Mental Health/Psychiatry/Psychology

Are You Keeping Secrets in Your Therapy?

Your therapist will not abandon you if you share them.

Middle-aged man sitting with female therapist
Middle-aged man sitting with female therapist
Photo: Daxio_Productions/DepositPhoto/9212076

We all want to present ourselves in a favorable way, but in therapy, we have different rules about that than we do in social discourse.

Timothy O'Neill’s story gets to the heart of a lot of the work we do in therapy. The two cardinal rules of therapy I learned in my training were: 1. Always explore any change in affect or emotion that you observe. 2. Always analyze the resistance.

Exploring emotion

In normal social discourse, if someone starts to cry, we get anxious, and the usual response is, “There, there, don’t cry.” We want the tearful person to feel better, but in most cases, we are uncomfortable with their emotion and don’t know what to say, so we try to shut it down.

But as a therapist, I don’t run away from those emotions. I might say, “I see there is a tear in your eye. Tell me about that tear.” I want to focus the patient on that feeling and to have them tell me about it.

Often, the patient responds, “I’m so sorry. I didn’t mean to cry.”

Then I am apt to respond, “Tell me why you think you can’t cry with me.”


Frequently, any display of painful emotions will lead to an area that the patient resists talking about. “I can’t talk about that. It’s too painful/too shameful.”

I respond, “Isn’t it ironic that you come to me because you are in pain, but then you tell me you can’t talk about it?”

Two things operate in this exchange: The patient wants the therapist to like them, and they are afraid the secret will damage that. The patient expects that the therapist will respond as others have.

In many if not most cases, what is going on is that the patient is so ashamed of themselves, that they believe everyone else must feel the same way about them. I might say, “You hate yourself so much you feel that no one can ever love you.” So often we are our own worst critics.

The therapeutic experience

Therapists are not supposed to be judgmental.

In our training and supervision — and often in our own therapy — we explore how our own life experiences might lead us to make judgments. We are, after all, human beings. We are expected to work out our own conflicts before we can assist others in working out theirs.

Three things account for the healing in psychotherapy:

  • Genuine warmth
  • Accurate empathy
  • Unconditional positive regard

Genuine warmth is perhaps a gift. Some have more than others. Others may have almost too much.

Therapists must learn how they are typically perceived by others so they can understand why their patients may not see them as most people see them. It is what leads us to ask, “Are you expecting me to react the way your father did?”

I tell trainees learning to be therapists that we don’t choose to do this work; we are called to it. We know what pain feels like because we’ve experienced it. We believe that emotional pain is the worst kind of pain, and we are called to help others deal with it. Our own pain is what allows us to “empathize accurately.”

A painful truth

Here’s a painful truth: Therapists don’t like all of our patients, and we definitely like some more than others. But — and this “but” is important — our job is not to like our patients. In fact, liking our patients too much can lead to problems. Our job is to set judgment aside and accept our patients regardless of what they might tell us.

It is this capacity to accept our patients, no matter what they tell us, that allows us not to abandon them as others in their lives may have.

So, Timothy O'Neill is absolutely correct. Sharing your most painful secrets is often extremely difficult. Trusting your therapist to accept you after you’ve shared them is difficult and sometimes takes a long time. Therapists know that our patients will test us; we expect that. But protecting those secrets can lead therapists to make wrong assessments.

Patients need to discover that the goal of therapy is not to have a therapist like you. The goal is to discover that you have worth at those times when you feel you have no value to others.

Written by

Gay father; Psychiatrist; Award-winning author FINALLY OUT. Chapter excerpt here: Top writer on Medium. Not medical advice.

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