In my little survey a significant number of responses indicated a desire to tell the therapist about some previously withheld issue but not knowing how. I invited folks to makes suggestions in the comments so I thought I'd start by responding here in the post to the comments.
1. I have found email to be a useful way to disclose the dark secrets to my therapist. In the early days of therapy I would email details... these days, it's sometimes just a word or two as a way of making myself talk about it in session.
Email or snail mail can both be helpful ways to begin to open up an uncomfortable subject. It is important that this disclosure be followed with talking about it in real time. Otherwise, if left unmentioned in session, it becomes another layer of the secret, a hit and run kind of disclosure that may break the silence but not make space to talk about the feelings, the issue and to glean what can be learned from the whole process.
2. I would add that as a patient it was important to me that I had a sense that I shared similar values with my therapist before I told her my deepest secrets. I don't think you have to be of the same religion, etc. ...
Optimally you learn about the area of shared values as you work with the therapist. That is part of the process of the beginning stage of therapy -- discovering if you and the therapist are a good fit for each other. And goodness of fit really cannot be known upfront before actually spending some time with each other.
Or what if the psychiatrist is amoral? You don't always know that immediately. I was reading a blog, recently, and a person who said he was a psychiatrist explained all the reasons that it's normal and natural for men to cheat on their wives. He didn't think it was wrong at all. I don't share that value. I think it's wrong. Assuming this guy is really a psychiatrist, what sort of impact do those beliefs have on the treatment of his patients? What about the patient who comes in and confides that that their marriage was destroyed because of infidelity? Is the psychiatrist going to minimize it because of his own behavior, and the fact that he doesn't see anything wrong with it? I think he will. What else does that psychiatrist think is okay to get by with? I'm not arguing for finding a "perfect" therapist as I know they don't exist.
There are those who believe that only someone who has experienced what you have experienced can help you -- this has been especially the case with issues of substance abuse and the like. All therapists have blind spots, because we are all human. It is part of our process as works in progress to deal with these blind spots as they come up and to become more conscious of them. But we can never reach the end of that process as there are always more blind spots to emerge.
There is a difference between understanding infidelity without making a moral judgment about it in general, and dismissing it as a source of pain in our patients. We make an empathic connection based on having experienced pain ourselves even if its source was not the same. So, a married therapist can help someone who never wants to marry or someone who wants to divorce.
My job as a therapist is not to evangelize for my way of life but to listen to my patients and try to understand and relate to them and what they want and need in their lives.
.... Trust is earned. People will talk when they feel trusting enough to do so. My therapist told me that in her experience it's not uncommon for clients to save the most difficult stuff to work on in therapy until the very last.
Indeed the ability to talk about everything develops in the and through the relationship.
3. Here is one of my ways of telling a secret. I realize that this is not a particularly good way, nor is it mature. I wait until there are about 30 seconds left in the session and I say, "I need to say something." Then I tell the secret and leave. That way it is out there, but there is no time to talk about it. By the time the next session comes I am a lot less anxious about it and am able to talk about it. Like I said, though, not very mature.
Hey, it works for you! And it is that following through and talking about it the next time that is crucial.
4. it is dangerous to tell some secrets to the wrong therapist...it can be very dangerous...there is no real and complete confidentiality in therapy and anyone who tells a client that is lying.
Therefore sometimes secrets are a very real and sane way to approach a therapist.
I've been both a therapist and a client, for the record.
In an ideal world of course everyone would have safe and trustworthy therapists.
If you have concerns about what your therapist might do if you disclose a secret, ask. This is an important part of the therapy process. Therapy is a relationship first and foremost.
also, subtle coercion happens in mental health care all the time depending on the bias of the therapist...sensitive folks are much more aware of such manipulations... not saying good therapy doesn't happen but if everyone pretends bad stuff doesn't we're not looking at the whole picture... figuring out how to get clients to spill the beans might not be the right approach...it could be figuring out how we're not letting the client be self-determining and thus creating an environment that doesn't feel 100% safe...