A newer version of the platform is available. Please refresh the page.
Jean Hanson, OISE/UT
© Jean Hanson. All rights reserved. Posted by permission of the author Jean Hanson.
Table Of Contents
Self-Disclosure
Scrupulous And Skilful Use Of The Technique
Use Of Self-Disclosure With Sexual Minority Clients
The Impact Of Not Disclosing
Disclosure Of Heterosexual Orientation
Risks Of Disclosure For Therapists
Risks Of Disclosure For Clients
Implications For Bisexual Therapists
Conclusion And Implications For Future Research
Conclusions
References
Therapists’ self-disclosure to clients is a controversial issue in counselling psychology. The usefulness of self-disclosure as a therapeutic technique, its effect on the client, the theoretical rationale, the timing, content and other issues, and indeed, whether or not it is a therapeutic technique (as opposed to a therapeutic mistake) are still in dispute. In this paper I explain how therapist self-disclosure is a therapeutic technique, and like any other technique, can be used skillfully or unskillfully, appropriately or inappropriately. When viewed from this perspective, criticisms about its use may be more clearly understood as objections to the unscrupulous or unskillful use of self-disclosure. What constitutes skillful and appropriate use of the technique with clients from the general population may not apply, or may need to be applied differently, with clients from sexual minorities, due to the prevalence of homophobia and heterosexism. In particular, when working with a stigmatized population, non-disclosure of the therapist’s stigmatized status has the potential to be as detrimental as disclosure.
I first discuss therapist self-disclosure in more general terms, synthesizing from the literature what constitutes the scrupulous and skillful use of the technique, using a feminist ethical framework. I then examine and synthesize theoretical and political literature, case studies, and empirical research involving both analogue studies and studies of therapists and clients, regarding the rationales for and benefits and risks of using this therapeutic intervention both for sexual minority clients and sexual minority therapists. I include special considerations of self-disclosure issues involving bisexual therapists and clients, and heterosexual therapists working with sexual minority populations. Finally, I make suggestions both for further research and for reducing heterosexism and homophobia among therapists.
Studies of therapist self-disclosure have proliferated since the early 1970s. Before then, the two most popular modalities, psychodynamic therapy (psychoanalysis) and behavioural therapy, were in agreement that therapists’ disclosure of information about themselves to clients was out of place in the therapeutic relationship (Auvil & Silver, 1984; Jacobs, 1999). With the rise of the humanist movement in the 1950s and 60s came the possibility that therapists might give information about themselves to clients as part of a therapeutic process that valued the congruence and transparency of the therapist in relation to the client (e.g. Jourard, 1971; Rogers, 1951; 1961). The feminist movement in the 1980’s added a political dimension, in which therapist self-disclosure was valued for its presumed role in fostering a more egalitarian relationship between therapist and client, promoting solidarity and empowerment, and allowing clients an opportunity to choose a role model (see, for example, Simi & Mahalik, 1997). Perhaps in response to these newer ways of approaching therapy, some psychodynamic therapists also began to consider whether and to what extent self-disclosure might have a place in their modality (see, for example, Bridges, 2001; Goldstein, 1994; Goldstein, 1997; Jacobs, 1999).
Theoretical papers and research studies have tended to define the term self-disclosure in discrepant ways. For an efficient summary of this history, see Knox, Hess, Petersen and Hill (1997). Knox et al. (1997) determined that the major trend running through most of the subdivisions of definitions of self-disclosure boiled down to: interactions “in which the therapist reveals personal information about him/herself, and/or reveals reactions and responses to the client as they arise in session” (p. 275). These interactions might also be described respectively as self-revealing (of personal information) or intrapersonal; and self-involving (revealing reactions and responses to the client during the session) or interpersonal. For the sake of simplicity and brevity, I will use the term “self-disclosure” to mean disclosures which are either or both of self-revealing and self-involving. As its use applies to sexual minorities, the self-revealing aspect of this technique — specifically, but not necessarily limited to, the therapist’s own sexual orientation — is often more at issue.
Scrupulous And Skilful Use Of The Technique
The success of self-disclosure as a therapeutic intervention rests largely on two factors: scrupulousness and skillfulness. Scrupulousness refers to the therapist’s intent to use self-disclosure as an intervention in the service of the client’s therapy. Some have warned that since inappropriate self-disclosure is a boundary violation (Gutheil & Gabbard, 1993; Kottler, 1986; Peterson, 1992), and boundary violations can be both precursors to sexual exploitation (Pope, 1990) and damaging in themselves in the same way that sexual exploitation is (Simon, 1991), then it would be better to err on the side of caution and not risk using self-disclosure that could lead to, or be perceived as, exploitation (Gutheil & Gabbard, 1993). These ideas stem from mainstream ethical codes, which use a principle of risk management, and tend to devolve into a series of rules about what may and may not be done (Brown, 1994). However, if a therapist does intend to commit abuse (consciously or not) then injunctions not to disclose will be meaningless (Zur, 2000). I suggest that, if therapists have this intention, consciously or unconsciously, they have stepped outside the scope of ethical practice, and the self-disclosure in this case cannot be called a therapeutic technique.
On the other hand, feminist therapy rests on the belief that therapy can be one of the means by which an unjust and oppressive society can be transformed, and that therapist and client may be each other’s allies in this process. Therapists are called upon to examine their own attitudes and beliefs in order to minimize, or preferably eliminate, any remnants of oppressive dominance (Brown, 1994; Feminist Therapy Code of Ethics, revised, 1999). Because sexual minority clients are likely to have faced, and to have issues pertaining to, individual and societal prejudice, discrimination, victimization, and other aspects of oppression, this ethical framework applies with particular appropriateness to this population.
In general, to use this intervention skillfully, therapists should, first, take each client’s individual situation into account, including their “social, emotional, cognitive and developmental level of functioning” (Mahalik, van Ormer, & Simi, 2000, p. 196). This may include taking into account the meaning the willingness to disclose would have for each client, as well as the content of the disclosure (Goldstein, 1994). Second, therapists should have a theoretical foundation and rationale (Auvil & Silver, 1984), which will vary somewhat according to each therapist’s theoretical orientation. Third, therapists may find it useful to orient their clients to this technique (Linehan, 1993) which may include re-orienting clients if they have learned different rules with previous therapists (Psychopathology Committee of the Group for the Advancement of Psychiatry, 2001), or sharing their thinking about why they wish to use it and obtaining agreement from clients to employ the intervention (Client Rights Project, 1998). Fourth, the disclosure should be carefully timed, both in terms of its use in any given session, and in terms of the overall therapeutic process (Auvil & Silver, 1984; Client Rights Project, 1998; Hendrick, 1987). Therapists are cautioned not to use self-disclosure too early in the therapy process, since they would be less likely to be attuned to the client’s responses (Auvil & Silver, 1984; Goldstein, 1994). Fifth, therapists should make sure self-disclosure occurs in context to something the client has brought into the therapy (Knox et al., 1997); the content should be brief, with few extraneous details; and therapists should stay focused on their clients (Auvil & Silver, 1984; Bridges, 2001; Goldstein, 1997; Jacobs, 1999; Knox et al., 1997; Wells, 1994). Finally, therapists should be prepared to notice how their clients respond to this technique, and initiate or participate in a discussion (at the time or at any time afterwards) about the effects of the intervention on the client, the therapeutic relationship or alliance, and the client’s therapeutic process (Ackerman & Hilsenroth, 2001; Bridges, 2001).
Studies of therapists who use self-disclosure, as well as theoretical articles, have revealed a number of rationales for the use of this technique. Some may fit more closely with certain modalities, and some may be more generally used. Disclosure for the purpose of furthering the therapeutic alliance may be intended to enhance the client’s co-operation; contribute toward a more real relationship; increase intimacy and warmth; allow the therapist to risk being more visible; increase the client’s trust and decrease anxiety and alienation; demonstrate the therapist’s understanding of something the client is trying to convey; address the client’s concern about some aspect of the therapist’s appearance or behaviour; or demonstrate the therapist’s willingness to take responsibility for a possible mistake (Ackerman & Hilsenroth, 2001; Auvil & Silver, 1984; Bridges, 2001; Brown, 1994; Goldstein, 1997; Linehan, 1993; Simon, 1988).
Disclosure used with the intent of fostering a more egalitarian relationship, or advancing client autonomy, may allow clients to be more in touch with their power, or to see the therapist as more human or fallible; it may help narrow the gulf between therapist and client or help increase the client’s sense of self (Brown, 1994; Bridges, 2001; Knox et al, 1997; Simon, 1988).
When self-disclosure is used for the purpose of modeling or skills training, it can demonstrate problem-solving or coping skills, self-acceptance, or assertiveness; it may also facilitate the client’s self-disclosure by demonstrating emotional openness and honesty (Bridges, 2001; Knox et al., 1997; Linehan, 1993; Simon, 1988).
Used to validate reality, this technique can help normalize the client’s experience or feelings; confirm the client’s perceptions; and perhaps help the client feel less alone, crazy or anxious (Knox et al., 1997; Linehan, 1993; Simon, 1988).
As a means of facilitating client insight or learning, self-disclosure may help the client to shift perspective or gain insight; allow the client to learn about her or himself; allow the client to see her or himself from the outside; and deal more effectively with life (Auvil & Silver, 1984; Bridges, 2001; Jacobs, 1999; Knox et al., 1997; Linehan, 1993).
If catharsis is a therapeutic goal, disclosure may help the client to discover, connect with and express previously withheld or suppressed emotions (Auvil & Silver, 1984; Jacobs, 1999).
Self-disclosure can be of use in the support, reinforcement and validation of the client. It can be seen as being supportive of the client’s efforts or goals; valuing of her or his decisions or actions; demonstrating understanding of past situations in which a client was hurt; or respectful of her or his current strengths (Auvil & Silver, Bridges, 2001; 1984; Goldstein, 1997; Linehan, 1993).
Finally, self-disclosure is implicated in the idea of clients’ right to make informed decisions. Some authors believe that clients, as consumers, have a right to know therapists’ values, positions, views or experience about some (potentially) controversial issues such as sexual orientation, abortion or religion in order to be able to evaluate the quality of the therapy they receive. Their position is that since psychotherapy is not value-free, therapists are likely to convey their beliefs and attitudes to clients in an indirect way, which may subtly influence them. If therapists are up front about their values and beliefs, clients can be clear about what they choose to be influenced by (Client Rights Project, 1998; Hawkins & Bullock, 1995; Mahalik et al., 2000).
Use Of Self-Disclosure With Sexual Minority Clients
The theoretical rationales for using this technique with the general population also hold true for sexual minorities. However, there is another, more specific rationale which should be considered for this population.
Oliver H. Bown, in a memo to Carl Rogers (1951, p. 165) stated that “acceptance is an emotional phenomenon, not an intellectual one. I think it implies that we feel something positive toward the client, rather than that we feel neutrally toward him [sic]”. Judith Lewis Herman (1992) later made the distinction between the therapist’s technical neutrality and moral neutrality. Technical neutrality refers to such issues as refraining from getting emotionally involved in clients’ decisions, not taking their difficulties personally, etc. Issues which involve injustice, and/or which have induced clients’ fear, guilt, shame, humiliation, embarrassment, or the taking on of blame, call for therapists to take a non-neutral moral position toward them. Survivors of childhood trauma, Holocaust survivors and their children (Herman, 1992), sexual minorities (Bernstein, 2000; Milton & Coyle, 1998), those who have had or are contemplating having an abortion (Client Rights Project, 1998) and even those who wish to examine religious values and concerns (Hawkins & Bullock, 1995) have all been identified as potentially benefiting from their therapists’ explicit stance of acceptance, affirmation (Milton & Coyle, 1998), nurturance, care (Brown, 1994) and moral solidarity (Herman, 1992). Laura Brown (1994, p. 109) described this stance as “the power to help someone feel powerful, to be willing to see, hear, feel, and know that which is still, or at first, silent, invisible, hidden, nameless.”
Although it is important not to stereotype individuals, in the case of sexual minorities (as, indeed, with any oppressed or stigmatized population), it may be as important to take the group to which a client belongs into account, as it is to take each client’s individual situation into account (Hertzberg, 1990). Because of the oppressive nature of heterosexism and homophobia, it behooves therapists to take a non-neutral, morally affirming stance toward their sexual minority clients. Disclosure of therapists’ attitudes towards and experience with sexual minorities (including information about having a relative or close friend who is a sexual minority), as well as their own sexual orientation, especially if they are also members of a sexual minority, can be a powerful way to accomplish this.
I would suggest that it is not enough simply to convey understanding of the client’s experiences of oppression. Therapists who have worked through their own internalized oppression can model their experience in a compelling way for clients struggling with the sometimes viciously oppressive influences in their lives (Connolly, 2001). Regardless of what their sexual orientations are, therapists who disclose their own sexual orientations are demonstrating both that they understand how important this issue is to many sexual minorities, and that they are committed not to access the privilege of remaining silent about their own sexual orientation due to their position as therapists. Heterosexual therapists who disclose their orientation are also refusing to benefit from heterosexual privilege which allows them not to make their orientation explicit. This kind of moral solidarity has high therapeutic value.
Several theorists and therapists (for example, Brown & Walker, 1990; Isay, 1996; Mahalik et al., 2000) agree that it is of therapeutic value for therapists to disclose their sexual orientation to sexual minority clients. Empirical studies and anecdotal clinical evidence have suggested that these clients often prefer therapists with the same sexual orientation, want to know the sexual orientation of their therapists, and in fact seek out therapists whose orientation is similar to their own (Bernstein, 2000; Goldstein, 1994; Isay, 1996; Liddle, 1997; McDermott, Tyndall & Lichtenberg, 1989). On the other hand, others claim that to indulge clients’ wishes for this type if information is to put clients at risk of putting too much emphasis on identification with the therapist (which is not seen as the primary task of therapy) and possibly terminating therapy prematurely “based on a fantasy of incompatibility” (Tillman, 1998, p. 274). Yet again, one study examining client-therapist match found that in some situations, the salience of the therapist’s sexual orientation may be less important than originally assumed (Moran, 1992), and clinical information suggests that it may not necessarily be the match itself that is important, but the fact that the therapist is willing to disclose at all (Bernstein, 2000; Goldstein, 1997). There is some evidence that a more successful therapeutic outcome ensues for sexual minority clients when mutual self-disclosure about shared sexual orientation was present in the therapist-client relationship (Liljestrand, Gerling & Saliba, 1978).
Disclosures of the therapist’s attitudes toward sexual minorities, and the therapist’s sexual orientation are more likely (though not always) to be issues for clients at the beginning of therapy, when clients are providing background information to the therapist and the therapeutic relationship is being developed (Bernstein, 2000). It would thus appear advisable for therapists to disclose this information as soon as it becomes apparent that the client wants it. Further, it may be advisable to volunteer the information as soon as the therapist knows, or even suspects, that the client is a member of a sexual minority (Bernstein, 2000). If the therapist has reason to think her or his client is from a sexual minority, it may show that she or he is willing and able to tackle the subject, and thus open it up for discussion. It also gives the client information on which to make an informed decision (Bernstein, 2000; Client Rights Project, 1998, Mahalik et al., 2000).
Studies of client-therapist similarity, or match, seem to be based on the assumption that minority-group clients are more comfortable with therapists from the same or a similar minority group, and therefore find the therapist more attractive, trustworthy and expert than a therapist from a dissimilar group (Moran, 1992; Strong, 1968). To the extent that this is true, it may have to do with expectations by the client that the therapist would be aware of issues faced by the group in question (such as shared cultural values, discrimination, stigma and prejudice), and would have personally experienced and dealt with those issues in such a way that she or he could be of assistance to the client. Also, the therapist would be expected to have enough information to understand when the issues particular to the group would not be an issue for a given client. Although minority group membership raises the odds that therapists may have experienced problems common to the group, it is no guarantee that they have successfully resolved them, or have sufficiently dealt with their own internalized oppression (Isay, 1996). It is also possible that therapists who are not members of the group have taken the time and effort to become educated about the issues common to a particular minority group (Bernstein, 2000).
Finding out information about a therapist’s sexual orientation, or attitudes and approach towards sexual minorities, may be part of a screening process that many sexual minority clients undertake. As a result, therapists who agonize about whether or not to disclose this kind of information to clients may have the decision taken out of their hands. Becky Liddle (1997) found that 63 percent of the therapists seen by 392 self-defined lesbian and gay clients had been pre-screened for gay-affirmative attitudes. Clients most commonly sought referrals from friends, acquaintances, or referral organizations in their gay and lesbian communities. The next most frequent approach was talking directly to potential therapists, and either asking about their attitudes toward and/or experience with gay or lesbian clients, or coming out to therapists and gauging their reaction. Less common screening methods included looking for therapists who advertised in gay newspapers or directories, finding a therapist the client knew to be gay or lesbian, asking reception staff at an agency to direct them to a gay-affirmative therapist, or choosing a therapist who worked in a gay or lesbian focused agency or one who ran a gay or lesbian support group.
This is consistent with findings that prospective clients (who were not necessarily sexual minorities) most frequently wanted information about therapists’ experience, credentials, personal characteristics (Braaten, Otto & Handelsman, 1993,) personal feelings, interpersonal relationships, and sexual issues (Hendrick, 1988). It seems reasonable to assume that the type of information about a therapist that would be most important to any prospective client would be those pertinent to her or his own issues. Anne Bernstein (2000), a heterosexual family therapist and mediator, also confirms that in her clinical experience, clients are likely to screen therapists. She distinguishes between what she terms “yellow pages” and “lavender pages” referrals. She calls yellow pages referrals those in which the prospective client obtained the therapist’s name from a mainstream referral source, and therefore is unlikely to have other information, such as the therapist’s attitudes and experience with sexual minority clients. Lavender pages referrals (which she named for a gay-positive directory of businesses in her area) may include personal referrals from the prospective client’s friendship and community network, and tend to come with testimonials about a therapist’s attitudes, experience, and sometimes sexual orientation.
Although in many cases, as it appears, the client has ways of finding out salient information, there are some instances in which clients may have little information about their prospective therapists — Bernstein’s (2000) “yellow pages” referrals — or other situations in which clients may have little choice (for example, those in small towns or rural areas with few therapists to choose from, or those who have been mandated or assigned to a particular therapist). In this case, therapists should consider disclosing their sexual orientation to their sexual minority clients.
The Impact Of Not Disclosing
If the therapist is a member of a sexual minority, not to disclose this information may be detrimental to the client in many ways. Not disclosing, especially if a client has asked for the information, can contribute to clients’ beliefs that they are untrustworthy; it can communicate the idea that some issues are out of bounds; it can also lead to feelings of betrayal and deception, if sexual minority therapists hide or lie about their orientation and clients find out about it later (Isay, 1996). Even more damaging is the implication that this issue is one about which the therapist seems to collude with the homophobic attitude that being a member of a sexual minority is something to be ashamed of and kept secret (Connolly, 2001; Sheridan, 1997). Richard Isay (1996), a gay psychoanalyst, writes:
am convinced…that the gay analyst or therapist who hides or disguises his sexual orientation does further damage to his [gay] patients’ self-esteem by conveying his own shame, self-deprecation, or fear of disclosure. Equally important, he fails to provide a corrective for his patients’ injured self-esteem that derives from internalized social attitudes and parental and peer rejection (p. 44).
Therapists who refuse to disclose may do so from the perspective that clients who ask for this information may have a low “frustration tolerance”, “an inability to trust without being able to fully control the psychotherapist” (Tillman, 1998, p. 278), or are offering material to be analyzed, interpreted or explored for its meaning, but not answered (Goldstein, 1994; Isay, 1996). Tillman (1998) exemplifies the agenda of some therapists: to be in control of the therapy, and by extension, the client. There are growing clinical and anecdotal reports that clients do not want to be controlled or frustrated in their attempts to have information that they consider to be pertinent to their therapy, and will not put up with it, either confronting the therapist and demanding the information or simply leaving treatment (Bridges, 2001; Goldstein, 1994; Goldstein, 1997; Vamos, 1993).
Eda Goldstein (1994) tells a poignant story of a 43 year old client who was seeing a psychoanalytic trainee. The client was described as a woman who had struggled with an attraction to women, but who had had difficulty accepting a lesbian identity due to shame and fear. Many previous therapists had urged her to be with men, and she had duly tried, but felt “empty and disinterested” (p. 424). The client felt close to her current analyst, in part because their gender, age, appearance and sense of humour were similar. The client said that she wished her analyst were a lesbian so she could understand her better. In fact, the analyst was a lesbian, but was instructed in supervision to stay “neutral and exploratory” (p. 425), since the supervisor believed the client’s sexual orientation was still in question, but not to answer the client’s request for information. The analyst-trainee did as she was told, though she felt “dishonest and rejecting” and was afraid that she was “imposing an intolerable frustration” on her client (p. 426). The client became “withdrawn and depressed” (p. 426). By the time the analyst-trainee finally decided to go against her supervisor’s advise and disclose her sexual orientation to the client, the client cancelled her appointment, indicated that she was terminating her treatment, and refused to discuss the matter further.
In analyzing this situation, Goldstein (1994) writes:
…I believe it would have been important for the therapist to self-disclose in this instance whether or not she was gay. The patient was expressing a self need for someone who would validate the patient’s existence and aliveness. Thus the human responsiveness reflected in self-disclosing rather than its exact content per se would have been affirming… Her shame over feeling different and about her longings for women contributed to her alienation from her own feelings and from others and to her lack of self-cohesion. Her years of therapy seemed to reinforce rather than repair her damaged self and fostered the suppression of her sexual orientation. The patient’s hope for herself and in relationships was revived in the transference providing her with another chance to make meaningful human contact and to complete her development but the therapist’s refusal to self-disclose was experienced as another traumatic loss. The therapist’s empathetic but not sufficiently responsive interventions dashed the patient’s hopes for a better solution, made the patient feel more hopeless, and led to an irreparable disruption in the treatment (pp. 426-7).
In this case, the therapist’s willingness to disclose would have been as important to the client as the content of the disclosure.
On the other hand, there is evidence to suggest that knowledge of the therapist’s sexual orientation is not the most important predictor of successful therapy. A field study conducted by Liddle (1996) found evidence that clients’ positive outcome measures were significantly related to therapist gender orientation. However, she also correctly observed that counsellors cannot change their demographic characteristics (gender, sexual orientation, etc.) in order to be perceived as more attractive, trustworthy or expert by clients. She therefore postulated that it would be important also to look at counsellor behaviours that might affect outcomes, and that could be changed. Nine inappropriate and four exemplary therapist practices concerning lesbian and gay clients were rated by respondents and correlated with outcome measures of a) client ratings of helpfulness/ unhelpfulness and b) termination after only one session. Exemplary practices included the therapist’s ability to deal with relevant sexual orientation issues, and the therapist’s ability to help a gay or lesbian client feel good about himself or herself. Inappropriate practices included the assumption that the client was heterosexual, indications that homosexuality was “bad, sick or inferior” (Liddle, 1996, p. 397) or should be renounced or changed, and the failure to understand the importance of issues of societal oppression and internalized oppression. (Milton and Coyle’s 1998 study of therapists of various sexual orientations included very similar practices.)
Outcome measures were also correlated with the gender and sexual orientation (if known) of the therapists. Gay and lesbian therapists, bisexual therapists of both genders, and heterosexual female therapists were all rated significantly more helpful than heterosexual male therapists. Male therapists of unknown orientation were rated significantly lower than all other groups. Relative risk ratios showed that 8 out of 9 inappropriate practices were significantly associated with both client ratings of therapists as up to 4 times more unhelpful or destructive and 5 times more likely to terminate after only one session. Therapists who used exemplary practices were 6 to 12 times more likely to be rated fairly helpful or very helpful.
Notably, therapist practices accounted for more of the variance than therapist demographic characteristics. Liddle (1996) concluded that although similar sexual orientation may increase the likelihood of therapy being helpful, it is not always necessary (30% of the two lowest rated groups — heterosexual and unidentified males — were rated very helpful).
Moran’s (1992) analogue study of 40 gay men and 40 lesbians, in which he found that the perceived sexual orientation of the therapist was not related to the perception of their attractiveness, trustworthiness or expertness, should be treated with caution. First, Moran (1992) notes that participants in the study were told that the therapists were either experienced or inexperienced, and lesbian/gay or married. Lesbians and gay men may be less likely than heterosexuals to presume that someone who is married is heterosexual, since many of us have also been married! It’s hard to know if Moran’s operationalization of the sexual orientation variable was valid. Moran (1992) also noted that his stimulus videos of the therapy sessions were 15 minutes long, and did not involve issues connected to the client’s sexual orientation. However, taken together, Liddle’s (1996), and Moran’s (1992) studies of sexual minority clients, Milton & Coyle’s (1998) study of therapists working with sexual minority clients, and some of Bernstein’s (2000) and Goldstein’s (1994) anecdotal evidence, suggest that it may not be the sexual orientation of the therapist per se that is the issue, but the way the therapist treats the client, that is more important (including understanding the importance of offering information concerning or responding to questions about the therapist’s sexual orientation). Although the therapist gender and sexual orientation may correlate with therapists’ exemplary or deficient treatment of sexual minority clients, they are by no means the same thing.
Disclosure Of Heterosexual Orientation
It is a mistake for heterosexual therapists to assume, because they have not explicitly revealed their sexual orientation to their clients, that clients would be unaware of it. First, most clients tend to assume their therapists are heterosexual unless there is an indication otherwise (Connolly, 2001; Sheridan, 1997). Second, there are many ways in which therapists may implicitly communicate such information, such as through pictures of significant others, symbols such as wedding rings, etc. As previously noted, heterosexual therapists who disclose their orientation are sending a message that they take the issue of sexual orientation seriously; that they understand the nature of their privilege; and that they are willing to address the power imbalance by making such a disclosure (Connolly, 2001).
Bernstein (2000) also advocates disclosure of sexual orientation if the therapist is heterosexual. She recounts a situation in which she was chosen as a therapist by a lesbian couple because she was the only one willing to disclose her sexual orientation over the phone to the prospective clients. The ironic thing is that the other names which the clients had been given belonged to lesbian therapists — none of whom would disclose their sexual orientation when asked.
Risks Of Disclosure For Therapists
This brings up the question of safety for sexual minority therapists. Bernstein (2000) was aware that her safety and comfort with disclosing her sexual orientation was an aspect of her heterosexual privilege. The only risk she was taking was the loss of the prospective client. On the other hand, although more and more sexual minorities are able to be, and are choosing to be open about their identities, in some contexts, it simply may not be safe to answer questions about or voluntarily disclose one’s sexual orientation, especially during a first-contact phone call, when many clients attempt to screen their prospective therapists. For example, therapists should consider carefully the advisability of disclosing a minority orientation if their clients, who are not bound by confidentiality, might give the information to others (Connolly, 2001), and especially if the disclosure could lead to a poisoned working environment up to and including the possibility of being fired (Sheridan, 1997); if they live or practice in smaller towns or more rural areas which may be less accepting; if they, for whatever reason, may be isolated from the support of the sexual minority community; or if there is a climate in which recent events have touched off a reactionary backlash. The sacrifice of the therapist is not required in order to create or maintain a good working relationship with the client.
Risks Of Disclosure For Clients
It is possible, as some believe (see, for example, Goldstein, 1997; Isay, 1996) that if therapists reveal a sexual minority orientation, it may have undue influence on clients who are still in doubt about their own orientation, although I could find no evidence to support this belief. More likely to be a risk for clients, however, is the likelihood of overlapping roles (Connolly, 2001).
Sexual minority therapists are likely to have some contact, at least, with sexual minority communities. Those communities, while likely to be located in geographically large areas, may seem more like small-town or rural communities in their size and interconnectedness (Brown, 1984; Morrow, 2000). One study of gay, lesbian and bisexual therapists found that over 90% of those responding had come across current or former clients socially (Lyn, 1995). Therapists therefore need to have considered the effects of overlapping roles and to have a plan in place for dealing with this issue responsibly (Brown, 1991; Connolly, 2001; Morrow, 2000).
Implications For Bisexual Therapists
Those with a bisexual identity have some issues in common with lesbians or gays, and some issues unique to bisexuals. Like lesbians or gays, bisexuals are marginalized in Western society. They may be subject to myths, negative assumptions, prejudice and discrimination, in the same way that lesbians and gays are. However, it is important to note that for bisexuals, it may not be only heterosexuals who act this way toward them, but gays and lesbians, too. Although heterosexuals justify their marginalization of bisexuals on the basis of their potential for relationships with same-gender people, gays and lesbians justify their prejudice against and distrust of bisexuals on the basis of their potential for accessing heterosexual privilege (Blasingame, 1995; Connolly, 2001), and disparage their principled commitment to both genders by claiming that they are only going through a phase, or are confused, promiscuous or unable to commit to one gender or the other (Connolly, 2001; Shuster, 1987). Because of the requirement from both communities to choose one gender or the other, bisexuals are constantly in the position of having half their identity denied, made invisible, or made the excuse for discrimination.
For a gay or lesbian therapist working with a bisexual client, it may be helpful for the client simply to know that the therapist has had to come to terms with a non-heterosexual identity. However, Connolly (2001) suggests that it is not enough for a bisexual therapist working with a bisexual client simply to claim a “non-heterosexual” identity. The issues specific to bisexuality, especially the issues of double discrimination from both heterosexual and gay/lesbian cultures, and the issue of the invisibility of part of the identity, make it important that bisexual therapists reveal their full identity to clients. As with gay or lesbian therapists disclosing to gay or lesbian clients, disclosure of bisexual identity gives clients information about the therapist’s social location in order to make informed choices, as well as conveying a commitment to honesty in the relationship, pride in the identity, and an understanding of the issues particular to the group (Connolly, 2001).
Conclusion And Implications For Future Research
The preceding information can be summarized as follows:
Although there have been several studies of therapists’ theoretical rationales for, beliefs about, and use of self-disclosure (Mathews, 1988; Simi & Mahalik, 1997; Simon, 1988; Simone, McCarthy & Skay, 1998), and numerous analogue studies of aspects of therapist self-disclosure using (primarily) non-client undergraduate students (see Watkins, 1990, for a thorough, though by now somewhat dated, review), there have been relatively few studies of the effects of this technique on actual clients (see, for example, Barrett & Berman, 2001; Hill, Mahalik & Thompson, 1989; Knox et al., 1997; Wells, 1994). Further, I have found no empirical studies of the effects on sexual minority clients of therapist self disclosure of sexual orientation, or attitudes about and experience with sexual minority issues. To study this issue would provide more information about the effects of self-disclosure in general, and would allow us to gain insight into the experience and needs of sexual minority clients, in particular. Also of interest would be the question of the effects of therapists’ refusal to disclose. Although Isay (1996) and Goldstein (1994) have provided several anecdotes detailing the detrimental effects, there may be differences in the way in which some clients perceive therapist non-disclosure. For example, clients who are more comfortable with their sexual orientations or gender identities, or for whom sexual orientation or gender identity is not an issue in therapy, may not experience therapist non-disclosure as detrimental.
Conclusions
One of the most striking themes in the literature was the suggestion that it was how people were treated, not whether or not the therapist and client were matched on sexual orientation, that was likely to result in client’s experiencing therapy as helpful. Liddle (1996) and Milton & Coyle (1998) detailed a number of behaviours and practices that therapists could choose to exhibit or refrain from. Ultimately, what therapists do or don’t do in this area likely has to do with their heterosexism and/or homophobia. We must find a way to tackle this issue.
At least one study of therapist attitudes toward lesbian and gay clients has suggested that therapists would benefit from courses on sexual minority issues (Crawford, McLeod, Zamboni & Jordan, 1999). My experience and that of many of my colleagues suggests that these courses — or even sexual minority content in more mainstream courses — are in short supply. A study of the curricula of several universities offering masters’ and doctoral level courses in counselling and psychology might begin to identify the lack and suggest remedies. In the interests of training therapists who are more well-rounded in cross-cultural work, graduate programmes could require students to take at least one course involving working with a population to which the student does not belong. (This does not preclude students from also taking courses in working with populations to which they do belong.) For example, men might choose to take a women’s studies or feminist counselling course; white people could take a course on racism or working with racial minorities; heterosexual people could take a course on homophobia or working with sexual minorities.
However, Gillis (1998) has pointed out that though programs for reducing heterosexism have been implemented with some success, prevention of heterosexism would ideally begin in elementary school. I would suggest that a multi-tiered program could be even more effective, with interventions aimed not only at children, but also at their parents. By the time potential therapists get to graduate school, it may be more likely that they would find course material or even whole courses on sexual minority issues, and more likely that a wider variety of students would enroll in them.
Finally, could self-disclosure of sexual minority therapists to heterosexual clients be of value in addressing heterosexism? No research has addressed this question yet, but some anecdotal evidence exists. Laura Brown recounts her experience with a heterosexual Christian fundamentalist client who knew that her therapist was a lesbian (Brown, 1994). Brown does not give any details about the nature of this disclosure to her client (such as how it came up, why it was disclosed, or under what circumstances), but states that it was peripheral to their relationship (which focused on the client’s recovery from abuse) until her client’s church began to exhort its congregants to support a “virulently anti-gay- and lesbian-rights bill” (Brown, 1994, p. 102) in the state legislature. At that point, it became possible, and in fact, necessary, for client and therapist to struggle with the issue of the therapist’s lesbianism. Brown held fast to the belief that “people empowered to value themselves will find it difficult to participate in the oppression of others” (Brown, 1994, p. 103). When the bill was finally defeated, the client was able to feel and express pleasure about it, and had had the opportunity to reflect on the meaning of the differences between her and her therapist and the greater meaning of those differences in the “larger social and political context” (Brown, 1994, p. 103). Perhaps the issues of homophobia and heterosexism will ultimately be addressed by just such personal struggling to discover the meaning of our relationships with each other.
References
Ackerman, S.J. & Hilsenroth, M.J. (2001). A review of therapist characteristics and techniques negatively impacting on the therapeutic alliance. Psychotherapy, 38, 171 — 185.
Auvil, C.A. & Silver, B.W. (1984). Therapist self-disclosure: when is it appropriate? Perspectives in Psychiatric Care, 22, 57 — 61.
Barrett, M.S. & Berman, J.S. (2001). Is psychotherapy more effective when therapists disclose information about themselves? Journal of Counseling and Clinical Psychology, 69, 597 — 603.
Bernstein, A. C. (2000). Straight therapists working with lesbians and gays in family therapy. Journal of Marriage and Family Therapy, 26, 443 — 454.
Blasingame, B. (1995). Power and privilege: Beyond the invisible fence. In N. Tucker, (Ed.), Bisexual politics: Theories, queries, and visions (229 — 233). New York: Harrington Park Press.
Braaten, E.B., Otto, S. & Handelsman, M.M. (1993). What do people want to know about psychotherapy? Psychotherapy, 30, 565 — 570.
Bridges, N.A. (2001). Therapist’s self-disclosure: expanding the comfort zone. Psychotherapy, 38, 21 — 30.
Brown, L.S. (1984). The lesbian therapist in private practice and her community. Psychotherapy in Private Practice, 2 (4), 9 — 16.
Brown, L S. (1991). Ethical issues in feminist therapy: Selected topics. Psychology of Women Quarterly, 15, 323 — 336.
Brown, L.S. (1994). Subversive Dialogues: Theory in Feminist Therapy. New York: BasicBooks.
Brown, L.S. & Walker, L.E.A. (1990). Feminist therapy perspectives on self-disclosure. In G. Stricker & M. Fisher (Eds.) Self-Disclosure in the Therapeutic Relationship (pp. 135 — 154). New York: Plenum.
Client Rights Project (1998). Client Rights in Psychotherapy and Counselling: A Handbook of Client Rights and Therapist Responsibility. Toronto: Client Rights Project.
Connolly, T. (2001). Therapist Self-disclosure of Sexual Orientation: Implications of Resisting Hegemonic Practice. Unpublished manuscript, OISE/UT in Toronto.
Crawford, I., McLeod, A., Zamboni, B., & Jordan, M. (1999). Psychologists’ attitudes towards gay and lesbian parenting. Professional Psychology: Research and Practice, 30, 394 — 401.
Gillis, J.R. (1998). Cultural heterosexism and the family. In A.R. D’Augelli & C.J. Patterson (Eds.), Lesbian, Gay and Bisexual Identities in Families: Psychological Perspectives (pp. 249 — 269). New York: Oxford University Press.
Goldstein, E.G. (1994). Self-disclosure in treatment: what therapists do and don’t talk about. Clinical Social Work Journal, 22, 417 — 433.
Goldstein, E.G. (1997). To tell or not to tell: the disclosure of events in the therapist’s life to the patient. Clinical Social Work Journal, 25, 41 — 58.
Gutheil, T.G. & Gabbard, G.O. (1993). The concept of boundaries in clinical practice: theoretical and risk-management dimensions. American Journal of Psychiatry, 150, 188 — 196.
Hawkins, I. & Bullock, S.L. (1995). Informed consent and religious values: a neglected area of diversity. Psychotherapy, 32, 293 — 300.
Hendrick, S. (1987). Counseling and self-disclosure. In V. Derlega & J. Berg (Eds.), Self-disclosure: Theory, research, and therapy (pp. 303-327). New York: Plenum Press.
Hendrick, S. (1988). Counselor self-disclosure. Journal of Counseling and Development, 66, 419 — 424.
Herman, J.L. (1992). Trauma and Recovery. New York: BasicBooks.
Hertzberg, J.F. (1990). Feminist psychotherapy and diversity: Treatment considerations from a Self Psychology perspective. In L. Brown & M. Root (Eds.) Diversity and Complexity in Feminist Therapy (pp. 275 — 297). New York: Harrington Park Press.
Hill, C.E., Mahalik, J.R., & Thompson, B.J. (1989). Therapist self-disclosure. Psychology, 26, 290 — 295.
Isay, R. A. (1996). Becoming Gay: the Journey to Self-Acceptance. New York: Henry Holt and Company.
Jacobs, T. (1999). On the question of self-disclosure by the analyst: error or advance in technique? Psychoanalytic Quarterly, 68, 159 — 183.
Jourard, S.M. (1971). Self-disclosure: An Experimental Analysis of the Transparent Self. New York: Wiley-Interscience.
Knox, S., Hess, S.A., Petersen, D.A., & Hill, C.E. (1997). A qualitative analysis of client perceptions of the effects of helpful therapist self-disclosure in long-term therapy. Journal of Counselling Psychology, 44, 274 — 283.
Kottler, J.A. (1986). On Being a Therapist. San Francisco: Jossey-Bass.
Liddle, B.J. (1996). Therapist sexual orientation, gender and counseling practices as they relate to ratings of helpfulness by gay and lesbian clients. Journal of Counseling Psychology, 43, 394 — 401.
Liddle, B.J. (1997). Gay and lesbian clients’ selection of therapists and utilization of therapy. Psychotherapy, 34, 11 — 18.
Liljestrand, P., Gerling, E., & Saliba, P.A. (1978). The effects of social sex-role stereotypes and sexual orientation on psychotherapeutic outcomes. Journal of Homosexuality, 3, 361 — 372.
Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press.
Lyn, L. (1995). Lesbian, gay, and bisexual therapists’ social and sexual interactions with clients. J.C. Gonsiorek (Ed.), Breach of trust: Sexual Exploitation by Health Care Professionals and Clergy (pp. 193 — 212). Thousand Oaks, CA: Sage.
Mahalik, J.R., van Ormer, E.A., & Simi, N.L. (2000). Ethical issues in using self-disclosure in feminist therapy. In M.M. Brabeck, (ed.), Practicing Feminist Ethics in Psychology. Washington: American Psychological Association.
Mathews, B. (1988). The role of therapist self-disclosure in psychotherapy: a survey of psychotherapists. American Journal of Psychotherapy, 62, 521 — 531.
McDermott, D., Tyndall, L. & Lichtenberg, J.W. (1989). Factors related to counselor preference among gays and lesbians. Journal of Counseling and Development, 68, 31 — 35.
Milton, M. & Coyle, A. (1998). Psychotherapy with lesbian and gay clients. The Psychologist, 11, 73 — 76.
Moran, M. R. (1992). Effects of sexual orientation similarity and counselor experience level on gay men’s and lesbians’ perception of counselors. Journal of Counseling Psychology, 39, 247 — 251.
Morrow, S.L. (2000). First do no harm: Therapist issues in psychotherapy with lesbian, gay, and bisexual clients. In R. Perez, K. DeBord, & K. Bieschke (Eds.), Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients (pp. 137-156). Washington: American Psychological Association.
Peterson, M.R. (1992). At Personal Risk: Boundary Violations in Professional-Client Relationships. New York: W. W. Norton and Co.
Pope, K.S. (1990). Therapist-patient sexual contact: Clinical, legal and ethical implications. In E.A. Morgenau (ed.), The Encyclopedia Handbook of Private Practice. New York: Gardner Press Inc.
Psychopathology Committee of the Group for the Advancement of Psychiatry (2001). Reexamination of therapist self-disclosure. Psychiatric Services, 52, 1489 — 1493.
Rogers, C.R. (1951). Client-Centered Therapy. London: Constable.
Rogers, C.R. (1961). On Becoming a Person. Boston: Houghton Mifflin.
Sheridan, P. M. (1997). Preparing to Work with Lesbian, Gay and Bisexual Youth. In M. Schneider (Ed.), Pride and Prejudice: Working with Lesbian, Gay and Bisexual Youth (pp. 69-82). Toronto: Central Toronto Youth Services.
Shuster, R. (1987). Sexuality as a continuum: The bisexual identity. Boston Lesbian Psychologies Collective (Eds.), Lesbian psychologies: Explorations and Challenges (pp.56-71). Chicago: University of Illinois Press.
Simi, N.L. & Mahalik, J.R. (1997). Comparison of feminist versus psychoanalytic/ dynamic and other therapists on self-disclosure. Psychology of Women Quarterly, 21, 465 — 483.
Simon, J.C. (1988). Criteria for therapist self-disclosure. American Journal of Psychotherapy, 62, 404 — 415.
Simon, R.I. (1991). Psychological injury caused by boundary violation precursors to therapist-patient sex. Psychiatric Annals, 21, 614-619.
Simone, D.H., McCarthy, P. & Skay, C.L. (1998). An investigation of client and counselor variables that influence the likelihood of counselor self-disclosure. Journal of Counseling and Development, 76, 174 — 182.
Strong, S.R. (1968). An interpersonal influence process. Journal of Counseling Psychology, 15, 215 — 224.
Tillman, J.G. (1998). Psychodynamic psychotherapy, religious beliefs, and self-disclosure. American Journal of Psychotherapy, 52, 273 — 286.
Vamos, M. (1993). The bereaved therapist and her patients. American Journal of Psychotherapy, 47, 296 — 305.
Watkins, C.E. Jr. (1990). The effects of counselor self-disclosure: a research review. The Counseling Psychologist, 18, 477 — 500.
Wells, T.L. (1994). Therapist self-disclosure: its effects on clients and the treatment relationship. Smith College Studies in Social Work, 65, 23 — 41.
Zur, O. (2000). In celebration of dual relationships: how prohibition of non-sexual dual relationships increases the chance of exploitation and harm. Retrieved on March 27, 2002 from https://www.zurinstitute.com/dualrelationships2.html