By: Ofer Zur, Ph.D. and Birgit Wolz, Ph.D.
Table Of Contents
Types of Self-Disclosures
Historical Context
Therapeutic Orientations
Different Populations
Ethical Decision-Making
Movie Vignettes and Analysis
Antwone Fisher, Bliss, Dressed to Kill, Frances,
Good Will Hunting, Grosse Pointe Blank,
House of Games, K-Pax, Prime, Stay,
Ordinary People, What about Bob?
Self-Disclosure in Psychotherapy
At its most basic therapist self-disclosure may be defined as the revelation of personal rather than professional information about the therapist to the client.
When therapist disclosure goes beyond the standard professional disclosure of name, credentials, office address, fees, office policies, etc., it becomes self-disclosure. Appropriate and clinically driven self-disclosures that are carried out for the clinical benefit of the clients and unavoidable (non-harming) self-disclosure that takes place in the community are considered boundary crossings (Gutheil & Gabbard, 1993; Lazarus & Zur, 2002; Williams, 1997 ; Zur, 2007). Inappropriate self-disclosures, such as self-disclosure that is done for the benefit of the therapist, clinically counter-indicated, burdens the client with unnecessary information or creates a role reversal where a client, inappropriately, takes care of the therapist, are considered a boundary violation (Gutheil & Gabbard, 1988; Zur, 2004a).
There are four different types of self-disclosures: deliberate, unavoidable, accidental and client initiated. Following are descriptions of these types.
SELF-DISCLOSURE IN HISTORICAL CONTEXT
Discussions of psychotherapist self-disclosure dates back to the earliest years of psychotherapy. As early as 1912, and consistent with the puritanical culture of his time, Freud emphasized that “The physician should be impenetrable to the patient, and like a mirror, reflect nothing but what is shown to him” (Petersen, 2002, p. 21). The rise of the humanist movement in the ’60’s advanced the argument that self-disclosure could be therapeutic and valuable. In 1971 Jourard (1971a) published Self-disclosure: An Experimental Analysis of the Transparent Self, which has been highly popular among humanistic psychotherapists ever since. The feminist movement of the 1970s and 1980s added a political dimension, in which feminist therapist self-disclosure was valued for its role in modeling and fostering a more egalitarian relationship between therapist and client (Brown, 1994; Greenspan, 1995; Simi & Mahalik, 1997). Simultaneously, the 12-step programs used in many support groups, which are based on mutual self-disclosure, have proliferated since the 1980s and 1990s. The 1990s have witnessed a cultural shift where celebrities and politicians, such as Oprah Winfrey, Kitty Dukakis, Elizabeth Taylor and Patty and Michael Reagan, have accustom the public to intimate and detailed confessions on national TV. At the same time, Oprah, Geraldo, Donahue and Roseanne-type shows have promoted extreme and often bizarre self-disclosure by people on TV in front of millions of strangers. In the new millennium so-called reality shows that promote uncensored voyeurism and uninhibited self-disclosure have burgeoned. Societal change in attitude has manifested itself also in medicine and mental health services. In the managed care era of the 1990s patients or clients have become consumers and physicians and psychologists have become providers. Consumers have been empowered to become informed and to question their providers’ experience and expertise. Modern consumers feel entitled to access all kinds of information about their medical caregivers, and they can turn to medical boards, federal medical data banks, consumer protection agencies and a vast array of private, for-profit enterprises that are ready to provide it. Finally, the Internet has brought about the most significant information revolution. Consistent with consumer requests for information, more and more psychotherapists are constructing consumer friendly, personal Web sites featuring not only professional data, but significant amounts of personal information as well (Zur, 2007).
