hasn’t decreased, but my investment needs to increase.” 

This final phrase reiterates that our adjustment reflects a stronger commitment to the client, not a weakened one. We’re disengaging in the wrong areas and reengaging in the right ones. We’re subtracting non-clinical interactions to deepen the clinical purpose. By expressing that our enjoyment hasn’t lessened, we maintain the appropriate degree of specialness that exists in every meaningful relationship. 

Conclusion: The Ongoing Practice of Returning 

Addressing unskillful self-disclosure isn’t a single moment but an ongoing practice. After we’ve initiated the repair, it’s important to continue monitoring our own pulls toward reciprocity. The loneliness that may have contributed to the initial drift doesn’t disappear simply because we’ve named the problem. 

This is where consultation, supervision, and our own personal relationships become essential. We need spaces where we can acknowledge our humanity: our loneliness, our need for connection, our own vulnerability to unskillful self-disclosure. When Claire came into my office, she made the right choice because bringing it forward made the repair possible. 

I’ve learned that therapeutic work isn’t about being perfect. It’s about being honest enough to recognize when we’ve drifted and courageous enough to find our way back. Every time we effectively manage our need for reciprocity and our loneliness, we strengthen our capacity to help our clients. Even when we don’t prevent unskillful self-disclosure, if we practice repair, we remind ourselves that while we may fail at our post, we’re still worthy of returning to it. 

Crossing Zero: The Art and Science of Coming Off—and Staying Off—Psychiatric Drugs

Leaving Behind the Disease Identity

I hope I’ve succeeded in conveying the message that psychiatric drug withdrawal is often more than pharmacology, dose reductions, and withdrawal symptoms. For many, stopping medication also represents a departure from seeing themselves as ill and lacking agency. This important process can be challenging if those around them continue to embrace the medical model and view them through the lens of illness as a “patient”. 

Even if this doesn’t apply to you personally, I encourage you to keep reading. It will provide you with an understanding of the daily challenges faced by those who do. 

I recall a former client, Ulrik, who arrived at my office one cold and grey Scandinavian February morning, wearing the broadest smile. He had just been to the student counselor the Friday before and was thrilled to be re-enrolled at university, having recently tapered off the antipsychotic that for so long had numbed his emotions and the cognitive abilities he needed to study. Yet it wasn’t just his return to university that was the source of his smile – it was his encounter with the student counsellor. She was the first person he’d met in years who didn’t know he had once been a psychiatric patient diagnosed with – and now fully recovered from – what psychiatry labels paranoid schizophrenia. This made all the difference in how she saw him. 

Like many people with psychiatric labels, Ulrik’s diagnosis had levied such stigma upon him that his completely normal emotional fluctuations and reactions were often misinterpreted as symptoms of illness. 

Those around him had grown accustomed to seeing him through the lens of illness, constantly scrutinizing and judging him, and his freedom to act naturally was heavily limited as a consequence. But for once, this way of being classified in advance as a sick person was gone. For Ulrik, it was a relief not to be defined and judged by his diagnosis. “She saw me as a regular person with aspirations, dreams, and a future full of possibilities. I haven’t felt this way in years. She had expectations of me, and that made me want to try,” Ulrik said, clearly emotional upon realizing the contrast with how many of his friends and relatives still sometimes viewed him as fundamentally sick and defective. 

That Monday morning, our entire hour together centered on the profound impact of others’ perceptions and how they shape a person’s path to recovery. “I also need to be part of something where I am need-ed and people count on me, where my contributions are valued and expected. People with jobs and families can easily take that feeling for granted – but for me, it’s what I long for most,” Ulrik added thoughtfully. 

Breaking free from over-identification with a diagnosis can be challenging, especially if the important people in your life continue to view you through that diagnostic lens. One common obstacle is when loved ones undergo so-called psychoeducation, where they are “educated about the illness” and where a person’s supposed “lack of insight” is interpreted as part of the illness itself. 

The question of disease identity – becoming so intertwined with a diagnostic label that it becomes an identity – is too big to fully cover here, and frankly, I believe it’s not appropriate for professionals to intrude into such deeply personal territory. Instead, we should leave the subject to those who have lived through it firsthand. Fortunately, one such book has just been written by American author and director of the Inner Compass Initiative, Laura Delano, titled Unshrunk

Research also indicates that family dynamics can significantly impact the recovery process. A meta-analysis dating back to 1998 showed that a family’s degree of what’s known as “expressed emotion” could predict the likelihood of relapse of psychosis, depression, and eating disorders. Expressed emotion is defined as “emotional over-involvement and critical communication from family members and closeones.” In such cases, addressing the issue with individual psycho- therapy can inadvertently problematize the individual who may merely be the bearer of symptoms within a broader family dynamic. Family therapy and Open Dialogue may be necessary. 

A Strategic Choice

Many people have to be strategic about who they involve in their efforts to taper off psychiatric drugs, knowing that the decision may not be well received or supported by everyone around them. It’s understandable yet unfortunate that this is sometimes the case, as support from loved ones is crucial to both coming and staying off psychiatric drugs. 

