Secrets in Therapy

Who is entitled to tell a secret - the client or the therapist?

Posted Jul 01, 2014

In a previous essay here I spoke of a lecture I attended on keeping secrets in therapy (sex-sociability). I stated “There are pros and cons to never keeping any secrets as a stated policy, always keeping confidentiality (my own policy), or ethics based on the situation.”

A reader in the Comments section responded by asking me to write more on the subject.  Anonymous says “I believe that the no-secrets policy of many marital therapists is the largest block to a huge segment of men and women who could otherwise benefit from couples therapy. It is a policy that serves the therapist, and not the individuals in the couple, or actually the couple in the long run (even if the ultimate disposition of that therapy is divorce).”

Let us clarify here.  When I see a couple for the first time I make sure that they know that I see my role as looking at what the divisive issues are and helping the couple find a workable solution to them. It’s not my job to adjudicate who is right and I do not consider myself as the defender of the relationship. If, as I see it, one or both would be better off ending this relationship I will offer my opinion honestly.  My opinions are only that, an opinion, but it is based on more than 40 years of professional experience with relationships. At the end of our first session I always ask each person whether s/he has any objections to my seeing the other privately if they so wish.  I do not see either alone unless I obtain the permission for that from both of them.

I am aware that many if not most therapists will not see a couple and the individuals in it separately.  They refer out to other therapists and confer with them when the situation warrants. So then you have three therapists involved, each with his or her own unique approach, and the costs of those therapists and potential confusion can be monumental. I am quite sure I know how to maintain my ethical boundaries and have never had a problem doing so.

If one party tells me in a private session something that has not been disclosed to the other partner that could present a major problem (a breach of trust, a secret sexual relationship, a firm intention to leave, for example) what do I do? I’m afraid the anonymous commenter thinks I will blurt it out in the next session since I said I don’t keep secrets: “Your spouse told me that she is secretly seeing another woman and feels she might be gay.  What do you think of that?”

That’s not what I mean by “no secrets”, I assure you all.  Everything said in any session with me is confidential unless there is a law against doing so. (If someone states s/he intends to kill himself or someone else, or says something indicating a child or an elder may be in danger I must by law alert the authorities). Otherwise, I work with the secret holder around what the consequences are for keeping a big secret from a spouse/partner (alienation, distrust, a barrier to intimacy) and we rehearse the best methods of disclosing it.  I then work with the other and the couple to mend the breach once the secret is out or to end the relationship gracefully if that’s what’s required. If a partner refuses to disclose the big secret I end our own relationship.  Working around an unspoken secret is like an agreement to ignore the elephant in the room – not workable for long.

Unless someone is in danger I don’t betray confidences ever.  I believe that’s what the anonymous commenter is afraid of and sees as an impediment for a “large segment of men and women” in seeing a counselor or therapist. If that’s true for you, a good way to handle this is to ask the therapist’s policy in the initial phone contact along with appointment hours, fees, etc.  “If I tell you something in confidence are you obliged to tell my spouse?”  Then listen carefully to the answer and clarify any ambiguity until you feel secure in trusting this person.

What has been found to be most effective in a therapeutic setting even more than the specific approach – psychodynamic (a la Freud), cognitive, behavioral, EMDR, or any new found wrinkle - is the relationship between the client and the therapist. If it is not based on the client’s trust and the therapist’s empathy I don’t think any good work can be accomplished.  Both empathy and trust need to be experienced by both parties.

You may not trust your partner and that is a very good indication that therapy is needed, but if there is anyone in whom placing your trust is justified, it needs to be your therapist.  Ask all your questions on the phone and make a wise decision.