What clients think of therapist self-disclosure

by Eleanor Dunn

Self-disclosing to clients is not an intervention that is generally accepted across the board. I remember distinctly in my training warnings against the use of it and how we would have to learn to evade clients’ attempts to get personal information out of us. In one sense, no one can evade some level of selfdisclosure. From the way we dress, to how we may decorate our office, to the way we speak, these all give clients information about who we are and what our values may be. However, deliberately and intentionally sharing information about ourselves with clients is another matter and remains a pretty controversial topic in the field.

Self-disclosure by therapists is something both clients and therapists appear interested in and it is easily found as the subject of blogs and webpages about therapy and the field of therapy when one searches for it (Conason, 2017; Pendlebury, n.d.). I have had my own interest in the topic, having sat on both sides of the therapeutic dyad and being able to draw on experiences with different therapists, all of whom used, or avoided using, self-disclosure in different ways. I was at times exasperated by both its use and its absence. In particular, I have wondered about how clients felt about the use of selfdisclosure by their therapists and if they were as instinctively wary about its use as therapists appear to be. The information I present below has its foundation in research I undertook as part of a master’s thesis and is based on the work of a systematic review of the literature looking at the question of how clients experience the use of therapist self-disclosure. A systematic review gathers all the published literature on a particular question and synthesises the findings in a way that can shed new light on it. The findings from my work were pretty clear about how clients generally feel about therapists selfdisclosing and challenge the way that this intervention may best be discussed and taught to therapists in training.

Differing views of therapist self-disclosure
The roots of the hesitancy around therapist self-disclosure is often traced back to the origins of the profession when Freud advocated that “the physician should be impenetrable to the patient, and like a mirror reflect nothing but what is shown to him”, the fear being that it could corrupt the evolving transference that the treatment was seeking to resolve (Freud, 1912/1963: 121). However, with the advent of more humanistic approaches championed by the likes of Carl Rogers and Fritz Perls, the person of the therapist became more central to the therapeutic endeavour and there was less proscription around the therapist using themselves in that process. However, caution and wariness still remain and often it can be a case of ‘don’t ask, don’t tell’ as therapists fear being judged professionally for using self-disclosure and worry that it reflects badly on their ability to hold good, ethical and professional boundaries (Dixon et al., 2001: 1489). On the other hand, certain schools of therapy actively encourage use of self-disclosure. Feminist psychotherapy is a case in point, where practitioners see it as necessary to use self-disclosure as a way to challenge and erode unhelpful power dynamics that can develop within the therapeutic relationship (Simi & Mahalik, 1997). Whatever people’s attitudes to therapist self-disclosure, therapists are using it. While it may not be used regularly, with estimates suggesting it makes up on average about 3.5% of all interventions (Hill & Knox, 2002: 258) the majority of therapists do admit to using it in some form (Farber, 2006: 136).

Defining therapist self-disclosure
As mentioned above, self-disclosure to a certain extent is unavoidable and there are many different types of disclosure. Zur (n.d.) defines four different types; deliberate, unavoidable, accidental and ones that come from the client deliberately seeking information about the therapist for example, by web searching. In the category of deliberate self-disclosure there are two distinct forms. Disclosures that reveal personal information about the therapist or experiences they have had in the past are often referred to as self-revealing disclosures. The other type is disclosures that reveal information about what the therapist feels about the client in the here and now of the therapeutic relationship. This is often referred to as self-involving disclosure. Because there is no universally accepted definition of therapist self-disclosure, it can be hard to compare results between studies as different researchers use different definitions or use vaguely delineated definitions for what they are studying and reporting on. For this reason, I focused my work solely on self-revealing disclosures which are easier to identify and have more data available in literature when it comes to clients’ experiences.

Client identified benefits of therapist self-disclosure
When clients are asked about this form of therapist self-disclosure, they have many positive things to say. My research highlighted three major ways in which therapist self-disclosure is viewed by clients as having a beneficial effect within the therapy process. Firstly, it can add greatly to the strengthening of the therapeutic relationship. Secondly, it can support the development of good relational dynamics between the client and therapist, and lastly, it can support positive changes within the client themselves.

Therapists are more than familiar with how important it is to build a good, trusting and connected relationship with their client if the therapy is to have any chance of proceeding well. Skills such as active listening, accurate empathy and unconditional positive regard are often cited as essential in this process. Having looked at what clients have to say about therapist self-disclosure, I would suggest it could well be an addition to this list. Clients talk about how much more understood they can feel when therapists share their own experiences with them, especially ones they may have in common. In one research paper studying what clients found helpful in bereavement counselling a client put it this way:

When people tell you that they know how you feel, you just think, ‘so you do, so you do’. She told me she had been through something ... I knew that she wasn’t being patronising in saying that she knew what I was going through.

(Simonsen & Cooper, 2015)

Clients also speak about feeling more connected to the therapist when self-disclosure is used, that it facilitates the building of that bond, deepening the sense of connection and moving it beyond the sense of the interaction being surface level. Here is an example from one client:

I think what self-disclosure did is instead of connecting at just a superficial level, it brought the connection deeper ... in our case especially because I was learning and growing on a spiritual level and her being able to connect with me there made it a synergistic experience.

