Tales from the therapist's couch

A woman who has for many years felt frigid and lonely in her marriage falls in love with another man. She becomes sexually obsessed with him, and terrified that her husband will discover her secret. In a mood of desperation, she tells the virtual stranger. He is flattered, aroused; they have a brief affair, her husband finds out and the whole pack of cards comes crashing down.

A woman who has for many years felt frigid and lonely in her marriage falls in love with another man. She becomes sexually obsessed with him, and terrified that her husband will discover her secret. In a mood of desperation, she tells the virtual stranger. He is flattered, aroused; they have a brief affair, her husband finds out and the whole pack of cards comes crashing down.

A man is possessed by homoerotic fantasies. He hides these from his wife as the world he mixes in is deeply homophobic. He becomes painfully unhappy, estranged from himself and his family. One night, after a solitary drinking binge, he acts out his sexual fantasies with a stranger on a common. He is seen by someone who tells his wife, and his world collapses.

These are the imaginary but familiar stories of the consulting room, the unshared secrets that go wrong. Secrets. If we didn't all have them, psychotherapists like myself would be without a job. The psychoanalyst D W Winnicott believed that we need secrets for our well-being. He also knew about the havoc they wreak when they become behaviours over which we have little control.

Very occasionally, people come to analysis because they have a secret that they want to unburden themselves from. More often, though, people come to see me not because something specific has been hidden, but because the hiding has gone on for so long that they no longer know what it is that they are suppressing. Like a yeast, the initial anxiety has gone forth and multiplied into a monstrous mockery of its earlier self. They are afraid, but know not why. They talk of phobias and anxieties, of unwanted fantasies and unlived lives.

This is where therapy begins. It often feels like collaborative detective work, searching and unravelling, sorting and understanding. What has been hidden? Why? What needs to be found?

For most of us, hiding and secrecy start even before we possess language. Fuelled with the turbulent and undisciplined squads of emotion that make up our early infancy, we are brought into a world of "shoulds" and "should nots". We learn that to feel safe and receive love we must close the door on the primitive dramas of our inner worlds, the messy, noisy and frustrating, the fearing, loving, hating and desiring. We learn to keep things locked away in order not to rock the boat.

It is little wonder that children get such delight from playing with secrets. The solitary dens, hidden treasures, secret languages and imaginary companions allow them to connect safely with the monsters from their deep. But as they grow older there are fewer permitted outlets for the inner demons. They are tucked away, denied, until eventually the crushed emotions return to haunt. They frequently take on new forms. The repressed rage felt towards a parent has become a panic attack, the repeated stifling of noisy behaviour is now the weight of a depression. By the time people come to see me, the secrets they confess are light years from their original form.

If the woman above had told her husband about her secret feelings for another man before acting on them, their marriage might have been saved. But she didn't know how to begin. As a very young child, she had been sexually abused by someone she had trusted. Her desire for a stranger was a symptom of her earlier suffering. She had never known how to integrate sexual feelings into a loving relationship. She had rarely had sex with her husband.

If the man with homosexual fantasies had talked about his anxiety to his wife, he might have been spared much sadness and humiliation. One of the reasons he couldn't was that his secret fantasies about men were bound up with his desire for the father he had never had. He had lived since childhood with the burden of a hidden secret and lived out its symptom because he had found no way to control it.

Symptoms don't disappear until the underlying causes have been well and truly exorcised. It is a wonderful moment in therapy when something is outed, cornered, found. There is a tremendous sense of someone at long last possessing the secret instead of the secret possessing them. As Winnicott puts it: "It is a joy to be hidden, but a disaster not to be found."

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the clinical material above refers to specific individual cases