Your client’s voice gets very low. In the hushed tones of deep shame, he confides, “I was so depressed yesterday, like never before. This was my marriage; it was so important to me, and I failed at it.” You are suddenly on high alert. You want to rush in and assure him that you know the feeling, as your divorce was the most soul-destroying experience you’ve ever had. You really want to tell him this, but do you? If you were to divulge this highly personal information, are you clear on the therapeutic benefit to your client?

Definition

We can define therapist self-disclosure as the situation in which personal, as opposed to professional, information is revealed by the therapist to the client (Zur, 2016). While there are numerous aspects to it, this post is concerned with two that tend to be controversial: the clinical and the ethical. They revolve around the question of whether the therapist should self-disclose, and if so, how, and in what context.

Theoretical orientation has a loud voice

We come to the crux of the controversy immediately in considering the therapist’s chief theoretical orientation. In general, those who disclose — and one study has shown that this was 90% of psychotherapists (Henretty & Levitt, 2010) – tend to see the therapeutic process as one of interconnection between therapist and client. Those who don’t generally disclose are more focused on working through clients’ projections. Looked at by modality, then, we can see the different takes on self-disclosure as dictated by the primary theoretical orientation of the therapist.

Traditional analysts

Freudian and Jungian psychoanalysts typically follow Freud’s injunction to serve as a mirror and a blank screen for clients, which frees them to project their own thoughts and feelings onto the therapist. Neutrality is thus important for the analysis of the transference. Conversely, more modern psychodynamic modalities (e.g., Psychosynthesis) have emphasised the importance of relational perspectives, and may disclose, albeit carefully (Stricker & Fisher, 1990).

Behavioural therapies, REBT (Rational Emotive Behaviour Therapy) CBT (Cognitive Behavioural Therapy), family therapy, Ericksonian and Adlerian therapies

Modelling, reinforcement, and normalising are important in these therapies, so self-disclosure is viewed as an effective tool for enhancing these techniques. In fact, if therapists do not answer clients’ appropriate questions with other than a question (such as: “Why do you want to know?”), they are deemed to be potentially disrupting the counselling process. Modelling through the use of examples from the therapist’s own life is reported to be a highly effective way of convincing clients of a technique’s utility (Tantillo, 2004, in Zur, 2016) and family therapies use it for purposes of enhancing the therapeutic alliance (Stricker & Fisher, 1990).

Group therapy

In this modality psychotherapists are free to share their thoughts, feelings, and perspectives responsibly, just as other members of the group are. This enables them to respond authentically and acknowledge or refute motives and feelings attributed to them (Zur, 2016).

Humanistic and existential psychotherapies

Psychotherapists’ transparency is critical here to the therapeutic alliance, which in turn is the primary factor predicting clinical outcome. Therapist self-disclosure allows clients to see that all human beings – therapists included — have failings and unresolved matters (Jourard, 1971).

Feminist therapy

Feminist therapy sees that therapist self-disclosure fosters a more egalitarian relationship and solidarity between therapist and client, which promotes client empowerment and aids them in making informed decisions in choosing female therapists as role models. Self-disclosure is viewed as the ultimate means of deconstructing isolation and shame and transmitting feminist values to the client (Kessler & Waehler, 2005).

Self-help therapies

These therapies use self-disclosure extensively, probably for similar reasons to what the humanists and feminists do.

When self-disclosure does occur, it may happen in different forms, through different avenues. Let’s look at those.

Types of self-disclosure

There are four or five types of self-disclosure, according to whether it was deliberate or not and initiated by client or therapist. Running through the types, there is the question of whether the disclosure was inappropriate (counter-clinical) or not.

Deliberate

Knox and colleagues (Knox, Hess, Petersen, & Hill, 1997) make the distinction between “self-revealing” and “self-involving” disclosures. The former describe information that therapists reveal about themselves (that is, “extra-session” material), whereas self-involving disclosures give the client information about the therapist’s personal experience and reaction to the client, which normally takes place during the session. The therapist must decide that any self-revealing disclosures will be clinically driven and appropriate; thus, they are purpose-driven: carried out for the benefit of the client and not to meet a need of the therapist. Self-involving disclosures can help clients to gain insight into their behaviours or symptoms. Kreiter describes an incident in which a Dialectical Behaviour Therapist once received 25 voicemails from a client before he could get back to her; the therapist used that opportunity to share his reaction to all those calls with the client, in order to help her gain insight into her behaviours and others’ reactions to them (Kreiter, 2017).

Unavoidable or non-deliberate

The moment the client steps into the therapist’s office – or before that, when the client arrives in the neighbourhood, for home offices – the client receives a huge volume of information before the therapist can utter a single word. How affluent (or not) the neighbourhood/community is; what sorts of family connections the therapist has (viewed through photos and wedding rings); and the age, gender, body shape (obese or not), and manner of dress of the therapist all unavoidably give away masses of information. How the therapist speaks (including any foreign accents or stutters), walks (slow or fast, and is there a limp?), and even smells (e.g., choice of perfume or aftershave) disclose information that the therapist may not have ever chosen to divulge verbally. Especially those therapists who work in small, rural communities or, say, on remote military bases must contend with clients knowing much about them than what they have chosen to disclose (Zur, 2016; Kreiter, 2017).

