Monday, January 30, 2012

When Therapist Disclosure Can Help

In my experience, I have found that sharing briefly about overcoming my own trauma history is sometimes the only thing that gives a client hope that they can heal. I have used this kind of self-disclosure to resolve therapeutic impasses, especially when a client views suicide as a viable escape from intolerable emotional pain.

 It depends on the individual client's needs and the boundaries of the therapist, as well as the therapist's theoretical orientation. From an experiential, feminist or trauma therapy perspective it can be very appropriate. From a classical psychoanalytic perspective, it can be very problematic.

When I am working with clients with a history of child abuse or neglect, they cannot trust me if they can't read my positive intentions.  Earlier in my career when I tried to remain a blank slate, clients with complex childhood relational trauma histories would commonly experience traumatic transference, projecting their expectation of betrayal onto me, and would sometimes be unable to get past seeing me as an abuser.  Now I am much more transparent about my emotional reactions to my clients. This type of disclosure helps clients with impaired trust to distinguish between the intent of my behavior and that of their abusers.

 On the other hand, clients without impaired trust could very well feel burdened by unnecessary therapist disclosure. I have made this mistake as well.  It is very important  that we monitor our own countertransference reactions to guard against inappropriate self-disclosure and make sure that disclosure is only intended to meet the therapeutic needs of the client.

A good resource is:  Zur, O. (2010). Self-Disclosure & Transparency in Psychotherapy and Counseling: To Disclose or Not to Disclose, This is the Question. Retrieved July 3, 2011 from http://www.zurinstitute.com/selfdisclosure1.html

What do you think about therapist disclosure?  Is it ever appropriate? Under what circumstances?

12 comments:

  1. Andrea,

    I draw heavily on feminist theory in my approach to therapy, and so the awareness of power in the therapeutic relationship is important to me. This has meant that, when it feels safe and appropriate, I have self-disclosed to clients. I make that decision based on whether or not I believe the self-disclosure is in the best interest of the client (yes to disclosing), or if I believe that the self-disclosure is to meet a need of my own (no to disclosing). In general, this has seemed to work well for my clients. I use my own peer supervision to be sure that I'm keeping healthy boundaries. Thanks for the thought-provoking post!

    Warmly,
    Ann

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  2. Hi Ann,

    As a trauma therapist, I also pay close attention to power issues in the therapeutic relationship. While taking a collaborative approach does not eliminate the power differential, it does seem to help my clients to view me more as a partner in healing. That has consistently helped abuse survivors to feel less out of control and more that they have choices that will be respected.

    Thanks so much for your comments about feminist theory. I appreciate your sharing your approach to decision-making about self-disclosure.

    Warmly,
    Andrea

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  3. I went to therapist recently for help in overcoming chronic illness. Within 3 sessions I knew more about the therapist then I felt appropriate. I looked up a previous therapist who had treated me for childhood s/a. He had always kept a professional distance, I felt safer and comfortable. I went in for an intake a month ago due to the chronic health issues, and he has picked up where we left off 15 years ago. Obviously kept good notes and due to his professional distance I felt comfortable immediately once again. And he has already demonstrated how the lack of control and loss of power issues translate to how I deal with my chronic health issue. So, I guess my point is, it is a personal and professional choice depending on the patients needs.

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    1. Hi Kim,

      welcome! You bring up a very important point. Cookie cutter approaches to therapy don't address the individual needs of each client. I try to be as attuned as possible to my patients' needs and encourage them to give me feedback if something I say doesn't work for them. I can be very different with one patient than I am with another, in terms of self-disclosure, method, etc. Thanks for the reminder that no therapy is one size fits all.

      Warmly,
      Andrea

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  4. Hi Andrea - great insightful post! I, too, as both you ladies post, self-disclose sometimes, and it is to both soften the power differential and to help the clients feel there is potential for healing, and also to seem more, um human, which is a piece of softening the power differential. The friendly warm therapeutic approach works best for me as well.

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    1. Hi Kathy,

      Good point! I think of it as being more genuine. I used to sit with my hands positioned in my lap in a professional posture and tried not to show my reactions to what clients were saying. That's how I was initially trained. There were two problems with that. First of all, I was mistaken to think that my clients weren't sensing my reactions anyway. I learned that lesson the hard way when clients reacted to my reactions even when I thought I had successfully maintained a neutral facial expression. Secondly, disguising my reaction was interpreted by some clients as being unfeeling and uncaring.

      There are still some clients that would feel burdened by my emotional reactions so I am still sensitive to that possibility and adjust how much I reveal about my reactions with each client based on their individual needs.

      Thanks for sharing your perspective.

      Warmly,
      Andrea

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  5. You're absolutely right, Andrea, it's definitely an individual decision, both for the therapist and also needs to be weighed with the individual needs of each client. I "came out" as being on anti-depressants on my blog, and it's my most popular post. I'm moved when search terms like "I'm embarrassed to take anti-depressants" lead people to my blog. I haven't had any negative reactions that I know of, but it wasn't an easy post to write or publish.

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    1. Hi Lunasea,

      I admire your willingness to share your story publicly in order to help convince others to seek help. It is great to hear that you have not had any negative reactions.

      Thanks for telling us about your experience and contributing to this conversation.

      Warmly,
      Andrea

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  6. Andrea,

    Thanks for a thought-provoking post. This is a topic that received quite a bit of discussion at my school.

    As I recall, there wasn't a consensus on the matter (different professors held different opinions). The conclusion that I drew was that you need to use your best judgment.

    I agree with what you and others have suggested that some limited self-disclosure may be warranted when you feel that it would be truly beneficial to the client and you have ruled out the possibility that you would be doing this to meet any of your own needs.

    In light of my being at the beginning of my career, I would probably feel the need to consult with my supervisor before being ready to make such a call.

    Warmly,
    Dorlee

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  7. Hi Dorlee,

    It is really good to hear that your school didn't present it as black and white. I agree that it is wise to discuss with your supervisor when you are just starting your career so you can weigh the pros and cons and make sure that you are taking all factors into consideration.

    Thanks for adding another perspective to this discussion.

    Warmly,
    Andrea

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  8. Hi Andrea,
    Thanks so much for this post. I also tried to be the blank slate early in my practice, but I found as you have that especially with teens and trauma survivors (or those who are both)--they need me to be emotionally present.
    Whether I share content or not depends on whether I think it will be helpful or a burden to the client.
    Thanks for your thoughts.

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    1. Hi Carolyn,

      Thanks so much for sharing how your practice has evolved over the years. It's nice to hear from a kindred spirit!

      Warmly,
      Andrea

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