The Big Reveal
Ethical Implications of Therapist Self-Disclosure
I was recently at a lecture where an audience member asked the speaker, psychologist Dr. Richard Schwartz, about his stance on the role of therapist self-disclosure. Dr. Schwartz paused for a moment before responding that he often urges supervisees to bring to mind the acronym WAIT before engaging in self-disclosure in a session (personal communication, September 18, 2014). Short for “Why Am I Telling?” he explained that this self-directed question is aimed at getting clinicians to consider whether they would be self-disclosing expressly for the client’s benefit, or if they would be doing so to fulfill a personal need. In the event that the therapist is inclined to self-disclose to gratify her own need, she is advised to abstain from self-disclosing in order to prioritize the client’s needs within the therapeutic relationship.
The question of what constitutes ethical and useful self-disclosure is one that comes up regularly during my training as a psychologist. Though I found the “WAIT” rule-of-thumb helpful in generally guiding my decision making, I was left wondering about how, as psychotherapists, we can assess whether or not our clients are likely to benefit from our self-disclosure in a given situation. Are there certain types of disclosure that, as a rule, are more useful than others? What are the client variables worthy of consideration? As psychotherapists, what do we need to know about in-session self-disclosure to make decisions that uphold the general ethical principles, particularly beneficence and nonmaleficence (APA, 2010)?
The present paper aims to address these questions and in so doing, puts forth a number of considerations to stimulate productive thinking about ethical therapist self-disclosure (TSD). The concept of TSD will be clearly defined and two distinct types of disclosure will be identified. Both research studies and theory will be presented to inform this analysis of potential advantages and drawbacks of TSD. Finally, a number of unique circumstances that may warrant special attention to the issue of TSD will be briefly discussed.
For many, the term “therapist self-disclosure” tends to evoke an image of a psychotherapist revealing some deeply personal fact about himself during a therapy session. In truth, therapist self-disclosure refers to a wide range of psychotherapist behaviors, which may be verbal or nonverbal in nature (Gibson, 2012). A verbal disclosure can be an explicit disclosure of fact, or a style of speaking that suggests membership to a particular culture. Examples of non-verbal disclosure include religious attire, office decoration, and public participation in political events within the community.
In her conceptualization, Audet (2011) identifies two distinct categories of TSD. Immediate self-disclosure, which is also known as self-involving or interpersonal self-disclosure, refers to the revelation of the therapist’s feelings about the client, the therapeutic relationship, or an in-session event. An example of such a disclosure would be a therapist telling his client that when she is regularly late to sessions, he is left wondering if she values her time in therapy. This kind of disclosure is generally used to address a process issue within therapy, and in so doing, bring the client’s attention to her potential impact on others. In contrast, non-immediate or intrapersonal self-disclosure refers to disclosed information about the therapist’s personal life and tends to shift the focus from the client. A therapist who shares having had a similar traumatic experience to that of the client can be said to be engaging in non-immediate self-disclosure. This type of TSD is often intended to promote client-therapist rapport, convey the fallibility of the therapist, and make the client-therapist relationship more egalitarian.
We turn now from the definition of therapist self-disclosure to a summary of the research done in the field. Historically, research on therapist self-discolsure has yielded mixed results about the desirability of self-disclosure (Gibson, 2012). One finding is that therapist self-disclosure likely impacts the therapist’s level of perceived professionalism and competence (cited in Audet, 2011). This issue may be especially pertinent for therapists in training who are still establishing their professional identity. Most of the research reviewed in Audet’s 2011 study demonstrated that low-disclosing therapists were generally rated by clients to be more competent than their high-disclosing peers. Yet one study found no substantial evidence that disclosing therapists were viewed as less competent and still another showed that clients perceived their disclosing therapist positively because they viewed them as being more real, human, and imperfect (Audet, 2011).
To better parse out the factors that differentiate between positively and negatively received disclosure, Audet (2011) conducted a qualitative study in which nine participants were asked to talk about a time when their therapist used non-immediate self-disclosure (that is, revealed information about his or her own personal life). As expected, the participants had mixed reactions to the disclosing instances. However, certain patterns of responding emerged. Participants were more likely to have positive experiences of self-disclosure when the disclosure was “infrequent, low- to-moderately intimate, similar to their experiences, or responsive to their needs and the emerging therapeutic relationship” (p. 92). Conversely, disclosures that led to negative experiences were described as “too frequent, repetitive, lengthy with superfluous detail, incongruent with their issue or personal values, or poorly attuned to their needs or the therapeutic context” (p. 92). Thus these findings suggest that amount and type of self-disclosure are important factors to consider when deciding on whether or not to disclose in a given situation.
