Thanks for your question. This is a fascinating dilemma, in that many who wrestle with similar issues often have trouble achieving anything, let alone the impressive roster you list above.

I think my first suggestion is to simply get curious about what is happening here. I’m a fan of what I call “emotional mindfulness,” meaning paying close attention to what happens, exactly, when you choose and take action toward a specific goal. When you start job hunting, are you filled with excitement? Anxiety? Dread? Pressure? Are you motivated to not let others down, and does it feel like the very goal itself is instilled by others’ priorities rather than your own? And if you don’t feel pride, what is it you feel? Pressure? Irritation? Emptiness?

Actually, everybody wants to please others to some degree, especially their parents. I’m reminded of this every time my baby daughter does something amusing; I smile or laugh, and she responds in kind. We are born wanting what Kohut called psychological “mirroring,” or having our progress mirrored in the pleased expressions of our folks. In fact, Kohut (founder of self-psychology) called the need for mirroring one of the essentials of human development. But there are other developmental needs, including individuation, or finding your own path, vocation, and values that give you satisfaction. Do you feel the choices given to you by parents, or “society” in general, are too narrow?

You seem to derive little or no pleasure from your very real achievements, and seem to almost blame yourself (“What’s my deal?”). Again, I’m curious as to the disconnect, and to the overall context in which this is happening. I’m sure it’s not your “deal” alone. Perhaps you’ve come to believe, through your experiences, that there are high expectations on you, and a risk of not fulfilling them.

You’re at an age where it’s appropriate to begin a more adult individuation process, to begin to explore what makes you happy, and ask existential life questions such as, “What’s so great about a 9-to-5 job?” and, “Do I really want to be a cog in the big machine?” and, “Is there more to life than wife and kids and paying bills?” and, “What’s it all about for me?” In this sense, your question reflects a very healthy awareness and a hunger for self-expansion, and that’s a good thing. However, the risk is that others may have a different reaction to “the new you.”

Every individual is different, but I traveled a lot when I was your age, wrote (unproduced) plays in cafes, made short films, and lived in Europe for a year. I’m not recommending this by any means, but I experimented quite a bit … with filmmaking, travel, volunteer work, dating, meditation, and so forth. It really helped inform my decisions later on when it came time to “grow up” and hunker down on career and marriage. My parents weren’t always thrilled, but so it goes.

What gives you pleasure or motivates you? Are you concerned that, should you pursue a more individual path, others won’t approve? If that’s the case, it’s a good time to start individuating, and finding your own way and learning to tolerate disapproval. I have found, both personally and with clients, that the people who love you do so unconditionally, regardless of your résumé and achievements. Most disapproval is temporary; people adjust. If not, a conversation needs to happen regarding the rigid “requirements” one feels to continue receiving approval. Self-denial and approval seeking are high prices to pay, and in the long run not a psychologically healthy recipe for love and life.

Perhaps, as with many your age, what lights the inner spark is not yet known to you. If that’s true, that’s OK, but it might be time to do some soul-searching, or consult with a career counselor or even a therapist to look at other options you might find interesting … because now is the time to experiment and explore avenues (safely) that you might not have considered. Perhaps there is some kind of pressure to do what’s expected of you, leading to a feeling of emptiness and/or resentment. Do you feel others will be “disappointed” if you don’t do the expected thing? Is there a risk in doing things for yourself rather than for those in your life? Are you concerned they’ll “reject” or abandon you in some way?

The other possibility—and again, this is highly speculative and to be taken lightly, since I don’t know you at all—is that there is some dysthymic or depressive symptomology here, or other organic condition which might be undermining average serotonin or dopamine processing in your system. You might want to get a checkup to rule out anything medical or psychiatric first.

The first step in any change is the kind of awareness you’re bringing to the situation. Try if you can to be patient and compassionate with yourself, and see this as a process. The question you raise is a crucial and common one at your stage of life; you might not get the answer as quickly as you like, but stay with it and keep seeking—this is precisely the kind of exploration that can open more doors (and perspectives) than you might think. Thanks again for writing.

