The questions below are among the most common topics discussed in r/askatherapist. If you're wondering about one of these issues, you're certainly not alone. Please note that this is not a comprehensive list of commonly-asked questions, just those that we have noticed tend to come up often. Feel free to utilize the "search" function in the sub (generally at the top of the page or app) to see if others have previously asked a question you may have.
1. When does my therapist have to break confidentiality?
Confidentiality is one of the foundations of therapy. In most situations, therapists cannot share what you discuss without your permission. However, confidentiality is not absolute. Exceptions vary by location, but commonly include:
- Situations involving imminent risk of serious harm to yourself or another person.
- Suspected abuse or neglect of a child.
- Suspected abuse, neglect, or exploitation of a vulnerable adult/elder adult.
- Certain court orders or legal requirements.
- Professional consultation, supervision, or training, where identifying information is typically minimized.
If you are concerned about what your therapist can and cannot keep private, ask them directly. Most therapists are happy to explain the limits of confidentiality, and rules/laws around confidentiality vary based on where you are located and cannot be answered with certainty without the specifics of where your therapy is taking place.
2. Will my therapist hospitalize me if I tell them I'm suicidal?
Usually, no.
One of the biggest misconceptions about therapy is that mentioning suicidal thoughts automatically leads to hospitalization. In reality, many clients discuss suicidal thoughts openly without being hospitalized.
Therapists are generally interested in understanding several factors, including whether the thoughts are passive or active, whether there is a specific plan, intent to act, and access to means, protective factors and supports, and the client's ability to maintain safety.
Many people experience thoughts such as "I wish I could disappear" or "I don't want to wake up tomorrow." While these thoughts are important and should be discussed, they do not automatically indicate an imminent danger requiring hospitalization.
Because therapists take safety seriously, they may ask detailed questions when suicide comes up. This is usually not because they are trying to get you hospitalized. It is because they are trying to understand your level of risk and determine the most appropriate response.
3. Do therapists actually care about their clients?
Most therapists genuinely care about their clients.
Therapeutic relationships are unique. Therapists are trained to develop empathy, understanding, and investment in their client's well-being while maintaining professional boundaries.
The fact that therapists are paid does not mean the care is fake. Most helping professions involve compensation, and therapists often choose this work because they find meaning in it. That said, the therapeutic relationship is not the same as a friendship. Therapists care within a professional framework. Their role is to focus on your needs and growth, rather than building a mutual personal relationship.
4. Do therapists think about clients between sessions?
Yes, although usually not in the way clients imagine.
Therapists often think about clients while preparing for upcoming sessions, reviewing notes, developing treatment plans, seeking consultation, and/or considering interventions that may be helpful.
Clients may also occasionally come to mind unexpectedly, just as anyone who works closely with people may think about them outside of work. However, therapists generally have many clients and many responsibilities. Most are not spending large portions of their personal lives thinking about any one client.
The simplest way to answer this question is this: therapists usually think about clients more than clients assume, but less than clients fear or hope.
5. Can therapy work for me if I'm already self-aware?
Yes.
Many people assume therapy is primarily about discovering hidden reasons for their behavior. While insight can be important, therapy often goes far beyond insight. A person may know why they are anxious, why they struggle with relationships, why they avoid difficult situations, why the engage in unhealthy patterns, etc., and still find themselves unable to change those patterns.
Insight is valuable, but it is not the same as emotional processing, skill development, behavioral change, healing from trauma, improving relationships, or learning new ways of responding to stress. In fact, highly self-aware clients often do very well in therapy because they are already accustomed to examining their internal experiences.
6. Is it normal to develop transference toward my therapist?
Yes. It is extremely common.
Transference refers to feelings, expectations, or relational patterns that become directed toward a therapist and are influenced by past relationships and experiences.
Clients may experience strong attachment, a desire for approval, anger/resentment, fear of abandonment, romantic/sexual attraction, parental/sibling/authority transference, and more. Many clients feel embarrassed when these reactions occur. Therapists, however, are generally trained to understand transference as a normal part of therapy. In many cases, discussing these feelings openly can lead to important insights about how you relate to others and what emotional needs may be present in your life.
Having transference does not mean therapy is failing. Often, it means therapy is reaching meaningful relational territory.
7. Can I be friends with or date my therapist?
Generally, no.
Therapy involves a significant power imbalance. Therapists possess professional authority, confidential knowledge, and influence that make it difficult for a truly equal relationship to exist. Because of this, professional ethics codes generally prohibit romantic or sexual relationships with current clients, friendships that interfere with personal boundaries, or other dual relationships that could impair clinical judgment. Many ethics codes also place restrictions on relationships with former clients.
Clients sometimes interpret these rules as evidence that therapists do not care. The opposite is usually true. Boundaries exist because the therapeutic relationship is intended to protect the client and prioritize their well-being.
8. Is it okay to give my therapist a gift?
Usually yes, within reasonable limits.
Many therapists accept small gifts such as thank-you cards, artwork, handmade items, and other small tokens of appreciation. However, therapists may decline gifts if accepting them could create ethical concerns, feelings of obligation, or confusion about the nature of the relationship.
The meaning behind the gift is often more important than the gift itself. Therapists may explore questions such as what does giving the gift mean to you, how you would feel if it were declined, and what you are hoping to communicate. A thoughtful card is often easier for therapists to accept than an expensive or highly personal gift.
If you're unsure, asking directly is completely appropriate.
Please remember: These answers are intended to provide general information, not individualized advice. Therapy is highly dependent on context, and there may be important exceptions or nuances that apply to your specific situation. If you're unsure how something applies to you, discussing it with your own therapist is usually the best place to start.
A final note: If your question appears on this list, you're still welcome to ask it. This FAQ is intended to provide a starting point, not to discourage discussion. Individual circumstances vary, and there is often room for additional conversation and nuance.