Ghosts in the Therapy Room



The Family Therapy



May/June 1993



. . . . . . . . . . . .






The Systemic Impact of

Family Secrets


By Evan Imber-Black



IN A LARGE, LOVING, MIDWESTERN FAMILY MUCH GIVEN TO storytelling, the waters of silence have closed over a baby girl, born with Down’s syndrome, who was sent to an institution three decades ago and never mentioned again. In Boston, a professor who grew up in orphanages has pretended for 20 years that his wife’s son from another marriage is his own. In New Jersey, a woman sits at the kitchen table with her 60-year-old mother, a survivor of Auschwitz, and learns that her father had another wife and three daughters, all murdered in Poland by the Nazis. At San Francisco General Hospital, a wife learns all at once that her husband is both bisexual and infected with the AIDS virus.


Such are the secrets that families carry—deeply entwined with what our culture defines as shameful. They can be handed down through the generations like booby-trapped heirlooms: A girl is molested by her uncle and tells nobody; 20 years later, a janitor rapes her daughter, and she also tells nobody. A Hollywood actor lies to his son and conceals three earlier marriages; the son finds out while reading back issues of the Los Angeles Times, becomes an investigative reporter and later has secret affairs of his own.


Touch a family deeply and you will find a secret—kept from the welfare department, the therapist, the boss, the neighbors, the children, the husband, or even from the secret-bearer him- or herself. There are secrets the whole family keeps from the outside world out of blurred feelings of self-protection and fear of stigmatization: that a daughter was born seven months after the wedding; that a supposedly English grandfather was a light-skinned Creole from the West Indies. There are secrets kept from children out of an illusory hope that they can be protected from pain: that a son is adopted or that a father was imprisoned for drug-dealing. There are secrets everyone knows, like alcoholism, that keep a family from reaching beyond its rigidly defended borders for help. There are secrets like AIDS or sexual orientation kept out of fear of losing a job, an apartment, a friendship. There are secrets the powerless keep from the powerful, and others, like incest and wife-beating, that the powerful use to keep the powerless isolated.


Secrets are systemic. They are kept by nations, by families and by individuals. We keep secret the things we are ashamed of, and the things we fear we cannot face. We also keep secrets when we are intimidated into silence. Within the family, secrets define who is in and who is out, drawing some members into hidden alliances and leaving others out in the cold. When secret-keeping becomes a way of life, secrets and betrayals ricochet like pinballs from one family member to the next, triangulating each in turn. In one family I worked with, a mother promised not to tell her husband about their daughter’s alcoholism. Within hours, the mother had told her husband and made him promise not to tell their daughter or me, their family therapist; within days, the father had told me, insisting I not tell his wife.


Secrets can grow like weeds through the generations, sending unexpected tendrils into every corner of a family’s life. They require at least avoidance, at worst outright lies that can become a habit, branching into seemingly innocuous areas until whole dimensions of life are off-limits to spontaneous talk. Secrets shape not only relationships, but inner lives. “If you knew, you would not accept me,” think the secret-keepers, while those kept in the dark grow worried and confused: “Something’s wrong, I’m not supposed to notice, and it must be my fault.”


When a family with a secret walks into a therapy session, the heaviness is palpable. The secret haunts the room like a ghost, looking over everyone’s shoulder, a tense and hovering presence. Everyone waits for the other shoe to drop. When secrets are skillfully uncovered, the truth can make people free. And yet for years the subject of secrets was almost a secret within family therapy itself.



WHEN I WAS TRAINED AS A FAMILY THERAPIST in the early 1970s, nobody taught me much about secrets, beyond a handful of caveats. Effective inquiry into secrets requires a focus on content as well as relationship, and at that time family therapists were in a broad-brush revolt against Freud, who specialized in excavating secrets. The book-lined offices of the individual therapists who followed him were repositories of secrets, much like the religious confessionals of earlier times. We wanted no part of that old role. In our eagerness to differentiate ourselves from everything that had come before, we insisted that it was the pattern of communication, not its content, that was important. We knew very little then about the pervasiveness of such destructive family secrets as addiction and sexual abuse, and we hadn’t thought much about how the power and values of the larger culture shaped what went on in the therapy office.


