A comprehensive guide to understanding doorknob confessions

Doorknob confessions, those last-minute disclosures, are common and quite significant in therapy.

This blog explains why they happen, how they affect treatment, and offers simple ways for therapists to handle them effectively.

We'll explore the psychology behind these confessions and practical strategies for managing them.

What Exactly is a Doorknob Confession?

A doorknob confession is when a client shares something important at the very end of a therapy session, usually when they're about to leave.

These can be big revelations, like past traumas they haven't mentioned, admitting they've relapsed in recovery, sharing a key problem they're dealing with, or even talking about having thoughts of harming themselves. 

It's not just something that happens in one-on-one therapy; it can also occur in therapy for couples or groups. 

These "doorknob confessions" frequently reveal essential information about a client's inner thoughts, relationship dynamics, unexpressed anxieties, or previously unmentioned experiences. Despite the challenges posed by their late appearance in a session, these revelations provide significant opportunities to improve treatment strategies, strengthen the therapeutic alliance, and facilitate deeper conversations in the upcoming sessions. 

However, it is crucial to handle these disclosures with care, as mismanagement can damage the therapeutic relationship, and hinder progress.

Why Do Clients Wait?

Doorknob confessions happen for many reasons that affect when and how clients share personal information. Therapists need to understand these reasons to respond with empathy and good clinical judgment.

• The fear of judgement: Clients often wait until the end of a therapy session to share important information due to fear of judgment or rejection. They worry about how the therapist will view them after disclosing sensitive details. By waiting until the last moment, when there's less time for discussion, they may feel safer sharing difficult information. This fear often comes from past negative experiences and can make the therapeutic environment feel risky despite its intended safety.
  
  

• The Overwhelming Nature of Therapy: Therapy can be deeply taxing on a client's mind and emotions. During a session, individuals frequently confront painful feelings and recollections. This intense internal struggle can hinder their ability to express or understand certain thoughts and emotions until the session nears its end, creating a psychological "release valve." Ironically, approaching the end of a session might generate a sense of urgency, enabling previously held-back information to emerge.
  
  

• Power Dynamics and Trust Building: The natural power imbalance in therapy can make clients hesitant to share everything. Trust develops over time through consistent displays of the therapist's reliability, empathy, and non-judgment. Sometimes, a doorknob confession acts as a test to see how the therapist will react, helping the client assess the safety of sharing more deeply. If tackled well, these confessions often diminish and become part of the regular conversations.
  
  

• Unconscious Defense Mechanisms: Doorknob confessions can stem from unconscious defense mechanisms rather than deliberate strategy. This behavior serves as a way to evade the immediate and extended emotional distress associated with in-depth exploration of the sensitive topic. Psychologically, it's a form of procrastination, using the session's imminent conclusion to temporarily postpone deeper engagement with the painful issue.
  
  

• Psychological inflexibility and internalized shame are key factors in non-disclosure, according to modern psychology. Psychological inflexibility involves avoiding distressing internal experiences, which can lead clients to postpone sharing important information to escape immediate discomfort, despite potential long-term negative consequences. Likewise, internalized shame, a deep-seated belief in one's inadequacy, strongly inhibits disclosure. The fear of revealing this perceived flaw makes the doorknob confession a highly vulnerable moment for the client.
  
  

• The Strategic Role of Timing: The timing of the disclosure – precisely at the end of the session – also plays a crucial role. For some clients, the looming departure offers a sense of control and a perceived reduction in vulnerability. They can "drop the bomb" and then immediately leave, avoiding the immediate "sit with" of the therapist's response or the pressure to dive deeper into the issue within the current session. 

How do doorknob confessions affect the therapeutic process?

Doorknob confessions, though brief, significantly impact therapy, changing how sessions end and influencing overall treatment progress. It is important for therapists to understand how this interplay of the need to confess can be utilized to improve the therapeutic progress. 

• Disruption of Session Flow: Presenting crucial information at the very end of a therapy session disrupts the session's intended course and therapeutic focus. This sudden disclosure of significant material leaves the therapist with insufficient time for proper exploration and intervention, potentially creating feelings of unease for both the therapist and the client due to the abrupt change in direction.
  
  

• Client Vulnerability: A mishandled doorknob confession can leave a client feeling deeply vulnerable and exposed. When a therapist responds inadequately or hastily to a client's deeply personal disclosure, the client may feel unheard, dismissed, or regretful of sharing. This can damage their trust in both the therapeutic process and the therapist.
  
  

• Negative Impacts of Poorly Handled Doorknob Confessions:
  Improper management of end-of-session disclosures significantly hinders therapeutic advancement. When pressing matters are left unresolved at the session's end, they can intensify and create emotional burdens for the client.
  
  Critically, a reaction that seems dismissive, hurried, or ill-considered can severely damage the therapeutic relationship. The resulting breach of trust is difficult to repair and may cause increased client reluctance, decreased openness, and even the client prematurely ending therapy.
  