Kind regards,
Darren

It sounds like this young girl might be stalking you. Follow your instincts here—as you say, this is a very difficult situation, and you were right to let your wife and the other camp counselors know about it. Staying away from this young lady, as you are doing, is the best course of action, but I would consider consulting an attorney as well, since the girl is a minor.

You think things are escalating and are worried about her mental health, and you would probably like to help her, just from a humanitarian standpoint. I don’t know the legalities in your state, but since you were her camp counselor, you may also be mandated to report her behavior and your fears about her mental health to her parents. I would check on this with my legal adviser and ask for any further advice, including about your Facebook account, which you might consider closing for a time. It is important not to contact her yourself, directly, as any contact may make things worse. If there is any communication at all between you, the young lady, and her parents, it should be mediated by an attorney.

Recently a memoir about a similar but much worse situation was published—Give Me Everything You Have: On Being Stalked, by James Lasdun. It’s a scary book, and I would not take it to heart as applying to yourself, but you might profit from reading about Mr. Lasdun’s experiences. Stalkers have a love-hate relationship with their victims, whom they see as ideal partners, and who they often believe are in love with them, but there is no real relationship and they in fact torture themselves and their victims with their fantasies and inappropriate behaviors.

Some people hope that, with time, the situation will just fade away and the person doing the stalking will find some other interest, but a decline in interest is not something you can rely on. Better safe than sorry—again, see an attorney.

I have no desire to alarm you any more than you are already. I agree that this situation needs to be brought to a healthy conclusion as swiftly, compassionately, and mindfully as possible.

Thank you very much for writing to Dear GoodTherapy.org for help. I wish for a speedy and positive end to this problem.

Best wishes,
Lynn

I see you understand yourself very well—better than most people do, in fact, and I think your understanding comes from your intellectual abilities, which I believe are way above average. You’re quite blessed to have this capacity, but the mind alone is not capable of changing this style of processing.

You write that you are in a relationship, and I wonder how your partner is impacted by your distortions, and how you deal with that together. You say that you obsess that your partner may be cheating, though there is no evidence that this is true. If you’re feeling unwanted, you might ask for excessive reassurance, which rarely works for very long to calm anxiety and which can be annoying to others. How does your partner react to your fears? Does your partner know ways to help? If not, couples counseling might be good for both of you.

Listen to the way you talk to yourself—what you say about yourself to yourself. Perhaps you berate yourself as you lose patience with your repetitive and catastrophizing thoughts. Be kind, as kind as you probably are to others. Remember that charity begins at home, and exercise compassion. And practice ways to so soothe yourself, perhaps through restorative yoga or long walks or jogs.

Finally, your obsessions may be an indication of obsessive compulsion, which often runs in families, and treatment can help effectively manage this. One way to treat obsessive thoughts is with cognitive behavioral therapy, during which people are exposed to situations that they are afraid of until they gradually become less sensitized. Psychodynamic psychotherapy with someone who specializes in helping people reach their unconscious feelings and work them out in relationship with the therapist might be ideal, or you might want to work with an art therapist or even a psychoanalyst.

Anti-anxiety or antidepressant medications benefit some people, too, but if you and your doctor decide that this is your path, you must be carefully monitored by a psychiatrist. If you do take medication, you might consider combining this with some form of psychotherapy.

Thank you very much for consulting GoodTherapy.org; I wish you a successful journey!

Kind regards,
Lynn

Thanks for writing in, and for the excellent question. I’d first like to congratulate you for having what appears to be an unusually expansive empathy, in that you are trying to do right by your fiancé in terms of your mutual sex life, his issues and sensitivity around trauma, and, of course, your own feelings about all this. Obviously, this is a complex question, which accounts for the long-ish answer you’re about to get.