In those days, many of us subscribed to models of family therapy that cast us as cybernetic technicians operating coolly and confidently on a family system without, somehow, becoming part of it. With the exception of Virginia Satir, family therapy’s pioneers didn’t pay much attention to how emotions, particularly shame, affected the lives of clients. And except for Murray Bowen and Ivan Boszormenyi-Nagy, most early theorists emphasized the here-and-now of family life, not its history, even though many secrets concern past events that silently shape the present.


All of this kept many of us out of the murky terrain of secrets. We fell back on a simplistic rule: that we’d rather not hear them. In the early 1980s, I worked within the Milan model to maintain neutrality toward all parts of the family system, and I was determined not to be pulled by individual family members into taking sides. I remember giving little speeches to my clients, telling them not to tell me secrets because I would not keep them. I tried to avoid having people call me at home or hang around my office door after the session was over.


Other family therapists heard individual confidences but insisted that clients divulge them to everyone in the family as soon as possible. Few of us were prepared for the lonely task of making our own ethical and clinical judgments and then helping people decide when, how and to whom to reveal what was hidden. And because few of us tried, few of us discovered how complex and messy the process can be.


With the exception of a groundbreaking 1980 essay by Mark Karpel in Family Process, remarkably little was written in the family therapy literature about secrets. When the early theorists discussed them at all, they usually emphasized elegant interventions that transformed their meaning for the family without necessarily disclosing their content to the therapist. In 1976, for example, Jay Haley published an account of the therapy of “a modern little Hans,” a boy who had been brought in for a dog phobia by his parents. The parents revealed indirectly that the husband had done something in the past that had disrupted communication between them—something they did not want to disclose. The therapist suggested they pretend they had told him the details of the incident and go on from there; the wife described her resentment in its aftermath, and her feelings of being taken for granted. Later, the therapist directed the husband to do something unexpected for his wife, and he brought her flowers. Over time, the parents’ relationship eased, and in response to this and other interventions, the son’s dog phobia disappeared.


Three years later, I supervised a case involving a couple who did not want to tell their therapist the details of a painful past incident that they fought about constantly. We decided they didn’t need to share their secret. Instead, they needed to change its meaning and lighten up. The therapy team and I devised a ritual in which the couple buried their secret at a remote spot and agreed to go there to finish the argument if the subject ever came up again. Six months later, the couple told us their relationship had been transformed; whenever their arguments veered toward their secret, one of them would tell the other, with laughter, “Take a trip!” and they would drop the subject and return to the current issue.


Sometimes this approach to the content of secrets clearly worked. And it saved family therapists from having to confront the sticky ethical and emotional dilemmas that secrets often raise. Whenever a therapist is told a secret, he or she must look anew at his or her ethical stance: Is this secret so destructive that the therapist must act immediately and call Child Protective Services or the women’s shelter? Who in the family has the right— or the power—to draw the boundary between a secret (concealed from those whose lives are directly affected by it) and something merely private (something that is nobody else’s business)? Must this particular 16-year-old tell his parents that his girlfriend is pregnant? Should this mother tell her daughter that she was born after a secret extramarital affair? Does an adult daughter have the right or the obligation to tell her mother that her father sexually abused her? And what if she wants to sue her father or go on a daytime talk show?


And once a therapist becomes open to hearing secrets, how can he or she avoid becoming a co-conspirator? What if a husband privately tells the therapist that he is having an affair and insists the information be kept out of the couple’s therapy sessions? What if a client won’t tell his former wife that he is HIV-positive? And if a secret should be opened, how can the therapist skillfully move a family from secrecy to openness, creating an atmosphere in which all possible rea tions to the secret can be accepted and held? All such sticky questions were foreclosed by the elegant simplicity of our early theoretical models.


