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.