The relationship of non-disclosure in therapy to shame and depression

This study aimed to explore the relationship between shame-proneness, depression, and non-disclosure in therapy in 85 men and women who had received treatment for depression.

Data were collected by means of a questionnaire, which assessed depressive symptoms, shame-proneness, non-disclosure in therapy, and reasons for non-disclosure.

In total, 54% of the respondents reported concealing depression-related symptoms and behaviours or other distressing experiences from their therapist. Shame was the most frequently reported reason for non-disclosure overall, but was a more frequent reason for non-disclosure of symptoms than experiences. Similarly, shame-proneness was significantly related to non-disclosure of symptoms but not to non-disclosure of experiences. For participants no longer in therapy, non-disclosure of symptoms made a significant independent contribution to current level of depressive symptoms after controlling for demographic variables, worst depression, and shame-proneness.

The hypothetical model put forward in this study predicting a significant relationship between shame, non-disclosure in therapy, and current depressive symptomatology was supported. The findings suggest that encouraging and facilitating the disclosure of shameful symptoms and related behaviours has positive implications for the effectiveness of treatment.