When people enter psychotherapy, even if they're desperate and deeply in need, they don't fully reveal themselves in the early phases of treatment. As in any relationship, it takes time to develop enough trust so you feel safe making yourself vulnerable. A prudent reserve makes sense: how can you be sure the stranger sitting in the chair across from you won't judge or laugh at you? Sometimes people who struggle with borderline issues will disclose powerfully intimate information right away, but they nonetheless keep some deeply shameful details in reserve. Everyone does.

Like most psychoanalysts, I advise my clients early on to be as candid as possible, holding as little in reserve as they can. I tell them I know it's a difficult thing to do -- no one discloses 100% of their most painful feelings, thoughts and memories -- but they need to do their best. I acknowledge that it will take time to build trust, for them to feel I'm a safe person. As we come to know each other, they gradually disclose the more shame-inducing aspects of their emotional lives. Often their secrets relate to sex.

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Why Sex Matters

Joseph Burgoin

Sexuality

January 6, 2013

One of my colleagues recently told me how dismayed she was that so many of her clients in long-term relationships or marriages seemed to have given up on sex entirely, or had passionless, unsatisfying sex a couple of times a year at most. (She herself has been married for more than 20 years and has an active sex life with her husband.) For the most part, the sex lives of my own clients in long-term relationships aren't so different from those of my colleague's clients. The clients who have managed to maintain active sex lives over many years of marriage share a view that I expressed two years ago, in a post that outlined three pieces of unorthodox advice concerning relationships.

My third suggestion in that post read as follows:

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How to Keep Your New Year’s Resolutions

December 29, 2012December 29, 2012

It's no secret that most people make and then break their New Year's resolutions, and there's plenty of Internet advice available on how to avoid such a disappointment: start small, make a detailed step-by-step plan, surround yourself with positive re-enforcement, etc. These are worthy suggestions, though they ignore the unconscious reasons why we often fail to fulfill our New Year's resolutions. Most people don't understand the psychological value and meaning of those "bad habits" they want to shed, to begin with, nor do they appreciate the additional stress occasioned by these healthier new habits they want to develop.

Let's begin with one of the most common New Year's resolutions -- to lose weight. When most people decide to go on a diet, they rarely consider how over-eating may serve to fulfill unmet emotional needs. In marriages without affection, or where sex has died, we often eat as a substitute for the physical contact we crave. Consuming food may also anesthetize emotions such as grief or anger that we can't bear to feel. Although loss of appetite is one of the primary signs of depression, depressed men and women may also seek relief from their painful symptions by eating. In other words, turning to food is often a defensive maneuver to avoid unbearable pain.

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defense mechanisms signs of depression

Accentuating the Positive

Joseph Burgoin

Defense Mechanisms

The Psychotherapy Relationship

December 15, 2012

I haven't heard it in a number of years, but every once in a while, a client will ask why we talk only about "what's wrong" in therapy. It's a valid question. Australian blogger Evan Hadkins, who frequently comments here on After Psychotherapy, has chided me for over-emphasizing the painful aspects of the work I do; the occasional site visitor will accuse me of "pathologizing" everything, rather than trying to view certain behaviors in a more positive or "normal" light. I've been thinking about the various reasons why I (and other therapists) don't accentuate the positive in our work more than we do. What follows are a number of explanations, each of which contains an element of truth.

1. Unhappiness Feels More Meaningful

You might recall that Tolstoy's Anna Karenina begins with a famous quotation: "Happy families are all alike; every unhappy family is unhappy in its own way." In other words, novelists don't write books about happy families because after you've described their experience one time, everything that comes after will be repetitive. The intricacies of misery are so much more interesting than satifaction, both in books and in therapy; happiness and contentment, after a time, become boring.

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