On the professional front dovetailing with the humanistic, feminist and self-help movements, several new approaches to therapeutic self-disclosure surfaced towards the end of the 20th century and at the beginning of the 21st. Authors from orientations, such as behavioral, cognitive and cognitive-behavioral, have discussed the therapeutic benefits of self-disclosure from the angle of their particular modality (Burns, 1990; Goldfried, Burckell & Eubanks-Carter, 2003; Lazarus, 1994). Even psychodynamic oriented therapists have reviewed the clinical utility of self-disclosure (Bridges, 2001; Goldstein, 1997; Renik, 1996). The end of the ’90s and the beginning of the new millennium have also seen increasingly open discussion about flexible therapeutic boundaries in general (i.e., Lazarus & Zur, 2002; Younggren & Gottlieb, 2004) and a surge in articles on self-disclosure in particular (i.e., Bridges, 2001; Kessler & Waehler, 2005; Petersen, 2002). Similarly, the APA Code of Ethics of 2002 introduced needed clarity to the issues when it stated that therapeutic interventions should be judged by the ” . . . prevailing professional judgment of psychologists engaged in similar activities in similar circumstances” (p. 162) rather than by certain theoretical orientations or arbitrary rules. Taken all together, it becomes clear that a positive view of professional attitudes toward self-disclosure have co-evolved with the cultural attitudes toward self-disclosure.
SELF-DISCLOSURE & THERAPEUTIC ORIENTATIONS
The attitude towards therapeutic self-disclosure is closely related to the therapist’s primary theoretical orientation. Generally, highly disclosing therapists viewed the focus of the psychotherapy process as an interconnection between the therapist and the patient, whereas less disclosing therapists focused on working through patients’ projections (Petersen, 2002; Stricker & Fisher, 1990). Different therapeutic orientations have obviously different takes on self-disclosure:
SELF-DISCLOSURE WITH DIFFERENT POPULATIONS
Therapists working with different populations have different rationales for self-disclosure:
ETHICAL DECISION-MAKING & SELF-DISCLOSURE
There are a number of concerns that are associated with self-disclosure. The one most commonly cited is that self-disclosure is not done for clinical-therapeutic purposes or for the client’s benefit but rather for the therapist’s. Thus the intent of the therapist is extremely important, as it should be focused firmly on the client’s welfare and should not be fueled by the gratification of the therapist’s needs or desires (Barnett, 1998; Bridges, 2001; Mallow, 1998 ; Zur, 2007). Several writers have raised the concern that the therapist’s self-disclosure should neither burden the client nor be excessive nor create a situation where the client needs to care for the therapist. Most scholars and ethicists agree, generally, that therapists should not share their sexual fantasies with their clients (Fisher, 2004; Gabbard, 1989; Pope et al., 1987; Stricker & Fisher. 1990).
As with any decision regarding boundary crossing, the decision to self-disclose is based first and foremost on the welfare of the client. Intentional and deliberate self-disclosure is made under the general moral and ethical principles of Beneficence and Nonmaleficence – therapists intervene in ways that are intended to benefit their clients and avoid harm to them (APA, 2002). Applying these principles to self-disclosure means that intentional self-disclosure should be client-focused and clinically driven and not intended to gratify the therapist’s needs. When self-disclosure is unavoidable, as often is the case in small communities, therapists must evaluate whether such exposure is likely to benefit, interfere or affect the therapeutic process in any way.
The client’s presenting problem, history, gender, culture, age, sexual orientation, mental ability and other client factors should be considered before the therapist elects to self-disclose. Therapists’ theoretical orientation and comfort with self-disclosure is often determined by their culture, gender and personality. These are obvious factors determining the extent of their self-disclosure. Therapists who work out of their homes should also be aware that this most personal of settings presents abundant self-disclosure that may have significance for some clients. The home office arrangement inevitably exposes the therapists’ personal, familial and even financial life.
Antwone Fisher
This movie is based on a true story about Antwone Fisher, an African-American in the U.S. Navy stationed in San Diego, California. He has trouble with his anger and gets into a fistfight with a fellow officer. This outburst is sudden, swift, and virtually unprovoked. Fisher has to be evaluated and treated by the African American psychiatrist, Dr. Jerome Davenport.
