Keeping Secrets from Your Therapist

When people enter psychotherapy, even if they’re desperate and deeply in need, they don’t fully reveal themselves in the early phases of treatment. As in any relationship, it takes time to develop enough trust so you feel safe making yourself vulnerable. A prudent reserve makes sense: how can you be sure the stranger sitting in the chair across from you won’t judge or laugh at you? Sometimes people who struggle with borderline issues will disclose powerfully intimate information right away, but they nonetheless keep some deeply shameful details in reserve. Everyone does.

Like most psychoanalysts, I advise my clients early on to be as candid as possible, holding as little in reserve as they can. I tell them I know it’s a difficult thing to do — no one discloses 100% of their most painful feelings, thoughts and memories — but they need to do their best. I acknowledge that it will take time to build trust, for them to feel I’m a safe person. As we come to know each other, they gradually disclose the more shame-inducing aspects of their emotional lives. Often their secrets relate to sex.

No matter how natural an act, despite the fact that almost everyone does it, most people feel too ashamed to discuss masturbation, at least at first. That’s understandable. After all, it’s incredibly personal and private, not something we usually discuss with other people. We do it “in secret,” out of the view of others; discussing it with another person, even a sympathetic therapist, can easily feel like exposure, as if we’ve been caught doing something that no one was supposed to see. It might also be difficult to admit to the fantasies we use to excite ourselves — the seduction scenarios, risky encounters with strangers, a fascination with schoolteachers or mild types of pain. Many people keep these fantasies a secret from their therapists for years.

Not every sexual activity or fantasy needs to be discussed, of course. Only when they’re shrouded in deep shame does it become important to explore them.

Clients also feel uncomfortable discussing the sexual activities that give them most pleasure, especially if they deviate too far from “normal” herterosexual sex in the missionary position. Anal stimulation, a pleasure in being spanked, talking “dirty” during sex … these are but a few of the areas that stir up deep shame and are often kept secret. Once they begin to open up, they may describe feeling like a “freak” or a “pervert.” They often say they’re afraid that I’ll be visualizing them in the act. When clients come around to disclosing shame-laden details about their sex/fantasy lives, it usually involves a kind of courage. I often acknowledge the bravery involved in making themselves so vulnerable; I regard as a sign of deepening trust in the psychotherapy relationship.

Some clients never reach that point, or need a lot of help to get there. In certain cases, it’s a conscious choice: I couldn’t possibly tell him that. Way too humiliating! Or they may have rationalized an exception to the rule of total candor: That’s not important. Why do I need to tell him? Sometimes, a kind of denial may have kicked in and certain ideas never rise to consciousness during session. There always seems to be something more urgent to discuss. Lately, I’ve begun asking my clients more direct questions about those important subjects noticeably absent from our work together.

Many years ago, one client and his wife had decided to pursue artificial insemination due to difficulties in conceiving a child the usual way. He was deeply ambivalent about having this child. After one of the scheduled inseminations, he came to session and told me that the doctors had cancelled the procedure because his sperm count that day was too low (or maybe it was that the amount of seminal fluid was too little). He didn’t seem all that disappointed. During our months of work together, this client had never mentioned the word masturbation; on a hunch, I asked him if he had masturbated the day before the scheduled insemination. With obvious shame, he confessed that he had masturbated three times during the night before their morning appointment. Although a highly intelligent man from a medical family, the link between his low sperm count and those three ejaculations hadn’t consciously occurred to him.

Not all secrets are about sex, but most of them involve shame. Clients understandably prefer not to describe thoughts, feelings or behavior that feel humiliating. I’ve known clients who felt ashamed to admit that they liked watching reality TV shows or reading pulp fiction, that they were consumed with poisonous envy for a certain person, that they admired an artist considered by others to be a lightweight. Whatever makes us feel like a “loser” in comparison to others stirs up shame, and for this reason, we may want to keep it a secret from our therapists. Especially if we idealize him or her, we may hold back details that we fear will incur a contemptuous response.

Because it’s difficult to identify something that’s not in evidence, we therapists often don’t know what we’re missing. We may have no idea about the importance of a certain subject because the client never goes anywhere near it. Sometimes they unwittingly let us in on their secrets when they tell us a dream. Sometimes, the therapist might have an empathic hunch, as I did with my client with the low sperm count. Sometimes, we just have to come outright and ask, especially when it comes to sexual matters.

