What patients don't say

A few weeks ago I had a session with a patient I've been working with off and on for over a year.  He's the kind of patient therapists love; he's introspective and insightful, he listens to feedback, he thinks about things in between sessions, and he attempts to use every technique we discuss at least once to see how it works for him.  He was a bit guarded when we first started working together.  Over time, however, he became more comfortable and talked more openly about things that bothered him.  I was surprised when he revealed to me a few weeks ago that he has been intentionally holding things back during our sessions.  When I asked him why he replied, "To protect you."  He explained that some of the things he's been through were so horrific that he did not want to subject anyone else to them.  He's tormented by memories of these events but has not shared his recollections because he fears they might be damaging to others.

His consideration for my feelings was touching and I told him so.  On the other hand, I wanted him to feel free to talk to me about anything.  I assured him I am capable of hearing his stories.  I explained that it is my job as a therapist to take care of myself emotionally so that I am able to listen to people's stories without becoming overwhelmed.  I told him I am diligent about self care.  I said some other things I can't recall.  Basically, I tried to persuade him that I can handle anything he decides to tell me.  I don't know whether or not I convinced him.

As a result of this incident, I realized I'd been taking for granted that most of my patients feel comfortable telling me anything.  Of course I know there are those who hold back but often these patients are upfront about that fact.  I've had plenty of patients tell me they don't know me well enough to tell me certain things. 

The thing that struck me most was the reason my patient had for holding back: he was afraid of damaging me with his thoughts, feelings, and memories. This in one way reveals something about the patient's character; he is genuinely concerned for the well being of others.  (Ironically, he claims to not like people very much).  Maybe that's the only thing it reveals.  I wonder though, if there's something about me that led my patient to decide to hold things back.  Is there something I said or did that drew him to his conclusion? 

I've searched my memory but can think of nothing.  If there is something I'm doing then it is something I am not aware of.  I am, however, paying more attention now.  Last week a different patient talked about how hard it is to cope with the horrible memories she has of her time in Afghanistan.  She doesn't talk to anyone about her memories because, in her words, "nobody wants to hear about this stuff.  Even I don't want to think about it and they're my memories!"  She went on to explain that the memories are her burden to bear.  I replied that hearing her memories is my burden to bear.  "That's why I'm here," I said. 

I'm not sure if spelling it out for people makes any difference.  I guess I'll have to wait and see.