An Elephant in the Consulting Room: Making Space for a Patient's Secret

Developing a private self is required for healthy development to proceed during childhood. However, when secrecy becomes a way of life, development becomes derailed. Secretiveness crowds out privacy during this critical phase of development for many reasons and the result is a secret self. This articles examines secrecy as an adaptive way to avoid shame, manage isolation, and hold onto the threads of identity, allowing for the preservation of a self. It also examines the ways in which secrecy creates emotional distance and prevents intimacy. To illustrate these ideas, I present my work with a patient who developed a secret self and came to treatment with a secret he has yet to reveal. Known between the therapist and patient as “the elephant in the room,” the secret became and remained central to the work and the therapeutic relationship.