Loose Lips Sink Ships: Therapist Self-Disclosure

Self disclosure in response to a question by the patient or as a technique to enhance therapy is a complex issue. Many of us utilise self disclosure as an empathic way  of normalizing patient behaviours, feelings or thoughts. Self disclosure may also be used as a way of enhancing empathy by saying “see I am like you”. This can be particularly important in groups that may feel marginalized in our culture such as by gender, orientation or culture.

So what do our clients think of our disclosures or for that matter our non-disclosures. An article in last years Counselling and Psychotherapy Research, looks at just this issue. The paper by Jean Hanson is called. Should your lips be zipped? How therapist self-disclosure and non-disclosure affects clients.

Albeit with a small sample she looked at qualitative themes in client narratives to uncover their views on their therapist instances of both disclosure and non-disclosure.

When participants reported disclosure as helpful, their reasons were similar to therapists’ rationales for disclosing. This supports both theory and empirical studies of therapists’ beliefs about the effects of disclosures. The greatest effect was on the alliance. The participants in this study valued their therapists’ disclosures because they contributed towards:

• a real relationship,
• a sense of connection, intimacy, closeness or warmth;
• trust, safety, or a decrease in alienation;
• a sense of being deeply understood, welcomed or cared about;
• an opportunity to identify with the therapist;
• a sense that the therapist would take responsibility for mistakes

Participants appreciated disclosures that made them feel their relationship was more egalitarian: the relationship seemed more balanced or mutual; the therapist appeared more human or fallible; or the disclosures helped them to be more autonomous.

Managing non-disclosure appears to be a more complex task in that on one level you are frustrating the client’s immediate need to attempt to meet what is perceived by the therapist as a more important need.

The most important element of skill that emerged from the few helpful nondisclosures in this study was that skilled therapists would frame their refusal to answer questions compassionately, in a way that clients could understand and accept as beneficial, even if they initially had negative feelings. For example, Lynn’s therapist would not comply when she begged him to give his opinion about decisions she was about to make. Although she felt frustrated in the moment, he had conveyed to her that he was refusing because he trusted her to make her own decisions. Ultimately, she felt validated by his ‘gentle firmness’.

The most often cited skill deficit in connection with non-disclosure was rigidity. Cardinal had a therapist who did not disclose as a matter of principle. Once she asked him casually where he was going for his vacation, and he replied that it was his policy not to disclose his personal business for safety reasons. Cardinal felt insulted that he did not take her character into account.

Skilled disclosures and non-disclosures tended to contribute toward the development of a positive alliance, while skills deficits were likely to slow or damage its development. However, a positive preexisting alliance mitigated the effects of skills deficits, while a negative or nonexistent alliance exacerbated the effects and could tip the scale towards termination.

Skilled disclosures and non-disclosures tended to contribute toward the development of a positive alliance, while skills deficits were likely to slow or damage its development. However, a positive preexisting alliance mitigated the effects of skills deficits, while a negative or nonexistent alliance exacerbated the effects and could tip the scale towards termination.

Comments

[Health-Psych]

Interesting article. Used with care, limited self-disclosure can bring many benefits but deciding on if and how much is like walking a tightrope.

[Rahul]

I agree that disclosures do help the client to relate themselves to their therapist and I have seen this put in to practise very successfully. Having said that skillful non-disclosures are probably the best way out. Imagine the therapist saying that 'I am like you' and the client actually ends up loosing confidence. However, what we do need to make sure to avoid Cardinal scenario. If you are not skillful enough with your non-disclosures, be smart enough with your discolsures.

[Chris Allan]

Thanks for your comments Rahul and Health Psych. I agree it can be a bit like walking a tightrope and that skillful non-disclsoure may be better than disclosure. However I think even when we use disclosure the critcal thing is picking up its impact on the therapeutic relationship. Exploring with the client how it felt when you disclosed the information allows for any repairs to the alliance that may need to take place if the disclosure was interpreted negatively or was poorly timed.

Regards
Chris

[Garth Mintun]

I like the approach that Narrative Therapy (Micheal White) uses and that is to "situate the response" and how it transports the person or moves the person to another (psychological ) place. The disclosure is client centered and focused.

[Lisa]

I find this interesting. I am actually a client, and although I find it comforting to have a good relationship with my psychologist, I definitely realise why the boundaries are there. However, I think one of the most important things is to be honest as much as possible with your client, (but obviously thinking about how to phrase your response from an empathetic viewpoint). If the client feels that they are being 'manipulated' somehow, (even if they are aware it's for their benifit), it can be enough to activate serious mistrust schemas and further damage the therapeutic relationship.

[Naomi Pinson]

Hello, I used your paper, "Coming Out: Self-Disclosure as a Specific Technique, with Specific Application to Sexual Minority Populations" for my grad theis in rehab psychology (Capstone). I am an "out" expatient who has been active in the survivor movement for multiple decades. After a stint as a practitioner I rejected it mostly because I found ethics around diagnoses and boundaries to so deficient as to amount to torture. Now I work in human rights for people receiving or who are trapped by the mental health authority. I really like what you have to say about the ethics of the dual role. The dialogue is not about "skill", it is very much about ethics, humanism and power. naomiruth

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With luck, this process is already under way.

[Learn Sexual Health]

it's all about behaviors, feelings or thoughts. I think we can't ignore this fact because I have been reading a lot of empirical studies and I think you're right: it'd be the best idea if the readers can analyzed the article above. 23jj

[Calvin Klein]

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[Lo]

mmm, Lisa says the most important thing is to be honest with your client - I suggest you read Lying on the Couch by Yalom and watch Ernest Lash, the therapist who decided that honesty is his most important therapeutic tool, get entangled in his own web.
I am also a client, and I think self disclosure is a tool to be used only by the most experienced and the most self aware therapists.
In fact I believe that even when used in small doses, and even when seemingly innocuous or therapeutic, the risk is great: self-disclosure is all too easily a vehicle for the therapist to force her/his unconscious agenda onto the therapeutic space.

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Good stuff as per usual, thanks. I do hope this kind of thing gets more exposure.