The first thing that comes to mind here is: There’s something not sexy about this for you; sex is a little like humor in the sense that it tickles us or it doesn’t. Your fiancé’s request to carry out what sounds like a role-play scenario doesn’t seem to hit the eros chord for you, and nothing’s more of a turn-off than forcing yourself to do something too edgy or discomforting.

Part of the uneasy factor is that the requested scenario seems to parallel your fiancé’s sexual abuse, which is still fresh for you (just having heard about it). Let me say here that what defines “healthy sexuality” could—and has—filled volumes upon volumes. It is a never-ending debate in my field. My own guidelines for “healthy” sex would mean, first and foremost, that the sex is consensual and safe for all parties. Other than that, the spectrum is infinitely broad. I know heterosexual men who like wearing stockings, and gay men who act brutish and tough in the bedroom. Working with sexuality means you’re dealing with the unconscious, and 10 different therapists would give you 10 different interpretations of what your partner’s sexual preferences are “really about.” As indicated, however, I get the impression from your letter that something about this feels uncomfortable, perhaps a bit unsafe, and I think that is at the core of what needs to be dealt with between you.

My clinical experience has shown me that a dynamic sexuality often includes a sense of experimentation, emotional expression, and spontaneity. There’s nothing at all wrong with role playing, though when the “play” part becomes rigidified, with an endlessly repeated “script,” to the point where mutual expression seems muzzled, where the sex has to be a certain way or someone will be unhappy, then it’s time to take a step back and see how things can be loosened up. Playfulness and humor, too, can be a way of masking or deflecting emotion, but if sex becomes too serious or heavy, it becomes stifling. Just as important here is the fact that what happens in the bedroom so often mirrors what is happening, emotionally and relationally, in the relationship itself. Sexuality is another spoke in the wheel of relating, not a separate wheel unto itself, though we often think of it that way. This leads me to wonder if you ever feel kept at a distance or put in a position of power in your emotional lives together.

I’m not exactly sure how dark or heavy a “flavor” we’re talking about here, though it sounds like (I’m assuming) you would be in the “perpetrator” role; if I assume that these scenarios have a sadomasochistic tinge, perhaps your fiancé is asking you to take the “S” role in a way you’d rather not. I’m imagining it might be painful to play a role in which you are hurting your beloved in a way parallel to earlier, horrifying experiences.

Whether these scenarios are healthy for a person to enact really depends on context and their psychological history (and is a source of intense debate among therapists). I believe that, for some people, allowing scenarios derived from trauma to emerge in a sexual context might actually give a person control and power over a previously painful narrative; they are able to “make use” of the trauma in a way they can control and derive pleasure from, a way of telling their story their own way, which now offers pleasure and not just pain. Ironically, allowing trauma memories to mingle with consciousness, even under the cloak of sexual fantasy, is a step forward for some who have completely dissociated or disconnected from such awful memories. For other people, such enactments can take on a compulsive flavor, where satisfaction can be found only by acting out one’s feelings and experiences this way, which inevitably makes their actual sexual partners feel distant and/or controlled. Where one draws the line between playful expression of one’s sensibilities and a darker, more destructive and harmful behavior is up for debate and highly dependent on specifics.

I think the only way to resolve this, since it so directly involves so many facets of your relationship, is to handle it relationally—that is, with your fiancé. This isn’t something you can figure out on your own. Dialogue is essential. I’d first decide what you are and aren’t willing to try in bed. Would you be up for trying a “light” version of his scenario, or exploring it, to see if there are aspects of it that can be treated as a kind of game, where play and spontaneity are included? Could it be seen as a kind of foreplay, where (again, not knowing the specifics) you could employ a little spanking or tying up or a scenario that is sexy to both of you and not too edgy or overwhelming? Or is it all just a big turn-off and not your “thing” at all?

I’d then sit down and relate as honestly as you can. You obviously care about him a great deal, want to please him but have concerns about his request. I’d try to stick to your own feelings. Saying, “I’m not sure this is a good way to resolve your issues” sounds a little therapisty; you might try saying, “The idea of this makes me (uneasy, uncomfortable, etc.).” Can a compromise be reached? Can the two of you let your sexual imaginations come up with something you both find desirable?

