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.
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.
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.