Therapeutic self-disclosure is the
act in which a therapist discloses personal information to a client.
Self-disclosure can involve therapists telling patients what they think or feel
about them—for example, telling a patient, “Of course I care about you”
(Siebold, 2011, p. 152). Self-disclosure can also involve therapists revealing
information about themselves that patients would not have otherwise known
(Siebold, 2011, p. 152).
Traditional psychoanalytic theory
prohibits self-disclosure, holding that non-disclosure (“anonymity,” to use the technical jargon) is “necessary for the
development and resolution of a transference neurosis” (Rosenblum, 1998, pp.
538-539). In other words, this theory holds that when therapists self-disclose
their clients stop seeing them as transference objects and start to see them as
they really are, thus damaging the
therapeutic process.
Although most therapists today at
least sometimes self-disclose to clients (Hanson, 2005, p. 90), some emphasize that
therapists can easily harm clients when they do so. For example, Meissner
(2002) writes that self-disclosure is sometimes appropriate (p. 856)—for instance,
when the therapist “has committed obvious errors or countertransference
enactments” (pp. 855-856)—but he focuses on the ways self-disclosure can harm the
therapist-patient alliance.[1] Self-disclosure, he writes, can create a
friendship between therapist and patient that in turn alters their professional
relationship. Ipso facto, the
therapist might lose his or her objectivity, or the therapist might start
“burden[ing] the patient with personal problems,” causing the patient to feel obligated to be there for the therapist (p. 847).
Meissner (2002) further writes that
“there is always a wish on the part of the patient, at times conscious but more
often unconscious, to draw the analyst out of the analytic stance, to
circumvent the alliance” (p. 848). Given this, patients often encourage
therapists to self-disclose in hopes of avoiding the topic at hand, namely, the
patient and the patient’s problems. When this happens, Meissner recommends practicing
non-disclosure returning focus to the patient (p. 849).[2]
While the above warnings against
self-disclosure seem prudent, it seems clear that self-disclosure is often helpful
and non-disclosure harmful. Renik (1995) writes that non-disclosure “encourages
idealization of the analyst as an authoritative observer of reality.” Non-disclosure,
he writes, “makes the analyst into a mystery, and paves the way for regarding
the analyst as an omniscient sphinx whose ways cannot be known and whose
authority, therefore, cannot be questioned.” Renik has found in his own
practice that practicing self-disclosure in turn encourages his patients to be
more honest.
Hanson (2005) found in his very
limited study that patients were “2½ times more likely to find disclosures to be
helpful, and twice as likely to experience non-disclosure as unhelpful” (p.
98). Those who find disclosure helpful felt this way because “they contributed
towards a real relationship, which included (1) a sense of connection,
intimacy, closeness or warmth; (2) trust, safety, or a decrease in alienation;
(3) a sense of being deeply understood, welcomed or cared about; (4) an
opportunity to identify with the therapist; and (5) a sense that the therapist
would take responsibility for mistakes” (pp. 98-99).
Hanson (2005) provides some
examples of self-disclosures that patients found helpful. In one case a therapist
told her patient that she too had been an incest survivor. Because of this
revelation, the patient felt “she could trust her therapist” and share without
being judged negatively (p. 99). In another case a therapist shared with her
patient that she too had harbored violent ideations after her lover had left
her. This revelation helped the patient believe that her therapist understood
and empathized with her (p. 99).
Hanson (2005) also gives examples
of self-disclosures that patients found unhelpful. One former patient recounted
how she had told her therapist that she feared getting a divorce because she
had small children. The therapist responded by telling her that he had gotten a
divorce with small children, so “it could be done.” The patient felt that the
therapist had said this because he wanted to go out with her and never went
back to him (p. 99). Another patient shared how her therapist called her promiscuous.
The patient wanted to know that her therapist liked her and felt hurt by the
comment (p. 100).
Hanson (2005) found a small number of
patients who found non-disclosure to be helpful, mostly because allowed them to
“imagine what they wanted about their therapists” (p. 100). Most of those who
found non-disclosure to be unhelpful complained that because of it they had
trouble connecting with their therapists. Consequently, they found that the
therapeutic alliance was hurt and that they could not trust them (p. 100).
* * * * *
Hanson, J. (2005). Should your lips be zipped? How
therapist self-disclosure and non-disclosure affects clients. Counseling and Psychotherapy Research, 5(2),
96-104.
Meissner, W.W. (2002). The problem
of self-disclosure in psychoanalysis. Journal
of the American Psychological Association, 50(3), 827-867.
Renik, O. (1995). The ideal of the
anonymous analyst and the problem of self-disclosure. Psychoanalytic Quarterly, 64(3), 466-495. Retrieved from https://manhattanpsychoanalysis.com/wp-content/uploads/readings/Newmans_course/Renik_ideal_of_the_anonymous_analyst.pdf
Rosenblum, S. (1998). Abstinence
anonymity and the avoidance of self-disclosure. Psychoanalytic Inquiry, 18(4), 538-549.
Siebold, C. (2011). What do
patients want? Personal disclosure and the intersubjective perspective. Clinical Social Work Journal, 39(2),
151-160.
* * * * *
Notes
[1] Meissner defines the therapeutic
alliance as “those components of the analytic relation concerned with
establishing and maintaining the collaborative and therapeutically effective
working engagement” between the therapist and patient (p. 846).
[2] Meissner tells the story of a
patient he had while he was still a candidate. This patient insisted on knowing
his educational background. Instead of answering, Meissner asked the client why
she felt she needed to know this information. He continues: “We quickly got
into her anxieties about undertaking an analysis, her resentment and
disappointment that she had to resort to the analytic institute and accept a
candidate as her analyst rather than a senior analyst with greater experience
and skill, and her resentment at her husband who did not make more money so
that she could afford private treatment” (p. 849).
No comments:
Post a Comment