In the early 1980s, influenced by the feminist critique of family therapy, my attitude toward secrets began to change. On the streets outside our offices, social movements were proclaiming that secrets—whether about counterinsurgency or White House coverups, childhood poverty or spouse abuse—were a political matter—deeply entwined with power, authority and cultural definitions of the shameful. Traditional values, which had made shame-bound secrets out of breast cancer, adoption, abortion and even epilepsy, were shifting with the times. The personal was political. And silence, especially silence kept by victims out of fear of stigmatization, had often helped sustain an unjust status quo.


The silence was first broken quietly in the 1960s and 1970s in living rooms and in small consciousness-raising groups. Women, gays and lesbians, incest survivors, disabled people, the families of the mentally ill, all discovered they had been blackmailed and disempowered by silence and shame. As they spoke out more and more publicly, their secrets were drained of their stigmatizing power. Women at speak-outs told strangers about rapes and molestations; famous women disclosed their abortions in newspaper ads. In 1975, Betty Ford talked publicly of her breast cancer, and three years later broke the silence about her alcoholism as well. Gay people wore pink triangles to work and marched in gay pride parades. Revelations that would once have been called indiscreet or foolish were now perceived as brave.


And when I turned my eyes from the street to the therapy room, I saw that by avoiding secrets, family therapists had sometimes colluded with oppression by silencing the less powerful, especially women and children. In the mid-1980s, feminist family therapists began opening this secret within our field, pointing out that in the very way we thought about and structured our therapy sessions, we were keeping secrets that endangered our clients. For years, in allegiance to our theoretical models, we had ignored the damage done by wife-battering and incest. Family therapist Joan Laird observed, “Family therapists, when they wrote about wife-battering at all, continued the silence with their language of systems, form, pattern, structure and game.” Even as late as 1987, Luigi Boscolo and Gianfranco Cecchin of the Milan group published transcripts of indirect circular interviewing with a family in which at least one daughter had been sexually abused by her stepfather. The parents had insisted the matter not be discussed in front of the daughters, and the therapists had agreed. Nothing was done to find out exactly what had happened or to protect the girls, even though one daughter had attempted suicide and another had been hospitalized.



THESE MORAL AND POLITICAL DILEMMAS made me doubt the simplicity of the field’s stand on secrets. Then, in 1985, a family utterly destroyed my belief that focusing solely on the systemic effects of secret-keeping was sufficient. Carrie, 73, and George, 74, a tense, gray-haired couple, came into my office on a cold March day and sat down in chairs on opposite sides of the room. Carrie, who had recently been hospitalized for unre­lenting anxiety, wore little white cotton gloves and kept her coat on. She told me she was terrified of germs and spent hours washing her hands. She would not touch anybody, play her beloved piano, visit her daughters, handle money or play cards. Her fear of germs and her hand-washing had become the only allowable topic of intimate family conversation.


George and Carrie first told me that the only conflict they had had in decades was over Carrie’s hand-washing. But their daughters, Ellen and Catherine, in a session alone, said that George and Carrie each complained ferociously about the other in private and got furious with the daughters if they mentioned the complaints in front of the other spouse. Both daughters seemed mysteriously mired in guilt and spent most of their free time worrying about their parents’ problems.


The daughters also told me that outsiders—professional helpers like me, and practically everybody else outside the immediate family—were handled with polite and distant diplomacy. Thus, therapy seemed doomed, even though the family kept appearing for session after session.


Then, Ellen urged me to see her parents separately to hear their secret complaints about each other. I did not want to become another triangulated daughter bound by secrets, and instead suggested that Ellen and Catherine become part of the therapy team. I asked them to act as my consultants, saying I needed their help because I was an outsider. They were to station themselves behind a one-way mirror and call me on the phone whenever they wanted to raise new topics or to alert me when their parents were being diplomatic and politely evasive with me. I asked the daughters to keep the plan a secret until the meeting, hoping to make a metaphorical comment on the process of secret-keeping.


