Secrets in psychotherapy: For better or worse?

Abstract

We investigated how concealment and disclosure of secrets, two related but distinct processes, unfolded over the course of open-ended therapy for 39 clients and 9 therapists, using hierarchical linear modeling to identify longitudinal patterns and investigate relationships with working alliance and session quality. Results indicated that over the course of therapy, 85% of clients disclosed at least one secret and 41% concealed at least one secret, with 18% of sessions including a disclosure and 4% of sessions including concealment. Over time, clients were less likely to disclose secrets, and the secrets they chose to conceal were rated as less significant. Clients rated the working alliance lower after sessions when they disclosed secrets versus when they did not disclose, although the working alliance was not rated as poorly when the disclosed secrets were viewed as significant. Clients rated session quality higher after sessions when they disclosed secrets versus when they did not disclose, particularly when they disclosed preoccupying secrets. Clients tended to feel neutral or positive about their disclosures. Implications for practice and research are discussed. Public Significance StatementThe results from this study suggest that in open-ended psychotherapy, disclosure of secrets occurs more often and is more closely related to the client's view of the therapeutic relationship and session quality than is concealment of secrets. The results also indicate that certain types of secrets, specifically those that are significant and preoccupying, matter in determining the patterns and impact of client concealment and disclosure.

Disclosure and nondisclosure of physical health issues in psychodynamic psychotherapy.

“…Clients were more likely to disclose about PHI that were related to mental health, distressing, relevant to what was going on in psychotherapy, a priority compared with other topics, and when there was enough time to talk about them. Clients discussed PHI in about 12% of their sessions, which is similar to the 18% of disclosed secrets in psychodynamic psychotherapy (Marks et al, 2019). Furthermore, we found evidence for both client and therapist effects in terms of PHI discussion, given that 20 of the 54 clients (36%) never disclosed about any PHI and clients of two of the 11 therapists (18%) never disclosed any PHI.…”

“…Clients indicated that they did not disclose PHI in 6% of sessions, similar to not disclosing secrets in about 4% of sessions (Marks et al, 2019). Almost one fourth (24%) of clients never reported having a PHI they chose not to talk about with the therapist and all the clients seen by five therapists never nondisclosed, suggesting that (as with disclosures) that both client and therapist effects influenced nondisclosure.…”

“…Embedded within a whole list of possible topics that could be disclosed, Farber and Hall found that therapists perceived body-related issues as among the least often disclosed of all topics. In other more general studies about disclosure, researchers have found that tended to withhold relevant information from their therapists (Hill et al, 1993;Kelly, 1998;Marks et al, 2019) because of shame (Baumann & Hill, 2016), avoidance (Hill et al, 1993), a wish to conceal undesirable aspects of self (Kelly, 1998), low salience and significance of the information (Slepian et al, 2015;Vrij et al, 2002), low levels of distress and desire for intimacy (McDaniel et al, 1981;Stiles, 1987;Stiles et al, 1992), and the perceived lack of relevance of the information to psychological concerns (Heaven & Maguire, 1996).…”

Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy

“…The therapeutic process in psychotherapy is aimed at facilitating clients' capacity to approach, recognize and reflect upon challenging life issues with openness and authenticity (Kolden et al, 2018). However, the process of opening up in treatment sessions is far from straightforward, as apprehension, shame or fright can prevail (e.g., MacFarlane et al, 2015;Baumann and Hill, 2016;Marks et al, 2019). It is natural that disclosure of personal material can take some time, sometimes opening up may occur only after months and sometimes it never happens (Farber, 2003).…”

The Synergistic but Troubled Relationship Between Psychotherapy Science and Practice: Moving Forward

“…For example, during her clinical work, one doctoral student became interested in client secrets. She initiated a change in research protocol to begin collecting data from clients about the secrets they were keeping from their therapists (Marks et al, 2019). In this way, the data collected in the MPCRL are always evolving depending on the interests that students and faculty bring to and develop during their time in the clinic.…”