What’s a Doorknob Confession?

When a patient’s therapy appointment wraps up, there’s a familiar series of events. The patient collects their belongings, exchanges pleasantries with the therapist, and exits the room before scheduling their next session, as needed.

But sometimes, those last moments of a therapy session aren’t always so predictable. There are times when a patient can reveal information that carries greater significance right as they have their hand on the door to leave — a last-minute bombshell that there isn’t enough time to discuss.

That’s what we call a doorknob confession or a doorknob comment, and the revelations may be significant. It could be a case where a patient who has suffered addiction in the past makes note of a relapse the previous week. Or, a patient with mental health struggles alludes to childhood abuse not otherwise mentioned in conversations with the therapist.

While their nature can vary, doorknob confessions or doorknob comments can be a difficult thing for most therapists to handle — both as they happen and in subsequent therapy sessions. 

The best place to start is by understanding what motivates patients to make a doorknob confession in the first place.

Doorknob Confessions Are Often Prompted By Fear of Judgment

A fear of judgment is one of the barriers that often prevents people from using therapy services. But these same fears can reveal themselves within the therapy setting as well.

When patients meet with a therapist — especially in early stages of the therapeutic relationship — they often have the fear they will be judged. This fear can prompt them to hold back emotions and information from their therapist, or wait until the end of a session to reveal these intimate details or feelings. With no more time left on the clock in that current session, doorknob confessions can be an effective way for patients to get things off their chest without having to talk more about the topic or receive feedback.

While doorknob confessions curb anxiety for a patient, it does so at the detriment of the therapy session’s impact. Therapists have to delay talking through the concern and providing support until future sessions. And while patients may avoid discomfort in the moment, they’ll feel less satisfied with the outcomes of their therapy sessions, as they are left sitting with their feelings versus talking about them.

The Value & Variables of a Good Therapeutic Relationship

When behavioral health professionals at a practice build better relationships with patients, patients are more likely to stay engaged and derive the most value from their sessions.

Research from the American Psychological Association highlights key factors that steer therapeutic relationships in the right direction and help avoid doorknob confessions. They include:

• Being a partner versus a director: Therapists and patients should be equal partners, with therapists actively assessing and asking for feedback from patients and working together to ensure the right goals are being met.
• Treating patients as individuals: Therapists should select treatment methods and stances based on individual patients, while preserving that flexibility to respond to the evolving concerns and motivations of patients.
• Repairing ruptures as they surface: If a therapist notices a patient is starting to pull away or becomes confrontational for any reason (e.g., misunderstanding a therapist’s comment), addressing the rupture as it occurs can help get the relationship back on track and minimize doorknob comments.
• Incorporate patient feedback into treatment: The therapeutic relationship can improve when questionnaires filled out prior to sessions provide insights into aspects of the patient-therapist alliance and potential blindspots to address.

How ClinicTracker Helps Build Trust Right Out of the Gate

Before a patient arrives for their first therapy session, ClinicTracker helps set the patient-therapist relationship up for success. Through the Patient Portal, patients can:

• Conveniently schedule their appointment online and receive automated appointment reminders
• Fill out all of the necessary registration paperwork, including insurance eligibility verification, and forms online versus at the office
• Easily access patient education videos, articles, and stories relevant to their treatment

Learn more about how you can use ClinicTracker to modernize your patient-practice relationship. Schedule a demo.