Intentional Self-Disclosure
These self-disclosures seem to be initiated by the psychiatrist for the purpose of modeling and normalizing. They seem appropriately and strategically implemented within the clinical context.
While Antwone waits for Davenport at his house, he looks closely at the psychiatrist’s home and studies his family pictures. Mrs. Davenport gets to know and like him. She encourages her husband to invite his patient to their house for Thanksgiving. Even though Davenport instructed his patient not to talk to his wife any more, he changes his mind and follows through with the invitation saying, “next Thursday, my house, my family, my dinner table.” Extensive self-disclosure takes place when his patient arrives for the dinner. Antwone gets to meet Jerome Davenport’s parents, his sister, niece and his wife’s relatives. He participates in their prayer and observes the lively family dynamics. When Davenport’s father asks Antwone about his mother’s cooking, he gets upset and leaves the dinner table. His therapist follows him to the living room, checks in with him and demonstrates his caring. This allows Antwone to experience a life-changing catharsis when both of them read Antwone’s touching poem that gives his emotional pain a powerful voice.
This extensive self-disclosure seems to aim at giving Antwone the opportunity to experience the warm-hearted atmosphere of a normal family as a corrective emotional experience. He seems to succeed with this intervention and takes advantage of the opportunity that presents itself when they connect in the living room.
After their sessions were terminated, Antwone runs into his therapist and tells him that he was right in encouraging him to find his family. Davenport answers, “I was right about the wrong reasons. … This stays between you and me, ok? … My wife and I, we were gonna have a bunch of kids when we found out that she couldn’t have any.” The psychiatrist’s stiff upper lip and grin-and-bear-it attitude had begun to undermine his marriage. He continues telling his patient that he found the best psychotherapy treatment for his wife but started shutting down himself. He was in denial about this until Antwone came into his life and “blew up this little secret and put me to shame, in a way I never thought possible.” He continues, “Because of you, Antwone, I am a better doctor, and I am learning to be a better husband. You don’t owe me anything. I owe you. You’re the champ in beating everybody who has beaten you. I salute you.” They salute each other and Davenport takes his ex-patient out to a meal.
Letting the client know his impact on the therapist has been labeled self-involving. Telling the client that he had positive influence on his psychiatrist is likely to raise his self-esteem and enhance his sense of self-value. This appears to be further enhanced by the fact that the therapist lets Antwone know that he is human and not infallible. The self-disclosure did not seem to interfere with the therapeutic process and outcome and, in all likelihood, enhanced it.
Bliss
Maria and Joseph see Alfred for couples therapy, while Maria secretly consults sex therapist Dr. Baltazar Vincenza. The latter therapeutic relationship ends when Baltazar starts teaching Joseph “the ways of love.”
When Baltazar agrees to work with Joseph, he tells him that everything they say or do must remain strictly confidential.
By asking for confidentiality, Baltazar discloses that his therapeutic approach can be considered ethically questionable.
Toward the end of the movie, Joseph encounters Baltazar’s new girlfriend in the sex therapist’s living room as she buttons her blouse. Shortly after that, Baltazar enters the room from his bedroom in a bathrobe. The therapist looks uncomfortable when she kisses him in front of Joseph.
Even though this is a case of accidental involuntary self-disclosure, Baltazar’s office location invites encounters as in this scene. Therapists who are working out of their home offices, or other locations other than standard medical offices, should pay attention to the significant self-disclosure that may occur in such a setting.
Dressed to Kill
After Kate Miller is brutally murdered, Dr. Elliot, her psychiatrist, and Detective Marino try to find her killer. Kate’s teenage son teams up with a prostitute, Liz Blake, who witnessed the murder, to do an investigation of their own.
Voluntary Self-Disclosure
The psychiatrist justifies his phone call with another patient when Kate comes into his office by telling her that he has to do all the office chores himself because his secretary is on vacation. There is no indication whether he intentionally let Kate know this detail about his professional life.
If this was a voluntary intervention, possibly to establish a therapeutic alliance, it might be therapeutically valuable; otherwise I would consider this a benign boundary crossing.
