Think Before You Get Personal
Robbie, a slight man in his fifties with receding hair and a warm, round face, makes a beeline for me before the workshop starts. He says, "I came to this because I got into real trouble disclosing something about myself to a couple. Even my wife is angry with me."
"Great," I reply, as Robbie lurches back a step, startled. "We'll discuss times when disclosures don't work, and if you're comfortable telling us what happened, we'll all learn from it."
Some 20 minutes into the workshop, Robbie recounts, "I was working with a couple last week. The husband, Bill, made an allusion early in the session to thoughts about other women. Things were tense between him and his wife, Anita. Finally, I said that I'd had a few fantasies over the 30-some years of my marriage, but I'd never acted on them. I wanted to indicate it was normal to sometimes have thoughts about other women. As I talked, Bill nodded. But suddenly, Anita screeched, 'What do you mean normal?! That's cheating!' The next day, I got a phone call from Anita's mother, accusing me of being a sex addict. And I practice and live in the same small town."
I sigh sympathetically, along with many other audience members, and say, "It's the old story: the message sent is often not the message received. What you disclosed was heard in one way by Bill and in another way by Anita."
Self-revelations are complicated when there's more than one client in the room because they're filtered through multiple dynamics. For instance, Anita may already have felt that since Bill and Robbie were both male, they were implicitly allied. Afterward, it seems she thought she could count on her mother, not her husband, to listen to her distress about what their therapist had said.
Without our being aware of it, our disclosures may provide a distorted picture of our personal relationships. Although Robbie was happily married, Anita's interpretation of what he said led her to believe his marriage was in trouble. Robbie's wife was hurt by this inference when she learned about it through the small-town grapevine.
Thus, despite our best intentions, self-disclosure can backfire. So why are we drawn to it so strongly as a therapeutic tool? Hundreds of therapists in workshops I've led in the United States, Europe, and Latin America have said they share personal information to strengthen the therapeutic alliance, demystify therapy, and reduce the power differential between themselves and their clients. Given that research has found that the quality and nature of the therapeutic relationship-not the specific model or method-account for up to 30 percent of the variability in therapy outcomes, they'd appear to be on to something. Research shows that clients consistently rate therapists' disclosures as useful-when they're done skillfully.
When I've asked people who've gone to therapy what was most helpful, again and again they've described times when their therapists shared something about their own personal struggles. Maria, a client who'd recently left her partner and family to move into her own place, said, "After I'd heard about Sara's ups and downs when she separated from her husband, I didn't feel crazy anymore. I was a person with understandable emotions and feelings, similar to what Sara had experienced." Numerous clients, from varied backgrounds and of different ages, consistently said things like: "My therapist's stories helped me see we're all human and I wasn't a bad person"; "I didn't feel put down coming to get help"; "I felt less alone"; and "I learned that we're all vulnerable, and that it's important to let others see it."
Therapists and clients are in an intimate, paid relationship, not a personal one; nevertheless, it's one with many personal aspects. Through many microinteractions, they negotiate and define what disclosures and connections are comfortable for them within their professional and client roles. In the past, strict rules for clinicians-like the old chestnut, "If a client asks you a personal question, turn it back by asking why he or she wants to know that information"-kept tight restraints on what therapists shared. In today's more collaborative, and with the informality of U.S. culture, both therapists and clients are likelier to step across previous professional guidelines.
Al, a gay therapist who leads therapy groups in HIV, gay, and substance-misuse communities, said: "Within stigmatized groups, it's usually the norm to have more diffused boundaries. My clients often know a lot about me before therapy even starts." When a therapist is from a dominant group and works with clients from oppressed populations, self-revelation can be crucial to breaking through the mistrust of authority and uneasiness about the therapeutic process.
The Elephant in the Room
I usually begin my workshops about the uses and misuses of self-disclosure with the comment, "We've been ignoring how much therapist disclosure happens, whether we mean it to occur or not." Then I show a cartoon of an elephant lying on a couch. A psychiatrist sits at the elephant's head, writing on a notepad. The elephant is saying, "I'm right there in the room, and no one even acknowledges me." People in the audience knowingly nod their heads and laugh.
Much of what we reveal is inadvertent. The watches and jewelry we wear or don't wear, how we dress, our hairstyles, how we talk, or how we decorate our offices all tell a story. Then there are unforeseen and undesired encounters outside of therapy, like the time in a grocery store when I was scolding my daughter and looked up to see a client watching me.