There’s (at least) one other reason why clients keep secrets from their therapists — when they sense that he or she can’t help with the issue. In a comment to my post about why sex matters, TPG was of the opinion that many therapists are uncomfortable talking about sex with their clients because of trouble in their own sex lives. A client might intuit this quite accurately without realizing it, and then stay mum on the subject. The truth is that we can’t effectively help our clients work through those issues that still give us trouble, unless we’re actively engaged in a process of confronting them within ourselves.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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53 Responses to Keeping Secrets from Your Therapist

  1. J says:

    I had a very good relationship with my therapist for the three years I saw her. We were extremely similar and our children went to the same elementary school.
    I know she is a professional, but when i could no longer see her due to insurance changes, the therapy was cut off, and it did hurt me that this also cut our therapy-relationship.
    For this reason, I have a hard time opening up to any therapist, and it’s what prevents me from seeing one now.

    • bobdick says:

      Hey J, I understand from the inside out how hard it is to balance wanting the therapist to like/love me, w/ recognizing that my therapist does what they do as a business, for money. Things usually go best when I do like a client, and I share that, like much of what all I feel/Think about a client. At this point in my career, I can & do see only people I pretty much like. Partly because that makes things go better , partly because I’ve found I don’t do well for folks I don’t like, and partly because I’d rather spend time w/ someone I like. From what I’ve read about therapists’ choice and preference in our own therapists, aside from lengthy experience, high competence and friends’ recommendations, we too seek someone warm and empathetic, who actually talks with us, whom we like and feel liked by . Though these feelings must be discussed and related to the problems we’re having, still I have to come to terms withthe fact that therapists had better be in this business to make a good living by doing things we’re good at with people who often feel so emotionally deprived and ashamed that they focus way more on our liking them than on what that means in their inner lives — at least till we come to terms with the more basic family relationship issues usually important for their happiness. Dr Bob

      • J says:

        Thank you for your response and for letting me see the other side. I guess these past few years that I’ve gotten older and money has gotten tighter it is easier for me to see that it is a business and less about my feelings towards my former therapist. Now that I know my core problem is shame -(which is how I found this blog.) I’ve read some really great books and it’s helped a lot.

  2. Warren says:

    There is a new level of depth and richness in this post, the writing more thoughtful and fulsome. Diffidence and a sense of not sharing transcended, something of yourself more freely and warmly given. I sens that it is healing for you too, not to ‘stay mum on the subject’ both literally and subconsciously.

  3. sioux says:

    I could hardly believe my eyes when I saw the title of your latest post. Just yesterday, I searched After Psychotherapy for “secrecy” (and came up empty-handed) then Googled “secrets psychotherapy,” which led me to the book “The Psychology of Secrets,” by Anita Kelly, parts of which are online at Google Books. What I really want to know is why some people (i.e., why I) have such a compulsion to keep secrets in the first place — I mean as a routine part of their personality. I have kept so many secrets, many of them dating to my childhood and adolescence, and I find that even after six months of therapy, I have not been able to tell most of them to my therapist. Some of these are sexual, including sexual abuse, and I guess all of them involve shame of some kind. Anyway, thank you for bringing up the subject. My therapist has never asked me about anything, suspecting, I guess, that it would probably activate too much defensiveness on my part. But I will take your advice and start unpacking some of these secrets, if for no other reason than to try to be truly known and seen by at least one person in my life.

    • bobdick says:

      Hi Sioux, I imagine we keep our secrets in order to avoid anyone else discovering who we really are and what we’re really like – i.e. unlikable and unloveable. The biggest secret of all is that everybody seems to have that same deep fear and hides whatever feels shameful about them to prevent avoidance, disgust and abandonment by both particular people and everyone in general. Speaking aloud these secret thoughts, feelings and behaviors to someone, perhaps a therapist, who accepts us despite who we really are, someone we’ve come to trust, admire and even love, seems the secret and scary path out of shame. It takes great courage and is well worth the risks.
      Dr Bob

      • Joseph Burgo, Ph.D. says:

        Nicely said, Bob.

