Self Disclosure By Therapists: Ethical & Clinical Considerations course (4 CE Credit Hours)
- How much should I self-disclose to my clients?
- To whom should I self-disclose?
- When should I disclose?
- What should never be disclosed?
- Can I get into trouble for disclosing too much?
These questions and many others are answered in this Clinical Update and in much more detail in our Self-Disclosure online course for 4 CE credits.
Self-Disclosure In Psychotherapy: A Recap
Self-disclosure has been one of the most misunderstood constructs in psychotherapy. Somehow the traditional psychoanalytic notion of neutrality and anonymity along with rigid risk-management advice have dominated our thinking on the issue. It overshadows sound and proven behavioral and cognitive-behavioral interventions, such as modeling and the emphasis of humanistic, feminist or group psychotherapy on authentic relationships.
At its most basic, therapist self-disclosure may be defined as the revelation of personal rather than professional information about the therapist to the client. When therapist disclosure goes beyond the standard professional disclosure of name, credentials, office address, fees, office policies, etc., it becomes self-disclosure.
There is a commonly held belief that self-disclosure is what we tell our clients. In fact there are many forms of self-disclosure, which involve the way we walk, talk, greet, discuss issues, spontaneously react to our clients, dress or decorate our offices, and how we answer or do not answer their questions.
ince the 1990s we have witnessed a cultural shift where celebrities and politicians, such as Oprah Winfrey, Elizabeth Taylor or Bill Clinton, have accustomed the public to intimate and detailed confessions on national TV. At the same time, Oprah, Dr. Phil and endless realty shows have promoted extreme and often bizarre self-disclosure by people on TV in front of millions of strangers. As a result, modern consumers feel entitled to access all kinds of information about their therapists. With the click of a button they can turn to medical boards, federal medical data banks and a vast array of resources that are ready to provide private information about their therapists. Of course, they can Goggle us and find all kinds of information that we had no idea was even available to the public.
Appropriate and clinically driven self-disclosures are carried out for the clinical benefit of the client. Many disclosures are simply unavoidable. Inappropriate self-disclosures are those that are done primarily for the benefit of the therapist, clinically counter-indicated, burdens the client with unnecessary information or creates a role reversal where a client, inappropriately, takes care of the therapist.
Types Of Self-Disclosure
There are four different types of self-disclosure:
1. Deliberate self-disclosure refers to the therapist’s intentional, verbal or non-verbal disclosure of personal information. It applies to verbal information shared by the therapist and also to deliberate actions, such a placing a certain family photo in the office or making a sigh in response to the client.
There are two types of deliberate self-disclosure: Self-revealing, which is the disclosure of information by therapist about themselves, and self-involving, which involves therapist’s personal reactions to client and to occurrences during sessions.>
2. Unavoidable self-disclosure includes a wide range of possibilities, such as therapist’s gender, age and physics, place of practice, tone of voice, pregnancy, foreign or any accent, stuttering, visible tattoos, obesity and many forms of disability, such as paralysis, blindness, deafness or an apparent limp. Therapists also reveal themselves by their manner of dress, hairstyle, use of make-up, jewelry, perfume or after shave, facial hair, wedding or engagement rings, or the wearing of a cross, Star of David or any other symbol. Therapists who practice from their homes disclose extensive information, such as economic status, information about the family and pets, sometimes information about sexual orientation, hobbies, habits, neighbors, community and much more. Therapists who practice in small or rural communities must all contend with extensive self-disclosure of their personal lives by virtue of the setting. Non-verbal cues or body language (i.e., a raised eyebrow or flinch) are also sources of self-disclosure that are not always under the therapist’s full control. Even not answering the client’s questions about the therapist’s personal life is considered a form of self-disclosure.
3. Accidental self-disclosure occurs when there are spontaneous or unconscious verbal or non-verbal reactions during a session. Also included are unplanned meetings outside the office.
4. A client’s deliberate actions are potentially rich sources that can reveal personal information about the therapist. Of course, the prime example is in the movie, What About Bob? A client can initiate inquiries about their therapist by conducting a simple Web search. Such searches can reveal a wide range of professional and personal information, such as family history, family tree, volunteer activities, criminal records, community and recreational involvement, political affiliations and much more. Therapists’ online biographies or professional resumes may also reveal significant information about the therapist. A client’s deliberate spying on their therapist can reveal a significant amount of private and personal information.
