Self-Disclosure & Transparency In Psychotherapy And Counseling

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. Appropriate and clinically driven self-disclosures that are carried out for the clinical benefit of the clients and unavoidable (non-harming) self-disclosure that takes place in the community are considered boundary crossings (Gutheil & Gabbard, 1993; Lazarus & Zur, 2002; Williams, 1997; Zur, 2007, 2008, 2009). Inappropriate self-disclosures, such as self-disclosure that is done 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, are considered a boundary violation (Gutheil & Gabbard, 1998; Zur, 2004a).

 
Types Of Self-Disclosures

There are four different types of self-disclosures: deliberate, unavoidable, accidental and client initiated. Following are descriptions of these types.

• Deliberate self-disclosure refers to therapists’ intentional, verbal or non-verbal disclosure of personal information. It applies to verbal and also to other deliberate actions, such a placing a certain family photo in the office, office décor or an empathic gesture, such as touch or a certain sound (Barnett, 1998; Gutheil & Gabbard, 1998; Mahalik, Van Ormer & Simi, 2000 ; Zur, 2007). There are two types of deliberate self-disclosures. The first one is self-revealing, which is the disclosure of information by therapists about themselves. The second type has been called self-involving, which involves therapists’ personal reactions to clients and to occurrences that take place during sessions (Knox, Hess, Petersen, & Hill, 1997).
• Unavoidable self-disclosure might include an extremely wide range of possibilities, such as therapist’s gender, age and physics. It also covers disclosure through 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 reveal themselves also by their manner of dress, hairstyle, use of make-up, jewelry, perfume or aftershave, facial hair, wedding or engagement rings, or the wearing of a cross, star of David or any other symbol (Barnett, 1998; Tillman, 1998 ; Zur, 2007). As will be discussed in the Home Office Section, when the therapy office is located at the therapist’s home, it always involves extensive self disclosures, such as economic status, information about the family and pet, sometimes information about sexual orientation, hobbies, habits, neighbors, community and much more. Therapists who practice in small or rural communities, on remote military bases or aircraft carriers, or those who work in intimate and interconnected spiritual, ethnic, underprivileged, disabled or college communities, must all contend with extensive self-disclosure of their personal lives simply because many aspects are often displayed in clear view of their clients by virtue of the setting. In many of these small community situations a therapist’s marital status, family details, religion or political affiliation, sexual orientation and other personal information may be readily available to clients (Brown, 1984; Campbell & Gordon, 2003; Hargrove, 1986; Nickel, 2004; Schank & Skovholt, 1997; Stockman, 1990 ; Zur, 2006, 2007). Non-verbal cues or body language (e.g., a raised eyebrow, flinch) are also sources of self-disclosure that are not always under the therapist’s full control. Clients, like people in general, are often more attuned to non-verbal cues, such as body language and touch, than to verbal communication (Knapp & Hall, 1997). Even for analysts who strive to minimize self-disclosure, every intervention nonetheless hides some things about the analyst and reveals others (Aron, 1991). A therapist’s announcement of an upcoming vacation, or at least time outside the office, is also unavoidable self-disclosures.
• Accidental self-disclosure occurs when there are incidental (unplanned) encounters outside the office, spontaneous verbal or non-verbal reactions, or other planned and unplanned occurrences that happen to reveal therapists’ personal information to their clients (Knox, Hess, Petersen, & Hill, 1997; Stricker & Fisher, 1990).
• Clients’ deliberate actions are also potential sources that can reveal personal information about the therapists. Clients can initiate inquiries about their therapist by conducting a simple Web search (Zur, 2007, 2008; Aur & Donnor, 2009). Such searches can reveal a wide range of professional and personal information, such as family history, criminal records, family tree, volunteer activity, community and recreational involvement, political affiliations and much more. Therapists do not always have control over what is posted online about them, which means they may not have control or even knowledge of what clients may know about them. Therapists’ biographies or professional resumes may also reveal significant information about the therapist. A client’s deliberate tracking, spying or stalking their therapist can reveal a significant amount of private and personal information.

