Self-disclosure in therapy?

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lingua_franca
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Self-disclosure in therapy?

Post by lingua_franca » Sun Dec 08, 2013 5:17 pm

I know there have been a few threads on working in mental health when you have had a mental health problem yourself, but they all seem to focus on whether having a diagnosis would preclude you from having a career in clinical psychology, or whether it would even give you some particular advantage. I'm not too fussed about either of these questions. My own view is that my past eating disorder is something that I can learn from in the way I learn from any other experience, not necessarily a special advantage, but not a barrier either - just one part of a much broader reservoir of experience from which to draw.

Whenever I've thought about how having had an eating disorder might affect me in clinical practice or shape my work and approach, I've never envisaged myself openly telling clients about it. It's more something that I'm conscious of behind the scenes rather than anything I'd ever discuss. But recently something happened to make me think about self-disclosure to patients and how that might help or (hinder) the therapeutic process.

Recently, feeling quite stressed and snowed under with the PhD, I arranged some counselling. I picked someone who has additional qualification in EDs and some impressive-looking experience, but I never intended disordered eating to be the main focus of the sessions. I just felt it would be helpful to have a practitioner who understands my mental health background, and who will be sensitive to the fact that my eating habits can take a hit when stressed. Currently I don't meet the criteria for any eating disorder. I explained this and my expectations for the sessions -some time-limited work with a focus on reducing anxiety and addressing perfectionistic thoughts, providing me with a clear thinking space once a week.

What happened next felt bizarre. The therapist interrupted to say that she didn't like to hear me talk about how I've been 'managing my eating difficulties'; she believes in full recovery, and she knows it's possible, because thirty years ago she had an eating disorder too, and look at her now - recovered. She told me that this was what inspired her to become a therapist. I felt a bit startled (perhaps it's just British reserve?) that she would share all this with me on our first meeting. Secondly, I do feel as though I manage a predisposition/tendency that will never be totally eradicated, and seeking support when my stress reaches a certain level is part of that management. This seems like a reasonable way to frame it, and one that's been keeping me well. She went on to say that we should do some more intensive long-term work to uncover the roots of my eating disorder, and suggested making a timeline or a life map. I explained that I've done this in the past, and it was very helpful, but not something I feel the need for now. I got the sense that she envisages herself as rescuing people who suffer as she once suffered, and that her past experiences were intruding on her ability to listen to me. That self-disclosure seemed to come at the wrong time and I don't think she used it to good effect.

Could it ever be used to good effect? I would be curious to know what the qualified CPs here think of a clinician's self-disclosure during therapy, the circumstances in which it might happen, how it fits with the ethical guidelines, and whether or not anyone here has ever done so...
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
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Borrowed Cone
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Re: Self-disclosure in therapy?

Post by Borrowed Cone » Sun Dec 08, 2013 6:13 pm

Sounds like an extremely unboundaried, uncontaining, unethical and generally unsafe therapist!

I believe that in the right context and for the right reasons, sharing experiences both-ways in therapy can be very powerful. But as ever there is no fixed rule, and one should always put their professional responsibilities first.

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matt.berlin
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Re: Self-disclosure in therapy?

Post by matt.berlin » Sun Dec 08, 2013 8:57 pm

There's a good paper here on self-disclosure in family therapy, which might also be helpful to people not working within a systemic approach. Basically, there are lots of different ideas about self-disclosure / use of self, and probably depends on who you are and how you are working. Ultimately though, the real test is whether or not sharing information is helpful. In this case, it doesn't sound like it was, if I've understood correctly.
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enid
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Re: Self-disclosure in therapy?

Post by enid » Sun Dec 08, 2013 9:29 pm

I personally wouldn't like it at all. Least of all in the first session. It took a number of years of therapy before my therapist told me something personal about himself, and that was a kind of life and death situation - i.e., I couldn't make our session last week because xxx happened.'
I would always come away feeling that the therapist's own agenda was too much at play. That is a personal view, from the perspective of someone who is coming towards the end of long-term therapy, rather than any experience of being a CP (I am not). I think he has told me two personal things in that time - one not being very personal at all, but to illustrate a point, and the other being imperative in terms of explaining what had happened the following week. Even if our experiences were identical I am not sure I would want to know. It's kind of my time, and like I say, I want to know that reflections and feedback are objective as they can be (given the situation, which of course isn't completely objective). Maybe I should read some of the papers though, to challenge my knee-jerk reaction to it.

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Re: Self-disclosure in therapy?

Post by Ruthie » Mon Dec 09, 2013 10:49 pm

Self-disclosure can be very useful in therapy but it is about the client's needs, not about the therapist's. I don't have any hard and fast rules about what to disclose and what not to disclose as these are situation specific but there are principles which are consistent with the model of therapy you are using. In general however, it is always about the client and what helps therapy. The therapist shouldn't expect confidentiality (so if I disclose to a client, I know they may disclose what I've said to colleagues or other clients or anyone). It's definitely not sensible to disclose something that is raw and unresolved.

I've disclosed to clients how I've managed tricky situations to model interpersonal effectiveness skills. I disclose how I once sat on a broken down bus and had to be told by the bus driver to get off because it wasn't going anywhere as the most wilful display of non-acceptance in DBT skills group (I was running late for a job interview and I really really really didn't need that bus to break down - but it's a great example of how accepting the situation meant I could get off the bus and do something more useful than refusing to believe I was going to be hideously late!)

I've disclosed my reaction to a client's story as a human being in a genuine way to demonstrate empathy and compassion. I have disclosed more personal things in specific situations where I think it will help the client but with care and often talking about it in supervision before and/or afterwards. These tend to be clients I know very well so I have a solid formulation and sense of how the self-disclosure is likely to help. I will usually ask the client if they want me to self-disclose or not so they have the option to say no.

