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Individual therapy may be said to have gotten its start when doctors noticed that neurological symptoms in some patients resolved after those patients discussed forbidden topics. At first, much energy was spent on articulating what the mind must be like for that to happen. Treatment largely involved sharing that knowledge with the patient. Eventually, therapists focused instead on what therapy must be like to induce patients to spill the beans (Freud, 1911-1915).

Ignoring and marginalizing parts of the self—ugly emotions, vicious thoughts, cringey memories—takes a toll on psychological functioning. It’s not just that the person spends so much mental energy playing whack-a-mole with pesky images. It’s also that the person lives on the verge of humiliation as they try to negotiate relationships without showing their inner self. People act like parents of toddlers who tantrum, never quite engaging in conversations or tasks at hand, always anticipating the noisy disruptions that constantly threaten their peace of mind.

Some relief is available merely from acknowledging one’s predicament to oneself. This is what meditation and journaling often do. Most people are not nearly as vicious toward themselves as they expect to be when they embarrass themselves. Most people’s darkest secrets are not nearly as gruesome as they feel them to be. But ultimately, acknowledging one’s shame only to oneself is just another way of seeing oneself as shameful. True acceptance follows from revealing oneself to someone else. True acceptance follows from revealing oneself to someone who is capable of disapproval but still accepts you. AI won’t work for this because AI will verbalize acceptance no matter what. It’s like asking a phone sex operator if your kinks are repulsive.

Who would you tell your darkest secrets to? Well, no one. But therapy doesn’t depend on your telling your worst secrets to the therapist. No one will ever tell their five worst secrets, but therapy can induce you to reveal secrets six through ten. And one can learn the habit of mind that therapy teaches, namely, to view oneself, as Janna Goodwin put it, “with the glorious indifference of a universe that expects of you nothing.” Or if you prefer, to view oneself with the warmth and welcoming curiosity that literary masters like George Eliot and William Shakespeare view their characters with.

So, then, who would you tell shameful secrets to, even if they are not your most shameful secrets? Therapists have been asking that question for over a century and have come up with clear guides. But note that the answer to that question is relevant only if therapy is supposed to help you get better. If it is supposed to make you merely feel better, a very different set of traits is needed. These feel-better traits include cheerleading, validation, upbeat responding, sound advice, minimizing abnormalities, and, let’s face it, physical attractiveness.

First and foremost among the traits that will induce patients to reveal themselves is a sense of purpose (Karson, 2018). This is often called the working alliance, and it is the one thing that scientific inquiry repeatedly and confidently identifies as effective. The therapist demonstrates a collaborative attitude that engages the patient in a shared understanding of why it is important to share secret feelings, passing thoughts, painful self-images, and embarrassing memories.

The working alliance is enhanced by specificity, which requires psychological insight. You will be more inclined to participate if the case formulation is something like, “When you socialize, you live in terror that your friends will see that angry little girl who wasn’t allowed the candy bar.” You will be less inclined to participate if the case formulation is, “It’s good for you to reveal yourself.” The alliance is also enhanced when the relationship itself is discussed, since talking about what is going on in real time is almost always a forbidden topic.

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Another important trait is often called wisdom, but I balk at that descriptor because it is so age-related. While I have no doubt that good therapists keep getting better at therapy, I don’t think what is needed is necessarily age-related. Instead, I would call it psychological-mindedness or circumspection or even a sense of humor in the grand sense of the term. Therapists who take things in stride communicate that they will take your secrets in stride. (Therapists who reassure you or validate you make you feel better, but they also make you wonder if they’ll be so reassuring and validating when you tell them what you did to the dog that time or what really turns you on.)

Keeping secrets is a crucial trait in a therapist. You are far more likely to reveal yourself to someone who will never tell anyone else, who will never even write it down. This requirement is under constant siege by insurance companies and recordkeeping policies, but if you are not planning on killing anyone, including yourself, and if you are not abusing children, your therapist need not write down or disclose any of the shameful details of your inner life. It’s worth noting, also, that the need for privacy is an impediment to outcome research. Almost all studies on therapy effectiveness violate the principles of therapy by intruding on privacy.

Our shame makes us polish our social mask. Anything the therapist does to encourage us to keep that mask on interferes with therapy. Therefore, the therapist must never be social with the patient. Patients will jump at the chance to socialize rather than reveal themselves. Indeed, many patients say they won’t reveal themselves unless the therapist does, too, but once there is any sort of social aspect to the relationship, the masks stay on.

One more trait will do for this blog post. The therapist must not only take you in stride, but also be reliable in every way to induce self-disclosure. Reliability shows itself in the consistency of the therapeutic attitude and in the welcoming curiosity that defines that attitude, but it also shows itself in starting and ending on time, and in keeping up their end of the therapeutic agreement about how they will behave.

Freud, S. (1911-1915). Papers on technique, In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. XII, 85-174), Hogarth Press.

Karson, M. (2018). What every therapist needs to know. Rowman & Littlefield.

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