What are doorknob confessions?

A doorknob confession happens when a client discloses something seemingly minor or understated at the end of a therapy session, but that in fact requires further discussion, reflection, processing, or treatment planning.

Examples of doorknob confessions

Doorknob confessions can be anything significant your client shares right before or as a session is ending. Possible examples of doorknob confessions include a client:

Disclosing they’ve been experiencing suicidal ideation or thoughts of self-harm
Disclosing significant relationship issues, such as infidelity or abuse
Disclosing a significant piece of personal history not yet revealed in therapy, such as a history of abuse, self-harm, or suicide attempts
Disclosing a relapse in a substance for which they’ve been in recovery

Why doorknob confessions happen

Often, these seemingly minor yet significant revelations arise because the client feels nervous or conflicted about discussing it in therapy. “Waiting until the last minute can feel ‘safer,’ as they feel they won't be required to discuss and process it in the moment, as the session has concluded or they are quite literally on their way out the door,” says Maddie Tong, a licensed psychotherapist and Headway’s senior associate of clinical education.

Doorknob confessions often come from a self-protective place. This means a client may be testing the waters of saying something out loud, ensuring they won't have to discuss it if they change their mind or don't want to in the moment. That said: It’s important for you as a clinician to take note of and revisit the confession, as there is a reason it's come up in the first place.

How therapists can address doorknob confessions

Taking a few steps during and after the doorknob confession can help to ensure your client receives the support they need with whatever they’re struggling with.

Acknowledge the confession.

It's crucial to acknowledge and reflect back what's shared during these moments to ensure important revelations aren't overlooked, explains Tong. For less urgent disclosures, and depending on the level of safety risk, you may consider thanking the client for disclosing and sharing that you look forward to learning more next session. Or, you can let the client know you’ve added the disclosure to your notes to discuss next time you see each other.

Know when to intervene.

If there’s a more immediate safety risk at hand, such as a client disclosing a plan for self-harm or suicide, be prepared to intervene. Before the client leaves, you may want to schedule an urgent follow-up session or review and agree on a previously created safety plan with your client. If the client is presenting with suicidal thoughts but has no current intent to act, be sure they know what steps to take if that increases, such as calling 911 or going to their nearest emergency room.

Be flexible.

It can be a challenge to make the client feel heard while managing important time constraints as a therapist. “But if a disclosure happens when your time is up, remember safety is your top priority, and you may need to be flexible,” says Tong.

If a client is at high risk for suicide, you'll need to cancel your next meeting if you have one, conduct a risk assessment, and make a full clinical decision on next steps. This can include liaising that client to the appropriate support, such as calling 911 or calling a support line together, and arranging an urgent follow-up the next day.

Practice self-care.

If the client's doorknob confession was stressful, take time before your next session to ground yourself, whether you take a few deep breaths, step outside for some fresh air, or reach out to a trusted colleague for support. By taking a few moments for yourself after these unexpected disclosures, you’ll be able to provide better mental health care to this client and your entire caseload.

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