How do I know when to disclose?

In my last post, I encouraged readers to give up on the idea of ‘never’ disclosing things about themselves, highlighting that simply existing and interacting with other people inevitably leads to disclosure.

Now, let’s consider the sort of self-disclosure many of us immediately think about – telling clients things about ourselves.

Therapy is often a conservative field. Our origins in psychoanalysis include the concept of the therapist as a ‘blank screen’ on to which clients would project their thoughts and feelings, transferring unconscious feelings onto the therapist. I feel that idea has continued to influence the profession 100 years later. We now know that this probably isn’t really how the therapeutic process works. The idea of co-regulation is ascendant in our understanding of child development, with research on mirror neurons and the idea of the mind as an interconnected system gaining traction and influencing therapy. It is clear that we are never so ‘blank’ as we may think, and that questions on what to disclose are more complex than ‘never’ or ‘always’. Decisions on self-disclosure are an issue of boundaries. In therapy, we all know boundary violations are harmful – yet, boundary crossings have the potential to be immensely helpful. The increasing shift towards having a lived experience workforce in mental health shows that the use of judicious self-disclosure is becoming increasingly recognised as not only acceptable, but sometimes important in the service of therapy.

Imagine you are in a session. A client comes to you with an issue, similar to one you have experienced before, now fully resolved, that you have grown from. This isn’t uncommon in your day-to-day work – you have noticed yourself working well with this presentation, and you’ve been developing a name for yourself. Your client, having told their story, looks at you and asks if you had ever been through anything similar. What do you do?

The generic guidance many of us are given involves things like saying, ‘oh, well, I had a friend who (insert own story), or to make a process comment ‘it seems like it’s important to you to feel like I understand.’

There are risks to disclosing stories about yourself. You might worry about whether this client is taking an undue interest in your personal life, or feel confronted by them wanting to know something about you. Your client might feel that their problems are too big for you, given your own struggles. You may worry that you will seem less professional if you disclose a struggle you have experienced. You could feel that it would take attention off your client and make the session about you, which would be harmful.

On the other hand, what positives might come of sharing some of your story? Could the client feel more deeply heard, respected and understood? Would your suggestions for coping strategies land differently if the client knows you have personally used them and found them helpful? Would learning about your own coping provide a sense of hope for the future?

If you are considering sharing about yourself, it is important to remember that you can’t just have a blanket rule about disclosures. What would be deeply validating and healing for one client could cause harm to another. I encourage you to consider the person in front of you, and carefully weigh up disclosures on an individual basis.

Here are some decision-making steps to take:

• Consider what the ethical dilemma actually is in a decision around self-disclosure.
• Consider the worst case scenario of disclosing vs not disclosing your story. Could telling your story lead to your client experiencing vicarious trauma? Could not telling your story lead to your client feeling you cannot possibly relate to them or support them, disengage in a spiral of hopelessness?
• Consider any literature that you might know about disclosure in particular circumstances – for example, I have extensive experience teaching DBT skills. When teaching the radical acceptance skill, a suggestion from the manual is for the therapist to consider disclosing something they have radically accepted.
• Consider how a disclosure sits with the Code of Ethics. Remember, the three key principles in the APS Code of Ethics are Respect, Propriety and Integrity. Is the potential disclosure demonstrating respect for the rights and dignity of your client? Is it professionally responsible? Is it non-exploitative?
• Talk through the potential disclosure in supervision or with trusted peers and colleagues and ask for honest feedback.
• What do you feel psychologically safe to disclose? If making a disclosure, you need to be able to keep the focus of the session on the needs of the client. Disclosure should not be about your needs, and the client should not feel they need to care for you.
• Reflect on what the desire to disclose might be about – is it a desire to be heard about ‘your stuff’ or is it primarily reflective of meeting the needs of the client? Pay close attention to any feelings of doubt or worry about the disclosure.
• Keep careful records about any disclosures you make as a tool of therapy – they belong in the clinical file.

People learn through stories, and sometimes sharing something of ourselves can support the therapeutic process. There have been times when a self-disclosure has been important to clients.

An example that has happened a few times is when I have had clients ask me how I manage to be confident and happy in a society obsessed with body image. I am indisputably, unapologetically fat and am confident and comfortable in my own skin. When I have been asked this question (and more than once), I often explore what has led to the client asking me the question. Ultimately, it is often clients wanting to know how they can feel more comfortable within their own bodies, how to achieve the confidence I have managed. When that happens, I think through the steps around disclosure, and will sometimes use aspects my story as a teaching tool, with a goal of:

1. Recognising the social pressures we all encounter about bodies
2. Teaching that it is possible to have an ‘imperfect’ body and be ok with it
3. Learning about values and living a meaningful life even when experiencing stigma and discrimination

I hope this entry helps you to consider self-disclosure a little more carefully. If you would like to read more about the ethics of boundaries, I highly recommend looking at psychologist and ethicist Ken Pope’s website. There are some extremely useful guides to ethical decision-making across a range of topics that may help you to reflect and consider ethical behaviour beyond just reading the code of ethics.