      • sioux says:

        Thank you for your thoughts, Dr. Bob. I had figured out the fear and shame connection, but I still wonder why I have always had such a propensity for secrecy, even from my childhood, and about every kind of thing—from any money I had to my whereabouts to who my friends were. I guess I always felt safer if I was the only one who really knew about me; it was also a kind of reproach, I think, of my parents and siblings. Anyway, I will keep your final words in mind as I come clean to my therapist. I do hope it is worth all the pain and anxiety.

        • TPG says:

          People in other countries look with puzzlement on the American obsession with transparency the way that Americans look with puzzlement at other countries’ obsession with honor 0r manhood. It’s entirely cultural. Therefore, we American keep secrets in part psychologically defensively. as a way to maintain our own individuality.

        • anonymouse says:

          sioux

          I’m not intending to cloud your journey of discovery here, but secrecy, shame and the like are very common in people who have been sexually abused and often it’s directly related to the abuse/power dynamic.

          In your own time and you’re own way, I believe you will come to understand that it was not your fault, you therefore deserve no shame, and the road to that is paved with demystifying the problem by not keeping it secret anymore.

          Your therapist is definitely a good place to start. Keep going with it. You’re not alone and you will get there :)

  4. Valentina says:

    My therapy went the opposite way, and this is probably one of the reasons it didn’t work. I’m an extremely sincere person through, after reading your book, I think this may be partly because I use “shamelessness” as a defence against shame.
    I didn’t feel hiding things from the therapist made any sense and there was nothing I was consciusly ashamed to tell her. Maybe years of confession as a practicing catholic had made it super easy to talk for a woman, as I am used to tell very intimete things to men.
    Over the years I began to hide more and more things and thughts from the therapist, when I felt she wouldn’t understand. For instance, sometimes I refused to have sex with a guy because I didn’t feel loved, but told the therapist I wasn’t attacted to him, because she would not accept my real motivation and call it an “excuse” or even evidence that I was a sadist who tormented the guys she dated by refusing sex. Please note that I was not in an exclusive or commited relationship with any of these guys and so the situations you described in the previous post don’t apply. They were free to choose to keep trying with me or seeing somebody more available. Not surprisingly, some of my alleged “victims” did both things.

  5. Nikita Rybak says:

    I was stunned by how mild these examples are. Anal stimulation? Pulp fiction? Those are some of the most innocent indulgences available to the mankind. Most people agree they are not things to be ashamed of, even though we don’t declare them proudly and openly.

    I agree with the TPG’s point. If even those innocent activities cause therapist anxiety, how can you talk about more ambiguous pastimes and fantasies? In my experience, such information is met with “why did you tell me that”, “what do you expect from me” attitude. While therapist may not say it quite so openly, it’s obvious he/she attempts to push the subject away.

  6. TPG says:

    Really wonderful stuff, and it picks up nicely on the last blog. Your point about secrets, sex, and therapist discomfort is especially well taken. I wonder if part of the issue too is the imbalance of the therapy room. That is, therapists keep plenty of secrets, so is there some unintended modeling for the patient? I know that’s a stretch, but the unconscious mind works in mysterious ways. The therapist is saying, in effect, “Do as I say, not as I do.” Not that I’m arguing for it to be done another way!

    I want to say too that I’ve been reading and commenting on your blog for quite a while now. You are a kinder, gentler, more humble blogger now, and it shows in great thoughtfulness and depth in what you’re writing. Your experiences of the last year have changed you for the better; at least, they’ve changed your blog for the better and made it even more compelling. Kudos.

    • Joseph Burgo, Ph.D. says:

      Thanks you. I do feel that I’m getting more comfortable talking about whatever happens to matter most to me. I’m enjoying the blog even more now.

  7. Lisa says:

    Hello!
    Speaking about shame regarding sex – Do you understand how fetishes are formed? For me personally, I really like being dominated, choked, and controlled. I love the feeling over being overpowered by a man. It is incredibly sexy to me and the thought can turn me on INSTANTLY. I have never thought too much about it until recently. I believe this is because I am the youngest in the family and have been always told that I am so young, I am such a baby. I think that because of this I never learned how to be the responsible one or how to be an adult. I always look to others for guidance rather than being the one to take control….I’m just beginning my process of exploration at this point. Yet, for others some fetishes are pretty intense – like the peeing on one another, etc. How do these things come about in the human psyche? Is it related to sexual abuse?