Try not to think too hard about what will help your fiancé resolve his trauma. Frankly, just having an open conversation wherein you are honest about your feelings, while empathic toward his, will likely be a healing experience for both of you. I honestly do not think any partner’s job is to help the other resolve any issues; that’s what therapists are for. Honest relating and working through things respectfully and lovingly is itself healing.  You can support him in his therapy work, of course, but you, too, are on a journey, and one person’s trauma does not “cancel out” the other’s desires or wishes to feel heard, respected, and safe—sexually and otherwise.

Thanks again for writing. Hope that helped.
Darren

It sounds like you have tried to get help in so many ways, yet nothing has worked for you. That must be incredibly frustrating. There is no question that being left by a parent is painful. You are entitled to feel anger and hurt, though I hear you say that you don’t want to feel that way anymore, that you want to let it go. If you want to let it go, you will need to find a way to forgive your mother. When we forgive, we actually release ourselves, not the other person. Your mother is still responsible for the choices she made. Forgiveness does not mean that you are OK with her choices or that you condone them. You can’t change the facts of her choices, but you do have an opportunity to change what those choices mean to you.

There is no quick fix for these kinds of feelings, and the strategies that work will vary from person to person. Some people respond well to mindfulness work, whereas some people find cognitive behavioral approaches (REBT in particular) most impactful. I can offer you a couple of strategies to try, though in my experience, working through these strategies with the help of a professional is most effective.

The strategies I can suggest involve reframing how you tell your stories. Right now, you tell your story about how your mom left you when you were 16. My hunch is that each time you tell it, you may re-experience some of the emotions of loss, anger, confusion, or grief that you felt at the time. This can reinforce those feelings of hurt and keep them activated. The first step to making a shift is to start telling the story from the third person rather than first. Become a neutral observer watching the events. Instead of saying, “My mom left me …” you narrate the story, saying, “The mother left her daughter and the family …” By approaching your story this way, you start to get some emotional distance from the events and they aren’t quite as triggering. You may notice details that you didn’t pay attention to before. This is the first step.

When you are ready, you can try telling the story from the points of view of others—other people in your family, and eventually your mother. Consider what they were thinking and feeling, how they made the choices they made, how they saw events. By taking on the perspective of others, it can sometimes shift how we feel about a set of events. Again, I’d recommend that you do this with the support of a therapist who can help guide you through this process.

Another approach I’d like to mention is re-parenting work. Again, I strongly recommend doing this with therapeutic support. The main goal of re-parenting is to go back to the time when you felt abandoned, hurt, and let down, and to allow yourself to feel deeply while also becoming the loving parent to yourself you wish you’d had. Allowing yourself to fully experience and feel the pain of your abandonment is the key to healing here. You learn to offer yourself the unconditional love and support you wanted from your mom. You learn to nurture yourself and heal those deep, painful wounds which can ultimately allow you to release the anger you’ve been holding on to. This approach can be intense, and it is important to find a professional you trust to help guide you through the process.

Best of luck,
Erika

It sounds like you have been a tremendous source of love, strength, and support for your girlfriend in her battle with depression. That takes incredible patience and compassion, but it can also take a toll on you. In cases of chronic depression, it is very common for partners to begin to feel more like caretakers than anything else. Very often, when one takes on the role of caretaker, it becomes such a consuming task that the caretaker loses touch with himself/herself. It’s a positive sign that you seem to have a solid sense not only of where she is, but also where you are. It also seems like you have come to the realization that this situation is not sustainable and that something must change. So the question, as you insightfully pose, is where do you go from here?

