Interviews
Social Worker-Deborah Hoffman
These interviews answer question about why people keep secrets and about how secret keeping turns into paranoia. She also discusses how she deals with confidentiality as a social worker.
Transcript of Interview with Psychotherapist
(Please keep in mind that this transcript is not in the same order as the videos above.)
Why do people keep secrets?
People keep secrets because they are fearful of the consequences of telling the truth. Often secrets begin because impulsively people are afraid to tell the truth and then must continue to lie.
Why do people expose secrets?
People end up telling the truth when the guilt becomes overwhelming and impedes functioning.
What parts of the brain are used to keep secret / lies? What other functions does that part of the brain deal with? What do you think is the correlation between the two?
I tend to look at withholding true information in psychoanalytic rather than in organic terms. A person has an id, ego and superego. The ego struggles to balance the impulsivity of the id (who wants what she wants when she wants it) and the superego (who represents conscious and avoids guilt.) everyone utilizes defense mechanisms which is how we avoid feeling overly anxious or uncomfortable when we do something our superego finds to be wrong. These include, repression, regression, sublimation, intellectualization. So for example, if someone lies, they can intellectualize to the point of convincing themselves that it was not ‘so bad.’ The way this affects other functions, is that these defenses become part of a person’s identity, so they could do other ‘bad’ things and protect themselves from feeling guilty by using the same defenses.
At what point does suspicion turn into paranoia?
Paranoia is constant suspicion, which is an unfounded or exaggerated distrust of others, sometimes reaching delusional proportions. Paranoid individuals constantly suspect the motives of those around them, and believe that certain individuals, or people in general, are "out to get them." Persons with paranoid personality disorder tend to be self-centered, self-important, defensive, and emotionally distant.. The disorder often impedes social and personal relationships and career advancement. Some individuals with PPD are described as "litigious," as they are constantly initiating frivolous law suits. PPD is more common in men than in women, and typically begins in early adulthood.
Have you ever had a patient that was became paranoid from loved ones keeping secrets from them?
is a psychological term, there is paranoid personality disorder, paranoid schizophrenia, delusional disorder. I have had patients who felt that they could not share secrets with loved ones for various reasons. Example, of birth of down’s syndrome child, inappropriate behavior.
How do you relieve your own secrets?
I don’t have so many that I do not share with friends.
Do you think that in healthy relationship secrets can exist?
Yes. Especially ones that occurred in the past… However, everyone has personal secrets that they may choose not to share. This is perhaps how they feel about another person or how they feel about something they did wrong. It is not necessary to share every aspect of your life unless the not sharing causes symptoms to erupt like anxiety and other disturbance.
Do you think people get a sense of power from keeping secrets?
Sometimes, but most of the people that I work with that keep secrets, do so because of the fear that sharing the secret would cause.
Do you think withholding secrets is a lie? What do you think your patients would say?
There is a sin of omission, but people are entitled to their own lives. In therapy, there is also a difference between not feeling ready to reveal something about you and outright lying about it.
Have you ever lied to a patient for their benefit?
Not lied outright, but I do not share personal information with them and if they ask, I do tell them that I am withholding.
What is a pathological liar? Why do they feel the need to lie instead of telling the truth?
mythomania Pathological lying is falsification entirely disproportionate to any discernible end in view, may be extensive and very complicated, and may manifest over a period of years or even a lifetime. Some people may not even realize that they are lying, but due to defenses report the truth wrongly(false memory syndrome.) However, in terms of psychological diagnosis, I have seen people who are A sociopath is typically defined as someone who lies incessantly to get their way and does so with little concern for others. A sociopath is often goal-oriented (i.e., lying is focused - it is done to get one's way). Sociopaths have little regard or respect for the rights and feelings of others. Sociopaths are often charming and charismatic, but they use their talented social skills in manipulative and self-centered ways.