    • Joseph Burgo, Ph.D. says:

      Those are complex questions. The answers usually relate to the person’s particular history and associations, but when humiliation is involved, it’s usually a way to make shame bearable and manageable by sexualizing it.

  8. Gordon says:

    Sometimes I disclose secrets when doing so will get me something in return like intimacy or respect. Many times I disclosed secrets in therapy so the therapist would believe I am committing and have courage. Kind of like asking her to accept me and also to use as leverage if she ever told me I’m not trying hard enough to change. Also, by her thinking I have courage I would feel proud of myself and that would help numb the feeling of shame a bit.
    In a way I felt that her asking me to tell her my secrets was some kind of threat, probably because I projected onto her my idea of mother and how, for me, a request from a mother is really just an order in disguise. I also sought her approval, like with my mother. I had merger fantasies with her. She did not address these even after I told her I fell in love with her. I fired her (mainly because she didn’t like talking about my past and avoided it) and then I had dreams where she was blown up and I grieved her loss as if I had lost a mother.
    I regret sharing those secrets now specially because she wrote them down on paper and now anyone who has access to those documents will have access to many of my deepest secrets.
    It feels like rape that has been recorded. Like deep betrayal.
    I understand why people are scared of disclosing such stories to a therapist. It’s hard for a client to differentiate the therapists from the-rapists.

  9. Michkell says:

    I, too, have a problem with this. Keeping secrets of the present (how I really feel–due to fear of hospitalization) and of the past (including sexual abuse stuff). I don’t really know how to be honest at all. In fact, I cancelled my appointment today telling my therapist that I was going out of town with my husband, when in fact, we just stayed home all day and there was no real reason for me to be unable to get to my appointment. I just didn’t want to and the lie came so easily–also accepted easily, that I did it.
    Lying to others has become a habit. I don’t lie about silly things, I lie only about how I am fundamentally doing. I feel it is the only way to maintain my autonomy and not make other have to worry about my actions. I am always fine.

  10. anon says:

    The one time I got into a sex discussion with a therapist, she responded in the most mocking and humiliating way imaginable. I still don’t know if it was deliberate and part of the therapy process – but she wouldn’t accept payment for the session.

    Not fun.

  11. L says:

    From personal experience I feel like some of the greatest opportunities for omission is during intake and disclosure of personal history and issues. I often wonder if this has set back the therapeutic process because I have found links to issues from the past but hesitated to submit that because it would make a liar out of me if I wasn’t sharing it at the beginning. It can’t be a rare occurrence, I can imagine, for clients to not report suicidal ideation, abuse, past mental health history, etc. at the beginning of the process but eventually it can’t help but be exposed in session. I often have felt the urge to “come clean” about all that I haven’t admitted to but shame is that overwhelming influencer that keeps it hidden within.

  12. Turtle says:

    I was puzzled how anyone ever trusts a therapist in the first place, so keeping secrets seems pretty natural. But then you indicate relationships that go on for years, which I’ve not heard of. The one time I tried therapy, he looked at my insurance, saw it covered 13 sessions, determined that was exactly what I needed, and by the end of 13 sessions, the “diagnosis” was that there’s nothing wrong with me that I can’t fix with a good self help book, and I should read a few.

    But then I guess that’s not really “keeping secrets” if he never bothers to ask anything.

    • alina says:

      I agree with you. Therapy is the business of making money, pure and simple. I tried many different therapists but the relationship never went on for more than 8 sessions because it was expensive (my insurance doesn’t cover much) and because it was a waste of time. Mostly filling out paperwork and being asked the same basic questions over and over. Because I’m a young woman they would assume I had an eating disorder and we would never get to the real issues.

      • Turtle says:

        I don’t think it’s “just to make money”; I think there are many therapists out there who DO care and are competent. The problem is, who has the time and the money to filter through looking for them? If you already have problems, and the therapist you encounter is incompetent, doesn’t care, or is just a bad match for your personality, it’s too easy to just save yourself the bother and not do it again.

        I suspect the field attracts a high degree of the wrong sort of person. That makes it hard for someone seeking help to find someone worthwhile.

