Making Decisions about Therapist Self-Disclosure

When I decided to take part in NaBloPoMo this month, committing to 30 posts in 30 days, I turned to my readers for topic bright ideas. One therapist-to-be reader suggested I write about therapist self-disclosure. How do we therapists make decisions about what personal information to share with our clients (or publicly where clients may access it). If you have a mental health and/or trauma history of your own, for example, do you share it or keep it private? Which takes precedence, the desire to speak up to raise awareness and decrease stigma or the desire to keep the focus of therapy on the client?

First off, let’s just acknowledge that no therapist is a complete blank screen. Nor do I think this is necessary or even desirable for therapy to work well. We convey things about ourselves indirectly and nonverbally in all sorts of ways: office location and decor, how or if we maintain an online presence, body language and tone of voice, to name just a few examples. If we practice in a small town  or within certain subculture communities, our personal lives may overlap in many ways with clients. Hopefully, all this can be grist for the mill, to be discussed as needed.

Why does your therapist want to discuss things like your reaction to his/her online presence or chance encounters out of session? Therapy is a different relationship than any other. Rather than just accepting things at face value, discussing even seemingly simple matters can help you gain greater insight about yourself and your patterns.

So what is my answer to the self disclosure question? I may indeed sound like a typical therapist as I answer “it depends”.

It depends on many things: your theoretical orientation, your personal comfort level (yes, therapists get to have feelings too) and always, always whether it is in the best interest of the client.

Therapists need to be sure that they are self-disclosing to further the treatment, not based on their own needs. I find that the Zur Institute is a great resource for therapists, with an extensive list of (free!) articles related to the therapy frame and boundaries.

article Self-Disclosure & Transparency in Psychotherapy and Counseling:

As with any decision regarding boundary crossing, the decision to self-disclose is based first and foremost on the welfare of the client. Intentional and deliberate self-disclosure is made under the general moral and ethical principles of Beneficence and Nonmaleficence – therapists intervene in ways that are intended to benefit their clients and avoid harm to them (APA, 2002). Applying these principles to self-disclosure means that intentional self-disclosure should be client-focused and clinically driven and not intended to gratify the therapist’s needs. When self-disclosure is unavoidable, as often is the case in small communities, therapists must evaluate whether such exposure is likely to benefit, interfere or affect the therapeutic process in any way.

How could a client be harmed by our disclosing personal information? Some clients may have had a history of blurred boundaries in their family of origins, of being used as a confidante or to meet a parents emotional needs. Some may be familiar with being in a caretaker role and more comfortable focusing on the other than attending to their own feelings.

As internet synchronicity would have it, in the process of writing this post I discovered a related article by Joanna Poppink, LMFT. She writes about her approach to responding to client requests for self-disclosure:

The key question I ask before I reveal personal information to a patient is this:  Will my answering this question burden the patient or will my answering support her healing?  Often, when I’m asked a personal question I will respond by saying, “I will answer your question.  But before I do, can you tell me why you want to know or what meaning this information has for you?”

She goes on to address the concern I raise above, how many clients have been overburdened with caring for the needs of others. We surely do not want to repeat this sort of pattern within the therapy relationship!

In being intentional about self-disclosure, whether it is spontaneous or in response to a client question, I find it invaluable to have both a theoretical framework I operate from and an in-depth understanding of the individual’s history and relational patterns. This of course takes time! Therefore, it might make sense to disclose less early on in the relationship. It takes time to make truly informed decisions about the impact and meaning this intervention will have.

Given that there are exceptions to every rule, we may think of reasons early self-disclosure might be necessary to establish a working alliance. For example, Dr. Zur raises the issue of therapist self-disclosure of sexual orientation in working with LGBT clients:

Self-disclosure is a very important issue as it relates to the key issue of being “out.” Accordingly, several theorists agree that there is high therapeutic value in the therapist self-disclosure of sexual orientation (Isay, 1996; Tillman, 1998; Mahalik et al., 2000). Several studies have suggested that gay and lesbian clients often prefer and seek therapists with the same sexual orientation, which apparently increases trust, affiliation and therapeutic alliance (Bernstein, 2000; Goldstein; 1997; Jones, Botsko, Gorman, & Bernard, 2003; Liddle, 1997; McDermott, Tyndall & Lichtenberg, 1989). Unless the client already knows the therapist’s sexual orientation prior to seeking therapy, very often the subject of their sexual orientation may be raised during the phone interview. As a result, self-disclosure is often a necessity for therapists who want or choose to work with this population.

Sometimes I think what matters most is the willingness to take the question seriously. To listen beneath the surface content. Maybe what clients are after in asking us questions is about more than the concrete answer. As Joanna Poppink wrote:

In other words, its not the information or event that is the issue. The sharing of our humanity is the point. The patient wants to know that she will be understood and appreciated. She wants to know I have a history that will inform me in terms of being present and empathic with her.

She wants to know that I can appreciate her pain and personal dilemmas. She also wants to know that I have survived my challenges and her stories will not shock me or cause me to judge her. Perhaps most of all, she hopes that I have healed from what she suffers and that if I have healed then she can heal too.