At the meeting, the parents professed complete comfort with the arrangement, and the daughters went behind the mirror. Almost immediately, the phone began to ring as the daughters challenged the family’s myths, secrets and taboos. It rang every three or four minutes all hour, and I became a conduit of information rather than an outsider from whom secrets were kept. In tiny, frightened steps, George and Carrie began to acknowledge conflicts between them for the first time. George said that he was resentful because he wanted to travel and to take Carrie places, and she refused. Carrie, on the other hand, felt George unfairly criticized her for “always getting her way.” The tension, palpable in the room, grew almost unbearable and there were moments, as family rules shattered, when I felt like a villain, pushing so hard on two people old enough to be my parents. Finally, there was an argument behind the mirror: Catherine felt we were getting somewhere, while Ellen worried about her parents’ health and warned me they needed to be protected. I reported this split in the daughters’ “therapeutic team” to the parents and asked them to go home and consider what we should do next.


Three weeks later, Catherine came to see me alone and told me that after the session the family had had its first open and impassioned argument ever. What impressed her was not what was discussed, but that it was discussed at all. In the course of the argument, Ellen— the good girl of the family—gave up her privileged position as the “irreproachable daughter” and revealed she was riving with her boyfriend and struggling with a drinking problem. Finally, the family was talking openly together about issues more complex than Carrie’s so-called phobia.


Within a month, Ellen went into treatment for her drinking, and Catherine started coming to see me individually every other week because she wanted more respect from her teenage sons and less involvement in her parents’ troubles. Three months passed, and I thought I’d never hear from George and Carrie again. Then, much to my surprise, Carrie arranged an appointment out of the blue, saying only that she thought it would be a good idea.


When she and George came in, they looked lighter, happier; they were smiling and dressed more brightly. As we talked and joked together, they revealed one secret after another. Carrie told me that she had been terrified of getting pregnant again after her daughters’ births. She and George, she said, had fought about sex for years and slept in separate bedrooms. They had fought much more, she said, about sex than about her hand-washing.


Slowly the room filled with the power of the unspoken, the unvoiced and the secret. Carrie, her voice shaking and near tears, told me a secret she had kept for nearly 50 years: her daughter Catherine had been born before she and George were married. While Carrie was pregnant, they had been banished by her family to another state. When George’s mother accidentally found out about the birth, she had written Carrie a brutal, excoriating letter—a letter Carrie had never told George about until that day in therapy. George and Carrie had married quietly after Catherine’s birth, with no sense of celebration, at a City Hall. I asked Carrie whether her daughters knew. She replied, “I know they know.” For years, she said, the girls had looked at other people’s wedding pictures and never asked to see their parents’.


The experience of having this long-held secret heard by an empathic and nonjudgmental witness helped catalyze rapid change. The rigid boundary that the secret had erected between this family and the outer world, so eloquently expressed in Carrie’s fear of germs, had been breached. Carrie came to the next session without her little white germ-protection gloves. She began to play the piano again, and asked to meet with what she called a “germ expert.” I arranged a meeting with a family doctor who replied honestly and respectfully to her questions—including, “How long can a germ live in a shoe?” — and her fears lessened enough so that she could go shopping.


George went on a fishing trip and Carrie spent the night at her sister’s home for the first time in 40 years. I suggested we make a video of their story and show it to their daughters, but I was at least 10 steps behind them. George, the previous master of circuitous conversation, said, “No, that’s too indirect—let’s just bring them in and tell them.”


In a family session in which I served primarily as a witness, a weeping Carrie, frightened that her daughters would think badly of her, courageously opened what had been hidden. Ellen cried and said she’d always known, but Catherine responded less tenderly. Now that the secret was out on the table, she felt less pressured to protect her parents from the secret of her own feelings. “Now there will be no more secrets in our family, and no more telling me something and then telling me not to tell my husband or my sister,” she told George and Carrie vehemently. She wanted to know why her parents had treated her so badly when she, too, had become pregnant before marriage. When the stormy session was over, Carrie stood up and took my two hands in hers, touching another human being for the first time in decades.