Accidental

You have a poor night’s sleep because your child was sick, so you smother a yawn in session, but the client notices. You dash into the grocery store for a few items (of course, you’re in casual clothes, with hair not combed) and you run into the client. You join a new club and find that the client is serving on the executive board of the group. These are all ways in which accidental disclosure can occur, and often they are beyond your, the therapist’s, control (Knox, et al 1997). What can we say? Life happens.

Clients’ deliberate actions/client-initiated

You may end up in a situation, also beyond your control, in which the client finds out more information about you, by virtue of searching the internet, than you would reveal face-to-face. With the plethora of data available these days, it may be more of a wonder if the client is not able to obtain information in this way. Some of it you may have pre-sanctioned, such as your professional website or your page(s) on, say, your peak body’s website. But clients have also been known to be clever at accessing therapist’s social media pages, family tree and history, legal and criminal records, political affiliations, and community and recreational involvement. As a therapist, you may not know everything that is posted about you online, so you may not even know about information (whether true or not) that clients are reading about you.  Clients may have a reaction to some of this information, but if you turn the tables around and search information about the client, it may feel like an invasion of privacy if the client wasn’t ready to reveal the information yet (Kreiter, 2017; Zur, 2016).

Inappropriate

Some theorists add in the type, “inappropriate disclosure”, for those self-disclosures which are done for the benefit of the therapist rather than the client. It can happen through natural human tendencies, but may result in the client being burdened with information which engenders in the client a feeling that he or she must take care of the therapist’s needs (Kreiter, 2017). For example, let’s say you must cancel all of your appointments for a day because your mother dies and you must attend her funeral. That horrible event seems quite a justifiable reason to cancel sessions with clients, but as soon as you say why you must cancel (a natural tendency), the client becomes solicitous over how you are doing, asking if you need more time before the re-scheduled appointment, and asking if there is anything he or she can do for you: not what they are coming to therapy for!

To summarise this very grey area of therapy, we can say that there are multiple types of self-disclosure, some more uniformly justifiable or therapeutically helpful than others. Another question whose answer determines how much controllable disclosure the therapist makes is that of which client populations are being served. We turn to that now.

Whom do you tell – or not?

There are multiple considerations in self-disclosure apart from therapeutic orientation and the type of disclosure that would occur. One prominent one is the question of which client populations disclosure is appropriate for. Research indicates that it may be most beneficial for clients with whom therapists already have a solid therapeutic alliance or those with whom the therapist shares membership in a small community (e.g., the LGBT community). Equally, clients with poor boundaries and significant self-identity issues may not be able to handle disclosures (Yoviene, 2014). Let’s look more specifically at the rationales for disclosure with specific populations.

Adolescents are frequently resistant to therapy and see the therapist as an extension of their parents; thus they feel honoured and respected with a therapist disclosure.

Clients, especially children, with intellectual disabilities or less capacity for abstract thought may benefit from direct answers to questions that ask for disclosure.

Religious/spiritual-based therapies

Clients for whom religious or spiritual holding is a deciding factor in which therapist to select may ask questions during the initial interview or later about the therapist’s spiritual orientation.

Self-help and 12-step programs value self-disclosure and therapist transparency. Many of these self-help or peer-supported modalities are now mainstream modalities, and may include facilitated groups for addiction, domestic violence and abuse, rape, parenting, bereavement, and divorce (Zur, 2016).

War veterans or others with PTSD seem to be a group for which there is wide agreement that self-disclosure is particularly important (Stricker & Fisher, 1990).

Minority group members tend to perceive therapists who self-disclose or who are seen as coming from the same group as being more trustworthy and expert than those coming from a different group.

Gay and lesbian clients relate therapist self-disclosure to the issue of being “out”; thus transparency is an extremely important issue for them and therapist disclosure of sexual orientation is critical (Zur, 2016).

The serve and limit of self-disclosure

Research shows that experienced therapists use self-disclosure more extensively than do novice therapists, perhaps because new therapists have had it drummed into them that they should be wary of any self-disclosure and – risk averse – they tend to go more “by the book”. Whatever the reason, all therapists should be aware of the ways in which self-disclosure can serve and limit the client. Some of these you will have been able to predict from our discussions above regarding theoretical orientation and client population served.

