Are You Keeping Secrets in Your Therapy?

Your therapist will not abandon you if you share them.

Loren A Olson MD
Invisible Illness
Published in
4 min readAug 9, 2020
Middle-aged man sits with female therapist while considering revealing a secret.

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

After reading Timothy O’Neill’s excellent story, When You Lie To Conceal The Full Extent Of Your Illness”, I thought it might be useful to write about what transpires on the other end of that couch.

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 ordinary 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…



Loren A Olson MD
Invisible Illness

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