Self-Disclosure & Therapeutic Orientations
The attitude towards therapeutic self-disclosure is closely related to the therapist’s primary theoretical orientation.
- Behavioral, cognitive and cognitive-behavioral therapies have emphasized the importance of modeling, reinforcement and normalizing in therapy and view self-disclosure as an effective vehicle to enhance these techniques.
- Humanistic and existential psychotherapies have always emphasized the importance of self-disclosure in enhancing authentic therapeutic alliance, the most important factor in predicting clinical outcome.
- Traditional analysts have followed Freud’s instructions to serve as a mirror and a blank screen for the client, freeing the client to project their own feelings and thoughts onto the rather neutral therapist. Neutrality, abstinence and anonymity, according to traditional analytic theory, are the foundations for transference analysis. In contrast, the interpersonal focus of several modern psychodynamic psychotherapies has emphasized the importance of self-disclosure in relational and intersubjective perspectives.
- Family therapy, Ericksonian therapy and Adlerian therapy use it for the purposes of modeling and therapeutic alliance.
- Group psychotherapy is another orientation that has stressed the importance of self-disclosure.
- Feminist therapy values therapist self-disclosure for its role in fostering a more egalitarian relationship and solidarity between therapist and client, promoting client empowerment and allowing the client to make informed decisions in choosing women-therapists as role model.
- Self-help based therapies use self-disclosure extensively.
- Narrative therapy also places a high value on what they call therapists’ transparency.
Self-Disclosure With Different Populations
Therapists working with different populations have different rationales for self-disclosure:
- Self Help and 12 Step Programs are the most common use of self-disclosure, such as Alcoholics Anonymous, Narcotics Anonymous, Over-Eaters Anonymous and other self-help and peer-support models.
- Children and those with a diminished capacity for abstract thought often benefit from more direct answers to questions requiring self-disclosure.
- Adolescents are often resistant to therapy as they frequently see adult therapists as authority figures and extensions of their parents.
- Religious and spiritual based therapies: Self-disclosure has a unique importance for therapists working psychotherapeutically with patients who hold particular religious or spiritual beliefs. These clients often ask therapists questions about their spiritual orientations and values as part of the interview process.
- Gay and lesbian clients present one the most convincing arguments for self-disclosure. Self-disclosure is a very important issue as it relates to the key issue of being “out.”
- War veterans with PTSD have often been cited as a group of clients with which self-disclosure seems clinically important.
- Minorities are often more comfortable with therapists who self-disclose or were observed or perceived by clients as coming from the same or a similar minority group.
To Zip Or Not To Zip?
- Be aware of the wide range of types and forms of self-disclosure and their potential impact on clients.
- Do not focus only on verbal and intentional forms of self-disclosure.
- National surveys have consistently shown that most therapists are involved in some form of intentional self-disclosure.
- Deliberate self-disclosure generally should be geared for clinical-therapeutic purposes and for the client’s benefit.
- Self-disclosure should not aim to primarily satisfy the therapist’s needs, pride or ego.
- Excessive or inappropriate self-disclosure may create a situation where the client is no longer the focus of treatment or where the client perceives a need to take care of the therapist.
- As with any decision regarding boundary crossing, the decision to self-disclose is based first and foremost on the welfare of the client.
- Almost all professional codes of ethics do not address directly the issue of self-disclosure.
- 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.
- When self-disclosure is unavoidable, as often is the case in small communities, therapists must evaluate whether such exposure is likely to benefit, interfere, have impact or effect the therapeutic process in any way.
- Therapists who are engaged with significant or systematic self-disclosure should document or explain their clinical rationale in the clinical records.
- As with any other intervention, deliberate self-disclosure should be determined by the client’s factors (i.e., presenting problem, history, gender, culture, age, mental capacity); therapist’s theoretical orientation; therapist’s culture and comfort with self-disclosure; and the setting of therapy (i.e., home office, military base, small town).