As a Therapist, Here Are the 5 Most Common Things People Bring Up in Therapy

As a therapist, I consider it such a privilege and a gift that people let me into their inner worlds. I get to hear people’s triumphs and am entrusted with shining a light into the darkness that not many other people get to see.

I hear it all—huge, exciting news my clients share with me, as well as some pretty messed up stuff that makes me so sad to think that another human could do this to someone.

But in between these two extremes, there’s a handful of themes that I hear all the time. If one of these resonates with you, please remember that just because a concern is common doesn't mean it's not real. If anything, it means you're not alone in having a hard time with it.

Feeling 'So F***ed Up'

You’re not f***ed up: f***ed up s**t happened. I absolutely do not believe that any of my clients are inherently f***ed up. I do believe that a lot of really messed up stuff has happened to them, though. Maybe the resulting feelings or behaviors are undesirable to themselves or others, but these are in reaction to what has happened to them.

I really find self-compassion to be at the core of so much of the work we do on ourselves. It’s really hard to get to any deeper work if we don’t even believe that we are deserving of basic levels of care and kindness to ourselves. 

Often, we lash out at either ourselves or others because our feelings have been invalidated, and we’ve been told that whatever isn’t a big deal. Self-touch can regulate our cortisol levels, which will then also regulate how we perceive stress.

Thinking They're 'Behind' in Life

Life is not a race—you can't be "behind" in life. But many people think they are. I will be honest: As a 40-year-old single woman with no human children, sometimes I feel "behind," too. It's natural for humans to compare ourselves to others. This served us when we were competing with others not to be eaten alive by a predator. We had to literally size up our competition to figure out our survival strategy.

But in the modern-day, behind our keyboards, comparing ourselves to others will mostly hurt us. Research shows that spending more time on social media is linked to higher rates of depression and anxiety.

Typically, if a client starts comparing themselves to someone else—particularly comparisons based on what they see on social media—I'll remind them that what they see on someone else's feed is a highlight reel. Sure, you may see a picture of a "perfect" family, but what you don't know is that one of the partners is battling a substance use disorder, and they had a huge fight just before this picture.

Part of our work will also be deconstructing where these views of where they "should be" came from. Their parents? Their peer group? Society? Some combination therein? I'll help people focus on whether they even want to play that game. Do you want 2.5 kids and a picket fence, or would you maybe be more happy as a nomad or some life path that doesn't even exist yet?

Thinking They 'Should Be Over This By Now'

It’s most often that I hear from my grief clients that they “should be over” it by now. Our society puts unrealistic expectations on just about everything mental-health related, but grief especially. Most company bereavement rules cover no more than a week, and the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5-TR, classifies some grief as abnormal and disordered after a year.

Or, I ask them to pretend that it is their best friend that they are telling me about. Would they say these same mean or unrealistic things to their best friend? For nearly everyone, this one question gives them at least a little bit of pause—sometimes before they then tell me why, “No, but I’m different,” but all I’m going for is interrupting those well-worn neural pathways with a bump in the road.

Feelings of Loneliness

As someone who made her career as a writer before becoming a therapist, a whole lot of my life is out there on the internet. This means I certainly self-disclose probably a little more than the average therapist since I know that it’s also totally possible that a client has read what I’ve written about any given topic. 

As I began to self-disclose a bit to this client, it struck me: the experience of feeling lonely is what was actually connecting us at that moment. Loneliness, I told her, is one of the most universal human emotions. It feels so paradoxical that feeling alone can unite so many of us, but we have a loneliness epidemic on our hands.

For starters, I help clients normalize these feelings with some psychoeducation, more broadly sharing statistics like those, followed by reminding them of societal factors (with so many of our interactions being digital these days) that also lead to loneliness. 

I walk a fine line between helping people see the forces that might have contributed to some of their problems—and helping them see places where they can change that. I never want a client to feel blamed for their problem—rather, I want them to see that they have the agency and power to change many of the things in their life they’re currently unhappy with. 

I’ll also do some reality testing with them of if these beliefs are accurate. I know that, for me, I can often feel lonely, but I do have many people who care about me. I tend to downplay how much I might matter to someone else, so my own therapist helps me challenge that to see where I do have support, which often makes me feel less lonely than I originally thought I was.

But, of course, there are plenty of people who are genuinely isolated. I will help them see if there are people in their lives they can start reaching back out to, or how they might be able to find more people in their lives around a shared interest or location. 

They 'Just Can't Get Motivated'

While we all struggle with motivation from time to time, if you find it more difficult than usual to focus or get things done, you're probably really frustrated! I'm pretty sure every single client I've ever seen has told me at some point or another that they're struggling with motivation.

I want to know what that means to them. Does "not feeling motivated" mean that they can't get out of bed and are struggling to fulfill their basic daily obligations, or does it mean that they have expectations that may be unrealistic to them?

Depending on their answer, I may tell them to do less because they're actually burnt out. On the other hand, if "not feeling motivated" means struggling with basic tasks, I will help them come up with strategies to make things easier for themselves, which could range from assigning them homework for accountability to recommending a consultation with a psychiatrist to consider medication.