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When is it Appropriate for a Therapist to Disclose with Patients?

I have been a therapist for 40 years, cutting my teeth in the field at a crisis intervention hotline and youth shelter in the late 1970s. Those of us who were there were psychology or sociology majors; hippies, most of us. The 20-something with Psychology 101 under my belt worked in the trenches with runaway and homeless youth and answered calls from people needing resources and who had suicidal ideation.

I learned a great deal about working under pressure and because I wasn’t too much older than some of my patients, I was often viewed as more of a peer than an authority figure. I have a clear memory of the staff painting the inside of shelter with the kids.

Rainbows and flowers adorned the walls and stairs and paint splashed all over us when we were done. I had yet to learn much about setting and maintaining boundaries in terms of what the teens knew about me. I think they viewed me as straddling the line between being one of them and still a step beyond where they were.

In the interceding four decades, I have worked in settings including inpatient acute care psych, community mental health, substance abuse, medical hospital, nursing home, home care, classroom, private and group practice. I have served individuals, couples, and families. The age range has been three-years-old to older adult.

Currently, I am in a group therapeutic practice. Some of my patients live and work in my community. One of the first things I tell them is that our paths may cross in public and if they do, I will maintain their confidentiality. They can approach me, but I won’t approach them. If they decide to greet me, I won’t acknowledge their status and won’t discuss anything of a therapeutic nature with them.

If they decide to introduce themselves to anyone I might be with, that is their choice as well. If it turns out that we have friends in common (this has happened on a few occasions), I remind them that I won’t share with our mutual friend that they are my client.

I have on a few occasions, run into patients at gatherings in someone’s home or a spiritual community of which I am part. I smile and allow them their space. Each time, they have come up to me. Some have introduced me to their family members or friends that are with them, as their therapist.

When is it Okay to Share Information?

The standard belief when it comes to self -disclosure with a client is that it is to be avoided since it could set up a transference-counter transference scenario. Another thought emerges from the work of Sharon Ziv Beiman of Tel Aviv University. In an article, entitled Therapist self-disclosure as an integrative intervention, she explores the benefits and hazards of information sharing. Overall, she finds it a positive practice, but one to be used judicially and responsibility.

When we are in a therapeutic setting, I have sometimes shared personal information with a client if I believe it is helpful. If they are facing the death of loved ones, I have let them know that I have been widowed and have lost both parents over the years and recently several friends.

I tell them this so that they are aware that therapists need to deal with this level of loss as well. That has launched into conversation about strategies that have worked for me, helping me to heal.

On occasion, when working in a substance abuse treatment setting, I have been asked if I was in recovery. I do reveal that I don’t have a substance addiction issue, but rather that workaholism and co-dependence had loomed large in my life.

When I have looked particularly fatigued, they have asked of I was getting enough rest. It helps them know that I have a sense of what it is like to have an addiction and that I need to take on my own inventory, per the 12- step program paradigm, every day.

It also reminds clients that my knowledge base is not strictly theoretical. It feels more genuine if they know that I have gleaned benefit from walking a similar journey. Theory they can get from a book. From me, they get anecdote and story, metaphor and symbolism and a sense of ‘been there, done that, got the t-shirt.’

I also don’t subscribe to the idea of a power differential that places the therapist in a ‘one up’ position. Rather, I see myself as someone with more education and experience in the topics we are exploring which assists me in acting as a caring and compassionate guide.

I remind them that they are the authority in their own lives and that my role is to hold a light up to assist them in finding their way through sometimes daunting territory. They are also clear that I am their therapist and not their friend and need to maintain that boundary.

Yesterday, I took a leap and revealed to a patient who was struggling with an issue from her twenties that I had a similar experience and was able to put it into perspective all these years later. Today, she reached out and thanked me, letting me know that it had a humanizing effect and helped the trust between us to grow.

I had no personal need to disclose, but rather, it felt as if she would seem less alone in her memories. Even as I have shared information, I have never said the taboo line, “I know how you feel.” None of us can have the total experience of another, although the scenario may seem familiar. We each carry with us, our history, perception, and relationship dynamics.

Noted researcher and author Brene Brown whose work focuses on vulnerability, authenticity and shame, has said, “Vulnerability is the birthplace of innovation, creativity, and change.” In order to be an effective and vulnerably human therapist, it seems necessary to know how to exercise discernment about what and when to self- disclose.

When is it Appropriate for a Therapist to Disclose with Patients?