A compulsive liar is defined as someone who lies out of habit. Lying is their normal and reflexive way of responding to questions. Compulsive liars bend the truth about everything, large and small. For a compulsive liar, telling the truth is very awkward and uncomfortable while lying feels right. Compulsive lying is usually thought to develop in early childhood, due to being placed in an environment where lying was necessary. For the most part, compulsive liars are not overly manipulative and cunning (unlike sociopaths), rather they simply lie out of habit - an automatic response which is hard to break and one that takes its toll on a relationship
Have you ever had a problem keeping confidentiality with your patients?
No… I take it very seriously. If I need to consult someone about a patient, outside of my agency, I do not use their name.
Is there ever a time that you feel you should tell a patients secret?
Yes. When I met the other person in a couple; or felt that the other member of the couple needs to be aware of the information. However, in the first case the information was never revealed, in the second, the person told their spouse themselves.
Do any of your patients have trouble sharing their secrets with you? How common is that? How do you establish a trusting relationship with patients so they feel comfortable sharing with you?
It takes awhile for everyone to develop trusting relationships, (when it develops too fast, that is not good either.) I have pretty good relationships with my patients, sometimes I will ask them a question and give my impression, however, if they correct me, I acknowledge that I made a mistake, I think that this helps them see that we are working together and that I do not see myself any better than them. It does take a while for many people to share secrets and some people hold in secrets for a lifetime and then cannot wait to spill them.
Where there ever cases where you felt it would be beneficial to a patient to keep a secret? For example, not sharing their feelings with a spouse or family member? In other words, are there necessary, or even “good” secrets?
Yes, a couple of times, I thought it was not worth sharing the secret with a family member. Flasher.
How does it feel to relieve people of their burdens? Do you feel the weight of patients secrets on your shoulders?
I feel good having true connections with patients, that they are comfortable in the relationship and are comfortable to share about themselves. I find it interesting to learn how people think and feel and cope with their lives. Sometimes, when I have a lot of patients that are depressed, I a heavy feeling, feeling down. However, I work in a clinic with other clinicians who are competent and we are able to share with eachother when we have especially difficult days. This is one of the reasons that I chose to work in a clinic rather than do private practice.
Why do people keep secrets?
People keep secrets because they are fearful of the consequences of telling the truth. Often secrets begin because impulsively people are afraid to tell the truth and then must continue to lie.
Why do people expose secrets?
People end up telling the truth when the guilt becomes overwhelming and impedes functioning.
What parts of the brain are used to keep secret / lies? What other functions does that part of the brain deal with? What do you think is the correlation between the two?
I tend to look at withholding true information in psychoanalytic rather than in organic terms. A person has an id, ego and superego. The ego struggles to balance the impulsivity of the id (who wants what she wants when she wants it) and the superego (who represents conscious and avoids guilt.) everyone utilizes defense mechanisms which is how we avoid feeling overly anxious or uncomfortable when we do something our superego finds to be wrong. These include, repression, regression, sublimation, intellectualization. So for example, if someone lies, they can intellectualize to the point of convincing themselves that it was not ‘so bad.’ The way this affects other functions, is that these defenses become part of a person’s identity, so they could do other ‘bad’ things and protect themselves from feeling guilty by using the same defenses.
At what point does suspicion turn into paranoia?
Paranoia is constant suspicion, which is an unfounded or exaggerated distrust of others, sometimes reaching delusional proportions. Paranoid individuals constantly suspect the motives of those around them, and believe that certain individuals, or people in general, are "out to get them." Persons with paranoid personality disorder tend to be self-centered, self-important, defensive, and emotionally distant.. The disorder often impedes social and personal relationships and career advancement. Some individuals with PPD are described as "litigious," as they are constantly initiating frivolous law suits. PPD is more common in men than in women, and typically begins in early adulthood.
Have you ever had a patient that was became paranoid from loved ones keeping secrets from them?
is a psychological term, there is paranoid personality disorder, paranoid schizophrenia, delusional disorder. I have had patients who felt that they could not share secrets with loved ones for various reasons. Example, of birth of down’s syndrome child, inappropriate behavior.
