I recently had a client tell me how much she liked me as a therapist, but also as a person. She acknowledged that she knew very little about me personally to make this acclamation. The limited disclosure of the therapist is true of most therapeutic interactions. While the client shares many personal and private details from their lives, the therapist usually discloses very little. This got me thinking about the role of therapist self-disclosure in therapy.
Self-disclosure is the revelation of personal information about the therapist during session. The clinical use of therapist self-disclosure is a highly debated topic. Some therapists air on the side of caution and take an objective stance in the room by not disclosing any personal information. In psychoanalytic theory, non-disclosure is the therapist’s standard position in order to conduct therapy within a strictly neutral frame (Hanson 2005). Non-disclosure can be viewed as a therapist's ethical requirement, since self-disclosure can blur the lines of professional boundaries and cause ruptures in client-therapist alliance. Other therapies, such as humanistic therapy and feminist therapy, contends disclosure as both expected and desirable in order to empathize with the client and reduce power imbalances (Hanson 2005). Unlike, disclosure, the use of non-disclosure is not typically questioned or justified. But can self-disclosure always be avoided? What qualifies as therapist self-disclosure? Is self-disclosure a mistake or an inevitable part of all interpersonal relationships?
There are five types of self-disclosure (Zur 2015) that I will explore:
- Deliberate Disclosure
- Non-Deliberate Self-Disclosure
- Accidental Self-Disclosure
- Inappropriate Self-Disclosure
- Client- Initiated Disclosure
There are two types of deliberate self-disclosure: 1) self-revealing, which is the disclosure of information by the therapist about herself, and 2) self-involving which has to do with the therapist’s personal experience and reaction to the client, which takes place during the session (Knox, et al., 1997). Self-revealing self-disclosure should be purposeful, clinically driven and appropriate. This type of disclosure should be carried out for the benefit for the client, not to satisfy a personal need of the therapist. A client once explained a religious ceremony to me. Unbeknown to this client, I share the same religious background with her and was familiar with this ceremony. In any other social interaction, I would openly have shared, even revealed in our commonality. However, in this instant I did not disclose, as it would not have benefited the client. Instead, I allowed the client to continue her description of the ceremony and found meaning in her interpretation.
In self-involving disclosure the disclosure provided by the therapist can help the client gain insight about a behavior or symptom. In Dialectical Behavioral Therapy (DBT), this type of self-disclosure is used to help the client better understand the impacts of her behaviors. A DBT therapist once shared that he had a client call him repeatedly when in a crisis. The client had once left him 25 voicemails before the therapist could get back to her. The therapist took this opportunity to disclose how he reacted to these multiple phone calls in order to help the client gain insight of her behaviors and others (including her therapist's) reactions to them.
Non-deliberate self-disclosure includes a range of possibilities, such as therapist’s distinctive physical attributes, such as gender, age, visible tattoos, piercings, pregnancy, disability or injury (Zur 2015). A home office can reveal extensive non-deliberate self-disclosure, such as therapist's economic status, neighborhood, community, family and pets. Therapists can present themselves by the manner in which they dress, the style of their hair, use of make-up, and adoring jewelry. Many clients pick up on these attributes, making assumptions of their own. After my engagement, a client admitted to taking notice to my ring and shared that she was happy for me. Even, a therapist's announcement of a vacation can constitute as non-deliberate self-disclosure, especially if pressed to reveal where the vacation is to take place.
Accidental self-disclosure occurs when there is a spontaneous verbal or non-verbal reaction (the raise of an eyebrow, a slight frown and an accidental yawn). Sometimes the therapist is unaware of these reactions or outside of her control. A therapist may have an unplanned negative response to a client's statement (Zur 2015). Accidental self-disclosure may happen when a client and therapist run into each other outside of the office.
Inappropriate or counter-clinical self-disclosure is disclosure done for the benefit of the therapist and not for the client. This type of self-disclosure can be a slippery slope as it can often burden the client with unnecessary information about the therapist or create a role reversal where the client feels that she must take care of the therapist's needs.
The following example illustrates how easy it is for simple disclosure to become counter-clinical. I had a client that I began working with around the November/ December holidays. On Thanksgiving, she reached out to me wishing me a happy holiday. During a session in late December, she asked me if I celebrated Christmas or Hanukkah, which happened to fall on the same day that year. Given some of the issues that she came into therapy with and her tendency to try to blur therapeutic lines, I was cautious with my disclosure and asked her why she wanted to know. She responded, "Because I want to make sure I text you the right holiday." Rather than my disclosure, what followed was a conversation about her need to see our relationship as a personal friendship rather than a professional and therapeutic one. Had I not been as cautious, this client would have continued to test boundaries, which would have impacted the rest of our work together.
