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Chapter: Essentials of Psychiatry: Couples Therapy

Couples Therapy: Secrets and Confidentiality

Unless a therapist sees both parties together at all times, he/she will eventually face a situation in which family secrets are dis-closed in individual sessions.

Secrets and Confidentiality

 

Unless a therapist sees both parties together at all times, he/she will eventually face a situation in which family secrets are dis-closed in individual sessions. Since secrets are a common source of dysfunction, discovering and dealing with them is a frequent occurrence.

 

The therapist needs to make a distinction between secrecy and privacy. Privacy is usually considered to mean information held by one person that they would prefer not to share but that does not directly affect their relationship with others. It usually implies a zone of comfort free from intrusion. Secrets are usually considered to be feelings or information that would directly affect a relationship. They are most often connected to fear, anxiety and shame, and are often shared, that is, some people in the system know, whereas some do not. There is also a gray area in which different people have different ideas about whether the informa-tion is important or not. (Does a spouse consider an extramarital affair that ended 10 years ago private or secret?)

 

In general, the best rule of thumb is that a secret should be disclosed if it is seriously affecting connections between peo-ple, posing danger to a family member (sexual abuse), or shap-ing family coalitions and alliances. In general, keeping secrets is such a serious barrier that it is better to disclose them, even if painful, because otherwise the sense of mystification and isola-tion in the unaware is very strong.

 

The therapist must carefully consider the timing and type of disclosure. Premature disclosure, before the therapist has an alliance with the family, can cause the family to leave therapy with no place to deal with potentially explosive material. This is par-ticularly true when there has been a history of violence or abuse.

        Although the following guidelines do not sufficiently cover all couples’ problems and situations, they do represent a generic set of ideas that therapists may apply to the specifics of many marital issues.


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