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Historical Context

Discussions of psychotherapist self-disclosure dates back to the earliest years of psychotherapy. As early as 1912, and consistent with the puritanical culture of his time, Freud emphasized that “The physician should be impenetrable to the patient, and like a mirror, reflect nothing but what is shown to him” (Petersen, 2002, p. 21). The rise of the humanist movement in the ’60’s advanced the argument that self-disclosure could be therapeutic and valuable. In 1971 Jourard (1971a) published Self-disclosure: An Experimental Analysis of the Transparent Self, which has been highly popular among humanistic psychotherapists ever since. The feminist movement of the 1970s and 1980s added a political dimension, in which feminist therapist self-disclosure was valued for its role in modeling and fostering a more egalitarian relationship between therapist and client (Brown, 1994; Greenspan, 1995; Simi & Mahalik, 1997). Simultaneously, the 12-step programs used in many support groups, which are based on mutual self-disclosure, have proliferated since the 1980s and 1990s. The 1990s have witnessed a cultural shift where celebrities and politicians, such as Oprah Winfrey, Kitty Dukakis, Elizabeth Taylor and Patty and Michael Reagan, have accustom the public to intimate and detailed confessions on national TV. At the same time, Oprah, Geraldo, Donahue and Roseanne -type shows have promoted extreme and often bizarre self-disclosure by people on TV in front of millions of strangers. In the new millennium so-called reality shows that promote uncensored voyeurism and uninhibited self-disclosure have burgeoned. Societal change in attitude has manifested itself also in medicine and mental health services. In the managed care era of the 1990s patients or clients have become consumers and physicians and psychologists have become providers. Consumers have been empowered to become informed and to question their providers’ experience and expertise. Modern consumers feel entitled to access all kinds of information about their medical caregivers, and they can turn to medical boards, federal medical data banks, consumer protection agencies and a vast array of private, for-profit enterprises that are ready to provide it. Finally, the Internet has brought about the most significant information revolution. Consistent with consumer requests for information, more and more psychotherapists are constructing consumer friendly, personal Web sites featuring not only professional data, but significant amounts of personal information as well (Zur, 2007).

On the professional front dovetailing with the humanistic, feminist and self-help movements, several new approaches to therapeutic self-disclosure surfaced towards the end of the 20th century and at the beginning of the 21st. Authors from orientations, such as behavioral, cognitive and cognitive-behavioral, have discussed the therapeutic benefits of self-disclosure from the angle of their particular modality (Burns, 1990; Goldfried, Burckell & Eubanks-Carter, 2003; Lazarus, 1994). Even psychodynamic oriented therapists have reviewed the clinical utility of self-disclosure (Bridges, 2001; Goldstein, 1997; Renik, 1996). The end of the ’90s and the beginning of the new millennium have also seen increasingly open discussion about flexible therapeutic boundaries in general (i.e., Lazarus & Zur, 2002; Younggren & Gottlieb, 2004) and a surge in articles on self-disclosure in particular (i.e., Bridges, 2001; Kessler & Waehler, 2005; Petersen, 2002). Similarly, the APA Code of Ethics of 2016, like the prior ethics codes, provides needed clarity to the issues when it stated that therapeutic interventions should be judged by the ” . . . prevailing professional judgment of psychologists engaged in similar activities in similar circumstances” (p. 162) rather than by certain theoretical orientations or arbitrary rules. Taken all together, it becomes clear that a positive view of professional attitudes toward self-disclosure have co-evolved with the cultural attitudes toward self-disclosure.

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Self-Disclosure & Therapists’ Transparency And Therapeutic Orientations

The attitude towards therapeutic self-disclosure is closely related to the therapist’s primary theoretical orientation. Generally, highly disclosing therapists viewed the focus of the psychotherapy process as an interconnection between the therapist and the patient, whereas less disclosing therapists focused on working through patients’ projections (Petersen, 2002; Stricker & Fisher, 1990). Different therapeutic orientations have obviously different takes on self-disclosure:

• 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 (Langs, 1982; Petersen, 2002). Self-disclosure within the analytic tradition is thought to result in gratification of patients’ wishes rather than analysis of them (Mallow, 1998). Along these lines Simon (1994) advocates that psychotherapists: “Maintain therapist neutrality. Foster psychological separateness of the patient . . . Preserve relative anonymity of the therapist” (p. 514). In contrast the interpersonal focus of several modern psychodynamic psychotherapies has emphasized the importance of self-disclosure in relational and intersubjective perspectives (Aron, 1991; Bridges, 2001; Burke, 1992; Cooper, 1998; Stricker & Fisher, 1990).
• Humanistic and existential psychotherapies have always emphasized the importance of self-disclosure and therapists’ transparency in enhancing authentic therapeutic alliance, the most important factor in predicting clinical outcome (Lambert, 1991; Norcross & Goldfried, 1992). Humanistic therapists assert that therapist self-disclosure allows patients to recognize that all people have failings and unresolved matters in their lives and that there is no essential difference, in fact, between psychotherapists and patients (Bugental, 1987; Stricker & Fisher, 1990; Williams, 1997). Jourard (1971b), in his widely quoted book, Self-Disclosure: An Experimental Analysis of the Transparent Self, discusses at length the importance of self-disclosure for humanistic psychotherapy.
• Group psychotherapy is another orientation that has stressed the importance of self-disclosure. Yalom states: “Group psychotherapists may–just like other members in the group–openly share their thoughts and feelings in a judicious and responsible manner, respond to others authentically and acknowledge or refute motives and feelings attributed to them” (Stricker & Fisher, 1990, p. 198).
• 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 (Freeman, Fleming, & Pretzer 1990; Goldfried, et al., 2003). Lazarus (1994), one of the founders of behavioral therapy, details the importance of therapists answering clients’ appropriate questions. He further lays out the potential disruption to the clinical process that can result from therapists always responding to clients’ questions with questions (e.g., “Can you tell me why you want to know?”) rather than answering the questions. In a similar fashion several authors discuss the importance of self-disclosure in Rational-Emotive Therapy (RET). Modeling the rational-emotive process by using disclosures and examples from therapists’ personal lives was reported to be a highly effective way to convince clients of its utility (Dryden, 1990; Tantillo, 2004).
• Feminist therapy values therapist self-disclosure and therapists’ transparency for its role in fostering a more egalitarian relationship and solidarity between therapist and client, promoting client empowerment and allowing them to make informed decisions in choosing women-therapists as role models (Brown, 1994; Greenspan, 1986; Kessler & Waehler, 2005; Simi & Mahalik, 1997). Therapists and clients joining together in political demonstrations and other political activities is encouraged as a means to model and empower clients. Greenspan (1995) states, “I am a great believer in the art of therapist self-disclosure as a way of deconstructing the isolation and shame that people experience in an individualistic and emotion-fearing culture” (p. 53). Self-disclosure is viewed in feminist therapy as the ultimate way to equalize the power differential between therapists and clients and the most effective way to transmit feminist values from therapist to client.
• Self-help based therapies use self-disclosure extensively (Mallow, 1998).
• Narrative therapy also places a high value on what they call therapists’ transparency (White & Epston, 1990).
• Family therapy, Ericksonian therapy and Adlerian therapy use it for the purposes of modeling and therapeutic alliance (Stricker & Fisher, 1990).

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Self-Disclosure With Different Populations

Therapists working with different populations have different rationales for self-disclosure:

• Self Help and 12 Step Programs is the most common use of self-disclosure and therapists’ transparency, such as Alcoholics Anonymous, Narcotics Anonymous, Over-Eaters Anonymous and other self-help and peer-support models. Many of these self-help modalities have entered the therapeutic mainstream and include clinician-facilitated support groups for addiction, parenting, abuse, rape, domestic violence, bereavement or divorce (Mallow, 1998).
• Children and those with a diminished capacity for abstract thought often benefit from more direct answers to questions requiring self-disclosure (Psychopathology Committee of the Group for the Advancement of Psychiatry, 2001).
• Adolescents are often resistant to therapy as they frequently see adult therapists as authority figures and extensions of their parents. Self-disclosure is one way to make adolescent clients feel honored and respected rather than judged and patronized.
• 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. Many clients choose their therapists because they are aware of their spiritual orientation (Geyer, 1994; Llewellyn, 2002; Montgomery & DeBell, 1997; Tillman, 1998).
• Gay and lesbian clients present one the most convincing arguments for self-disclosure and therapists’ transparency. 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.
• War veterans with PTSD have often been cited as a group of clients with which self-disclosure seems clinically important (Stricker & Fisher, 1990).
• 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. Such therapists were viewed as more trustworthy and expert than those from a dissimilar group (Sue & Sue, 2003).

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Ethical Decision-Making & Self-Disclosure

There are a number of concerns that are associated with self-disclosure. The one most commonly cited is that self-disclosure is not done for clinical-therapeutic purposes or for the client’s benefit but rather for the therapist’s. Thus the intent of the therapist is extremely important, as it should be focused firmly on the client’s welfare and should not be fueled by the gratification of the therapist’s needs or desires (Barnett, 1998; Bridges, 2001; Mallow, 1998 ; Zur, 2007). Several writers have raised the concern that the therapist’s self-disclosure should neither burden the client nor be excessive nor create a situation where the client needs to care for the therapist. Most scholars and ethicists agree, generally, that therapists should not share their sexual fantasies with their clients (Fisher, 2004; Gabbard, 1989; Pope, Tabachnick, & Keith-Spiegel, 1987; Stricker & Fisher. 1990).

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, 2016). 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.

The client’s presenting problem, history, gender, culture, age, sexual orientation, mental ability and other client factors should be considered before the therapist elects to self-disclose. Therapists’ theoretical orientation and comfort with self-disclosure is often determined by their culture, gender and personality. These are obvious factors determining the extent of their self-disclosure. Therapists who work out of their homes should also be aware that this most personal of settings presents abundant self-disclosure that may have significance for some clients. The home office arrangement inevitably exposes the therapists’ personal, familial and even financial life.

Extensive Bibliography on Self-Disclosure in Psychotherapy and Counseling

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