How to handle doorknob confessions as a therapist

Picture this: you’re wrapping up a session with a client. As you prepare to say goodbye they drop a completely unexpected confession. Maybe the client admits that they just cheated on their long-term partner, or they acknowledge that their eating disorder has been particularly difficult to manage for the last six months. Or the confession could be something more urgent, like they’ve been experiencing suicidal thoughts.  These are known as doorknob confessions. Also called truth bombs or bombshells, doorknob confessions are when a client shares critical information during the last few moments of a therapy session. Doorknob confessions tend to be topics that are dramatically different than other things covered in the session, and require more exploration than is doable during the remainder of the session. 

Why do doorknob confessions happen?

If you’ve experienced a doorknob confession from a client, you may be asking yourself why. The client had the entire session to speak up. Why did they wait until the last few minutes to share what was on their mind? Well, there are actually several explanations for this behavior. 

1. The client is new to therapy or therapy with you. 

If your client is new to therapy, the whole experience might feel a bit awkward for them. They may still be learning how to engage with a therapist or they may not even fully understand the issues that brought them to therapy in the first place. And if they do know what they’d like to discuss with you, they may feel anxious, embarrassed, or uncertain about how to start the conversation.  For clients who are new to therapy or therapy with you, doorknob confessions are a less threatening way to build emotional intimacy. Clients get a preview of how you’ll respond without having to engage in an entire conversation about the issue.

2. The client is avoiding the issue.

Sometimes, clients will make a doorknob confession so that they can acknowledge what’s bothering them without having to actually discuss it. By waiting until the end of the session to speak up, a client has their therapist’s attention but can defer the conversation until a later date. This type of avoidant behavior is seen in clients who fear their therapist’s judgment, as well as in clients with social anxiety or other mental health symptoms that make it difficult or embarrassing for them to discuss sensitive issues.  If you know that your client is afraid of judgment, you can respond to their confession with something like: “Let’s pick up this conversation next week and get it all out on the table. I’m here to listen without judgment.” 

3. The client is testing your reaction. 

In some cases, clients may use doorknob confessions as a tool to evaluate the safety and limits of the therapeutic relationship. For example, the client might not feel completely comfortable sharing sensitive information with you so they hold out until the end of the session. Or the client could be testing you to see if you’ll offer them more time to speak or if you’ll strictly enforce the session’s end time. Although this type of behavior can be challenging, testing limits is healthy and should be encouraged with clients. 

4. The client needs more time. 

If your client continues to share important information at the end of a session, it’s possible that your current therapy arrangement doesn’t provide enough time for them to open up. You may want to consider extending or increasing your sessions until you and your client feel like you’ve adequately discussed the content of their confession. If a client is using commercial insurance to pay for sessions, find out if their insurance has session or length limitations so you can discuss any additional costs with them before adding more time. 

5. The client is looking for a helping hand. 

In some cases, doorknob confessions are a cry for help. If a client’s confession relates to something like suicidal ideation or sexual harm to a minor, they probably know that the therapist has an ethical and legal obligation to intervene. 

How to address doorknob confessions in the moment

The session is nearly over, you’ve recapped next steps, and just as you’re about to end the conversation, your client decides to share a difficult experience or emotional realization. What do you do? As the therapist, it’s your job to make a quick decision about how to appropriately react to the doorknob confession.  If the confession is weighty but can wait until your next session, let the client know that you’ll prioritize the issue the next time you meet. It’s important that you validate their vulnerability and willingness to share, then emphasize that they’ll have an opportunity to explore it next session. Here’s an example of how to frame it:  “I appreciate you sharing what’s on your mind today. I see that this concern is upsetting for you so I want to make sure we have enough time to unpack what’s going on. Our time is up for today, but let’s make this the first topic we discuss during our next session.” If a client requires non-urgent support before the next session, you can:

• Remind them about the coping skills they learned during treatment. If you have a history with this client, suggest that they utilize tools and resources you previously discussed. For example, if a client’s anxiety symptoms have become difficult to manage, remind them of healthy ways to cope such as making sleep a priority, staying physically active, challenging and reframing irrational thoughts, and connecting with supportive friends and family.
• Offer additional treatment if the situation becomes overwhelming. If the client seems like they would benefit from additional support and you have availability in your schedule, consider offering an extra session to help address the issue. You can say something like: “We’ll work together to figure this out, but not today. Today’s session has finished. Why don’t you come in for an extra session later this week?”

That said, there are certain situations that require crisis intervention. For example, if the confession relates to a psychiatric emergency like suicidal thoughts, please call 911. Other high-risk confessions, such as being a victim of domestic violence, may also require assistance that cannot wait until the next session. Each state has a Child Protective Services organization and an Adult Protective Services agency.

How to integrate doorknob confessions into the therapeutic process

Doorknob confessions can be a great opportunity to understand what’s on the client’s mind. Although the timing might not always seem ideal, these revelations offer a chance to teach appropriate coping methods and help facilitate positive change in a client’s life. Below are two ways to integrate doorknob confessions into your therapeutic process.

1. View the confessions as a chance to build deeper trust with the client.

Trust is the foundation of a good therapeutic relationship. One way to build that trust is by setting clear expectations around the client-therapist relationship, including the length and cadence of sessions. If the therapist chooses to extend the session because of a doorknob confession, they may be signaling to the client that they’re unpredictable and untrustworthy or that they don’t trust the client to be on their own. Although it can be tempting to give clients a few extra minutes to continue their thought, it’s actually in the best interest of the therapeutic relationship to end the session and address the confession the next time you meet. 

2. Address the confession head-on at the beginning of your next session. 

If a client concludes a session with a doorknob confession, plan to make that the first agenda item in the following session. You can say something like: “Last session you shared [confession]. I appreciate you opening up to me. I want to make sure that we have as much time as we need during today’s session to discuss your concern and how it’s affecting you.” As best practice, and as a way to help avoid additional doorknob confessions, let the client know when you have five or ten minutes left in the session. This verbal notice offers clients a chance to consider any last-minute thoughts or questions before the session ends. 

How Rula can help

If you’ve never experienced a doorknob confession, it can be challenging to know how to respond. The same goes for situations such as ending treatment with a client or creating treatment plans that are compliant with commercial insurance. At Rula, therapists have access to resources to help them navigate tough situations. Therapists in the Rula network can join biweekly case consultations, collaborate with our clinical team to brainstorm approaches to discharge and get advice from other therapists on Rula’s private online therapist community. Plus, Rula can even help connect you with new clients who are the right fit for your interests and expertise.  To learn more about how Rula can help therapists build, grow, and manage their practice, check out our website. Find a therapist with Rula