In therapy, the current or past events we reference and the themes and topics we pick up on (or don't address) can be telling. In the third session with a divorced couple and their older children who primarily lived with the mother, I found myself focusing on her financial difficulties. I asked questions about how much child support the father gave. It turned out he was paying substantially more than their divorce agreement required, and that wasn't an issue. My inquiries pointed a finger at my own experiences with my parents' divorce. As family therapist Charles Kramer noted, "It is impossible not to reveal ourselves. And when we try to be a blank screen, we reveal that we are concealing, which is a message in deception."
Some disclosures can derail the therapeutic process. Shared information may make clients feel they need to take care of the therapist or that the therapist isn't there for them. A colleague, Ava Lin, worked with a woman, Karen, who'd been sexually abused by her father. After a year of sessions, Karen was still blaming herself for the abuse. She had ongoing difficulties with sexuality and intimacy with her husband, and was still unable to tell him what her father had done. She also didn't feel ready to join a group for survivors of abuse. Ava consulted with her supervisor and made a decision to share with Karen that she, too, had been sexually abused by her father, and this was part of the reason why she'd developed a specialty in helping individuals with sexual problems. Ava then described part of the journey that took her away from her shame and guilt.
At first, Karen seemed surprised, relieved, and a little disquieted to hear these disclosures. She asked Ava about how she'd worked through her self-blame, and conversations ensued that helped Karen let go of some of her feelings and share more with her husband. However, in response to Ava's asking her how it affected her to have this information, Karen said, "It makes me feel protective of you and worried about saying things that will be hard for you to hear, or give you flashbacks. Now I'm watching you to see if you're OK." From then on, Ava worked with Karen to reassure her that she didn't need to "take care of her therapist." She made an extra effort to monitor her own affect whenever she shared anything further in therapy about her abuse experiences and checked in frequently to see whether Karen was feeling concerned about her.
So in the discussion about self-disclosure, we need to move beyond an either/or frame, as in "yes, do it" (often the stance of feminist therapists), or "no, keep tight boundaries" (often the position of traditional psychoanalysts). A both/and frame-which looks at when, where, and how revelations by therapists support the therapeutic process and when they get in the way-establishes a more realistic place from which to analyze and understand the possibilities and dangers inherent in disclosure. Focusing on the timing and process of disclosures can move us out of an "it's good" or "it's bad" position. The ways we disclose, read cues from clients, and ask questions and discuss what's been divulged provide safeguards for our clients and opportunities to advance their therapeutic goals.
The Importance of Emotional Control
I hit the play button on my message machine: "We got bad news; Peter has prostate cancer. Call us as soon as possible. We need a session." Isabella's voice was pitched as high and sharp as a whistle. I'd worked with her and Peter and their two teens off and on for several years, but I hadn't seen them for six months.
I called their house. Isabella answered, "It looks serious. We won't know the details until his surgery. Our lives have been thrown up into the air like pick-up sticks. Who knows where they're going to land?"
My right hand splayed out on my chest over the rhythmic thud of my heart. What would this diagnosis mean for Peter? And for the family?
Isabella went on, "Peter's mom doesn't want us to say the C-word or tell the kids. They're smart; they'll figure it out. What should we do?"
As I listened to her, I wondered if I should tell her that I'd had a bout with cancer when my daughter was a teen, and we, too, struggled through the fear, ambiguity, and deep sense of loss of control she was describing. Would my telling her reassure her or impede or detract from what she was saying? Would it be better to allude to it briefly when we met face-to-face, so I could "read" more easily whether the disclosure was helpful?
I chose not to say anything on the phone, for multiple reasons. I already had a stronger alliance with Isabella than with Peter, so that connection might get tighter if I told her first. I also wanted to have a direct sense of how Peter was doing emotionally and make sure that my own feelings about my cancer experience didn't knock me off balance when I talked to them. When we make disclosures, it's essential that we stay in emotional control of what we reveal and that we keep our attention on our clients.
To see whether sharing my experience would be appropriate and pertinent, I decided to wait until our session the next day. That would give me 24 hours to reestablish my equilibrium. Often, helpful disclosures are about challenging and emotional times in the therapist's life. The process of disclosure is a delicate balance-tapping into feelings that can create affective connection between us and our clients, while ensuring that those emotions don't take over.
I met with Isabella and Peter the following afternoon. A few minutes into the session, he said, "We've decided to tell our daughters tonight and need help. We've never had to do anything like this before."