Subsequently the psychiatrist asks Kate how she thinks he is performing, doing his own office work. He wants her to praise him for this effort.
The therapist, in this situation, self-discloses his wish to have positive regard from his patient. This boundary crossing could interfere with the therapeutic process as the therapist primarily attends to his own needs rather than to the client’s.
Self-Disclosure about Therapist’s Sexual Feelings Toward a Client
After Kate reveals to the therapist that she doubts her own sexual attraction, she asks him whether he finds her attractive and if he would want to sleep with her. Elliot answers, “Yes.” His patient asks in response, “Then why don’t you?” And he says, “Because I love my wife, and sleeping with you is not worth jeopardizing my marriage. Is it worth it to you to jeopardize yours?”
The topic of therapists’ sexual attraction towards their clients has been discussed at length in the professional literature (i.e., Pope, K. S., Sonne, J., & Holroyd, J. (1993). Almost all ethicists strongly advocate against it-having sexual feelings? Expressing sexual feelings? Acting out sexual feelings? While sexual feelings toward clients are a common and normal part of therapy, therapists must handle these feeling by getting consultation, personal therapy or any other way to process their feelings so they do not interfere with the therapeutic process. Termination and referral are also possibilities if other options are exhausted. The movie implies that Elliot is attracted to his patient, Kate, and doesn’t act on it. Kate’s questions can be interpreted as a covert invitation. It is ultimately Elliot’s responsibility to professionally manage his own feelings and make sure they do not interfere with therapy.
Frances
The actress Frances Farmer was a rebel since her teenage years. To gain control over her life, Frances’ mother, Lilian Farmer, orchestrates a series of hospitalizations. After an evaluation by a psychiatrist, Dr. Symington, Frances undergoes shock treatment and a lobotomy.
Self-Disclosure about Therapist’s Feelings About Client
These couple of examples seem to exemplify self-disclosure that is not done for the client’s welfare. The star-struck psychiatrist should have worked through his feeling of admiration for his star-client so he can treat her effectively. His need to be admired by his client, if this is the case, is inappropriate and can interfere with treatment as well.
Good Will Hunting
Will Hunting, a working-class, young math genius is wasting his talent. Mathematics professor Lambeau takes him under his wing and finds a therapist for his protégé. In his therapy with Sean McGuire he begins the healing process of his childhood traumas.
The movie presents several significant and deliberate self-disclosure situations. These situations include voluntary and involuntary self-disclosure of the therapist’s feeling about his client (i.e., self-involving).
Voluntary-Strategic Self-Disclosure
These examples of self-disclosure and the language McGuire uses appear to be designed to build and support the therapeutic alliance, to demonstrate emotional risk-taking in romantic relationships, to teach how this supports intimacy, to model ways of dealing with loss and abuse and to encourage Will to talk about his childhood abuse.
Involuntary Self-Disclosure
At the beginning of their fourth session neither the client nor the therapist say anything. Eventually McGuire nods off. This provokes Will to start talking by telling a joke, which opens a door for the therapist to direct him toward subjects that are close to his heart.
Involuntary disclosures by body language are common and not preventable. While many therapists neither attend to nor acknowledge them, they are a significant part of human (and animal) interactions.
After Sean McGuire demonstrates how true intimacy can look by sharing stories about him and his wife, Will asks, “Have you ever thought about getting remarried?” Without owning it the therapist appears hurt and vulnerable and replies in an evasive fashion. Consequently, his client confronts him with his unresolved grief, and McGuire terminates the session prematurely.
Therapists’ emotional reactions to clients are clinically complex issues. One can argue that therapists’ emotional responses to material presented in the session may be unavoidable. What is important is that the therapist process and attend to his/her own responses in a way that, at least, does not interfere with the clinical process and, hopefully, enhances it. Needless to say, each situation is different and different clients and different settings are likely to require different approaches.