You’ve asked some really important questions about yourself: “Am I codependent?” “What’s my issue?” “What steps can or should I take?” These questions are as important as they are complicated. I strongly encourage you to begin your own therapy. Developing a strong therapeutic relationship with a clinician will afford you a much-needed opportunity to focus on yourself. You’ve managed to take care of your girlfriend and remain connected enough to yourself to come up with these questions. A trusted therapist will help you thoroughly explore these questions, develop insights, and create and implement a plan of action. You might also want to look for a caretakers’ support group. The burden on caretakers is significant, and there is great therapeutic value in realizing you are not alone. You’ve been shouldering a significant burden on your own for years; it sounds like you are ready to let someone help you carry the load.

You mention that your girlfriend’s medication does not seem to be helping her. The specific mention of medication but not therapy makes me wonder whether your girlfriend is in therapy. If she is not, I would suggest you encourage her to begin therapy, in addition to the medication treatment. Medication treats symptoms, but it doesn’t address all of the problems that often underlie depression. In order for her to have a chance at any kind of substantive change and lasting relief, she needs to be working on these issues in therapy. Also, it is very important that a psychiatrist, and not a general practitioner, be managing her medication. Psychiatrists are the experts in the medical treatment of depression, and they will be able to provide better care than a general practitioner.

Also, if her depression has lasted for years with no improvement, it might be time to look at changing the treatment plan. This could mean adding individual and/or group therapy to her treatment regimen, trying a new therapeutic approach, or making a change to her medication. Consider suggesting that she talk about these possibilities with her psychiatrist and therapist (if she has one). If, after years of treatment, she isn’t getting any better, something probably needs to change. Your girlfriend should know that she has the right to be an active participant in her treatment plan and to discuss changes to this plan with her clinicians.

You took a leap when you wrote in with your question. I hope you will take another one and find some support for yourself. This is a painful, complicated issue, and you deserve to have support as you work on figuring out what is best for you.

Respectfully,
Sarah

Does this song sound familiar?

“Every Breath You Take” by The Police:

Every breath you take
Every move you make
Every bond you break
Every step you take
I’ll be watching you

Some people think it’s a love song, but according to Sting himself, it’s the opposite—as he put it, “very, very sinister and ugly.” Does it remind you of your relationship with your girlfriend? The song is about a stalker, someone who watches every single thing their partner does or wants to do and takes away their freedom. In such a relationship, a person might feel safe and loved at first, in a secure space, but that space quickly turns into a prison.

You say you’ve read many articles about insecurity and the damage it can cause. I am not going to suggest any more books or articles to you; I think it’s time you stop reading and start doing. I think you already know all you need to.

In the kind of relationship you describe—of possessor and possessed—both partners are insecure. You ask if you should leave. I ask why you need to ask. What do you want to do? I suggest that you seek professional help and a support group so you can learn to listen to yourself, act on your true needs and desires, and develop better, healthier relationships that will help you honor your own inner guide and grow.

Respectfully,
Lynn

It is hard to be fully invested in a relationship if you’re already thinking about the messy ending. You are right about the statistics—many marriages do end. There are no guarantees. I do know that very few people go into a marriage with the intention of getting a divorce. Marriage is a leap of faith. It seems pretty clear that you are not ready to make that leap right now—and that’s OK. It’s good to know that is where you are.

What I think is interesting is that you say that you are fine with long-term commitments or even one life-long commitment. I’d be curious to know more about why that feels safer to you than marriage. The “split” rates for relationships are higher than for marriages. There are even fewer guarantees in “nonbinding” (for lack of a better term) relationships. The risks of not being able to trust, of being hurt, of friends taking sides are just as high. If you were to have children with a lifelong partner outside of marriage, custody issues would still be present; they would just look slightly different. You’d still have to figure out dividing up shared stuff (possibly even your home). There are even fewer guarantees in this kind of relationship, yet something about not being legally bound to another person seems less risky to you.