That provided a natural opening for me to say, "I don't think you know this about me, but I had breast cancer 10 years ago. My daughter was 13, and I, too, struggled with how to talk with her. If you think it would be useful for you to hear a little about that, let me know." As I spoke, I tried to pay careful attention to my tone of voice and body language. When we disclose potent information like this, it's crucial that we don't communicate that we need a particular reaction, such as reassurance or support. We need to be comfortable with a minimal response, a negative response, or no response at all. A small, tentative disclosure like this is usually best. Clients' verbal feedback and nonverbal clues can inform you about whether to say more.
Later, Isabella said, "I'm afraid our daughters are going to have questions that we don't have answers to. How did that go with your daughter?"
I said, "I tried to let her know that there were a lot of unknowns, but we could keep talking, and she was free to ask whatever questions she wanted to. Interestingly, she didn't have a lot of questions; she says now that she just tried to focus on her life, so as not to worry too much or give me things to worry about. But every kid is going to have their own way of coping." This led us into a conversation about the coping styles of their children and what they could do as parents to tap into them.
Later in the session, Peter said, "I want to continue to work. Isabella wants me to use my sick leave and concentrate on my recovery. Work is central for me, and I don't want to be just a 'patient.' What did you do?"
Isabella's gray-blue eyes were locked onto my face. How could I respond in a way that connected with their two different perspectives and concerns? After a moment, I said, "I did continue to teach, but I cut back on nonessential things, like those long committee meetings at the university." I chuckled and they laughed. "And I scaled back my private practice. I needed time for the treatments and getting my strength back after them. You might need more down time than you expect, Peter. But I hear what you're saying about work; continuing to work really helped me focus on things other than the cancer." I then turned the conversation back to them by suggesting that they ask each other questions about their different perspectives on whether Peter should work.
This example reflects several key choice points when deciding to self-disclose. I needed to remain in control of what my disclosures might bring up emotionally. I also needed to consider whether the information would be useful to my clients or get in the way of our conversation. When I did decide to reveal my experience with cancer, it was a brief foray, formed as a question to them, after which I monitored my body language and made sure I behaved neutrally. Later, when Isabella, and then Peter, asked me questions, I responded with a focus on the process, rather than on the solutions I'd reached, and quickly turned the conversation back to their situation.
I realized that revealing something that was so important in my life had connected me with the sessions differently. I felt seen and witnessed by Isabella and Peter, albeit briefly. This is an aspect of therapeutic process we seldom discuss, but one that can help keep us involved and intrigued with our work.
Too Much Information
At times, I've derailed sessions with an inappropriate disclosure. Stuart and Kiran originally came to see me for couples' therapy. In the fifth session, they wanted to sort out what to do after their teenage son had stolen liquor from them and taken it to a friend's house, where the parents had let the teens party and drink "because it was safer than if they were doing so off in the woods." Rather than asking them questions about their policy on keeping liquor in their home or what they thought about the parents' decision to let the teens drink illegally, I lectured them: "When my daughter was a teenager, I kept no alcohol in the house. And it's a terrible mixed message for adults to let teens in the community drink at their house when they know it's against the law." My strong feelings and opinions were on display. The couple reacted with surprise, and my tirade took us off track.
It would've been much better if I'd said something like, "When my daughter was a teen, I was unsure about whether to keep liquor in the house," and then turned the discussion back to their concerns. That would've minimally disrupted the session while gently introducing an idea to them about removing alcohol from the house. Overall with disclosures, it's better to emphasize challenges you've faced, not your own answers.
Therapist self-disclosures can come out unexpectedly and unplanned. One colleague worked with a family in which the daughter, Loung, was upset because she hadn't gotten into the college to which she'd applied for early admission. Without thinking much about it, Tom related that he'd gotten into his first-choice school, but, ultimately, didn't think it served him well, and that he should've gone to a less competitive college. Loung's mother responded to his story with her thoughts about life's varied options and how, when one door closes, it can mean that others are opening. While the mother seemed to welcome the substance of Tom's disclosure, it wasn't well received by Loung. She felt he hadn't understood how disappointed she was-and how could he, when he'd gotten into the college he wanted to get into?
We need to keep asking ourselves the same crucial questions: in what ways might this disclosure be helpful to my clients? How can I reveal something briefly and then turn the conversation back to their concerns? What viewpoints are embedded within this disclosure? How might different clients respond? Are multiple ideas available to them within what I'm sharing?
What's Good for the Goose . . .