  13. Warren says:

    Everybody who has commented hitherto, has mistaken the signifier attributed to the word ‘fetish’. It is a definite word, a definite article no less in classical English. And we must take care to note that specific words have specific historical meanings. What people want to signify in their use of the word,’fetish’, here, is actually perversion. But the mystification, is that, when they use the word ‘fetish’ to mean what they imagine to be perversion, they are also wrong in this articulation also. What they are indeed articulating, is a false ideology of transgressing a societal code, there in lies the excess of libidinal ‘x’, the thrill of transgression itself, which is somatised as fetish/perversion, but in actuality in neither. All therapists and trainee psychologists/psychiatrists, see Jacques Lacan, for more on this, although you should already know it.

  14. pippa says:

    Dear Joseph,I wrote to you about recovery I think, from a teenage sexually abusive relationship and at the age of 66 perhaps finding myself having intence sexual responces to the occasional man I find attractive,and asked you for any helpful comment.
    I find your writing above helpful by seeming to be open to a broader lot of people: not just regular ,seemingly, quite well evolved couples.(My interpretation of your writing)

    So you encourage me by your more inclusive attitude to further discuss and pursue my own life,at this point in the sexual area of myself.You bring great encouragement to many I am sure,Joseph,therapists as importantly, as we can get blocked by them and not realise.Pippa.

  15. Matthew says:

    The problem with the standard therapist client relationship is that there’s pressure to assume that you should trust. After all, you’re paying them, right? It can make up for the lack of wise people we can be vulnerable with in our isolated society, but the setup is still unnatural and forced. You don’t built trust over time as you would a friend – you go in there with the assumption that you’re going to talk about everything. In some ways, it’s forced intimacy. It’s pressure to open up your soul before you might be ready. Ideally we need to listen when we’re ready to open up to sharing something, but the reality is that most people just want to get results quick, and patience is hard when you’re paying someone a good hourly rate.

    There are many screwed up therapists out there, and part of why people go to therapy in the first place is because their own judgments are haywire. So sometimes the pressure to open up leads to revealing things before what is natural.

    It can be hard for a therapist to see this as that’s his job. There is something unnatural about starting this relationship this way – I think in villages in ancient times you’d see someone that you might not know well, but have at least built trust around. Any time you force trust, there’s a counter reaction and it sets a tone for the rest of the therapist relationship that can be disempowering.

    • Sarah says:

      I agree with this. And I also don’t believe anyone becomes a therapist because they’re caring. They become therapists because of a personal need. My former therapist tried to facilitate bonding by deliberately using words in the first sessions like “us”, “we” and “together” (I believe he picked this up in AEDP workshops). I asked him to stop. It was unnatural, forced and had the opposite effect than intended-I felt suspicious and disappointed. I don’t want fake intimacy, I want real-no matter how long it takes.
      He would also sit like me, another mirroring/bonding technique. It was ridiculous. I kept forgetting to ask him to stop-it kind of amuses me now to think of him doing that. Just because a therapist says she has no judgment, accepts you and does all the right things to make clients feel safe, doesn’t mean they ARE safe. My therapist ultimately betrayed me. I don’t understand how people are expected to trust a stranger on a deeply intimate level just because that stranger has a business claiming to be someone who can be trusted this way. It takes virtually years before a person knows another person enough to trust them deeply, and therapists are people we can’t get to know personally. It’s quite a leap of faith to choose to trust a therapist early on; some people get burned and some don’t. It’s a gamble.

  16. Y says:

    I agree with some of the other folks. My previous therapist became squeamish and uncomfortable when sex came up, and my current therapist, while open to the topic, calmly waits until he is able to delicately change the topic. If I’m lucky, he’ll release a philosophical moan.

    When I talk about sex in therapy it’s often about testing limits. I want to make sure that I can truly talk about anything, and that I expect him to be able to handle it. Besides, what I really want to talk about is need. I want to say that I need him to love me, even though he never will (not the way I fantasize about). I want to say that I need to know why my parents didn’t love me. I need to feel angry and envious because he has it all figured out, and I don’t.