Audet (2011) also discovered that her participants appeared to have predetermined notions of therapeutic boundaries and believed those boundaries to be important. Even so, most perceived therapist self-disclosure as generally helpful as long as it did not violate those boundaries. In summarizing this idea, one participant stated that “‘the professional boundary is there, but you’re still connecting as human beings and a little personal sharing enhances the experience” (p. 94). On the other hand, two participants stated that though their therapist’s self-disclosure humanized the therapist, it did so at the cost of violating their own personal boundaries. One participant expressed feeling disappointed by a piece of disclosure as it led her to feel critical of a personal decision that her therapist had made. The study also suggested that self-disclosure influenced the clients’ judgments of the therapist competence and credibility, as two participants reported that they initially questioned their therapist’s age, experience level, and professionalism as a result of the self-disclosure. Compelling though these findings are, it is important to generalize with caution, both due to the small sample size and due to the fact that the data relies exclusively on the clients’ potentially inaccurate memories of past events
Gibson’s 2012 study adopted a different perspective, instead considering the qualities of therapists who use more self-disclosure as well as the timing and manner in which they do so. Findings suggest that newer therapists are less likely to disclose than more seasoned therapists. The therapist’s theoretical orientation is a significant factor in determining whether he would generally regard disclosure to be helpful or harmful, as therapists who believe it to be helpful use it more often. Generally speaking, therapists tend to disclose less to more symptomatic clients. Further, timing appears to matter, as toward the end of the treatment episode, the therapist is likely to disclose more frequently. The context of the therapeutic relationship also matters, as clients who have strong alliances with their therapists are more likely to rate disclosing therapists as warmer. And, corroborating Audet’s (2011) findings, Gibson demonstrated that so called “self-involving” disclosures that focused on the therapists’ thoughts and feelings about the client tended to be received more positively than disclosures of information about the therapist’s life outside of the therapeutic relationship. Disclosures of intimacy, which emphasize the therapist’s emotional reactions and thoughts within the present moment of the session, are most valuable to the client.
Mixed empirical data notwithstanding, the issue of therapist self-disclosure is controversial in large part owing to differences in theoretical orientation. Indeed, Irvin Yalom has opined that “more than any other single characteristic, the nature and degree of therapist self-disclosure differentiates the various schools of . . . therapy” (Peterson, 2002, p. 22). Thus from an ethical perspective, what is considered beneficial from one clinician’s viewpoint may be deemed clearly harmful for another. Thus a brief discussion of the theoretical implications of TSD is in order.
In classical psychoanalytic theory, self-disclosure was considered unequivocally counterproductive as it was believed to distort the client’s transference and so preclude its resolution (Peterson, 2002). Sigmund Freud articulated this notion when he stated that “[t]he doctor should be opaque to his patients, and like a mirror, should show them nothing but what is shown to him” (Gibson, 2012, p. 288). Notably, however, Freud regularly engaged in self-disclosure with his clients and was known to share his own dreams and memories with them. That the father of psychoanalytic theory was unable to completely refrain from disclosing may support the idea that total therapist anonymity is neither possible nor desirable. Accordingly, with the rise of more contemporary psychodynamic schools, the therapist-client relationship became increasingly important. Therapist “opaqueness” was no longer the ideal, as it comprised a warm therapeutic relationship, so psychodynamic practitioners became more flexible about their use of self-disclosure (Gibson, 2012). That being said, modern psychodynamic therapists are still among the most judicious about the use of self-disclosure, as they believe that it can compromise the transferential field of therapy.
The discourse about self-disclosure abounds with conversations about the concept of “boundaries.” Defined as “the ground rules of the professional [therapeutic] relationship,” (Barnett, 2011, p. 316), boundaries are in place to provide a sense of safety and predictability for the client, and reinforce the belief that the therapist will act in the client’s best interests. Some examples of common boundaries in therapeutic relationships include starting and ending each session on-time and abstaining from engaging in romantic or social relationships with one another. Many contend that non-immediate self-disclosure violates therapeutic boundaries in that it blurs the roles of the therapist and the client, and puts the client in a position where he feels impelled to take care of the therapist’s perceived needs (Audet, 2011). This role-reversal would be burdensome to the client who would feel pulled to subjugate his needs to that of the therapist. Alternately, therapist self-disclosure may put the client in a position where he or she censors important information in an effort to not offend the therapist. For example, a staunchly atheistic client may choose to not share intense feelings of anger toward her devoutly Christian family members if she knows that her therapist is deeply religious. This, of course, would rob the client of the opportunity to process these complex and perhaps problematic feelings in the context of therapy.