Self-Disclosure about Therapist’s Feelings about Client (i.e., Self-Involving)
The type of self-disclosure that involved the therapist’s reaction to the client has been called self-involving (Knox et al., 1997). The above interventions seem to be crucial for Will to start trusting his therapist and for the therapeutic process to begin.
Grosse Pointe Blank
A psychiatrist, Dr. Oatman, is alarmed to learn that his patient, Martin, is a hit man.
Self-Disclosure about Therapist’s Feelings about Client
Toward the end of one session Dr. Oatman says, “I can’t be your doctor, Martin. I am emotionally involved with you. I’m afraid of you and that constitutes emotional involvement. It would be unethical for me to work with you under these circumstances.” As the psychiatrist gets more upset, he says that he feels compelled to be creative in a very interesting way, or else Martin will blow his brains out.
Providing feedback to clients of how they affect their therapists is a highly complex and equally debated issue from clinical and ethical perspectives. Surveys have shown that significant numbers of therapists have expressed their appreciation, love and anger to their clients. In this situation it is hard to determine whether the feedback is for clinical purposes or just an appropriate expression of feelings. The psychiatrist is correct that it is unethical to work with the hit man under such threatening circumstances. However, withdrawing is not a simple option if it may involve the psychiatrist’s own assassination. Therapeutic objectivity and efficiency suffers when the therapist is intimidated. The movie presents a realistic and highly complex situation that does not lead to a simple resolution.
House of Games
Margaret Ford, a repressed psychiatrist, tries to help her patient, Billy, with his gambling addiction. Her patient is laying a trap for Margaret when she allows the con artist, Mike, to become her guide through this underworld of confidence games.
Self-Disclosure About Self as Part of an Assumed Additional Role.
Dr. Ford is involved in a significant amount of self-disclosure as she leaves the office and engages in mental combat with professional gamblers. She clearly reveals her ignorance and cluelessness in regard to the world of con artists, gamblers and her naiveté or presumptuousness in regard to how con men operate.
This is a perfect example of how therapists, who leave their professional home-turf, are exposed in regard to their naiveté and sense of capability at best or superiority at worst.
K-Pax
Dr. Mark Powell is intrigued by his new patient, Prot, who claims to be an alien from the planet K-PAX. In order to evaluate his knowledge in astronomy the psychiatrist takes his patient to his astronomer friend, Steve Becker, and a group of astrophysicists. Later he brings Prot to a garden party with his wife, Rachel, his children and friends. Powell’s superior, Claudia Villars, does not agree with his approach.
Voluntary Self-Disclosure
Powell brings his patient home to celebrate the Fourth of July with his family. After Prot gets to know all the family members he is curious and looks around in his therapist’s house. When Powell’s wife, Rachel, sees him, they get into a conversation in which Rachel reveals details of her husband’s personal history.
Powell sets himself up for extensive self-disclosure when he brings his patient to his home. By not preventing Prot from wandering around his house the psychiatrist loses any knowledge or control over his patient’s discoveries about the therapist.
Ordinary People
Conrad is the second son of a mild-mannered successful attorney, Calvin, and a selfish, controlling mother, Beth. He sees a psychologist, Dr. Berger, after a suicide attempt. Conrad blames himself for his older brother’s drowning death that resulted from a boating accident.
Voluntary (assumed) Self-Disclosure
Dr. Berger fumbles with his record player and turns on some music. He reveals his musical taste.
The psychiatrist establishes a real relationship to help his client trust him and to lose his fear of revealing his secrets.
Prime
Rafi Gardet dates a younger man, David Bloomberg. After hearing about this relationship in their sessions for some time, her therapist, Dr. Lisa Metzger, finds out that Rafi’s boyfriend is her own son.
Voluntary Self-Disclosure
When Rafi tells her therapist about her relationship, she says, with excitement in her voice, “You were right about Jewish men. … Well, you are married to one.” And Metzger responds, “Yes, but he has ADD”.
If this was a deliberate humorous response, it might serve the therapeutic alliance.