(Audet & Everall, 2010)

The sense of trust between the client and therapist also benefits from use of self-disclosure. For certain client groups, for example prisoners or those from marginalised ethnic groups, who may be particularly wary and cautious when it comes to trusting a therapist this may be especially true. Such clients may even test the therapist in this regard, and may see disclosing by the therapist as a prerequisite for their own disclosing: “If I’m going to tell you about myself, I want to know something about you” (Phiri et al., 2019).

With the trust comes safety, as clients report that it feels safe for them to be themselves, without fear of judgement when the therapist shows a little of themselves too.

The final factor I found that clients noted as contributing to the therapeutic relationship was the sense of comfort and ease that comes when the therapist uses self-disclosure. Its use helps to take the spotlight off them, lets them relax into the relationship and supports them to open up themselves. Here’s an example of how a court mandated client spoke of his therapist’s use of self-disclosure:

He shares his life experiences with me too. He talks about his family. He talks about his kids, about how he’s got one on the way, stuff like that. He showed me pictures of the sonogram or whatever, where they take pictures of the baby, and that’s personal. That’s personal stuff, and so that in exchange just loosened me up, and I started talking about my personal life. So that makes it easy. (Bitar et al., 2014).

In addition to supporting the therapeutic relationship, therapist self-disclosure also has an influence on the dynamics between the client and therapist. It has been generally accepted that there is an inherent power imbalance in the therapeutic relationship (Audet, 2011; Brown and Walker, 1990). Feminist theorists in the field have been particularly vocal about addressing this issue, as they strove to dismantle the societal inequalities that could be replicated in the therapeutic process, especially as regards the treatment of women. Indeed, feminist therapists have been actively encouraged to selfdisclose as a way to reduce the view of the therapist as ‘expert’ and to support egalitarianism (Brown and Walker, 1990). Clients seem to agree that this is the case, that they do feel the imbalance in power becomes reduced when therapists self-disclose, that its use levels the playing field: “The counselor ain’t way up here and I’m way down here. We’re both the same- we’re both human beings” (Bitar et al., 2014). Clients can be discerning however, and certainly have the ability to know the difference between a therapist acting professionally and one who strays into something more like a friendship. The therapist needs to use the skill of self-disclosure astutely to get the right balance, as I will talk more about later. Here is how one client put it: 

It’s that combination that’s good. My therapist has the theory and analytical abilities, and if she’s disclosing how she’s lived her own life, and in her case quite successfully, I think it all helps (Audet, 2011).

If a therapist achieves this balance, it can be seen as an example of them establishing both mutuality and asymmetry within the relationship. It can be tricky though, as my research brought out, and different clients did seem to want different things. Some loved the intimacy and levelling brought by the disclosures and the others were wary of it. This could possibly be explained by different attachment styles of the clients, though the literature is silent on this point, but it suggests that the therapist does need to know their client pretty well in order to pitch the level of self-disclosures at one that is not off putting for the client. Consider, for example, how this particular client dealt with her/his therapist self-disclosing:

It was a brand-new experience for me and it took me a few minutes to digest how I felt about the whole experience. I had a certain idea of what I thought a therapist was supposed to be like. And then to have them tell me some personal information, I wasn’t sure how far we were going to go with that personal information.

(Audet & Everall, 2010)

The research even threw up an example of a client who really liked the idea of the relationship moving more towards a friendship as a result of the therapist self-disclosing. This may raise alarm bells with many therapists, and certainly what the client wants and what the client needs are not always the same thing, but it is interesting to notice how there can be a gulf between what a client is ok with and what the therapist is ok with.

The final beneficial effect of therapist self-disclosure that I identified in my research was that of changes in the client. Outcomes can be hard to measure in psychotherapy, and it is particularly hard with a phenomenon like therapist self-disclosure where it may be used only rarely, perhaps many weeks distal to when the outcomes are measured. Having said that clients do report that the self-disclosures did seem to have an impact on them and their behaviours. Firstly, they report that the stigma and shame they may be holding around their experience becomes alleviated following therapist self-disclosure. Their experiences are normalised, validated and they feel less like outcasts. Disclosures also bring the client hope, especially when the therapist has had an experience similar to the client and come through it, this appears to give clients encouragement that the same can be true for them. In disclosing, therapists are also offering themselves as a model to the client and clients talk of being able to learn from this and let it influence their own decisions and behaviour, for example how to deal with anxiety or relationship challenges.