Opening the secret was only the beginning. Months of work followed. In subsequent sessions with George and Carrie alone, we looked at how cultural values and pressures had influenced the meaning the family had given their secret. In the 1940s, an illegitimate birth was freighted with shame; premarital sex was widely condemned, and women took the brunt of the social punishment for it. Placing these beliefs in the context of the more liberal 1980s allowed George and Carrie both to challenge and forgive their own parents for their harsh response to Catherine’s birth—and forgive themselves for their own harshness about Catherine’s early pregnancy.


We also noticed how the painful secret had been repeated for three generations: not only Carrie, but her daughter as well, had become pregnant before marriage. Perhaps these pregnancies were symptoms of a misguided family loyalty; perhaps they were a nonverbal way of trying to open the secret; or perhaps they occurred because it is hard to learn from experiences that nobody admits have happened.


Now that the big secret was out, the daughters seemed to feel less guilty. No longer did they feel compelled to demonstrate family loyalty by keeping secrets and protecting their parents. A more complex definition of loyalty emerged, one that involved clearer boundaries and a genuine and respectful interest in their parents’ lives. Over time, rituals fostered hearing across the generations. Carrie attended her granddaughter’s wedding; Catherine and Ellen held a wedding anniversary celebration for their parents—the first in their lives—and the daughters openly celebrated their own birthdays as well.



IN THE EIGHT YEARS SINCE I SAW George and Carrie, I (like other family therapists) have encouraged many families to open secrets. Sometimes our role is relatively straightforward and the ethics are clear. I believe, for example, that people have an existential right to the truth about their births and deaths. I don’t think people who are dying of cancer should have it kept from them—as is done regularly in other countries—and I encourage parents to tell children the truth about their parentage, after careful coaching and consideration of the effects on other members of the family system.


In rare cases, such revelations can have almost miraculous results. In Healing the Hurt Child, for instance, Dennis Donovan and Deborah Mclntyre describe a 10-year-old girl who had been put in special education classes for a selective math disability. She had never been told that she was adopted and her parents had lied about the date of their wedding. For years, the little girl had scrutinized her parents’ wedding picture—taken, she was told, in the spring—and wondered why flowers that bloomed in fall were flowering in front of the church. Like many children from whom secrets are kept, she had spent years wearing cognitive blinders, narrowing her perceptions to avoid noticing the difference between what she sensed and what she was told. When a therapist asked her how long it took to make a baby, and she was finally allowed to calculate that she had been 15 months old when her parents were married, her “math disability” disappeared.


In many such cases, therapists can help clients carefully and gradually liberate themselves from the values of the majority culture that made them ashamed of so much of their lives. But recently, the cultural climate has shifted, and we must now often slow clients down from revealing too much, too soon. There is a complex middle ground between telling everybody and telling nobody—a subtle zone of privacy almost invisible in our culture nowadays, torn as it is between compulsive shamebound secret-keeping and wholesale, televised revelation.


If cultural norms once made shameful secrets out of too many things, many clients now struggle with an equally rigid assumption, fostered in part by the mass media, that opening secrets—no matter how, when or to whom—is morally superior and automatically healing. In the late 1980s and early 1990s, for example, celebrities like Jane Fonda, Suzanne Somers, Oprah Winfrey and Magic Johnson spoke publicly of their struggles with bulimia, familial alcoholism, childhood sexual abuse and HIV infection. When they spoke to reporters, they effectively told everybody in the country all at once—family members, friends, enemies, and unknown fans.


These stars are powerful and wealthy people, protected from the repercussions ordinary people face for such revelations. A similar style of revelation is rehearsed in 12-step recovery meetings, where painful childhoods are revealed to anonymous strangers and the saying goes, “You’re only as sick as your biggest secret.” The more disconnected and alienated the culture has become, it seems, the more eager people are to blurt out their intimate wounds on the electronic mass-confessional of the daytime talk shows.