I wonder if the issue may not actually be the act of marriage, but the level of trust required to risk committing yourself fully to another person. It is not unusual for children of divorce to struggle with that trust. They experienced firsthand how marriages can end. It can profoundly impact their feelings of safety and security and limit their willingness to trust in others. You say that, right now, it feels like you have to choose between a very scary “risk-it-all” approach or be doomed to a life alone. There is definitely a middle ground which can allow you meaningful relationships without such high levels of fear. I strongly encourage you to explore these feelings with a therapist in your area.

Best of luck,
Erika

Wow. It sounds like you feel like you’ve really had the rug pulled out from under you. It’s certainly understandable; you’ve had daily contact for three years and it has suddenly ceased. The sense of loss you are feeling is likely compounded by how literally life-saving this communication was for you. The absence of it seems to have left you feeling very alone in dealing with a tremendous amount of anxiety. You indicated that your therapist believes that you are ready for this, so I’m wondering if the two of you have discussed the possibility of this uptick in anxiety and created a plan for handling it. If not, it might be helpful to spend some time talking about this in session. While it might very well be time to eliminate this particular source of support, it makes sense to have some strategies in place to fill this void.

The therapeutic relationship that forms between a client and a therapist is a very special and unique relationship. It is healing and powerful and not at all a fantasy. From what you have said, I feel confident that your therapist does care very much about you—daily emails for three years certainly provide supporting evidence. While you did not conjure up a fantastical relationship where none actually existed, you experienced a heightened version of this already unique relationship. The therapeutic relationship is different from any other kind of relationship, in part, because it is so one-sided. The relationship is designed for the sole purpose of helping the client. Because you were suicidal, you needed even more from your therapist than someone who was not suicidal, and you got more in the form of daily emails. Now that you have made so much progress and the suicidality has abated, your therapist has eliminated the additional support that was needed to get you to where you are today.

Finally, you mention this change in the relationship is tapping into some abandonment issues. While it certainly doesn’t feel like it now, this could be a wonderful opportunity. You see, your therapist has not abandoned you; she is still there for your weekly Monday sessions. She is still there to help you through this transition, and she is still there to help you process the issues of abandonment that this is bringing up for you. Because you have faced so much abandonment in the past, you might see it in the present where it doesn’t really exist. I wouldn’t be surprised if exploring this with your therapist and coming to terms with it is one of the final steps in healing from the abandonment in your past.

Sincerely,
Sarah

Thanks so much for your question. Boy, it sounds like you’re going through a really tough time, and I’m sorry to hear about your childhood abuse; I know how intrusive and debilitating posttraumatic stress symptoms can be. What’s kind of a “double whammy” here is the fact therapy doesn’t seem to be helping. What’s interesting to me is that it sounds as though it’s all up to you to make it work, when in fact the therapist is a 50/50 collaborator in the process. It’s sad to me you feel you’re “blindly” fumbling around, as if you have no help finding direction. I always challenge my clients when they take whole blame for any “stuckness.” Therapist and client form a system, like two atoms in a molecule, and every relational system seems to reach a kind of homeostasis, or regular pattern, which on the one hand provides a sense of stability and reliability, but on the other can lead to the sort of stalemate you’re talking about. I would agree with you that you’re not capable of change by yourself; your therapist needs to be an active participant, and the way you describe therapy makes it sound as though there’s tremendous distance between you two.

I’m also curious as to what made you decide to quit at that particular juncture. A sense of boredom? Frustration? Sometimes it takes time to get to a point where change begins, but until then it can feel eternally slow. I’m not saying that’s happening here, but sometimes we hit a wall, and just beyond the wall is a new phase. Always darkest before the dawn, as the cliché goes. Sometimes it’s true.

I want to tell you that—and I have zero doubt about this—your therapist is part of the problem here, and the solution. Therapy is, in part, a business arrangement, and as the customer you are not satisfied and have every right to voice your concerns. I would strongly encourage you to have at least one more session and air your true feelings. Let it all hang out; we’re professionals, but we’re not perfect, and feedback is terribly important. Yes, it’s true that we are “experts” of a kind, but psychology is not medicine (it’s part art/part science, in my view). Everyone is different and comes with his or her own history, perceptions, feelings and interpretations that warrant close exploration so that you and your therapist can co-construct a way of working that you both feel is productive and going somewhere. It’s almost like co-creating a language that exists solely within the “psychic sphere” of therapy, to borrow Freud’s phrase.