It's to everyone's advantage not to have a bored therapist. Being aware of what our clients' stories evoke for us about our own lives keeps us engaged, even if we choose not to self-disclose. An unsung benefit of being a therapist is that clients can challenge us to face and/or revisit central issues in our own histories.
Decades ago, a client named Lenore deliberately seemed to sit much closer to me than to her husband, Gus. It was our third couples session. I was a novice therapist, working with a cotherapist, Dick, who sat behind a one-way mirror and phoned in from time to time. Five minutes into the session, Lenore said to Gus, as she carefully scanned my face, "You're never going to hit me again." This was the first we'd heard of violence in the relationship. Gus and Lenore initially had come in asking for help with their differences over parenting their young son.
Gus said in a voice hard with anger, "It doesn't happen that often." I felt my face flush; it was what I'd said to myself about the punches and kicks my partner had inflicted upon me over the last six years. I quickly began to inquire about Lenore's safety and when and where Gus lost control. Together with Dick, we developed a plan for a series of interventions into the violence.
Driving home that night, I was marked by shame, just as I'd been marked by the bruises that had blossomed on my skin three or four times a year. How could I call myself a therapist when I didn't have the courage to take action as Lenore did?
Dick and I worked with Gus and Lenore for nine months. She decided to leave the marriage. I never disclosed to them anything about my situation. It wasn't appropriate; I was embroiled in something that was out of control in my own life. Several years later, with an imprint of Lenore's words on my tongue-You're never going to hit me again-I finally entered therapy with my partner.
A few years ago, I was asked to provide training on family violence to a group of therapists in Ecuador. Their organization, Junto con los Niños y las Niñas, provides wraparound services for families for three to four years, so the children can get off the streets and back into school. I'd worked with them before and had deep respect for the in-home therapy they were providing for families with children who were working on the streets selling Chiclets, darting into traffic to wash windshields when cars had stopped at red lights, or eating fire. I began the training by talking about the years I'd lived in a violent relationship. I spoke about my shame and how I'd lied and covered up, shared steps that women often take before they can leave an abusive situation, and talked about couples dynamics. I invited questions. In 30 years of training other therapists, I've found that my capacity to reveal relevant personal information in an appropriate, controlled way can have a powerful impact on how much trainees are willing to engage, stretch their learning, and take risks.
The participants in Ecuador careened into the topic. One therapist talked about her failures to address violence with families she worked with. Another woman exposed patterns of violence in her extended family. We soon had a wealth of case material and examples to inform us as we delved into different intervention strategies.
Refusing to disclose can be detrimental to training and therapy. When I ask workshop participants who've been clients to reflect on how therapists' refusal to reveal personal details affected treatment, they respond with comments like: "I thought my therapist was arrogant" and "I shut down myself."
From her interviews, researcher Jean Hanson has found that clients working with therapists who don't self-disclose often describe the experience as problematic. For example, Rose said her therapist "neither offered information nor answered my questions. If I asked her things, I felt embarrassed, like I was making a social blunder. I stopped seeing her without telling her I was quitting; I had no sense of personal loyalty to her. I couldn't cleave to her as a person."
Maintaining Standards and Connection
A year after Peter had recovered from prostate surgery and treatment, he and his wife asked me to speak to the prostate-cancer support group with which they'd become active. I went to rural New Hampshire and talked to the couples, mostly older people, about the psychological impact of cancer. I came away with deep admiration for Peter and Isabella's openness in the group and the degree to which they were willing to help others. The following year, Peter, an avid kayaker, began training for a month-long trip paddling through lakes, rivers, and old canals for hundreds of miles to raise awareness about prostate cancer. After a couples session, he said shyly to me as the three of us were standing in the doorway to my house, "How about if you and your partner go kayaking with Isabella and me sometime? Or . . . we're not supposed to do that, right?"
This is what it often comes down to in therapy. Self-disclosures on my part and contact outside the office at the support group had created a strong personal relationship within the professional-multiple connections for Peter, his wife, and me-which supported all of us in our therapeutic journey. Now he was trying to stretch the boundaries between us, which was a human thing to do. I realized, however, since we were still working together in therapy, that boundaries must be maintained.
I said ruefully, "No, we can't go kayaking with you." Peter looked crestfallen. I gave them each a hug good-bye, and said, "But it sure would've been fun!" They headed out the door, and I called out to Peter, "That's one of the sweetest things a client has ever asked me." A huge baby-style grin spread across his face.
Illustration © Curtis Parker
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