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What Films can Teach Psychotherapists about Therapist Self-Disclosure in Psychotherapy

By: Ofer Zur, Ph.D. and Birgit Wolz, Ph.D.
 

 

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).

TYPES OF SELF-DISCLOSURES

There are four different types of self-disclosures: deliberate, unavoidable, accidental and client initiated. Following are descriptions of these types.

  • Deliberate self-disclosure refers to therapists’ intentional, verbal or non-verbal disclosure of personal information. It applies to verbal and also to other deliberate actions, such a placing a certain family photo in the office, office décor or an empathic gesture, such as touch or a certain sound (Barnett, 1998; Gutheil & Gabbard, 1998; Mahalik, Van Ormer & Simi, 2000 ; Zur, 2007). There are two types of deliberate self-disclosures. The first one is self-revealing, which is the disclosure of information by therapists about themselves. The second type has been called self-involving, which involves therapists’ personal reactions to clients and to occurrences that take place during sessions (Knox et al., 1997).
  • Unavoidable self-disclosure might include an extremely wide range of possibilities, such as therapist’s gender, age and physics. It also covers disclosure through place of practice, tone of voice, pregnancy, foreign or any accent, stuttering, visible tattoos, obesity and many forms of disability, such as paralysis, blindness, deafness or an apparent limp. Therapists reveal themselves also by their manner of dress, hairstyle, use of make-up, jewelry, perfume or aftershave, facial hair, wedding or engagement rings, or the wearing of a cross, star of David or any other symbol (Barnett, 1998; Tillman, 1998 ; Zur, 2007). As will be discussed in the Home Office Section, when the therapy office is located at the therapist’s home, it always involves extensive self disclosures, such as economic status, information about the family and pet, sometimes information about sexual orientation, hobbies, habits, neighbors, community and much more. Therapists who practice in small or rural communities, on remote military bases or aircraft carriers, or those who work in intimate and interconnected spiritual, ethnic, underprivileged, disabled or college communities, must all contend with extensive self-disclosure of their personal lives simply because many aspects are often displayed in clear view of their clients by virtue of the setting. In many of these small community situations a therapist’s marital status, family details, religion or political affiliation, sexual orientation and other personal information may be readily available to clients (Brown, 1984; Campbell & Gordon, 2003; Hargrove, 1986; Nickel, 2004; Schank & Skovholt, 1997; Stockman, 1990 ; Zur, 2006, 2007). Non-verbal cues or body language (e.g., a raised eyebrow, flinch) are also sources of self-disclosure that are not always under the therapist’s full control. Clients, like people in general, are often more attuned to non-verbal cues, such as body language and touch, than to verbal communication (Knapp & Hall, 1997). Even for analysts who strive to minimize self-disclosure, every intervention nonetheless hides some things about the analyst and reveals others (Aron, 1991). A therapist’s announcement of an upcoming vacation, or at least time outside the office, is also unavoidable self-disclosures.
  • Accidental self-disclosure occurs when there are incidental (unplanned) encounters outside the office, spontaneous verbal or non-verbal reactions, or other planned and unplanned occurrences that happen to reveal therapists’ personal information to their clients (Knox, Hess, Petersen, & Hill, 1997; Stricker & Fisher, 1990).
  • Clients’ deliberate actions are also potential sources that can reveal personal information about the therapists. Clients can initiate inquiries about their therapist by conducting a simple Web search (Zur, 2007). Such searches can reveal a wide range of professional and personal information, such as family history, criminal records, family tree, volunteer activity, community and recreational involvement, political affiliations and much more. Therapists do not always have control over what is posted online about them, which means they may not have control or even knowledge of what clients may know about them. Therapists’ biographies or professional resumes may also reveal significant information about the therapist. A client’s deliberate tracking, spying or stalking their therapist can reveal a significant amount of private and personal information.

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:

