You sit down, the clock starts, and your mind freezes. You talk about work or the kids, but the real stuff stays locked up. The panic you felt in the parking lot. The argument you are ashamed of. The secret you rehearsed saying. You leave wondering: “Is this a me problem, or do I need a different therapist?”
If that resonates, you are not alone. Here is the good news: feeling hesitant does not mean you are bad at therapy. It usually means something important is happening in the relationship. With the right moves, that stuck feeling can become a turning point. This guide explains how to tell whether you can work it through with your current therapist or whether a switch would serve you better.
First principle: the relationship is a core part of the treatment
Decades of research show that the quality of the working relationship, often called the therapeutic alliance, predicts how much people benefit from therapy. In a large meta analysis covering more than 30,000 patients, a stronger alliance was consistently associated with better outcomes across many therapy types. The average association was moderate and meaningful, not a trivial link.
Equally important, alliance is not just a nice feeling. When there is a strain in the relationship, researchers call it an alliance rupture. Addressing it directly by naming what feels off and exploring it together is linked with better results. Therapists who are trained to recognize and repair ruptures tend to see stronger outcomes. In other words, the way you and your therapist work through stuck moments is part of the healing.
Bottom line: If you cannot be fully honest, that is not a personal failing. It is information about the alliance. What you do with that information matters.
Common reasons people hold back, and what to try first
Shame and self protection
Many of us learned to hide painful truths to stay safe or keep the peace. Research on self concealment shows that hiding distressing information is associated with more psychological distress. A 2024 and a 2025 paper add that people who habitually conceal tend to keep more secrets and often view secrecy positively, which can reinforce the habit. Bringing this pattern gently into the room is often the first brave step.
Try this: “There is something I want to say and I am nervous I will be judged. Can we slow down and make space for that?” Naming the process is a powerful way to test safety.
Not knowing the confidentiality rules
Many people hold back because they are not sure what stays private. In general, therapists keep what you share confidential. Common exceptions involve imminent safety risks, mandated reporting of abuse or neglect of children or vulnerable adults, and disclosures required by law. Under HIPAA, psychotherapy notes receive special protection that is distinct from the medical record. Ask your therapist to explain how confidentiality and its limits work in your state and setting. Clarity makes honesty easier.
Try this: “Before I share something hard, can you walk me through how confidentiality works here and the limits I should know about?”
The therapist missed you, or stepped on your toes
Therapists are human. Misattunements happen. So do microaggressions, which are subtle slights tied to identity that can make the room feel unsafe. Studies find that microaggressions relate to weaker working alliances, and that cultural humility from the therapist helps to repair trust. If something felt off, you can name it and see how your therapist handles it. The response tells you a lot.
Try this: “When you said X last week, I felt Y. I am not sure if that is what you meant, but it made me pull back. Can we talk about it?”
Mismatch in approach, pacing, or goals
Sometimes it is not who they are, it is how they work. Maybe you wanted skills right away and got open ended exploration. Maybe you wanted depth work and got worksheet after worksheet. That is a task or goal mismatch. Good therapists invite feedback and will collaborate to adjust the plan.
Try this: “Could we align on short term goals? For the next month I would like help with [sleep, panic, a hard conversation]. I am open to trying [CBT skills, behavioral experiments, or another concrete approach].”
A quick roadmap: try to repair, then decide whether to switch
Use this sequence first. If things do not improve after one to three sessions, a switch may be wise.
- Name the process. Tell them that you are holding back and why.
- Watch the response. Do they welcome feedback, get curious, and collaborate on a plan? Or do they become defensive or minimize your experience?
- Test a repair. Agree on one concrete change. For example, begin with brief agenda setting, add a mid session “are we on track,” and slow down when emotions spike. Then reassess.
If they invite feedback and follow through, that is a good sign. If not, it is reasonable to find someone who is a better fit. Research on premature termination shows that many people stop therapy early, and that clear conversations about fit, goals, and progress reduce the risk of drop out. You are not failing therapy by advocating for yourself.
A factual story that might sound familiar
Reporting and interviews with clients over the past few years have highlighted a similar pattern. A client raised a direct concern, such as being misgendered or feeling pushed into a framework that did not fit. In some cases the therapist owned the miss, apologized, and adjusted. Trust grew. In other cases the therapist was defensive, and the client switched. The through line was simple. Your feedback is data, and a responsive therapist uses it to strengthen the alliance. (For alliance research that supports this, see the rupture repair meta analysis above.)