How therapist self-disclosure can serve the client

  • It builds rapport and trust
  • It can equalise the relationship, reducing the power differential between counsellor and client, thereby reducing intimidation
  • It instils hope, especially in cases where the therapist successfully overcame something the client is currently dealing with
  • Clients feel like they are less isolated in an experience
  • It can provide a model for appropriate social interaction (especially for anxious, depressed, or socially unskilled clients)
  • It can normalise a client’s experience and validate it/them, thereby reducing shame (Hall, 2016; Howe, 2011)

How therapist self-disclosure can limit the client

  • Boundaries can be blurred and the professional relationship compromised, as the client comes to view the counsellor more as a “friend”
  • Role confusion can result
  • It can take the focus off the client, and cause the client to perceive that the therapist does not want to listen
  • The client may view the therapist as too impaired to help him or her
  • The client may feel burdened with the therapist’s disclosure, and thus hold back or censor information
  • The client may perceive the counsellor as being “too involved”
  • Clients may indirectly feel pressured into disclosing material they are not yet ready to divulge (Hall, 2016; Howe, 2011)

We can never predict ahead of time how a client will react to a disclosure, and each situation is unique. Nevertheless, there are some guiding principles for whether to disclose or not, apart from above considerations of theoretical orientation and type of client population.

Guiding principles for disclosure

  • WAIT! Hall (2016) proposes a mnemonic for the first principle: consider Why Am I Telling?
  • Be brief. Long narratives are unhelpful and damaging.
  • Make “I” Statements. The disclosure is your opinion, based on your experience. Make that clear.
  • Consider your client’s values. Alienation and rupture of the therapeutic relationship result when the therapist makes disclosures not aligned with client values. Check yours for this.
  • Consider the impact. If the disclosure would cause the client to feel burdened or trying to meet your needs, keep mum; the disclosure would be counter-clinical (Hall, 2016).

Relevant ethical principles: Checkpoints

Throughout this discussion, clinical and ethical considerations have been intertwined, but let us now separate out the ethical issues. The three ethical principles which are most relevant to therapist self-disclosure are those of beneficence, nonmaleficence, and respecting the fiduciary relationship:

  • Beneficence: as therapists we observe an ethical code of seeking to benefit the client rather than ourselves. Respect for the dignity of the client is paramount, as opposed to taking advantage of him or her.
  • Nonmaleficence: We strive to do no harm. Thus, we do not use the client for our own gratification, or to advance our own goals; we do not act with undue influence or coercion.
  • Fiduciary relationship: We strive to not exploit the client, monetarily or in other ways. Thus, any self-disclosure that is exploitative or narcissistic/exhibitionistic, or which seeks to unburden the therapist without benefit to the client, violates the fiduciary relationship and is unethical (Gutheil, 2010).

Summary

Clearly, therapist self-disclosure is a controversial topic with many views of how, when, to whom, and in what context it will be beneficial for the client. Theoretical orientation, type of disclosure made, and type of client population all contribute to the uniqueness of each situation in determining whether a disclosure should be made. While going for benefits such as enhanced hope, trust, and therapeutic relationship with a consequent reduction in isolation and shame, we must continually be on the lookout for any blurring of boundaries, role confusion, or other burdening of the client which would signal that, in disclosing, we are acting for our own ends rather than the client’s – and we must assess our own comfort levels with any disclosure. Ultimately, both disclosure and non-disclosure may foster or impair the therapeutic alliance.

References

  • Gutheil, T.G. (2010). Ethical aspects of self-disclosure in psychotherapy. Psychiatric Times. 2010; 27(5). Retrieved on 5 June, 2018, from: Hyperlink
  • Hall, L. (2016). Five golden rules for using self-disclosure in counselling. Open Colleges. Retrieved on 5 June, 2018, from: Hyperlink
  • Henretty, J.R., & Levitt, H.M. (2010). The role of therapist self-disclosure in psychotherapy: A qualitative review. Clinical Psychology Review. 2010; 30: 63-77.
  • Howe, E. (2011). Should psychiatrists self-disclose? Innovations in Clinical Neuroscience. 2011 Dec; 8(12): 14-17. Published online 2011: PMID: 22247813
  • Kessler, L. E., & Waehler, C. A. (2005). Addressing multiple relationships between clients and therapists in lesbian, gay, bisexual, and transgender communities. Professional Psychology: Research and Practice, 36(1), 66-72. http://dx.doi.org/10.1037/0735-7028.36.1.66
  • Knox, S., Hess, S. A., Petersen, D. A., & Hill, C. E. (1997). A qualitative analysis of client perceptions of the effects of helpful therapist self-disclosure in long-term therapy. Journal of Counseling Psychology, 44(3), 274-283. http://dx.doi.org/10.1037/0022-0167.44.3.274
  • Jourard, S.M. (1971). Self-disclosure: An experimental analysis of the transparent self. Canada: John Wiley & Sons.
  • Stricker, G., & Fisher, M. (Eds.). (1990). Self-disclosure in the therapeutic relationship. New York, N.Y., U.S.: Plenum Press.
  • Yoviene, L. (2014). To disclose or not to disclose? The role of therapist self-disclosure and implications for mentoring relationships. The chronicle of evidence-based mentoring, R. Spencer, (Ed.). Retrieved on 5 June, 2018, from: Hyperlink
  • Zur, O. (2016). Self-disclosure & transparency in psychotherapy and counselling: To disclose or not to disclose, this is the question. Zur Institute. Retrieved on 5 June, 2018, from: Hyperlink