  • Traditional analysts have followed Freud’s instructions to serve as a mirror and a blank screen for the client, freeing the client to project their own feelings and thoughts onto the rather neutral therapist. Neutrality, abstinence and anonymity, according to traditional analytic theory, are the foundations for transference analysis (Lang, 1982; Petersen, 2002). Self-disclosure within the analytic tradition is thought to result in gratification of patients’ wishes rather than analysis of them (Mallow, 1998). Along these lines Simon (1994) advocates that psychotherapists: “Maintain therapist neutrality. Foster psychological separateness of the patient . . . Preserve relative anonymity of the therapist” (p. 514). In contrast the interpersonal focus of several modern psychodynamic psychotherapies has emphasized the importance of self-disclosure in relational and intersubjective perspectives (Aron, 1991; Bridges, 2001; Burke, 1992; Cooper, 1998; Stricker & Fisher, 1990).
  • Humanistic and existential psychotherapies have always emphasized the importance of self-disclosure in enhancing authentic therapeutic alliance, the most important factor in predicting clinical outcome (Lambert, 1991; Norcross & Goldfried, 1992). Humanistic therapists assert that therapist self-disclosure allows patients to recognize that all people have failings and unresolved matters in their lives and that there is no essential difference, in fact, between psychotherapists and patients (Bugental, 1987; Stricker & Fisher, 1990; Williams, 1997). Jourard (1971b), in his widely quoted book, Self-Disclosure: An Experimental Analysis of the Transparent Self, discusses at length the importance of self-disclosure for humanistic psychotherapy.
  • Group psychotherapy is another orientation that has stressed the importance of self-disclosure. Yalom states: “Group psychotherapists may–just like other members in the group–openly share their thoughts and feelings in a judicious and responsible manner, respond to others authentically and acknowledge or refute motives and feelings attributed to them” (Stricker & Fisher, 1990, p. 198).
  • Behavioral, cognitive and cognitive-behavioral therapies have emphasized the importance of modeling, reinforcement and normalizing in therapy and view self-disclosure as an effective vehicle to enhance these techniques (Freeman, Fleming, & Pretzer 1990; Goldfried, et al., 2003). Lazarus (1994), one of the founders of behavioral therapy, details the importance of therapists answering clients’ appropriate questions. He further lays out the potential disruption to the clinical process that can result from therapists always responding to clients’ questions with questions (e.g., “Can you tell me why you want to know?”) rather than answering the questions. In a similar fashion several authors discuss the importance of self-disclosure in Rational-Emotive Therapy (RET). Modeling the rational-emotive process by using disclosures and examples from therapists’ personal lives was reported to be a highly effective way to convince clients of its utility (Dryden, 1990; Tantillo, 2004).
  • Feminist therapy values therapist self-disclosure for its role in fostering a more egalitarian relationship and solidarity between therapist and client, promoting client empowerment and allowing them to make informed decisions in choosing women-therapists as role models (Brown, 1994; Greenspan, 1986; Kessler & Waehler, 2005; Simi & Mahalik, 1997). Therapists and clients joining together in political demonstrations and other political activities is encouraged as a means to model and empower clients. Greenspan (1995) states, “I am a great believer in the art of therapist self-disclosure as a way of deconstructing the isolation and shame that people experience in an individualistic and emotion-fearing culture” (p. 53). Self-disclosure is viewed in feminist therapy as the ultimate way to equalize the power differential between therapists and clients and the most effective way to transmit feminist values from therapist to client.
  • Self-help based therapies use self-disclosure extensively (Mallow, 1998).
  • Narrative therapy also places a high value on what they call therapists’ transparency (White & Epston, 1990).
  • Family therapy, Ericksonian therapy and Adlerian therapy use it for the purposes of modeling and therapeutic alliance (Stricker & Fisher, 1990).

SELF-DISCLOSURE WITH DIFFERENT POPULATIONS

Therapists working with different populations have different rationales for self-disclosure:

  • Self Help and 12 Step Programs is the most common use of self-disclosure, such as Alcoholics Anonymous, Narcotics Anonymous, Over-Eaters Anonymous and other self-help and peer-support models. Many of these self-help modalities have entered the therapeutic mainstream and include clinician-facilitated support groups for addiction, parenting, abuse, rape, domestic violence, bereavement or divorce (Mallow, 1998).
  • Children and those with a diminished capacity for abstract thought often benefit from more direct answers to questions requiring self-disclosure (Psychopathology Committee of the Group for the Advancement of Psychiatry, 2001).
  • Adolescents are often resistant to therapy as they frequently see adult therapists as authority figures and extensions of their parents. Self-disclosure is one way to make adolescent clients feel honored and respected rather than judged and patronized.
  • Religious and spiritual based therapies: Self-disclosure has a unique importance for therapists working psychotherapeutically with patients who hold particular religious or spiritual beliefs. These clients often ask therapists questions about their spiritual orientations and values as part of the interview process. Many clients choose their therapists because they are aware of their spiritual orientation (Geyer, 1994; Llewellyn, 2002; Montgomery & DeBell, 1997; Tillman, 1998).
  • Gay and lesbian clients present one the most convincing arguments for self-disclosure. Self-disclosure is a very important issue as it relates to the key issue of being “out.” Accordingly, several theorists agree that there is high therapeutic value in the therapist self-disclosure of sexual orientation (Isay, 1996; Tillman, 1998; Mahalik et al., 2000). Several studies have suggested that gay and lesbian clients often prefer and seek therapists with the same sexual orientation, which apparently increases trust, affiliation and therapeutic alliance (Bernstein, 2000; Goldstein; 1997; Jones, Botsko, Gorman, & Bernard, 2003; Liddle, 1997; McDermott, Tyndall & Lichtenberg, 1989). Unless the client already knows the therapist’s sexual orientation prior to seeking therapy, very often the subject of their sexual orientation may be raised during the phone interview. As a result, self-disclosure is often a necessity for therapists who want or choose to work with this population.
  • War veterans with PTSD have often been cited as a group of clients with which self-disclosure seems clinically important (Stricker & Fisher, 1990).
  • Minorities are often more comfortable with therapists who self-disclose or were observed or perceived by clients as coming from the same or a similar minority group. Such therapists were viewed as more trustworthy and expert than those from a dissimilar group (Sue & Sue, 2003).