    If only we were allowed to tell our therapists our secrets…

  17. KT says:

    My experience with secrets is similar to others expressed. In therapy specifically there could be many reasons I would not say something. One is shame. I hate disclosing things to people if I feel I will be judged. It used to be extremely hard for me to admit “bad” things I did to anyone but especially someone who I want to respect me (like my therapist). I remember when I was in my first therapy in my 20′s I had a therapist I deeply respected and wanted to like me very much. I had lots of transference going on with him I’m sure. I decided I needed to admit that I smoked but it was incredibly scary and anxiety provoking to think about it. One day I decided I would do it. I will never forget the session because right at the beginning I told him I wanted to admit something to him. It took the ENTIRE session for me to get to it. It was the craziest hour I remember spending in therapy. He just waited until I was ready to tell him and I squirmed for literally 49 minutes and at the 50th minute I finally told him. I smoke sometimes. I couldn’t believe how hard it was. That was it, I didn’t die and he was like “that’s ok”. I realized it was a major breakthrough for me though.
    I also wanted to say that in my most recent therapy I got into a control struggle with my therapist. In my life somewhere I learned not to disclose things to people unless they asked. I decided at some point if someone didn’t ask me about something, they weren’t interested enough to know. So I don’t tell people things if they don’t ask. Well in classic psychodynamic psychotherapy apparently, the therapist usually lets the client lead. This created a very hard dynamic for me. If my therapist didn’t ask me questions about myself I didn’t want to tell him anything and then I assumed he wasn’t interested and didn’t care about me. I wanted him to lead. I thought he didn’t care, he said he did, we were both stubborn. This seems to be a way I kept “secrets” I guess. It will be interesting to explore this if I ever go back.

  18. Dingbat says:

    I struggle with revealing my deepest secrets with my therapist, because even though I’ve been seeing him for over a year, he’s still a stranger to me. I know maybe five things about him, only three of which he voluntarily revealed, and one of those three I already knew! I completely understand his desire to keep his personal life private. In fact, I’m a medical student applying for psychiatry residencies, and I intend to keep a similar separation b/w myself and my patients, though not to that extreme. At this point, I could never talk to him about sex – I was best friends with someone for 7-8 years before we finally had an open, honest, and PERSONAL discussion about sex (partly opinions, but mainly desires, preferences, experiences).

    • Joseph Burgo, Ph.D. says:

      I think that you can “know” your therapist without being privy to the details of his or her life. There’s an emotional intimacy that develops over time, a coming to know one another in profound ways, even if you’re not a part of the other’s everyday life. This intimacy should eventually lead to trust and a feeling of safety.

    • alina says:

      @Dingbat – sometimes it’s good to not know too much about your therapist. When I was 18 I saw my first therapist, a charming 28 year old in his first year of practice. I developed a bit of a crush on him, idealized him, and because I wanted to know more about him, searched him on Facebook. Well I ended up finding out stuff I didn’t like about him and lost a lot of respect for him in the process.

      @Dr.Burgo I don’t know if you use social media, but please remember to keep your settings private, there are a lot of nosy patients like myself out there! : )

      • Dingbat says:

        Since I posted here, I’ve actually sort of accepted that difference (in a good way). A week or so after Dr. Burgo’s comment, I had an appointment with my therapist. During that appointment I kept the doc’s comment in the back of my head. Later, I reflected on how he was when I first started seeing him and how he is now, and I realized that our dynamic HAS changed. He seems more relaxed, makes more jokes. We even talked casually about football a few times, something that wouldn’t have happened a year ago. So I think I’m okay with it now.

        That makes me sad, because I’ve built a relationship with him but will have to move in a few months. I’m really reluctant to look for a new therapist, only because I don’t want to waste time telling someone my story and then decide they’re not the right fit. I still remember the first few appointments with my current one, and I was crying the whole time; it was really painful. Of course, I cried after that too :-) but the first few were the worst

  19. GreenEyes says:

    Great topic Joe.

    The most pressing secrets I’m keeping atm relate to wanting a more personal rather than therapeutic relationship with my T. Mainly because I know my wishes will never come true.
    No doubt there’s some sort of romantic/erotic transference happening but I’m scared of going near it.

    On the subject of sex, I had a really difficult experience many years ago where my therapist confessed he had fallen in love with me and wanted me to leave my marriage. My father had just died so I was incredibly vulnerable and fragile and very young (mid 20s). The therapist I saw immediately after him spent the first session pounding me about my sex life, sex habits, masturbation, fantasies etc. I felt this was outrageously inappropriate and sensed he was getting off on what I was saying. I never paid the bill. Tact, timing and trust are so important with anything that is linked to shame and humiliation.

