DSC8883 - SECTION 4: THERAPIST SELF-DISCLOSURE: BENEFITS AND CONTRAINDICATIONS

There are several important reasons why the clinician may want to use self-disclosure in the course of clinical work with clients. There are also situations in which self-disclosure is clearly contraindicated.

In this section, we will spend some time looking at both of these important issues. We will begin with a look at some of the important benefits of self-disclosure.


Benefits of Self-disclosure

There has been a substantial amount of research to indicate that self-disclosure has the ability to enhance the therapeutic relationship and engender client disclosure (10). It may be helpful here to go into some more detail about how this works.

To begin with, under the right circumstance self-disclosure can help decrease client anxiety. This occurs because clinician self-disclosure may help normalize the client’s feelings, give them perspective, and allow them to realize that others have had similar experiences.

Secondly, several studies have found that self-disclosure can further the therapeutic relationship by increasing client trust and by encouraging personal disclosure by the client. The reciprocal nature of disclosure in a relationship is well-documented in the literature (1; 3).

Thirdly, many clients enter therapy without good models for how to engage in personal discussions about important issues and problems. Clinician self-disclosure can provide the client with these alternative role models, as well as models of alternative ways of thinking and behaving.

Fourthly, a well-timed, relevant self-disclosure not only displays empathy, but also is a clear indicator for the client that the clinician has both heard and understood (10).

The choice to use self-disclosure should be purposefully aligned with an understanding of these benefits, and carefully evaluated to make sure that the benefits outweigh any potential risks associated with self-disclosure. These risks are related to the contraindications for using this kind of intervention.

Benefits Summary:  

• The “dyadic effect”: openness from the clinician supports openness from the client. 
• Self-disclosure contributes an experiential component to the corrective emotional experience, improving emotional attunement through the use of mirroring and responding.
• Self-disclosure provides behavioral and social feedback that helps the client see him/herself more clearly and situate him/herself in relation to others.
• Self-disclosure models effective affect management and interpersonal effectiveness skills.

(Source: Karen Maroda, (2012) Psychodynamic Techniques: Working with Emotion in the Therapeutic Relationship.)

A purposeful alignment of the intervention with the client's needs also involved understanding the overall purposes for the self-disclosure in line with the overall treatment goals. This means that the clinician needs great clarity about why and how this intervention is being selected.

• The self-disclosure must be for the therapeutic benefit of the client, not the personal need of the clinician.
• The disclosure of emotion must contain real emotion.
• The clinician must feel comfortable in making the disclosure. 
• The choice to apply self-disclosure should be under the control of the clinician at the time when it is being considered.
• The technique of self-disclosure must align with the larger style of the clinician and his/her authentic way of relating.
• Self-disclosure should only be used if the client wants it, if the therapeutic relationship is solid and strong, and if both the clinician and client are able to engage usefully about what is occurring in the treatment at the time of the disclosure.

Contraindications for Self-disclosure

There are a number of circumstances that contraindicate the use of self-disclosure. Some of these emanate from the 1) clinician’s assessment of the client, while others emanate from 2) the clinician’s assessment of his/her own feelings.

Careful attention should be paid to the existence of these two circumstances when determining if self-disclosure is appropriate. We will look at these contraindications in the brief section that follows.

Contraindications for Self-Disclosure based on Client Issues

Self-disclosure should not be used with the following:

• Clients who have problems with boundaries or reality testing and tend to idealize the clinician. These clients are likely to distort the meaning of the disclosure.
• Clients who are seeking inappropriate closeness.
• Clients who tend to focus on other’s needs rather than their own.
• Clients who are very self-absorbed or narcissistic and would experience the disclosure as an annoyance.
• Clients who make demands for personal information meant to disrupt or resist the therapy.
• Clients who are trying to avoid or distance themselves from their own emotional feelings.
• Clients who are severely mentally ill, or who present with serious substance abuse problems.

Contraindications for Self-Disclosure based on Clinician Issues

Self-disclosure should be used with caution when clinicians:

• Feel coerced by the client to disclose.
• Feel emotionally vulnerable.
• Are concerned that the client may misuse the information or share it with others.
• Have intense positive or negative feelings about the client.
• Disagree strongly with the client’s point of view.
• Believe the disclosure will burden the client.

There are also a few other circumstances where self-disclosure may be an appropriate action to take in the context of an overall therapeutic relationship. These are show below, with commentary to follow:

Other Indications Summary: 

• When the client asks directly for a response.
• When the client is repetitively stuck in an emotional scenario from the past that stimulates a strong emotion in the clinician.
• When the clinical work is at an impasse that cannot be resolved simply by focusing on the client’s emotional experience.
• When a client expresses the notion that their feelings, thoughts, or experiences are strange or abnormal and the clinician knows the contrary to be true.
• When the client engages in all or nothing thinking.
• When the client believes he/she is the only one to have experienced something.
• When the client has been struggling to achieve a particular goal and seems to be losing confidence.
• When your clinical ability is diminished or affected by illness, pre-occupation with thoughts or worries, or other internal or external factors – but only if the client’s response to that information would be useful emotional clarification about the circumstances occurring.
• If the diminishment of clinical ability is too serious, or if the client would be harmed by the diminishment of ability, it may be preferable to reschedule the session.

(Source: Karen Maroda, (2012) Psychodynamic Techniques: Working with Emotion in the Therapeutic Relationship.)

Self-disclosure can serve as another vehicle for normalizing a client's experience and/or providing a more human response to client concerns that their difficulties place them outside the boundaries of normal human experience. Because there are deep concerns that all human beings experience about being abnormal and unacceptable, the use of self-disclosure, used correctly and in a well-targeted way, can bridge the gap between the client's experience and the world of normal social experience. 

It must also be noted that clients may have an experience of emotional distance from a clinician if that clinician comes into the treatment session not operating at their optimal capacity for attunement and emotional connection to the client. Left unaddressed, the client may worry that the cause of the emotional distance may be attributable to a disruption to the therapeutic relationship caused by the client. Honesty from the clinician about not being at their best may be preferable to the client's tendency to assume blame for or become angry at the disruption to the attuned relationship.  

With certain clients or with a degree of impairment that is too high, it may also be preferable to reschedule the session to avoid problems with this consideration. Clinicians must be prepared to understand which approach takes better care of the client in this area. 

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