This is a very complex situation in regard to self-disclosure. While not very common in big metropolitan areas, this situation can easily arise in smaller communities. The therapist, in this case, self-disclosed on several levels. She first discloses the fact that the client’s date is also the therapist’s son and then revealed how she feels about it. That self-disclosure has prompted the termination of therapy. Then after termination she revealed that she agreed with her client that it was a “very strange” situation. Lastly, there is an immense level of self-disclosure after termination when the client comes as a friend of the family to a special dinner where she is introduced to her former therapists’ relatives, husband, cooking and much more.
Self-Disclosure As Part of a Home-Office Setting
Metzger sees her clients in her home office, which is located in one of the bedrooms in the house.
The home-office setting creates a situation where significant self-disclosure is inevitable. Rafi, like all other clients, is instantly aware of where her therapist lives, the price range of her residence, the socio-cultural aspects of her neighborhood, how well kept her home is and how her living room is furnished.
Involuntary/Accidental Self-Disclosure
Because the door is open, Rafi steps into the office. Metzger looks surprised, turning around after busily trying to adjust the temperature at an air conditioner. The therapist says, “I am sorry it’s so hot here. …I can’t figure this stupid thing out.”
This is an example of an accidental self-disclosure. Even though it might have not been therapeutically intended, the therapist’s statement can turn out to be beneficial since she shows her human and imperfect side.
Stay
A Psychiatrist, Sam Foster, treats to save art student and painter Henry Letham. Foster tries to do everything to figure out why and where his patient wants to kill himself in order to prevent the suicide.
Involuntary Self-Disclosure
For a second meeting Henry comes into the psychiatrist’s office unexpectedly. Referring to a painting on the wall he asks the psychiatrist, “Who did that?” Foster tells him that his girlfriend painted the picture. When the patient noticed an engagement ring on the psychiatrist’s table and asked, “Where did you get that?” Foster tells him that he bought it.
The psychiatrist seems to answer a basic question regarding the painting or the engagement ring in a simple way by answering it honesty and directly. The implication seem to be consistent with humanistic and feminist therapy which asserts that such direct answers are likely to create familiarity, trust and authentic relationships and, therefore, enhance therapeutic alliance.
When Henry looks for his therapist outside the office, he finds him playing chess with a blind friend. Foster introduces his patient to his chess partner by name. Henry believes that the psychiatrist’s friend is his father. Letham did not reveal that Henry is his patient.
This is an accidental and unavoidable self-disclosure. The introduction to Foster’s chess partner might be appropriate to avoid an awkward situation. The therapeutic alliance might have been jeopardized if the therapist had not recognized this surprise meeting in some way.
What About Bob
After one therapy session Bob Wiley follows his psychiatrist, Dr. Leo Marvin, to his lakeside summer home in order to further discuss his problems. There, Bob befriends Marvin’s son, Sigmund, daughter, Anna, and wife, Fay.
Voluntary Self-Disclosure
When he arrives at Dr. Marvin’s office, Bob first looks at the psychiatrist’s family photos on a shelf. He asks, “Is this your family?” When the therapist answers “yes,” Bob tries to guess the names of the family, throwing out multiple possibilities. The therapist tells his patient how he is related to each person in the pictures and mentions their names.
Family pictures in the office are voluntary self-disclosure, while Bob’s inquisitory questioning solicits involuntary self-disclosure from the therapist. Dr. Marvin might want to bring a personal element into his office environment in order to support building therapeutic alliances with his patients. Putting up several family pictures in a therapy office can lead to boundary crossings if they are there only for personal reasons. The same principle applies to the therapist’s explicit description of the people in these photos. After Bob tells his therapist that he is the first person who is able to help him, Marvin pulls his own book from the shelf saying, “There’s a groundbreaking new book that has just come out. … Now, not everything in this book applies to you. But I am sure that you can see, when you see the title, exactly how it could help.” The title of his book is Baby Steps.
The context of this scene suggests that the primary reason for Marvin to self-disclose by showing and selling Bob his book is his own need, not a therapeutic intervention through bibliotherapy.
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