Sep 08

Therapist Self-Disclosure: Appropriate, Powerful Uses

Several therapists have written and spoken publicly about the topic of therapist self-disclosure.

One prominent psychologist who’s done so is David Treadway, whose late-stage cancer became the subject of a memoir, Home Before Dark: A Family Portrait of Cancer and Healing (2009). It includes contributions from his wife Kate and his two young adult sons, Michael and Sam.

Treadway’s previous Dead Reckoning: A Therapist Confronts His Own Grief (1996) was similarly self-disclosing about the effects of his mother’s suicide. It included (Publishers Weekly) “parallels between what Treadway’s patients are experiencing and his own problems; revelations of his own therapy; excerpts from his family’s painful recollections; and incidents from his own ongoing life.”

Whether as a therapist or in his writing, Treadway views such openness as a carefully chosen act that can be helpful to others if used appropriately. In Andrea Bloomgarden and Rosemary B. Menutti‘s 2009 Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy, you can find his chapter on what he calls “clinically constructive self-disclosure.”

Another psychologist, Ofer Zur, has said that “(T)he decision to self-disclose is based first and foremost on the welfare of the client.” He acknowledges four types of therapist self-disclosure (“Self-Disclosure and Transparency in Psychotherapy and Counseling“):

  1. Deliberate–such as having a family photo on display in the office or responding  with personal reactions to clients’ statements
  2. Unavoidable–when things about the therapist are observable, e.g., approximate age, ethnicity, gender
  3. Accidental–for example, a client and therapist run into each other at a community event
  4. Clients’ Deliberate Actions–when questions are asked or when info is tracked down, e.g., on the internet (very common these days)

The thoughtful therapist is aware of different ways in which personal info might be revealed and works on ways not to have self-disclosure interfere with a client’s work. Above all else, it should not be about the shrink trying to get his/her own needs met.

Possibly the only shrinks today who don’t sometimes use self-disclosure or at least deal with it to any significant degree are the traditional analysts, those who may still subscribe to the “Don’t just say something, sit there” strategy and who believe in a strict interpretation of the “blank screen” approach, i.e., “only if I am inscrutable to you can you do the important work of projecting your childhood stuff onto me.”

Psychoanalyst Linda B. Sherby addressed this in the process of writing Love and Loss in Life and in Treatment (2013), which is about the grief process related to the death of her husband George. Although she anticipated condemnation from other analysts regarding her self-disclosure she felt “it was important…to demonstrate how a therapist’s present life circumstances affects the therapeutic relationship because I do believe that particular aspect of the patient/therapist interaction has been largely ignored.”

States Janine Roberts, Ed.D., an author and scholar who’s studied therapist self-disclosure (Psychotherapy Networker):

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.

Furthermore, Roberts cites research indicating “that clients working with therapists who don’t self-disclose often describe the experience as problematic.”

Increasingly, I think that clients expect or want from their shrinks more personhood and less unknowability. Very often they’re working themselves to be more open and better understood—so isn’t it useful for therapists to model this in appropriate ways?

Jul 10

Laughter in Therapy: Important Quotes That Support It

       “I shyly laugh, inwardly praying she won’t be one of those shrinks who would rid me of my favorite coping mechanism. Sure humor’s a defense – so what?” Daryl Stone, a therapist in therapy, on laughter in therapy, from my novel Minding Therapy

If laughter‘s so good for us, doesn’t it belong in therapy—on either side of the process? (Naturally, I’m referring only to the healthy, not-hurtful kind.) Some quotes by well-known folks who’ve appreciated laughter:

Mark Twain: When you laugh, your mind, body, and spirit change.

Madeleine L’EngleA good laugh heals a lot of hurts. 

Lord Byron: Always laugh when you can, it is cheap medicine. 

Bob Hope: I have seen what a laugh can do. It can transform almost unbearable tears into something bearable, even hopeful.

Victor Borge: Laughter is the shortest distance between two people.

Bob Newhart: Laughter gives us distance. It allows us to step back from an event, deal with it and then move on.

Ethel Barrymore: You grow up on the day you have your first real laugh at yourself.

William James: We don’t laugh because we’re happy – we’re happy because we laugh.

LET’S BACK THIS UP WITH SOME RESEARCH

For further details about any of the following snippets, click on the corresponding resource link.

Melanie Winderlich, Discovery, reports scientific reasons why laughter is healthy: it decreases stress, helps coping skills, and boosts your social skills, among other things.

Gretchen Rubin, The Happiness Project: “Laughter is more than just a pleasurable activity…When people laugh together, they tend to talk and touch more and to make eye contact more frequently.”

Psychologist Ofer ZurThe Zur Instituteasserts that laughter in therapy is cathartic.

Feb 23

Bad Therapy Boundaries and Beyond On TV and Film

Looks as though How I Met Your Mother has finally found a way to get rid of Kevin, he of bad therapy boundaries, he who never should have been dating his former client Robin.

Let me make this brief: Before knowing that she can never have kids, Kevin proposes. Robin discloses. He again proposes. She accepts. She discloses she doesn’t want kids either. He’s unfazed. She insists he really thinks this through. He un-proposes. Done.

So, this has gone the way of all of those inappropriate shrink/client relationships we’ve seen on TV or in movies that eventually crumble because in the end the client realizes he or she’s been exploited or because of other negative effects on the client’s well-being or…

Whoa. Wait a minute. Wait a darn minute. That actually never happened on HIMYM, and…well, has it ever happened anywhere on TV? In the movies?

Back around 1993, a study regarding therapy boundaries in U.S. movies showed that there were 22 that featured female therapists having sexual relationships with male clients; eight had male therapists getting involved with female clients. (In real life, by the way, more male therapists take advantage of female clients than the other way around.)

The psychiatrist behind this film research, Glen O. Gabbard, states: “Dr. Hannibal Lecter in the movie The Silence of the Lambs was probably more ethical than most screen psychiatrists–he only ate his patients.” (For more info, see the second edition—1999— of Gabbard’s book Psychiatry and the Cinema, cowritten with his brother Krin, a literature professor.)

As stated by Dr. Ofer Zur, Ph.D., author of Boundaries in Psychotherapy: Ethical and Clinical Explorations (2007) on his website:

Sexual relationships between therapists and current or recently terminated clients are always unethical and often illegal.

Whereas in real life, most clients who’ve become lovers of their therapists are significantly harmed emotionally, most of the celluloid clients and shrinks seem to suffer no such thing. Many of these films, in fact, have even been billed as exciting “romances” by their producers. And, Zur adds:

What is interesting about some of these movies is that they depict the sexual relationships as effective in promoting health and healing.

Fortunately, more and more of the public is aware that it’s wrong for therapists to develop romantic or sexual relationships with clients and/or clients’ family members. One way that I see this every day, in fact, is in the disproportionately large number of hits to this blog by people searching for info about whether or not the therapist in the movie 50/50 and Kevin on HIMYM have been unethical. It’s as though these searchers already know the answer but need some validation.

I don’t remember if the following scene from The First Wives Club (1996) happens before or after Annie (Diane Keaton) finds out that her therapist (Marcia Gay Harden) has become involved with her husband—probably before—but, in either case, it may serve as some small comfort to those who’ve felt betrayed by their shrinks: