Monday, January 12, 2015

Competency #3: Research therapeutic self-disclosure

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