On another note: One of the many sad things about trauma is it can challenge us in forming attachments to others, including, of course, to the therapist. He or she may become an authority or parental figure whom we are afraid to confront, but clients often report that it is very healing for them to tell me the truth when something bothers them, and to have me listen and understand each of our contributions so we can work it through. Some of the very best work happens when a client is unhappy with something and we process it. Additionally, there are often beliefs about the self based on past abuse that have to be brought to light. Some may unconsciously feel they “deserve” to suffer because of the belief that they brought the trauma on themselves. To a child, assuming they are the cause is less frightening than no cause at all. I hear a note of this when you ask if you are capable of change. Everyone is capable of change, my friend—in fact, we are changing every second of every day! We are organic, physically and psychologically. It’s the illusion or experience of staying the same that is so painful. (The new gray hairs I saw in the mirror today are testament to this.)

There are even unconscious motives for change not to happen, in some cases. Abuse and mistreatment are often, tragically, the only way some caretakers have ever related to their children; clinging to the symptoms is, symbolically (for some), a way of holding on to Mom or Dad. Some would rather believe they are bad than accept that their caretaker, often idealized, treated them so horribly. It’s like losing a parent, and the underlying grief and loss can create terrible apprehension. All of this needs to be explored in the consulting room.

I’m describing a very psychodynamic way of working, by the way. There are other modalities to employ with these types of injuries, including cognitive behavioral therapy, EMDR, somatic experiencing, neurofeedback, spirituality, peer support, and so forth. I use an eclectic mix, depending on what the client finds helpful. But again, without sustained feedback, I don’t know what’s helpful.

You might also look into a peer support group instead of, or in addition to, individual treatment. Finding a group of people who can relate and accept you as you are, because of (not in spite of) your challenges, can be tremendously healing.

Please don’t give up. I recommend that you talk to your therapist or try with another one, and ask for a treatment plan or set of goals that you both agree are obtainable and desirable. Each goal should have specific methods or ways of working that you both, again, feel comfortable with. The technique of therapy shouldn’t be a mystery; there are many unknowns, of course, but this isn’t hocus pocus and there have been some tried-and-true methods shown to work over the past hundred years. The key one appears to be a trusting relationship with your therapist, and I think that even if you decide this one ultimately isn’t for you, you deserve a fair hearing as to why you’re unhappy and the changes you’d really like to see (and what seems to be getting in the way). You don’t and shouldn’t have to go through this alone.

Respectfully,
Darren

Great question—simply and clearly put—and I enjoy thinking about it. Thank you. I’m afraid my answer is going to be pretty long, though, because the question touches on a variety of issues.

Let’s start with the difference between secrecy and privacy. I’d like to keep my weight private. But if I wear a body stocking sometimes, that’s my secret because I’m a little ashamed about it. Someone else might not be. The contents of my email are private and I don’t want my husband to read them—even if I don’t keep any deep and dark secrets from him. My diary is private, and may contain a few secrets too; I don’t want anyone to read it. Sometimes privacy and secrecy overlap. Clearly, what’s private and what’s secret varies from one person to the next, but the development of boundaries of what is private grows with a child’s increasing independence from his or her parents. A child might ask the therapist, “Can I tell you a secret?” but really mean “Can I trust you? Can I tell you something that you will keep private?”

Privacy between people, called confidentiality when it refers to communications between therapist and client, is a prime value in therapy—the therapist under most circumstances must keep everything said in session private so the client can speak freely. This rule is a bit different when working with minors.

First off, there are legal issues which apply to minors in therapy. Minors are unable to consent to treatment; their parents consent on their behalf. There are exceptions to this (minors who are married or in the armed services), but generally anyone under the age of 18 is not legally able to make treatment decisions. A parent who consents to treatment for a minor child has the legal right to know the content of the child’s treatment. For more information, please consult this American Psychological Association page: http://www.apa.org/monitor/mar02/confidentiality.aspx. Reports on content may be more or less detailed, depending on the agreements the parents, child, and therapist have made with one another. Often, a general sense of progress or lack thereof is reported; specifics may not be.

Privacy issues in clinical practice are not as clear as the legalities are. The child needs privacy, and needs to be able to speak freely and know that the parents will not be told about what is said, in order to foster independent growth. Children’s needs for privacy grow as they mature, and the therapist might encourage the child to develop personal boundaries about what the parents (and others) should know and what they do not need to know—what should be kept private. This seems to conflict with the law.

To preserve clarity, remain within legal boundaries, and protect the child /client, therapists should make clear at the outset of treatment what the therapist’s relationship will be with the child and with the parent and how information will be shared—in short, who will know what and when. Clearly, as the child matures this will change—people need more privacy as their independence and individuality develop. When this happens, the therapist will meet with parent and child to explain that the structure previously agreed upon must be adjusted.

At the same time, the therapist cannot promise the child that all information will be kept private if it is felt helpful to the child to tell the parent. If the therapist feels the parent may harm the child as a result of information the therapist might report, the therapist should seek legal advice. The therapist is mandated to report indications of possible harm to the client or others; neglect or abuse must be reported in most states. This applies to both children and adults.

All my best,
Lynn

I’m so impressed with you! First of all, in spite of your fear of being judged, you have taken the very courageous step of writing in with your question. Second, it sounds like the daydreaming and fantasizing have served as a very adaptive behavior—you have been able to get some relief from the depression and low self-esteem by escaping into your imagination. Unfortunately, it seems like this coping strategy has taken on a life its own and become somewhat of an impediment to your ability to function in your daily life.

In some ways, what you are describing isn’t completely dissimilar to how substance-abuse issues can develop—someone is in discomfort, seeks relief in alcohol or drugs in order to escape the discomfort, and ultimately comes to depend on the substance to an extent that it interferes with life. That said, one critical difference between what you are describing and substance abuse is that there is quite likely some real value in what you are using to escape. Most successful people begin their journey toward success by imagining it—they dream about their success and then they begin creating goals (and working toward them) that will move them toward their dream. I suspect that the life you have created in your imagination is closer to the life you desire than your actual, current life is. If my suspicion is accurate, then it makes sense to do what you can to start moving toward the life you have imagined for yourself.

Given your struggles with depression and self-esteem, you might be thinking: easier said than done! This is certainly true, but it does not mean that it is impossible to live a life closer to the one you imagine; it simply means that you need to get treatment to address the depression and self-esteem. Right now, these issues might be all that is keeping you from working on making your fantasy life a reality.

This brings me to your fear of disclosing your fantasy world to a therapist. First, there is no shame in the fantasy life that you have created; in fact, I believe it will ultimately serve as a road map to move you to the life you have been dreaming about. However, if you are still feeling anxious about sharing this world with a therapist, know that you don’t have to in a first, second or even third session. In fact, I would say if disclosing it is so anxiety provoking that it is preventing you from seeking treatment, do not disclose it until you are confident that you have a trusting, therapeutic relationship with a therapist. Sometimes when people disclose too much before a really strong working alliance is established, they feel exposed and vulnerable to an intolerable degree and they leave therapy prematurely.

You can avoid this by finding a therapist who you believe could be a good fit for you and setting up an initial session. You might even set up an initial session with a couple of different therapists and see who you feel most comfortable with. Once you believe you have a good match, work on building a strong therapeutic relationship and when you feel ready, open up about your fantasy life. As the depression and self-esteem issues begin to be addressed and you open up about your fantasies, you just might find that these very fantasies will become your road map and your therapist will serve as a supportive guide as you follow the map to your dreams.

All my best,
Sarah