    • Joseph Burgo, Ph.D. says:

      I agree about tact and timing. It’s not something you can just rush into in great detail. With new clients, my questions tend to be discrete and general.

  20. Viv Barker says:

    I see from the comments that I am very fortunate to have a therapist who is wise, kind, respectful and tactful. She is the only one I’ve ever tried, & I’ve been with her for about 15 yrs. I think of her as a dear friend and life coach. At this point in life, with her help, I think I have a strong enough ego that I would be out the door immediately if a therapist made me feel bad about myself.

    Until beginning therapy in my mid-40′s I was always one to be too open with others. I had no secrets, & didn’t want to be around anyone who didn’t welcome me with open arms & preferably share their similar experiences. (I’m picturing myself, like a cartoon dentist w/head mirror– many must have fled from me!) If I felt that the other person withdrew from me, even the teeniest bit, as a result of what I’d shared, I felt AWFUL.

    Dr Burgo, thanks to your blog, & the reading I’ve been doing here about shame, I’m starting to really get this. That awful feeling is definitely shame, & I think I understand why I feel it in such moments– or any time I sense anger or dislike toward me–( looks like I must be working pretty hard to keep that ever from happening!)

    My family of origin was dominated & warped by my manipulative, abusive borderline narcissist grandfather. To get around successfully in his presence– that is, with minimal damage to one’s boundaries– it was best to have a confident, pleasant, respectful, businesslike manner. (Naturally, as with any predator, never display fear.) This was how you got him to LIKE you (unwritten corollary: one must please grandpa /keep him LIKING you or all hell breaks loose).

    The shame I feel when someone is displeased with me is utter mortification & humiliation that I can’t lay off on anybody else. It feels as if I have let myself down by stupidly exposing myself to very real danger.

  21. Emma says:

    Amazing post, I always read your blog have never brought myself to comment but this really hit close to home. Even though my psychologist knows alot about my childhood which I shared emailed (couldn’t bring myself to say it to her face) I still have kept things hidden from her. I fear she will reject me or not be able to help me with certain things. I also have a major fear of trusting her, despite the fact she continues to prove to me she is loyal and I can trust her.
    I often wonder what goes on inside your heads when you sit and talk with us? Maybe I’m just paranoid but I always get this feeling she thinks to herself that I’m odd or beyond help :(

    • Joseph Burgo, Ph.D. says:

      Be brave and talk to her about all those things! It’s important for her to understand your fear that she’ll view you as beyond help.

  22. alina says:

    The #1 reason I do not open up to therapists is because they dismiss me and refer me to a new therapist. Masturbation is not a big deal, it’s hardly illegal. But if you confess you have suicidal thoughts they’ll kick you out pretty quick. Then refer to you to a new therapist who will do the same. I’ve had this experience with 6 people! Can’t seem to find a therapist who is affordable and will listen to me.

    • Y says:

      What? You had multiple therapists reject you because you were suicidal? That is insensitive, inhumane, and must have been extremely painful for you. What ever happened to first do no harm?

      I implore you to keep trying to find the right therapist. There are practitioners out there that are both well trained and willing to reduce their fee. I hope you never experience such traumas again. Peace and love, my friend.

      • alina says:

        Thanks Y, you’re very kind : ) Fortunately there are some very good therapists out there. Dr. Burgo who writes this blog seems very compassionate! I’m a student and look for sliding-scale fees so that limits me quite a bit. But I no longer live in an abusive home so that cured my suicidal impulses pretty quick.

  23. Sarah says:

    How do you know if your therapist is discussing sex in an appropriate manner?

    For example, is is a red flag if a therapist asks questions about your sex life when you have never mentioned that it’s an issue that you wanted help with? Or if you do mention sex, and he/she wants to hear more details about your sexual experiences, activities, specific feelings, etc.?

    My last therapist occasionally asked me for more details about sex than I was comfortable revealing, like asking me if I was having orgasms when I had sex with my boyfriend. I had a squeamish feeling that those questions were inappropriate but I never knew if he was doing something wrong by asking. It didn’t happen frequently but when it did, the comments/questions came out of the blue and kind of shocked me.

    • Joseph Burgo, Ph.D. says:

      Those kind of questions don’t strike me as inappropriate per se. He may have felt that you were holding back important information. I think the red flag is when you sense there’s an inappropriate level of interest.

