Wednesday, April 04, 2007
Does this mean I have to tell you a secret?
In my professional life, I get told secrets all the time. I regard it as an honor to be the repository of people’s secrets and for some it is an important part of the treatment. I believe that many, or even all of us, feel that we carry these terrible skeletons in our closets that will drive away anyone who knows of them. These skeletons rarely are actual skeletons. To date, no one has confessed a murder to me, thank heaven.
Some people tell me of things they actually did that they find shameful; others are more ashamed of a thought, feeling or fantasy. The common theme is the shame.
The whole issue of secrets is a tricky one in therapy. I think that secrets are a necessary and often healthy part of life. But some people feel that they are obligated to tell me their secrets and it puts them in a bind. I will explain to them that they never need to rush something like this. A forced revelation is often too traumatizing. I also tell people that if anything is truly important we will get to it in the future, so there is no hurry.
What is so important about these secrets? Secrets are part of a question that people carry inside them which is whether they are truly likeable and loveable. As long as they hold back a secret or two or three, they can continue to believe that no one truly knows them for who they really are. It is a Catch 22—the secret holds them hostage to their belief that they are unacceptably ugly inside, but the secret is too shameful to be told. Amazingly, most of the secrets I am told are pretty easy to accept. There have been a few exceptions but I have never stopped respecting and liking someone because they told me a “deep, dark secret.”
In a way, I think this is because the capacity for guilt means the person has qualities that I can empathize with. Once many years ago, I treated a man for a medical condition who had been imprisoned for two murders. I found I couldn’t feel a genuine physician-patient relationship with him. He scared me and he was a thief and manipulator while in the hospital. We would diagnose such a person with anti-social personality disorder. People with this diagnosis rarely seek out therapy.
Even the few kids I see with severe behavior problems, what psychiatrists call Conduct Disorder, have the potential to improve. So I try my best to give them a fair chance, although on occasion I have had to call it a day if the lack of honesty and cooperation is too extreme. I don't think I'd ever want to treat antisocial adults. It is just not in my ability to invest enough of myself in this personality type.
I’m not sure if this essay isn’t too frank to post on my blog so I am going to save it for another day. Maybe one day it will lead somewhere.
Addendum: Obviously I decided to post it after all. The comments on my previous post suggested that I should go ahead and stick my neck out a little. We'll have to see how it goes.