These revelations helped break open some nationally held secrets, such as the pervasiveness of family violence, incest, HIV infection and addiction. After Magic Johnson spoke out, for example, the paralysis created by secrecy about AIDS within the black community was broken. AIDS was no longer perceived as a predominantly white and homosexual disease, and black clergy and black politicians became willing to grapple with it. Openness also empowered incest victims, who found their voices and were recognized as authorities on their own experience. Never again would any “expert” be able to credibly assert that incest occurs only once in a million families. But at the same time, such revelations have become entertainment, used to sell dish soap and manufacture celebrity. Few public voices help people think through how their revelations will affect their most intimate relationships long after the confrontation—or the talk show—is over.


Dusty Miller, a therapist and professor of psychology at Antioch New England in southern New Hampshire, says she has seen incest survivors pushed by their own fear and anger as well as by outside pressure to confront relatives too soon. “There’s a party line now that incest survivors should disclose the secret to the rest of the family,” she says. “One woman I saw in therapy flew to California and confronted her father. He died of a heart attack within a week, and the mother was furious and devastated. That’s an extreme example, of course. More often, the damage occurs to the woman herself. If the disclosure is not carefully planned and the relative blames her or denies it ever happened, her experience of reality may be devalued, and she may blame herself for not having said things right or for making too big a deal of it. In most cases the secret should eventually come out, but there’s a tendency to have it happen too quickly and assume that confronting and disclosing alone will do the trick.”


Miller urges clients to explore their own feelings thoroughly within the privacy of therapy, and to disclose first to more peripheral family members, or to an adult of the parents’ generation. Revelation, she points out, does not occur in a vacuum but within a relationship, and she has learned the hard way just how crucial a trusting relationship can be. In the mid-1980s, she saw a 26-year-old recovering heroin addict who began her first therapy session by revealing graphic details of sadistic sexual abuse by her father. “Despite her nervousness, which indicated that she didn’t feel safe with me, she insisted on telling me as much as she could squeeze into the first session,” recalls Miller. “I was uncomfortable. I didn’t feel she was ready to jump right in.”


The rapid disclosure was dangerous, not healing. The woman had complex feelings of loyalty toward her father, and telling the secret made her feel she was betraying him. The more she told the therapist, the more she cut her arms with razor blades between sessions. And because she had not yet developed a relationship of trust with Miller to counterbalance her attachment to and fear of her father, she could not experience Miller as a protecting presence. “She was telling me painful facts and memories without having a sense of who I was or what our relationship meant,” said Miller. “It was almost as though she was telling her story on “Oprah Winfrey.” But at the time, I didn’t know how to stop her.” Nowadays, Miller explains clearly to incest survivors why she wants them to take time before they tell her too much.


As Miller’s experiences point out, it is crucial for therapists to create a zone of privacy—a protected space and time in which a client can safely disclose a secret, and feel and think through its implications. This protected space is often missing in our culture at large, dominated as it is by such instantaneous intruders into family privacy as the telephone, the cellular phone and the fax machine—and by such intrusive images as the weekly television program “Cops,” whose camera crews film people blinking in the flood lights as they are arrested for pulling a knife on a girlfriend or selling 10 dollars worth of crack cocaine.


In contrast, therapy can create a sanctuary from intrusion and societal shame, a breathing space to decide if one has a responsibility to share a secret, and how, when and to whom to tell it. The process can take months. When a secret is shared in therapy, a sanctuary is created, and it is important that clients leave that sanctuary at their own pace, as long as nobody is in danger.


Two years ago, for example, New York family therapist Peggy Papp and I saw a family after the 17-year-old daughter, who was moderately mentally retarded, had been raped. In a private session several weeks after therapy began, the girl’s agitated mother, crying and shaking, told me that she had been repeatedly molested by an uncle when she was a child. She had told her aunt, who had called her a “whore” and broken her arm; bound by shame, she had never shared her secret again. When she told me, in a caring and validating environment, her anxiety and shame lifted almost immediately, and she began to see herself more positively. But Papp and I did not push her to tell her family; it did not directly affect anybody else’s life, and we encouraged her to think of it as her private business, to share only if she chose. Over the next four months, after coaching and considering the effects of the revelation, she told first her mother, then her sister, and finally her husband and children. The revelation had a freeing effect on many relationships within the family, but she never chose to tell anybody outside it.