How do you relieve your own secrets?
I don’t have so many that I do not share with friends.
Do you think that in healthy relationship secrets can exist?
Yes. Especially ones that occurred in the past… However, everyone has personal secrets that they may choose not to share. This is perhaps how they feel about another person or how they feel about something they did wrong. It is not necessary to share every aspect of your life unless the not sharing causes symptoms to erupt like anxiety and other disturbance.
Do you think people get a sense of power from keeping secrets?
Sometimes, but most of the people that I work with that keep secrets, do so because of the fear that sharing the secret would cause.
Do you think withholding secrets is a lie? What do you think your patients would say?
There is a sin of omission, but people are entitled to their own lives. In therapy, there is also a difference between not feeling ready to reveal something about you and outright lying about it.
Have you ever lied to a patient for their benefit?
Not lied outright, but I do not share personal information with them and if they ask, I do tell them that I am withholding.
What is a pathological liar? Why do they feel the need to lie instead of telling the truth?
mythomania Pathological lying is falsification entirely disproportionate to any discernible end in view, may be extensive and very complicated, and may manifest over a period of years or even a lifetime. Some people may not even realize that they are lying, but due to defenses report the truth wrongly(false memory syndrome.) However, in terms of psychological diagnosis, I have seen people who are A sociopath is typically defined as someone who lies incessantly to get their way and does so with little concern for others. A sociopath is often goal-oriented (i.e., lying is focused - it is done to get one's way). Sociopaths have little regard or respect for the rights and feelings of others. Sociopaths are often charming and charismatic, but they use their talented social skills in manipulative and self-centered ways.
A compulsive liar is defined as someone who lies out of habit. Lying is their normal and reflexive way of responding to questions. Compulsive liars bend the truth about everything, large and small. For a compulsive liar, telling the truth is very awkward and uncomfortable while lying feels right. Compulsive lying is usually thought to develop in early childhood, due to being placed in an environment where lying was necessary. For the most part, compulsive liars are not overly manipulative and cunning (unlike sociopaths), rather they simply lie out of habit - an automatic response which is hard to break and one that takes its toll on a relationship
Have you ever had a problem keeping confidentiality with your patients?
No… I take it very seriously. If I need to consult someone about a patient, outside of my agency, I do not use their name.
Is there ever a time that you feel you should tell a patients secret?
Yes. When I met the other person in a couple; or felt that the other member of the couple needs to be aware of the information. However, in the first case the information was never revealed, in the second, the person told their spouse themselves.
Do any of your patients have trouble sharing their secrets with you? How common is that? How do you establish a trusting relationship with patients so they feel comfortable sharing with you?
It takes awhile for everyone to develop trusting relationships, (when it develops too fast, that is not good either.) I have pretty good relationships with my patients, sometimes I will ask them a question and give my impression, however, if they correct me, I acknowledge that I made a mistake, I think that this helps them see that we are working together and that I do not see myself any better than them. It does take a while for many people to share secrets and some people hold in secrets for a lifetime and then cannot wait to spill them.
Where there ever cases where you felt it would be beneficial to a patient to keep a secret? For example, not sharing their feelings with a spouse or family member? In other words, are there necessary, or even “good” secrets?
Yes, a couple of times, I thought it was not worth sharing the secret with a family member. Flasher.
How does it feel to relieve people of their burdens? Do you feel the weight of patients secrets on your shoulders?
I feel good having true connections with patients, that they are comfortable in the relationship and are comfortable to share about themselves. I find it interesting to learn how people think and feel and cope with their lives. Sometimes, when I have a lot of patients that are depressed, I a heavy feeling, feeling down. However, I work in a clinic with other clinicians who are competent and we are able to share with eachother when we have especially difficult days. This is one of the reasons that I chose to work in a clinic rather than do private practice.
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