Red flags that point toward finding a new therapist
- Consistent minimization or defensiveness when you share feedback
- Boundary violations such as inappropriate self disclosure or dual relationships
- Repeated failure to honor your identity, for example continued misgendering after correction
- No alignment on goals after repeated attempts
- You feel less safe over time and efforts to repair do not help
The alliance is a legitimate predictor of benefit. Your fit matters.
When honesty is hard even with a good therapist
Sometimes the therapist is a solid fit and honesty is still hard. That is common when shame and self criticism are loud, when trauma cues send your nervous system into protect or appease mode, or when anxiety makes your mind go blank once you are in the room.
Evidence based strategies that help:
- Put it on paper. Bring a short note with the one or two things you most want to say. Hand it over if words will not come.
- Use process language. “I want to tell you X, and I notice my chest is tight and my mind is blank.” This slows the moment and invites safety. It is also the first step in repairing small ruptures.
- Ask for structure. Many clients feel safer with brief agenda setting at the start, a midpoint check, and a five minute wrap up to consolidate gains.
- Name identity and culture. If parts of who you are feel relevant, invite them in. Cultural humility improves alliance and outcomes.
“What if I am worried about what goes in my record?”
It is reasonable to ask. Under HIPAA, psychotherapy notes receive special protection and are kept separate from the designated medical record. Progress notes, diagnosis, treatment plans, and billing information are part of your record and are more widely shareable for treatment, payment, and operations. Therapists may disclose information without consent only in limited circumstances, such as imminent safety risk, mandated reporting, or a court order. Ask your therapist how they document and what your rights are. Clarity builds trust.
How to switch therapists without losing momentum
- Tell your current therapist if you can. You can say, “I appreciate our work. I am looking for someone whose approach or expertise fits my needs better.”
- Request referrals. Therapists often know trusted colleagues who focus on your concerns or share lived experience that matters to you.
- Interview for fit. Ask new therapists about their approach, experience with your concerns, and how they handle feedback and ruptures.
- Carry forward what worked. Bring any exercises, worksheets, or summaries that felt useful. You are building on progress, not starting over.
Switching is common. Ending with one therapist and starting with another is not a failure. Your job is to find the environment where you can be the most honest version of yourself.
A note about safety and why honesty matters here
Therapists may need to act if there is an imminent risk of harm to you or to someone else. That duty to protect or warn is grounded in state law and the Tarasoff line of cases. If you are wrestling with suicidal thoughts, self harm, or safety concerns at home, it is vital to be direct so your clinician can respond appropriately. If you are not ready to tell your therapist, you can call or text 988 first. You will reach trained counselors who can help you think through next steps.
If you live in Eastern Virginia, Region Five can help
You do not have to figure this out alone. Region Five’s network of Community Services Boards serves Chesapeake, Colonial Williamsburg, Hampton and Newport News, Norfolk, Portsmouth, Virginia Beach, Western Tidewater, the Eastern Shore, and the Middle Peninsula and Northern Neck. We can help you:
- Sort out fit questions. Is this a repair you can make, or a mismatch that calls for a new therapist
- Access same day assessments and short term counseling in many localities
- Find ongoing therapy that aligns with your needs, culture, and goals
- Get crisis support any time, day or night
Call the Region Five Crisis Call Center 24/7 at (757) 656 7755, or contact your local CSB for same day access options. If you need immediate emotional support anywhere in the United States, call or text 988. If you are in immediate danger, call 911.
The takeaway
Feeling like you cannot be fully honest in therapy does not mean you are doing it wrong. It means your nervous system is protecting you, or the relationship needs attention. Because the alliance is a real driver of healing, you are allowed to ask for what you need, to offer feedback, and to switch therapists when repair is not possible. That is not quitting. That is choosing yourself.
If you are ready to explore your next step, repairing the fit you have or finding a better one, reach out. Region Five will meet you where you are.
Clinical note: This article is educational. If symptoms are sudden, severe, or safety is a concern, seek immediate help. Region Five Crisis Call Center: (757) 656 7755. Nationally: call or text 988.