In a similar manner, Gary Sanders, a psychiatrist and family therapist in Calgary, Alberta, did not tell the parents, seen in family therapy, that their 16-year-old son had confided that his girlfriend was pregnant. Instead, Sanders referred the young couple to a family planning clinic willing to keep their visit confidential, and they decided on an abortion, which the boy paid for himself. “Ethically, I didn’t feel that simply because he was a young person I had to tell his parents,” says Sanders, who spoke to the parents instead about the boy’s growing need for privacy as he matured. As for worries of having been drawn into an alliance with the boy, Sanders says, “I’m always in an alliance. I’m in an alliance with health.”


Holding this zone of privacy is not always a simple matter. Sometimes the therapist feels an alliance—and an ethical responsibility—to someone who is not even in the therapy room. Lascelles Black, a family therapist on the HIV team at Montefiore Family Health Center in the Bronx, recently saw a gay couple, both devout Christians, who were in turmoil because one partner, Clive, continually delayed telling his former wife, Hilda, that he was HIV-positive. “I was uncomfortable,” recalls Black, who saw the couple for a month without any apparent progress. “It was an ethical dilemma, and the secret was potentially life-threatening.”


Some therapists in Black’s situation— and those whose clients are involved in secret extramarital affairs—set a deadline and will not continue therapy beyond a couple of months unless the secret is divulged. But Black sensed a secret behind the secret, and instead of setting a deadline, he asked Clive what he most feared about telling his former wife. Crying, Clive revealed that Hilda’s brothers, violent men, had already threatened the life of a man who had infected her cousin with the AIDS virus. Clive was afraid the brothers would kill him, and his lover, too.


Once the secret was out, the two men could make practical plans within the privacy of therapy to deal with the reality they faced. Black reminded Clive of his moral responsibility toward his former wife and helped arrange a joint session with her. There, Clive told Hilda of his infection and of his fears, and she agreed with Black’s suggestion that she not tell any member of her family until she had been tested. Luckily, she tested negative and decided to keep the matter private.


All AIDS secrets do not work out so well, and all moral dilemmas are not so neatly resolved. Black recently counseled a middle-class man who had tested positive for the AIDS virus and refused to inform the people with whom he shot amphetamines and shared needles on weekends. “It’s stressful, and it makes me angry,” said Black, who is bound by confidentiality laws. “I have this secret, and there is no way I can share the burden.”


Black’s dilemma underscores the loneliness that comes when therapists keep secrets. Secrets often pose ethical dilemmas that are not resolved through simple rules. They must be thought through, issue by issue, and family by family. Swiss family therapist Rosmarie Welter-Enderlin, for example, saw one woman for eight months as she slowly disengaged from a passionate extramarital affair with her husband’s boss. Despite her uneasiness, Welter-Ederlin did not pressure the woman to tell her husband, and she saw both of them in couples therapy after the secret was finally revealed. Three years later, in a research follow-up, Welter-Enderlin told the husband about her discomfort with the role she had played. “In the Old Testament it says that there is a time for everything,” he told her. “I would have gone crazy or killed my boss if Silvia had told me about her affair when she was still daydreaming and not prepared to give it up. It was good that she took her time to disengage and that you, her therapist, allowed her that time and kept quiet.”


In another case that demonstrates the complexity of keeping family secrets and living with the consequences, an experienced therapist kept a family’s dangerous secret for nearly two years. She was seeing a closed and isolated family in court-ordered therapy after repeated, but unsubstantiated, reports of physical abuse of the children—charges the intimidated children had repeatedly denied. After three months, the mother confided that she was drinking heavily and had hit her children.


