Managing doorknob confessions: A guide for therapists

You’re likely no stranger to unexpected moments in a client session. But perhaps the most challenging of these are the “doorknob confessions” – those significant disclosures clients make as they’re about to leave, often when you’re least expecting them. These moments can leave you feeling caught off guard, wondering how to respond, and concerned about how to manage the situation effectively. But there are ways to handle them that give you and your client room to process what’s been revealed. 

Why do doorknob confessions happen?

In this Psychology Today article, Grant Hilary Brenner MD, DFAPA writes that doorknob confessions happen for a variety of reasons, and recognizing these reasons can calm your own sense of urgency and help you respond more effectively. Sometimes, clients might not feel ready to dive into a difficult topic earlier in the session. Other times, they might be testing the therapeutic relationship or gauging your reaction. It can also be a way of protecting themselves from a deeper exploration they aren’t yet ready for. Whatever the reason, your response is crucial. It sets the tone for how these situations will be handled in the future and impacts the trust and openness in your therapeutic relationship. 

Practical steps to handle doorknob confessions

In the moment, it’s natural to want to dive deeper into your client’s revelation, but the reality is that you have a schedule to keep and other responsibilities to attend to. You might have another client waiting, paperwork to catch up on, or simply the constraints of a finite session time. Your challenge is to acknowledge your client’s disclosure with empathy while also maintaining your professional boundaries and managing your time effectively. These eight steps, based on public research can help you get started: 

Stay calm and acknowledge the disclosure

When a client drops a bombshell as they’re about to leave, your first instinct might be to scramble to address it immediately. Instead, take a deep breath. Acknowledge the significance of what they’ve shared and let them know that you’ll need to discuss it further in the next session. This approach validates their experience and shows that you’re taking their disclosure seriously. In her article “Don’t Let the Doorknob Hit You: A Relational-Intersubjective Exploration of Leaving and Remaining within the Therapeutic Frame” published in Psychoanalytic Social Work, Professor Margaret Arnd-Caddigan explains that clients who make doorknob confessions need to “structure experience”; whether that means extending the session or deciding to review in the next depends on the type of structure needed. 

Set clear boundaries and expectations 

While it’s essential to be responsive and understanding, you also need to maintain the structure of your sessions. Keep calm and stick to the plan you already have for scheduling and structure. Gently remind your clients that significant disclosures require dedicated time to explore thoroughly and let them know you’d like to give their concern the full attention it deserves in the next session. This approach sets a healthy boundary while assuring them you won’t overlook their last-minute concerns. 

Use the moment to explore ambivalence 

Sometimes, a doorknob confession can be an expression of ambivalence or resistance to exploring a particular issue. Use this as an opportunity to gently inquire about their hesitation or fear. In her Psychiatric Times article, Daniela V. Gitlin, MD, invites her readers to “Embrace those doorknob moments for what they are: new material that you can use to move the treatment forward.” Open-ended questions like “what made you share this now?” or “how did it feel to share this with me at this moment?” can provide valuable insights into your client’s mindset and emotional state. 

Normalize this type of disclosure 

Naming the pattern can put your client at ease. Consider saying something like, “It’s not unusual for people to wait until the end to share something big, but it’s definitely worth talking about more.” This simple act of normalizing the situation can reduce any shame or anxiety they might feel. 

Use supportive language 

Show genuine care in your tone and words. Clients often sense how you feel about their doorknob confession by the way you respond. Stay empathetic and remind them that it’s okay to need extra time or space for difficult conversations. 

Schedule a follow-up 

Offer a quick follow-up, whether it’s inviting them for an additional session or having them plan to share more at the start of the next visit. This gives them a clear roadmap (the structure mentioned by Professor Arnd-Caddigan). They’ll know you’re not leaving them hanging, and it also keeps your schedule realistic. 

Prepare for the next session 

Before the client leaves, make sure you both are on the same page regarding the next steps. If necessary, adjust your session plan to accommodate a deeper dive into the disclosed topic. Preparing ahead of time shows your commitment to addressing their concerns thoroughly and can help alleviate any immediate distress. 

Reflect on your own reactions 

After the session, take a moment to reflect on your response. Consider whether your reaction was helpful or if there’s room for improvement. This self-reflection is crucial for your growth as a therapist and for enhancing your ability to manage similar situations in the future. 

Navigating the aftermath 

Doorknob confessions can be emotionally taxing, not just for clients but for you as well. It’s essential to have systems in place for managing your own emotional response and ensuring you’re providing the best care possible. This might involve supervision, peer consultation, or engaging in self-care practices that help you process and reflect on your experiences. 

Balancing compassion with accountability 

Doorknob confessions don’t have to derail your work. You want to be compassionate and present but also maintain the structure that keeps therapy productive. Stay calm, acknowledge the disclosure, and assure your client that you will return to it. This approach maintains your therapeutic frame while giving the client the attention and support they need. You’ll both be better off moving forward with a clear plan for addressing the issues that matter most. Over time, they may feel more comfortable bringing significant topics into the session earlier. With practice and reflection, you’ll become more adept at navigating these situations, ultimately enhancing the therapeutic relationship and supporting your clients’ growth and healing.