"˜it’s probably nothing, but while I’m here . .’
"˜my husband will go mad if I don’t just mention . .’
"˜oh, and I promised a friend I would ask . . "˜
Family doctors are used to it. Just as the patient is saying goodbye they have an apparent afterthought and the real reason for the visit starts to become clear. This reason is important to their patient if not necessarily life threatening. But why does the patient treat their problem in such a seemingly casual fashion? Well, choose from embarrassment, shame, anxiety, fear, or maybe all of the above.
Of course the good thing about the people in my scenario is that they have plucked up the courage to speak. In so doing they have jumped a significant mental barrier and finally have the chance to resolve their problem. We have no estimate of the numbers of people who see their doctor for "˜backache’ and simply can’t dig deep enough to find what it takes to say what’s really troubling them.
Therapists may assume their client’s will disclose information to them fully and freely, albeit with a bit of prompting and probing to help the process along. With depression however, there is a strong relationship between being prone to shame and non-disclosure during therapy. Research conducted by Dr Anne Hook and Professor Bernice Andrews, at Royal Holloway, University of London, concludes that 54 per cent of depression sufferers conceal depression-related symptoms, behavior and depressing experiences from their therapist. What’s more, those people who do not disclose their symptoms have a poorer outcome after therapy.
In this example, information from people with depression was obtained via questionnaires sent to the Fellowship of Depressives Anonymous, a UK charity. The most frequently reported reason for non-disclosure of symptoms during treatment for depression was shame.
Disclosure of symptoms appears to be more important for recovery than disclosure about upsetting experiences. This may partly be due to the fact that experiences can be described in a more detached fashion and are easier to gloss over. For therapists, the knowledge that so many clients are reluctant to disclose symptoms, points to the importance of recognizing the powerful emotion that shame represents in terms of its potential to block therapeutic progress. Encouraging patients to talk about shame could therefore become an effective component of the treatment process both in depression and in disorders, such as post traumatic stress disorder, where shame is a known component.
Hook, A., Andrews, B (2005) The Relationship of Non-disclosure in Therapy to Shame and Depression. British Journal of Clinical Psychology 44 (3) 425-38.