  24. rita says:

    You MUST find out if the therapist is trustworthy and can bear your secrets without punishing you for revealing them. A therapist who can’t tolerate your secrets can cause a lot of harm. While I was in therapy I was put on a new anti-anxiety medication which in rare cases causes priapism in males. Being female, at first I didn’t recognize that it can also raise libido in women, but after researching the drug I found a lot of information about a connection to “persistent genital arousal disorder.” After years of anti-depressants and a legacy of child abuse I had virtually no sex drive, and in my confusion I thought the sexual urges were related to another kind of transference (not sexual, more of an infantile feeling) that started towards my female therapist. This confused connection caused me such distress and anxiety (I’ve been married many years and have not been attracted to a woman before) that I went into a very dissociated state. My therapist discharged me at this point because I made her “uncomfortable.” I was so distressed when she cut me off that I ended up writing letters to both her and my doctor about what the medication was doing to me, an excruciating admission. My doctor stopped the medication, at which point the sex drive quickly decreased. My therapist took me back, conditional on me not making her feel uncomfortable again. She told me a week later that I could trust her because she “wasn’t going anywhere.” We lasted a few more months before she cancelled an appointment, which made me very upset. My expression of anger (again in a letter) apparently made her uncomfortable — so at our next session I was discharged again, this time with (as she put it) no possibility that she would ever change her mind. This took me completely off guard because I didn’t know expressing anger could break her rule about being made uncomfortable. Apparently my bouts of dissociation, distressing sexual confusion, and anguish over abandonment meant no more to her than reasons for HER to be uncomfortable enough to dismiss me. I ended up being hospitalized by my M.D. My motivation to tell the therapist my sexual “secret” was strong because I was becoming attached to her during the time she first wanted to discharge me. Yet if I HAD kept secrets from her, both sexual and emotional, I’d still be in therapy rather than suffering ignominious rejection as a punishment, but still painfully wondering what I did wrong. I’m not sure there is any point in seeing another therapist since my trust has been destroyed. At least with self-help books, the disclaimers are printed in the preface!

  25. Annie says:

    “They often say they’re afraid that I’ll be visualizing them in the act.” This is my exact problem. I want to talk about this stuff to my therapist at some point so I can tell him about one particular experience, but I can’t bring myself to.

  26. Jane Doe says:

    I would have loved to have a therapist to trust. Instead, I spent 10 years in the hands of a psychopharmacologist who wasted my 150 dollar per month med checks talking mainly about himself and his bonsai trees and his numerous trips around the world. The other couple of minutes were spent downplaying my side effects, so I learned quickly to shut up about those. He also made sure to tell me I was incurably ill and would need his happy pills for the rest of my life. It wasn’t until I had a full blown manic/psychotic break on an increased dose of an SSRI that I began to wonder why I was with this guy. Until then, any doubt was hushed by my oldest and constant companion, shame.

  27. Daniel says:

    I am glad to have found this article. Came across it when searching for “should I call my therapist if I attempted suicide and failed.” I understand that I shouldn’t keep secrets from her, but feel so ashamed and am fearful that she’ll have me committed. Not sure what to do, but your article gave me something to ponder.

    • Joseph Burgo says:

      If you’re still a risk to yourself, she would have an obligation to intervene, so I understand your concern. Still, I don’t see how constructive therapy is possible without full disclosure.

  28. Liz says:

    Interesting article. I have a hard time opening up to EVERYONE, not just therapists. I seem to have a compulsion to be perfect, or at least try to maintain that image. I know intellectually that I’m far from perfect, and that others know I’m not perfect, but I just can’t stop acting like that. Even to my closest friends and family, I’m always “great.” I don’t know how convincing I am, but I wish I could be vulnerable sometimes and let people in. It makes me feel like an imposter, that I can’t be honest about my true feelings. In therapy I desperately want to be completely honest, so that I can get better, but I compulsively sugar coat everything and leave out the worst details. I rehearse conversations in my head of things I want to say all the time, but I can just never follow through. I’m not even scared of judgement (at least not consciously), and I know that my people will love me regardless, but I just can’t seem to make the words come out :( it’s like I’m scared of people finding out that I’m human… Like I want to be better than that …

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