From loved ones, I often hear that the powerlessness and fear of revisiting past struggles from before the medication can be a difficult combination. For both parties, I hope this chapter has eased the feeling of powerlessness and that together you can see concrete, practical steps to take if withdrawal and emotional re-emergence becomes challenging. The situation is likely new and unfamiliar to both of you, and there is often an element of having to chart a path through it together. 

And to loved ones: Remember that simply being present as a human companion offers a powerful antidote to low mood, racing thoughts, and anxiety. In the end, the same principle applies to any form of sup- port during difficult times: The more atypical and to you incomprehensible your loved one’s reactions and behaviors, the more crucial it becomes to remain open and curious about what they are experiencing. Strive to look beyond the surface – to the emotions, experiences, and unmet needs they are grappling with. 

This excerpt is published with permission from the author, Anders Sørensen. 

Measuring the Unmeasurable: How to Know When Therapy Is Working?

Ever wonder if therapy is really helping? I’ve sat on both sides of the couch—first as a client, now as a clinician—and I’ve often heard the line, “Therapy isn’t working for you.” Usually, that says more about the person saying it than about the reality of what’s happening on the couch. 

Izzy’s Story: Healing on Your Own Timeline

This question came into sharp focus after a session with a 36-year-old client I’ll call Izzy. Not long ago, he shared that his mother had remarked, “You’ve been in therapy for two years and it’s not working.” Her words landed heavily. Izzy had come to me less than 24 hours after an unthinkable loss—his girlfriend had been killed in the middle of the night under tragic and complicated circumstances. The fact that he had the courage to seek help so quickly was impressive. 

Over the past two years, Izzy has navigated the raw terrain of grief. We’ve been bearing the unbearable together; slowly piecing together a life that no longer looks like the one he imagined while learning to grow around grief. His mother’s remark felt dismissive and were deeply wounding, as though the depth of his love and sorrow could be timed. Instead of compassion, she offered judgment, measuring his healing against her own expectations.  

I’ve discovered that what often looks like judgment is really a projection of someone else’s discomfort. Izzy’s story reminds me that progress isn’t always visible to others—and that’s okay. Healing doesn’t follow a stopwatch

Shayna’s Story: When Progress Can Be Quantified

Some gains in therapy are concrete and measurable. Shayna came to therapy with severe anxiety and somatic symptoms, many mornings she got physically ill from the stress. Driving felt impossible without taking alternate routes to avoid feeling unsafe on the highway, and seeing a doctor was terrifying. She was afraid that they would find something seriously wrong. 

As we unpacked her fears, validated and normalized her emotions, things began to shift. Shayna gradually stopped getting sick in the mornings. With courage, she went to her mammogram and colonoscopy. She even found a doctor she could trust despite feeling shaky and afraid. The hardest hurdle, driving, is still a work in progress, but she continues to show up and face the challenge. 

In Shayna’s case, progress is not abstract. She stopped getting sick. She faced the screening tests and doctors she once avoided. These steps were visible proof that healing can sometimes be measured in clear, undeniable ways. 

Concrete Wins You Can See

Other clients show measurable progress in different ways. One client, terrified of flying, eventually took a cross-country flight without panic. Another, who hadn’t cried after losing a loved one, began to access and release his grief. A 25-year-old moved out of his home after planning and executing steps used in therapy. 

These milestones are tangible, and important. They show that therapy can create results we can point to, celebrate, and even track. 

Subtle Shifts That Make a Difference

So much of therapeutic growth is quieter and harder to tally. Change happens beneath the surface—in noticing patterns, sitting with discomfort, and making different choices. Clients start recognizing which relationships drain them and which restore them, and which old beliefs no longer serve them. Many learn to nurture themselves with curiosity and compassion rather than judgment. Some become choosier about what they allow in their lives. 

These subtle shifts often manifest in daily life: responding more calmly in conflict, steadier self-talk, asking for help when needed, and seeing people—including oneself—with nuance. I see transformation in clients: behaviors that once triggered intense stress now pass with more ease, and moments of self-compassion come more naturally. 

For clients recovering from trauma, progress involves layers of insight, emotional processing, and coping skills. Progress may not appear on a chart, but it shows up in life: a disagreement that doesn’t escalate, a decision made from clarity rather than panic, a boundary held firmly, a quiet sense of relief in being kinder to yourself.  

What Progress Really Looks Like

So how do you know therapy is working? It isn’t about speed, neatness, or whether others notice. It’s about internal shifts that allow you to live more peacefully, confidently, and authentically. Some gains are visible: overcoming a fear, reducing symptoms, or achieving a milestone.  

Others are felt in small but profound ways: calmer reactions, steadier self-talk, greater ease asking for help, and the ability to hold complexity—recognizing that a parent could have loved you in one way and harmed you in another, less black-and-white thinking, and understanding that many things can be true at the same time. Every type of progress matters. 

If you’re wondering whether therapy is working for you or for someone you love, look for the small changes that ripple into everyday life: the subtle ease in reactions, moments of kindness toward ones self, or the ability to stay present with someone difficult. Even something as simple as using the word ‘no’ as a full sentence can be a quiet victory—one that often becomes the foundation for lasting change.