Listening to secrets is part of the everyday work of a psychodynamic clinician. Despite its importance, this topic has not received extensive attention in the analytic literature. The impact on the clinician in unexpected emotional and physical ways deserves greater scrutiny than has generally occurred in training. It can be experienced as uncanny and disturbing. This lecture describes how guilt and shame, no-entry defenses, and somatic countertransference reactions take root when ‘what has been hidden, but in plain sight’ emerges seemingly out of the blue in analysis or psychotherapy. Countertransference reactivity of the therapist when treating patients who keep secrets and the role this plays in the development of dissociated somatic reactivity and burnout will be demonstrated in clinical examples of patients with eating disorders, addictions, life transitions, and bereavement. Emphasis will be placed on how to attend to the therapist’s self-care needs and how to enhance resilience as secrets emerge, are contained, and worked through in the therapeutic dialogue.

CE Credits