I believe that we can and must connect with our clients in this way, conveying understanding and compassion. I also believe that we can do this whether we answer a particular question or not. We can do it by being present in a real way, disclosing as is clinically appropriate.

I look forward to hearing others’ experiences, from both sides, with self-disclosure in therapy.

Kathleen Young, Psy.D.

References:

Poppink, J. (2008). Professional Boundaries with Eating Disorder Patients: considering right brain studies and work of Dr. Allan Schore. Retrieved 11/26/2010 from http://eatingdisorderstoday.typepad.com/eating_disorders_today/2008/01/professional-bo-1.html

Zur, O. (2010). Self-Disclosure & Transparency in Psychotherapy and Counseling: To Disclose or Not to Disclose, This is the Question. Retrieved 11/26/2010 rom http://www.zurinstitute.com/selfdisclosure1.html.

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17 Responses to Making Decisions about Therapist Self-Disclosure

  1. Dear Kathleen,

    Thank you for including my thoughts in your important and always relevant discussion on therapist self disclosure. I agree with you that the “blank screen” idea doesn’t hold up. We reveal information about ourselves through our clothes, jewelry, office furniture, waiting room, shoes. We reveal through what we exhibit and what we omit. Our challenge is to discover how our patient takes in that information and interprets it in her own psyche. Often, her interpretation is not obvious and, if discovered, can be helpful in the therapy work.

    I’m glad to have the opportunity to dialogue with you in this way and delighted that “internet synchronicity” brought us together.

    Joanna Poppink, MFT
    Los Angeles psychotherapist
    author: Healing Your Hungry Heart to be released 08/11 by Conari Press

    • Hi Joanna-

      Thanks so much for visiting and commenting. I was delighted to find your article as I thought through what I wanted to write about self-disclosure. These sort of connections are what I love about social media!

  2. b says:

    my counselor shared with me that she had healed from childhood abuse and that has brought me great comfort while we are starting my healing process because i know she understands the difficultly that i am facing as well as i know that it is possible for me to actually heal from this. i can see how a person looks that has come out on the other side and that alone has brought hope in what has previously been a hopeless situation.

  3. Excellent recap of the complexities involved in self-disclosure in psychotherapy and counseling.

    You were on the mark, when you wrote: “So what is my answer to the self disclosure question? . . “it depends”.

    The new frontier of self-disclosure is what I called “Googled Factor” (at http://www.zurinstitute.com/onlinedisclosure.html ). It related to psychotherapists’ intentional, unintentional and unwitting disclosures on the Web.

    • I really appreciate your work on this subject and am delighted to have you visit my blog, Ofer!

      The internet really adds all sorts of complexities to this issue! I noticed you have written about that in depth and I look forward to reading more. The article you link to in your comment is a great resource for therapists!

  4. Kerro says:

    I’ve been really interested in this post, thank you. My therapist has shared/disclosed quite a bit about her life, and it’s often puzzled me why. I like that she does, it makes her more “human”, but perhaps that is part of the method in her madness?? Thanks again, Kathleen, I’ve been loving your posts lately – great job. :)

  5. Anonymous says:

    Only thing I would like to add is about working self disclosure out with the client, I can tell loads about my counsellor from their presence and the environment we meet in.

    My hope is self disclosure is something we ‘do with’ rather than ‘do to’ the people we are privileged to be alongside.

    Thanks for such a thought provoking post!

    John
    wilsoncounselling.co.uk

  6. Here’s a link to an experience I had with a therapist, from my blog…

    http://wp.me/p17Bx4-4H

    Not only was it self disclosure but excessive self disclosure!

  7. Exactly! I was happy to find a therapist after that, that was fully able to give a “corrective experience”!

  8. Nicole says:

    Kathleen-

    I read your blog in regards to Self Disclosure, I truly understand why you say it depends. I am currently in therapy and I am not very trusting of anyone therefore its hard for me to talk about certain things out of fear of the therapist not understanding or relating to what i am talking about because if there is not understanding or relation that how does the therapist know how to help me? The therapist prior to the one I currently have I can tell she related to me with some things because her body language and her response to things showed that. She did not necessarily have to tell me her life story for me to feel like she understood, because through her reactions I knew she did. She went the extra mile for me and made sure I was safe at times and even called to check on me. I dont ask my therapist personal questions because I dont know if it will tarnish the working building relationship, and I dont like to over step boundaries. Now with my current therapist she will give examples of what she would do to cope with certain events but other than that I have not got to the point were I know for sure if she understands me or not her responses and actions are different than the last therapist. She did open herself up for me to contact her whenever but it still feels weird I never can work myself up to just calling my therapist whenever. And she talks to me on my level almost like a really trusting friend whether than a therapist..I dont know how to explain it I hope i am making sense. But Thats why I agree with you when you say it depends…I personally dont want a therapist to tell me their life story because I will then feel bad and not want to burden them with my issues. I dont like putting my issues on someone else knowing that they have their own to work through. I dont know I hope I am making sense….

  9. Pingback: Best Tweets for Trauma Survivors (week ending 12/03/10) « Third of a Lifetime

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