Starting with Carl Rogers’ client-centered model, humanistic psychotherapies have taken a considerably divergent stance on the issue of therapist self-disclosure. Humanistic theory holds the genuine connection between therapist and client as a singularly important agent of therapeutic change (Gibson, 2012). Authenticity and genuineness in the therapeutic relationship are considered “a necessary prerequisite for patient openness, trust, self-knowledge, the enhancement of the capacity for intimacy, and personality change” (in Peterson, 2002, p. 23). To that end, humanistic therapists often use TSD to facilitate honest connection and so self-disclosure becomes an indispensable tool of the therapy.
Similarly, feminist psychologists have historically regarded self-disclosure as a critical component of successful psychotherapy. From the point of view of this orientation, therapist self-disclosure is used as a mean of maintaining a productive “egalitarian relationship,” and a “method of forming connections between personal and political issues” (Peterson, 2002, p. 22). Thus self-disclosure is consistent with the feminist therapeutic goals of neutralizing the power differential between therapist and client and in so doing, “decreas[es] the client’s feelings of shame, and transmit[s] feminist values from the therapist to the client” (Peterson, 2002, p. 22).
Other theoretical orientations that generally view therapist self-disclosure in a favorable light include cognitive behavioral therapy (CBT) and rational emotive therapy (RET). Within the CBT framework, TSD is conceptualized as a way to model and reinforce new perspectives for the client (Audet, 2011). Similarly, an RET practitioner may self-disclose a personal experience as a memorable demonstration of how the ABC (activating events-beliefs-consequences) model may lead to emotional difficulties (Peterson, 2002).
Hence, a basic understanding of the fundamentally different theoretical stances on self-disclosure illuminates why an instance of self-disclosure that is considered therapeutic by one clinician may be thought of as harmful by another. Theoretical variations aside, certain factors require special consideration from therapists deliberating self-disclosure. One such factor is the client’s culture. Though a client from the United States is likely to regard lack of therapist self-disclosure as a sign of professionalism, a client from some other culture may view a non-disclosing therapist as aloof or impersonal (Barnett, 2011). Thus regardless of theoretical leaning, inflexible adherence to therapeutic boundaries without regard to the client’s unique cultural circumstances may result in “recreating shaming, oppressive experiences for racially and ethnically diverse clients, most of whom may have histories of discriminatory, shaming, and oppressive experiences” (Barnett, 2011, p. 407). Culture may also become a salient factor for therapists considering disclosure of a marginalized identity. Peterson (2002) describes an example of this in which a gay therapist may choose to disclose his sexual orientation as a way of assuming the position of “role model” for a gay client who may otherwise be hard-pressed to find such a model. In this instance, the potential benefit of non-immediate self-disclosure may outweigh the risk for harm.
A second significant consideration is that of the client’s age. In treating children and adolescents, total non-disclosure could seriously compromise necessary rapport between the client and therapist (Gibson, 2012). In more extreme cases, avoiding self-disclosure in response to personal questions from a child client can interfere with their ability to master reality (Peterson, 2002). Conversely, when a therapist uses immediate self-disclosure to express her feelings about a child client, she increases the child’s trust in her and shows that transient problems that arise during the therapeutic relationship do not weaken the therapeutic relationship. In the case of newly autonomous and potentially guarded adolescents, the use of thoughtful self-disclosure can serve to model openness and authenticity. Age is also a concern worthy of consideration when disclosing with elderly clients (Peterson, 2002). Therapist self-disclosure with elderly clients is ill-advised in situations in which they are socially isolated. The rationale is that such clients are at a high risk for using the therapist to fill the role of an intimate friend, and by doing so, can blur professional boundaries.
The client’s personality traits should also inform the therapist’s assessment of potential benefit and harm. Barnett (2011) urges clinicians to be wary of disclosing to clients who are especially self-absorbed and likely to see their therapists as an extension of themselves. This can become especially problematic if, as a result, the therapist becomes resentful of the client for not recognizing his separateness. Similarly, Goldstein (1994) suggests that the following kinds of clients are likely to be harmed by therapist self-disclosure: those who focus on the needs of others, those who fear closeness with the therapist, those with poor reality testing capacities, and those with poor boundaries. Clients possessing the latter two traits may feel inclined to take on the characteristics of the therapist.
