In honor of our spookiest holiday, I put out the following question on social media: "What's the scariest thing to bring up in therapy?" Read on for the answers I received and considerations for those who want to bring up something they're less than thrilled to discuss in therapy.

Scary Subjects

Not surprisingly, most answers fall under the broader category of shame. Here are the answers, with the most common listed at the top:

• Sex/Masturbation

• General Shame

• Childhood trauma

• Rape/Sexual Abuse

• Ongoing issues that should be "fixed" by now/Failure

• Substance Use/Addiction

• Self-love

• Lack of progress in therapy

• Mothers

• Issues with your therapist

• Defense mechanisms you're not ready to let go of

• Self-perception

• How you enable others

• Love

• Trusting others

• Difficulty with basic daily functioning

• Affording therapy

• Thoughts about death

• Thoughts about suicide

• Finances

• Culture when your therapist is of a different culture

• Intrusive thoughts

How to Say the Hard Things

No one comes to therapy because it is easy or fun. It is an extremely difficult task to go inside yourself and confront what you see. To then discuss it with another human being takes courage and vulnerability. If you are currently in, have been in, or are considering therapy, please go ahead and give yourself the biggest props! Here are some considerations and tips if you have something difficult you want to bring up in therapy:

1. Cut yourself slack.
   If you are really struggling to bring something up in therapy, that is completely natural. Everyone has certain topics that are particularly charged or hard to broach for them. If you have lived through trauma or have experienced invalidating close relationships, you may have learned that it is unsafe to discuss what you honestly think and feel. In addition, it is typical to feel some level of self-blame if you've experienced certain types of trauma, even if it is in no way your fault. This can lead to increased feelings of guilt, shame, and fear of bringing it up. Give yourself grace and time with this.

2. Set boundaries.*
   You do not have to talk about anything you are not ready to talk about. Especially in the beginning stages of therapy, your therapist may ask you about things like a history of abuse and trauma, your relationship with your parents, your sexual orientation, and more. You have every right to say, "I am not ready to talk about that." It can be traumatizing to talk to someone you don't trust about something that is so difficult. You may never feel good about discussing certain things with your therapist, but over time, you may feel safer or more comfortable to do so. It is okay to wait.

3. Talk about how you feel (about talking about how you feel).
   Before even broaching the difficult subject, it may be more comfortable to talk about the fact that you don't want to talk about something. This may look like telling your therapist, "I have something important to discuss, but I am overwhelmed by fear that you will judge me for it." A good therapist will be able to talk through that fear with you, what it means to you, where it's coming from, and what you need to feel supported. You can also test the waters, asking, "What would you say to someone who's been through ____?" or, "I want to talk about some trauma I went through as a child, but I'm worried it's going to be too upsetting." Therapists can help you build emotional regulation skills so that you know you can survive the difficult emotions that come with talking about trauma or shame.

4. Set yourself up for safety.
   If you know you want to bring up something challenging in therapy, make sure you have a plan in place to the extent possible. There is always a chance your therapist may unintentionally respond to something you say in a way that feels invalidating or judgmental. Even if your therapist responds perfectly, you may find it overwhelming and painful to continue. While you can't control your therapist's reaction, there are things you can do to make yourself feel as safe as possible. Know your boundaries and be prepared to say to the therapist, "I don't want to talk about this anymore today. Can we talk about something else instead?" Let a trusted friend or family member know you plan on discussing this in therapy and have them on standby afterward so you have someone to talk to if you need to. You can also use grounding coping skills to feel centered after a difficult session. This could include the 5, 4, 3, 2, 1 exercise or 4-square breathing. If you live with other people and want to have some space after bringing up something rough at therapy, let them know that's what you need. Make sure you don't have something super important to do after the session - give yourself some time to relax and watch your favorite show, go on a walk, get your favorite local coffee, or whatever else will help you feel grounded and safe.

Bringing up scary topics in therapy is never easy. It helps to keep in mind the above tips. In addition, no therapist should think you're "bad" because of what you have been through or are thinking. The whole point of therapy is to have a non-judgmental space in which you can truly be yourself. I hope with time you are able to feel safe bringing up whatever difficult thoughts or feelings you have so that you can a greater sense of peace.

*Please note, I am not talking about life-threatening situations in this section. If you are in a life-threatening situation, either due to yourself or someone else being a danger to you, please contact someone you trust and let them know.

Special thanks to fellow social worker Maggie Burkett Digilova, LMSW for her help on this piece!