Confessions in the Consulting Room: Why they shouldn't come fast and furious

But I'm not a saint yet. I'm an alcoholic. I'm a drug addict. I'm homosexual. I'm a genius.
― Truman Capote, Music for Chameleons.

I have a dread of premature confessions in the consulting room: that might sound strange considering the consulting room will hopefully become a safe space where almost nothing is withheld for fear of censorship, and the most secret confessions are shared and ventilated, but I do and I will explain why. The deathbed gathering is another unique setting where secrets, withheld during a lifetime, suddenly explode into confession. More often than not deathbed secrets are about illicit sexual narratives or unsuspected illegitimate lives that their owner has repressed. Suddenly, there is a compulsion, almost like the last rites, to fess up with the last breath.

Creative therapy opens the individual up to new possibilities of emotional intimacy - possibilities of finding a sympathetic and trained listener - giving the individual courage to deconstruct their secret and sometimes guilt-ridden fears, which cultivate and spawn secrets out of developmental shame, guilt and fear of rejection. This stands in contrast to those unsolicited deathbed confessions, whose compulsive delivery may drive their involuntary recipients into therapy out of disbelief and shock.

When I am asked to try and provide a definition of therapy and there are many, I often quote Adam Phillips:

Therapy provides an opportunity for someone who has hitherto organized their lives to avoid the imagined catastrophe of certain conversations; and they come into analysis, however fluent they may be, because they are unable to speak.

(Phillips 1990)

Not surprisingly the sofa in my consulting room has heard or shared as many secrets as any Roman Catholic confessional and yet I remain wary of premature confessions: of confessions that spill out like dirty washing before there has been any time for an authentic therapeutic relationship, based on mutual trust, to be negotiated. I have become wary of individuals who arrive for their initial assessment and within minutes I find myself the recipient of their secret and disabled lives. The speed of confession feels uncomfortable and even inappropriate: I watch their social persona collapse while I become premature hostage to all the warts, and toxins of their guilt infected personhood.

I used to feel flattered that some people appeared to find me so sympathetic and approachable that they wanted to confide in me without having ‘sounded me out' or discovered my credibility to midwife their hidden ‘self’, or personal shadow into the light without judgement. It is undoubtedly an advantage for a therapist to have a self-presentation that projects kindness, and a non-judgmental quality of listening, but it is impossible for the individual know more at a first assessment beyond an intuitive sense that this therapeutic vessel is a safe place to return to. Those instant confessors - who use me as if I was merely the flimsy fabric that conceals priest from confessed - are the people who rarely book a second consultation.

I have learnt that premature confessions, even in the consulting room, where they can lead to temporary elation or excessive and immediate relief, are not to be encouraged. At least not the variety that is an equivalent of psychic diarrhoea. These compulsive outpourings are better tactfully discouraged, which is a delicate intervention as one does not want to risk provoking a further layer of rejection.

Sometimes, when I see the person I am assessing wants to use me as a confessor, I will say something like, ‘Today we are getting to know each other, and it will take a couple of sessions before you really know if the shoe size fits and you want to employ me as your therapeutic partner.’ If someone replies, ‘Well, the only way I can know that is by testing you out’, I will know that they are acting in a considered way and have not become inappropriately disinhibited with the relief of finding someone who they are employing to become their temporary land fill.

Premature confession in therapy can facilitate an instant, but spurious relief when it is delivered before a foundation of trust and genuine intimacy has been accomplished, which is no quick or effortless task. I encourage people to go slow during their first sessions as a confession is only a beginning. In a secular context it requires careful deconstruction and processing before it can trigger meaningful change. I am not in the business of absolution.

When a serious disjunction exists between an individual’s idealized public persona and the messiness of their private life, the likelihood is that they will not return to therapy after an incontinent confession at the first assessment. On two occasions, I have been left with a linen basket full of the dirtiest underwear and I never saw the publicly identifiable owners again.

In one instance I listened to someone with a responsible public identity, describe multiple infantile distortions in his psyche and systemic breakdowns in his family. Fortunately, they were solo activities and did not challenge my ethical responsibilities of safeguarding but as we said ‘Goodbye’, I knew he would not be returning to face his shadow. Afterwards, he rang the referrer to say he was unexpectedly leaving London and asked them to let me know and to compliment me on my professional skills, which was not without irony. I have found that the greater the dissonance between the private and public mask, the harder it will be for the person to tolerate their confession.

The consulting room lacks the privileged communication of sin and anonymity of the priest’s confessional box. For some people anonymity is appealing, others require the mirrored and compassionate reflections of a human face. In particular the eyes and their acknowledgement of pain.

I have learnt, through experience, the technical skill of stopping someone from vomiting out shame-filled guilt prematurely. An authentic relationship needs to be created first, in which to contain, understand, console and repair volcanic or compulsive acts of confession.

(Photo: Micheal Pennington in Measure for Measure 1974. By John Haynes)

Hilary Mantel and Jane Haynes in conversation Autumn 2009 (left) & BBC - Podcasts - Start the Week with Andrew Marr (right)



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