I'm concerned about your therapist self-disclosure for a couple of reasons. They've started by cutting you off as you've discussed your point of view and basically said they don't like you saying what you're saying. That sounds like a therapist issue to me and your hypotheses about why they may have disclosed like that seem quite astute to me. Also, I think you are very realistic in recognising that if you have a history of eating disorder then at times of stress, your eating patterns are likely to take a hit. Being aware of that and planning how to manage it is realistic, necessary and vital to recovery. We all have our vulnerabilities and default modes to which we fall back in times of stress and awareness of them is absolutely key to not getting caught up in them. It also sounds to me like your therapist has disclosed something very personal in the first session without any sense of where you are coming from (or worse - negating and invalidating your point of view and experience) and hasn't sought permission from you to disclose.

Therapy isn't always comfortable and indeed you can be far too comfortable in therapy and not making changes but I think if the therapist (as opposed to the therapy) is making you feel uneasy from the get go then perhaps it isn't a good match and it may be worth looking elsewhere.

Hope that helps.

Ruthie

PS. In the hope that this is a more helpful self-disclosure albeit not from your therapist - I remember the hair tearing out stress of certain stages of a PhD - well done for seeking additional support and if it hasn't worked out right for you this time, try again. Good luck with the PhD!
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

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Re: Self-disclosure in therapy?

Post by Ruthie » Tue Dec 10, 2013 12:04 am

Short and sweet but here is what Judith Beck says about self-disclosure and gives examples that are quite consistent with how I use self-disclosure (phew - I'm obviously not going too wrong!)

I think her point about showing we are human is important and something that comes up. I disclosed in a CBT group on my PICU recently about how frustrated I felt and irritable I became when the trains had been delayed yet again and asked them to think about how I should manage my frustration when the trains where yet again delayed later in the week (which they no doubt would be). Aside from finding it quite comical (shall I say I am prone to exaggeration for comic effect at times), I hope it acknowledged that we all feel frustrated when we have restrictions placed on us or obstacles put in our way and helped people to see how can lead to irritability and even aggression (and no, you'll be glad to know I didn't hit anyone at the railway station) but that recognising that everyone is in a similar boat (from the other commuters pushing and shoving to the harrassed station staff, to the other patients on the ward and the nursing staff) can be a good way to tolerate the frustration.

There's another paper here which looks good but I haven't read it!

Ruthie
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

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Princess86
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Re: Self-disclosure in therapy?

Post by Princess86 » Tue Dec 10, 2013 10:20 am

Just had a look at the second look you posted Ruthie - if people are interested in reading more about self-disclosure, the CBT self-disclosure article is part of a special edition on therapist self-disclosure. One of the papers focuses on the role of shame in trainee self-disclosure in supervision, and another focuses on culture and self-disclosure by therapists. If anyone would like copies I've got access to the journal... Thanks for the link Ruthie :)

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Re: Self-disclosure in therapy?

Post by Ruthie » Tue Dec 10, 2013 1:27 pm

I would love to read the articles princess - can you email them to me?

Cheers!

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Re: Self-disclosure in therapy?

Post by Princess86 » Tue Dec 10, 2013 4:08 pm

Sure Ruthie, if you PM me your email address I'll send them over :)

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Re: Self-disclosure in therapy?

Post by Randomswirls » Fri Dec 13, 2013 4:06 pm

I work as a peer support worker and peer trainer and my whole job is thus based around self disclosure as every client I see knows that I have mental health issues etc. that said I think very carefully about what I disclose before I disclose. As an example if a client has been in hospital I will talk about my experiences but will be led by them so one client I mentioned I knew a nurse and that I had found her lovely whilst with another I talked about how alienating I found it. I don't think it would be pertinent to disclose about my time in hospital to a person if they hadn't been there and so it goes on.

My experience of self disclosing is so positive and I have seen how positively people have reacted to it and all of my clients have found it beneficial even when I've disclosed barely anything. This was illustrated to me when a client hadn't understood my role in the first two sessions and when I saw her on our third session she understood it the whole focus of our work changed and the next time I saw her the change was amazing because if I could recover having spent longer in hospital then she to could get a job.

A flip side of the coin is how staff have reacted to having me and my colleagues on the team and as I have used services in the area I know a few staff members as a patient and they have openly said its pushed their boundaries but that this has been a really positive experience. I've also started co facilitating a group on the ward I was a patient on and being able to have conversations with staff (including the co facilitator) who know me as a patient about how weird it is has been interesting and it will be interesting to see how my presence impacts on the ward in the long term.

That said disclosure has to be relevant and should I ever work in a more therapeutic role I would think about it differently as it isn't always appropriate and it's not always welcome. In my care the boundaries are constantly being challenged and I have found that quite difficult to manage at times. I have got used to it and put on my service user hat on when being a service user and my work hat on when I work.

Princess id be really interested in those articles as well.

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Princess86
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Re: Self-disclosure in therapy?

Post by Princess86 » Fri Dec 13, 2013 5:16 pm

Happy to email the articles to you randomswirls. PM me your email address and I'll send them over. :)

lingua_franca
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Re: Self-disclosure in therapy?

Post by lingua_franca » Fri Dec 13, 2013 7:17 pm

This thread has been really helpful. Thanks everyone! Princess, I'd love to read those articles too (although my brain is balking at the thought of having more to read :lol: ). I'll e-mail you. Ruthie, thank you for the encouragement, and for widening the discussion of self-disclosure to include things other than mental health - that's given me a few new ideas.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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schizometric
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Re: Self-disclosure in therapy?

Post by schizometric » Sat Jan 04, 2014 6:24 pm

Would love to read these articles too Princess, if you don't mind!
Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind.

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