Special life circumstances pose a unique challenge to clinicians who are mindful about their use of self-disclosure. Bereavement and serious illness are particularly difficult issues for therapists to negotiate when weighing the possible benefits and harms of disclosing personal information. Peterson (2002) shares an anecdote in which a therapist opted not to tell her clients about her husband’s recent death and her process of bereavement. Ultimately, several of her clients found out in other ways and were emotionally harmed by what they perceived to be the lack of the therapist’s confidence in them. In such a case, the therapist is put in a difficult position where she must simultaneously consider her own need for privacy, the potential risk of putting the client in a caretaking role by disclosing, and the possibility of hurting or alienating a client by withholding the information.
Therapist illness is another instance in which the therapist must weigh her considerable need for privacy against the client’s need for therapeutically pertinent information (Peterson, 2002). To fulfill the ethical principle of autonomy, the therapist must disclose serious illness so that the client is in a position to make informed consent about continuing treatment. However, doing so can negatively impact the therapy if the client feels pressured to hide feelings of anger toward the therapist, or if such a disclosure inhibits the client from voicing her own needs.
The practice of ethically-sound self-disclosure is far from being a simple, straight-forward, or even intuitive matter for the thoughtful clinician. Instead, it is an art that depends on the psychotherapist’s ability to integrate theory, research, and self-awareness.
The present paper has provided some considerations for psychotherapists assessing the potential harm or good that may come out of a given piece of self-disclosure. Gleaned from the above discussion, the following questions are intended to guide decision-making about using effective and beneficial self-disclosure in psychotherapeutic practice:
- a) Is this piece of self-disclosure intended primarily to help the client or to a gratify a personal need (of, for example, validation or support from the client)? If it is the latter case, the therapist may benefit from addressing the issue at hand in supervision, consultation, or personal therapy.
- b) Does the client need to know this piece of information to make informed consent about his or her treatment?
- c) Might this disclosure negatively impact the client’s perception of the therapist’s competence and professionalism?
- d) How much and how often is the therapist disclosing with a particular client? Might the amount of disclosure be excessive and thus distract from focus on the client?
- e) What type of self-disclosure is being used? Immediate or non-immediate? What does the research say about this kind of disclosure?
- f) How does the therapist conceptualize self-disclosure from his or her chosen theoretical orientation? That is, what kind of self-disclosure, if any, is consistent with what he or she believes is the agent of change in psychotherapy?
- g) Is the decision to disclose informed by the client’s cultural context?
- h) Is the decision to disclose informed by the client’s developmental age or stage?
- i) Does the client display personality traits that make it more likely that he or she would be harmed by the therapist’s disclosure?
- j) Might the therapist’s desire for keeping certain personal information private negatively impact the client? If so, how can the therapist utilize supervision to minimize harm to both the client and her or himself?
By regularly contemplating these questions, a psychotherapist may come to develop his or her capacity to use self-disclosure in an optimally beneficial and ethical manner.
Cite This Article
Sadighim, S. (2014). The big reveal: Ethical implications of therapist self-disclosure. Psychotherapy Bulletin, 49(4), 22-27.
American Psychological Association (2010). Ethical principles of psychologists and code of conduct: Including 2010 Amendments. Retrieved from http://www.apa.org/ethics/code/index.aspx. DOI: 10.1037/a0020168
Audet, C. T. (2011). Client perspectives of therapist self-disclosure: Violating boundaries or removing barriers?. Counselling Psychology Quarterly, 24(2), 85-100. DOI: 10.1080/09515070.2011.589602
Barnett, J. E. (2011). Psychotherapist self-disclosure: Ethical and clinical considerations. Psychotherapy, 48(4), 315-321. DOI: 10.1037/a0026056
Gibson, M. F. (2012). Opening up: Therapist self-disclosure in theory, research, and practice. Clinical Social Work Journal, 40(3), 287-296. DOI: 10.1007/s10615-012-0391-4
Goldstein, E. G. (1994). Self-disclosure in treatment: What therapists do and don’t talk about. Clinical Social Work Journal, 22, 417-433.
Peterson, Z. D. (2002). More than a mirror: The ethics of therapist self-disclosure. Psychotherapy: Theory, Research, Practice, Training, 39(1), 21-31. DOI: 10.1037/0033-322.214.171.124
This article is extremely informative and extremely well-written.