One of the questions that often arises during psychotherapy is why some patients continue to avoid certain subjects even after they have been attending therapy for weeks, months, or sometimes years.
At first glance, this may seem surprising.
If someone has decided to enter psychotherapy, attends regularly, trusts their psychotherapist, and wants to feel better, why would they deliberately avoid talking about something that may be central to their difficulties?
The answer is rarely straightforward.
People avoid certain subjects for many different reasons, and those reasons vary from one individual to another. Some avoidance is entirely conscious. Some develops almost completely outside conscious awareness. Some is rooted in trauma, while other forms arise from long-established personality patterns, depression, or ways of coping that have become deeply ingrained over many years.
One important distinction needs to be made from the outset.
The avoidance discussed here is different from the understandable hesitation that many people experience when attending psychotherapy for the first time.
Most new patients arrive feeling anxious.
They wonder what the psychotherapist will think of them.
They worry about confidentiality.
They fear becoming emotionally overwhelmed.
They may question whether therapy will really help or whether discussing painful experiences will make them feel worse.
These concerns are entirely normal and have been discussed in previous articles on resistance and beginning psychotherapy.
The type of avoidance considered here is different.
Here we are talking about patients who have already established a therapeutic relationship. They know the setting, they trust the psychotherapist to some degree, they understand the boundaries of therapy, yet certain subjects remain consistently absent from the conversation.
The question becomes:
Why?
One common reason is conscious concealment.
Some patients deliberately avoid discussing particular aspects of themselves because they do not want the psychotherapist to see what they believe is their “real self.”
They may come to therapy genuinely wanting help with anxiety, depression, relationship difficulties, or emotional distress. At the same time, they carefully avoid describing the behaviours, decisions, fantasies, or patterns that repeatedly contribute to those very difficulties.
In these situations, avoidance often becomes a form of concealment.
The patient wants relief from suffering but does not want the therapist to see the parts of themselves they fear will be judged, criticised, rejected, or misunderstood.
This is not necessarily dishonesty in the ordinary sense of the word.
More often, it reflects fear.
The patient worries that if the psychotherapist truly sees them, they may no longer be accepted.
Sometimes this concealment involves behaviours the patient finds deeply embarrassing.
Sometimes it involves difficulties within intimate relationships.
Sometimes it concerns aggressive thoughts, jealousy, shame, pornography, infidelity, compulsive behaviours, addictions, or actions that conflict with the person’s own values.
The patient may speak openly about many areas of life while carefully steering the conversation away from the one subject that feels most threatening.
This creates a particular challenge for psychotherapy.
If the central issue remains hidden, therapy may continue for some time without reaching the heart of the problem.
Another form of avoidance is very different.
In these cases, the patient is not consciously hiding anything.
Instead, certain experiences have become almost impossible to approach because they are associated with overwhelming emotional pain.
This is often seen following significant trauma.
The person may have experienced abuse, violence, severe neglect, frightening accidents, sudden bereavement, or other experiences that exceeded their ability to cope emotionally at the time.
The mind protected itself by keeping these experiences at a distance.
Talking about them now may feel as though the original trauma is happening all over again.
The patient is not refusing to discuss the subject.
They are frightened of what will happen if they do.
Many people describe feeling that if they begin talking, they will never stop crying.
Others fear losing control.
Some worry they will become emotionally overwhelmed and no longer function at work, at home, or in everyday life.
Others believe that reopening old wounds will simply make everything worse.
In these circumstances, avoidance represents an attempt at self-protection.
The psychotherapist’s role is not to force disclosure.
It is to create sufficient emotional safety that the patient gradually discovers they can think about painful experiences without becoming overwhelmed by them.
Containment becomes essential.
When patients feel that difficult emotions can be held safely within the therapeutic relationship, they often become increasingly able to approach experiences that once felt impossible to discuss.
A third pattern of avoidance is often seen in people experiencing severe depression.
Here the process is different again.
Many people with significant depression become increasingly withdrawn from the outside world.
Their attention gradually turns inward.