Using therapist self-disclosure with skill
As I touched on above, the therapist has to use their self-disclosure well in order to get the benefits that are possible from the intervention. This was the last theme that came out of my research. Published literature suggests that there can be negative outcomes in up to 30% of cases where therapist selfdisclosure is used (Hill et al., 2018). Indeed, I came across what I felt were some pretty shocking examples of therapist behaviour in this regard over the course of the research. One example was where a client described how his therapist would dominate the space with her disclosures, sometimes lasting up to 15 minutes, and where he was left disheartened and with a sense that she was trying to outdo him in terms of the material he brought to the sessions. It was a clear example of where the use of self-disclosure had strayed into being anti-therapeutic and where the roles of client and therapist became blurred and even reversed. The client put it this way:

It almost felt like a parent-child relationship ... like I was the therapist and she was the patient getting everything off her chest. I wasn’t asking her, ‘How does that make you feel?’ but it’s just I didn’t do much talking.

(Audet & Everall, 2010)

Clients also became uneasy if the information disclosed by the therapist revealed a difference in values, morals or some other dissimilarity between them.  This is a particularly important consideration in multicultural therapy and for therapists seeking to be culturally competent (Constantine & Kwan, 2003). I found a striking example of this in some research based on quasi-experimental rather than actual therapy sessions. In the example the therapist disclosed how she felt her white heritage made it easier for her to attend higher level education than her Latino/a client. Not surprisingly the client evaluated this disclosure negatively and reported feeling annoyed by it and how it highlighted the difference in privilege between them. Disclosures also work best when they are relevant and speak to the material the client is bringing to the sessions. Here, the clients seem more receptive to the disclosures and benefit from them in a positive way. I found this in my research, but can also speak to it from my own experience as a client with memories of sitting with one therapist who would frequently update me with happenings in their personal life that had little to do with my reasons for being there.

The timing and intimacy level of disclosures are also important to consider. Low intimacy disclosures work well to put the client at ease in the beginning phases of therapy, whereas disclosures with a higher level of intimacy can work well when the client-therapist bond is well established. Again however, the therapist needs to judge the needs of the client with care as too much intimacy in the disclosure can be overwhelming for some:

 After a while I’d want to run away from the intimacy of the moment. I didn’t want to be in it too long. Things would come up and I’d be like, ‘Oh this is too flowery or too touchy-feely for me’ ... So it was kind of that feeling sometimes where ... it almost got to be like ... too much emotion in one day and I just wanted to numb out from it.

(Audet & Everall, 2010)

Unsurprisingly clients don’t like insensitive disclosures, with an example from the literature being a therapist who spoke in detail about his work with sex offenders to his young female client (Zucker, 2015). Another element to consider is that it is not advisable for therapists to disclose about something that is ongoing for the therapist at that time.

Following other writers and researchers on this topic, I compiled some guidelines for therapists based on what I gathered from the client’s perspectives. Thus, it is not helpful if:

1.  Therapist self-disclosure is used too frequently or excessively

2. Therapist self-disclosure reveals significant differences in morals, values or characteristics between them and the client

3.  Therapist self-disclosure is not relevant to the material being brought by the client

4. Therapist self-disclosure is insensitive or gives details of an ongoing situation for the therapist

5. The timing is poor and does not match the intimacy level that the therapeutic relationship has reached

So, therapist self-disclosure can be a really useful tool to use, but it is not without its risks and given those risks one important element of its use is for the therapist to check in with the client how they receive and respond to their disclosures and work through responses as required. This won’t be very foreign to therapists working in a humanistic and relational way but it is important to remember and it helps keep the needs of the client central and allows exploration of how the disclosures may be affecting the therapeutic relationship.

Conclusion
The use of therapist self-disclosure does remain controversial in the field. The completion of the master’s research was an interesting experience for me and, as I grappled and engaged with the material, I found the topic of therapist disclosure was arising more in my sessions as clients asked me about whether it was ok for them to enquire about me, or told me experiences of previous therapists who crowded them out with their self-disclosures. I found I was in a good position to discuss these things with my clients in a way that felt useful and therapeutic. I also noticed as I read some of the clients’ experiences reported in the published papers that I was at times taken aback by some of what they reported other therapists were disclosing to them. Yet, as I began to see more clearly the potential benefits of disclosing, I became less judgemental about the vignettes of sessions I was reading about and saw them as the therapist using disclosures in an adaptive way according to the needs of their clients. Clearly the clients valued them and becoming looser around ‘the way it should be done’ has been useful to learn. Consequently, I have also found myself much more comfortable to disclose myself, in a way that is less anxious and more relaxed, and there is a confidence that comes with knowing and being familiar with the research findings that came out of my research. Finally, having been through that whole process, and considered the views given by clients, I would advocate that emphasis and consideration be given to this skill in the training of psychotherapists so they can use it with competence and effectiveness. It is not a skill that is given much time or attention and perhaps it is time that changed

 

Eleanor Dunn is an IAHIP accredited psychotherapist working in private practice. In Autumn 2021 she set up an independent practice based on Baggot St in Dublin together with another colleague. Prior to becoming a psychotherapist, she worked for 15 years with people experiencing homelessness. She can be contacted at eleanordunncounselling@gmail.com or see www.centred-psychotherapy.com

References

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IAHIP 2022 - INSIDE OUT 96 - Spring 2022