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.

Self-Disclosure In the Movies

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

  • To normalize his patient’s anxiety about dating Davenport reassures Fisher, “Everybody gets tongue-tied sometimes, everybody.” Antwone asks, “Even you?” And the psychiatrist responds, “Even me.”
  • When asked, the psychiatrist speaks openly about his wife and their relationship. Antwone appreciates the modeling because he doesn’t have any relationship experience. In one scene, after Davenport wishes Antwone good luck for his first date, he says, “You never know. These things can escalate.” “Escalate into what?” asks his patient, and the psychiatrist responds, “My wife and I escalated into marriage.” Both laugh after this exchange.

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

  • Symington is star-struck over having a famous movie star as a patient. He tells Frances that he has been following her career, and reveals that he needs her to admire and respect him.
  • He also makes a joke that shows his need to be appreciated for his cleverness.

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

  • During their first session Will tries to gain control by asking most of the questions. First he comments on the many books on McGuire’s bookshelves. The therapist asks him whether he has read some of these books and what he thinks about them. In order to maintain the upper hand Will responds with frustration, “I am not here for a fucking book report. They are your books. Why don’t you read them?” And McGuire says, shrugging his shoulder, “Yeah, I did. I had to.” His client comments, “This must have taken you a long time.” The therapist admits, “Yeah, it did.”
  • Responding to Will’s continued questioning, McGuire tells him what kind of weightlifting he does and how many pounds he lifts.
  • During their second session on a park bench the therapist discloses his emotions about his wife’s cancer and her death.
  • In another session Will states how he wants to make his new romance perfect by keeping his distance. In order to model vulnerability and convey that imperfections are desired aspects of an intimate relationship, McGuire says, “My wife used to fart when she was nervous. She had all sorts of wonderful idiosyncrasies. She used to fart in her sleep. One night it was so loud it woke the dog up. She woke up and asked, ‘Is that you?’ I didn’t have the heart to tell her. … Yeah, Will, she’s been dead for two years and that’s the shit I remember. … Those are the things I miss the most — wonderful things, the little idiosyncrasies that only I know about. That’s what made her my wife.” They both laugh.
  • During later sessions McGuire continues to answer Will’s questions about his thoughts, feelings and behavior in his relationship with his wife in order to give him a sense of what emotional intimacy in a healthy relationship can look like. He also tells Will that he doesn’t have any regrets about having opened up to his wife, even though she died. To help Will understand this on more than an abstract level, Sean McGuire demonstrates the importance of his marriage by first talking about his strong interest in baseball in a demonstrative fashion. Then he tells his client that he gave up an important game for his wife when they first met.
  • After Will says, “You fucking talk more than any shrink that I have seen in my life,” McGuire responds, “I teach this shit, I didn’t say I know how to do it.”
  • In order to encourage him to talk about his physical abuse as a child, McGuire shares how he was beaten by his alcoholic father.

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)

  • During their second session on a park bench, Sean McGuire starts the conversation saying, “I thought about what you said to me the other day. I stayed up all night thinking about it. Then something occurred to me. I fell into a deep peaceful sleep and haven’t thought about you since.” He continues talking to his client about the difference between his own real life experiences in many significant aspects of life and Will’s expansive but exclusive book knowledge.
  • Toward the end of this session the therapist says, “I can’t learn anything from you that I can’t learn in some fucking book, unless you want to talk about you. Then I am fascinated. I’m in.”

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.

  • After Dr. Metzger figures out who her client’s boyfriend is, she doesn’t disclose to Rafi for some time that the person she dates is her own son. Eventually Dr. Metzger tells her client the truth about the fact that she is the mother of her boyfriend, David. Rafi gets angry and says, “You betrayed me.” Her therapist acknowledges the betrayal of trust and tries to convey that she did it to preserve their relationship. When her client doesn’t believe her, she responds, “This was harder for me than for you.”
  • After Metzger and Rafi discontinue therapy, and against his mother’s initial resistance, David brings his girlfriend home for a family dinner. The therapist and her ex-client tell each other that they missed each other. Rafi gets to know her therapist’s husband, parents and parents-in-law. To welcome her and thank her for a present, Lisa gives her ex-client a kiss. Rafi observes her therapist now in the roles of a cook with an apron and a host. Lisa and Rafi sit next to each other at the dinner table and talk to each other as they clean up together after dinner. When the tension between them reaches a peak, Rafi tells Lisa how “very strange” this new situation is for her, while Metzger pretends that she doesn’t have any problems with the visit.

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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