With a plethora of information available to clients by way of the Internet, client initiated disclosure has become easier than ever. Clients can use the Internet to search therapist’s professional websites and blogs, educational and training information, professional experiences, orientations of treatment, but also personal information such as a therapist’s private social media pages, legal records, political affiliations, community and recreational involvement (Zur 2015). Some clients may have a strong reaction to information about their therapist that they discover via the web.
My first time meeting a new client, she shared that she had Googled me prior to our first session and assumed that I had done the same to her (I had not). A quick Google search can reveal a lot of information about a client’s therapist, including what a therapist may knowingly or inadvertently disclose online. Of note, a therapist-initiated disclosure, such as a therapist Googling a patient prior or during the course of treatment, may also feel like an invasion of privacy, especially if it reveals something that the client was not ready to share in treatment.
Disclosing My Beliefs on Disclosure
I have been casually blogging for about a year now. While I felt that blogging could help grow my practice, there was a part of me that was hesitant to begin blogging in the first place. Behind the anonymity of a computer screen, I am more inclined to share personal parts of myself to an unknown reader than I am in a face-to-face in the therapy room.
If you adhere to the idea that a blog is like an online diary, where one can post messages and others can view and respond to these posts, then blogging may be seen as a form of a therapist's deliberate self-disclosure. When a person becomes a therapist, she does not give up the privileges of self-expression. However, there is a level of self-disclosure that naturally comes with any type of freedom of expression. A client gaining insight to a therapist's viewpoint through their blog is not necessarily problematic, but one does need to be mindful about what this type of deliberate self-disclosure may do to the relationship. When publishing and maintaining my blog, I use good judgment and think about what affects my words may have on my current and prospective clients.
In summary, I acknowledge that self-disclosure tends to be a therapeutic gray area and therapists often disagree on what amount of disclosure is appropriate. Some therapeutic orientations, such as humanistic, feminist and existential psychotherapies emphasize the importance of self-disclosure and transparency to reduce power differentials, build trust and enhance authentic therapeutic alliances (Hanson 2005). However, too much self-disclosure may risk the client viewing the therapist as a friend rather than a professional helper. Further poorly executed self-disclosure, can actually increase distrust by making the client feel as though the therapist is more focused on their own issues rather than those of the client (Ferraro, 2010). In cognitive and behavioral therapies, self-disclosure can be an effective vehicle for modeling, reinforcing and normalizing new techniques learned. By revealing failings and successes in the therapist's life, it may convince the client of the effectiveness of the treatment. However, the client may feel that the therapist is impaired and unable to help them.
In my experience, building a therapeutic relationship and teaching new skills can all be done without the use of self-disclosure. Self-disclosure may initially make the client feel more comfortable, but be harmful for the relationship later. The decision not to disclose has helped me to maintain my objectivity in the therapy room. Through this objectivity, my clients have been able to identify and explore projections, vocalize needs and see themselves through the therapeutic relationship. I often share similarities with my clients—a favorite place, a familiar tradition, or a shared sentiment—but I chose not to disclose. What would this gain? Perhaps a temporary or superficial connection may be gain through my self-disclosure. But the connection that my clients and I have built in the room is based on trust and safety, not self-disclosure.
Ferraro, J (2010). How psychotherapists’ self-disclosure affects the therapeutic relationship with clients [Blog post]. Retrieved from http://psychotherapist-nyc.blogspot.com/2010/06/how-psychotherapists-self-disclosure.html
Hanson, J. (2005) Should your lips be zipped? How therapist self-disclosure and non-disclosure affects clients. Counseling & Psychotherapy Research. Doi: 10.1080/17441690500226658. Retrieved from Wiley Online Library http://onlinelibrary.wiley.com/doi/10.1080/17441690500226658/full
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. doi:10.1037/0022-018.104.22.1684
Leslie, R. (2009). Self-disclosure: Personal blogs. [Blog post]. Retrieved from Avoiding Liability Bulletin http://www.cphins.com/self-disclosure-personal-blogs/
Zur, O. (2015). The Google Factor: Psychotherapists' Intentional and Unwitting Self-Disclosure on the Net. Online Publication by Zur Institute. Paper retrieved on month/day/year from http://www.zurinstitute.com/onlinedisclosure.html.
Zur, O. (2016). Self-Disclosure & Transparency in Psychotherapy and Counseling: To Disclose or Not to Disclose, This is the Question. Retrieved month/day/year from http://www.zurinstitute.com/selfdisclosure1.html.