In a decision so risky and controversial that the therapist wants to remain anonymous, she did not report to protective services, as the law requires. “There had been a long history of unsubstantiated investigations and if I’d reported, it would have been more of the same,” she said. “I would have lost my alliance with both parents, and the kids would have once again denied to the authorities that they had been abused. I needed to do something new. I was just forming an alliance with the children, and the wife needed some time to figure out what to do.”


But although she kept the secret from local social agencies, the therapist moved too fast in opening the secret within the family. Eager to enlist the husband’s support for alcohol treatment, she encouraged the woman to discuss her drinking in a couples session, even though the husband was deeply suspicious of therapists and other outside authorities. The couple did not show up for their next session and when the therapist called the house, the wife told her she had been injured in a “fall”.


Again, the therapist did not pursue or report the obvious—that the husband might have beaten his wife—and instead talked to the husband on the phone, acknowledging his feelings of violated privacy. The family returned to therapy, and six months later, with her husband’s support, the wife successfully completed a detoxification program. “I was very uncomfortable until things finally resolved, and that took two years—a long time,” she said. “I was worried that I was going to collude with the family, that there would be more violence and I would get in trouble. It was an isolated feeling, a bit like being part of the family myself,” she said.


Before therapy ended, the husband told her why he was so deeply suspicious of interventions by outside authorities: he had grown up in a war-torn country and had to escape from invading armies through streets littered with bodies. Since childhood, he had conflated all civic and professional authority with the brutal power of foreign soldiers on a rampage. The search for the origins of his shame and fear of revelation, like many people’s, led almost inevitably out of the therapy room and back into a wider world of politics and history.



IT IS HERE—IN A WIDER CULTURE still dominated by billboards and television ads of white, happy, middle-class families—that the shame that feeds secrecy is manufactured—about our infertility, our sexuality, our graying hair, our lack of success at work, our unhappy children, our credit-card debts, our suicidal relatives. Here—on the streets, in the workplace, on the airwaves and in the classroom—we learn to present a public face, to hide the difference between who we are and who we think we should be. We learn to do this because we know the costs involved in not doing so; many secrets, if revealed, would once have brought punishment for deviance, and others still do. Families who conceal suicides are not acting in a vacuum; they are responding, perhaps unknowingly, to the time when the bodies of suicides were buried at crossroads, or outside cemetery walls. A generation ago, children who were victims of incest were clinically described as “seductive,” and women who had abortions ran the risk of prosecution. Today, homosexuals still run the risk of being beaten—in the Navy and on the street—and people with AIDS can and do lose their jobs. Considering these very real costs of openness, it’s not surprising that we do not willingly give information away to people who have the power to punish us for it. The sharing of secrets is an act of trust.


In therapy, when we are given this trust, we can help restore imbalances of power within a family that have made honesty dangerous or that allow secrets to be kept from those for whom the information is vital. And perhaps, as we are liberated from our individual versions of shame, we can gain the courage to open the national secrets that disempower us all. When we open these larger secrets—like Watergate, or the failure of the Catholic Church to confront the problem of pedophile priests—we may face a wholesale reordering of our thoughts, beliefs and emotions. Whole sale trust in beneficent authority disappears, to be replaced by something far more textured and empowering. Once-secret pain—of Vietnam Veterans, of Utah residents who lived downwind of atomic testing sites, and of the residents of Love Canal—turned out to be secrets that vitally affected us all. When Los Angeles burned, the crisis opened a national secret about the widening gap between the rich and poor—a secret we all knew, but weren’t allowed somehow to notice or act upon. What is kept secret does not vanish, neither within the family, nor on the national level, and we keep such secrets from ourselves at our own peril.



Evan Imber-Black, Ph.D., is professor and director of Family and Group Studies, Department of Psychiatry, Albert Einstein College of Medicine. She is editor of Secrets in Families and Family Therapy, just published by W.W. Norton.


Networker contributing editor Katy Butter also contributed to this article.