Their emotional world becomes smaller.
Their thinking becomes dominated by hopelessness, exhaustion, self-criticism, and emotional pain.
In these circumstances, certain topics may remain untouched not because the patient is consciously hiding them, nor because they are directly traumatised by them, but because their entire psychological world has narrowed.
The depression itself absorbs almost all of their emotional energy.
The patient becomes preoccupied with surviving each day.
Communication often becomes reduced.
Speech may slow.
Thoughts become repetitive.
The psychotherapist’s attention is naturally drawn towards the patient’s withdrawal, silence, hopelessness, and emotional isolation.
The absence of other important subjects therefore becomes part of the therapeutic picture.
What is not being spoken about becomes just as significant as what is.
Avoidance can therefore look very different depending upon the individual.
Some people avoid because they are frightened of being seen.
Others avoid because they are frightened of remembering.
Others avoid because depression has narrowed their emotional world so profoundly that many important aspects of life simply disappear from conscious reflection.
The consequences for therapy can nevertheless be similar.
Long-term concealment usually limits progress.
Psychotherapy depends upon openness, trust, and the gradual exploration of experiences that have remained hidden, misunderstood, or emotionally overwhelming.
When important subjects remain consistently outside awareness, therapy may become restricted to the surface.
Sessions continue.
Conversations continue.
Yet the deepest areas of emotional life remain untouched.
This is why experienced psychotherapists pay careful attention not only to what patients talk about, but also to what they consistently avoid.
The absence itself becomes meaningful.
Sometimes the missing subject quietly points towards the very area that requires the greatest understanding.
Another interesting process sometimes develops.
The patient may unconsciously attempt to draw the therapist away from the central issue.
Lengthy discussions about work, politics, family disagreements, finances, or daily events may become repeated session after session.
These conversations may be genuine and important.
However, they may also function as distractions that prevent both patient and therapist from approaching the emotional conflict underneath.
When this happens repeatedly, the therapist may gently explore the process itself.
Rather than immediately asking about the hidden topic, they may wonder together why certain conversations always seem to move away from particular areas.
This allows the avoidance itself to become part of the therapeutic work.
Occasionally, avoidance may also contain an element of envy.
The patient unconsciously experiences the therapist as emotionally healthier, more secure, or more psychologically integrated than themselves.
Rather than moving towards this healthier position, part of the patient attacks the very process that could help them develop it.
By withholding important information, diverting conversations, or repeatedly avoiding crucial subjects, they unconsciously interfere with the therapeutic work itself.
This is not because they consciously wish to sabotage therapy.
Rather, the healthier aspects represented by the therapist may temporarily feel difficult to tolerate.
Recognising this process with sensitivity can be extremely important.
The goal is never to expose or embarrass the patient.
Instead, psychotherapy aims to create an atmosphere where difficult subjects gradually become less frightening and more understandable.
Over time, the patient begins to discover that speaking openly does not destroy them.
The feared consequences often prove far less overwhelming than expected.
In clinical practice, patients frequently describe a sense of relief after finally discussing subjects they had avoided for months or even years. The anticipation of disclosure is often far more frightening than the experience itself. Once difficult experiences can be thought about, understood, and contained within a safe therapeutic relationship, they usually become less powerful than when they remained hidden. Ultimately, successful psychotherapy depends not on forcing patients to speak, but on creating a relationship in which they gradually feel safe enough to talk about what once seemed impossible to put into words.
DISCUSSION POINTS:
- Why might someone continue to avoid certain subjects even after they have been attending psychotherapy for some time?
- What is the difference between consciously concealing information and unconsciously avoiding painful experiences in therapy?
- How can past trauma make it difficult for someone to talk about certain events, even when they genuinely want to recover?
- Why is what a patient does not talk about sometimes just as important as what they do discuss during psychotherapy?
- How does a strong therapeutic relationship help patients feel safe enough to approach subjects they have been avoiding?
- In your view, why can confronting difficult experiences gradually in a safe therapeutic environment lead to greater emotional understanding and lasting psychological change?
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