Is Discussing Your Childhood in Therapy Helpful?

It can be—but revisiting one's childhood is not required for therapy to work.

Reviewed by Devon Frye

Key points

• CBT focuses primarily on present challenges, thoughts, behaviors, and emotions.
• CBT helps clients identify harmful beliefs and develop and strengthen more accurate and helpful beliefs.
• CBT therapists explore past events only if they are crucial for changing deeply held negative beliefs.
• Many people don't need to revisit their childhood to achieve therapeutic progress.

Have you seen movies and TV shows about therapy? Often, a fictional therapist leads a patient on a lengthy—and usually painful—exploration of his or her childhood. In these scenes, discussions of childhood often lead to a “breakthrough,” i.e. an ah-ha moment when the patient realizes that their current distress stems from something that happened to them decades ago.

But what happens next? And how do these revelations help patients achieve remission of their mental health condition, achieve their goals, live in alignment with their values, and increase their sense of well-being? Often, they don’t.

In fact, this portrayal of therapy can backfire. Many people don’t want to discuss painful events from their childhood, and promulgating the idea that it is a necessary part of healing can deter them from seeking help. In fact, you don’t have to talk about your childhood in therapy—unless you want to and the therapist can provide a clear rationale for how it will help you.

Cognitive behavior therapy (CBT) addresses clients’ most distressing current problems, focusing on how clients can feel even just a little bit better in the coming week. CBT therapists help clients develop new ways of thinking about the situations in their lives, teach them skills that they can implement immediately both in and out of session, and help them make progress toward their important goals and aspirations. CBT has been demonstrated to be effective for the treatment of many mental health conditions and quality of life concerns in thousands of peer-reviewed studies.

Do CBT therapists ever discuss childhood experiences? Yes, under several conditions.

Often, clients hold unhelpful beliefs that formed during childhood and became strengthened over time. For example, a client may believe “I’m unlovable,” “I’m worthless,” or “I’m a failure,” as a result of the meaning they put to an event or series of events that occurred when they were young.

Typically, the therapist and the client uncover enough evidence from the client’s current life to conclude that a negative belief is not true, or certainly not entirely true. The therapist and client work together to identify a new belief that fits the evidence, for example, instead of “I’m a failure,” they strengthen a more accurate and helpful belief such as “I have strengths and weaknesses, like everyone else.”

However, sometimes the therapist and client agree that working on current issues hasn’t sufficiently changed one or more of the client’s key unhelpful beliefs, especially at the emotional or gut level. The client might say, “I know intellectually that I’m not a bad person, but I still feel that way.” Before discussing childhood events, the therapist provides a clear rationale for doing so and the client agrees to talk about key childhood experiences associated with the origin or strengthening of the problematic belief. When discussing childhood events, CBT therapists can help the client develop a different understanding of these events and then help the client use their new understanding when working through current issues.

A client I’ll call “Janet” had suffered many emotional traumas as she was growing up. We identified that her belief that she was unlovable was interfering with her ability to achieve her aspiration of having close friendships. Janet was estranged from her parents, had no siblings, and had only one friend with whom she was not particularly close.

We initially worked on improving her social skills. She took a few cautious steps—smiling at people and responding more lightheartedly when others initiated conversations. As she began to take greater social risks and was met with either neutral or positive responses, she began to see that her belief wasn’t completely true.

That is, she began to understand that it was inaccurate at the intellectual level. But, as she described, “I still feel like it’s true.” Her unlovability belief was holding her back from having the close friendships she desired.

I provided a rationale to Janet for talking about her childhood. She agreed to investigate with me the meaning she put to some traumatic childhood and adolescent experiences (e.g., years of bullying at school), which were connected with her idea that she was unlovable. As a result of our discussion, she recognized at the intellectual level that the bullying actually meant something quite negative about the bullies, but not about her. But she still believed at the emotional level that the bullying meant she was unlovable.

One of the most painful experiences occurred when she was 12. Janet agreed to imagine and narrate this event to me in detail as if she were 12 years old. She also allowed herself to feel the negative emotion that reliving this incident evoked. I questioned “12-year-old Janet” about what she was thinking. Then I encouraged a dialogue between “12-year-old Janet” (which represented the emotional part of her mind) and “older Janet” (her current self, with her intellectual understanding of the event). Older Janet was able to help her younger self understand that she was not unlovable.

This imagery technique helped convince Janet, at both the intellectual and emotional levels, that her belief of unlovability just wasn’t true. Then we discussed what new experiences Janet, who now “felt” more likable and loveable, could try in the coming week in the service of reaching her aspiration of greater connection with others. The reason for talking about Janet’s childhood was to change her thinking so she could take steps toward her current goal.

Of course, many people, even those with strong negative core beliefs, don’t need or benefit from an exploration of their childhood. They are able, with good treatment, to make strides every week in their thinking, emotions, and actions. And not only do they improve their lives and feel better, but they stay better.