  

• Safety concerns: Doorknob confessions involving immediate safety concerns like abuse or self-harm present a critical challenge. Therapists must balance mandatory reporting and risk assessment with client support, requiring swift clinical judgment, potential session extensions, crisis service coordination, and immediate follow-up. Ethical and legal obligations must be met while preserving the therapeutic relationship.
  
  

• Risks Associated with Unaddressed Topics: Leaving significant topics unaddressed until the end of the session carries several inherent risks:
  
  

  • Heightened Emotional Distress: Clients might feel more worried, ashamed, guilty, or even hopeless if they think their important concerns weren't truly heard or dealt with properly. This can make their existing emotional problems worse.
    
    

  • Unexplored topics: Key insights or hidden problems that come up in those last-minute confessions might not get explored. These could be things that are actually stopping the client from getting better in therapy.
    
    

  • Damaged Trust: If clients feel like their therapist didn't respond well or follow up on what they shared, it can really hurt the trust they have. This can make them less likely to open up in the future.
    
    

  • If someone shares something about immediate danger (like hurting themselves or others) at the very end, there might not be enough time to properly figure out how to keep them safe. This could put the client or others at risk.

How to handle doorknob confessions in therapy?

A thoughtful, empathic, and clinically sound strategy is essential for effectively navigating doorknob confessions. The priority is to consistently acknowledge the client's feelings, preserve a strong therapeutic connection, and guarantee they feel understood and supported, even when time is short.

1. Maintain calm and grounded : A therapist's first response to a significant last-minute confession is critical. Remaining calm and grounded is paramount. Techniques such as deep breathing, self-reflection, or mindful grounding can enable therapists to preserve professional objectivity and empathy, thereby avoiding impulsive reactions. The therapist's composure can provide considerable reassurance to a client who has just shared something deeply vulnerable.
   
   

2. Acknowledge and normalize: Acknowledge and normalize the client's disclosure with a profound verbal response. Validate their courage in sharing without overreacting or escalating. Express appreciation for their vulnerability with phrases like, "Thank you for trusting me with that. I can hear how difficult it must have been to bring that up." Help alleviate any shame or fear about the timing by normalizing delayed disclosure: "It's common for important things to surface as we approach the end of a session."
   
   

3. Set a boundary to manage time effectively: Acknowledging a client's important disclosure at the end of a session requires carefully balancing validation with time management. An empathetic response that recognizes the significance of the issue while setting a boundary for the current session is crucial. For instance, saying, "It's important that you've brought this up, and it's something we need to explore fully. Since our time is limited today, let's make sure we dedicate sufficient time to discuss this in detail during our next meeting," effectively communicates care and ensures the session remains within its allotted time. This method shows consideration without letting the session extend beyond its scheduled end.
   
   

4. Utilize reflective listening by paraphrasing the client's disclosure and reflecting their emotions, even at the end of a session. For example, saying, "It sounds like you've been carrying this for a while, and it took courage to share," shows you're present and builds trust.
   
   

5. Prioritize and Intervene: Therapists require sharp clinical judgment to promptly assess the importance of disclosures made at the end of a session, especially concerning immediate safety and treatment objectives. When a "doorknob confession" reveals a crisis, potential harm, or necessitates mandatory reporting, immediate steps are crucial. These may include extending the current session for a brief risk evaluation, contacting emergency services (with consent or as legally required), or scheduling an urgent follow-up. For less critical yet meaningful disclosures, the emphasis should be on validating their significance and creating a definitive plan for more thorough discussion in future sessions.

Key Phrases to Use and When to Use Them

Here are some key phrases to help you address various aspects of doorknob confessions. Feel free to adapt these guides and phrase them in a way that best suits your needs.

• To maintain calm: (Internal thought/action) Deep breathing, self-reflection, mindful grounding.

• To acknowledge and normalize: "Thank you for trusting me with that. I can hear how difficult it must have been to bring that up." "It's common for important things to surface as we approach the end of a session."

• To set a boundary for time: "It's important that you've brought this up, and it's something we need to explore fully. Since our time is limited today, let's make sure we dedicate sufficient time to discuss this in detail during our next meeting."

• To use reflective listening: "It sounds like you've been carrying this for a while, and it took courage to share."

• Establishing a clear follow-up plan: "Since our time is almost up, let's prioritize this topic at the very beginning of our next session. I want to ensure we have enough time to explore it thoroughly."

• Offering reassurance and ongoing support: "We will work through this together." "I'm here to support you with this."

• Probing the Emotional Landscape: "What was it like for you to share that with me right as we were ending last time?"

Conclusion

Effectively addressing doorknob confessions is crucial for successful therapy. Therapists should remain calm, validate the client's disclosure, and set clear boundaries by explaining that there isn't enough time to fully address the issue but it will be a priority next session. In cases of potential harm, ensuring safety is paramount. Consistency in acknowledging these late disclosures and revisiting them in the next session builds trust. Ultimately, a therapeutic environment of trust and open communication minimizes doorknob confessions, allowing for more meaningful therapeutic work.