Addressing Secret Keeping with Psychologically Inflexible Clients

As therapists, we depend on our clients to honestly share their thoughts, feelings, and experiences with us so we can be of help to them. Yet, for a variety of reasons clients may not always feel able to be forthcoming with their therapists. While not all information may be relevant in therapy, if clients conceal particularly painful or central events in their past, they may ultimately feel less understood by and connected to their therapist, treatment plans may be incomplete or off track, and therapeutic progress may be negatively affected.

We recently published a study (Lear, Luoma, & Chwyl, 2021) that found that a client’s level of psychological inflexibility (PI) at the start of therapy predicts secret-keeping in therapy. There were two main findings:

• Clients who were high on psychological inflexibility at intake were 3 times more likely to withhold therapy-relevant information from their therapists.
• Psychological inflexibility was a stronger predictor of secret keeping than shame, a well-documented correlate of client non-disclosure in therapy.

Here are some tips for how to discuss secrets with people who are likely to be keeping them:

1. At intake, assess whether your client is psychologically inflexible. If so, they are likely to keep important secrets that may impact therapy down the road.
2. For those likely to keep secrets, discuss the following topics in an early session:
   • Secrets are a normal part of therapy
   • It’s also normal keep them to yourself until you know me better. It would be expected that you don’t fully trust me as we don’t know each other very well.
   • At the same time, it’s usually important to discuss important secrets at some point during therapy. So, while I’m not encouraging you to share any secrets you might have now, it’s likely that if you have some, hopefully you’ll bring them up at some point.

Discussing these topics is important in reducing shame and increasing the sense of the client’s control over the therapy process. In addition, if you have a client who has a lot of shame, interventions to increase self-compassion might be important to allow the client to eventually be able to relate important information.

If you are interested in reading the article, you can find a copy of the pre-print on the author’s ResearchGate page here.

Authors: Kati Lear, Ph.D., Jason Luoma, Ph.D.